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How to talk to a difficult teenager – what to say and do

How to talk to a difficult teenager – what to say and do

Have hope!

Parents can learn how to talk to a difficult teenager and reduce arguments and negativity.  There are good responses for when you and your teenager fight or argue or get stuck in the same negative communication patterns, but there are three very important principles to consider.

  • What you say and do depends on your unique situation, your difficult teenager, and what the problem is. There are no magic words or actions that work for every teen.  It’s up to you to experiment–discover which responses fit your child’s behaviors and customize them.
  • How you say it will determine success or failure. Doing this well means you must have an iron grip on your own feelings and behavior and not be a parent.
  • Improvement takes time. Pace yourself for a marathon.

1. Identify what goes wrong

Difficult teenagers typically sabotage dialogue when they experience mental and emotional overload.

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.

Circle your teen’s most common sabotage techniques (below) and address one at a time. Learn to spot them the moment they come up, and plan ahead how you’ll respond.  You should not tell them what you are doing because it will only feel like blame or insult.

  • 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.

2. Prepare yourself emotionally and learn techniques used by therapists

Be a quiet witness, not 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; just don’t allow yourself to express them.

  • ‘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:  “I hear you telling me you want to make more of your own decisions.”

Use “I” Statements – Avoid 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 want to be around them ever.”

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 stay.”

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 temporarily.

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.  Can you go make yourself some tea?”

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. Accept the limits

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

You may have tried to motivate your teenager to think about their future, but ultimately your teenager takes responsibility for the details.  This 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”, don’t push back—they KNOW what you think—you might ask if there are other options.

Teens are innocent and pure in a way adults are not.  They have standards and values (unless they are a sociopath).  Look for opportunities to appeal to these values.

Remember this…

…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

Borderline children – how they function and how you can help

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.  Or they create a toxic work environment.  Or they drive away good friends, hate them for leaving, and suffer from loneliness.

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.
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.”

Advances have been made in recent years.  One study tracked borderline patients who had been hospitalized at least once over a 10 year period.  With follow up treatment  “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 borderline 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.

For specific examples of what your borderline child will say and for how you can respond, see: How to talk with your difficult teenager – what to say and do.

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 son 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, their son continued with bullying and verbally abusing his siblings right in front of those cameras, and he would get caught and deny it each time.  His denials in the face of clear evidence became a great source of private amusement for his parents.

Be patient – You are unlikely to receive your 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.

Never expose your heart like this!  Armor yourself emotionally.  Visualize those knives as fluff balls, or visualize your child as a toddler with a just another temper tantrum.  Find something that works for you and help the co-parents and siblings armor themselves too.

Address your own PTSD! Families who live with a borderline child 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 untreated borderline personality disorder in adulthood

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 borderline child with each of these aspects!

  • 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 borderline child’s future around.

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Welcome

Welcome

This website is dedicated to helping parents and caregivers of troubled children, teenagers, and young adults.  Use the search box to explore articles or read trending articles, and find information about how to manage challenging behaviors.  You can do this–your skills really can improve your family life as well as that of your child.

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.

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.

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

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.

  • Eat 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.

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

Actively 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.

–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.

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.


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The best vitamins for your child’s brain

The best vitamins for your child’s brain

The vitamins listed here are absolutely essential for your child’s brain, and it’s highly likely your child doesn’t have enough.  People with psychiatric disorders commonly have physical problems that are symptoms of vitamin deficiency.  Take digestive problems, for example–low levels of B vitamins cause digestive disorders, especially B12.

“One of the most common deficiencies seen in patients with mental disorders is B vitamins”*

B1 – Thiamine helps neurons to send electrical signals.  A proper level in the blood stream wards off depression. B1 is found in beans, asparagus, beef, oranges, sunflower seeds, oats, and green peas.

B2 Riboflavin is also needed for neurons to send electrical signals.  B2 is found in sunflower seeds, fish, poultry, bananas, leafy greens, and sweet potatoes.

B6 prevents memory loss, improves memory, and helps reduce depression, and increase hemoglobin in the blood which supplies oxygen to the body and brain.  B6 is found in sunflower seeds, fish, poultry, bananas, leafy greens, sweet potato

B9 – Folic acid helps in formation of nerve tissue, or the neurons in the brain.  B9 is found in spinach, asparagus, beans, avocado, lentils, and broccoli.

