Category: oppositional defiant disorder

How to respond to a manipulative and difficult teenager

How to respond to a manipulative and difficult teenager

A screaming teenager is a scary thing.

Have hope!

Parents really can learn how to talk to a difficult teenager and reduce fights or frustration, and improve communication.  Below are effective responses to verbal manipulation or accusations from your teen. The right words in the right tone can help you regain your authority and model maturity.

  • WHAT you say and do depends on your unique situation, your teenager, and what the problem is. There may be ‘magic’ words that work for your child but not others.  You’ll want to experiment and modify them over time because your change naturally changes.  It’s up to you to thoughtfully choose which responses below best address your child’s negative behaviors and improve the relationship.
  • HOW you say it may be as important as what you say, because controlling your voice and attitude is a skill you need to be successful. Pulling this off means getting an iron grip on your own feelings and behavior.

1. Identify what goes wrong

Difficult teenagers will sabotage a dialogue for many different reasons.

As an adult, you know about managing emotions, but your teenager doesn’t have a clue and is too young to articulate what he/she really means or needs anyway–and they know it.  Talking with you makes them anxious and insecure, and they may resent your authority.

These are typical argument techniques teens use.  Learn to spot them the moment they come up and plan ahead how you’ll respond.

  • Make excuses – It’s not my fault and I shouldn’t get in trouble.
  • Lie – keep secrets, fake an attitude to avoid the conversation or hide something
  • Exaggerate – revise history or express extreme insult or trauma over minor things
  • “Catastrophize” – assume the worst and that it’s going to be forever
  • Entitlement – I’m unique, I’m superior, what you say doesn’t apply to me, I get things my way
  • Hostility – insults and verbal abuse
  • Overconfidence – I’m exceptional, I already know, you don’t know what you’re talking about
  • Self-pity – I’m broken and no one cares
  • Minimize – make light of others’ needs and feelings, deny their actions have consequences
  • Vague – Guess what I’m thinking/feeling. If you’re wrong it means you (don’t love me, don’t care, are stupid).
  • Silent treatment – I plan to make you crazy by ignoring you –or- I can’t handle this and want to disappear.
  • Keep score – I win and it means I get my way (and you’re stupid).
  • Righteousness – I’m an adult and have rights and can make my own decisions.
  • Pet me – Praise me, flatter me, agree with me or I’ll make you regret it
  • Harp – repeatedly bring up a sensitive issue to get you upset, whine about things long resolved

Don’t waste precious energy fretting about your difficult teenager’s immaturity.  Work with who they are now.

 

2. Prepare yourself emotionally and learn techniques used by therapists

Be more of a witness than a participant

To talk to a difficult teenager, mentally take off your parent hat and become a neutral observer without emotions or bias from bad memories.  This is absolutely critical because you must be able to remove any negative tone in your voice.  Your child reacts to tone of voice more than what is said.  Your feelings are certainly important, but it’s better to be very cautious about expressing them.

Parent can learn therapy techniques when they talk with their teenager.

  • ‘Channel’ your inner therapist like an actor who gets into character. Faking it works, and may even help you be more effective. [check out YouTube videos].
  • Practice quieting your thoughts, and beliefs, and feelings.
  • Remind yourself you are a good, competent parent; trust yourself and your good intent.
  • See strengths, pay attention to what’s great about your child
  • Avoid justifying or explaining yourself. Your teenager can pick up on something you say and use it against you.

In these examples, the parent doesn’t react to the emotions they feel or try to justify themselves.

Reframe – Present a different point of view of the facts, or reveal details that show the ‘facts’ aren’t what they seem.

Teen:  “If I don’t do well in this class, you’re going to punish me by sending me to stupid summer school because that’s all you care about are grades.”

Parent:  “Last year you had the same concerns at the end of the term, and then I saw you focus and pass the class with a really high grade and be really proud of yourself.  I think you will do this again.”

Paraphrase – Say the same thing you heard using different words.  This helps your child know if they said what they really meant, and gives them the option to clarify and provide details.

