borderline personality disorder : Raising Troubled Kids

Borderline children – how they function and how you can help

Borderline personality disorder makes a child wonderful yet horrible; lovely yet vindictive; a great friend or manipulative bully; anguished or glowing with joy; self-hating yet self-important; self-centered but also charitable.

Are you ready to bang your head on a wall? Or praying for the day your child turns 18, when you can change the locks on your doors? Children with borderline personality disorder (BPD) can traumatize everyone around them.

Children with BPD believe others will abandon them, and this makes them do one of two things:

1. Do everything possible to obtain and keep love and admiration;
2. Or if they detect the slightest hint of disapproval, blame themselves or others so as to feel they made a decision to break or run away from a relationship. This can disguise horrible feelings of abandonment.

A borderline child can be very engaging and affectionate… sometimes at random and sometimes when they want something. Because they can be vindictive, they may also turn on charm as a way to embarrass you in front of others (such as in a meeting with a teacher or family counselor). Since they often seem wonderful to other people, parents have been judged. People often suggest they take care of their own issues instead.

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

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

A study published in 2008 in Science showed that brain activity in people with borderline personality disorder was abnormal—their brains lack activity in the ‘cooperation’ and ‘trust’ regions, called the bilateral anterior insula. People with borderline personality disorder do not have an internal, natural sense of fairness or social norms, and distrust is their default mentality. Some suggest that borderlines do not receive the attention they need as an infant and toddler. Early neglect is also a predictor of reactive attachment disorder, which has similar trust issues.

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

borderline brain — *The brain of a borderline person showed no activity whatsoever during the teamwork game.*

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

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

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

Evidence for hope

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

“…almost 20 years after the designation of borderline personality disorder, understanding and hope have surfaced for people with the condition and their families. Advances have been made in recent years. Researchers studied 290 hospitalized patients with the condition over a 10 year period: 93% of patients achieved a remission of symptoms lasting at least two years, and 86% for at least four years.” Published in The American Journal of Psychiatry, the research argues that once recovery has been attained, it appears to last. (from “Trying to Weather the Storm”, by S. Roan, September 07, 2009, Los Angeles Times)

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

Treatment

Psychotherapy is the primary treatment of BPD, and the gold standard is dialectical behavior therapy (DBT), which helps the person attain and maintain lasting improvement in their personality, interpersonal problems, and overall functioning. It simply teaches coping skills so patients learn to control their emotions, calm down, and not destroy relationships. Medications support the therapy by reducing depression or anxiety and self-destructive behavior.

(from “What Therapy Is Recommended for Borderline Personality Disorder in Adolescents (13-17 years)?” by M. Muscari, 2005, http://www.medscape.com/viewarticle/508832)

When to hospitalize:

In an emergency, when your child has serious suicidal thoughts or an attempt, and/or is an imminent danger to others, or is incapable of calming down and functioning.

Consider psychiatric residential care when your child has persistent suicidal thoughts, is unable to participate in therapy, has a co-morbid (co-existing) mental disorder (e.g. bipolar, depression, narcissistic personality disorder), a risk of violent behavior, and other severe symptoms that interfere with living.

Other mental health supports your child may need:

Treatment for substance abuse.
Therapy that focuses on violent and antisocial behaviors, which can include emotional abuse or physical abuse, baiting, bullying, and sexualized behaviors. (The most effective therapy is DBT or Dialectical Behavioral Therapy.)
Therapy that also focus on trauma and post traumatic issues if present.
Reducing stressors in the child’s environment. Most children with BPD are very sensitive to difficult circumstances, for example: an emotionally stressful atmosphere; internal and external pressures to succeed or change; inconsistent rules; being around others who are doing better than them.

What parents and caregivers can do

With a co-parent or support person: Maintain a united front.
Communicate privately with each other to effectively set limits. A BPD child will do everything in their power to split authority figures against each other!
Have each other’s back even if you’re not in full agreement.
Never ever give away power by making democratic decisions or explaining your reasoning. Anything you say or do will be challenged or used against you in the future.

Maintain family balance.

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

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

Become skilled in Dialectical Behavioral Therapy (DBT). It is the gold standard for treating
Borderline Personality Disorder. It is the only therapy proven to promote genuine behavioral change and improve mental health. You can ask questions or bring your child back to reality with the following examples.

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

business card

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

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

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

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

knives in your heart — *Never expose your heart like this! Armor yourself. Visualize those knives as fluff balls. Visualize your child as a toddler with a just another temper tantrum. You can handle it.*

Address your own PTSD! People who live with someone with BPD often need help coping with bullying, wrenched emotions, and the instability that person brings into the household. A parent or family member may need their own therapy, antidepressants, and self-care skills for reducing anxiety.

Simple self-care for you and other family members

Three or more (very) deep breaths when stressed, the brain needs oxygen to begin a calming process. Singing is a superb option.
Magnesium or Kava kava, these substances naturally help calm nerves
Sleep in a dark, cold room is the best way to promote deep sleep. Avoid screen time an hour before bedtime.
An activity that feeds your soul, such as a hobby, a loving pet, a gripping novel, just playing
Direct support from a trusted friend–face-to-face is ideal, but calls, texts, and emails as needed are really helpful too.

Characteristics of BPD in adulthood, if untreated

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

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

Help your child with guidance and mentoring on each of these aspects… and be relentless!