B12 is needed for the myelin sheath that covers and protects neurons, and signs of deficiency are bowel and stomach problems. Probiotics for gut health are helpful, but so is sufficient B12.  It is found in seafood, eggs, cheese, leafy greens, milk, and red meat.

All vitamins are best obtained through food, not pills.

Vitamin CAscorbic acid regulates the production of neurotransmitters like dopamine, and protects the brain against oxidative stress, which is when there are too many “free radicals” (one kind of chemical), and too few “antioxidants” (another kind of chemical).  Vitamin C is found in citrus, tomato, kiwi, strawberry, mango, pineapple, cantaloupe, and green vegetables.

Calcium is an actual nerve cell messenger.  It controls how signals pass between neurons.  Calcium is found in dairy (milk, hard cheese, and yogurt), sardines and salmon, beans and lentils, almonds, collard greens, tofu, and figs.

Magnesium is essential for many chemicals in the brain and body. It promotes the metabolism of B vitamins as well as signal transmission between neurons.  Magnesium calms people.  It is found in nuts, pumpkin seeds, black beans, avocado, brown rice, and leafy green vegetables.

Zinc helps regulate the electrical signals between neurons.  It is found in pumpkin seeds, beef, shrimp, nuts, chocolate, wheat germ, and oysters.

Vitamin D is essential because it directs the production of neurotransmitters, nerve growth, and nerve connections.  Lack of Vitamin D is a common problem in people with psychiatric disorders.  (Did you know that ~75% of individuals who are hospitalized for mental illness have severe Vitamin D deficiency?) The best forms are from egg yolks, milk with vitamin D, and sunlight.  Supplements have some benefit, too.

See the list of brain foods in this article, The Brain Diet for Troubled Kids.

“Essential Vitamins and Minerals for Brain Function”


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What hallucinations are like, from those who know

What hallucinations are like, from those who know

If you care for a child experiencing hallucinations but don’t know what it’s like, these first-hand accounts may help you better understand and support your child.


This writer is taking medications, which help, but do not fully eliminate the hallucinations.

“The reason my thoughts inaccurately capture existence is because my understanding of existence is different insofar that I have to daily navigate through illusory experiences.

How hallucinations look/sound

“They look like I am looking into another dimension, their bodies fade into the background, but they sound real.  I can tell that it is from another dimension but cannot distinguish it from other normal people’s realities because my reality is all I know.

“In general I find my experience with hallucinations unfavourable because they make other people in this reality quite distant.  Learning complicated tasks is a hundred-fold more complicated for me to manage than regular people.  I literally am disadvantaged by the hallucinations in the academic sphere, but seem to thrive with the hallucinations in other ways such as long distance walking and jogging.  People should NOT interact with me when I am hallucinating because when I am hallucinating, it means I am being overpowered by another dimension and can’t understand what is going on anyway.

“If family members and friends are concerned about my wellbeing they should encourage me in a positive way to do different projects on my own like reading books about subjects that interest me or go on long excursions like long distance walking and jogging.  Heavy exercise seems to alleviate paranoia and negative thought patterns like being suicidal or angry with others.”

–By Anonymous 1, who lives with schizoaffective disorder


This writer responded to questions I asked.

1. How would you describe visual/auditory hallucinations to someone who has never experienced these? What do you see/hear?

I often see people’s faces and gestures twist up and look and act angry. I hear my name a lot. I see people hiding and running to avoid me catching them and [people] watching me.

2. How do they look or sound? 

Angry, abnormal colored skin, and strange upsetting body language.

3. Can you tell when you are hallucinating while it is occurring?

Sometimes…I don’t always notice right away but there have been times when I knew it wasn’t real.

4. Do you like or dislike hallucinating?

I do, because I feel like God is reaching out to me to protect people from evil.

5. How should someone interact with you if you’re hallucinating?

Calmly, if the situation has highly intense feelings and reactions I could go into a panic attack lasting 1-3 days.