Teen: “You stupid effing b1tch, you never care what I think and keep trying to control me and I hate you!”

Parent:  “It sounds like you’re telling me you just want to make more of your own decisions. Is that true?”

Use “I” Statements – Always void saying “you” because your child can interpret it as blame or insult regardless of your intent.  Simply owning your feelings or stating your observations doesn’t impose your view and is hard to argue with.

Teen:  “You said you would help me but all you want to do is see me fail. You could care less about me and even my friends think you’re a bad parent.”

Parent:  “I definitely care; I explained the best I could why I can’t afford the time/money right now.  I am frustrated by this situation too.”

Validate feelings and explore why

Teen:  “You didn’t listen to me when I told you my teacher was picking on me.”

Parent:  “Maybe I misunderstood or didn’t think he was treating you differently than your classmates.  I’m listening now; can you give me more details?”

Check the facts

Teen:  “My friends hate me and I don’t care about them anymore.”

Parent:  “What happened?”

Teen:  “They all went to a movie and I wasn’t invited, and told everyone else what a great time they had.”

Parent:  “Wasn’t that the day you lost your phone charger?  Could they have tried to contact you but your phone was dead and you never got the message?”

Reflect on the bigger picture

Teen:  “School sucks.  It’s never helped me and everyone there is an a55hole and I already know what I need to know anyway.  Don’t try to make me go.”

You:  “OK, school isn’t working for you. Do you have plans if you drop out? a job or a class for a new skill or occupation?  You are growing up and will be on your own someday, and you will want your own money.”

Deescalate a heated moment without placing blame or accepting blame. You might apologize or change the subject or end the communication.

Teen:  “Stop f**king treating me like you’re my therapist!”

Parent:  “I’m sorry that it feels that way.  I’m not your therapist but a parent trying to communicate with their son/daughter the best they can.   I need to check my messages so we’ll talk about this later.  Make yourself some tea and we’ll get back to this later.

Other ways to deescalate:

Take a time out so you and your difficult teenager can calm down and gather your thoughts.

Converse via text, even in the same house, even in the same room.  No talking, only texting.  This works surprisingly well.

Talk to your teenager through a door, you do not need to look at each other, and perhaps your teen feels safer in another room.

 

3. Improving is more realistic than fixing

It helps to lower your expectations of your teenager.

The goal is not to stop your difficult teenager’s challenging behaviors but teach them how to be appropriate with others.  How you talk to your difficult teenager only needs to be healthy, which is not necessarily comfortable.

A healthy conversation means both parties:

Feel heard and understood even if there’s disagreement

Feel safe because they expect no emotional assaults

Feel enough trust and to talk again later

 

4.  Pay attention to what improves or wrecks a conversation.

Visualize yourself as a wild animal trainer trying to teach an uncooperative creature to perform a task. You try various techniques and expect the animal to resist.  You keep trying until the resistance diminishes, and then you start supporting with positive feedback.  Some of the techniques below will work; some will fail spectacularly.  When you find those that work, mix them up or your difficult teenager will catch on and try other tactics.

Let your difficult teenager rant for a while.  Teens often vomit out emotions regardless of how they sound or if they make sense and parents don’t need to respond.

Ask why and how. Explore the underlying cause by using simple questions that can’t be answered with Yes or No to help them identify and articulate what they mean and need.

Redirect.  Change the subject, or have a pre-planned list of actions for ending a tough dialogue.

  • DEFLECT for manipulation and button-pushing:

“Consciously ignore” (pay attention but mentally or physically withdraw)  – Pretend you didn’t notice when he/she resorted to blaming, demanding etc.

Change the subject – ask what they want from the grocery store; ask if they remember an upcoming event

Escape – excuse yourself for the bathroom.  Say you forgot to call someone back who left an important voicemail.

  • SUPPORT for anxiety, whining, and obsessive thoughts:

“We’ll get through this together;” “I am looking after you.”

Confidently reassure, and point out what’s going well.

Deny false charges against you without explaining, just state the fact.  “I did not say that;” “I am not accusing you…”  Period.

