Category Archives: teenagers

by | January 3, 2013

Is my teen ‘normal’ crazy or seriously troubled?

photo8A high percentage of teenagers go through a rebellious or irrational phase that is quite normal for their age and brain development.  The difference between normal teen craziness and abnormal behavior is when the teenager falls behind his or her peers in multiple key areas.  At a bare minimum, a normal teen should be able to do the following:

  • Attend school and do most school work if they want to;
  • Have and keep a friend or friends their own age who also attend school;
  • Have a maturity level roughly the same as his or her peers;
  • Exercise self-control when he or she wants to;
  • Have basic survival instincts and avoid doing serious harm to themselves, others, or property.

photo5It is normal for teens to be inconsistent, irrational, insensitive to others, self-centered, and childish.  Screaming, for example, is normal–regard this the same as a toddler temper tantrum.  It is a phase that most teens grow out of unless something else is holding them back.

This is your challenge:  even teens with mental disorders have some normal teenage behavior traits like those listed above.  How do you tell which is which so you can get help?  Look for pervasive patterns of social and behavioral problems that are more serious, and in almost all settings.  The patterns repeat and the outcomes are increasingly worse.

photo2

Some signs of abnormal unsafe* behavior

*“Unsafe” means:  there’s a danger of harm to themselves or others, property loss or damage, running away, seeking experiences with significant risk (or easily lured into them), abusing substances, and physical or emotional abuse of others.

  • If a troubled teenager does something unsafe to themselves or others, it is not on impulse or an experiment, but is intentional and planned.
  • They have a prior history of intentional unsafe activities.
  • They have or seek the means to do unsafe activities.
  • They talk about or threaten unsafe behavior.
  • There are others who believe there is something abnormal or unsafe about your child.  (e.g., your child’s friend comes forward, their teacher calls, other parents keep their children from your child, or someone checks to see if you’re aware of the nature of his or her behaviors).


photo7How psychologists measure the severity of a child’s behavior 

“Normal” is defined with textual descriptions of behaviors, and these are placed on a spectrum from normal to abnormal (“severe emotional disturbance”).  Below are a few examples of a range of behaviors in different settings.  These descriptions are generalizations and should not be used to predict your child’s treatment needs, but they do offer insight into severity and the need for mental health treatment.

School behaviors

Not serious - This child has occasional problems with a teacher or classmate that are eventually worked out, and usually don’t happen again.

Mildly serious - This child often disobeys school rules but doesn’t harm anyone or property.  Compared to their classmates, they are troublesome or concerning, but not unusually badly behaved.  They are intelligent, but don’t work hard enough to have better grades.

Serious - This child disobeys rules repeatedly, or skips school, or is known to disobey rules outside of school.  They stand out as having chronic behavior problems compared to other students and their grades are always poor.

Very serious - This child cannot be in school or they are dangerous in school.  They cannot follow rules or function, even in a special classroom, or they may threaten or hurt others or damage property.  It is feared they will have a difficult future, perhaps ending up in jail or having lifetime problems.

photo6Home behaviors

Not serious - This child is well-behaved most of the time but has occasional problems, which are usually worked out.

Mildly serious - This child has to be watched and reminded often, and needs pushing to follow rules or do chores or homework.  They don’t seem to learn their lessons and are endlessly frustrating.  They can be defiant or manipulative, but their actions aren’t serious.

Serious - This child does not want to follow rules, even reasonable rules.  They take no responsibility for their behavior, which can include swearing and damage to the home or property.  They will do and say anything to get their way.

Very serious - The stress caused by this child means the family cannot manage normally at home even if they work together.  Running away, damaging property, threats of suicide or violence to others, and other behaviors require daily sacrifices from all.

photo9Relationship behaviors

Not serious - The child has and keeps friends their own age, and has healthy friendships with people of different ages, such as with a grandparent or younger neighbor.

Mildly serious - The child often aggravates others by arguing, teasing, bullying or other immature behaviors, and friends often avoid them.  They are quick to have temper tantrums and childish responses to stress.  Or they have no friends their age, or risky friends.

Serious - The child is frequently mean or angry to people and animals, and can be manipulative or threatening, or damage others’ property.  They have poor judgment and take dangerous risks with themselves or others.