6. What should loved ones do or not do if you’re hallucinating but they are concerned about your welfare?

DON’T :

-> Never raise your voice or let yourself become agitated

-> Try to take control of the situation

-> Take anything personally

DO:

-> Hand me things I can hold in my hand for centering (leaves, rocks)

-> Remind me of the people who care about me

-> Be honest with me if I ask how realistic it was

–By Anonymous 2, who lives with schizoaffective disorder


This is a first-hand account drawn from the SARDAA newsletter (Schizophrenia and Related Disorders Alliance of America).

Somewhere around the age of 17 or 18, I noticed that I was not feeling quite right mentally.  Things were confusing, not making any sense, and I started losing my sense of connectedness.  I started drinking to cope and became an alcoholic when I entered college.

Anyway, I got sober by entering treatment and Alcoholics Anonymous about a year later.  I was exhilarated, although things still didn’t seem to be quite right.  I felt lost.  About 14 months into my new life, I decided to find some meaning to my existence.  While on a trip with an acquaintance I noticed things were really quite different.  The leaves in the wind seemed to be talking to me.  Cloud formations had special meanings.  Television and radio shows were talking about my life.  And I thought I could read peoples’ minds and communicate with them without speaking.  I thought I had found what great spiritual leaders termed “being spiritual.”  I truly thought I had been blessed by God and that I had a direct pipeline to Him.  I felt happy and scared at the same time.  I was in a different world.

About one week later I decided to travel out to the West Coast to really find myself, given this new-found power.  While traveling, it seemed like God’s voice entered into my thoughts and told me to do something if I wanted real peace and power in my life.  That being, to run my car off the road and leave the rest to Him.  I did this only to find no peace, but a totaled car and a trip to the state mental hospital.

Since that time, I’ve been dealing with a disease called schizophrenia.  It has been an uphill struggle.  At the time of this writing, I believe I’ve found a way to pull myself out of psychosis and feel connected like before the alcoholism and schizophrenia.  Today I feel peace, own a thriving business and have a wonderful relationship with my wife.  We’re in the process of planning a family.  This has been accomplished by the philosophy of Schizophrenia Alliance, Alcoholics Anonymous, and a few special people in my life.


Readers, what does your child experience?

Do any readers have a child (of any age) who can describe what they’re experiencing when their mental health is poor?  Please share in the comments section, or if you wish to stay completely anonymous, please contact me and I will add your child’s story without any identifying information.

Back to School: Tips for the Transition

Back to School: Tips for the Transition

Starting school after a summer vacation triggers behavioral problems in many troubled children and teens.  A rocky start can result in problem behavior for a couple of months.  Your child does poor academically during those months, and their behavior primes teachers to treat them differently.  This guest article by Eileen Devine, LCSW, breaks down the issues and offers solutions for parents.


Back to School: Tips for the Transition
Eileen Devine, LCSW

It’s that time of year again—back-to-school sales at all the stores, school emails and supply lists, fresh questions about new teachers and new classrooms. The summer break is winding down, which for some brings relief at the idea of returning to more structured days (with some respite for parents and other caregivers).  For others,transition into school brings the dread and stress of educating a new teacher on our child’s unique way of being in the world, bracing for what seems to be inevitable challenges inherent in our child’s experience of school.

Wherever you fall on that spectrum between relief and dread, there are things you can do as a parent to begin building a new foundation of collaboration with your child’s teacher. Set up a goal for everyone that leads to a successful school year.

To Disclose or Not to Disclose

Many children with brain differences (trauma-induced, biologically based.) might appear to be “neurotypical” or normal, causing their brain-based disability and related challenges to go unnoticed.

Teachers often don’t recognize the symptoms of your child’s disability and interpret them as disrespect, defiance, lack of motivation or laziness.

Parents with whom I routinely work will struggle with when to disclose that their child has a brain-based disability that makes seemingly simple tasks incredibly difficult.  Parents are worried about the impact this disclosure might have on their child, that the stigma accompanying various diagnoses will cause negative ramifications.  (See “Teachers and Stigma – Judging and Blaming Families“)  The stigma is real, and yet with this reality in mind, my challenge to a parent is always this:

What will the impact on your child be if you choose not to disclose?

How will you advocate for them?

