Category: mental illness

Typical parenting mistakes – 9 ways we make things worse

Typical parenting mistakes – 9 ways we make things worse

Good parenting means knowing what NOT to do as a parent.

Hey, it’s hard not to lose your cool with some children.  And once you do, you may feel guilty or a failure as a parent.  (There’s no manual for ‘normal’ kids either!)  You deserve credit for trying to be better.  The easiest way to improve your parenting is to know what’s wrong first.

1…Treat your child or teen like another adult who knows how to behave appropriately and has memorized the rules, even the unspoken ones.  Answer your child’s frustrations (with you) by offering explanations that show how reasonable you are.

2…Find fault with your child and let them know about it over and over again.  If they do something positive, let them know it’s not enough.  Let your tone of voice reveal how frustrated, angry, stressed or resigned you feel because of them.

3…Pretend your child has no reason for their behavior.  Ignore his or her unique mental health needs or the challenges they may face.  Are they being picked on at school or by a sibling?  Do they fear abandonment?  Are they stressed about an upcoming event?  Is your home too chaotic?

4…Make rules and only enforce them once in a while, or have the consequence come later than the misbehavior (“I’ll get to you later.”  “This is punishment for what you did this morning.”).

5…Don’t treat your child appropriately for his or her age.  Make long explanations to a three year old about why you’ve set a certain rule.  Assume a teen wants to be just like you.

6…Expect your child to logically, rationally accept your reasonable rules.  Parents expect common sense from children who are too young to reason (3 or 4), or from teens or young adults (up to early 20’s) who have a long track record of doing things that don’t make sense.

7…Keep trying the same things that still don’t work.  Like repeating yourself, talking at them rather than with them, or screaming.  (Don’t be embarrassed if you’ve screamed; we’ve all done this.)

8…Jump to conclusions that demonize your child.  “You’ll do anything to get your way,” or “You are so manipulative and deceitful,” or “You don’t listen to me on purpose,”  “I’m tired of your selfishness…”

9…Make them responsible for your feelings.  If you lose your cool because you’re stressed and blow up over something they did, insist they do the apologizing after they react poorly.

 

–Margaret

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ADHD kids become troubled adults

ADHD kids become troubled adults

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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All T-shirt photos found at Dr. Kenny Handelman’s
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.

 

Balancing teen rights vs parent rights when the teen has a mental disorder

Balancing teen rights vs parent rights when the teen has a mental disorder

 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?  Maybe they hate you, or they say and do crazy things.  You want to guide them with incentives and consequences, but these haven’t worked.  You’re traumatized by their 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.

Many parents worry because their teen seems to have too many rights for their own good.

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 led to undeserved charges of child abuse.

Problem – A young person can 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 their parent(s) can lose custody for being negligent.  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 abundant support to prevent loss to the Black Hole of their child’s disability.   The emotional, physical, and financial costs to family members are too high.  If a parent’s authority is undermined when others blame them for their child’s behavior, and an education and health care system focus only on the child’s needs, the parent rights are 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   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 wellbeing and self-care.

Teens have rights too, which should be respected

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.

Teenagers today want two things.  Allow as much as appropriate:

  1. Freedom
  2. A say in what happens to them

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 a majority of troubled young people are capable of being accountable when they have the right support and treatment.

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 consumers to assume reasonable responsibilities. Greater involvement in their health increases the likelihood of recovery. 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.”

 


Youth with mental disorders demand rights!

Youth with mental disorders demand rights!

Troubled young people have rights, and a national organization is there to support them. 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 ~16 to mid 20’s.  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 rights to services 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 rights to get treatment from trained, sensitive 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

Defying ODD: what it is, and ways to manage.

Defying ODD: what it is, and ways to manage.

Not only is ODD exhausting, but parents must find the energy and doggedness to be consistent, and the compassion and forgiveness to be nurturing.

ODD is caused by abnormal electrical activity in the brain, it is not in the character or ‘soul’ of your child or teen, and not something they can control.  If your child could do better on their own, they would.  You are the one who can make the most difference.

