Category: parenting

Brace yourself for borderlines

Brace yourself for borderlines

Borderline personality disorder is “All Of The Above”:  lovely and creative; manipulative and vindictive; tortured and anguished; glowing with energy and joy; self-hating, self-centered, perceptive and gifted, a victim… Without warning, a person can switch from one presentation to another.

Are you ready to bang your head on a wall?  Do you want to abandon your child in the wilderness?  Are you praying for the day they turn 18, when you can change the locks on your doors?  Children with borderline personality disorder (BPD) bring out the worst in everyone around them.

A borderline child or teen is not a “drama junkie” on purpose.  There brain is primed to overreact.

Yes, BPD kids really believe that others are out to get them, and that all their problems are someone else’s fault.  They are appalled that others mistreat them horribly.  They are insulted and defensive when they detect criticism, even when there isn’t any.  They can never be pleased, and it’s always about them.  Most exasperating for you, they turn from monstrous, to sweet and charming, and back to monstrous in an instant.

“Does this explain why I can go from 0 to 60 in two seconds?”
–17-year-old girl when told she was diagnosed with borderline personality disorder

Especially confusing, a borderline teen can be very engaging and affectionate… sometimes at random, and sometimes when they want something.  They will also turn on the charm in a way to to embarrass you in front of others (e.g. family therapy.  Since they seem so wonderful to other people, you are asked why you get upset at your clearly wonderful child.  People often recommend that you take care of your own issues instead.

Even though their manipulation and upheaval is relentless, strive for compassion.  Trust me, your borderline child will suffer more than you in every important aspect of life.  They make a mess of their relationships because of their anger, instability, substance abuse.  Their clingy behavior is annoying.  They drive away good friends, hate them for leaving, and then suffer from loneliness and depression.  They make a mess of their jobs, often fired or forced to resign, and then bounce from one job to another… and they don’t understand why it happens to them.

When playing a game that requires teamwork, the brain of a normal person shows activity in the bilateral anterior insula.

For goodness sakes, why?

A study published in 2008 in Science showed that brain activity in people with borderline personality disorder was abnormal—their brains lack activity in the ‘cooperation’ and ‘trust’ regions, called the bilateral anterior insula.  Borderline personality patients do not have an internal, natural sense of fairness and social norms, and little to no level of trust.  Some suggest that borderlines do not receive the attention they need as an infant and toddler.  Early neglect is also a predictor of reactive attachment disorder, which has similar trust issues.

When playing the teamwork game, the brain of a borderline person showed no activity whatsoever.

Statistics

Another research study reported that borderline personality disorder occurs as often in men and women, and sufferers often also have other mental illnesses or substance abuse problems.  (In my personal observations over many years, teenagers with borderline personality disorder are often diagnosed with bipolar disorder.) Another study reported, “The disorder occurs in all races, is prevalent in females (female-to-male ratios as high as 4:1), and typically presents by late adolescence.”  It is estimated 1.4 percent of adults in the United States have this disorder.

In infants:  the children who were later diagnosed with borderline personality were more sensitive, had excessive separation anxiety and were moodier. They had social delays in preschool and many more interpersonal issues in grade school, such as fewer friends and more conflicts with peers and authorities.

As teenagers, borderline children can jump between any behavior: extremely manipulative; more promiscuous; aggressive and impulsive; more likely to use drugs and alcohol; assaultive; and more likely to cut and attempt suicide.  “…research shows that, by their 20’s, people with the disorder are almost five times more likely to be hospitalized for suicidal behavior compared to people with major depression.”

Evidence for hope

Trying to Weather the Storm
Shari Roan, September 07, 2009, Los Angeles Times

“Borderlines have the thinnest skin, the shortest fuses and take the hardest knocks.  In psychiatrists’ offices, they have long been viewed as among the most challenging patients to treat.

“But almost 20 years after the designation of borderline personality disorder, understanding and hope have surfaced for people with the condition and their families.  Advances have been made in recent years.  Researchers from McLean Hospital in Massachusetts studied 290 hospitalized patients with the condition over a 10 year period:  93 percent of patients achieved a remission of symptoms lasting at least two years, and 86 percent for at least four years. Published in The American Journal of Psychiatry, the research argues that once recovery has been attained, it appears to last.

“Having a relative with BPD can be hell,” says Perry D. Hoffman, president of the National Education Alliance for BPD http://www.borderlinepersonalitydisorder.com.  “But our message to families is to please stay the course with your (child) because it’s crucial to their well-being.”

Treatment

“What Therapy Is Recommended for Borderline Personality Disorder in Adolescents (13-17 years)?”(excerpt)
Mary E. Muscari, PhD, August 9, 2005, http://www.medscape.com/viewarticle/508832

Psychotherapy is the primary treatment of BPD, specifically long-term dialectical behavior therapy (DBT), which helps the person attain and maintain lasting improvement in their personality, interpersonal problems, and overall functioning.  DBT appears to be the most effective.  It focuses on coping skills, so patients learn to better control their emotions and behaviors. This may be complemented with medications that help with mood stability, impulsivity, psychotic-like symptoms, and self-destructive behavior.

There are several appropriate therapies in addition to DBT, and all share common elements:  1. The bond between the patient and therapist is strong.  2. Therapy focuses on the present rather than the past, on changing one’s behavior patterns now regardless of how patients feel about the past or if they see themselves as victims.

On DBT:  I recommend this straightforward self-help lesson to get started learning the concepts and skills:  http://www.dbtselfhelp.com/html/dbt_lessons.html.