If you don’t disclose, how will your child access the accommodations they so rightfully deserve, based on their brain-based disability?

If your child is not fully understood by those who interact with them each day, the ability for your child to having meaningful and positive relationships with school staff is greatly diminished. I always advise pro-active planning (early disclosure) vs. waiting for a problem to occur, which can force the disclosure under less-than-ideal circumstances.

Getting Clear on Brain Tasks

When was the last time you gave serious consideration to exactly which cognitive skills or brain tasks are especially difficult for your child? We often can pinpoint the situation or recall the event where it occurred, but what brain task was involved that sent your child into a meltdown or a fit of rage?

Does your child get “stuck?” Does your child’s thinking limit his or her ability transition without substantial support? Do they get trapped in verbal or behavioral loops? Are they unable to initiate an appropriate activity independently, even one that you know they love?

Does your child only see black and white? Are they cognitively inflexible, and respond to everything as, now or never, right or wrong?

Do they have difficulty processing sensory input? If so, what types of sensory input are especially challenging (noise, bright lights, crowded spaces, smells)?

Does your child struggle with social and emotional skills? Do they act younger than they are, and are they still learning what it means to think of others, empathize, share, and compromise?

Is their verbal communicating “off?” What do you know about the limits their brain has turning thoughts into speech?  How would you describe their memory and recall challenges?

Teachers and other school staff need specific answers so they can appropriately treat your child.

As parents who daily experience challenging situations with our child, we usually have no difficulty articulating what event or situation “set our child off” or caused them distress. But if we can take a step back and link it with brain function, we gain an essential piece of the puzzle in terms of how to understand our child in all environments and situations.

Taking the step back, making the list of brain tasks and then translating them for others—teachers, para-educators, administrators, bus drivers— is essential for these professionals and their ability to be pro-active in their approach with your child.

I clearly remember my own first steps up the steep learning curve of trying to understand an individual with brain differences from a neurobehavioral perspective. It was challenging. I needed reminders and re-teaching. I needed to be gentle with myself when I failed to parent differently, and needed support in doing it better the next time around.

Teachers are on their own steep learning curve with this approach. It’s often not taught in education classes or offered in professional development sessions, leaving educators unprepared or ill-equipped to see children from this lens. There are ways we can help bring the information together for teachers in a concise, but comprehensive way, to help them understand what it means for our child to struggle with those identified brain tasks.

Write a succinct summary of what brain tasks your child has the most trouble with and translate what this looks like in the classroom. Then explain what works to help.

For example, for a 9-year-old child who is experiencing “dysmaturity” (a gap between the developmental age and the chronological age) might be emotionally closer to age 4.  One might observe:

Johnny’s social behavior is frequently younger than his chronological age (as much as 4-5 years younger). Because of this social and emotional developmental gap, he can sometimes be seen as irresponsible or ‘acting like a baby;’ this is what it looks like when he is much younger developmentally. Remembering that he’ll benefit (and be safest) when understood as being a younger age than he appears, will help prevent development of frustration, personalization and anxiety for Johnny.

For LaQuisha, the 11-year-old in fifth grade:

LaQuisha is a very good listener, but she listens slowly (think: ten-second-child in a one-second world). She will often say “I don’t know,” or “What?” because she cannot maintain or track the typical flow of classroom conversation. Slowing down and giving her space between sentences works for her. Giving her prompting questions or other visual cues before the instruction or classroom discussion begins will allow her to participate more fully in what is being discussed.

For Miranda, who is 13 and in middle school:

Miranda struggles with memory and recall, which makes changing classrooms throughout the day— each with its own teacher and differing set of rules and expectations— overwhelming for her to manage. She will benefit from visual cues and reminders from each teacher about those rules or expectations, which she can keep at the front of each section in her binder for that particular class.

For Omar, who is a 16-year-old in high school:

Omar has significant challenges related to executive functioning as a result of his brain-based disability. One of the ways you will see this in the classroom is when he is unable to initiate a task on his own (freezes up or gets stuck) and he may need additional prompting and support to get into the assignment at hand. He also experiences difficulty forming links, such as hearing instructions and then transitioning into doing the expected task (hearing into doing), seeing instructions for a writing assignment on the board and then translating that into writing on a paper (seeing into writing), formulating his thoughts and then verbalizing them (thinking into talking). He will experience success in your classroom if it is understood he needs more time and support in this area.