Apologize immediately when guilty.  “You’re right.  That was not the right thing to say and I apologize,” nothing more.  You may be guilt-tripped into apologizing multiple times, so say something like: “I apologized and it was the right thing to do.  I haven’t done it again and won’t apologize again.”

Set simple boundaries like you might for a fussy young child.  “You can get angry and run to your room, but you can’t slam the door.”  Remember that anger is normal, but harm is not acceptable.  Screaming is normal, but ugly insulting words are not acceptable.  Depression and sadness is normal, but isolating is risky–they need to be in the presence of others.

No offering reasons or lessons.  Conflict is not a teachable moment.  Your teen absolutely cannot reason when they’re flooded with emotion.  Trying to teach something can seem patronizing and disinterested in their concerns.

Appeal to a higher self:  During a fight or argument, listen carefully for something your child says (without prompting) that reflects good values and character, even the tiniest teensiest thing.  Incorporate their stated good values in all your communications.

 

5.  Help your difficult teenager think about their future

Help your teenager think about their future.

You may have tried to motivate your teenager to think about their future, but ultimately your teenager takes responsibility for the details.  T

his helps:  Provide a list of open-ended questions, worksheet-style, which they answer for themselves.  Examples:

  • What do I care most about?
  • How can I feel better when I’m upset?
  • How can I cope with boredom?
  • What am I good at?
  • What are three things I’m most thankful for, why?
  • Who do I trust and why do I trust them?
  • Where do I see myself in 5 years? How will I get there?

Ideally they share their answers with you but this should be optional.  If you do see them, absolutely avoid guiding or correcting answers even if you think they’re wrong!  The point is to start them pondering and exploring.  If they write “kill myself” or “run away” or “use drugs” —they already know what you think—but they may be reaching out for help with statements like these.  You can ask what they really mean or offer are other options.  For threats of self-harm, see “Use the “S” word:  talk openly with your child about suicide.”

PATIENT PERSISTENCE.  Results aren’t quick so pace yourself for a marathon

Teens are innocent and pure in a way adults are not.  They have standards and values though it rarely seems that way.  Look for evidence of decency and caring of others or self.   Show appreciation for the little things they do even if your praise creates a backlash.  They WILL remember what you said someday.

Parents should know that even a difficult teenager will love them.
Remember this…
Teenagers can make a parent feel like they've been stabbed in the heart, but it's only words..
…when they do this.

 

Good luck.

 


You can find additional practical and common sense approaches to parenting here:  Solid Wisdom For Parents Of Troubled Children And Teens

How to manage defiance and oppositional defiant disorder

How to manage defiance and oppositional defiant disorder

Troubled children and teenagers who are pathologically defiant have a brain condition with many possible causes or diagnoses.  Whether they are overtly aggressive or “passive-aggressive,” parents have options for reducing symptoms of defiance and limiting the stress they bring into the household.

anterior cingulate gyrus
In a healthy brain, the pink region doesn’t light up quite like this when a person is confronted with a limit or rule. A healthy child starts considering options and ways to work around.

If your child is defiant to a degree that affects their life functions, this is what’s happening in their brain.  The pink color of this curving central region indicates intense electrical activity.  This is the brain scan of a 13-year-old boy with severe oppositional defiant disorder (ODD).  Hyper-charged activity in this region can also be responsible for obsessive compulsive disorder (OCD), unstoppable rages, pathological gambling, chronic pain, and severe PMS.

It is called the anterior cingulate gyrus (ACG), which allows a person to shift attention to different subjects and think flexibly–something defiant kids don’t do well.  Nor do they regulate emotions, something the ACG also does.  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.

Typical traits of children with oppositional defiant disorder.

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

Unrelenting defiance is a true disability that negatively affects a child’s life and future.  I’ve seen highly intelligent defiant or ODD diagnosed children experience academic failure or enough suspensions or expulsion to hold them back a grade.  This is a can’t-win-for-losing path that really sucks, doesn’t it?