When to hospitalize

  • In an emergency – when your child has serious suicidal thoughts or an attempt, and/or is in imminent danger to others.
  • In long-term residential care – when your child has persistent suicidal thoughts, is unable to participate in therapy, has a co-morbid (co-existing) mental disorder (e.g. bipolar, depression, narcissistic personality disorder), risk of violent behavior, and other severe symptoms that interfere with living.

Other treatment a borderline may need:

  • Treatment for substance abuse.
  • Therapy that focuses on violent and antisocial behaviors, which can include emotional abuse or physical abuse, baiting, bullying, and sexualized behaviors.
  • Therapy that focuses on trauma and post traumatic issues when an adolescent loses their sense of reality.
  • Reduce stressors in the young person’s environment.  Most adolescents with BPD are very sensitive to difficult circumstances, for examples: an emotionally stressful atmosphere at home; teasing in school; pressures to succeed or change; consistent rules; being around others who are doing better than them, etc.

What parents and caregivers can do

With a partner or spouse:  Maintain a united front.  Communicate continually to stay on the same page when managing your child and setting limits.  Have each other’s back even if you’re not in full agreement.  Always take disagreements out of earshot of your child.  Any disagreement they hear will be used against you.

Maintain family balance.

Keep things relaxed.  If you need to set boundaries and apply pressure, do it only to maintain  appropriate behaviors and reminders for self-calming.  Let other things go.

Use praise proactively.  Borderlines crave attention and praise.  When they deserve it, pour it on thick.  And pour it on thick every single time they demonstrate good behavior and positive intention.  One can’t go too far.  When an argument or fight comes up, search your memory banks for the most recent praiseworthy thing they did or said, and bring it up and again express your gratitude and admiration.  This does two things:  it reinforces the positive;  and it redirects and ends a negative situation.

Become skilled in DBT and help your child stay in the here and now.  Keep up the reminders that enable them to stay in the moment, to take those extra few seconds to think things through before reacting.

  • Did your friend really intend to upset you?  It sounds like they were talking about something else.
  • The delay wasn’t planned just to make you mad, perhaps you were just frustrated by being asked to wait, and it was no one’s fault.
  • The tear in your jacket isn’t a catastrophe.  It is easily fixed and I can show you how.

Prevent dangerous risk taking – Teens with borderline personality are exceptionally impulsive and prone to risky behavior.  Consequently, parents should consider:

  • Tightly limiting cell phone use, email, texting, and access to social networking sites
  • Using technology to track their communications (this is legal), or disabling access during certain time periods
  • Reducing the amount of money and free time available
  • Searching their room (this is also legal)

A couple I know fully informed their borderline teen that all internet activity would be tracked, as well as cell phone calls.  The father also installed cameras in the home, at the front and back doors, in plain sight.  Nevertheless, his son continued with bullying and hurtful behavior towards siblings right in front of those cameras, and he would get caught and pay consequences repeatedly.  His persistence in the face of obvious monitoring became a great source of private amusement for his parents–humor really does provide relief.
–Margaret

Be patient – You are unlikely to receive the child’s respect, love, or thanks in the short-term.  It may take years.  But be reassured that your child will thank you for your firm guidance and limits once he or she matures to adulthood.

Other characteristics of BPD

Good things:  They can be very financially and publicly successful in many different fields, especially in the creative arts, and especially acting.  They are so perceptive that they can ‘channel’ any character they want.  They can be enchanting, and alluring, easily attracting devoted fans, friends, and lovers.

Bad things:  Signs and symptoms of BPD may include significant fear of real or imagined abandonment; intense and unstable relationships that vacillate between extreme idealization and devaluation; markedly and persistently unstable self-image; significant and potentially self-damaging impulsivity (spending, sex, binge eating, gambling, substance abuse, and reckless driving); repeated suicidal behavior, gestures, or threats; self-mutilation (carving, burning, cutting, branding, picking and pulling at skin and hair, biting, and excessive tattooing and body piercing); persistent feelings of emptiness; inappropriate anger or trouble controlling anger; and temporary, stress-related severe dissociative symptoms or paranoid ideation.

  • Chronic depression: Depression results from ongoing feelings of abandonment.
  • Inability to be alone: Chronic fear of abandonment also leads to these adolescents having little tolerance for being alone. This results in a constant search for companionship, no matter how unsatisfying.
  • Clinging and distancing: Relationships tend to be disruptive due to the adolescents’ alternating clinging and distancing behaviors. When clinging, they may exhibit dependent, helpless, childlike behaviors. They over idealize he person they want to spend all their time with, constantly seeking that person out for reassurance. When they cannot be with their chosen person, they exhibit acting-out behaviors, such as temper tantrums and self-mutilation. Distancing is characterized by anger, hostility, and devaluation, usually arising from discomfort with closeness.
  • Splitting: Splitting arises from the adolescents’ inability to achieve object constancy and is the primary defense mechanism in BPD. They view all people, including themselves, as either all good or all bad.
  • Manipulation: Separation fears are so intense that these adolescents become masters of manipulation. They will do just about anything to achieve relief from their separation anxiety, but their most common ploy is to play one individual against another.
  • Self-destructive behaviors: The behaviors are typically manipulative gestures, but some acts can prove fatal. Suicide attempts are not uncommon yet usually happen in relatively safe scenarios, such as swallowing pills at home while reporting the deed to another person on the telephone.
  • Impulsivity: Poor impulse control can lead to substance abuse, binge eating, reckless driving, sexual promiscuity, excessive spending, or gambling. These behaviors can occur in response to real or perceived abandonment.

