What to do about screaming teenagers

What to do about screaming teenagers
11 votes

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 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.

Family Balance

Keep your energy in balance so you can maintain your family's foundation.  Too much spent on your child affects everything else your family needs to survive.

Keep your energy in balance so you can maintain your family’s foundation. Too much spent on your child affects everything else your family needs to survive.

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

1 Comment

Filed under anger, anxiety, Screaming, stress, teenagers

Life with a schizoaffective teen

Life with a schizoaffective teen
61 votes

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.

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 memories of life as a great queen for 1000 years, and talked about it in extraordinary detail.  Imagine her dismay when she discovered her mom now rules.

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 that you” 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.  Perhaps it’s because their emotional awareness gives them the ability to form friendships and relationships, and talk about feelings (unlike many “pure” schizophrenics).  See article at the end of this post, “Social Interaction Increases Survival by 50%.”

Family Balance

Keep your energy in balance so you can maintain your family's foundation. Too much spent on your child affects everything else your family needs to survive.

Keep your energy in balance so you can maintain your family’s foundation. Too much spent on your child affects everything else your family needs to survive.

Now about you

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 serious crises  (hospitalization) but these may space farther apart over time with treatment, 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 to 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

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

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.”

64 Comments

Filed under bipolar disorder, depression, mental illness, mental illness, parenting, schizoaffective disorder, schizoaffective disorder, schizophrenia, schizophrenia

Managing resistance: tips and advice

Managing resistance: tips and advice
3 votes


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.

1 Comment

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

Marijuana and psychosis in teens

Marijuana and psychosis in teens
5 votes

Underside of normal brain. Shown area has blood flow.

 

It’s a myth that marijuana is safe.  While it has clear, proven benefits for certain physical ailments, the drug’s effect on those with psychiatric vulnerabilities, especially adolescents, can lead to psychosis and debilitating long-term cognitive impairment.  Marijuana should not be political or partisan, yet it is.  The research is international, which tends to refute the argument that concerns are political instead of medical.  Advocates use the term “safe herbal medicine,” but avoid mention of its horribly unsafe effects.  Like any psychoactive drug, there is serious risk of harm.

16-year old with 2 years regular marijuana use.

 

I was at a fundraising event once, chatting with a biochemist about brain chemistry.  At one point he turned and asked a friend passing by about his party the night before, and the friend said that everyone was so stoned they could hardly stand up.  This man then said he was sorry he missed it.  I asked the scientist if he was aware of the negative effect marijuana had on the neurotransmitter serotonin, and how it causes psychosis. “You’re joking!” he said sarcastically.  “What are you, some uptight ultra right reactionary?”  A person nearby overheard us and chuckled and said to me, “Where have YOU been?”  I’m just a parent who cares about kids, who is not buying the story out there.  And I’ve read the peer-reviewed research on marijuana going back 20 years.

18-year-old with 3 year history of marijuana use, 4 times per week

 

I share this story because I assumed that an expert in the biological chemistry would know we don’t fully understand the astonishing complexities of brain chemistry, nor the compounding effect of genetics on a person’s reaction to substances.  Why didn’t this man question his belief that marijuana is perfectly safe?

At the end of this article are summaries of  research studies that have been conducted worldwide since 2004.  All found negative effects of marijuana use on teens.

 “When THC (tetrahydrocannabinol) was administered in one trial, it caused both patients and controls to experience transient increases in cognitive impairments and schizophrenia-like… symptoms.”

 There are side effects.  We know some people cannot stop using alcohol once they start, and that serious addiction runs in families.  We now know that pharmaceuticals help some people, but have deadly side effects in others.  Why isn’t marijuana, with proven negative side effects, also considered a risky substance like antipsychotics or arthritis medications or statins?  Because it’s a plant, and not made by a giant corporation?  Because it’s popular?

I work with adolescents in the juvenile justice system.  A young man on my caseload grew noticeably depressed after starting regular marijuana use—this was tracked by weekly urinalysis.  He said that smoking helped him feel better.  I asked if he got depressed afterwards, and he shrugged.  I asked if he thought it was safe, and he said, “Sure, because it’s natural.  Everyone knows that.”