Two different psychiatric approaches to defiant behavior and ODD

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

The attention deficit approach uses therapy in combination with medications, such as Straterra (chemical name is atomoxetine), Ritalin (methylphenidate), Risperdal (risperidone, an antipsychotic), Adderall (amphetamine) and Depakote or divalproex (a mood stabilizer).  This is not a complete list because new compounds are being formulated to reduce side-effects.

The depression & obsessive-compulsive approach combines therapy in combination with serotonin-based antidepressants such as Prozac (fluoxetine) or Zoloft (sertaline), and Anafranil (clomipramine, for anxiety). Again, this is not a complete list.

Treatment must also include holistic or ‘lifestyle’ approaches.

These are absolutely essential.  No amount of medication or therapy will help a child whose physical body is in poor shape!  The brain is an organ too, like the heart or liver, and needs the right nutrients and oxygen delivered through the blood.

  • avocadoEat brain food that includes nutrients and minerals listed in these articles:  The best vitamins for your child’s brain, and The brain diet for troubled kids.
  • Avoid foods that cause mood extremes and limit cognitive functions (such as memory and processing speed) such as:  food fried in oils other than olive oil, refined sugars and starches (flour, white sugar), saturated and hydrogenated fats, diuretics like caffeine, and any other foods that have dyes or nutrients removed by processing (for example, apple filling in pastry instead of actual apples).
  • Get more sleep and exercise – these have an immediate and direct impact on brain health!  In even one day, a brain will under-perform if there’s been inadequate sleep or exercise.  Sleep restores brain function and memory, and exercise pumps oxygen to the brain and causes the release of positive hormones and neurotransmitters.
  • Drink water (sports drinks are OK too if they don’t have caffeine)

Defiance and ODD often include symptoms of other disorders

  • 50-65% of defiant children also have ADD or ADHD
  • 35% 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 also have learning disorders

Anthony Kane, MD 

Other conditions can cause oppositional defiant disorder

  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, resulting in rapid ups and downs of sugar in the blood
  5. Systemic lupus erythematosus, Wilson’s disease
  6. Side-effects of 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
  7. Autism spectrum disorders
  8. PANDAS – an acronym for a strep infection-caused disorder that can make a previously normal child violently resistant.  (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections)
  9. Dehydration

If your child has these traits, it will be easier to reduce defiant or ODD behavior

  • 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.

Choose your battles
Let’s face it, consistently enforcing limits isn’t possible 24/7.  It’s exhausting.  Take a break; let some things go.

Parenting that works for ‘normal’ children does not work for defiant children or teenagers.

First, be kind to yourself; this is hard.  Get enough sleep, maintain your supportive relationships (spouse or partner, children, friends), schedule breaks and getaways, and guard your physical and emotional health.  Don’t expect quick results because success may take weeks or months. 

Address just one issue at a time, then strengthen yourself for running a marathon.

Find something positive to do together.  Your child needs for closeness and appreciation and joy, like everyone.  Ask your child what positive activity interests them most, or try new activities until one brings about a good chemistry between you and your child.

Praise is a powerful tool for managing disruptive behavior.  Make an effort to inject positive energy into your relationship with your child or teen.  It’s likely that this relationship has become mostly negative over time.   Caution: don’t expect thanks when you praise your child.  They are typically self-absorbed and not thinking about you.

Set limits – “Consistent limit setting and predictable responses from parents help give children a sense of stability and security.  Children and teens who feel a sense of security regarding the limits of their environment have less need to constantly test it.”
–Webster-Stratton and Hancock, Handbook for Parent Training, 1998

ignore childActively ignore – 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 a temper tantrum, whining or sulking, baiting or teasing, or making continuous demands or loud complaints.  Pretend you don’t care and even turn your back if possible.  Give attention only after their behavior is ending or over.

Make the behavior uncomfortable.