Drawn from:
Risk taking adolescents: When and how to intervene (excerpt)
David Husted, MD, Nathan Shapira, MD, PhD , 2004
University of Florida College of Medicine, Gainesville

–Margaret

Life at home is a war zone

Life at home is a war zone

Homes with troubled children are war zones–very different from those with physically-disabled kids.   We can’t make things better for our child with wheelchairs or ramps or other specialized equipment.  We need serious fire power.  This story tells what it’s like to live with our child, seek mental health treatment, and find social and emotional support for ourselves.  It is inspired by, and much quoted from, Emily Perl Kingsley’s “Welcome to Holland,” about having with a son with cerebral palsy.  The original is at the end of this article.

Welcome to the War Zone

I try hard, often unsuccessfully, to describe the experience of raising a child with a brain disorder – to try to help people who have not shared that difficult experience to understand it, to imagine how it would feel.  It’s like this… When you’re going to have a baby, it’s like planning a fabulous vacation trip – to Italy.  You buy a bunch of guide books and make your wonderful plans.  The Coliseum, the Michelangelo David, the gondolas in Venice.  You may learn some handy phrases in Italian.  It’s all very exciting.  After months of eager anticipation, the day finally arrives.  You pack your bags and off you go.

Several hours later, the plane lands.  The stewardess comes in and says, “Welcome to Afghanistan.”  “Afghanistan?!?” you say.  “What do you mean Afghanistan??  I signed up for Italy!  I’m supposed to be in Italy.  All my life I’ve dreamed of going to Italy.”  But there’s been a change in the flight plan.  They’ve landed in Afghanistan and there you must stay.

They’ve taken you to a dangerous unstable place full of fear.  You have no way to leave, so you ask for help, and citizens offer to help but you must pay in cash.  Instead of help, they lead you down one blind alley after another.  You are afraid because you are different, you are a target because you stand out.  After spending most of your cash, you can’t ignore it any more–you are in very serious trouble–completely alone in a strange country, surrounded by people who don’t like you.  You won’t be rescued.  You can only think about hiding and praying and holding yourself together.

After a few years of ‘round-the-clock stress and isolation, you make a couple of connections, and arrange an escape across the border.  There are dangers in the next country, but your connections help.  Your escape seems to take forever, yet you finally make it home!  But everyone you know has been busy coming and going to Italy… and they’re all bragging about what a wonderful time they had there. And for the rest of your life, you will say “Yes, that’s where I was supposed to go. That’s what I had planned.” And the pain of that will never, ever,  go away… because the loss of that dream is a very, very significant loss.  But… if you spend your life mourning the fact that you didn’t get to Italy, you may never feel the fulfillment of using your character-building experience to help others escape Afghanistan.

Margaret

– – – – –

“Welcome to Holland” by Emily Perl Kingsley – http://ourlifeinholland.blogspot.com

“I am often asked to describe the experience of raising a child with a disability – to try to help people who have not shared that unique experience to understand it, to imagine how it would feel. It’s like this….When you’re going to have a baby, it’s like planning a fabulous vacation trip – to Italy. You buy a bunch of guide books and make your wonderful plans. The Coliseum. The Michelangelo David. The gondolas in Venice. You may learn some handy phrases in Italian. It’s all very exciting. After months of eager anticipation, the day finally arrives. You pack your bags and off you go. Several hours later, the plane lands. The stewardess comes in and says, “Welcome to Holland.” “Holland?!?” you say. “What do you mean Holland?? I signed up for Italy! I’m supposed to be in Italy. All my life I’ve dreamed of going to Italy.” But there’s been a change in the flight plan. They’ve landed in Holland and there you must stay. The important thing is that they haven’t taken you to a horrible, disgusting, filthy place, full of pestilence, famine and disease. It’s just a different place. So you must go out and buy new guide books. And you must learn a whole new language. And you will meet a whole new group of people you would never have met. It’s just a different place. It’s slower-paced than Italy, less flashy than Italy. But after you’ve been there for a while and you catch your breath, you look around…. and you begin to notice that Holland has windmills….and Holland has tulips. Holland even has Rembrandts. But everyone you know is busy coming and going from Italy… and they’re all bragging about what a wonderful time they had there. And for the rest of your life, you will say “Yes, that’s where I was supposed to go. That’s what I had planned.” And the pain of that will never, ever, ever, ever go away… because the loss of that dream is a very very significant loss. But… if you spend your life mourning the fact that you didn’t get to Italy, you may never be free to enjoy the very special, the very lovely things … about Holland.”

The Holland story has been used widely by organizations such as NAMI (National Alliance of Mental Illness), as a way to help parents with troubled kids accept their situation when their child is identified as having a brain disorder.  Holland just seems too nice, too peaceful, to relate to our situations.

Naturopathic and holistic mental health treatment

Naturopathic and holistic mental health treatment

This guest article is by a naturopathic physician in Portland, Oregon USA, who specializes in mental health treatment for children and adults.  Following is a summary and link of a podcast about the use of holistic/alternative medicine for the treatment of ADHD.

 

Addressing Mental Health Issues From a Holistic Perspective
Krista Tricarico, ND.  www.openmindmedicine.com

Holistic treatment

The health of the mind and body are intricately linked. Just as our thoughts strongly influence our physical health, our individual physiology affects our mental and emotional well-being. The foods we eat, our digestive health, the toxins in our environments, our hormones, lifestyles, experiences, beliefs and attitudes all play important roles in our physiology and biochemical make-up. As a philosophy, holistic mental health recognizes this beautiful web of interdependency.

Holistic approaches for adults and children can be used in conjunction with psychiatric medication, but unlike pharmaceuticals, holistic mental health treatments usually have the “side effect” of improved physical health and a richer emotional experience. Rather than suppressing or covering up symptoms with a drug, the goal of treatment is to address underlying causes and work towards integration and balance.