Chronic fear of abandonment which results in a constant search for companionship, no matter how unsatisfying.
Clinging and distancing: Disruptive relationships due to the person’s alternating clinging and distancing behaviors. When clinging, they may exhibit dependent, helpless, childlike behaviors. They can over idealize the person they want to spend their time with, constantly seeking that person out for reassurance. When they cannot be with their chosen person, they exhibit acting-out behaviors, such as temper tantrums and self-mutilation. They distance themselves by being hostile and insulting, usually arising from discomfort with closeness.
Splitting: Splitting arises from the person’s inability feel people are safe, and is the primary defense mechanism in BPD. They view all people, including themselves, as either all good or all bad.
Manipulation: Separation fears are so intense that people become masters of manipulation. They will do just about anything to achieve relief from their separation anxiety, but their most common ploy is to play one individual against another.
Self-destructive behaviors: Threats are most often manipulative, but some acts can prove fatal. Cutting is very common. Suicide attempts are common yet often happen in relatively safe scenarios, such as swallowing pills at home while reporting the deed to another person. Another behavior is to set up a scenario where they are victim so as to get attention and love.
Impulsivity: Extremely rapid shifts in mood can lead to substance abuse, binge eating, reckless driving, sexual promiscuity, and excessive spending or gambling. These are similar symptoms of bipolar mania, but BPD behaviors happen for different reasons, usually in response to real or imagined abandonment.

You really can turn your child’s future around.

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What will happen in your troubled child’s future?

Are you scared for your child’s future? Is he or she is falling behind? On a scale of 1 to 5, where 1 is “Normal” and 5 is “Worst Case Scenario”, what will your child’s future adulthood look like?

This chart depicts a spectrum of outcomes of mentally ill children when they become adults. No matter how ill your child is, if he or she gets support and treatment early, their future adult life could end up in the NORMAL column, and out of the RED column. A network of family, friends, and professional staff can keep them from the worst-case scenario in the far right column, and move them in the direction of normalcy.

“Wellbeing” is possibly the most important.

This is a checklist of childhood problems that lead to poor future outcomes as adults. Jump on them one by one.

Friend problems: they have inappropriate friends, or no friends, or they mistreat friends (and siblings).
Behavior problems: they do or say disturbing things (swearing, hurting, breaking, manipulating, sinking in depression, attempting suicide…). Everyone is stressed.
School problems: disruptive behavior; poor grades (or a sudden drop in good grades); bullying or being bullied.
Health problems: physical health problems become mental health problems, and vice versa:
- trouble with sleep
- digestive system and gut problems
- poor diet and lack of exercise
- epilepsy or neurological disorders
- hormones during puberty
- substance abuse.

Age 16, starting mental health treatment

We designate legal adulthood between the ages 18 and 21. That’s too young. Many normal healthy young people at this age are immature and irresponsible, but your son or daughter may lag well behind them. Your child may need support and rescuing well into the 20’s or early 30’s–this is not unusual.

You’ll survive the marathon of tough years by pacing yourself, finding support for yourself, and protecting your mental health.

There is reason for hope. Your child may take many horrible directions in their teens and 20’s, and you may feel hopeless about their future, or helpless as you witness their life nosedive. If you can hang on and marshal support, your child will find a circuitous path to recovery. It will have sharp turns and back steps and falls, but they’ll find it… and enter stable adulthood.

Age 20, after consistent mental health treatment

Some parents and families have seen the worst. They’ve endured violence due to their child’s addiction; sat in court when their son or daughter was convicted of a crime; or they waited in the Emergency Room when their son or daughter was admitted for psychiatric care. They also lived to see their child achieve the sanity to finish their education, support themselves, develop good relationships, and get that future you always wanted for them.

How two parents handled a “worst case scenario” and supported their child’s wellbeing:

These are true stories of mothers who stuck by their very ill adult children and provided what little they could to bring a bit of wellbeing. These mothers found some peace by simply doing what they could. Their child still had hope.

One had a grown son with schizophrenia and a heroin addiction who lived in squalor in supported housing. He spent all of his disability assistance money on heroin and nothing else. Her efforts to help him met with verbal abuse and threats of violence, and she feared for her safety. What could she do, witness his slow suicide by starvation or overdose? She arranged to visit him once a week in the parking lot, and brought 2 sacks of groceries in the trunk of her car. He was to come out and get the groceries while she stood at a safe distance. This worked. He was still verbally abusive when he got the groceries, but he got food and she stayed safe. Did he have wellbeing? Was his life humane?

He lived indoors
He had enough food and clothing
He had encounters with social services and police, which led to some health care
A support system was available if he was ready for help.

One had a son addicted to methamphetamine who was lost to the streets. One day, she discovered a nest of old clothes and rags in an overgrown area behind her garage, and instinctively knew it was from her son. “Good,” she thought, “He’s alive; I can keep him safe.” She rarely saw him come and go, but she replaced the rags with clean blankets and a sleeping bag, and put out food for him, and provided a tent. She couldn’t free her son from addiction, but she could keep him safe from the streets and its desperate people, and fed and sheltered in a way he accepted.

Like in the previous story, her son had a modicum of safety and support, and ongoing monitoring if he was ready for help.

–Margaret

Please share your story.

What to know about psychiatric residential treatment

Have you been searching for psychiatric residential treatment for your child? Do all the programs sound wonderful? Ads include quotes from happy parents, and lovely photos and fabulous-sounding activities. But what’s behind the ads? Residential treatment programs are diverse, but there are important elements they should all have. Here’s how to avoid low quality residential treatment.

Psychiatric residential treatment is serious stuff–it’s difficult to do–especially when troubled children and teens are put together in one facility.

Should you ask other parents for their opinion of a program? In my experience with a child in psychiatric residential care, and as a former employee of one, word-of-mouth is not a reliable way to assess quality or success rate. There are too many variables: children’s disorders are different; acuity is different; parents’ attitudes and expectations are different; length of time in the facility is different; what happens once a child returns home is different… It’s most helpful to ask questions of intake staff and doctors or psychologists on staff. Quality psychiatric residential care facilities have important things in common.

