Category Archives: teachers

Mothers and Teenage Daughters: a School Counselor’s Story

Mothers and Teenage Daughters: a School Counselor’s Story
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This article contributed by Benjamin Dancer.

I’m a high school counselor, which means I work with parents every day. Because I’ve made a career out of my work with adolescents, I see what a parent might be seeing for the first time. This includes a long list of unfortunate life events.

Back when we were teenagers, there wasn’t a massive network of servers positioned strategically across the globe to capture and record, forever, the embarrassment of our adolescent choices.

As a parent, I have a lot of empathy for other parents. It’s not easy, especially when you’re going through something for the first time. My life, on the other hand, is a little bit like Groundhog Day. In a sense, I’ve never left high school. Every school year I see the same things. Different kids, but the same behavior: alcohol, drugs, tobacco, bullying, kids running away from home, pregnancy and something new: sexting.

Take an adolescent boy with an underdeveloped prefrontal cortex, which by definition means he is incapable of fully contemplating notions such as consequence; take this teenager raging with sex hormones and give him a tiny device that he will carry with him everywhere, a device capable of sending messages instantly to anybody, anywhere in the world, and install a camera in that device. What do you imagine might go wrong?

facebook sextingWhen you and I were adolescents, we were no less reckless, no less idiotic with our choices, no less eager to use our bodies as grownups. The difference is that our stupidity has been forgotten by history. Back when we were teenagers, there wasn’t a massive network of servers positioned strategically across the globe to capture and record, forever, the embarrassment of our adolescent choices.  Sexting changes everything.

Over the last seventeen years in my work of mentoring adolescents and partnering with their parents, I’ve seen a lot of parenting styles. I’ve learned some important strategies in dealing with the situations teenagers present–strategies the average parent doesn’t have the time, through repetition, to learn. I feel confident telling you that there are some really good ideas out there. And some really bad ones, too.

Because I’m a writer, it occurred to me to write it down, what I’ve learned over the years. I’m a parent. I know it just as well as you do. We need a little grace in our lives.

Sexting book coverExcerpt from SEXTING AT SCHOOL:

The police called the sexting child pornography. So I understood Nicole’s concern: she wanted to talk to me about her daughter. Jessica was fourteen and three years younger than her boyfriend. He had been distributing images of Jessica through his phone. Nicole was worried; she was scared, and understandably so.

Jessica still thought she was in love.

“He calls her a bitch,” Nicole told me. “I read the texts. He says horrible things to her.”

“And she still wants to be with him,” I said.

The pain I felt for her was communicated in my voice. As a teacher, I see the scenario every year, but Nicole was experiencing this for the first time. Jessica was her daughter. Not long ago she was her baby. I could only begin to imagine the suffering the situation provoked. Nicole was in no position to hear how common this was.

Why do girls throw themselves at boys who treat them badly?

In Jessica’s circumstance there was a tremendous amount of grief. She had barely processed the loss of her dad. He was killed in an accident over the summer.

“I can’t stop her from being with him. I’ve tried. I took away her phone. I grounded her. She sneaks out of the house. I drop her off at school, and she ditches to be with him.” The mascara was now running beneath Nicole’s cheekbones, “Last night, she told me that she wished it was me who was dead. He was waiting for her out front. I saw her get into his car.”

sexting image“I can’t imagine what that’s like,” I told her. “I’m sorry.”

“Unless I physically restrain her, she will find a way to get back to him.”

I allowed for a long silence, as I thought there might be more Nicole needed to say.


“What did I do? What did I do wrong?”

I didn’t answer her question. And I didn’t dismiss it. I sat with her in it.

* * * * *

My role with Nicole is not all that different from my role with Jessica. It doesn’t matter whether you’re fourteen or forty, what you need is for someone to listen. What you need is for someone to understand.

Jessica and I talked later the same day.

“She went through my phone,” Jessica was angry. “She read my texts.”

I let her know that I understood her frustration.

“She won’t let me leave the house.”

“Why?”

“She’s trying to keep me from him.”

“Have you told her that you love him?”

“Yes.”

“And…?”

“She hates him. She doesn’t want me to see him.”

“Why does she hate him?”

At this Jessica paused. We had already talked about the pictures. She had told me stories about the boy. The way he had flaunted his sexual conquests. He was in my English class, and I had seen it firsthand: there were countless other girls.

After a long silence, she answered my question, “She thinks he’s not good for me. Is he?”mean boyfriend

It was ground we had already covered. In past conversations Jessica told me that she respects her mom for trying to protect her. I handed Jessica a box of tissues. She wiped the tears and told me, “No. He’s really, really mean.”

I listened to her cry for several minutes. I was thinking about her father. I knew the man well. I liked him. I was thinking about her mother. I was thinking about my own daughter.  It was true for all of us. What we need is empathy.

“I’m sorry,” I told her.  She questioned me with her eyes.

So I answered it, “I’m sorry you’re so alone.”

Jessica’s whole body shook when she sobbed.

* * * * *

no cell phoneThe last time Nicole was in my office she asked me if she should return Jessica’s phone. We had a similar conversation the day she asked me if she should call the police.

“What do you think?”

“I think Jessica needs to figure this out for herself. I’ve tried to protect her, but I can’t. I just can’t protect her from everything.”

“Does that mean you’ll give it back?”

“No. She’s not ready for that.”

“I don’t know the answers to the particulars,” I told Nicole, “but I know this. You’re a good mom. Jessica needs you right now. She needs you to be confident in your role.”

I saw the tears washing through the mascara, gave Nicole the box of tissues, and kept on going.

This is universal: the teenager wants desperately to have her independence, and she is terrified of it.

“Jessica loves you, and she knows that you love her.  Jessica is not aware of the fact that she is conflicted about this. She’s just a kid. As much as she pushes you away, she wants you to be strong, to love her.”