  • Example:  If your kid swears, test them, “C’mon, you can do better than that, be creative, I’ve heard all those things before.”  They can get frustrated when they aren’t getting the reaction they want from you, and defy you by giving up.
  • Another example:  Your teen refuses to get out of bed for school.  Don’t nag or repeat, repeat, repeat.  Remove the bed covers and set them far enough away that your child has to get out of bed to retrieve them.  (“Managing Resistance,” John W. Maag)

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

Use reverse psychology: it’s a good kind of manipulation.  Insist or pressure your child to do something they think you don’t want them to do, so they will defy you and do it… which is indeed what you wanted in the first place.  Pretend to agree or disagree with a behavior or choice so that you get the outcome you want.

A mother I know did this with her 14 year old daughter who’d threatened to cut off all her hair and self-tattoo her face.  The mother said she “went ballistic” over the idea of her daughter’s beautiful hair being cut (she knew it would grow back, whereas a tattoo would be permanent).  The results were exactly what the mother wanted.  Her daughter totally butchered her hair, and the tattoo idea never came up again.

Offer unexpected rewards – On random occasions, reward appropriate behavior with something they like.  They are more likely to do a desired behavior if they expect something they want and aren’t sure when it will be offered.

Redirect their attention.  If you’re entering a situation where you know your child will become defiant, distract them.  Make yourself a list of actions or behaviors you can do that are distracting during times when their defiance should not be tolerated, such as when there’s a threat to safety.

Keep your power. Claim your throne as ultimate decision maker and boundary setter.

Don’t treat your home like a democracy or try to be fair and equal.  Be a benevolent dictator.  A troubled child should not have an equal say in how things are done.  To keep your authority and power in the household, tell your defiant child that you’ll listen and consider compromise, but make no promises.

Never justify your decision or provide reasons.  Reasoning does not work; it only promotes endless arguments. As your child ages into adulthood, an adult child will continue to require limits, and limits will still need enforcement. To a parent, it will feel like you’re treating your adult offspring as a child. YOU ARE and you should be, and this is the interesting part:  they won’t notice.

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 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, throw this down, too.”  (Child stops throwing books in defiance.)

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

  • Teen:  “I hate you f- -king b- -ch!”
  • Parent:  “Sounds like you’re really angry.”
  • Teen:  “Shut up you stupid 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.  I feel this is stressful for both of us, so let’s take a break and talk about it later.”
  • Teen: F—k you!  I’m not talking to you ever.  (Well that’s not true, but they may ‘defy’ you by avoiding the behavior.) 

Call their bluff.

  • Child:  “I’m going to run away!”
  • Parent:  “OK, if you do, call me, and I’ll bring your stuff and maybe a snack.  Here’s the runaway hotline phone number if you don’t want to call directly.”  Then walk away.  If they do run and call, you’ll know where they are and can fetch them or call the police.
  • Child:  I’ll kill myself!  (This rarely true if shouted in anger and defiance. Your child may be throwing out threats to see how you react and get you to back down.)
  • Parent:  “If you really mean that, this is serious and means we need to get you to a hospital!  Let’s get ready and go because you need to get assessed.”

Warning, once you make progress regaining authority and reducing defiance, a honeymoon phase will be followed by a huge backlash… but this is a good sign! 

It’s proof your work is having an impact.  Extreme resistance to behavioral change is a common response called an “extinction burst;” see diagram below.  Pressure builds because it’s exhausting to try and control an urge to misbehave, and they eventually explode.  This as predictable so plan ahead.  The extreme “burst” is evidence the ingrained behavior is ending or going extinct.  There may be more bursts that test your resolve.  Eventually, your child likely stops defying at least one rule.  Pick the most critical behaviors that need extinguishing and keep up the effort.  Eventually, they back off again, and the pattern continues until it’s just not worth it to defy these rules anymore.

extinction burst

–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.

Some rules for you

Don’t blame your child.  It’s easy to think they’re being bad on purpose because they’ll act like it, and show amusement when they’re bad or belittle you. Keep in mind that their behavior is no one’s fault, and your child would not choose to behave like they do if they understood what it meant.