Pay attention, this is what teens think:  marijuana is natural and therefore safe. That’s what sellers tell them and that’s what they tell each other.  Advocates use the comforting term “safe natural herb.”  Did you know that commonly used herbs are NOT safe?

  • Comfrey is used in tea for arthritis pain, but causes liver damage.
  • Arnica is used for pain, but causes kidney damage.
  • Cinnamon bark is smoked by teens, and it causes disorientation, unconsciousness, and kidney damage.
  • Ephedra (ma huang) causes heart attacks.

Research into smoked or consumed marijuana is repeatedly linked to the onset of psychotic symptoms such as hallucinations, cognitive impairments, and schizophrenic-like symptoms, regardless of a person’s age, even if they don’t use other narcotic substances.  The risk is especially high for adolescents because they start using marijuana early.

A note on medical marijuana – The plant Cannabis sativa has two substances of interest:

  1. cannabidiol (CBD) – the molecule considered safe for a variety of treatments, and even approved by the upstanding American Medical Association;
  2. tetrahydrocannabinol (THC) – the molecule responsible for the high and the one that can produce psychotic symptoms.

Safe medical marijuana should not be the smoked leaf and buds, but as a dosed aerosol, and available by prescription, just as all other medications with possible negative side-effects.  Legalizing only this form makes sense. Otherwise, legalization is not about medical need but recreational use.

“Increasing levels of cannabis use at ages 14-21 resulted in lower levels of degree attainment by age 25, lower income at age 25, higher levels of welfare dependence, higher unemployment, lower levels of relationship satisfaction, and lower levels of life satisfaction.” (read more below)

 More than half the young people on my caseload have diagnosable disorders, or a history of addictions and disorders in their families.  They’re already in trouble with the law. The last thing they need is the means to self-induce psychosis.

Share this information with other parents.  This isn’t about keeping  medicine away from people who need it, nor is it a “righteous” ploy to pick on people who like to get high.  The danger for children is real.

–Margaret

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


Early Marijuana Use Heightens Psychosis Risk in Young Adults (summary)
John McGrath MD, Rosa Alati MD Archives of General Psychiatry, published online March 1, 2010,
MedscapeCME: Psychiatry and Mental Health

“Early cannabis use increases the risk of psychosis in young adults,” reports lead investigator John McGrath, MD, of Queensland Centre for Mental Health Research in Brisbane, Australia.  “Apart from having an increased risk of having a disorder like schizophrenia, the longer the young adults reported since their first cannabis use, the more likely they were to report isolated symptoms of psychosis.”

Investigators assessed 3801 study participants at ages 18-23 years, identifying first marijuana use and three psychosis-related outcomes:  non-affective disease, hallucinations, and the Peters et al Delusions Inventory Score.  “Psychotic disorders are common and typically affect 1 or 2 people of every 100” Dr. McGrath said, “…(I) was surprised that the results were so strong and so consistent…  We need to think about prevention.”

Results mirror those of another study conducted by Michael Compton MD, published in the American Journal of Psychiatry (November 2009), where investigators looked at 109 patients in a psychiatric unit and found that daily marijuana and tobacco use was common.  Of those who abused cannabis, almost 88% were classified as weekly or daily users before the onset of psychosis.

Emma Barkus, PhD, from the University of Wollongong in New South Wales, Australia, says other studies suggest that those who are engaging in risk behaviors about the age of 14 years are more likely to persist as they get older, adding further support to the role of cannabis use in predicting earlier psychoses.
– – – – –

Evidence Accumulates for Links Between Marijuana and Psychosis (summary)
Michael T. Compton, MD, MPH – Assistant Professor, Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, Georgia, 2008

Cannabis is the most abused illicit substance in the general US population, and the most abused illegal drug among individuals with schizophrenia.This literature reviewed studies that examined (1) associations between cannabis use and clinical manifestations of psychosis, and (2) the biologic plausibility of the observed links.

The initiation of cannabis use among those with psychotic disorders often precedes the onset of psychosis by several years.Cannabis use in adolescence is increasingly recognized as an independent risk factor for psychosis and schizophrenia.  Progression to daily cannabis use was associated with age at onset.