* * * * *

I talked to Jessica again a week later.

“Do you still see him?” I asked.

She was embarrassed, “Yeah.”

“Is he good to you?”

“Sometimes.”

“How about last night?”

She hesitated then said, “Last night he left me in a parking lot. I had to borrow a phone and call my mom to come pick me up.”

“Why’d he leave you?”

“To hook up with someone else.”

“Will you see him again?”

“Probably.”

“I have a vision for you,” I said.

Jessica smiled, like she had heard lines like that from me before.

But that didn’t deter me. I have an advantage over most parents of teenagers: I’ve made a career out of the adolescent. Their behavior can be alarming, infuriating and even demoralizing, but after seventeen years of guiding teenagers as they come of age, I have established proven routines.

I have a pretty good idea of how many repetitions it will take, of how many times I’ll have to say it before Jessica can even make sense of the words, of how many more times I’ll have to repeat it before she begins to adopt the language as her own.

So I told her again, “In my vision of your future, you will love yourself too much to let a boy treat you badly.”

* * * * *

BenjaminDancerThe story above is a composite of a dozen mothers and a dozen daughters I’ve work with over the years. In my FREE e-book, I analyze that narrative–elucidating what I believe to be the important parenting considerations.  

Find out more at: SEXTING AT SCHOOL, a FREE download at Goodreads.com, or if you’re feeling generous, you can buy it for $0.99 at Amazon.com.

About Benjamin Dancer:

Benjamin is a high school counselor at Jefferson County Open School where he has made a career out of mentoring young people as they come of age. He wrote the novels PATRIARCH RUN, IN SIGHT OF THE SUN and FIDELITY. He also writes about parenting and education. You can learn more at:

Website:      BenjaminDancer.com

Facebook:    https://www.facebook.com/benjamin.dancer

Twitter:        @BenjaminDancer1


Like this post or have a comment?  Please give it a rating (above) and share your thoughts. Your comments are helpful for other parents who read Benjamin’s article.  Thank you.

Margaret

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Filed under defiant children, discipline, mental illness, parenting, teachers, teenagers, teens, therapy, troubled children

Bullying and how to stop it – for parents and teachers

Bullying and how to stop it – for parents and teachers
4 votes

Most of us have bullied someone and have been bullied at some time in our lives. We have an aggressive trait that helps us stand up to a threat. We are emboldened to fight when we fear for ourselves or family, or simply when we’re “not going to take this anymore!” Mature people don’t do this without cause, but children and teens lack maturity and can engage in bullying throughout their school years. (Even the nicest children can bully another person.) Victims of bullying usually don’t have the power and skills to prevent it or to protect themselves.

“This is a huge problem in the schools… it’s particularly common in grades 6 through 10, when as many as 30 percent of students report they’ve had moderate or frequent involvement in bullying.”
–Dr. Joyce Nolan Harrison, assistant professor of psychiatry, Johns Hopkins School of Medicine.

Bullying occurs when others aren’t paying attention… or when there is an audience
In schools, bullies target victims where and when authorities can’t see, isolated but in crowds: hallways, the school lunch room, the playground or gym, and the bathroom or dressing room, not in plain sight of others who might report an incident. Or they have an audience that supports the bully or ignores the situation and doesn’t want to get involved… or tell.

Bullies target those they consider “weak” or simply “different”
What makes a target child “weak” could be so many things. Bullies seize on anything: a physical, emotional, or mental vulnerability–children with learning disabilities or autism spectrum disorders are often targets. But any “different” child is at risk: a child from another culture is different, a boy who seems effeminate or a girl who seems masculine. The list of reasons children are bullied is so long that it is impossible to proactively avoid attracting the attention of a motivated bully or bullies: physical features, small stature, younger age, shy or meek personalities, bad fashion sense (or perfect fashion sense), even being a Straight “A” student is cause for being victimized. A child’s family member might be perceived as an embarrassment that elicits bullying (a brother is in prison, a father lost his job). Or a child might be a member of a group that’s hated by the parents, who teach their child to hate the group. Some victims are chosen simply because they are at the wrong place at the wrong time:

A teen walks his usual route home from school. He is reasonably well liked but doesn’t stand out. Ahead are three troublesome youth he doesn’t know. No one is around. He’s still at a distance, but starts to feel uncomfortable. They stand side-by-side on the walk ahead of him and stare.

What would a street-wise kid do?

He crosses the street without breaking stride, but also watches them—they have to know he sees them. If he pretended to ignore them it could inflame their anger. They start taunting. Meanwhile, the teen has been thinking of ways to protect himself just in case: there’s a store is nearby or within running distance, there’s a neighbor who’s usually at home. If he has a phone, he pulls it out and is ready to dial 911. He stays alert and looks confident, and they eventually drop the effort and let him move on.

Bullies punish kids who try to stop the bullying

Those who “snitch.” Victims who ask for help are often targeted by the bully more intensely, and often joined by associates who simply jump the bandwagon (curious behavior described as “the madness of crowds”). The culture of tweens and teens has low tolerance for those who tell on others. Those who join the bullying episode against the victim can do it without thinking, or perhaps they feel empowered to vent anger on someone, or just want to fit in.

Those who try to stop them. A heroic bystander steps in to stop a bullying episode and becomes the target themselves.

Those who want to leave the bullying group. Some kids have second thoughts and feel uncomfortable about the bullying and try to leave, but they can’t. Leaving attracts intense, relentless bullying for “voting with their feet”—this is a hallmark of gang behavior

Sadly, some children appear to “set themselves up” for bullying. This victim is a child with a fatalistic attitude and low self-esteem, who doesn’t recognize when others take advantage of them. They feel they must endure and don’t take steps to protect themselves out of excessive fear of drawing retribution. These are the kind of children who can become victims of physical or emotional domestic violence as adults.

