Category: defiant children

Your rights as the parent of a teen with a mental disorder

Your rights as the parent of a teen with a mental disorder

Parents have more rights than they think.

In a previous blog article on the subject of parents rights, I described how parents can be shocked to learn that their troubled teenager has the right to refuse treatment, Balancing teen rights with parent rights when the teen has a mental disorder.

What if your teen refuses treatment?  They get worse. Over months and years, if your child experiences serious symptoms of the disorder, such as schizophrenia, depression, or bipolar disorder, their brain loses cognitive function just as in Alzheimer’s disease.  Breaks in treatment means loss of brain function, and they become more vulnerable to multiple hospitalizations.  A troubled teenager can refuse treatment  for any reason however–explaining the mental health risks could go nowhere.

If a teenager had any other illness besides a behavioral disorder, refusing or withholding treatment would be considered child abuse and grounds for removing the child from the home.

Laws in many countries err on the side of protecting a person’s civil rights, but a teenager is not ready to take the responsibility that goes with these rights.(An excellent website on pertaining to Special Education Law is Wrightslaw. Click on “Topics from A to Z.”)

What if you’re teen becomes involved in crime?

  • For safety and health reasons, you have the right to search your teen’s room and remove or lock-up risky items like drugs, weapons, razors, pornography, or anything affecting health (rotten food, unclean garments, chemicals). Be careful: this can destroy trust if done inappropriately. Inform your teen only if you find and remove unsafe items but otherwise leave everything else alone!
  • You can set any curfew time you think appropriate, and you do not have to adhere to curfew times used by law enforcement. Suggestion: compare with other parents’ curfews. Your teen will more likely follow rules that his or her peers follow.
  • You can monitor everything in your home, and on your computer and phone. You can limit cell phone services, and get GPS tracking on the phone and in the car. Prevention is more effective if your teen is informed about this, and it prevents others from taking advantage of your child, too.
  • You can report your concerns to anyone: teachers, other parents, and the local police precinct.
  • You can search for your child by calling other parents or businesses, or visiting their friends’ homes, or searching public places where your child might be.
  • You can and should call the police if your child runs away, or if your child is being harbored by someone who wants to ‘protect’ them. It is illegal to harbor runaways and those who do are subject to criminal charges.
  • You can and should notify anyone who encourages your teen to run away or who takes your teen with them without your permission, that this is custodial interference and subject to criminal charges.

What if your child’s mental health provider doesn’t share information you should know as the parent?

“Communication between providers and family members needs to be recognized as a clinical best practice.”*

  • You have the right to contact any mental health professional directly, and provide information relevant to your child, your family (e.g. marital conflict), and your family’s needs (e.g. bullied siblings). The professional can legally receive and document this information, but may not be able to discuss it with you.
  • You have the right to communicate freely and openly with a practitioner or teacher about anything you both already know—no confidentiality exists.
  • You have the right to schedule your own appointment with a professional without your teenager, and ask for information about how to get help for yourself and your family, and what kinds of help you may need.
  • You have the right to information about your child’s diagnosis and behavioral expectations, the course of your child’s treatment, and how you should interact with your child at home.
  • You have the right to a second opinion. And you have the right to change treatment or refuse treatment based on that second opinion.
  • You have to right to participate fully in medical decisions about your child. For example, you have the right to ask a doctor to stop or change medication or treatment that is creating behavior problems or side effects, which harm your ability to manage your teen.
  • You have the right to “information about the treatment plan, the safety plan, and progress toward goals of treatment.” *

What if your child’s provider claims they must keep all information confidential to protect patient privacy?

“While confidentiality is a fundamental component of a therapeutic relationship, it is not an absolute.”*

“Medical professionals can talk freely to family and friends, unless the patient objects after being notified of the intended communication. No signed authorization is necessary.”