Very serious - The child’s behavior is so aggressive verbally or physically that they are almost always overwhelming to be around.  The behaviors are repeated and deliberate, and can lead to verbal or physical violence against others or themselves.

photo1If your child’s behavior falls along the spectrum encompassing Serious to Very Serious behavior, get good mental health treatment for them now and spare them a difficult future.

Pay attention to your gut feelings.

If you’ve been searching for answers and selected this article to read, your suspicions are probably true.  Most parents have good intuition about their child.  If you’re looking for ways to “fix” or change your child… all I can say is that this approach will probably not work.  You may need to work on yourself; you may need to change how you relate to your child or picture your situation.  Regardless, seek help.

photo4Early treatment, while your troubled teenager is young, can prevent a lifetime of problems.  Find a professional who will take time to get to know your situation, and who will listen to what you have to say–a teacher, doctor, therapist, or psychiatrist.
–Margaret

Your comments are welcome.

(Tell me how I’m doing. Please rate this article above, thank you kindly.)


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by | June 17, 2012

Finding humor in your crazy child

Note of caution: it’s never appropriate to make fun of a child.  The purpose of this article is to help a parent’s stress by finding humor in their situation, private humor–never to be shared with the child or anyone else who will share it with the child.

“I don’t suffer from insanity, I enjoy every minute of it.”

Things can only go downhill so far until you lose it.  Troubles build, going from bad to horrible, and then your child says something so bizarre or silly, and even though it may be politically incorrect, and even though it may seem sick or hurtful or embarrassing, there is absolutely nothing left to do but laugh.

“That boy gave me so much trouble, then one day he said to me, “Mom, why is it always about you?” !
–Mother of an 18-year-old son with mild schizophrenia

Stop pretending your family is normal.

For parents like you, humor is necessary, even “gallows humor.”  Laughter is a legitimate strategy for relieving stress, and brain scans prove it.  An emergency room nurse once told me that ER staff joke about patients to cope with the intensity of their job, but only among co-workers.  They diagnose some victims as “too stupid to live,” or refer to motorcyclists as “organ donors.”  The police joke amongst themselves about knuckleheads.  A juvenile justice therapist told me her team tells youth sex-offender jokes!

“… as high as 94 percent of people deem lightheartedness as a necessary factor in dealing with difficulties associated with stressful life events.”
–David Rosen, Professor of Psychiatry and Behavioral Science, Texas A & M University, May 2005

Even if you child-proofed your house, they would still get in.

You have permission to laugh at all the crazy, zany, exasperating, nonsensical, and nutball things your child does or says, just never in their presence… or in anyone’s presence who doesn’t understand. It doesn’t mean you don’t love or care your child, but it helps your own mental health. In the support groups I run, a parent will occasionally share a funny story about their troubled child and the room roars with laughter.

The 15-year-old girl had professed suicidal thoughts for so long that no one could remember a time when tragedy wasn’t looming. They had locked up every potentially dangerous item, but the terrified parents were never certain they could keep her safe from herself.  Removing the knives and rope was obvious.  But household chemicals?  Daily life became a quest to guess what else she could possibly use to kill herself, then hide it.  But her mother realized one day that her daughter would probably not ingest household chemicals.  They tasted too bad, and mom knew she would not go through the discomfort.

You can’t scare me, I have teenagers!

At health class in high school, the students saw a film about trauma in children.  Upon returning home from school, a 14-year-old son exploded with fury, berated his mother, then charged off to his room and slammed the door, once, twice, three times.  The mother was accustomed to this behavior and went to his room and attempted to calm him down.  He screamed, “I finally found out why I’m having so many problems!  I learned in health class that I am a ‘feral child’ because you abandoned me when I was a baby!“

The 20-year-old schizophrenic son angrily obsessed that his mother spoke with his school counselor when he was 11.  He railed that this invasion of privacy was wrong, immoral, hurtful, illegal, unethical, and stupid, and every other sin he could think of.  Mom learned to let him vent, but one day she became exasperated and said, “That was nine years ago! I apologized a hundred times. What more do you want?” The son stopped for a moment, confused, and said, “I don’t believe you. Did you erase my memory again?”

The 16-year-old daughter had bipolar disorder. She also had grandiose plans to become a famous person and lead an “epic” life.  She was immensely proud of having an ‘exciting’ disorder that gave her permission to be crazy.  Once she made an unsuccessful attempt to lose weight, explaining, “I tried anorexia but didn’t have the discipline.”


The main purpose of holding children’s parties is to remind yourself that there are children more awful than your own… or maybe not.