What to ask about the staff:

What is the training and licensure of staff? Are there therapists with MSW degrees, registered nurses, psychiatrists and psychiatric nurse practitioners, and is a medical professional available on site 24/7?
There should be a high staff to patient ratio, and a physically comfortable environment with lots of emotional support.
Do the staff seem mature to you? Do they support each other, are they a team? There is often heavy staff turnover at residential treatment centers because the work is emotionally draining, so staff cohesion is as important as the qualities of each individual.
Safety is paramount. What are the safety and security plans in the facility? Staff must be able to safely manage anything that can go wrong with troubled kids. They should be trained in NCI (Nonviolent Crisis Intervention), “training that focuses on prevention and offers proven strategies for safely defusing anxious, hostile, or violent behavior at the earliest possible stage.”

What to ask about programs:

Does the program specifically identify parent/family involvement as part of treatment? Does it emphasize parent partnership with staff? Ask. Whether you live close or far from the center, even out-of-state, you should be regularly included in conversations with staff about your child’s treatment. You should also be included in a therapy session with your child periodically; some facilities can connect with you over Skype. Your child’s success in psychiatric care depends on their family’s direct involvement.
The program should coach you in specific parenting approaches that work for child’s behavioral needs. While your child is learning new things and working on their own changes, you must know what to establish back home when they return.
You should be informed why your child is getting the treatment or behavioral modifications he/she is receiving.
Last and most important: when your child leaves, there should be a discharge meeting and a discharge plan. What this means: all staff who worked with your child get together with you and discuss what treatment should continue once they go home. Medication management and therapy is identified in advance, appropriate school accommodations are discussed, changes in the home environment are discussed if needed… You should never leave without knowing what comes next in the months following care.

Body health is brain health, and vice versa.

Mental health treatment will include medication and therapy, but must also include positive activities and an educational program. The whole body needs care: exercise, social activities, therapeutic activities (art, music, gardening), healthy food, restful sleep, etc.

Is your child emotionally safe as well as physically safe?

You should be able to visit the unit or cottage where your child will live, see their bedroom, and see how the other children interact with staff and how staff interact with each other.

What to ask about the business itself:

Can you take a tour ahead of time? Can your child or teen visit too if appropriate?
Are emergency services nearby (hospital, law enforcement) that can arrive quickly?
Does the facility have a business license in their state? Do they have grievance procedures? Is the center accredited as a treatment facility, and by whom? In the U.S., the main accreditation authority for healthcare facilities is The Joint Commission.

Psychiatric residential treatment works miracles, but it doesn’t work for all children. Some need to go into treatment more than once to benefit. Some fall apart a few weeks or months after discharge. These are common. What’s important is that staff observations and advice help you and your child with insight and skills for managing his or her unique symptoms, and for communicating effectively.

Good luck.

What was your experience when your child was in residential care? Please share your comment so others can learn.

Is my teen ‘normal’ crazy or seriously troubled?

A high percentage of teenagers go through a rebellious or ‘crazy’ phase that is normal for their age and brain development. The difference between normal teen-crazy and truly troubled behavior is when the teenager falls behind his or her peers in critical areas. At a bare minimum, a normal teen will be able to do the following:

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

It is normal for many teens to be inconsistent, irrational, insensitive to others, self-centered, and childish. Screaming or swearing is normal–regard this the same as a toddler temper tantrum. Outlandish imagination and ideas are normal in the adolescent phase too. These are behaviors that crazy teens grow out of unless something else is holding them back. What you’d call troubled behavior, the kind that necessitates mental health treatment, is a matter of degree.

This is your challenge: How do you tell the difference? Troubled teens with mental disorders have the same challenging behaviors as ‘normal’ crazy teens… How do you know if they need serious mental health treatment? Look for pervasive patterns of social and behavioral problems that stand out against their peers, patterns which persist or occur in different settings. Look back at how long these patterns have been occuring. Are the patterns repeating themselves, or are behaviors increasingly worse? Do you You your troubled teen is slipping behind and won’t grow out of it.

Signs of abnormal behavior

A sudden change in behavior.

An abrupt change in friends and interests, and loss of interest in things your teenager used to enjoy. This might indicate the onset of a serious mental illness or drug use or both.
Unusual ideas, or obsessive beliefs, or unrealistic plans, see: “Unsettling: what psychosis looks like in children and young people.”
Others think there is something abnormal about your child. (e.g., your child’s friend comes forward, their teacher calls, other parents keep their children from your child, or someone checks to see if you’re aware of the nature of his or her behaviors).

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

If a troubled teenager does something unsafe to themselves or others, it is not an accident, but something impulsive, intentional, and planned.
They have a history of intentional unsafe activities.
They have or seek the means to do unsafe activities.
They talk about or threaten unsafe behavior.

How psychologists measure the severity of a child’s behavior

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

School behaviors

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

Mildly serious – This child often disobeys school rules but doesn’t harm anyone or property. Compared to their classmates, they are troublesome or concerning, but not unusually badly behaved. They are intelligent, but don’t work hard enough or focus enough to have better grades. They could use help from a school counselor, teachers, and possibly a therapist for themselves or the family.

Serious – This child disobeys rules repeatedly, or skips school, or is known to disobey rules outside of school. They stand out in the crowd as having chronic behavior problems compared to other students and their grades are poor even if they’re very intelligent. This child needs mental health or substance abuse treatment.

Very serious – This child cannot be in school or they are dangerous in school. They cannot follow rules or function, even in a special classroom, or they may threaten or hurt others or damage property. It is feared they will have a difficult future, perhaps ending up in jail or having lifetime problems. If they cooperate, this child requires intensive mental health and or substance abuse treatment.