Always describe your child’s strengths too, not just their limitations.  Suggest how a teacher can help your child be successful by building on things they are naturally good at and enjoy.

From the Flipside – Tips from a Teacher

Many of these ideas are formulated from the perspective of a parent preparing for a child to return to school, but what about the teacher’s perspective? What suggestions would a thoughtful, experienced special educator have for parents and children about to shift into back-to-school mode?

Kelly Rulon is a teacher I’ve come to know through her work with our daughter. She’s been teaching special education for seven years, working across multiple schools and districts. She’s a strong believer in research-based systems and instruction. In her experience, with those in place, every child can be educated in their neighborhood school, without restrictive placements.

Here’s what she had to say, from a teacher’s perspective:

I know that transitioning back to school can be a time of great anxiety, both for parents and kids. A little preparation can go a long way. Here are a few things that can help your student get emotionally ready to return to the routine of school:

  1. Set aside time for an intentional conversation about the return to school. Ask your child what they are excited about for the year, as well as what might be causing feelings of nervousness. It’s a wonderful opportunity for you to connect with them. As a teacher, I love hearing about these things too! It really gives everyone the chance to begin the year with a strengths-based approach, as well as an idea of potential struggles. Knowing about these feelings early on helps to get folks on the same page, and to get some proactive strategies in place.
  2. The looser, less-structured routines and schedules of summer can be fun, but moving abruptly from that to school day schedules can be hard. Help your child gradually get back into the school routine ahead of the first day of school, be it bedtime or wake-up time or meal time. This will help with that exhausting transition back to school. (I know I’m asleep before my head hits the pillow those first few weeks back!)
  3. I always invite my students to come for a short visit to the school during the week of in-service, before school begins. It’s a busy time for teachers as we’re prepping away for Day 1, but a short, informal visit helps me establish positive, low-stakes contact with challenging students and families. This may not be the case for all teachers— and I have many colleagues who have wonderful family relationships without this meeting— but it’s worth an ask if you think your child could benefit from a preview.


A book I like is by Diane Malbin
, “Trying Differently Rather Than Harder.” It is an easy-to-read resource on the neurobehavioral approach. Although specific to FASD (Fetal Alcohol Spectrum Disorder), the information applies to other neurobehavioral challenges. Buying your teacher a copy of the book and highlighting sections that are particularly reflective of your child is a wonderful way to expand understanding of your child.


As Kelly suggests above, before school begins, but when teachers have returned to prepare their classrooms, contact the school and request a 30-minute introductory meeting with the teacher(s). Use this as an opportunity to set the stage for collaboration and provide the teacher(s) with the concise-but-comprehensive write-up you’ve thoughtfully prepared. This is not the meeting to go into your child’s extensive history or to detail their previous challenges in school. Keep it short and positive, making it clear that you’re there to be a source of support in how to work with your child. If you know your child has a “honeymoon” stage at the beginning of the year, be upfront about that, so the teacher is not blindsided by it. If you know your child typically has a rough transition back, but then settles into the routine after a certain amount of time, let the teacher(s) know this, too, and suggest ways you can work together to support your child through the anticipated rough patch.

Bringing it all Together

Transitions are hard, and from my experience working with parents who have children with brain-based differences, the back-to-school transition is often one of the hardest. My final suggestion is for you, as the parent, to make your own plan for self-care. Focus the plan on what you will do to take care of yourself as you gear up to support your child through this potentially intense period. Rally the troops you have around you to help buffer some of the stress. Be clear with those closest to you about what you need during this period to make it through without burning out.

If you have a thoughtful, well-considered plan in place for you and your child, if you’re positive, clear, supportive and realistic with your child’s teacher(s), and if you’re able to place your child and their needs at the center of the conversation, the transition back to school doesn’t have to be simply a rewind of previously challenging transitions.