Study evidence also supported biological links between cannabis use and psychosis.  In the brains of heavy users, interactions with specific cannabinoid receptors are distributed in brain regions implicated in schizophrenia.  Other studies report elevated levels of endogenous cannabinoids in the blood and cerebrospinal fluid of patients with schizophrenia.  When THC (tetrahydrocannabinol) was administered in one trial, it caused both patients and controls to experience transient increases in cognitive impairments and schizophrenia-like positive and negative symptoms. – – – – –

Chronic toxicology of cannabis.  (summary)
Reece, Albert Stuart; Clinical Toxicology (Philadelphia, PA.)   vol. 47  issue 6, Jul  2009 . Medical School, University of Queensland, Highgate Hill, Brisbane, QLD, Australia.

 Findings: There is evidence of psychiatric, respiratory, cardiovascular, and bone toxicity associated with chronic cannabis use.  Cannabis is implicated:

  • In major long-term psychiatric conditions including depression, anxiety, psychosis, bipolar disorder;
  • Respiratory conditions include reduced lung density, lung cysts, and chronic bronchitis;
  • elevated rates of myocardial infarction and cardiac arrythmias;
  • linked to cancers at eight sites, including children after in utero maternal exposure.- – – – –

Marijuana Use, Withdrawal, and Craving in Adolescents (summary)
Kevin M. Gray, MD, Assistant Professor in the youth division of the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina in Charleston.

Findings in the literature survey:  Initiation of marijuana use typically occurs during adolescence.  Recent data indicate that in the United States, 42% of high school seniors have tried marijuana; 18% have used it in the past 30 days; and 5% use it daily.  Among adolescents aged 12 to 17, 3.6% met criteria for cannabis use disorder (abuse or dependence) and 2% met criteria for cannabis dependence.

More than half (51%) of adolescents reported that marijuana is fairly or very easy to obtain.  Ironically, this ready availability may be a “reverse gateway” from marijuana use to cigarette use to nicotine dependence.  Earlier initiation is associated with problem-related marijuana use: “hard” drug use, poly-drug use, and academic failure.  Using marijuana once per week or more during adolescence is associated with a 7-fold increase in the rate of daily marijuana use in young adulthood.  Cannabis dependence increases the risk factors for impaired driving and delinquent behavior.  Chronic use is associated with impaired immune function, respiratory illnesses, cognitive problems, and motivational impairment. 

There is a debate whether marijuana use begins as “self-medication” for psychiatric disorders, or whether habitual marijuana use can predispose some individuals to psychiatric symptoms.

Social anxiety disorder in adolescence is associated with 6.5-times greater odds of subsequent cannabis dependence, and vice versa, frequent marijuana use during adolescence appears to increase the risk of subsequent development of anxiety and depressive disorders.  The prevalence of cannabis abuse is 2 to 3 times greater among adolescents who have major depression.  Also linked in both directions: conduct disorder predicts marijuana and other substance use, while early-onset marijuana use predicts conduct disorder.

Five treatment regimes were studied: motivational enhancement/cognitive-behavioral therapy (MET/CBT), family education and therapy intervention, a community reinforcement approach, and multidimensional family therapy.  All resulted in positive but modest outcomes, with MET/CBT and community reinforcement treatments being most cost-effective.

Emerging evidence indicates rewards for marijuana abstinence may be positive.  Multi-systemic therapy, an intensive approach that incorporates individual, family, and community components, has demonstrated effectiveness among delinquent adolescents.

Withdrawal: Marijuana withdrawal symptoms are a constellation of emotional, behavioral, and physical symptoms that include anger and aggression, anxiety, decreased appetite and weight loss, irritability, restlessness, and sleep difficulty, which result specifically from withdrawal of marijuana’s psychoactive ingredient, THC.  Less frequent but sometimes present symptoms are depressed mood, stomach pain and physical discomfort, shakiness, and sweating.  Onset of withdrawal symptoms typically occurs within 24 hours of cessation of THC, and symptoms may last days to approximately 1 to 2 weeks.