–Susan McAndrew, Deputy Director of Health Information Privacy, U.S. Department of Health and Human Services

Teachers and mental health professionals have leeway with confidentiality.  Professionals often misunderstand the Health Information Privacy and Accountability Act (HIPAA), which defines what must be kept confidential. Many also misunderstand the Family Educational Rights and Privacy Act (FERPA) and state laws that govern confidentiality, so they tend to err on the side of confidentiality. However, the American Psychiatric Association states:

“Disclosures can sometimes be justified on the grounds that they are necessary to protect the patient. For instance, it is generally acceptable for a psychiatrist to warn a patient’s family or roommate when the patient is very depressed and has voiced suicidal thoughts”* or plans to harm others.

Professionals should provide explicit information about safety concerns: such as the warning signs of suicide; the need to adhere to medication and other treatment; an explanation of how your teen’s disorder can impair judgment; an explanation of reasons the teen must avoid substances like alcohol and drugs (including some over-the-counter drugs); and the need to remove the means for suicide, especially firearms, sharp objects, matches, chemicals, etc.

How doctors and therapists manage confidentiality

Their basic philosophy is to do what is in the best interest of their patient. For example, if the teen is in an abusive family situation or seeking care only on the condition of confidentiality, their privacy will be protected. “The default position is to maintain confidentiality unless the patient gives consent… However, [family members or friends] may need to be contacted to furnish historical information…” If the practitioner determines that the teen is (or is likely to become) harmful to him- or herself or to others, and will not consent, then they are… “justified in breaking confidentiality to the extent needed to address the safety of the patient and others.
–The American Medical Association, 2001, “The Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry.”

A good professional will be honest with your teen, and tell them that they will communicate with parents based on what they already know. They will also tell your child that suicide or violence risk will always be communicated to you and/or an emergency medical service. From everyone’s perspective “It is always better to defend an inappropriate disclosure than to defend a failure to disclose with bad outcome (e.g. injury or death).”

Giving a teenager with behavioral problems the rights to make critical medical decisions is too risky!

I hope that families and mental health advocates can someday agree on how to maintain civil rights without letting a person control their future when they are not in their right mind. Until then, work with the system as best you can. I find that teachers and practitioners do their best to help families despite the restrictive civil rights and confidentiality mandates. Good luck.

How am I doing? Please rate this article, thanks.  Margaret

* Reference“The Clinician Should Maintain a Confidential Relationship With the Child or Adolescent While Developing Collaborative Relationships With Parents, Medical Providers, Other Mental Health Professionals, and Appropriate School Personnel,” developed by Jerry Gabay JD and Stewart S. Newman MD. The authors would like to acknowledge the support of the Oregon Council of Child and Adolescent Psychiatry for their support of this effort.

Five-minute wisdom for parenting troubled children and teens

Five-minute wisdom for parenting troubled children and teens

From many years of  counseling parents, I’ve found the following parenting wisdom quickly helps parents understand, clarify priorities, and take the next steps.

You are not alone. All families experience the same fears no matter what the child’s challenges: guilt, anger, frustration, failure, and mental and physical exhaustion.

There is a way. The steps to finding peace in the home are the same for all families.

You can start now. You can improve behavior without having a diagnosis, and the techniques work for the majority of difficult children.

There is reason for HOPE. They have the capacity to do better. With support and treatment, difficult children improve.

Have realistic expectations: They may not be ready for adulthood, and may need extra support into their 20’s… but that’s OK. There’s time to catch up with their peers.

Plan ahead for a crisis, brainstorm options for an effective response and create a checklist. We can’t think clearly in a tension-filled moment.

GOOD Things to do for Your CHILD or TEEN

Pay attention to STRENGTHS not weaknesses. Always find something great about them.

Guide them to their gifts. Give them ample opportunity to do what they are already good at.

GOOD Things to do for YOU

o Be your own cheerleader. Silently think, “I can handle this;” “I’m the one in control.

o Regularly talk through your feelings with others who understand and won’t judge.

o Get a life, maintain personal interests, and set thoughts of the child aside without guilt.

o Commit to doing the best you can, and accept that this enough – plan to let go someday.

You’ve done a good job when they are able to take responsibility for their own care. This is a monumental personal achievement!