Parents

If your child is a victim, be aware that they live between a rock and a hard place. Be careful that your involvement doesn’t make things worse for them

Armor your child with multiple skills
There is no one way to handle every bully situation so flexibility is key. Together, develop a list of multiple options:

  • Ask friends to accompany them
  • Go to a place where people are and find an adult to help. Walk the other way, walk down different hall, walk to other side of street, use a different bathroom.
  • Request loudly “LEAVE ME ALONE” when there’s an audience to witness the bullying, such as on a bus or standing in line.
  • Use body language to project a firm stance. This can be the way your child stands or the loudness of their voice when the bully is present to show confidence, alertness, and empowerment.
  • Let your child know you take them seriously and will do something about it. Give them emotional support.
  • Let your child know you will back them up by working with the school.
  • Use the situation as a learning opportunity to help your child develop a backbone and inner strength. Even with your support, this will not be easy for your child to handle. Be a model of strength and resolve rather than of vengeance or anger.
  • Consider mental health issues that might be making things worse for your child: ADHD, ODD, depression, bipolar disorder, borderline personality disorder, chaos and stress at home, PTSD, substance abuse, and others.

Help the bullied kids find each other. If there are a bunch of them together, they can stand the bully down. They don’t have to beat the bully up. They just have to say, ‘Why are you treating my friend this way?’ The bully will often move on… Parents can appropriately take matters into their own hands. You need to enlist the help of all the other parents of bullied children… Parents have to work as a group. One parent is a pain in the [butt]. A group of parents can be an educational experience for school authorities.”
–William Pollack, assistant clinical professor of psychiatry, Harvard Medical School

Don’t

  • Don’t tell your child to “let it go, ”or “it’s no big deal,” or “it happens, deal with it.”
  • Don’t tell your child to be tough. What does “tough” mean? What do you want them to do?
  • Don’t punish or dismiss a child who complains too much, or blame him/her for setting themselves up and asking for it. Ironically, a victim is sometimes treated as the problem child.
  • Don’t bully your child at home! Are you doing this? Think. Your child learns to accept the inevitability of bullying because he or she is accustomed to it at home.

How things can go wrong: A boy is in the shower after PE class and gets slapped on the butt most days. He is too proud/embarrassed to tell his parents, or he tells and they react poorly. Perhaps he’s blamed for not standing up for himself, or a parent shows up outraged at school and yells at the bully or school staff. Now the boy’s parent is the problem and may be suspected of bullying their child. Or school staff overreact with swift punitive actions to the bully. Time passes and the bully starts up again bit by bit, only much more subtly. The boy is afraid to report it again because the encounters are more secretive. The bully denies his behavior and recruits others to advocate for him. They jump on the bandwagon because they don’t know the history, and the boy doesn’t want to tell everyone he is being sexually harrassed. It’s a vicious cycle.

Teachers and schools

“You can’t learn if you’re being bullied, if every day you’re frightened of how you’re going to be treated.”
–William Pollack, cited above

Teachers, pay attention to signs that there’s a skilled, secretive bully at the school.

  • Notice who others avoid.
  • Notice a child coming into the class who’s upset and ask them about it later, promise you’ll protect their anonymity if you can get them to reveal a bully, but don’t pressure them.
  • Observe the problem kid and their subtle interactions with others.
  • Allow a victim(s) to have distance from bully, permission to use a different bathroom, to have their desk placed farther apart, to have a locker farther apart, or even a different class if possible.
  • Inform the parents of your concerns in addition to the principle and school counselor.
  • Focus your behavioral interventions on the bully (not the victims)

Avoid diagnosing the situation. You are not the expert. You don’t know why a bully is a bully, or why a victim is a victim, or anything about their parents. Ensure a school counselor is involved in any discussion about how to manage a bully problem in the school.

Avoid jumping to conclusions! Your actions can unintentionally undermine or harm either the child or their parents. You don’t know until you know.

“Bullies are like the lion looking for a deer that’s left the herd,” says Patrick Tolan, director of the Institute for Juvenile Research at the University of Illinois. “They try to single out the weakest kid. The best way to stop this is to work on increasing inclusion by helping the bullied kids with social skills.”

Bullies are usually bullied themselves (see another articleBullies like their victims, are also at risk). Only very small percentage are sociopathic, or who are intrinsically cruel and without empathy, perhaps 1 in a 100. How do you tell? If someone sets a clear boundary with punitive consequences, the disturbed bully will relentlessly target a victim regardless of how much trouble they get in.

I wish to personally thank Barry Diggs, probation and parole officer for the Oregon Youth Authority, for his insights into bullying behavior, which helped me develop this article. Margaret

If you have helped a child effectively cope with bullying, please share your story in the Comments below so others can learn from your story.


Research

Bullying Linked to Violence at Home
April 2011

Bullying is pervasive among middle school and high school students in Massachusetts and may be linked to family violence, a new study finds. In a survey of 5,807 middle-school and high-school students from almost 138 Massachusetts public schools, researchers from the Massachusetts Department of Health and US Centers for Disease Control and Prevention found that those involved in bullying in any way are more likely to contemplate suicide and engage in self-harm compared to other students. Those involved in bullying were also more likely to have certain risk factors, including suffering abuse from a family member or witnessing violence at home, compared to people who were neither bullies nor victims.