The mother of a violent 10-year-old daughter said “I just bought a gallon of spackle on sale, which is great.  Spackle is my friend!”  Another mother with a violent 16-year-old son agreed.  She said she’d become skilled at repairing and texturing dry wall after all the damage he’d done.  Both moms brainstormed starting a company to repair homes battered by troubled children. “It would help the parents, and we could offer support too… and not judge!”

Several parents with troubled children were sharing their frustration from hearing ‘normal’ families talk proudly about their wonderful children, and the fun things they did together.  Each parent had had similar experiences, which made them feel a mix of emotions–embarrassed, ashamed, left out.  One mom finally blurted, “Those stupid happy families, I hate them!”

Do you have a funny story or quote to share about your child?  Please add it in the comments section–you’ll lift another parent’s day.

–Margaret


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by | May 29, 2012

Your troubled child from birth to 18, what to expect and do

Parents face daily challenges with a troubled child or teen, and easily overlook the future.  I know I did.  What’s going to happen as they grow and change?  What does one plan for?  It helped me to hear from parents who had already traveled this path.  Based on their experiences, these are some things you can expect–and do–before your child  reaches the pivotal age of 18.

Your child may not be ready for adulthood by age 18, but be OK with this.  Collective experience indicates your son or daughter  will continue to need your support and health care management into their mid-20′s.

If he or she reaches young adulthood with the capacity to maintain well-being on their own, you’ve done a good job.

From birth to age ~5

You – Consider yourself lucky if he or she has an identifiable behavior problem early!  You have ample time to understand your parenting needs and prepare, and use the many “special needs” services for young children.  Start a file and keep absolutely every medical and school record and contacts for people and services.  You are about to become a case manager.

Your family

  • Talk with siblings frankly.  Explain that sister or brother has a different brain and will be treated differently.  Inform them you will be distracted by their sibling’s need for appointments and other issues, and that it may feel unfair.  Ask for their patience.  Reassure them you love them very much.
  • Talk with your partner or spouse about revising expectations for your child, and accepting that your life may be harder than you planned .  Discuss how you will work together and share responsibilities, and work through disagreements about parenting the child in the future.

Everyone – Keep friends, activities, and plans the same.  Keep hobbies and interests alive.  Be as inclusive as possible of your special needs child but don’t sacrifice your family’s needs.  It’s a tricky balance.

Ages ~6-11  – young children

If your child’s behavior problems started at this age, read the above.  It still applies, except you may find fewer services, and sadly, more blame.  Seek professional help now.  Early intervention is the key to future mental health.

What to teach your family:

    • Our lives will be different from other families, but this is normal for families like ours.
    • We will support your sister or brother, but we will take care of ourselves and each other, we will have each other’s back.

What you should do:

  1. Make safety a high priority in your home, emotional safety as well as physical safety.
  2. Focus on schedules and planned time for activities every day.  Maintain this structure consistently, including weekends and holidays.
  3. Teach your child skills for managing behavior–they may not be able to stop it completely.
  4. Modify your home to reduce stress: Less noise or over-stimulation.  Better diet. A separate time-out  space.  Lock up valuables or dangerous items.  Consider a therapy pet.  Create a  tradition of whole-family activities:  Wii, playing cards, board games, exercise games, art or crafts, movie night…
  5. Take frequent “mental health breaks.”  Be generous with yourself without guilt.  Let other family members have breaks too.

 Managing resistance: tips and advice

Practical ways to calm yourself, your child, your family

From ~12-18 – ‘tweens and teens

If your child started having problems at this age, most information above still applies, but this may be the most difficult period!

Two things happen in the teen years:

  1. They enter a normal phase of development where they seek their own identity, and want freedom and a social life separate from the family.  But they take more risks, and expose themselves to more risks.
  2. Some mental disorders start at this phase, or get much worse and become quite serious:  major depression, bipolar disorder, schizophrenia and schizoaffective disorder, anorexia, borderline personality disorder… Risks include school failure, criminal activity, substance abuse, suicide, and assault.

Priorities

Safety – You may need to take unusually strong measures to ensure physical and emotional safety. Many need to lock up all knives, or allow siblings to lock themselves in their own room for protection, or search their teen’s room, or take away the cell phone and internet access.

Your well-being and that of other family members - Assertively seek outside support for your family, such as a support network of friends and family, or a religious community or support group, or mental health treatment for yourself, or all of the above.