KEYS to CALM

In a neutral patient voice, give directions or requests . You will need to repeat yourself, calmly, several times. Your voice should not communicate strong emotions. Tone of voice, not words or volume, is what creates a bad response.

Don’t rush calm. Give the child plenty of time to unwind and settle. Calm is more important than quick.

Ensure there’s a calm place to go – a time-out space, even for you.

Get an appropriate therapy animal – a calm and durable creature unlikely to be harmed.

Reduce chaos in your home: noise, disorder, family emotional upheavals, the intrusive stimulation of an always-on TV, etc.

Ideas for MANAGING resistance

You want your child to be resistant to the negative things they’ll face in life. It represents willpower, and is a strength to cultivate.

o Be quiet and LISTEN. If you respond, address how they feel, not what they say.

o Use reverse psychology-ask them to do something you don’t want them to do, so they can defy you and do the opposite.

o Choose your battles. Let them think they’ve won on occasion.

o For an ODD child, give multiple instructions at once, including things they do and don’t want to do. It becomes too much work to sort out what to defy.

o Actively ignore – Stay in the vicinity but don’t respond, look away, act like you can’t hear. They eventually give up. Works best for ages 2 – 12.

o Mix it up – Be unpredictable. Give a reward sometimes but not all the time. Try new ways to use incentives or set boundaries and structure.

DON’T make these Nine COMMON Parenting MISTAKES

1. Treat your home like a democracy, let your child have an equal say in decisions.

2. Find fault with them and tell them about it repeatedly. If they do something positive, it’s not good enough.

3. Pretend your child has no reason for their behavior. Ignore his or her needs or challenges. Are they being bullied? Are they having a hard time sleeping? Is your home too chaotic?

4. Make rules and only enforce them once in a while, or have consequence come later.

5. Don’t treat your child appropriately for his or her age. Make long explanations to a 3-year-old about your reasoning. Assume a teen wants to be just like you.

6. Expect common sense from children who are too young (5), or from young adults with a long track record of not showing common sense.

7. Keep trying the same things that still don’t work. Repeat yourself, scream, show how frustrated you are with them.

8. Jump to conclusions that demonize the child. “You are manipulative and deceitful,” “You don’t listen to me on purpose,” “I’m tired of your selfishness…”

9. Make your child responsible for your feelings. If you lose your cool, insist they apologize.

Problem SYMPTOMS, not problem children

– Does not show common sense and is not influenced by reason and logic;

– Has no instincts for self-preservation, and poor personal boundaries;

– Has no well-adjusted friends; has friends who are risky or troublesome;

– Doesn’t respond to rewards and consequences;

– Has limited character strengths: honesty, tolerance, respect for others, self-control;

– Does not make plans they can realistically achieve, hangs on to fantasies;

– Acts younger than their peers. Will not be ready for adulthood by 18;

– Lives in the here and now; doesn’t think about the past or future;

– Does not notice their effect on others.

Your PRIORITIES in Order

1. You and your primary relationship(s)

2. Basic needs and responsibilities: housing, clothing, food, income, health

3. Your challenged child or teen.

How parents spend their time when a child has a mental illness. Make the slices equal in size–too much for one, too little for others.
Time spent on all the important things better supports the child and the family they depend on.

 

 

 

 

What to do when they stop listening

What to do when they stop listening

You don’t have to feel this frustrated.

At some point in their development, all kids stop listening. It’s frustrating but normal. There are lots of good advice for getting normal children and teens to listen, or at least follow the rules and directions given by the parent.But it’s different when your child has serious behavioral disorder, and when their behaviors are extreme or outright risky. Your priority may be to prevent destructive behavior and family chaos when they hate you, blame you, or are willing to take extreme risks. Then who cares about the dishes or homework?

First things first, avoid upsetting yourself.

Avoid repeating things over and over, raising your voice, or expressing your frustration. It really matters.  This stresses you as much as it stresses them. Children and teens with disturbances have a hard time tracking, and it may be pointless to expect them to listen. Your child or teen is overwhelmed by brain noise and does not hear even hear you.