Cyber Bullying (this is a superb and comprehensive article by an expert on cyberbullying)

http://www.psychiatrictimes.com/display/article/10168/1336550?GUID=32E9A484-0468-4B38-8A03-0EE478D3256C&rememberme=1

Survey: Half of High Schoolers Report Bullying or Teasing Someone
“Ethics of American Youth Survey”, Josephson Institute of Ethics

Half of U.S. high schoolers say they have bullied or teased someone at least once in the past year, a new survey finds. The study also found that nearly half say they have been bullied during that time. The study surveyed 43,321 teens ages 15 to 18, from 78 public and 22 private schools. It found 50 percent had “bullied, teased or taunted someone at least once,” and 47 percent had been “bullied, teased or taunted in a way that seriously upset me at least once.” The survey asked about bullying in the past 12 months: 52% of students have hit someone in anger. 28% (37% of boys, 19% of girls) say it’s OK to hit or threaten a person who angers them. “There’s a tremendous amount of anger out there,” Michael Josephson says. (Founder of the Institute of Ethics)

Victims of Cyberbullying More Likely to Suffer Depression than Perpetrators:
ScienceDaily, September 2010

Young victims of cyber bullying, which occurs online or through cell phones, are more likely to suffer from depression than their tormentors, a new study finds. Researchers at the Eunice Kennedy Shriver National Institute of Child and Human Health Development in the US looked at survey results on bullying behavior and signs of depression in 7,313 students in grades six through 10. Victims reported higher depression than cyber bullies or bully-victims, which was not found in any other form of bullying. Researchers say it unclear whether depressed kids have lower self-esteem and so are more easily bullied or the other way around.

Cyberbullying Teens and Victims More Likely to Have Psychiatric Troubles
Archives of General Psychiatry, July 2010

Teens who cyberbully others through the Internet or cell phones are more likely to have both physical and psychiatric problems, and their victims are at heightened risk for behavioral difficulties, a new study finds. Researchers collected data on 2,215 Finnish teens 13 to 16 years old. The survey found that teens who were victims of cyberbullying were more likely to come from broken homes and have emotional, concentration and behavior problems. In addition, they were prone to headaches, abdominal pain, sleeping problems and not feeling safe at school, the researchers found. Cyberbullies were also more prone to suffer from emotional and behavior problems, according to the survey.

Bullying And Being Bullied Linked To Suicide In Children
International Journal of Adolescent Medical Health; July 2008

Being a victim or perpetrator of school bullying, the most common type of school violence, has been frequently associated with a broad spectrum of behavioral, emotional, and social problems. According to international studies, bullying is common, and affects up to 54 percent of children. Researchers at Yale School of Medicine reviewed studies from 13 different countries and found signs of a connection between bullying, being bullied. and suicide in children. Suicide is third leading cause of mortality in children and adolescents. Lead author of this report, Young-Shin Kim, M.D. said “the perpetrators who are the bullies also have an increased risk for suicidal behaviors.”

Kids with ADHD more likely to bully
Linda Carroll, MSNBC, reporting on the Journal of Developmental Medicine and Child Neurology, February 2008

A new study shows that children with attention deficit hyperactivity disorder are almost four times as likely as others to be bullies. And, in an intriguing corollary, the children with ADHD symptoms were almost 10 times as likely as others to have been regular targets of bullies prior to the onset of those symptoms.

A study followed 577 children for a year. After collecting data on bullies and victims and identifying those children ADHD, there was a corollary between ADHD and bullying. Study co-author Dr. Anders Hjern, a professor in pediatric epidemiology at the University of Uppsala in Stockholm said “These kids might be making life miserable for their fellow students. Or it might turn out that the attention problems they’re exhibiting could be related to the stress of being bullied.”

Unfortunately, treating ADHD won’t remedy the bullying because drugs for the condition impact a child’s ability to focus, but not the aggression that leads to bullying, says Kazdin, a professor of psychology and child psychiatry and director of the Parenting Center and Child Conduct Clinic at Yale University, and president of the American Psychological Association.

Bullying Tied to Sleep Problems
Sleep Medicine, June 2011

Children who are aggressive and disruptive in class are more likely to have sleep-disordered breathing than well-behaved children, according to new research. Conduct problems, parent-reported bullying, and school disciplinary problems were all associated with higher scores on a measure of sleep-related breathing disorders, according to researchers. The study collected data from parents on each child’s sleep habits and asked both parents and teachers to assess behavioral concerns. The findings suggest that bullying may be prevented by paying attention to some of the unique health issues associated with aggressive behavior.

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On psychiatry and stigma

On psychiatry and stigma
2 votes

When parents complain about psychiatrists, it’s often due to them judging the parent as being the reason for child’s problems; one might call this a bad “bedside manner,” but with huge consequences for the family.  If parents aren’t listened to, or are talked down to, they can’t help, nor live with, their incredibly stressful child.  Yet poor customer service is not unique to psychiatry; the medical field has lots of practitioners who aren’t helpful or people-friendly.  What’s different about psychiatry is that The Rest Of The World often thinks it is sinister and evil.

Our Own Worst Enemies
Nada Logan Stotland, MD, MPH

“Oncology manages to cloak the most primitive possible treatments—poison and burning—with elaborate protocols. Yet the mention of psychiatry conjures ECT, and ECT conjures images of the snake pit.  …We are the only specialty with our own dedicated hate group. We shouldn’t be our own worst enemies.”  May 18, 2010, Blog @ www.psychiatrictimes.com

o        Dr. Stotland, above, mentions ECT  (electroconvulsive therapy), or “shock therapy.”  It reboots the brain and is the only thing that keeps some people alive and eases their suffering.  So how is ECT worse than shocking a stopped heart with a defibillator–two paddles on the chest and BOOM!  Which is more barbaric?

o        In the TV medical dramas, there’s this common scene:  a patient is in a hospital bed surrounded by doctors, and the patient is bleeding, or screaming in pain, or convulsing.  Somehow this is acceptable in prime time.  What if the scene was different.  Instead, an agitated, hallucinating patient is being restrained, and injected with a drug that immediately calms and relaxes them.  My guess is the public would find it sickening and unethical.

o        When a sweet-looking child loses all of his or her hair after being poisoned by chemotherapy, it evokes sympathy and compassion.  But if this same  child’s hair was lost while taking a psychiatric medication, then it would be seen as a barbaric side-effect of forcing drugs on children to send them to zombie-land.  Cancer treatment is forgivable,  treatment for brain diseases is not.