As a naturopathic physician, my goal is to support the wisdom of the body and mind and facilitate an individual’s inherent ability to heal. Naturopathic Doctors (ND’s) are licensed primary care physicians who have attended a four-year, postgraduate-level naturopathic medical school and are clinically trained in the art and science of natural therapies. In addition to conventional diagnosis, laboratory testing and pharmaceutical medications, the scope of naturopathic medicine includes nutrition, counseling, homeopathy, botanical medicine, physical therapies, and mind-body approaches. Naturopathic training does encompass the same basic bio-medical sciences as conventional medical training, but the approach to health and disease differs considerably. It is the philosophy of naturopathy that clearly differentiates this medicine and directs how we approach each patient.

Treatments

This will look different for each person and will be guided by conversation and individual interests as well as physical exam and laboratory analysis when appropriate. I have found the following therapies to be key factors in mental health recovery.

Counseling

Some patients see me primarily for counseling, and people with this focus are welcomed. Others are either interested in a blend of counseling and naturopathic approaches or seek care strictly for holistic medical support. A young person’s treatment needs and interests also change over time, so I meet a patient where they are at this moment. My counseling approach has a strong emphasis on self-awareness and mindfulness. Self-observation coupled with an attitude of curiosity, openness and acceptance allows for conscious insight and more freedom in the responses to the stresses and challenges a young person faces daily. Mindfulness-based therapies are a particularly effective approach for depression, anxiety and addiction issues, and can lead to increased clarity and a sense of contentment.

Nutritional Therapies

The foods we eat have a direct impact on the chemistry of our bodies and brains and, therefore, on our mood, thoughts and behavior. Our brains require the correct balance of amino acids, fats, vitamins, minerals and glucose in order to function properly, and individual needs can vary drastically. I work with all patients, children and adults, to uncover their unique nutritional needs through history-taking, diet analysis and lab testing, and then help individuals address underlying biochemical imbalances through shifts in their diet and nutritional supplements. Food allergies or sensitivities can play a significant role in mental health, as well, and the removal of these foods from the diet can have a profound impact on one’s healing. Orthomolecular psychiatry is a field of medicine that has applied these nutrition-based therapies in the treatment of conditions such as schizophrenia, bipolar disorder, anxiety and depression and has helped shape my naturopathic practice.

For more information about orthomolecular medicine, visit www.orthomolecular.org.
For more information about food allergy testing, visit www.usbiotek.com.

Homeopathy

Homeopathy is a gentle yet powerful system of healing based on the principle of “like cures like.” People have observed since ancient times that a substance that causes an illness or symptom can, in very small doses, cure the same problem by stimulating the body’s intrinsic healing ability. Through an in-depth interview, I strive to understand a child’s unique physical, mental and emotional experiences and, after careful study, select the appropriate remedy. Homeopathy offers a safe and elegant treatment that is a natural complement to counseling and can be used alongside conventional medications and other naturopathic treatments. As a truly holistic and individualized form of medicine, it is particularly well-suited to psychological and psychiatric concerns. Although identifying the effective remedy can sometimes require patience and perseverance, the results of successful homeopathic treatment are profound and long-lasting.

Restoring Digestive Health

Many mental and emotional concerns have their origins in the gut. It is important to identify and treat conditions such as hypochlorhydria (low stomach acid), candida overgrowth, gut dysbiosis (a bacterial imbalance in our digestive tracts), parasites, inflammation, leaky gut (increased permeability of the intestinal wall), and food allergies as they have direct effects on brain function. Imbalances in the gut play a significant role in many neuropsychological conditions. Conversely, our emotions strongly influence our appetite and digestion. The nervous system and the digestive system are intricately linked by a constant exchange of chemical and electrical messages including nutrients and neurotransmitters. Anything that affects one realm is likely to affect the other, and I have found that addressing gastrointestinal health is often foundational in one’s mental health recovery.

Blood Sugar Balancing

The sugar in our blood is called glucose, and this is the primary fuel for our bodies. Being one of the most sensitive and demanding organs, our brains require a constant supply of this glucose to perform its never-ending functions. A healthy body is able to regulate the blood sugar to provide a consistent energy source for the brain; unfortunately, this function is commonly impaired. Hypoglycemia is a condition in which the body can’t sustain constant glucose levels and can be a causative factor in attention and behavior issues, anxiety, panic attacks, rapid-cycling bipolar disorder, insomnia and addiction. Elevated blood sugar over time not only leads to diabetes, heart disease and obesity but also mood and behavior disturbances, decreased mental functioning and dementia. Many psychiatric medications put people at additional risk for blood sugar problems only exacerbating this problem. Balancing your blood sugar is an important component of disease prevention and general health and will also support your mood, energy, metabolism and mental functioning.

Amino Acid Therapy

Supplementation with amino acids can help optimize neurotransmitter levels. Amino acids are the building blocks of proteins that our bodies transform into neurotransmitters such as serotonin, melatonin, GABA, dopamine, epinephrine and norepinephrine. These are the messenger molecules that allow our nerve cells to communicate and have a direct impact on our mood, learning, attention, pain and pleasure perception, sleep, energy, and thought processes. Most psychiatric drugs manipulate our body’s ability to process these neurotransmitters in an attempt to alter the levels of these important chemicals. Instead of, or in conjunction with, antidepressants or anti-anxiety medications, we can give the body the amino acids it needs to make more neurotransmitters and avoid the negative side effects of the drugs. Neurotransmitter testing is available and can help guide the treatments. Targeted amino acid therapy is a powerful tool for addressing a wide variety of mental health concerns and provides a safe and effective alternative to these medications.

For more information on amino acid therapy, visit www.neuroassist.com.