Don’t ignore other challenges that might be responsible for their behavior.  They may face bullying at school, lack of sleep, or stress from things at home for example.

teenage mouse
Seriously, defiant teenagers think this way, and can’t see the obvious right in front of them.  I got this cartoon from a therapist who treats teenagers with criminal convictions, who are required by juvenile court to get counseling.

Always enforce your rules as immediately after the fact as possible.  Why:  If enforcement comes later or only occasionally, the child does not connect the broken rule with the punishment. They really don’t, even when you explain it quite clearly.

Don’t direct anger at your child.  If you do, apologize.

  • They can use your reaction against you, and tease or bait you to get you angry again
  • Don’t model that anger is an OK response to stress.
  • Do model that apologies are a proper response

Avoid explaining and justifying rules. Defiant children and teenagers are not able to reason once their emotions take control. They will only resist harder and pelt you with arguments. (What’s interesting is I’ve observed parents trying to reason with young children (4 or 5), too young to be reasonable in the first place, or with young adults (early 20’s) who have a long track record of being unreasonable.

Don’t interpret everything as pathological defiance or oppositional defiant disorder.  Some rebelliousness is normal for children.  It’s especially so if parents are over-controlling.

Don’t keep trying the same things that still don’t work.  Like yelling or repeating yourself over and over (Don’t be embarrassed; we’ve all done this).

It helps to lower your expectations for your child’s behavior and progress.  What you want may be totally unrealistic, and more than you and your child can handle.

I once saw a bumper sticker that said “I feel much better now that I’ve given up hope,” and found it strangely comforting. 

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.”  Is this really what you want?

Two training approaches that help parents like you: 

Parent Management Training:  this is an intensive educational program that has been proven to help parents handle extremely difficult children, including those defiance and ODD.  PMT teaches parents precisely how to assert consistency, keep interactions predictable, and promote pro-social behavior in their child.  A good explanation can be found at this link: Encyclopedia of Mental Disorders.  Examples of parent management training include:  the Total Transformation and the Incredible Years.

Collaborative Problem Solving:  CPS teaches how to negotiate with a defiant or resistant child.  This may seem like giving in, but it depends on how one negotiates or comes to a compromise.  If defiance is a result of something the child needs but can’t express appropriately, a CPS approach helps the parents hone in on the  underlying need, which may be simple and easy to address.  A great place to find out more is on the Think:Kids website.

Find the energy and doggedness to be consistent, and the compassion and forgiveness to be nurturing.
This is a heroic endeavor.


If you would like to get ongoing updates on the latest news and research in child & adolescent mental health, follow my Facebook Page.

What to know about psychiatric residential treatment

What to know about psychiatric residential treatment

residential centerHave 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:

copy

  • 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.

  • residential programsMental 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.

“You’re under arrest!”: Crime and Troubled Teens

“You’re under arrest!”: Crime and Troubled Teens

You’ve tried everything. Now you watch helplessly as your troubled teenager starts down a path leading to jail, and you wait for that call from the police. There’s been a crime. It finally happened like you thought it would.  But this bad news can be good news. This may be the point when things start to turn around.

“Experts estimate that from 40 percent to 70 percent of youth in the juvenile justice system suffer from some form of mental health disorder or an illness – anything from ADHD to full-blown psychosis. About 15 percent to 25 percent have mental illnesses “severe enough to significantly impair their ability to function.”” (see “Mentally ill minors put in juvenile hall” at end of this post)

Juvenile crime is considered as serious as adult crime, and juvenile “detention” is just like jail for adults. Yet there is one critical distinction between teenage and adult justice: teens are given a second chance for a clean record and an education.  If your jurisdiction is enlightened, they will get treatment for mental illness or addictions. An adult criminal record is forever a barrier and an embarrassment. It comes up when a former convict applies for a job, a loan, a college degree, military service, a rental, or even a volunteer opportunity.

The juvenile justice system is only partially punitive because society recognizes that the teenage brain is the problem that causes much crime, whether or not they have a mental disorder or addiction.  Enlightened juvenile court judges want their rulings to be “rehabilitative” or “restorative” justice. Enlightened agency directors understand the need for additional support services for learning disabilities, addiction, mental illness, and vocational training.