Craving: Patients’ craving of marijuana is evidenced after presenting them with cues associated with marijuana (e.g. sight or smell of the substance, films of drug-taking locations, and drug-related paraphernalia).   Exposure to cues leads to robust increases in craving, along with modest increases in perspiration and heart rate.  Cue reactivity can predict drug relapse.

Craving and withdrawal symptoms interfere with successful cessation of use and sustained abstinence.  In addition, medications are often used to target withdrawal from substances, such as benzodiazepines for alcohol dependence and clonidine and buprenorphine for opioid dependence. These medications could be combined with psychosocial interventions, or developed to complement concurrent psychosocial treatments. – – – – –

Legalization of Marijuana: Potential Impact on Youth (summary)
Alain Joffe, MD, MPH, W. Samuel Yancy, MD the Committee on Substance Abuse and Committee on Adolescence – PEDIATRICS Vol. 113 No. 6 June 2004, pp. e632-e638

Scientists have demonstrated that the emotional stress causedby withdrawal from marijuana is linked to the same brain chemical that has been linked to anxietyand stress during opiate, alcohol, and cocaine withdrawal.  THC stimulates the same neurochemical process that reinforcesdependence on other addictive drugs.  Current, well known, scientific informationabout marijuana shows the cognitive, behavioral,and somatic consequences of acute and long-term use, which include negative effects on short-term memory,concentration, attention span, motivation, and problem solving.  These clearly interfere with learning, and have adverse effects on coordination,judgment, reaction time, and tracking ability.  http://pediatrics.aappublications.org/cgi/content/full/113/6/e632 – – – – –

The Past, Present, and Future of Medical Marijuana in the United States (summary)
By John Thomas, JD, LLM, MPH, Professor of advanced law and medicine, civil procedure, and commercial law at the Quinnipiac University College of Law, Hamdon, Connecticut, January 6, 2010

Cannabidiol (CBD) is considered safe and has a variety of positive benefits, and this component should be legalized.  However, the other narcotic component in marijuana, tetrahydrocannabinol (THC), is responsible for the high, and too much may not be a good thing because it can produce psychotic symptoms in people. – – – – –

 Medical Marijuana:  The Institute of Medicine Report (summary)
Ronald Pies, MD, Editor in Chief – Psychiatric Times. Vol. 27 No. 2 , January 6, 2010

Marijuana is not a completely benign substance. It is a powerful drug with a variety of effects.  However, except for the harms associated with smoking, the adverse effects of marijuana use are within the range of effects tolerated for other prescription medications. Cannabinoids can induce acute transient psychotic symptoms or an acute psychosis in some individuals… (but it is unclear) what makes some individuals vulnerable to cannabinoid-related psychosis.  There is a pressing need for more high-quality research in the area of medical marijuana and cannabinoid use. – – – – –
 
Link Between Cannabis Use and Psychosis Onset at a Younger Age (summary)
Ana Gonzales MD, Santiago Apostol Hospital in Vitoria, Spain, Journal of Clinical Psychiatry. August 2008

Researchers found a strong and independent link between cannabis use and the onset of psychosis at a younger age, regardless of gender or the use of other drugs.  The link is related to the amount of cannabis used.  “The clinical importance of this finding is potentially high,” Dr. Gonzalez-Pinto given that cannabis use is extremely prevalent among young people… estimates of the attributable risk suggest that the use of cannabis accounts for about 10 percent of cases of psychosis.”The findings showed a significant gradual reduction in the age at which psychosis began that correlated with an increased dependence on cannabis. Compared with nonusers, age at onset was reduced by 7, 8.5, and 12 years among users, abusers, and dependents, respectively, the researchers report. – – – –
Cannabis use and later life outcomes. (summary)
Fergusson DM, Boden JM, Addiction;  Pages: 969-76;  Volume(Issue): 103(6), June 2008

A longitudinal study of a New Zealand birth cohort tracked subjects to age 25 years.  Cannabis use at from ages 14-25 was measured by:  university degree attainment to age 25; income at age 25, welfare dependence during the period 21-25 years, unemployment 21-25 years, relationship quality, and life satisfaction.  Other indices were measured to adjust for confounding factors:  childhood socio-economic disadvantage, family adversity, childhood and early adolescent behavioral adjustment and cognitive ability, and adolescent and young adult mental health and substance use.The findings were statistically significant.  Increasing levels of cannabis use at ages 14-21 resulted in lower levels of degree attainment by age 25, lower income at age 25, higher levels of welfare dependence, higher unemployment, lower levels of relationship satisfaction, and lower levels of life satisfaction. – – – – –