Home behaviors

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

Mildly serious – This child has to be watched and reminded often, and needs pushing to follow rules or do chores or homework. They don’t seem to learn their lessons and are endlessly frustrating. They can be defiant or manipulative, but their actions aren’t serious enough to merit intensive treatment, though a school counselor or private counselor would be very beneficial.

Serious – This child cannot follow rules, even reasonable ones. They can’t explain or take no responsibility for their behavior, which can include damage to the home or property, or harm to themselves or others. They need mental health treatment or substance abuse treatment.

Very serious – The stress caused by this child means the family cannot manage normally at home even if they work together. Running away, damaging property, threats of suicide or violence to others, and other behaviors require daily sacrifices from all. Police are commonly called. This child needs intense psychiatric treatment and/or substance abuse treatment, and likely residential treatment.

Relationship behaviors

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

Mildly serious – This child may seem extra immature. They will argue, tease, bully or harass others, and most schoolmates avoid them. They are quick to have temper tantrums and childish responses to stress that always require extra attention from parents and caregivers.

Serious – The child has no friends their age, or risky friends, and can be manipulative or threatening. They can have violent tendencies, poor judgment, and take dangerous risks with themselves and others. They don’t care about others’ feelings, or may readily harm others physically or emotionally. This child needs therapy and psychiatric mental health treatment or substance abuse treatment.

Very serious – The child’s behavior is so aggressive verbally or physically that they are almost always overwhelming to be around. The behaviors are repeated and deliberate, and can lead to verbal or physical violence against others or themselves. This child needs intensive psychiatric and/or substance abuse treatment.

Pay attention to your gut feelings.

If you’ve been searching for answers and selected this article to read, your suspicions are probably true. Trust your intuition. Most parents have good insight into their child. If you’re looking for ways to “fix” or change your child, there just aren’t any easy methods or medications or therapies to do this except over time. Treatment means multiple life changes in addition to medication and therapy, and these can include help for insomnia, a change in diet, treatment for digestive system problems, and household changes to reduce stress.

Mental illness is serious and recovery is a long slow process. It is understandable if you want them to recover quickly–your stress can be intolerable. Avoid pushing for recovery because it will only stress your child and lead you to disappointment. Instead, cooperate with professionals (teachers, treatment providers), and prepare yourself for a parenting marathon. What’s the best way to prepare? Work hard on your own mental health and wellbeing. Lower your expectations for steady progress. This advice and wisdom from other parents may help you face this daunting task.

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

–Margaret

Your comments are encouraged. Your story helps others who read this article.

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Faith can help, and harm, a family’s mental health

When faith helps

Most of the time, people can heal and find peace and self-acceptance through faith. All the world’s great faiths, those that have lasted centuries, are kept alive for this reason. All have common themes of healing and service to others. When things go poorly, meditation and prayer, with others or in private, lead to connection and wholeness. Faith reveals that things are better, and will be better, than they seem.

When families are in crisis because of their troubled child, parents tell me they depend on faith, even parents who don’t profess a faith practice. They say it’s their only source of strength. Most families with a child who is sick, disabled, or mentally ill will go through dark times, when a parent’s world is simply too overwhelming. Most often, no answers are forthcoming, nor any rescue. The only choice is to hand over their burden to a “higher power,” God, the Buddha, Allah, the Great Spirit… This act of “handing over” is a foundation of healing in Alcoholics Anonymous, Narcotics Anonymous, and dialectical behavioral therapy (DBT).

Few things help a family more than a supportive community of believers. There will be one person who listens to a frightened parent on the phone, and another person who takes a traumatized sibling on an outing, and another person who provides hugs and cookies. If a mentally ill child continues to decline, a good faith-based support network will stay on. The child may not thrive, but the family does, and has the strength and forbearance to handle the years’ long task of supporting their mentally ill loved one.

Science shows that faith results in better lifetime outcomes for a child

This writer typically trusts science, but in the depths of my family’s despair, only faith and the prayers of others kept me from falling apart.

There are scientists among the faithful who have asked the question: does faith really help the mentally ill? In another blog post, Spirituality and mental health, some research are summaries of research going back 36 years. (Follow this link for the research citations.) The answer? Yes, faith makes a real and measurable difference in improving mental health.

More recent scientific research shows clear evidence from brain scans that meditation and prayer change brain electrical activity, from anxious or agitated to serene and grounded. The person actually feels and behaves better. This article has more information on this, Yoga – Safe and effective for depression and anxiety.

Like prayer, “talk therapy” or psychotherapy also shows improvement on brain scans. Imagine, just talking with someone improves the physical brain. According to the article appended below, “When God Is Part of Therapy,” many prefer therapists who respect and encourage their faith. It just makes sense.

When faith harms

This section is a personal appeal to faith communities who have unconscionably failed families and their children with mental disorders.

Faith communities depend on people, and people have biases and foibles. Many of ‘the faithful’ hold negative beliefs about others, right or wrong. Children who suffer, and their families, are identified as possessed, of evil character, disbelievers, victims of abuse, or cruelest: those who are paying for their sins. Families are repeatedly told these very things today.

“Sometimes, people hide from the Bible. That is, they use the Christian holy book as an authority and excuse for biases that have nothing to do with God.”
–Leonard Pitts Jr., Miami Herald

Stigmatization from a faith community is a cruel betrayal.

A child’s inappropriate behavior is not a choice, it is a verifiable medical illness, one with a higher mortality rate than cancer: Mental illness more deadly than cancer for teens, young adults. Families with sick children need support; our sense of loss is devastating.

Testimonials

Mother with five children, one with bipolar disorder:

“We were members of our church since we were first married, all our daughters grew up here, but when my youngest spiraled down, I was told the sins of the father are visited on the sons. Or we weren’t praying enough. I knew they thought (Dad) had done something bad to her. We left and went church shopping until we found a pastor who understood and supported us.”