This public attitude must change.   It victimizes the victims who live with mental disorders, and their providers and families.   Mental health treatments are no more barbaric than those of other medical illnesses, but the stigma manifest in blame, prejudice, and ignorance of brain function are cruel–can’t people see we are doing the best we can to get help for sick people?  Let the dialogue be about improving lives instead of finding fault with doctors, sufferers, and families.

mp

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ADHD kids become troubled adults

ADHD kids become troubled adults
4 votes

I have been so wrong about ADHD.  I confess I used to think attention disorders were not as serious as other disorders.  Sure, these kids had big problems, but they didn’t seem to compare with the disabling, even dangerous, symptoms of disorders like bipolar or schizophrenia.  ADHD kids just seemed more ‘functional’ to me, and the treatments seemed to work better.  While other families talked about psychotic breaks, suicide, and uncontrollable rages, I heard parents of ADHD kids talk about intense frustration and daily calls from school.  Heck, ADHD kids could attend school!  When I attended children’s mental health conferences, the ‘youth-talk-back’ workshops were all led by young people with ADHD.  They were articulate about their experiences and needs, answered questions, and interacted appropriately with audiences.  So many strengths!  Youth with other disorders are challenged by all of these tasks.

I confess, I also found ADHD funny…

…but my perception changed radically when I found recently published research on children with ADHD who were followed from childhood to adulthood.  These studies revealed deeply unsettling news—the long-term effects of ADHD can be serious.  Adults with ADHD have a higher risk of developing other psychiatric problems, being victimized and incarcerated, and facing lifetime struggles with education and employment.  Summaries from 10 research studies on the long term prognoses of ADHD are found at the end of this post.

Children and teens with ADHD deserve the chance to reach adulthood with skills that keep them from sliding inexorably downhill, which studies show is common.

Treatment is imperative, not optional!  ADHD hits hardest in adulthood, but starts in childhood when parents have an opportunity to change it’s course.  Parents and caregivers should aggressively and persistently seek an appropriate treatment for their ADHD child that improves functioning:  behavior at school and home, school attendance and educational attainment, self-esteem, and self-actualization.  In addition to medical/medication treatment as recommended, the child must learn self-management and self-calming skills so they can control impulses when they reach adulthood.

Little things start adding up – Without skills (and/or medication), a person with ADHD slips up on life’s daily little challenges–losing, forgetting, neglecting, overreacting, disappointing others, and undermining themselves in a thousand different ways.
Needing others and resenting it – I’ve noticed that those with ADHD seem to find or attract others they can depend on.  They seek and get support to be functional, but the effort can weigh heavily on their “caretakers” (spouse, friends, co-workers) and family.  They lose opportunities to practice self-reliance when this happens, and they resent their dependence on others.  Who wants to be stuck within other’s limits, and on the receiving end of their frustration and impatience?

 
Unfinished business – Those with ADHD drag unfinished projects with them indefinitely, keeping them in an actual or metaphorical garage full of costly but unfinished projects.  Little repairs become big expensive repairs through lack of maintenance.  Bills don’t get paid, licenses don’t get renewed, debtors get away with never paying them back.
 
Guide your child to his or her gifts –
From personal experience with ADHD children and adults, I know they can love, be affectionate, funny, generous, and show empathy for others.  They strive to be better.  Think of careers your child or teen might pursue that require creativity, energy, and enthusiasm.  Introduce them to experiences that challenge them, and ignore the myth that they can’t focus or that they mess things up, not true.  ADHD kids readily focus on projects they enjoy, demonstrate mental nimbleness with complexities, multitask with accuracy, and shine in emergencies, whether debugging software, making music, or even doing surgery.

Writer’s commentary: To medicate or not to medicate?  Two extremes, neither appropriate. I’ve read articles that question the existence of ADHD, or vilify the families that treat with medications. Prejudice against this disorder and parents is common. Even uninformed people think they understand ADHD, and comfortably spread personal opinions about the use of medications or consequences for ADHD behaviors. This is unhelpful. Public controversy over ADHD negatively influences parents’ decisions regarding diagnosis and their choice of a child’s treatment.

At one extreme: some think medications turn children into zombies, and that ADHD is a fake diagnosis or treatable with natural substances or meditation, etc. Non-drug options may help, but what if the results are marginal and short-lived? What if a parent stubbornly sticks with a treatment that fits a personal goal and refuses to notice that it’s not working? If a non-drug remedy is effective, there will be hard proof: the child will keep up with school, maintain grade level, exhibit behaviors appropriate for their age, and show signs of self-control. These are more important to a child’s future than a parent’s loyalty to a belief.

Ironically, the choice of drugs for those of us with children with severe disorders may be easier than for parents of ADHD kids. Drugs keep psychotic kids safe and alive, here and now. Worrying about side effects is a luxury.

At the other extreme: some parents want a “quick fix” with pills, but chemical control also makes it easier for these parents to avoid hard parenting work like teaching their child to check impulses and set boundaries. And if parents are happy with the drug, might they overlook their child’s discomfort with side effects and ignore this child’s need for an adjustment? Might they also overlook how their home environment promotes distraction and chaos? A pill will compensate for bad parenting and a crazy-making lifestyle until the child reaches adulthood, having never been taught to make choices that promote their gift of creativity and reduce their risk of addiction, or having never been taught self-discipline.