If you think your child or teen’s defiance is oppositional defiant disorder, you have practical ways to manage your child’s exasperating condition.  This information comes from psychiatric, psychological, and child behavior resources– information to help you work effectively with mental health providers or teachers.  You’ll need to ask them focused questions to learn everything they know about ODD.  Professionals pay better attention to knowledgeable parents (which shouldn’t be the case, all parents deserve attention).  Go in armed with knowledge.

This is what ODD looks like.  The pinkish curving region in the center of the 3-D brain image below represents hyper-charged electrical activity in a 13-year-old boy with severe oppositional defiant disorder.  This feature is typical of ODD, but also typical in individuals with obsessive compulsive disorder (OCD), “Road Rage,” pathological gambling, chronic pain, and severe PMS.

The name of this region is anterior cingulate gyrus (ACG), and scientists believe this area is responsible for enabling a person to shift attention and think flexibly, traits which are deficient in ODD kids.  It is also the brain region known to regulate emotions.  Children with a hyper-charged ACG have “a pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which 4 or more of the following are present:

  • Often loses temper
  • Often argues with adults.
  • Often actively defies or refuses to comply with adults’ requests or rules.
  • Often deliberately annoys people.
  • Often blames others for his or her mistakes or misbehavior.
  • Is often touchy or easily annoyed by others.
  • Is often angry and resentful.
  • Is often spiteful and vindictive.” 

–From the “Diagnostic and Statistical Manual of Mental Disorders, 4th Edition,” published by the American Psychiatric Association, 2000.

There are two different medication approaches to ODD:

  • treat it as a form of attention deficit disorder;
  • treat it as form of depression and obsessive-compulsive disorder.

The attention deficit approach may use Straterra (chemical name is atomoxetine), Ritalin (methylphenidate), Risperdal or risperidone (for patients with low IQ), and Depakote or divalproex (a mood stabilizer).  This is not a complete list because new compounds may come into the market.

The depression & obsessive-compulsive approach may use serotonin-based antidepressants such as Prozac (fluoxetine), and Anafranil or clomipramine (used to treat OCD).  Again, this is not a complete list.

Oppositional defiant disorder often includes symptoms from other disorders, so you may be coping with more than defiance.  Below are common disorders that combine with ODD:

  • 50-65% of these children also have ADD or ADHD
  • 35% of these children develop some form of depressive disorder
  • 20% have some form of mood disorder, such as bipolar disorder or anxiety
  • 15% develop some form of personality disorder
  • Many of these children have learning disorders

Anthony Kane, MD 

Other medical conditions that can cause disruptive behavior like ODD:

  1. Neurological disorders from brain injuries, left temporal lobe seizures (these do not cause convulsions, no one can tell these are happening), tumors, and vascular abnormalities
  2. Endocrine system problems such as a hyperactive thyroid
  3. Infections such as encephalitis and post-encephalitis syndromes
  4. Inability to regulate sugar, rapid increases and decreases of blood sugar
  5. Systemic lupus erythematosus, Wilson’s disease
  6. Side-effects of prescription medications:  Corticosteroids (anti-inflammatory and arthritis drugs such as Prednisone);  Beta-agonists (asthma drugs such as Advair and Symbicort)

–From Peters and Josephson.  Psychiatric Times, 2009.

ODD is a disability.  It isn’t easy to manage, but you can do it.  Your child may need multiple medications and a large variety of approaches to therapy and behavior modification.  You will need patience as his or her teachers, doctors, or specialists try different approaches until they discover one that improves your child’s behavior, so hang in there!

Some good news, if your child has these traits, it will be easier to improve or overcome ODD behaviors:

  • A normal IQ
  • A first-born child
  • An affectionate temperament
  • Positive interactions with friends their age
  • Nurturing parents who can consistently set clear behavioral limits

–From the Journal of American Academic Child and Adolescent Psychiatry, 2002.  Author J.D. Burke.

People’s natural instincts of parenting do not work with an ODD kid.  They need completely different techniques than normal children. 

How to reduce ODD behaviors

Shield yourself.

First get a shield, then prepare yourself for the intensity of parenting a defiant kid because you are about to run a marathon.  Get enough sleep, maintain your other important relationships (spouse or partner, children, friends), schedule breaks or getaways, and guard your physical and emotional health.  Don’t expect quick results with these techniques; it may take weeks or months… years.