Mother of two children, one with acute pervasive development disorder:

“I wish we had a “special needs” church. We’re so afraid our kid is going to say something and we’re not going to be accepted. We haven’t gone to church for years because of this. They just turned their backs on us, it happened to another family with a deaf child. They avoid parents in pain. Deep down in my heart I believe in the Lord, but there are days when I wonder “where is God?” People call out to pray for a job, or a kid’s grades, but we wouldn’t dare ask for us, no one would get it, we’d be told we were bad parents or didn’t punish him enough.”

Mother of two children, one with schizoaffective disorder:

“When I went up to the front to light a candle and ask for a prayer for my daughter, I expected people would come up afterward and give a hug or something, just like with other families with cancer and such. But it didn’t happen. No one even looked at me. I left alone and decided never to go back.”

Some good news

FaithNet

The National Alliance on Mental Illness (NAMI) has recognized the need for the mentally ill to be part of faith communities, and the negative experiences most face when they attempt to participate in a religious community. NAMI started FaithNet to encourage and equip NAMI members to engage with and share their story and NAMI resources with local faith groups, and appeal for their acceptance.

Key Ministry

Key Ministry: Welcoming Youth and Their Families at Church
Stephen Grcevich, M.D., president, Key Ministry and child & adolescent psychiatry in private practice, Chagrin Falls, Ohio

“Key Ministry believes it is not okay for youth living with mental illness and their families to face barriers to participation in worship services, educational programming and service opportunities available through local churches.”

Churches in American culture lack understanding of the causes and the needs of families impacted by mental illness, which poses a significant barrier to full inclusion.

“A study published recently by investigators at Baylor University examined the relationship between mental illness and family stressors, strengths and faith practices among nearly 5,900 adults in 24 churches representing four Protestant denominations. The presence of mental illness in a family member has a significant negative impact on both church attendance and the frequency of engagement in spiritual practices.” When asked what help the church could offer these families, they ranked “support for mental illness” 2nd out of 47 possibilities. Among unaffected families, support for mental illness ranked 42nd.

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When God Is Part of Therapy
Tara Parker Pope, March 2011, New York Times

Faith-based therapy is growing in popularity, reports Psychology Today, as more patients look for counselors who can discuss their problems and goals from a religious frame of reference.

Studies show that people prefer counselors who share their religious beliefs and support, rather than challenge, their faith. Religious people often complain that secular therapists see their faith as a problem or a symptom, rather than as a conviction to be respected and incorporated into the therapeutic dialogue, a concern that is especially pronounced among the elderly and twenty-somethings. According to a nationwide survey by the American Association of Pastoral Counselors (AAPC), 83 percent of Americans believe their spiritual faith and religious beliefs are closely tied to their state of mental and emotional health. Three-fourths say it’s important for them to see a professional counselor who integrates their values and beliefs into the counseling process.

The problem for many patients in therapy is that many patients are far more religious than their therapists.

Nearly three-fourths of Americans say their whole approach to life is based on religion. But only 32 percent of psychiatrists, 33 percent of clinical psychologists and 46 percent of clinical social workers feel the same. The majority of traditional counselor training programs have no courses dealing with spiritual matters.

When children are hospitalized with other ailments, the family draws sympathy and support from others. But because of mental health stigma, most families like ours don’t when our child is hospitalized. If not blame, we are second-guessed, or as bad, met with silence or a change of subject.

Stigma is prejudice, and harmful to children

Stigma victimizes the victims

“Misconceptions based on perception rather than fact have been shown to be devastating to children’s emotional and social well-being.”
–Dr. Bernice Pescosolido

Stigma, blame, judgment… It only takes a few individuals to harm a child or family with their words, but it takes a whole society to allow it. In this article, I’m going to present recent research on the negative stereotyping of families and children with mental disorders, and share stories from families I know. I hope readers will be empowered to speak out against this form of prejudice and mobilized into changing our society’s attitudes.

Stigma takes many forms.

The most common scenario of stigma is when you are seen as a bad parent, perhaps even an abusive one, or your child is seen as stupid, spoiled, attention-getting, or manipulative. Another form of stigma is having others show disrespect to parents who seek help from the mental health profession. Psychologists are “flakes,” and families who see them are “wackos.” “Where’s your faith?”, some say, or “why don’t you quit making excuses for your child and give them real consequences?”

One of the more destructive forms of stigma is the condemnation parents receive when they “drug their child to fix them.” Too many believe drugs turn children into “zombies” (see research study below). Because of the stigma of treatment, I’ve seen many parents try every alternative treatment possible to help their child, only to have their child struggle year after year in school, fall farther behind their peers, make no progress in therapy, and other setbacks that medicines can prevent. These parents cling to the belief that they are doing the right thing, yet some children really need medicines, and the drugs don’t turn them into zombies. [In today’s treatment approaches, drugs are always considered a piece of the treatment puzzle, never the complete answer.]

A mother’s story about her experience with stigmatization:

This mother lost her best friend of 20 years because the friend got tired of hearing the mom talk about her very troubled 10-year-old son. In frustration, the friend wrote her a letter saying the mom was neurotic, and that she should quit trying to control her son, that her son’s behavior was a cry for help. The friend said she needed to set her son free and get help for her emotional problems, and that she wasn’t going to “enable” this mom anymore by being her friend. The mom was stunned and hurt by the letter. She intellectualized that she didn’t need a friend like this, but her heart was nonetheless broken by the betrayal. The son turned out to have brain damage from a genetic disorder and it was getting worse.

It’s hard enough to be reminded over and over again how our children don’t fit in, and how we may never have the same joys as parents of mentally healthy children.