Doctors:  Pot Triggers Psychotic Symptoms (summary)
May 1, 2007
Aetna Intelihealth – Mental Health

 LONDON — New findings show physical evidence of the drug’s damaging influence on the human brain.  In some people, it triggers temporary psychotic symptoms including hallucinations and paranoid delusions. Two of the active ingredients of cannabis: cannabidiol (CBD) made people more relaxed.  But second ingredient: tetrahydrocannabinol (THC) in small doses produced temporary psychotic symptoms in people, including hallucinations and paranoid delusions. According to Dr. Philip McGuire, a professor of psychiatry at King’s College, London, THC interfered with activity in the inferior frontal cortex, a region of the brain associated with paranoia. “THC is switching off (a chemical) regulator,” McGuire said, “effectively unleashing the paranoia usually kept under control by the frontal cortex.”In another study, Dr. Deepak Cyril D’Souza, an associate professor at Yale University School of Medicine, and colleagues tested THC on 150 healthy volunteers and 13 people with stable schizophrenia. Nearly half of the healthy subjects experienced psychotic symptoms when given the drug.  Unfortunately, the results for the schizophrenic subjects was so much worse that researchers scrapped adding additional schizophrenic subjects to the study.  The negative impact was so pronounced that it would have been unethical to test it on more schizophrenic people.”One of the great puzzles is why people with schizophrenia keep taking the stuff when it makes the paranoia worse,” said Dr. Robin Murray, a professor of psychiatry at King’s College in UK.  She theorized that schizophrenics may mistakenly judge the drug’s pleasurable effects as outweighing any negatives. – – – – – 

7 Comments

Filed under depression, mental illness, parenting, schizoaffective disorder, schizophrenia, teens

Parenting mistakes – 9 ways to make things worse

Parenting mistakes – 9 ways to make things worse
1 votes

Knowing what NOT to do as a parent can sometimes be as informative as knowing what to do.

1…Treat your child or teen like another adult who has an equal say in how things are done.  Treat your home as a democracy, where everything must be fair and equal.  Answer your child’s accusations by offering explanations that show how reasonable you are.

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

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

4…Make rules and only enforce them once in a while, or have the consequence come much later than the misbehavior (“I’ll tell your father when he gets home.”).

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

6…Expect your child to logically, rationally accept your reasonable rules.  Parents expect common sense from children who are quite young (4 or 5), too young in the first place, or from young adults (up to early 20’s) who have a long track record of doing things that don’t make sense.

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

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

9…Make them responsible for your feelings.  If you lose your cool and blow out over something they did (stress pushes parents over the edge sometimes), insist they do the apologizing.

Leave a Comment

Filed under mental illness, parenting, teens

ADHD kids become troubled adults

ADHD kids become troubled adults
4 votes

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

I confess, I also found ADHD funny…

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

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

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

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

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

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

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

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

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

Margaret

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

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

– – – – – – –

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

2 Comments

Filed under law enforcement, mental illness, parenting, teachers, teens

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

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

 If you’re a parent of a troubled teen, how much decision making power should your child have?

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

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

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

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

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

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

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

What about a Parent Bill of Rights?

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

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

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

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

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

What are parent responsibilities?

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

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

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

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

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

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

Learn and practice an entirely different approach to parenting.

What about youth responsibilities?

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

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

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

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

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

 


1 Comment

Filed under mental illness, teachers, teens

Youth with mental disorders demand rights!

Youth with mental disorders demand rights!
1 votes

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 – – – – – – – – – –

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

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

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

1 Comment

Filed under mental illness, parenting, teachers, teens

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

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

Parenting a defiant ODD child or teen could be your hardest job ever. 

Not only is it exhausting, but you must continually find the compassion and forgiveness to be nurturing, and the energy and doggedness to be consistent.