But what if they are refusing to listen?  That’s a different issue.  They ARE listening, and they are definitely communicating back to you.  This is resistance and defiance.  (see Managing resistance – tips and advice )

Things to do when they stop listening

Use technology: texting and email.

This mother should be texting her daughter instead

This approach is so simple and so effective that therapists encourage high-conflict parent-teen pairs to communicate exclusively using email and texts, even if the parties are in close proximity, like at home together! Think about this. You are using their chosen medium; you can keep it brief and concise; both you and your child have time to reflect on your response. Your conversation is documented, right there for both of you to track. No one is screaming or repeating themselves.Word of caution
Watch what you write. Don’t use emotionally charged words or tone. Be sure to read texts and emails over and over before sending! “The Journal of Personality and Social Psychology 2006 revealed that studies show e-mail messages are interpreted incorrectly 50% of the time.”

Move somewhere closer or farther, change your body language
Instead of communicating with your voice, use your body. For some children and teens, an arm around their shoulders calms them quickly. Or try standing calmly and quietly. Or put some distance between you and your child’s personal space, even if it means stopping and getting out of the car and taking a short walk. Experiment to see what works for your situation.

Use a third-party
Maybe you are the wrong person to carry the message and settle a tense situation. Don’t be too proud to admit that, for whatever reason, your child will not listen to you no matter how appropriately you modify your approach. So use a substitute or third-party. Is there another person who has a better rapport and can convince your child to complete a chore, do homework, leave little sister alone—a spouse, a grandparent, a teacher or counselor, a therapist? What about a friendly animal, live or stuffed? For young children, you can bring out Kitty and ask her to tell Joey that mommy and daddy only want him to do this one simple chore.

Draw a picture, make a sign

As a young child, I recall my parents hounding me for something, I don’t even remember what.  Then they’d ask, “What do you want me to do, draw a picture?” Well, yes in fact, I understood pictures and they didn’t frighten me as much as my parents yelling at me. Pictures and signs work, put them up where the family can see them (and your troubled child won’t feel singled out).  Maybe a funny comic gets a point across in a non-threatening way.  Some sign ideas: “It’s OK to be Angry, not Mean,” “STOP and THINK,” “Our family values Respect and Kindness,” “This is a smoke-free, drug-free, and a-hole free home.”

Time outs for you
.
Take your own sweet time to calm down and think things through what to say when you’re challenged by your offspring. Consider how you’ll respond to swearing. Put him or her on hold. Don’t return texts or email right away, “I’m busy and I’ll reply in 30 minutes.” Be specific on time, then follow through, or they might learn to blow you off with the same casual phrase, expecting you to forget. 

A Precaution

Watch your tone of voice
From infancy, we are wired to pick up emotions in the voice—it’s literally in our brain.  Your tone is very powerful and can be calming or destructive. Think about asserting strength and caring in your voice without lecturing. Be assertive but forgiving. Be firm and not defensive. Don’t get caught apologizing for upsetting your child or justifying your rules. 90% of parents know the right thing to say, but its common to say it the wrong way.

Is your child bullying you with their behavior?
I’ve observed child verbally bully and abuse their parents. This is not communicating and not negotiable. You have options for standing up to this without making things worse. Temporarily block their email or calls, or ignore and let them go to voicemail. Declare bullying unacceptable. Pull rank and apply a consequence. You cannot let their harassment continue because they will use it on others.
About that mean-spirited voicemail or email.
When you get an ugly message, tell yourself you are hearing from a scared, frightened person, and you’re the one whose feelings they care about the most. See this as a good thing. They are trying to communicate but it’s mangled and inappropriate. You want them to stay in contact and engage with you even if its negative. When a disturbed child stops communicating is when you must worry.  It hurts, but your hurt will pass.  You can handle it.  They will still love you , and some day they will show you.  Be very patient.
If the things they communicate hurt.
It is best that you take your feelings out of the picture and seek other sources of affirmation and support—this can’t come from your child. If they write “I hate you,” maybe they are really saying “you make me mad because you are asking me to do something I can’t handle now.”