Margaret

 
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ADD ADHD Blog

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High School Students With ADHD: The Group Most Likely to…Fizzle

 Breslau J, Miller E, Joanie Chung WJ, Schweitzer JB.Childhood and adolescent onset psychiatric disorders, substance use, and failure to graduate high school on time. Journal of Psychiatric Research.  Jul 15 2010

 Adolescents with attention deficit/hyperactivity disorder (ADHD), conduct disorder, or who smoke cigarettes are least likely to finish high school (HS) on time or most likely to drop out altogether, researchers at the University of California, Davis, School of Medicine (UC Davis) have found.

Lead investigator Joshua Breslau, PhD, ScD, medical anthropologist and psychiatric epidemiologist reported that of a total of 29,662 respondents, about one third (32.3%) of students with combined-type ADHD were more likely to drop out of high school than students with other psychiatric disorders. This figure was twice that of teens with no reported mental health problems (15%) who did not graduate. Students with conduct disorder were the second at-risk group (31%) to drop out or not finish on time. Cigarette smokers were third in line, with a staggering 29% who did not finish high school in a timely manner.

Educational achievement squelched in children with ADHD
Newsletter – NYU Child Study Center, New York, NY, February 2009
Attention Deficit/Hyperactivity Disorder (ADHD) is one of the most common disorders in childhood and adolescence, with prevalence estimates ranging from five to ten percent.  Children with untreated ADHD drop out of high school 10 times more often than other children.

Adult psychiatric outcomes of girls with attention deficit hyperactivity disorder
American Journal of Psychiatry, January 2010
Researchers studied age 6 to 18-year-old girls with diagnosed ADHD and followed up after 11 years.  Conclusions:  By young adulthood, girls with ADHD were at high risk for antisocial, addictive, mood, anxiety, and eating disorders. However, ADHD medications appear to reduce the prevalence of multiple disorders at least in the short term.  These findings, also documented in boys with ADHD, provide further evidence for negative long-term impacts ADHD across the life cycle.

Brain abnormality found in boys with attention deficit hyperactivity disorder
Journal of Abnormal Psychology, March 2009
Researchers trying to uncover the mechanisms that cause ADHD and conduct disorder found an abnormality in the brains of adolescent boys suffering from the conditions. The research focused on two brain areas, the “mid brain” striatal, and cerebral cortex.  The mid brain motivates people to engage in pleasurable or rewarding behavior.  The cortex notices if an expected reward stops and considers options. However, this doesn’t occur as quickly in boys with ADHD or conduct disorders.  Instead, the mid brain region keeps trying for rewards, which is a quality of addictive behavior.

Kids with ADHD more likely to bully, and those pushed around tend to exhibit attention problems
Developmental Medicine & Child Neurology, February 2008
Children with attention deficit hyperactivity disorder are almost four times as likely as others to be bullies. And, in an intriguing corollary, the children with ADHD symptoms were almost 10 times as likely as others to have been regular targets of bullies prior to the onset of those symptoms.  Bullies were the kids in class who couldn’t sit still and listen, didn’t do their homework and were almost constantly in motion.  Children with ADHD symptoms make life miserable for their fellow students, and they too can develop attention problems related to the stress of being bullied.

Girls’ hyperactivity and physical aggression during childhood and adjustment problems in early adulthood:  A 15-year longitudinal study.
Archives of General Psychiatry, March 2008
Girls with hyperactive behavior such as restlessness, jumping up and down, and difficulty keeping still or fidgety, and girls exhibiting physical aggression such as fighting, bullying, kicking, biting or hitting, all signs of ADHD, were found to have a high risk of developing adjustment problems in adulthood.

Teen’s inattentive symptoms may determine how long they stay in school
Forum for Health Economic & Policy, November 2009
Poor mental health of children and teenagers has a large impact on the length of time they will stay in school, based on the fact that at conception there are differences in genetic inheritance among siblings. This study provides strong evidence that inattentive symptoms of ADHD in childhood and depression in adolescents are linked to the number of years of completed schooling.

Children with ADHD more likely to participate in crimes
Yale School of Public Health and University of Wisconsin at Madison, October 2009
Children with ADHD are more likely to participate in crimes such as burglary, theft and drug dealing as adults.  Those who had attention deficit hyperactivity disorder as children were at increased risk of developing criminal behaviors.  Researchers said one reason is that children with ADHD tend to have lower amounts of schooling.

ADHD may affect adults’ occupational and educational attainments
Journal of Clinical Psychiatry September 2008
Adults who have ADHD generally have lower occupational and educational attainments as adults than they might have reached if they didn’t have the disorder, at least compared to what attainments would have been expected given their intellect.  “Educational and occupational deficits… are a consequence of ADHD and not IQ,” lead researchers Dr. Joseph Biederman said. The finding strongly underscores the need for “diagnosing and treating ADHD to avert these serious consequences,” he said.

Attention-deficit/hyperactivity disorder (ADHD) in the course of life.
European Archives of Psychiatry and Clinical Neuroscience, September 2006.
ADHD is a pervasive disorder that extensively impairs  quality of life and that can lead to serious secondary problems.  Long-term studies have demonstrated that the disorder is not limited to childhood and adolescence. The clinical experience indicates substantial difficulties for adults whose ADHD is not diagnosed and treated, and they often create extensive costs for the welfare system. The evidence-based psychiatric treatment available is highly effective and inexpensive.

70% of crystal meth (methamphetamine) inpatients had ADHD
Journal of  Addiction Disorders. 2005, and the blog: Adult ADHD Strengths.
Methamphetamine-dependent inpatients were screened for childhood attention deficit hyperactivity disorder (ADHD), and of the participants, 70.6% screened positive for ADHD and reported significantly more frequent methamphetamine use prior to baseline.  ADHD participants exhibited significantly worse psychiatric symptomatology.  At a three-week follow- up, all who didn’t complete treatment screened positive for ADHD.