Balancing Hormones

Our hormones are produced and controlled by our endocrine glands and include chemical messengers such as thyroid hormone, cortisol from the adrenals, insulin from the pancreas, and estrogen, progesterone and testosterone from the reproductive organs. As parents of adolescents who are entering puberty know, hormonal change has a profound effect on behavior. Imbalances or disturbances in any of these interconnected systems can alter the way our brain functions. For example, thyroid dysfunction is an often-overlooked, underlying cause of depression, anxiety, poor memory and fatigue, and PMS is a well-recognized cause of mood swings, depression, anxiety and sleep disturbances. Helping the body regain its delicate hormonal balance can have far-reaching effects for the mind.

Detoxification / Heavy Metal Chelation

We are exposed to an extraordinary amount of toxins through our food supply, the air we breath, and even our tap water. Toxic exposures affect the health of our brains. When the body encounters more toxins than it can effectively process, it stores these chemicals in fat cells, and our brains are largely made up of fat. Some people are good detoxifiers. Others with autism, ADHD, Alzheimer’s, Parkinson’s, depression, chronic fatigue, schizophrenia and bipolar disorder are often not. Supporting detoxification and the safe elimination of toxins can be a key component to mental health recovery. I assist patients with appropriate detoxification strategies whether that is a gentle cleanse, a more intensive detox protocol or heavy metal chelation.

Mind / Body Treatments

Mind/body treatments engage the power of your mind in your own process of healing. I use therapies such as breath work, meditation, memory reintegration, relaxation strategies, and Emotional Freedom Technique (www.emofree.com) to help patients move towards a state of awareness and peace. Reflecting on and connecting with one’s own spirituality can also be an effective stress-management tool. Learning to consciously calm the mind and relax the body has a powerful effect on our neurotransmitters, hormones and immune system, and ultimately our health and sense of well-being.

Dr. Krista, www.openmindmedicine.com


Foods that support brain and mental health

  • Avocado
  • Walnuts, almonds, other nuts and seeds
  • Salmon, tuna, sardines, mackerel, herring, trout
  • Ground flaxseed
  • Brightly colored fruits and vegetables – eat the rainbow
  • 70% cacao and higher dark chocolate
  • Green tea (stone ground from whole tea leaves)
  • Berries:  acai, blueberry, cranberry, blackberry

 

Herbs and other alternatives that support brain and mental health

  • Fish, cod liver or krill oil (if you could only have one thing, this would be it)
  • L-theanine or kava kava for calming and reducing anxiety
  • Turmeric, curry and other antioxidants
  • B-complex vitamins
  • Magnesium
  • Light therapy, for improved mood and energy

 

Substances that are bad for brain health

  • Alcohol
  • Artificial food coloring
  • Artificial sweeteners
  • Sugars: cane sugar, soft drinks, corn syrup
  • Hydrogenated/partially hydrogenated fats and trans fats (fried foods). Saturated fats are fine, it’s the hydrogenated and trans fats that are bad.  I actually highly recommend organic coconut oil
  • Nicotine, THC, all other controlled substances

 


Integrative Management of ADHD – What the Evidence Suggests
By Richard Balon, MD | January 6, 2011

The use of complementary and alternative medicine treatments by children and adults with ADHD is the rule rather than the exception…more than half of parents who have children with ADHD treat their child’s symptoms with vitamins, dietary changes, and expressive therapies—but only a small minority tell their doctor. And roughly 8 out of 10 patients who use these treatments regard them as their primary therapy.

On child psychiatry and stigma

On child psychiatry and stigma

When parents complain about psychiatrists, it’s often because the psychiatrist treats them as being the cause for child’s problems.  Doctors often do not understand what life is like in the family’s home, and how impossible it is to follow through on their recommendations.  Interestingly, psychiatrists who themselves have a troubled child are keenly aware of the challenges.  In fact, they too can go crazy with grief, and guilt, and a sense of failure… just like parents who aren’t medical doctors.  A doctor’s negative attitude towards parents has huge emotional consequences for them.  If parents aren’t listened to, or if they are talked down to, it adds a load to their emotional baggage and is debilitating.  It weakens their capacity for caring for their incredibly stressful child, and for themselves.  To be fair, the medical field has lots of practitioners who aren’t helpful or people-friendly.  What’s different about psychiatry is that The Rest Of The World stigmatizes anything related to mental health or brain health… it’s as if brains are always healthy, and if someone has a behavior problem it’s their fault.  Many also think mental health treatment itself is sinister and evil, and that psychiatrists and psychologists themselves are provide fake or harmful treatments to unsuspecting people.

Our Own Worst Enemies
Nada Logan Stotland, MD, MPH

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

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

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

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

This public attitude must change.   It victimizes the victims who live with mental disorders, and the confrontations and insinuations families experience is emotionally debilitating.   Mental health treatments are no more barbaric than those of other medical illnesses, but the stigma unique to mental health manifests itself in blame, prejudice, and the cruel insensitive comments of others.  Let the public dialogue discuss improving lives instead of finding fault with doctors, sufferers, and their families.

–Margaret

What to do about screaming teenagers

What to do about screaming teenagers

When their screaming starts, you brace yourself.  You armor your gut to protect it from the verbal pummeling.  Their cruel words pierce your heart.  When it’s over, you want to strangle them or abandon them in a wilderness.  In his  play, King Lear, William Shakespeare wrote, “How sharper than a serpent’s tooth it is to have a thankless child!”  That was 500 years ago and little has changed.

BUT THIS WILL PASS.  Your teen will quiet down and apologize someday… it may take a few years, but someday.  Until that bright day, remember that you’re tough enough to take it, and tough enough to persevere in the face of high drama and lots of noise.  You are not failing as a parent, but proving you care enough to be a good parent.  Paradoxically, your screamer appreciates your engagement because it’s reassuring to them.  Screaming teens are horribly insecure, and need you to prove you care for them.  This isn’t rational, or fair, but don’t take the screaming personally.  And don’t take it seriously unless the behavior is new or out-of-character, or unless your screamer makes threats of harm.