Good luck out there,
–Margaret

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Managing defiance: tips and advice

Managing defiance: tips and advice

If you raise a defiant child or teen, this is a most important piece of advice:  take care of yourself, your primary relationships, and the rest of your family. You have a life, and your other children need nurturing.  Schedule regular times for you and the others to relieve tension and do something that takes you out of the home and brings you joy.  The time or expense is worth every bit as much as psychotherapy.

These are typical traits of defiant children.

  • They act younger than they are. Don’t expect them to mature quickly.
  • They live in the here and now, and can’t think about the past or future.  They don’t see how their actions result in a series of consequences.  They can learn sometimes, but only if it is pointed out immediately after an incident.
  • They don’t notice their effect on others.  Sometimes you can ask one of the others how they feel immediately after an incident, or you can gently report how it makes you feel.
  • Their brain is easily overloaded, and they have a hard time with changes.  And yet, you can use this overloading problem to your advantage (more below).
  • They cannot follow your reasoning, so don’t try.
  • Defiance may be a strength in their future. With mature skills, they’ll better resist negative things they’ll face in life.

 

One of the most effective things you can do is control your tone of voice.

Managing defiant children is a balancing act.  If you go too far asserting authority you can draw more resistance, especially if you become emotional.  Your defiant child is very sensitive to a tone of voice that sounds (even a tiny bit) defiant or impatient or angry.

Practice ahead of time

Before you make a request or set a boundary on your child, practice what you will say in advance.  Play the dialogue out in your head—imagine their reaction to your request or rule, and practice that neutral tone of voice.  Remind yourself that you are the authority, and that you are more resolved and persistent than they are.  Your message doesn’t have to be rational or justified.  You may get away with things like, “Because I’m the mommy (or daddy) and I say so”.

Approaches that work

Be a benevolent dictator

Since your home is not a democracy and your child does not run the household, they are not entitled to have all their needs fulfilled or opinions considered.  When they make a demand, thank them for letting you know their opinion, and explain how you will weigh their needs with those of everyone else.  Your child will find your decision completely unfair, but remind yourself that “fair” is not “equal.”   (It’s not desirable to treat everyone and every situation equally.)  Say it’s the best you can do for now.  As their accusations fly, dial back your interest, get busy with something else, and become distracted

Allow some aggression

When it’s appropriate and safe, ask your child to do more of what they’re already doing so that they turn it around and defy you by stopping the behavior. Example: your child refuses to take a direction and throws a book on the floor in anger.

Parent:  “There’s only one book on the floor. Here is another one, now throw this on the floor.”  (Child throws book down.)

“Here’s another one. Throw this down too.”  (Child throws book down.)

“And here’s another book, throw this one down, too.”  (Child becomes frustrated and angry, but stops throwing books in defiance.)

Be a marshmallow

Show no resistance, instead, listen and respond to how they feel, not what they say.  Show them you are open to genuine talk later when the stress dies down.

Teen:  “I hate you, you f- -king b- -ch!”

Parent:  “Sounds like you’re really angry.”

Teen:  “Shut up you stupid wh- -e!  You c – -t!”

Parent:  “Can you tell why me you’re angry so I can do something about it?”

Teen:  “Leave me alone f- -k face!  Stop patronizing me!”

Parent:  “OK, I hear you don’t want me to patronize you, so I won’t.  I feel this is stressful for both of us, so I’d like to take a break and maybe talk about it later.”

Call their bluff

Child:  “I’m going to run away!”

Parent:  “OK, if you do, find a way to call me, and I’ll bring you your stuff and maybe a snack.”  Then walk away.  If they do run and call you, you’ll know where they are.

Reverse psychology

Parent:  “Oh my God, I can’t believe what you’ve done to your hair, that’s horrible!  What are people going to think?  That’s worse than tattoos.  You have to stop this nonsense!”

(One mother used this technique to get her daughter to stop her plans to make a homemade tattoo on her face.  After all, hair grows out, but facial tattoos can be forever.)

Overload their brain circuits

Give your child or teen multiple instructions quickly, and include things they do and don’t want to do.  It becomes too much work for them to sort out what to defy.