 

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Teen rights vs. parent rights when the teen has a mental disorder

Teen rights vs. parent rights when the teen has a mental disorder
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 If you’re a parent of a troubled teen, how much decision making power should your child have?

How can your teenager possibly make decisions for themselves if they’re brains aren’t functioning normally?  They hate you, or they say and do crazy things for unfathomable reasons.  You want to guide them with incentives and consequences but these haven’t worked.  You’re traumatized by their history of unstable behavior and it affects your thinking.  Perhaps you get stuck in a power struggle, or you give up power because asserting your authority just puts gasoline on their fire.  You know they can make good on serious threats, such as running or causing serious personal or material damage.  Or they may completely fall apart.

Decent, caring parents, who aren’t out to “fix” or punish their child, often feel their teen has too many rights:

Problem – A teen’s statements to treatment providers are completely confidential after age 14.  Privacy is important, and the therapist needs the young person’s trust to help them with therapy, but some information could be shared with parents on a case-by-case, “need to know” basis.  A parent should be able to partner with the therapist, so they can structure interactions at home that support therapeutic goals.  For example, if the teen talks about dangerous activities with a best friend that the parent doesn’t know about, I think the parent could be coached to appropriately reduce contact with this friend or defuse the dangerous influence they have over the teen.  If a therapist can’t reveal this much, can’t they at least tell a parent what to watch for, what to set boundaries on?  How to respond?

 Problem – A teenager has the right to refuse medication or therapy at age 14 (in practice, most providers are reluctant to force treatment at any age).  But if their refusal leads to a serious crisis, I know from experience that most parents have no option but calling 911 or using force to keep themselves and others safe.  Yet force undermines the parent-child relationship, and has lead to undeserved charges of child abuse.

Problem – A young person has the right to refuse school attendance even when there are consequences, and the parent can be held liable for neglect.  This is of special concern to a parent who risks losing custody to the state or to a vindictive ex.

Problem – A teenager can commit a crime and a parent can lose custody.  Sometimes crime is the only way for a young person to get the help they need, but sometimes this means they descend, step-by-step, into a justice system that presumes bad parents create bad kids.

Parents of troubled teens need greater control over their situation, and lots of outside support, to prevent losing too much to the Black Hole of their child’s disability.   The emotional, physical, and financial costs to all family members are exceptionally high.  If a parent’s authority is undermined by a society that thinks they are the kid’s problem, and an education and health care system that focuses only on the child’s needs, the parent and family see their own rights being trampled.

What about a Parent Bill of Rights?

  1. Parents and families have a right to personal safety including the safety of pets, and the right to protect themselves, their belongings, and personal space.
  2. Parents have a right to ensure and sustain their financial, social, and job stability, even if it means periodically putting aside the teen’s needs.
  3. They have the authority to create house rules based on respect, safety, and shared responsibility.
  4. And they have the right to enforce houserules and expect them to be followed.
  5. Parents and families members have the right to be human and make mistakes.
  6. Parents and families have the right to take time out for their own well being and self-care.

When does a youth’s rights supersede a parent’s rights?

The youth, because of their disability, has a right to make progress at their own pace, and choose their own path of learning.  They also have the right to reasonable family accommodations because of their different needs.  Like any human being, especially one’s child, they have the right to respect and support regardless of inconvenience.  They also have the right to negotiate for what they want, and to expect earnest efforts towards compromise.  The last, and this is very important, they have the right to choose incentives and consequences that work best for them.

You know your teen will reach adulthood and independence whether they are ready or not.  They will do what they want, perhaps suffer serious consequences, and there’s nothing anyone can do about it.  So do something about it now.

Look at the future from their perspective. Young people in the mental health system face life needs and challenges different from peers. They often don’t reach 18 without experiencing significant setbacks due to their disorders.  They have missed opportunities for the education and life skills needed for adulthood, and lack of youthful achievements that boost confidence and self-esteem. Teens and young adults with disorders may have to manage these the rest of their lives!  Once age 18 is reached, supports they’ve depended on are abruptly dropped.  They are exported to an adult system where they must start from scratch to establish a new support network that will assist them towards an independent life.  Your job is to change from parent to mentor as these new supports are developed.

What are parent responsibilities?

Acceptance:  this is the nature of your child and it’s OK.  They will still be part of the family and get your support.  Your child would function better if they could.

Positive attitude:  yours is not a lost child, there are resources out there to help them, and you really do have the energy to find and use these resources.

Realistic expectations:  brain disorders are termed “disabilities” for a reason.  You cannot expect their lives to unfold like yours did, or even like others their age.  They will redefine what progress means for them.

Support without strings attached:  your teen doesn’t owe you for the life you’ve given them, nor must they pay you back for your extra sacrifices.

Take good care of yourself so you can handle your situation.

Access and use information on the disorder and it’s treatment regime.

Learn and practice an entirely different approach to parenting.

What about youth responsibilities?

My previous post, “Youth with mental disorders demand rights!” presents a document created by members or Youth M.O.V.E (Motivating Others through Voices of Experience), a peer-to-peer organization for teens and young adults http://youthmove.us.  I have a suggestion for M.O.V.E.:  consider developing a youth Responsibilities document.  I believe young people are also responsible for acceptance and realistic expectations, like their parents, as well as being accountable for themselves.

The following list is a good place to look for other ideas.  It was developed by adult mental health consumers (part of this list has been de-emphasized because it does not yet apply to youth).  Everyone, regardless of their medical and mental health situation, should do what they can to take responsibility for their health treatment.