Difficult teenagers are inconsistent, irrational, insensitive to others, self-centered, childish and…  should I go on?  It may have nothing to do with a disorder per se.   Screaming teens are as normal as screaming babies.  Regard their screaming as you would a toddler temper tantrum.  It is a phase that most teens grow out of unless something else is holding them back.

The way to handle a screaming teenager is to handle yourself first, because you are the king or queen, holder of all power in the parent-child relationship, and you must use your power wisely.  Don’t scream back. Don’t reward screaming by losing your cool. Don’t get hooked.

When the screaming starts, do a personal check-in on your thoughts and feelings

How am I doing?
I am handling it.  This isn’t as serious as it seems.  It’ll be over in less than 10 minutes.

How am I feeling?
I choose how to feel and I won’t let this bother me.  I will rise to the occasion and come out stronger.

What are my options?
I will be persistent until I regain power over our household.  I will live within my values.  I will take care of myself when it becomes stressful.

Keep your expectations realistic

  • You don’t need to be in total control, just one step ahead of your teen.
  • Be prepared for screaming to worsen before it gets better.
  • If you get an apology, accept it, even a weak apology.
  • Don’t expect to hear that they love you, or that they appreciate what you’ve done for them.
  • They will not give you credit for being the good parent you are, yet.

Two simple demands:
1. lower the volume,
2. clean up the language.

Set the boundary on the loudness of screaming and the use of mean-spirited, foul language.  Remind your teen that it’s OK to be angry; it’s not OK to assault with screaming and ugliness.  Give them an example of what you’d rather hear, for example:  “You are not being fair to me;”  or “Don’t say that about my friends…”

If they can’t communicate themselves in a straightforward non-screaming manner, then restate what you think they mean, using different words so they know you got their message: “You think I’m being unfair to you,”  “You don’t like me criticizing your friends.”  Ask them if you are correct.  Make it clear you got the message even if you disagree with them.  It becomes awkward to scream once you’ve shown you heard them.  It will take them off guard as they think of some other thing  to be upset at you about.

Until a teen can manage basic communication with you, they are not ready to discuss the substance of their complaint.  Make a sincere effort to look deeper and try to understand what’s bothering them.  You will often get this horribly wrong and upset your teen immeasurably, but they will realize on some level that you are aware of  their deep pain and seething rage… and feel more secure.

This mother should be texting her daughter instead

Use technology and avoid screaming altogether.   Get on your cell phone and text your child, or use email.  This works surprisingly well because you’ve entered their virtual world where they feel safe from your presence, and have time to contemplate and cool off.  Writing/texting is slower, and that’s the point.  Therapists often direct feuding parents and children to communicate only by email for a while.

Listen to what they need and feel, not to what they say.

Most teens have similar needs: to feel heard, to be loved, to make one’s own choices.  Take these away and you have an angry screaming teenager.  But teens also struggle with emotional distress:  family instability, problem with a love interest, or something else they don’t want to share with you because they’re afraid of how you’ll react.  Teenage years are emotional hell, remember?  Ugly rumors on social sites, bullying, grade worries, frets over appearances… would you want to go through your teens again?  Does the thought make you want to scream?

A teenager may be a screamer because of genuine physical discomforts.  Physical things make people irritable, and teens more so:  lack of sleep, dehydration, lack of exercise; excessive sugar and fat; constipation; the monthly period.  A change in the length of daylight affects mood, whether going into the spring or into the fall.  Don’t forget to assess the home environment.  Has there been a significant change in family life?  a traumatic event?  Always consider drug and alcohol use.  If their behavior is unusually or uncharacteristically aggressive or violent, or if it’s changed for the worst recently, get a urinalysis and look for methamphetamine or marijuana. UA kits are available at drug stores or online.  Go through a  medical diagnostic checklist when the misbehavior starts.  Sometimes a few glasses of water is all your teen needs to become human again.  Have a glass yourself.

What if you, the screamee, are the problem?  Are you too strict?  lenient?  picky?  Do you nag without realizing it?  You might be the one who needs to change.  If so, admit when you’re wrong and be the first to apologize and set the good example.  My first apology to a recalcitrant child was awkward and defensive, but I had to swallow my pride and apologize for something I said.  Over time, it got easier, and apologies happened normally and easily in the family.

Self care, find a way to let yourself down easy

Leave people and chores behind for a while, go scream in a pillow, and pull yourself together.  Talk to someone who can listen or provide a point of view that’s helpful.  Set aside a dollar after every screaming fit, and treat yourself to something special later.  Let your screamer know that you’re looking forward to their next screaming episode so you can save more and get something nice.

Humor heals

Don’t forget to laugh.  Any parent who’s survived the teenage years will understand that we all need a sense of humor.  It may be a little twisted, but I find these bumper stickers funny.

“Mothers of teenagers know why some animals eat their young.”

“Grandchildren are God’s reward for not killing your own children.”

“Few things are more satisfying than seeing your children have teenagers of their own.”

 

Do you like this article?  Please rate it at the top, thanks!

–Margaret

Life with a schizoaffective teen

Life with a schizoaffective teen

I have first-hand experience raising a child with schizoaffective disorder.  Up until my child’s onset of the disorder in the ‘tweens’, I never thought I had much patience or backbone.   But one’s character strengthens with trials, and I learned I was patient and stronger inside than I thought.  Parenting my child entirely changed my life’s direction.

Farther down this post are practical tips and advice for raising your child.