Tips from professionals that may work for you:

Parent Management Training – PMT refers to intensive educational programs that are “evidenced based,” proven to help parents gain the skills they need for extremely difficult children, especially those with ODD.  These programs are intensive, but substantiated interventions in child mental health.  PMTs help parents assert consistency and predictability, and promote pro-social behavior in their child.  A good explanation can be found at the Encyclopedia of Mental Disorders.  Examples include:  the Total Transformation and the Incredible Years.

Find something positive to do together.  Your child has normal needs for closeness and appreciation and joy.  Ask your child about their interests, and if their ideas don’t work for you, try new activities until one brings about a good chemistry between you and your child.

Praise is one of the most powerful tools for managing disruptive behavior.  Make an effort to inject as much positive energy into your relationship with your child or teen.  It’s likely that this relationship has been close to 100% negative, yes?   Caution: don’t expect thanks or joy from your child once they’re praised; it’s not about you.

Set limits – “Consistent limit setting and predictable responses from parents help give children a sense of stability and security.  Children and teens who feel a sense of security regarding the limits of their environment have less need to constantly test it.”  (Webster-Stratton and Hancock)

Active ignoring – This works for best with children between the ages of 2 and 12.  It involves purposefully withdrawing your attention away from your child when they are misbehaving, such as in a temper tantrum, or when whining or sulking, or when making continuous demands or loud complaints, etc.  Pretend you don’t care and even turn your back if possible.  Give attention only after the behavior is over.

Make the behavior uncomfortable for the child/teen.

  • Example:  If your kid swears, test them, “C’mon, you can do better than that, be creative, I’ve heard all those things before.”  They can get frustrated when they aren’t getting the reaction they want from you, and give up.
  • Another example:  Your teen refuses to get out of bed for school.  Don’t nag or repeat, repeat, repeat.  Remove the bed covers and set them far enough away that your child has to get out of bed to retrieve them.  (“Managing Resistance,” John W. Maag, jmaag1@unl.edu)

Give multiple instructions at once, where at least one of the instructions is what they want to do, and one is what you want them to do.  “Close the door while you’re yelling at your sister and don’t forget the light.”  Your child will be overloaded as they try to figure out which thing they’re supposed to defy.  Kids tend to get flustered by the mental effort and comply without knowing they’re doing it. (from “Managing Resistance,” see above)

Reverse psychology:  Yes, this works, and it’s OK when important.  Example:  your child is bouncing on the furniture.  You turn on music and say “hey, try this, see if you can bounce to the beat, it’s harder to do on the floor.”  This is a good kind of manipulation.

Unexpected rewards – Occasionally reward appropriate behavior with something they like.  They are more likely to do a desired behavior if they expect something they want and aren’t sure when it will be offered.

“Why should I have to do this when it’s my kid’s responsibility to behave?”

It’s your responsibility as a parent to do what you can to help your child be successful.  ODD is a genuine disability that negatively affects their life and future.  I’ve seen highly intelligent ODD kids experience academic failure or enough suspensions and expulsions to hold them back a grade.  This is a can’t-win-for-losing path sucks, doesn’t it?

Warning, once you start consistent enforcement, things get worse at first – Defiant behavior will increase once your family system is changing.  This as a good sign—you are regaining your authority!  Your child’s backlash is a common human psychological response, and it’s called an “extinction burst,”  see diagram below.  As parents change their approach to handling inappropriate behavior, the child becomes more defiant to test their resolve.  View this as predictable and plan ahead.  It won’t last, and they will eventually comply with this one rule.  They then find another rule to defy and ramp up their defiance.  As you enforce it, they back off again, and the pattern continues until it’s just not worth it to defy these particular rules anymore.

 

–From “Behavioral Interventions for Children with ADHD,” by Daniel T. Moore, Ph.D., © 2001, http://www.yourfamilyclinic.com/shareware/addbehavior.html .  The author requests a $2 donation through PayPal to distribute his article or receive printed copies.