Education – This is critical, even if it’s only for one or two classes per day.  If your teen cannot complete high school in time with their peers, it’s not a disaster. They may not graduate now, but they can finish their education eventually.  It’s never too late.

Positive peers and adult mentors - Keep your son or daughter from risky youth or adults.  Encourage activities with anyone they like and trust whom you approve of.

Ongoing mental health treatment –  your child may not believe (or accept) they have a mental health problem but they can at least comply with treatment.

By age 18

At a minimum, this is what your child needs–fundamental criteria for a functional adult life:

  • A steady job and income, or a meaningful activity (volunteering, school)
  • Healthy, stable relationships
  • Maintenance of health and hygiene
  • Decent housing, maintenance of housing and belongings
  • Maintenance of financial stability

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by | April 23, 2012

ARE YOU OVERREACTING?

angry-girl1

Like many parents, you might go to extremes to control situations so they won’t get out of hand. You might not intend to go overboard, but so much frustration has built up that any little irritation sets you off like a warrior on a battle for control. Or a battle to make things stop now.  Overreactions are emergency alarms without the emergency.

You can’t see it coming, in an instant you are on an unstoppable mission to fix, contain, punish, or halt anything that upsets your sense of well-being, imagined or not. Overreactions are sure signs of stress, you need a break!  Overreactions may also come from the fear of losing the day you planned, or the life you planned and came to expect.  If you are overreacting to gain control, you are actually losing control.  Your parenting choices need considered, thoughtful decisions instead of an automatic 911 call. When your blood boils, you’re not aware how your behavior creates a toxic environment around you and the rest of your family… nor how it worsens a troubled kid’s behavior.

  • Are you so stressed and traumatized that you just can’t stand it anymore and want your child to stop misbehaving now, immediately, yesterday?
  • Is every little minor thing a reason to pull out the heavy artillery and throw a fit?
  • Do you play a victim or martyr to get sympathy?  You probably deserve sympathy, but this is not the way to get it.
  • Do you overwhelm difficult situations with your own explosions?

It’s common for parents with really difficult kids to get stuck this way, so forgive yourself if you overreact, and stop and look at what this does to your relationships and interactions with your troubled child.

  • If you’ll do anything to make your child stop a challenging behavior, might you go too far with little things? Will you call the police because they slammed the door, or will you strike them because they slammed the door?
  • If you need sympathy and attention, will you share so much personal information about your child, that your child starts hearing about it from others? How will this make them feel? When others hear you constantly complaining, might they consider that the problem is you?
  • Do you mirror your child’s bad behavior to show them what it looks like? Are they interpreting this the way you hope, or are you lowering yourself?

Overreactions sabotage opportunities for improvement. They terrify everyone (all family members); your family may start to hide things from you, or downplay things, just so you won’t overreact. When family members feel a need to keep secrets, they don’t speak their minds. Someone takes sides against you to counterbalance the negativity. Now you feel less in control and receive less of the support you need for your own well-being.

If you feel exhausted and hopeless, or lash out as a way of coping, you are carrying significant stress and/or depression. Before you completely lose control, and lose your self-respect and rightful authority as a parent, take care of yourself and get help for both your physical and emotional exhaustion . Always, always make sure you are emotionally centered and healthy, or you will never be able to help your child become healthy.

Remember, your child and family needs you to be 100% together.  Let some things go for the greater peace.  Center yourself so you can notice when your child is doing well and offer praise.  When centered, you are flexible, patient, compassionate, and forgiving.   This draws people towards you, to look after you and care for you.  Go ahead, aim for sainthood.  Just starting down that path would start to make things wonderful and healing for everyone.

 


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by | March 29, 2012

Animals that make good therapy pets

Dogs, cats, and “pocket pets” like ferrets, birds, or lizards are therapeutic for children who struggle with any disability: physical, behavioral and developmental. A calm smiling dog, an affectionate cat, or a small pet they can hold is a great therapist. The right animal offers unconditional love and affection, and the right animal makes your child feel special. If you are considering animal therapy or a pet for your child, strategically pick the right animal. If your child will attend an animal therapy program, or you plan to select their own pet, monitor your child’s interactions when they are first introduced to the creature. Be honest with yourself, the animal you like may not be the best for your child. Hyperactive and barking dogs, aloof cats, fearful hamsters, and noisy birds don’t work and can be outright stressful. Pay attention to this—people are too often unaware how much negative energy fussy pets generate and how distracting and chaotic they can be.