My Story:  Schizoaffective teens have both schizophrenic symptoms (thoughts disconnected from reality) and affective symptoms (unstable emotions and moods).  What an unfair combination of experiences to sabotage one’s brain.   My child had to persevere through intense feelings, excruciating anxiety, and thoughts that rarely touched on facts.  How could anyone maintain any semblance of normalcy during this?   The mental effort of holding oneself together was exhausting.

My child was often exasperated with me, as other teens are with their parents:  “Mom, you don’t understand me, it’s like the TV’s on, the radio’s on, the stereo’s on, you’re talking to me, and I’m trying to read a book, and I can’t not think about every single thing.”  Right, I couldn’t relate.  I could not imagine processing 10,000 inputs at once without going crazy.

Hallucinations feel normal when you’re in them

My child had a slow early onset of hallucinatory experiences beginning about 11 or 12, and was able to hide it until 14.  She considered the hallucinations and voices normal, and became accustomed to them.  Eventually, she noticed that others didn’t see or hear the same things:  the rhinoceros walking by; the sky turning green; words writing themselves on a blackboard.  To my child, here was proof of being special, magical, a traveler on the metaphysical plane.  Because there was proof, she felt superior to others and that she had special powers.

I have never had hallucinations, but imagine they are like dreaming wide awake.  My child’s audio hallucinations included something out of Monty Python:  two loudly arguing British ladies, with thick Cockney accents, relentlessly criticizing each other’s cooking and husbands.  She complained it was impossible to hear what the teacher said in class.  (Even today, during summers when she is happy, the stand-up comic voice visits and tells jokes throughout the day.  Our family witnessed many outbursts of laughter and giggling for no apparent reason, then started laughing contagiously.

My child’s visual hallucinations took fascinating forms:  stairs looked like a cascading waterfall; a living room chair continually rotated in space instead of standing still; moving objects left trails in space, like a series of images seen with a strobe light.

She awoke one morning with stories of her life as a queen for 1000 years, and talked about it in extraordinary detail.

My child is the bipolar type of schizoaffective person.  While depressive types don’t have the highs or excessive agitation,  they still suffer with anxiety and paranoia.  When she was in a down cycle, she darkened her room and slept in a pile of bed-clothes on the floor.  She avoided things with negative symbolic meaning, such as certain people, certain streets, or certain names.   For some reason, sunflowers and Christmas were upsetting.  During depressive phases, she talked about suicide, or “caught” other disorders such as anorexia and PTSD.  I was often accused of abuse and endured many hurtful words.

Haunted by anxiety and paranoia

Anxiety and panic are torturous, and I wished I could have spared her from the pain.  She would obsess on a past emotional hurt and become horribly upset for hours, days, weeks at a time. (In my stress and ignorance back then, I yelled at my child unaware of how hard this impacted emotional memory.)  I had to apologize a zillion times.

My child continues to obsess on ancient hurts, now well into adulthood.  Any traumatizing experience can become a theme in the life story of a schizoaffective person.   They will refer to it and make connections to it for the rest of their lives.   Big issues with my child are about money (having money, people stealing money, having no control over money).   It’s common for her to interpret any event as the turning point when everything started to go downhill, “That’s when you took all my money, “That’s when you ruined my life.”

It may not be preventable.  It’s the very nature of schizophrenia spectrum disorders to find something to be paranoid about.  The point is for a parent to learn to avoid triggering the traumatic memories, and avoid reasoning or explaining what really happened.  Our children cannot reason once upset.  I had to learn to “de-escalate” my child, don a quiet and patient demeanor, affirm feelings, show empathy, and change the subject (“redirect”) etc.

Stalkers of famous people often have schizoaffective disorder

She did some reading and told me that people with schizoaffective disorder often believe they are connected to a celebrity’s life as lovers or confidantes, and some will stalk that person.  John Hinkley is a famous case.  He believed he was the boyfriend of actress Jodie Foster.  In her film, “Taxi Driver,” her would-be boyfriend attempted to assassinate the president to impress her.  Hinckley did the same, and attempted to assassinate then-President Ronald Reagan.  In prison, Hinkley was diagnosed with schizoaffective disorder.  The Beatles musician, John Lennon, was killed by Mark David Chapman, who believed he was the rock star and John Lennon was impersonating him–Chapman is another person with schizoaffective disorder.  I was amused that she realized, only then, that her ever-present (invisible) boyfriend was a famous rock star.

Partial complex seizures can simulate symptoms of schizoaffective disorder

Partial complex seizures of the left temporal lobe (temporal lobe epilepsy) cause, enhance, or simulate symptoms of schizoaffective disorder.  If your child has not had an EEG, request one.  If there is seizure activity, it can be treated by anticonvulsants such as Tegretol (carbamazepine).  This helped to reduce many of my child’s symptoms, such as intermittent bouts of terror, seeing auras around people, and color changes in the sky.  (See an abbreviated article with an explanation at the end of this post.)

Lessons I learned

  • Don’t challenge your child’s beliefs about their experiences, even if you think they are strange, focus instead on keeping your child functional: taking meds, attending school, engaging in safe activities, and managing personal care.  You will be better able to correct/redirect their thinking once they feel comfortable speaking openly with you.
  • Believe and act on any references to suicide or destructive ideas—this may be manipulation, but don’t take the chance.   If you believe your child is being manipulative or overly dramatic, ask them respectfully to stop.  Yes, just ask.
  • Allow your child to talk comfortably about their hallucinatory experiences.  You want to know what they are witnessing or monitoring in their head.  You want to know if a voice is verbally abusing your child, or telling them to hurt themselves or others.
  • “Inoculate” your child from cruel voices or messages–teach them to deny the power of the voice or not take it seriously.  Example:  “I know you can’t stop [this voice] from pestering you, but it’s OK to resist [him] or ignore [him].  [He] has no power over you.”  She was very upset once because her rock star boyfriend/ghost yelled at her.  I told her to tell him, “Stop it and leave me alone! Don’t talk to me that way!”  She did (somehow), and it worked!  The rock star guy stopped talking to her for a couple of days (as if he was sulking), and returned and was nice to her again.