Tips for effective parenting of an ODD child through adulthood

Don’t treat your home like a democracy, where everything must be fair and equal.  You must be the supreme ruler, the benevolent dictator.  Your child does not have an equal say in how things are done.  Parents must keep their authority and rightful power in the household, and tell their ODD child that they make the important decisions, plus, the decisions may not always seem fair. Tell them you’ll listen to what they have to say but make no promises. Once you’ve made a decision, avoid explaining your reasons when they challenge you. This helps you keep their power, and it limits endless arguments and accusations. As your child ages into adulthood, you must still hang on to your power. The adult child will continue to require limits, and limits will still need enforcement. To a parent, it will feel as if you’re treating your adult offspring as a child. YOU ARE and you should be, and this is the interesting part: they won’t notice.

Don’t blame or belittle your child-–this goes for all children–but a difficult child can bring out the worst in an exhausted parent. It’s easy to think they’re being bad on purpose because they’ll act like it, and show amusement when they’re bad or belittle you. Keep in mind that ODD is no one’s fault, and your child would not choose to have ODD if they understood what it meant.

Don’t ignore your child’s unique needs that have nothing to do with ODD.  They may face bullying at school, lack of sleep, stress from a chaotic home, or other challenges like any other child.

Always enforce rule breaking as immediately after the fact as possible.  Why:  If enforcement comes later or only occasionally, the child does not connect the broken rule with the punishment. Or, they believe they can still get away with breaking a rule and then talk their way out of consequences later.

Don’t let your stress turn into anger directed at your child.

  • They can use this against you by teasing or baiting to get you angry again!
  • You’ll be modeling that anger is an OK response to stress.

Take care of your emotional wellbeing. Check in with yourself if you feel you are losing control. All parents with troubled children need to work extra hard at maintaining a level head. It’s a good skill to have anyway.

Avoid justifying your rules or offering explanations. Children with ODD are not able to reason when they turn defiant. They will only resist harder and use your words to argue more with you. Even if they can understanding your reasoning in a calm moment, this will vanish once they become defiant again.  (What’s interesting is I’ve observed parents trying to reason with young children(4 or 5), too young to be reasonable in the first place, or with young adults (early 20’s) who have a long track record of being unreasonable.

Don’t interpret everything as ODD-defiance.  Some rebelliousness is normal for children, especially if parents are over controlling.

Don’t keep trying the same things that still don’t work.  Like making excuses; like screaming.  (Don’t be embarrassed; we’ve all done this.)

Don’t jump to conclusions that demonize the child.  It hurts you as much as it hurts them. I often hear parents say:  “Why does he keep doing this?, or, “Why doesn’t she stop after I’ve told her not to, over and over again.”  Then they answer their own questions:  “It’s because he always wants his way,” or, “She’s doing this to get back at me.”  As they tell their story, I hear them taking things personally:  “He does this just to make me mad;” “She manipulates the situation because she wants more (something) and I won’t give it to her.”

Good luck with your defiant ODD child.   Hang in there.  I WISH YOU THE BEST!

–Margaret

How am I doing?  Please comment.


 

Teachers and Stigma – Judging and Blaming Families

Teachers and Stigma – Judging and Blaming Families

As parents of troubled children, we already know that our child’s disorder or behavior will not work in most classrooms.  Teachers don’t need to tell us this or explain why our child needs to change in order to learn–we already stay up at night worrying how our child or teen will make it in the world.  Most parents have tried everything:  we’ve looked for other educational options (which almost never exist or we don’t qualify), we’ve asked or pleaded for help, we’ve read books and scoured the internet for advice…  When nothing works, some parents and caregivers just give up and try to muddle through.

When it comes to working with teachers, it feels like you can’t win for losing

Those parents who’ve tried everything become deeply frustrated and take it out on school staff.  This reaction makes sense when you’ve been there like I have.  I probably looked bad at meetings, angry, stressed, anxious, and confused—and that’s how I was treated.  I could sense teachers assumed I was this way all the time and thus the cause of my child’s disorder.