Parent:  “Keep up the yelling and close the door on your way out.  And be sure to get louder out there so all the neighbors can hear.  Dinner is at 5:30.”

(What happens?  The door is slammed maybe, but your child is home at 5:30 for dinner.)

Actively ignore

This works best with children 2 through 12.  They try to get a reaction by annoying you or threatening to do something you don’t want them to do.  Stay in the vicinity but don’t respond, look away, and act like you can’t hear them.  Go into another room or outside, for example, and the annoying child will follow you to continue to get your attention with annoying behavior.  If they flip the lights on and off, or ring the doorbell repeatedly, or turn up the volume too loud, maybe you can switch a circuit breaker off and walk away… or if driving, you can pull over, stop the car, and get out and wait.  This article can help with other ideas.  Defying ODD: What it is and ways to manage.

Mix it up

  • Be unpredictable.  Give a reward sometimes but not all the time, and your child will keep trying the good behavior to get the reward.
  • Instead of a consequence, occasionally use bribes to stop a behavior.
  • Allow them to do something they like to do, but within limits of boundaries.
  •  Choose your battles; let your child win unimportant disagreements.
  • Be sneaky on occasion if  (or frankly manipulative) if nothing is working.  For example: suggest you’re considering a very serious consequence that you don’t intend to follow through on.

Have realistic expectations

It’s easy to get stuck in rut—it happens to everyone—but your child is stuck too.  Remember,  it’s not the child’s fault and it’s not your fault.  Your child may not go through life the same as others and may always have problems, but your job is to help them learn from their mistakes the best you can.  This may not happen for many years.  If your child’s condition is serious, they may face serious problems because of their disability, but you’ll know you’ll have honored them, lived your values, and loved unconditionally.

It is heroic to stick it out with your defiant child or teen when you don’t see progress.

Hope

  • They have the ability to do better.
  • With treatment, children improve (e.g. therapy, exercise, medication…).
  • Things usually work out.
  • Help is out there.

–Margaret

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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.


 

Get your power back and reduce your child’s tantrums

Get your power back and reduce your child’s tantrums

If you have lost control of your troubled child and your household (most of us have), you know how hard it is to get things back on track–especially for following house rules. Each time you try to enforce a rule, it’s ignored, or your child throws a huge tantrum that you give in rather than spend more precious energy.  Who wants to invite another backlash?  Who wouldn’t give up and just try to get by and muddle through?

A powerful tantrum is a good thing; it’s evidence that you are regaining authority.

This seems counterintuitive, but the more your child fights back, and the more power they lose and the more you recover your authority. Fighting back harder and harder against rules and boundaries, then having an over-the-top tantrum, is a normal psychological response that psychologists call an “extinction burst.”  It means the original behavior goes extinct so to speak..  We all do this to some degree. It has been measured through behavioral observations of people of all ages and has nothing to do with troubled behavior.  The term “extinction burst” is even used by dog and horse trainers to describe a behavioral change in training. 

It goes like this: parents set a rule and start firmly enforcing it, and one of two things happen: 1) a huge tantrum, or 2) things are OK for a little while, and then tantrums start up again.  If you can hold the line, psychological studies show that when massive tantrums fade, the extinction burst peaks.  They give up their own power and change their behavior.  Look at this diagram:  The vertical scale indicates level of bad behavior.  When a rule is firmly enforced (intervention), the tantrum peaks then it falls off quickly.

If you can stick it out through that huge tantrum, you will see fewer tantrums over time.  It works, but one must be like a rock and have support when The Big One happens. But be prepared, you might need to face several extinction bursts.  Little by little, simple rules will be followed, or they’ll be followed most of the time (you will always be tested).  But by this point, enforcement becomes easier.

Plan for major tantrums ahead of time and recruit help for holding a firm protective wall.

For explosive and aggressive children, it can be scary or dangerous to be on the receiving end because you know about the potential for violence and harm.  Prepare family members and others, and explain how the tantrum will be handled and how everyone will be kept safe.