Adult responsibilities that could be applied to youth and young adults:

“In a health care system that protects consumers’ rights, it is reasonable to expect and encourage consumers to assume reasonable responsibilities. Greater individual involvement by consumers in their care increases the likelihood of achieving the best outcomes and helps support a quality improvement, cost-conscious environment. Such responsibilities include:

  1. Take responsibility for maximizing healthy habits, such as exercising, not smoking, and eating a healthy diet.
  2. Become involved in specific health care decisions.
  3. Work collaboratively with health care providers (teachers, parents) in developing and carrying out agreed-upon treatment plans.
  4. Disclose relevant information and clearly communicate wants and needs.
  5. Show respect for other patients and health workers (students, coworkers, neighbors, siblings).
  6. Use the health plan’s internal complaint and appeal processes to address concerns that may arise.
  7. Recognize the reality of risks and limits of the science of medical care and the human fallibility of the health care professional.
  8. Be aware of a health care provider’s obligation to be reasonably efficient and equitable in providing care to other patients and the community.
  9. Become knowledgeable about your health plan coverage and health plan options (when available) including all covered benefits, limitations, and exclusions, rules regarding use of network providers, coverage and referral rules, appropriate processes to secure additional information, and the process to appeal coverage decisions.
  10. Make a good-faith effort to meet financial obligations.
  11. Abide by administrative and operational procedures of health plans, health care providers, and Government health benefit programs.
  12. Report wrongdoing and fraud to appropriate resources or legal authorities.”

 


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Youth with mental disorders demand rights!

Youth with mental disorders demand rights!
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Youth M.O.V.E. (Motivating Others through Voices of Experience) offers peer support, social and educational support, and advocacy for youth with brain disorders.  The Oregon Chapterin  partnership with Portland State University, wrote  a Youth Bill or Rights for teens to young adults between ~13 to about 30.  As you can see in the Rights document below, they believe youth should be allowed to guide their mental health treatment, and receive respectful, humane care.

“YOUTH BILL of RIGHTS  –  We believe that all youth should have the following rights in their mental health care:

1) Youth have the right to be leaders of their psychiatric treatment plans.

Youth should be informed of the possible side effects of medications, how long recommended medications take to go into effect, and the possible long-term effects of recommended medication. Service providers should work with youth to explore possible alternatives to using psychiatric medication before medication is given. Communication between youth and all medical providers should be collaborative, clear, and with limited use of medical terminology.

2) Youth have the right to evaluate their mental health services.

Mental health counselors, social workers, psychologists, and other service providers should provide opportunities for youth to evaluate the satisfaction of their services throughout the duration of care in a respectful and non-threatening manner. This includes evaluation of the relationship with the provider, counseling plans, and implemented treatment models.

3) Youth have the right to service transitions that are as non invasive as possible.

When youth are transitioning into new services, mental health programs should strive to make the transition as accommodating as possible for the youth. Youth should be consulted on the ways they would like to end their relationship with the current provider and whether they would like the current provider to share their file with their new provider. Providers should share if there will be any changes in the costs of services and/or insurance coverage.

4) Youth have the right to trained, sensitive treatment providers.

Youth should have access to mental health professionals that are familiar with the unique needs and challenges of youth with mental health needs. All mental health professionals should have specialized training that fosters positive youth development and support. Youth mental health service consumers should be included in the creation and implementation of these trainings.”

This document was created and signed in 2009 by 30 mental health service-experienced youth gathered in Portland, OR, from the following states: California, Hawaii, Idaho, Illinois, Kentucky, Maine, Massachusetts, Missouri, Michigan, New York, North Carolina, Oregon, Texas, and Washington.  http://youthmove.us

 This list of rights is similar to the “Mental Health Consumer Rights” developed by adult mental health consumers, which is appended at the end of this article.

What do you think?  I say “bravo,” these are appropriate and necessary–anyone receiving treatment must be comfortable and safe with care providers, and treated with dignity and respect, period  But I’d like to see something similar for parents and caregivers, too, who also participate in treatment and need to feel respected and heard.

What does your teen or young adult child think?  Tell them about an opinion survey where they can comment and read other’s comments, http://mentalhealthyouthbillofrights.blogspot.com .

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Adult Consumer Bill of Rights – for adults in mental health service systems

  1. Information Disclosure:  Consumers have the right to receive accurate, easily understood information and may require assistance in making informed health care decisions about their health plans, professionals, and facilities.
  2. Choice of Providers and Plans:  Consumers have the right to a choice of health care providers that is sufficient to ensure access to appropriate high-quality health care.
  3. Access to Emergency Services:  Consumers have the right to access emergency health care services when and where the need arises.
  4. Participation in Treatment Decisions:  Consumers have the right and responsibility to fully participate in all decisions related to their health care.
  5. Respect and Nondiscrimination:  Consumers have the right to considerate, respectful care from all members of the health care system at all times and under all circumstances. An environment of mutual respect is essential to maintain a quality health care system.
  6. Confidentiality of Health Information:  Consumers have the right to communicate with health care providers in confidence and to have the confidentiality of their individually identifiable health care information protected.
  7. Complaints and Appeals:  All consumers have the right to a fair and efficient process for resolving differences with their health plans, health care providers, and the institutions that serve them, including a rigorous system of internal review and an independent system of external review.
  8. Consumer Responsibilities:  In a health care system that protects consumers’ rights, it is reasonable to expect and encourage consumers to assume reasonable responsibilities.

The federal Substance Abuse and Mental Health Services Administration (SAMHSA) established the Consumer Bill of Rights Workgroup to promote and implement the Presidential Advisory Commission’s Consumer Bill of Rights and Responsibilities in health care. http://mentalhealth.samhsa.gov/consumersurvivor/billofrights.asp

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