Those parents who give up don’t show up.  They can’t face another school meeting to listen to the litany of their child’s problems, feeling nagged with advice given in a tone of impatience, never getting help, hope, or heard.  Not showing up also makes perfect sense.  Who wants another downer?  It’s best to stay home and conserve precious emotional energy.  These parents look apathetic and neglectful at best–I personally know a couple who’ve given up.  I’ve heard school staff wondering aloud if these parents were using drugs, abusive, or criminally neglectful.  I personally knew they weren’t.

Teachers have the same paradoxical attitudes held by the public at large when it comes to troubled children.  They may try to be neutral when they work with parents, but underlying attitudes and feelings still come out:

  • We sympathize but you’re still to blame;
  • You can change things if you want to, but you don’t really care;
  • We know what your child needs, you don’t.

I truly believe teachers care about children and teens which is why they are teachers.  Their professional education centers on children’s development and learning, but not on the intricacies and psychology of family relationships or children’s mental health!  Their qualifications and license are for giving their students a quality education, not for doing social work with families.  Even if teachers recognize that families struggle with their child, there is still a sense that the cause of a student’s lack of achievement “sits squarely on the shoulders of parents”  who simply “don’t care.” *

* Taliaferro, JD; DeCuir-Gunby, J; Allen-Eckard, K (2009).  ‘I can see parents being reluctant’: Perceptions of parental involvement using child and family teams in schools.  Child & Family Social Work, 14, 278-288

> Find out more about this research at the Research and Training Center http://www.rtc.pdx.edu/ – “School Staff Perceptions of Parental Involvement,” August 2009, Issue #164 <

Mixed messages from schools

 

Teachers and schools give mixed signals to families, on the one hand encouraging parents to work with their child’s teacher, and on the other hand becoming “offended when… parents would take the side of their children or question a teacher’s assessment.” *  When it comes to mental health, teachers simply aren’t trained to recognize or diagnose disorders.

Parents with troubled kids in school have additional responsibilities, but their energy and time reserves are the lowest: they have Child and Family Team (CFT) meetings to attend; Individual Education Plan (IEP) meetings; waivers, Releases of Information (ROIs); and many communication attempts to follow through on each of these.

Teachers need to believe in the ability of parents to contribute to their child’s well being and understand parents’ need for support when children have mental or emotional disorders.  And “…schools must change practices so that information can be shared with a socially just approach.  Schools must meet families where they are rather than embracing misperceptions and stereotypes…” *

Let’s change this situation, and here’s how you can help

If you are a teacher, parent, or other education advocate, there’s a program available from the National Alliance on Mental Illness (NAMI) to develop understanding and partnership between schools and parents with troubled children.  It’s called Parents and Teachers as Allies.

This is an in-service mental health education program designed for teachers, administrators, school health professionals, families, and others in the school community.  The curriculum focuses on helping everyone better understand the early warning signs of mental illnesses in children and adolescents and how best to intervene, and how best schools can communicate with families about mental health-related concerns.

The program is also designed to target schools in urban, suburban, rural, and culturally-diverse communities.  The toolkit is being developed to be culturally sensitive and will include a Spanish language version.

For more information about this program, please contact: Bianca Ruffin, Program Assistant, Child & Adolescent Action Center, Email: biancar@nami.org, Phone:  703.516.0698

For Fathers Who Raise Troubled Kids

For Fathers Who Raise Troubled Kids

Where are the men?

Every year, I attend several conferences around the nation that focus on the families, children, and policies associated with children’s mental health.  The majority in attendance are women.  Other meetings I attend on children’s mental health in social services and in advocacy groups also have a majority of women present. People who attend my family support group are also mostly woman:  bio mothers, adoptive mothers, girlfriends, stepmothers, grandmothers, aunts, and sisters involved in caring for a troubled child.  Anyone else notice this?

We need the men.  I know they are out there.  I know they are engaged in raising a troubled child and probably alone with their concerns.  They are not just biological fathers, they are stepfathers, boyfriends, adoptive fathers, foster fathers, uncles, and brothers, but I’ll call them all “dads” here.