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

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

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

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

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

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

There are two different medication approaches to ODD:

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

–         The attention deficit approach may use Straterra (chemical name is atomoxetine), Ritalin (methylphenidate), Risperdal or risperidone (for patients with low IQ), and Depakote or divalproex (a mood stabilizer).

–         The depression & obsessive-compulsive approach may use serotonin-based antidepressants such as Prozac (fluoxetine), and Anafranil or clomipramine (used to treat OCD).

At the end of this article are a list of other medical conditions that can cause disruptive behavior.

Unfortunately, oppositional defiant disorder usually includes other disorders, so you may be coping with more than defiance.  Below are common disorders that combine with ODD:

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

–From http://addadhdadvances.com/ODD.htmlAnthony Kane, MD 

Other medical conditions that can cause disruptive behavior like ODD:

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

–From Peters and Josephson.  Psychiatric Times, 2009.

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

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

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

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

You try everything but nothing works.  People’s natural instincts for parenting do not work with an ODD kid—they need completely different techniques than ‘normal’ children.

How to reduce ODD behaviors

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

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

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

Praise is one of the most powerful tools for managing disruptive behavior.  Take responsibility to inject much-needed positive energy into your relationship with your child or teen.  It’s likely that this relationship has been almost 100% negative, yes?

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

More praise – ‘Catch’ them doing something good.  Offer praise and make it sound genuine even if they respond in anger, then let it drop.  Spend as much time praising as disciplining!  And don’t expect thanks, it’s not about you.

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

–Find out more at http://www.sosprograms.com/chapters/p_eng_chapters/EngParents03.pdf.

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

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

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

Surprise rewards – Reward appropriate behavior with something they already like (that is acceptable to you).  They are more likely to do a desired behavior if they expect something they want and aren’t sure when it will be offered.

At the end of this article is a list of things to do to make ODD worse.  Avoid these!

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

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

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

 

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


How to make ODD worse -or- DON’T TRY THESE AT HOME

Don’t treat your child like another adult who has an equal say in how things are done.  Don’t treat your home as a democracy, where everything must be fair and equal.  Don’t answer your child’s accusations by offering reasonable, rational explanations.

Don’t keep finding fault with your child and let them know about it over and over and over.  If they do something positive, let them know it’s not enough.

Don’t ignore your child’s unique needs or the challenges they face everyday, such as bullying at school, or fear of abandonment, or stress from a chaotic home.  Just pretend they have no reasons for their behavior.

Only enforce rules once in a while, or have the consequence come later (Famous example: “I’ll tell your father when he gets home.”).  Don’t get angry about something, then direct your anger to your child and let them know it’s because of the stress they’ve caused you.

Don’t treat your child appropriately for his or her age.  Don’t make long explanations to a three-year-old about why you’ve set a certain rule.

Stop making rational justifications for your rules and stop expecting your child to logically, rationally accept them.  What’s interesting to me when I see parents doing this is that their children can be quite young (4 or 5), too young to be reasonable in the first place, or they can be young adults (early 20’s) who have a long track record of being unreasonable.

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

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

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

–Margaret   How am I doing?  Please rate this article at the top, thanks.


 

9 Comments

Filed under ADHD, bipolar disorder, defiant, defiant children, depression, discipline, mental illness, oppositional defiant disorder, oppositional defiant disorder, parenting

Teachers and stigma – judging and blaming families

Teachers and stigma – judging and blaming families
1 votes

Troubled kids' families also want improved classroom behaviorAs parents of troubled children, we already know that our child’s disorder or behavior will not work in most classrooms.  No one needs to tell us this or explain why our child needs to change in order to learn–we already stay up at night worrying how our child or teen will make it in the world.  Most parents have tried everything:  we’ve looked for other educational options (which almost never exist or we don’t qualify), we’ve asked or pleaded for help, we’ve read books and scoured the internet for advice…  When nothing works, some parents and caregivers just give up and try to muddle through.

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

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

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

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

–  We sympathize but you’re still to blame;

–  You can change things if you want to, but you don’t really care;

–  We know what your child needs, you don’t.

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

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

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

Mixed messages from schools

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

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

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

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

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

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

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

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

3 Comments

Filed under depression, mental illness, oppositional defiant disorder, parenting