Ideas for what you can do when you’re blamed and judged.

First, resist defending yourself; it can attract more unwanted attention and disagreement. You don’t have the time or emotional energy to explain or teach someone who will challenge everything you say. Do everything you can to avoid people like this—many have had to cut off some family members and friends, and even their clergy or religious communities.

My story: when my child was diagnosed with a serious mental disorder, I stood up in front of my church congregation, explained what was happening, and asked for prayers for my family. At the end of that service, people started avoiding me. There were no more hello’s. There wasn’t even eye contact. The abrupt isolation from people I knew was devastating and I stopped attending. What did I say? Why did this happen? I thought if my child had a ‘socially acceptable’ cancer others would know what to do or say to ease the isolation and grief.

Second, actively seek supportive people who just listen. You need as large as possible a network of compassionate people around you. You may be surprised how many people have a loved one with a mental or emotional disorder, and how many are willing to help because they completely understand what you’re going through.

Third, politely and assertively say thanks but no thanks. Try something like this: “Thanks for showing interest, but we are getting the help we need from doctors we trust.” Or simply, “please don’t offer me advice I didn’t ask for.” No apologies.

It’s hard enough to be reminded over and over again how our children don’t fit in, and how we may never get have the same joys as parents of mentally healthy children.

–Margaret

Public Perceptions Harsh of Kids, Mental Health (excerpt)

May 1, 2007 (USA TODAY)

Though the subject has been analyzed in adults, until now there has been limited research illuminating how the public perceives children with mental disorders such as depression and attention deficit disorders, according to experts from Indiana University, the University of Virginia and Columbia University. The findings are published in the May 2007 issue of Psychiatric Services.

The study, based on in-person interviews with more than 1,300 adults, indicates that people are highly skeptical about the use of psychiatric medications in children. Results also show that Americans believe children with depression are more prone to violence and that if a child receives help for a mental disorder, rejection at school is likely.

“The results show that people believe children will be affected negatively if they receive treatment for mental health problems,” says study author Bernice Pescosolido, director of the Indiana Consortium for Mental Health Services Research, in Bloomington. “Nothing could be further from the truth. These misconceptions are a serious impediment to the welfare of these children.”

According to the study:

Those interviewed believed that doctors over-medicate children with depression and ADHD and that drugs have long-term harm on a child’s development. More than half believed that psychiatric medications “turn kids into zombies.”
Respondents thought children with depression would be dangerous to others; 31% believed children with ADHD would pose a danger.
Respondents said rejection at school is likely if a child goes for treatment, and 43% believe that the stigma associated with seeking treatment would follow them into adulthood.

Pescosolido and her colleagues say such stigma surrounding mental illness — misconceptions based on perception rather than fact — have been shown to be devastating to children’s emotional and social well-being.

Population studies show that, at any point in time, 10% to 15% of children and adolescents have some symptoms of depression. About 4 million children, or 6.5%, have been diagnosed with ADHD, only 2% less than the number of children with asthma.

“People really need to understand that these are not rare conditions,” says Patricia Quinn, a developmental pediatrician in Washington, D.C.

To banish the stigma linked to mental health problems in children, the public has to get past labels and misconceptions, Pescosolido says. Normalizing these conditions would help too, Quinn says. “We need to view depression and ADHD like we do allergies,” she says. “They are very treatable.”

Things that protect troubled girls from delinquency

Both boys and girls get in trouble with the law. Boys are in the majority for arrests for crime, but statistics indicate that girls’ arrests are increasing: “…between 1996 and 2005, girls’ arrest for simple assault increased 24%.” Of 1528 girls studied over a period from 1992 and 2008, 22% committed serious property offenses and 17 % committed serious assaults. (Girls Study Group, U.S. Department of Justice, 2008. www.ojp.usdoj.gov).

Troubled girls easily become criminal, but also risk being a victim

Girls who have behavioral disorders, from addictions or past trauma or emotional disorders, begin to have delinquent or criminal behaviors as early as middle school. What makes a girl’s criminal activities different from boys is that girls put themselves at high risk of being victimized themselves. How can a parent or caregiver prevent their daughter from engaging in criminal behavior, and trapping themselves in a social world where their stresses and disorders can worsen?

The Girls Study Group quoted above studied which factors protected girls from becoming criminal, or helped them stop and reengage in activities that improve and stabilize their lives. Protective factors did not prevent all criminal activity however, yet the first one has been shown to be the most effective.

Support from a caring adult. THIS IS THE SINGLE MOST IMPORTANT FACTOR in preventing girls from criminal activities of any kind.
Success in school helped prevent aggression against people, but not property crimes.
“Religiousity,” or how important religion was to troubled girls, meant they were less likely to be involved with drugs.

Risks to girls that are different from boys:

Early puberty is a risk if the girl has a difficult family and comes from a disadvantaged neighborhood. Biological maturity before social maturity causes more conflicts with parents and more negative associations with older boys or men.

Sexual abuse, which girls experience much more than boys, including sexual assault, rape, and harassment. But abuse of any kind affects both boys and girls equally.

Depression and anxiety, which girls tend to suffer more from than boys.

Romantic partners. Girls who commit less serious crimes are influenced by their boyfriends. But for serious offenses, both boys and girls are equally influenced by a romantic partner.

Once she’s regularly breaking rules, it’s not easy to turn things around for a troubled girl. It requires constant, persistent efforts to:

Keep her away from risky associates.
Keep her in school and up with studies.
Keep telling her what’s great about her, what’s special, what’s powerful and good.

If you are a parent or caregiver, and you are lucky enough to have a strong mentoring relationship with your troubled daughter, keep it up despite any occasional law-breaking activities. She’ll need consequences, but they should be obstacles to overcome rather than punishments—such as earning back privileges by having good behavior for a period of weeks or months.