Eileen Devine, LCSW, works in Portland, OR as a therapist supporting parents of children with special needs. She is also a consultant for families impacted by FASD (Fetal Alcohol Spectrum Disorders) and other neurobehavioral conditions through her private practice, FASD Northwest, working with families nationally and internationally. She lives with her husband and two amazing kids, one of whom happens to live with FAS (Fetal Alcohol Syndrome). For more information, visit FASD Northwest.

Unsettling: What psychosis looks like in children and young people

Unsettling: What psychosis looks like in children and young people

This eerie painting is by a young woman of 22 diagnosed with schizophrenia. She is encountering a threat, real or imagined, and her paranoia is compounded by being watched from the window above. Note the symbolic references to communications links and satellites.

Odd, eccentric, a little weird:  people experiencing psychosis are living in dream space.  If you haven’t experienced psychosis yourself, it’s a little like the period just before you awake, when you’re in a dream but also aware of your surroundings.  Your dream and emerging consciousness weave together in a wonderful or horrible or simply odd narrative.  If you try to explain it someone, you realize it makes no sense, yet it made a lot of sense while you were dreaming.

To a parent watching a psychotic child, you may observe that they see, feel, hear, move about, and respond to you as if fully conscious, but it’s important to know that they simultaneously inhabit the subconscious. As a result, they don’t notice that what they do and think is any different from anyone else.  The term “anosognosia” refers to their inability to recognize this, and it explains why so many resent being told they have a problem and need treatment.  They simply aren’t aware that anything is different about them.

Evidence of psychotic behavior

Parents of a child who was eventually diagnosed with a psychotic disorder often report that their child was always a bit different from their peers–slightly eccentric, a unique individual who had an interesting way of looking at the world. Parents have also reported the following behaviors when their child was exhibiting psychosis.  (Not all of these are present in each child.)

The most common diagnoses that have psychotic features are schizophrenia, schizoaffective disorder, bipolar disorder, and depression.  This story about schizoaffective disorder gives some real world examples of psychosis:  “Life with a Schizoaffective Teen.”

Psychotic behavior can have a long slow onset

The image on the left is of a 15-year-old boy with early onset schizophrenia. The purple regions have normal neuron density, red regions have low neuron density. In the 2nd image, the red area at the top of the brain is in the cerebral cortex, the region of executive function and rational thought.

It’s easy to miss signs of early psychosis! Sometimes a child or young person starts showing eccentric behaviors that aren’t serious or are easy to interpret as something else: creativity and imagination; immaturity; puberty; influences from immature friends; too much video gaming…  Your child may have been experiencing mild visual or aural hallucinations for some time, even a couple of years, and just assumed it happened to everyone so they never reported it.  As psychosis emerges in the early teens, their thoughts and behaviors start affecting friendships or school work.  The child stops doing things they once enjoyed.  Someone might assume they’re experimenting with drugs.  They seem so much like other difficult, distracted, or defiant teens that a parent can be lulled into thinking they are not seriously mentally ill… but psychosis is very serious.

If this describes your child, immediately (and I mean immediately) find a psychiatrist and get an assessment.  The earlier you can treat psychosis, the better the outcome for your child.  Psychosis is degenerative.  The longer a brain stays in a state of psychosis, the more neurons it loses.  Early treatment via therapies, medication, diet, and other physical supports can literally prevent neuron loss and future psychotic breaks that require hospitalization.

Psychosis can emerge abruptly

For disorders on the schizophrenic spectrum, this is common in young men in the late teens and early 20’s.  However, adults in their 30’s and 40’s have also been known to have sudden onset of psychosis.  It’s tragic, you witness this young person launching into adulthood, studying in college or starting employment, and suddenly his or her personality changes.  Their behavior worsens, and it becomes evident they’ll never be able to have the future they planned.  They need immediate treatment, possibly hospitalization if the psychotic break reaches a crisis point.  If this is your child and they are past age 18, use every means possible to get help for them!

Self-portrait by a 24-year-old woman diagnosed with schizoaffective disorder. Her image is a modified mug shot photo taken of her after an arrest.

What worsens psychosis and what you can do to relieve it

Help your child get enough hours of sound sleep. The best sleep environment is a cool very dark room.  Once my child became unable to attend high school, I allowed her to nap any time of the day.