In the system, teen criminals (“adjudicated youth”) are required to participate in consequences and treatment; it’s a “carrot and stick” approach.

  • The carrot:  The teens attend school and receive training for vocations such as car repair or catering.  They participate in positive character-building activities such as training dogs for adoption, building and maintaining hiking trails, or constructing homes for Habitat for Humanity.
  • The stick: Teens have a complete lack of freedom, whether in detention or out on probation, intensive monitoring (including random urinalysis), immediate consequences for behavior violations, and physical labor to pay back victims (community work programs).

When a police officer calls to say your son or daughter has been arrested, use this as an opportunity to help your kid. It’s a perfect teachable moment. Not only do you have their attention, you can hand the problem over to the Law to enforce their behavior and treat their disorders or addictions. Your son or daughter cannot refuse—when held or convicted on criminal charges, your child has no rights to anything except humane treatment and an appearance before a judge. You are off the hook. You can step back and relax… and be the Good Guy for once.

How to work with the juvenile justice system:

  • Be an active partner with the court. Cooperate fully with the judge, court counselor or therapist, and any attorney, case worker, or probation officer involved.
  • Show up for everything:  visitation, family therapy, court hearings, and parenting classes even if you don’t think you need them.
  • Stand shoulder-to-shoulder with staff.  If your teen has a probation officer, do what they tell you, even if it means tattling on your kid.
  • Be cooperative with staff, and they will work harder for you and your son or daughter. Support the programs required for your teen, and support your teen when they struggle. Your involvement will someday impress on your child that you’re on their side and care.
  • Change your ways.  If you’ve been too harsh with your teen in the past, go easy on them now and let him or her see your good side. If you’ve been too easy on them or too protective, demonstrate backbone. Show you know what’s best for them and that you will remain in charge once they are released.
  • Stick with your child.  If your teenager becomes a Frequent Flyer in the system, it doesn’t mean they are lost.  Remember, they have that uncontrollable teenaged brain and need more time and lessons for it to reach maturity.

Once they come home on probation you need to set strict limits on their activities, and work with the probation officer or social worker to enforce them. These are harsh at first, but should be negotiated later when behavior improves, with consultation with the juvenile justice staff.

Remove risks:

  • Don’t allow them to stay out late ever. Set an early curfew, and report them to their probation officer if they are late.  When they get angry about this, explain that you are bound by the law and that they should discuss their concerns with the officer.
  • Not negotiable: ban drugs and alcohol, especially marijuana. (“Marijuana is uniquely dangerous for troubled teens”.)  Hide prescription drugs and alcohol if you use them. You have the right to search their room and belongings.  If pertinent, hide weapons, matches, or other means of harm to themselves or others.
  • Stop or limit contact with risky friends. This may mean monitoring visits, monitoring cell phone use and internet access, or blocking access entirely if used for crime.
  • Limit access to money to prevent drug/alcohol purchases or escape plans. Get receipts if necessary.
  • Reduce free time. Busy them with as many activities as you can–a job is the ideal.
  • Build your own network of other concerned parents to track your kid… in other words, to spy on them.  Besides other parents, I even contacted businesses where my teen was known to hang out, such as a mall and cafe.  See  “Gang up on your kids: Parent networks for tracking at-risk children.”

Three Goals:
     1)   stay at home
     2)  stay in school
3)  stay out of trouble

Three House Rules:
     1)  continue mental health treatment
     2)  no violence when upset
     3)  clean body, clean clothes

Build their esteem as you would for any troubled child. Guide them to their strengths. Give your teenager something to do that they good at, and allow them ample opportunity to shine. More at  The good things about bad kids.

Extreme measures. I know of three cases where parents took drastic steps to help their son or daughter stay out of trouble, and these worked!