Things you can do

  • Low stress is a priority. Create a low-key environment in the home, limit sensory input, use quiet or soft voices as much as possible.
  • Allow your child to avoid over-stimulation–crowds or energized spaces with too many things happening (parties, malls, sports events or activities, slumber parties, or whatever they say it is).
  • Don’t argue with them if something they say doesn’t make sense to you.  Listen attentively and avoid offering your opinions.  Let me repeat, don’t reason with someone who is inherently irrational.  Ensure they are safe, comfortable, and appropriate, and spend quality time listening like you would any other child.
  • Help them avoid anxiety-causing things or places.  Go out of your way.  Make a point of driving down a different road, or bringing them home from an event early, even if it’s inconvenient.  This is respectful and humane because they are  agonizing about something that you don’t experience.  You need their trust in you to protect them from their own mind.
  • Ask your child what they need to calm down or settle.  If they want to be in a dark room with the windows covered with foil, fine.  If they want to listen to loud ghastly music through headphones, fine.  Just watch.  It will be obvious if it settles them, or helps them focus and relax.
  • Allow your child to be weird at home as long as they adhere to basic rules.  “I respect your freedom to be who you want to be, but you must take showers and wear clean clothes.  Hygiene is the family policy.  This rule won’t change, but I am happy to help you with this if you want.”  No reasoning or justification, just a simple statement of the rules everyone follows.

You can ask for, and expect, respectful behavior

It is possible to ask your schizoaffective teen to stop disrespectful or harmful, inappropriate behavior, and it is possible to set a boundary if done in a respectful straightforward manner without justifying yourself.

Example of something I said to my daughter during a particularly dark period:  “I’m leaving the house and I’ll be gone about 2 hours.  Do not try to commit suicide, stay right here in your room and be calm.  I’ll bring you a snack when I get home.”  Note that this gave her a reason to wait until I came home.

Outcomes are poor with schizoaffective people, but statistics say they have a better long-term prognosis than those experiencing schizophrenia (see “Outlook for schizoaffective disorder and schizophrenia”).  Perhaps it’s because their emotional awareness gives them the ability to form friendships and relationships, and talk about feelings (unlike those suffering with ‘pure’ schizophrenia).  See article at the end of this post, “Social Interaction Increases Survival by 50%.”

You are in this for the long haul.  You will experience a roller coaster ride of emotions.  Pace yourself as if in a marathon.  There may be multiple crises  and hospitalizations, but these may space farther apart over time with treatment and family support, and you’ll have respite.  Your child will settle into stable, repeated patterns unique to them, and you’ll learn which triggers to avoid, and to ignore what isn’t important.  You’ll also learn how to bring them back into positive states of mind, and set up a healthy environment where they choose to stay.  Have hope.  I lived this, and can attest to it.

 

–Margaret

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Please add a comment about your experiences.  Your observations help others. 

– – – – – – – 

Complex Partial Seizures Present Diagnostic Challenge  (summary)
Richard Restak, M.D. | Psychiatric Times, September 1, 1995

Temporal lobe epilepsy (TLE), is now more commonly called complex partial seizure disorder. It may involve gross disorders of thought and emotion, and patients with temporal lobe epilepsy frequently come to the attention of psychiatrists.

A Dr. Jackson observed in the late 1800’s that seizures originating in the medial temporal lobe often result in a “dreamy state” involving vivid memory-like hallucinations sometimes accompanied by déjà vu or jamais vu (interpreting frequently encountered people, places or events as unfamiliar). Jackson wrote of “highly elaborated mental states, sometimes called intellectual aura,” involving “dreams mixing up with present thoughts,” a “double consciousness” and a “feeling of being somewhere else.” While the “dreamy state” can occur in isolation, it is often accompanied by fear and a peculiar form of abdominal discomfort associated with loss of contact with surroundings, and automatisms involving the mouth and GI tract (licking, lip-smacking, grunting and other sounds).

– – – – – – –

Social Interaction Increases Survival by 50%

Psychiatric Times. July 30, 2010

Theoretical models have suggested that social relationships influence health through stress reduction and by more direct protective effects that promote healthy behavior. A recent study confirms this concept.  Findings from a meta-analysis published in PLoS Medicine indicate that social interaction is a key to living longer. Julianne Holt-Lunstadt, PhD of Brigham Young University and colleagues analyzed data from 148 published studies (1979 through 2006) that comprised more than 300,000 individuals who had been followed for an average of 7.5 years. Not all the interactions in the reports were positive, yet the researchers found that the benefits of social contact are comparable to quitting smoking, and exceed those of losing weight or increasing physical activity.

Results of studies that showed increased rates of mortality in infants in custodial care who lacked human contact were the impetus for changes in social and medical practice and policy. Once the changes were in place, there was a significant decrease in mortality rates. Holt-Lundstadt and colleagues conclude that similar benefits would be seen in the health outcomes of adults: “Social relationship-based interventions represent a major opportunity to enhance not only the quality of life but also of survival.”

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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Parent to Parent Guidance

Parent to Parent Guidance

Margaret Puckette is a Certified Parent Support Provider, and assists parents on how to effectively raise their troubled child. She believes parents need realistic practical guidance for family life and school, not just information about disorders. Margaret has mentored families for over 20 years. She is an author & speaker, and knows from personal experience there is reason for hope.

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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