Rules for house rules:

  1. Few
  2. Fair
  3. Strictly Enforced

Run a tight ship at home, but only have a few hard-and-fast rules, maybe 2 or 3, to save your energy.  Holding fast on enforcement is draining.  Pick the rules carefully because they need to make sense and feel fair to everyone, and they need to be about safety and family wellbeing, examples: we will eat every dinner together as a family; curfew is 8 pm; if there is any outburst, the person must stay in their room for 15 minutes…

You may be surprised how relieved everyone will be after living through chaos for so long!  They will be thankful someone is finally in charge instead of the troubled child.  When I put on my armor and set about getting my power back, it was exhausting and very stressful, but consistent order brought a sense of security and safety. Use common sense and be flexible, set aside some rules temporarily if your child is in crisis or the family is too stressed at the moment.  Be very strict on only a few critical things, for example:  have zero tolerance for violence against others and alcohol and drug use.

You earn more respect when you are in control and better protect everyone’s peace of mind. 

You are the king or queen of your home, it is not a democracy.  Make reasonable and fair rules, enforce the rules with an iron hand at first, and then relax bit by bit, and live in a peaceable kingdom (with problems you can handle).

 –Margaret
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When parents disagree on discipline

When parents disagree on discipline

Your primary relationship comes first

Stress can affect the most solid relationships. Families like yours, with a troubled child, have a higher divorce rate than the general population, 50% higher. Coping with your child will bring out any and all relationship issues that may have been manageable under normal circumstances. If your relationship is falling apart, and it was mostly healthy before this period of stress, then it must be a priority over the child for now. Get counseling, if not together than singly. Or ask for help from supportive friends–prayers, cheerleading, or the opportunity to vent. Partners must stand by each other and present a solid front as the family leaders. This is just as important for your child as it is for you. Let this draw you closer together rather than pull you apart.

The most common situation I’ve seen is men emphasizing discipline and women emphasizing protection–neither is wrong.

This must be worked out and balanced.  Your mission must be identical and your goals must be balanced.  Sometimes the child needs discipline, and sometimes they need protection and nurturing.  Discipline need not be uncaring or harmful, and protectiveness need not be enabling.  While your grapple with this ongoing polarity, here’s a good way to manage in the mean time.

  • Stand strong, shoulder-to-shoulder
    If you strongly disagree, then together make a list of the things you agree on and worry about the disagreements later. This list should include:
  • List each parent’s strong points, so you can remember what attracted you in the first place, and strengthen your bond and respect.
  • Never ever argue in front of children, and make a rule for how and where to argue.  Observing parents arguing creates problems that worsen your child’s behavior.  Stress is an obvious result.  But what about kids who manipulate their parents in order to get their way with something?  Parents can be played against each other!  This happened to me and it damaged my relationship with my children’s father for years (yes, we divorced too).  Don’t let this happen to you.
  • An agreed-upon role for each parent, which is something that they’re good at.  If one parent is competent at handling a specific challenge, the other steps back, and vice versa.
  • Take turns managing the household for a period while the other takes a break.
  • Set aside personal feelings temporarily to co-manage one specific little problem at a time, a problem you both agree on.

Have each other’s back

A true story with names changed:

Susan and her daughter Pam were constantly fighting over who hurt who the most by what each said. Jason, husband and father, was frustrated and angry by these conflicts, but avoided interfering because he knew he’d upset both his wife and daughter. Yet Jason was always able to calm Pam down quickly because their relationship was different. One day, Jason took his wife aside and suggested they try something. He suggested that Susan step back from certain daily interactions with Pam, those which always ended in fights, and let him do the communicating. Susan did not like the idea that Pam had “won” by getting all of her dad’s attention, nor did she like the implication she couldn’t handle their daughter! But Jason came up with the idea that if he saw Susan and Pam slipping into a fight, he would use a code phrase, like “Hey dear, can you help me find the _____?”, and Susan would catch herself, save face by stepping out to look for the ____, and let Dad take over. This worked wonders rather quickly. Nothing was ever discussed openly, but after a few weeks, both mother and daughter started to catch themselves starting a fight, and one or both would find some reason to step away from the situation.

–Margaret

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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.
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