True story – a single father was worried about his son’s gang involvement, especially since the son was still on probation for a crime, and additional charges would draw lengthy prison time. Dad sold the family home and bought another one in a neighborhood ‘run’ by an opposing gang. The son was terrified to leave the house except for his new school, a long way from his gang brothers. This son graduated high school and left the area for college… alive, uninjured, and with a clean record.

True story – After a couple of years trying to keep their daughter out of trouble, parents started looking for work in a smaller town.  They wanted to find a safer place with fewer risks and more eyes. After she completed her mandated one year probation, the family moved.  She was upset to leave her friends, but they were the problem friends. Her crime sprees ended.

True story – a single mother was on the edge of sanity and financial ruin trying to manage the world her son created.  While visiting a juvenile justice counselor with her son, the counselor made an off-hand comment about handing him over to foster care so that she could get her job back and sleep at night.  With a heavy heart, she went forward and obtained a “voluntary placement” for him (temporary state custody), and he went to a foster home.  After two years, he was ready to come home and she was ready and empowered to support him.

A note of caution:  You may have seen ads for outdoor programs or “boot camps” for at-risk teens. Some of these programs are extremely inappropriate for troubled youth, even traumatizing. Or some may not allow teens with a criminal history. Get advice about therapeutic programs for your at-risk teenager from a counselor or social worker, not just from the program itself.  Your teen’s providers often know which ones are appropriate.

The people in the Juvenile Justice System

In my personal experience, 99% of employees in juvenile justice are there because they care about teens, they like teens and “get it” about them, and they believe in the power of what they do. My co-workers have many success stories among their cases. Some former delinquents come back to work for the juvenile justice system and use their hard-won experience to help the next generation.  Ironically, it’s the one job where a criminal record helps!

If you are concerned about what your child will experience in the juvenile justice system, just call and ask.  You may be surprised.

Challenges, risks, and potentially serious problems

  • A troubled young person in detention or incarceration is exposed to others with criminal behavior. They may bully or be bullied or both.  They may meet fellow inmates to sell drugs to when they get out, or learn who can supply them with drugs. Depression is common, and presents as anger or self-destructive behavior, such as getting in trouble on purpose.
  • Not all juvenile departments provide mental health treatment, or treatment is inadequate.  And sadly, there are still places where staff and citizens don’t believe in the mental health “excuse” for bad behavior.  You may need to be an assertive advocate for treatment.  Work with your child’s public defender, who is provided by the court, and give them evidence of mental health problems in  medical records.  Your child will need to sign a waiver for the attorney to have the records.
  • Some states have Mandatory Minimums–pray it’s not yours. Certain crimes lead to long prison sentences regardless of the circumstances of the crime or the mental illness of your child. My state of Oregon will incarcerate anyone over age 15 for seven years if they commit one of these crimes. This made sense to the voters who put it into law, but the reality is a worst-case scenario for how NOT to rehabilitate youth.  No one I’ve ever met in our state, from judges to prosecuting attorneys to sheriffs to probation officers, thinks it’s a good idea–the outcomes have been horrible for reasons too lengthy to go into here.
  • Each county and state has a different culture and attitude towards juvenile delinquents. Some are exceptionally harsh, or they neglect the kids’ legitimate needs; some are reluctant to treat kids like individuals with different needs and strengths; some get that right balance of punishment and rehabilitation. It depends on the judges, the county, and the state. Each is different.

Is your child at risk from criminal involvement or charged in a crime?  Please comment so other parents who read it can learn from your experience.  Thank you.

How am I doing?  Please rate this article above, thank you.

–Margaret


Mentally ill minors put in juvenile hall (excerpt)
Daily Bulletin, Mediha Fejzagic DiMartino, June 12, 2010

“Juvenile halls have become catch-all basins for severely mentally ill youth.  Designed as secure holding facilities for minors who are going through the court system, juvenile detention centers now double as a default placement option for youth diagnosed with schizophrenia, bipolar disorder or major depression.   “There is no place for them in [our system],” said a county juvenile court judge in California.  “We can’t just arrest our way out of the problem. Juvenile hall is not a place to house mentally ill.”