If you don’t or can’t have a mentoring relationship, find out who can (or already does). Admit you might not be the sole support for her success, and work in partnership with a caring adult. Find out who believes in her already. Find out who she asks for help if she’s feeling fearful or down about herself. Listen to her if she talks about someone she’s grateful for for helping her through difficulties. Girls respond really well to someone who believes in them.

Teen girls can be turned around and it’s always worth the effort. She might be hard to take sometimes, but find something, anything, that’s good about her and let her know. Over time, you’ll start noticing more and more great things about her, and then she’ll start noticing them too.

Gang Up on Your Kids: Network with Other Parents to Track Troubled Kids

An article in the local paper told the story of a mother who desperately tried to get help for her at-risk son to keep him out of a gang. Yet he became a victim of a drive-by shooting and was in intensive care for days, but he lived. In the article, she said something I’m very familiar with; she said other parents never told her what they suspected, nor did anyone let her know if her son was at their house when he ran away. Just knowing her son’s whereabouts could have helped her intercept dangerous activities. Like her, I never got information from other parents who might have been (or should have been) concerned about my troubled child. Why didn’t other parents stay in touch and help each other control their children?

At-risk kids hang out together, they know each other’s stories (true or not), and protect each other, and parents are out of the loop. What if parents got together too, shared stories, and supported each other’s goal of protecting their child from making mistakes? Kids’ unsafe plans and activities are no match for the many eyes and ears (and cleverness and wisdom) of all their parents combined.

How to track at-risk kids and join forces with other parents:

Go on the internet, check out Facebook and other social media, and look for your child’s page and the pages of his or her friends. The police do this all the time; it’s one of their main investigative tools! At-risk children share everything over the internet: photos, favorite places and people, favorite activities (even illegal ones), and other incriminating information. It’s easy to identify kids who are at-risk.

Contact the parents or caregivers of your child’s friends, by phone or email anytime you find out that their child or teen was with your own child while doing unsafe activities.

I did this. Some parents were thrilled to find support, but a couple were angry with me at first. After all, I was delivering bad news. They defended their child, or accused my child of telling stories. I just said, “I thought you’d want to know. My kid is in trouble, but you may want to know your child was also involved.” It took some backbone to stay online, but they eventually calmed down and expressed disappointment in their child. They often hadn’t suspected anything. Then I asked if we could join-up and inform on each other’s kids to keep them safe. Always, I received a strong yes.

Compare notes and share news about friends, friends of friends, which houses were dangerous (e.g. adult not at home, or adult provides drugs or alcohol), which places they hang out, and who might victimize them or be victimized by them.

Call a teacher and ask who your child hangs out with at school, or if they know another parent who is worried about their kid, call that parent and make a pact to keep each other informed. Whether they help you or not, at least they know someone’s watching and paying attention.

True story – One mother I know recruited a “spy network” with her son’s friends’ parents and with employees of businesses he regularly frequented, such as a skateboard shop near his school and a coffee house. She was able to keep track of where he was if he ignored her curfews, and inform the community police of adult associates (usually 18-24) who were known to provide drugs, alcohol, and cigarettes to youth. Her information helped empower other parents who hadn’t known what to do, but were then able to restrict their teen’s activities away from home and make it uncomfortable for unsafe people to associate with them.

True story – A father I met took the “spy network” idea a step further and had contact cards, like business cards, which he gave away to police, teachers, other parents, and anyone he met who knew his daughter. The contact cards basically said “Please help us keep Kari safe and call us, her parents, anytime she is at the following places [ … ] or doing something you believe is inappropriate. Thank you very much for your help. We will keep your calls confidential from our daughter.” Then the card gave the parents’ names, number, and email address. This greatly limited their daughter’s contact with unsafe or inappropriate friends and adults, because they knew they might be watched and reported if she was around. Surprisingly, this attention improved the girl’s progress in family therapy, as she stated she felt more like her parents cared.

Word gets out quickly among the groups of at-risk kids and the adults who enable them. If you let enough people know that they may be watched when at-risk kids are around, then they will avoid these kids and even ask them to leave their company. Don’t forget: you are smarter and more experienced than young people. You, as a parent, are not alone with your concerns about your child.

Reach out to the other parents in your community. You will be surprised how many will thank you.

–Margaret

Call 911 – Make a crisis plan for your troubled child

Don’t let your family become emotionally battered when your troubled child or teen goes through one crisis after another. It’s the last thing your family needs—more stress and exhaustion! Since your main job as a parent or caregiver is to reduce stress, you must manage the inevitable emergencies in a way that quickly settles down your family, as well as get help for your child. Are you prepared to head off a crisis when you see one coming? Does your family have a crisis plan for when (not if) your troubled child has a mental health emergency that puts everyone or everything in danger?

Never be afraid to call 911 when there’s a danger of harm. You will NOT be bothering them!

I got my crisis plan idea from the “red alert” scenes on Star Trek, when red lights flash and an alarm sounds, and crew members drop everything and run to their stations with clear instructions for protecting the ship.

Think of your family as crew members that pull together when someone sounds the Red Alert because your child is becoming dangerously out of control. Each family member should know ahead of time what to do and have an assigned role, and each should know they will be backed up by the rest of the family. This will be tremendously reassuring to everyone. Together, you can manage through a crisis, reduce the dangers, and ensure everyone is cared for afterwards.