Criteria for the right animal

  • The animal’s natural manner fits your child’s emotional needs.
    • Quiet, if child easily experience sensory overload;
    • Uplifting and affectionate, traits that help a withdrawn or anxious child;
    • Interactive, if your child needs to be drawn out or receive attention: a bird that speaks, or a dog that follows instructions;
  • The animal bonds with your child and likes to be with them for long periods. The animal has a preference for your child.
  • Your child is able to treat the pet humanely. Animals can be abused consciously or unconsciously by troubled children.
  • You appreciate the animal too, and aren’t concerned about mess, smell, hair, or feathers in your home. You should consider yourself the one responsible for its care. This pet is a therapist first, not a lesson in responsibility for your child. They can learn responsibility later.
  • The child’s pet should still be welcome and cared for if it doesn’t work out for your child. If it’s not wanted, consider a rescue shelter or humane society that can find another caring owner.

Dogs

Most people are familiar with therapy dogs. Their natural affinity with humans, even untrained, is a reason that dogs are the most popular of pets. If you are interested in getting a puppy to train as a therapy dog, you can find instructions on how to train certified therapy dogs, and modify them to fit your home. Certified dogs need significantly more training because they can be used in nursing homes, hospitals, and schools. “How to train a therapy dog”

Birds

The parrots and parrot-like or hooked beak birds have marvelous personalities and bond for life. These colorful birds prefer not to fly, but instead spend their time socially with people, other birds, even dogs and cats! The best low-cost option is a parakeet, extremely low maintenance, and happily chirpy, easily tamed and easily trained to talk.

“Patients hold and stroke cockatiels so tame that they often fall asleep in a human lap.” Maureen Horton, the founder of “On a Wing and a Prayer” tells of “non-responsive patients in wheelchairs who suddenly begin speaking again while petting a cockatiel as their relatives weep at the transformation.” She described bringing her birds to visit a group of violent teenage delinquents who clamored to touch a cockatoo named Bela. “For a few minutes,” Horton says, “these hardened criminals became children again.”
– “On a Wing and a Prayer,” a pet-assisted therapy program, uses birds to visit patients.” Connie Cronley, Tulsapeople.com

Fish

Fish can’t be held, but few things beat the visual delight and serenity of a beautiful aquarium. Fish do have personalities and form interactive communities in a tank, which are fun to watch, and individuals are fun to name. There is a reason aquariums are commonly placed in waiting rooms and clinics, lobbies, and hospitals.

“Pocket pets”

These are usually mammals that like to be cuddled and carried around, often in pockets: ferrets, mice, rats, gerbils, hamsters, guinea pigs, and very small dogs. It is best to select a young animal that is calm and won’t bite, and handle it gently and often so that it becomes accustomed to being held. Challenges with many pocket pets include running away or escaping their enclosures, urine smell, and unwanted breeding. As the main caretaker, you will want to be comfortable with their needs.

Reptiles

Lizards are also excellent pets and demand little attention, and they are readily accepted by children. My bearded dragon, Spike, comes with me to my support groups. Dragons are a very docile species–safe with young children and popular with teens and parents. Other good species are anoles (often called chameleons), iguanas, and geckos.

“I’d have to say my Leopard Gecko Mindy is very much therapy for me. She really is my therapy lizard, she wants to sit with me when I’m upset and tolerates me, which even my two dogs and cat won’t. She’ll just find a place on me and curl up and be like “I’m here, I won’t leave you.””
–User name “Midori”, Herp Center Network

Horses

Properly trained horses are extraordinarily healing. certified horse therapy programs are considered medically effective treatment and often covered by health insurance. Horses benefit disabled children and teens across the board: those with physical disabilities such as paralysis and loss of limbs, mental/cognitive disabilities such as development disabilities and retardation, and children with mental and behavioral disorders. The horses are selected for their demeanor and trained to reliably respond appropriately to children who may misbehave. Therapists are specially trained also to collaborate with the horse as a team. Horses have a “large” serenity and a lack of concern with the child’s behavior. They are also intelligent and interactive like dogs, provide a warm soft hide to lean on, and they empower their riders. A child on a horse will connect with the animal’s rhythmic bodily movement, which stimulates the physical senses and keeps the child physically and mentally balanced. According to parents and children in these programs, horses change lives.  New research proves horses are genuinely effective:  Study Suggests That Equine Therapy is Effective (http://blogs.psychcentral.com/equine-therapy/2013/01/equine-therapy-effective-a-new-study-suggests-so/).