Your child needs mental and sensory stimulation to keep their mind from spinning out on their obsessions, hallucinations, and paranoia, but the amount must be tolerable.   Stimulus must come from the tangible, sensory world (e.g. not screen time, videos, books).  Concrete interaction with reality diverts their attention from obsessive thoughts or voices.  They will benefit from regular (perhaps limited) social interaction*, an undemanding therapy animal, creative work (such as art and music), and being out in nature.

CBD in marijuana has many medical benefits and is considered safe, but the THC is not.  THC is also addictive, and available in very highly concentrated oils… extremely dangerous.  Like THC, any addictive substance, from alcohol to methamphetamine, will interfere with treatment for psychosis.  The drug’s influence trumps everything. Drugs are literally self-induced psychosis.  See:  “Marijuana is Uniquely Harmful to Troubled Teens”;  “Marijuana is Dangerous.”

In every way possible, keep your child away from any material, people, or messages that upsets them.  These only add gasoline to the fire and increase the likelihood of future psychotic breaks.  They may obsess on the same things for the rest of their lives.  If someone who’s psychotic is exposed to intense emotional experiences that feed their obsessions and paranoia, people have been known to do to horrible things to themselves or others.  An example at the time of this writing is of a young woman with psychotic bipolar mania who tragically pulled out her own eyes.

Find ways to redirect your child’s attention elsewhere and help them get a grasp on the reality.  Help them calm down (“deescalate” them) and help them learn ways to calm themselves down.

A diagnosis of an illness that includes psychosis is devastating

Psychosis and/or a psychotic crisis in a child who previously led a normal healthy life blindsides everyone, especially the family.  Allow yourself to go through the stages of grief as you would after any death…  because it can feel like the ‘death’ of your child and their future and your hopes for them.  Get help from others as you would after any death.  Here you are, grieving, but your child needs you to be strong!  Get help for your own mental health.

Reason for hope

Children who receive regular social support from family and loved ones do well over the decades.  They can avoid homelessness, hospitalizations, harm.  They can get advanced education, keep strong relationships, maintain employment.  They get a life of wellbeing.  This has happened with my adult child after years of horrendous experiences.

Cognitive Enhancement Therapy

A relatively new therapy has been developed and tested that meaningfully helps people with chronic psychotic disorders.  “CET attempts to increase mental stamina, active information processing, and the spontaneous negotiation of unrehearsed social challenges. It does so with a focus on enhancing perspective taking, social context appraisal, and other components of social cognition… CET has been shown to have remarkable and enduring effects in a study of persons with schizophrenia or schizoaffective disorder…”
–CET Training LLC, “approved and recognized by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) as an evidence-based practice.

What are your experiences?  Have you found anything that helps?

–Margaret

*Social Interaction Increases Survival by 50%
Psychiatric Times. July 30, 2010

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

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


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Welcome to the 911 Club for Parents of Troubled Kids

Welcome to the 911 Club for Parents of Troubled Kids

You may already be a member of the 911 Club, a community of parents who depend on emergency services for managing their mentally ill child. Our T-shirts are black and blue like bruises. Only people raising a mentally ill child or young adult join. Club rules are simple:

1. Focus on safety first.
2. Continually manage the trauma you and your family experience.
3. Accept that no one is guilty or a failure.
4. Ask others for emotional and physical help.

Every day, an emergency is just around the corner.

Parents with troubled children, no matter the age or diagnosis, are forced to make difficult decisions and take extreme actions… like calling 911.  It’s not something they choose, and they’ll avoid it if possible.  They are like any other parent with a severely disabled or physically ill child—they will do anything to help their child, but instead of wheelchairs or chemotherapy, they need emergency responders.

Ten things that parents of troubled children often do:

  1. Call police
  2. Call an ambulance
  3. Call a crisis line repeatedly
  4. Search a child’s room, especially if the child is a teenager or may be suicidal
  5. Spy on their child: read their email, texts, social media or search histories, read their journals
  6. File criminal charges or get a restraining order
  7. Lock up common household items (matches, knives, scissors, fuel, chemicals, and anything conceivably dangerous in the wrong hands)
  8. Participate in endless meetings, appointments, and therapy sessions. Complete dozens of forms and continually pursue financial or community mental health resources
  9. Block out people who used to be friends, block their child from troubled friends
  10. Never share stories with ‘normal’ people to avoid bombardment with uninformed and unsolicited opinions.