“We’ve been down on our knees in pain for our kids…”

At a national “Building on Family Strengths” conference in Portland, Oregon, was a presentation on the subject of dads helping dads.  It was the first time I attended a seminar where mostly men attended.  I asked the panel, founders of Washington Dads, www.wadads.org, “why hasn’t there been a gathering like this before?”  Apparently, panel members tried to find help and it wasn’t there, so they started a support organization for themselves.  They believe it’s the only one like it in the nation.

The messages – One panel member said men feel they are supposed to fix the problem, but since they can’t  they feel like failures.  Another said that “dads are often not the main caregivers, and perhaps they lack experience,” and after trying what they think will work, are at a loss when it doesn’t.  Another, “we want a quick fix, but a clear concrete fix will do… we want to know how to problem solve.”  That’s a big one, men fix things, they want to get together and hash out solutions.  “Men talk solutions right away instead of talking through emotions.”  They said men like rules or instructions such as Collaborative Problem Solving techniques, the use of technology, and concrete, measurable plans such as IEPs. (Here is another story about a father who wants to fix his daughters illness.)

In general, moms tend to feel guilty, but dads tend to be resentful:

  • Their family’s problems are right out there in public
  • Mom is too lenient and easily gives in to the child.
  • The child gets all the attention; other family members are neglected.
  • Quality relationships with all family members are lost.

Dad’s emotions are there but expressed very differently.  “Some men need to vent aggressively… blow a gasket, but only other men are OK with this.”  Some want to reveal things to each other they wouldn’t share with their wife or partner; “men need to bond without women present” and with personal face-to-face contact.  Men tend to have custody issues too, and often face challenges to their rights to visit their children or maintain relationships with them.

Gentlemen, trust me, moms want you to have support.  You can form a group and get yourself some buddies.

Help me find articles about other issues fathers face:

  • custody of the children
  • disagreements with mom
  • their influence on treatment, or placement, or educational issues
  • their need for social support with other men.

– – – – – – – – – – – –

Research on the very positive influences of fathers

Devoted dad key to reducing risky teen behavior – Moms help, but an involved father has twice the influence, new study finds  [EXCERPT],  By Linda Carroll, June 5, 2009

Teenagers whose fathers are more involved in their lives are less likely to engage in risky sexual activities such as unprotected intercourse, according to a new study.  The more attentive the dad — and the more he knows about his teenage child’s friends — the bigger the impact on the teen’s sexual behavior, the researchers found.  While an involved mother can also help stave off a teen’s activity, dads have twice the influence.

“Maybe there’s something different about the way fathers and adolescents interact,” said the study’s lead author Rebekah Levine Coley, an associate professor at Boston College. “It could be because it’s less expected for fathers to be so involved, so it packs more punch when they are.”

Dad’s positive effect
Parental knowledge of a teen’s friends and activities was rated on a five point scale.  When it came to the dads, each point higher in parental knowledge translated into a 7 percent lower rate of sexual activity in the teen.  For the moms, one point higher in knowledge translated to only a 3 percent lower rate.  The impact of family time overall was even more striking. One additional family activity per week predicted a 9 percent drop in sexual activity.

Child development experts said the study was carefully done and important. “It’s praiseworthy by any measure,” said Alan E. Kazdin, a professor of psychology and child psychiatry at Yale University.

Why would dads have a more powerful influence?

“Dads vary markedly in their roles as caretakers from not there at all to really helping moms,” Kazdin said. “The greater impact of dads might be that moms are more of a constant and when dads are there their impact is magnified.”  Also, Kazdin said “when dads are involved with families, the stress on the mom is usually reduced because of the diffusion of child-rearing or the support for the mom.”

In other words, dad’s positive effect on mom makes life better for the child, Kazdin explains.

The study underscores the importance of parental engagement overall, said Patrick Tolan, a professor of psychiatry and director of the Institute for Juvenile Research at the University of Illinois in Chicago.  “For one thing, the more time you spend with them, they’re going to get your values and they’re more likely to think things through rather than acting impulsively.”

Coley hopes that the study will encourage both moms and dads to keep trying to connect with their teenage children, even as their kids are pushing them away.  “…it’s normal for teens to want to pull away from the family, [but] that doesn’t mean they don’t want to engage at all,”

Linda Carroll is a health and science writer living in New Jersey. Her work has appeared in The New York Times, Newsday, Health magazine and SmartMoney.