–Margaret

How has your child’s pet improved mental health?
Your comments help others who read this article.

The science behind animal therapy

Are dogs man’s best therapist?
Psychiatric Times. H. Steven Moffic, MD. February 29, 2012

Note: this is an excellent article by a psychiatrist who moved from disbelief to belief that dogs have a genuine therapeutic value, healing some of the most psychiatrically challenging children. http://www.psychiatrictimes.com/blog/moffic/content/article/10168/2040421

Children’s best friend, dogs help autistic children adapt (summary)
Journal: Psychoneuroendocrinology, 2011, Universite de Montreal

Dogs may not only be man’s best friend, they may also have a special role in the lives of children with special needs. According to a new study, specifically trained service dogs can help reduce the anxiety and enhance the socialization skills of children with Autism Syndrome Disorders (ASDs). The findings may lead to a relatively simple solution to help affected children and their families cope with these challenging disorders.

“Our findings showed that the dogs had a clear impact on the children’s stress hormone levels,” says Sonia Lupien, senior researcher and a professor at the Université de Montréal Department of Psychiatry and Director of the Centre for Studies on Human Stress at Louis-H. Lafontaine Hospital, “I have not seen such a dramatic effect before.”

http://www.npr.org/blogs/health/2012/03/09/146583986/pet-therapy-how-animals-and-humans-heal-each-other?ps=sh_stcathdl

Pet therapy: how animals and humans heal each other. (summary)
by Julie Rovner, March 5, 2012, National Public Radio

“A growing body of scientific research is showing that our pets can make us healthy, or healthier. “That helps explain the increasing use of animals — dogs and cats mostly, but also birds, fish and even horses — in settings ranging from hospitals and nursing homes to schools, jails and mental institutions.”

“In the late 1970s that researchers started to uncover the scientific underpinnings animal therapy. One of the earliest studies, published in 1980, found that heart attack patients who owned pets lived longer than those who didn’t. Another early study found that petting one’s own dog could reduce blood pressure.

“More recently, says Rebecca Johnson, a nurse who heads the Research Center for Human/Animal Interaction at the University of Missouri College of Veterinary Medicine, studies have been focusing on the fact that interacting with animals can increase people’s level of the hormone oxytocin. “That is very beneficial for us,” says Johnson. “Oxytocin helps us feel happy and trusting.” Which, Johnson says, may be one of the ways that humans bond with their animals over time.”


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by | March 5, 2012

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

You really do have more rights than you think.

Some background: In a previous blog article on the subject of rights, I described how parents and caregivers can be shocked to learn that their troubled teenager has the right to refuse treatment, Teen rights versus parent rights when the teen has a mental disorder.

What if your teen refuses treatment?  They usually get worse, sometimes much worse. Tragically, if your teen experiences psychosis for a long period, such as in schizophrenia or bipolar disorder, their brain degenerates just as in Alzheimer’s disease.

If a teenager had any other illness besides a behavioral disorder, 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 likely not ready to take the responsibility that goes along with these rights. An excellent site covering laws pertaining to Special Education Law is Wrightslaw. Click on “Topics from A to Z.”

  • For safety and health reasons, you can 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). Caution: this can destroy trust if done inappropriately! Inform your teen only if you find and remove unsafe items but otherwise leave everything else alone! If you call the police regarding illegal items, and if your child is charged, their criminal record can be expunged by age 18.
  • 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 subject to criminal charges.
  • You can notify anyone who encourages your teen to run away or stay away from home, or who takes your teen with them without your permission, that this is custodial interference and also subject to criminal charges.

You have the right to be involved in treatment

“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.” *

“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 Providers 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 you based on what you already know. They will also tell your child that suicide or violence risk will always be communicated to you and/0r 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 sole right to make critical medical decisions is crazy!

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.


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by | July 1, 2011

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

How am I doing?  Please rate this article at the top, thanks!


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by | March 26, 2011

Brace yourself for borderlines

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 to embarrass you in front of others (such as in 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 bounce from one to another… and they don’t understand why it happens to them.

For goodness sakes, why?

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

 

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

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.

Statistics

One research study reported that borderline personality disorder occurs equally 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 few friends and more conflicts with peers and authorities.