Have a crisis plan for the home, the workplace, and the school…

…and start by asking questions. Here are some examples:

o Who goes out and physically searches for a runaway? This person should be able to bring the child back to school or home without mutual endangerment, and they should know how to work with police or community members.

o Who gets on the phone and calls key people for help? Who do they call, the police or a neighbor or a relative? Does your town or city have a crisis response team for kids? Some do.

o Who should be appointed to communicate with the child? This should be a family member or friend that the child trusts more than the others.

o Can a sibling leave to stay at someone else’s house until things cool down at home? Which house? An escape plan for a sibling can protect them and help them manage their own stress.

o Who should step in and break up a fight? And what specifically should they do or say each time to calm the situation? Believe it or not, your troubled child can often tell you what works best and what makes things worse. Listen to them. It doesn’t have to sound rational to you if it works to calm them down quickly.

o How should a time-out work? Who counts to 10, or who can leave the house and go out for a walk? Where can someone run to feel safe and be left alone for a while?

o What should teachers or co-workers do to calm down a situation and get their classroom or office back to normal as quickly as possible?

Experiences and evidence has shown that a rapid cooling down of emotions and rapid reduction of stress hormones in the brain supports resilience—the ability to bounce back in a tough situation. Your entire family needs resilience, not just your troubled child. A simple crisis plan makes all the difference.

The Troubled Teen Industry – A warning about boarding schools and outdoor camps

*This is a troubled teen in a military-style camp, not an adult military recruit who’s there by choice.*

There is a troubled teen industry out there—boarding schools, outdoor programs, and “boot camps” that are not licensed, not certified, and not experienced with youth with disorders. Maybe you’ve seen the ads that promise to improve your teen’s behavior in the back of a print magazine, or a pop-up ad. They promise that their program will “fix” your child. They promise that your teen will learn important lessons about respect and about following your rules. There are quotes from satisfied parents about how the program saved their teen’s life, but you can’t contact them. The ads claim that staff are highly trained, strict, and caring. The location is usually too far to check out easily, an airline flight away from home, often in a rural area. The cost is outlandish. To help with payment, the program provides financial advice to parents about getting loans and 2^nd mortgages.

It’s a red flag if they –>promise<– to ‘correct’ your child.

You’re a desperate parent and you’ll do anything you can to stop the craziness and get a break. You tell yourself it must be a nice place, especially if it advertises a religious approach*, even though you haven’t seen it in person. The representative on the phone seems to know exactly how you feel and what your teen needs. If you’re desperate, you may not think to ask if the organization is a legitimate behavioral health treatment facility. Many are not!

*Claiming a religious affiliation is no guarantee of a genuine, effective faith-based program.

What to ask:

What is the training and licensure of staff? You want to know if they have therapists with MSW degrees, registered nurses, psychiatrists or doctors, and if a professional is available on site 24/7. Mental health programs are about treatment and stability through medication or therapy, and positive activities with lots of emotional support. Safety must be paramount. Staff must be aware of the types of things that can go wrong and how crises should be handled.

Does the camp or school have a business license in their state? Are staff licensed to practice behavioral health? Do they have grievance procedures?

Is the camp or school accredited as a treatment facility, and by whom? Does it have mental health agency oversight? Are emergency services (hospital, law enforcement) a phone call away? If your child’s mental health is a concern, read “What to know about psychiatric residential treatment.”

punish boy in boarding school — It’s understandable if you’ve “had enough!” and want your child punished, but excessive punishment does not work. (Quote of camp counselor, “If I can’t make a kid puke or piss in his pants on his first day, I’m not doing my job.”)

Can you call and talk to your child when you request? Can you visit? Can your child call you when they request it? Some of these programs limit or disallow parental contact. Why? According to a testimonial at a children’s mental health conference, a young man was used as slave labor at a camp. The staff kept communicating to his mother that he was misbehaving, that he hated her and didn’t want to talk, and that they recommended he stay another 6 months. In this way, they drew out his stay for 3 years.

I’ve heard personal testimony from parents and troubled young people whose condition was worsened by the camp or school, or who felt betrayed by their families. On rare occasions, children have died at the hands of young, untrained staff who thought they were just disciplining the child. Other stories included teens being offered drugs by staff or other campers, or sexual relationships with staff or campers.

Check out the article below. The problems in the “troubled teen industry” are significant enough such that an advocacy group has formed to change state laws to protect youth.

Unlicensed residential programs: The next challenge in protecting youth. –excerpt-

By Friedman, Robert M.; Pinto, Allison; Behar, Lenore; Bush, Nicki; Chirolla, Amberly; Epstein, Monica; Green, Amy; Hawkins, Pamela; Huff, Barbara; Huffine, Charles; Mohr, Wanda; Seltzer, Tammy; Vaughn, Christine; Whitehead, Kathryn; Young, Christina Kloker

American Journal of Orthopsychiatry. Vol 76(3), Jul 2006, 295-303.

According to this article, many private residential facilities are neither licensed as mental health programs nor accredited by respected national accrediting organizations. The Alliance for the Safe, Therapeutic and Appropriate use of Residential Treatment (A START) is a multi-disciplinary group of mental health professionals and advocates that formed in response to rising concerns about reports from youth, families, and journalists describing mistreatment in the unregulated programs. There is a range of mistreatment and abuse experienced by youth and families, including harsh discipline, inappropriate seclusion and restraint, substandard psychotherapeutic interventions, medical and nutritional neglect, rights violations and death.

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You really can turn your child’s future around.

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What will happen in your troubled child’s future?

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Is my teen ‘normal’ crazy or seriously troubled?

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Faith can help, and harm, a family’s mental health

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Stigma is prejudice, and harmful to children

Stigma victimizes the victims

Ideas for what you can do when you’re blamed and judged.

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Things that protect troubled girls from delinquency

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Gang Up on Your Kids: Network with Other Parents to Track Troubled Kids

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Call 911 – Make a crisis plan for your troubled child

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The Troubled Teen Industry – A warning about boarding schools and outdoor camps

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