– – – – – – –

The Father-Daughter Relationship During the Teen Years – Ways to strengthen the bond  [EXCERPT],  by Linda Nielsen

According to recent research and my own 30 years of experience as a psychologist, most fathers and teenage daughters never get to know one another as well, or spend as much time together, or talk as comfortably to one another, as mothers and daughters.  Why is this bad news?  Because a father has as much or more impact as a mother does on their daughter’s school achievement, future job and income, relationships with men, self-confidence, and mental health.

When I ask young adult daughters why they aren’t as comfortable sharing personal things or getting to know their fathers as they are with their mothers, most make negative comments about men.

  • “Because he’s a man, he doesn’t want to talk about serious or personal things.”
  • “Because men aren’t capable of being as sensitive or as understanding as women.”
  • “Because fathers aren’t interested in getting to know their daughters very well.”

If a daughter grows up with these kinds of negative assumptions about fathers, she will not give her father the same opportunities she gives her mother to develop a comfortable, meaningful relationship. As parents, we strengthen father-daughter relationships by teaching our daughters how to give their fathers the opportunities to be understanding, communicative and personal.

Creating more father-daughter time alone – Regardless of a daughter’s age, the most important thing we can do is to make sure fathers and daughters spend more time alone with one another.  Since most fathers and daughters haven’t spent much time together without other people around, they might feel a little uncomfortable at first.  If so, they can start by taking turns participating in activities that each enjoys.  One idea:  The father could choose 15 or 20 of his favorite photographs from various times of his life — as a little boy, a teenager or a young man — and then use the pictures to tell his daughter stories about his life.  The key to the success of this father-daughter time is that they alone are sharing this experience.

Staying involved during dad’s absence – Teenage daughters and fathers can strengthen their relationship during dad’s absence through e-mails, letters, pictures and a touch of silliness.  Before dad departs, for one example, father and daughter can talk about how much their relationship means to each of them and agree to write or e-mail at least twice a week.

Linda Nielsen is a psychology professor at Wake Forest University in Winston-Salem, N.C. Her most recent book is Embracing your Father: How to Create the Relationship You Always Wanted With Your Dad. For more information on father-daughter relationships visit www.wfu.edu/~nielsen/.

– – – – – – – – – –

Early Father Involvement Moderates Biobehavioral Susceptibility to Mental Health Problems in Middle Childhood

Boyce, W. Thomas; Essex, Marilyn J.; Alkon, Abbey; Goldsmith, H. Hill; Kraemer, Helena C.; Kupfer, David J.;  Journal of the American Academy of Child and Adolescent Psychiatry, v45 n12 p1510-1520 Dec 2006

[my summary in everyday English:  When fathers are engaged in nurturing and parenting a child from infancy, the child develops healthy responses to social situations when they reach the middle childhood years ~age 9.  The father’s engagement actually improves brain function on the emotional level and reduces activity in the stress area of the brain.  If a father is not involved, the child is at a high risk of behavioral problems.  Also, if a mother is depressed in their child’s early years, the child is at an ever higher risk of behavioral problems.]

Parent to Parent Guidance

Parent to Parent Guidance

Margaret Puckette is a Certified Parent Support Provider, and partners with parents for successfully raising their troubled child, teen, or young adult. She believes parents and families need realistic practical guidance for home and school life, not just information about disorders. Margaret has mentored families for over 20 years. She is an author & speaker, and believes mentally healthy families raise mentally healthy children.

You Can Handle This.

You Can Handle This.

You are not alone. It's no one's fault. Behavior disorders are disabilities! Troubled children need a very different parenting approach than 'normal' kids.

Care for yourself first, then set new goals:
1. Physical and emotional safety for all
2. Acceptance of the way things are
3. Family balance, meet the needs of all
4. One step at a time, one day at a time

Practical Guide for Parents

Practical Guide for Parents

A guide with practical steps for reducing stress at home and successfully raising a troubled child. You use the same proven techniques as mental health and other professionals. It starts by taking care of your wellbeing first, then taking an entirely different approach to parenting.
Amazon $14.99, Kindle $5.99