In teenagers:  they are more promiscuous, aggressive and impulsive, and more likely to use drugs and alcohol. Cutting and suicide are more common.  “…research shows that, by their 20s, 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” (excerpt)
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 life-threatening mental disorder (e.g. bipolar), continued 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!

Revise your priorities, put your borderline child’s needs  after the other important things in your day.

  1. You absolutely must come first, period, end of story.
  2. Then the other family members
  3. Then the basics of housing, food, and bills
  4. And finally, your borderline child.  (They will feel slighted, but they always feel slighted, even when you give them 100% of your time.)

Keep things relaxed.  Limit any pressure you apply to maintaining appropriate behaviors and self-calming.

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 squelches 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 amusement for his parents, which softened his emotional impact on their lives.
–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

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 and usually take place in relatively safe places, 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

- – - – - – - – - -

How am I doing?  Please rate this article at the top, thanks!

–Margaret


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by | October 13, 2010

What to do about screaming teenagers

When their screaming starts, you brace yourself.  You armor your gut to protect it from the verbal pummeling.  When their cruel words pierce your heart, it breaks.  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.

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, 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.

How am I doing?  Please rate this article at the top, thanks!

–Margaret


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by | July 18, 2010

Managing resistance: tips and advice


For those who raise resistant, defiant children or teens, this is the single most important piece of advice:  take care of yourself, your primary relationships, and the rest of your family.  Your child cannot take everyone down.  You have a life and so do the rest of the family members.  Protect your other children from PTSD – Post Traumatic SIBLING Disorder.  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.

Before we get to the practical “how to” advice, make note of these facts about defiant and resistant children:

  • Physical age is not emotional age.  They act younger than they are.
  • The child lives in the here and now; they don’t think about the past or future.  They don’t see how their original actions result in a series of consequences.
  • The child does not notice their effect on others.
  • Their brain is easily overloaded, which explains their problems, but you can use this overloading problem to your advantage (see below)
  • They are inherently irrational and cannot follow your reasoning, so don’t try.
  • Believe it or not, you want your child to be resistant to the negative things they’ll face in life.  It is a strength to cultivate because it takes a strong will to face challenges.  YOU need to be resistant.

Managing resistant children is a balancing act.  If you go too far asserting authority you can draw more resistance, especially if you become emotional, so STAY COOL.  You’ll have to stand rooted and calm many times before they reduce their behavior, so embrace patience.  Patience is good medicine for stress.  Don’t get stuck believing you’ve lost patience… because you haven’t!

Practice ahead of time

Before you set a boundary on your recalcitrant child, practice what you will say in advance.  Play the dialogue out in your head—imagine their reaction to your request or rule, and plan a neutral-toned response.  Remind yourself that you are the authority, and you are more resolved and persistent than they are.  Your message doesn’t have to be rational, e.g. “Because I’m the mommy (or daddy) and I say so.”

THESE ARE PRACTICAL IDEAS, BUT NOT IRONCLAD RULES.  USE YOUR BEST JUDGEMENT.

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 down 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, I’ll give you 50 cents to call me and tell me where you are, and I’ll bring you your stuff.”  (then walk away)

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 the kid is home at 5:30 for dinner.)

Actively ignore

As mentioned in a previous post* 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 don’t care or 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.   * Defying ODD: What it is and ways to manage

Mix it up

Be unpredictable.  Give a reward sometimes but not all the time, so the child keeps trying the good behavior to get the reward.  Instead of a consequence, use bribes to stop a behavior.  Allow them to do something they like to do, only with appropriate boundaries.  In my personal opinion, I think it’s also OK to manipulate a situation and allow the child to think they’ve “won.”  Choose your battles.  Let some things go if you’re too stressed.

Have realistic expectations

It’s easy to get stuck in rut—it happens to everyone—but you can climb out.  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, they may always have problems, but your job is to help them bounce back and learn from their mistakes.  If you can do that, you’ve wildly succeeded.  The best you can is the best you can do.

Bottom line

One must be a saint for sticking it out for their troubled child or teen, whether a bio parent, foster parent, grandparent, adoptive parent, or other family member.  If the child’s condition is serious, they may never make it in the world because of their disability, but you’ll know you’ll have honored them, lived your values, and loved unconditionally.

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.

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Filed under bipolar disorder, defiant children, mental illness, oppositional defiant disorder, parenting, teenagers, teens

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