Parents can see an emergency coming, but can do little to prevent it.

All parents of troubled children have barriers to getting help, even when it’s blatantly obvious that the child needs it.  Why?  The aftermath of a recent high school shooting in Florida by provides details:

  1. The tragedy has to happen first: “A neighbor warned the sheriff’s office …and begged them to intervene. She was told there was nothing deputies could do until Cruz actually did something.”
  2. Mental health professionals don’t take history into account; and they are ignorant that children can behave well in their presence: “An investigator … spoke to Cruz, and advised that he was “not currently a threat to himself or others” and did not need to be committed.
  3. Family and other eyewitnesses are ignored by the people and institutions they depend on. “Lynda Cruz’s cousin warned deputies Cruz had rifles and pleaded for them to “recover these weapons.”


Policymakers, mental health professionals, and emergency responders out there:  fix this!

Part of the reason parents or family of the mentally ill person can’t get timely help is because of civil rights laws.  To those in the mental health community, start talking about how to handle this.  The present situation is unacceptable!  Stop protecting an acknowledged dangerous person’s rights over those of innocent victims. It’s not OK. This is just like some gun advocates who think it’s more important to sell assault rifles to protect their personal rights over those of innocent victims.

True Story

An upsetting thing happened in my city about 10 years ago that could have been my story. A man took his grown son to the emergency room because the son had been insisting he was going to stab someone—he suffered from untreated schizophrenia. When there, the staff found no reason to hold the son despite his history of violence and his father’s testimony. The father pleaded with them to put his son in a 72-hour hold and they refused.

Within minutes, the son ran off into the surrounding neighborhood, and within an hour, had stolen a steak knife from a restaurant, and ran out and stabbed a man walking on the sidewalk. (The victim lived, fortunately.) The father told the reporter that he’d been trying every possible means to stop this from happening in the hours before the event. Getting the son to go with him to the ER was an extraordinary feat in and of itself. He was beside himself with frustration and sadness and anger.  Now his son had aggravated assault and attempted homicide charges, and faced prison instead of a hospital.

–Margaret

U.K. needs to be a “999 Club”; Germany needs a “112” Club; a “110 Club” in China…

School Shootings, Guns, and Child Mental Illness

School Shootings, Guns, and Child Mental Illness

Up until recently, news of devastating school shootings swerved to public fights about gun control.  I had hoped past shootings would stimulate discussion of mental health treatment (see Guns and Mental Illness: the Debate from a Parent’s Perspective,” written 5 years ago in 2013). After this recent shooting in Florida, it now is.  But be careful what you wish for.  Mental illness is on the radar, but the subject swerved off into mental illness as a significant lethal threat to the public.  (I think this is compounded by a morbid fascination with psychopaths. The lurid TV series “Criminal Minds” plays to this–the entire plot line equates mental illness with psychopathy, torture, and murder.)  Damn it.

Look at the raw numbers below.  Shouldn’t the other deaths caused by children’s mental illness be on the table too?

Deaths by school shootings in elementary, middle, and high schools in the U.S.:

2000-2018 – Deaths by school shootings: 110 children*

2000-2018 – Foiled attempts at school shootings: 19 schools*

Child deaths by suicide in the U.S.:

2014-2015 – Between the ages 10-24: 17,304**

2013 – Suicide by firearm between the ages 10-19: 876***

*(Wikipedia, based on contemporaneous news reports)
**National Institute for Mental Health (latest available numerical data)
***Centers for Disease Control and Prevention (latest available numerical data)

Effective advocacy for preventing suicide (via mental health treatment) requires effective ‘marketing.’

Parkland, Florida, image from metro.co.uk

I wonder about the marketing aspect–the campaign that tells a gripping story that motivates others to act.  Let’s compare:  School shootings are public tragedies, with images of ambulances filmed from helicopters, and wrenching quotes from the anguished.  But suicides happen alone; they are private self-inflicted tragedies.  No helicopters, no candlelight vigils.  People keep their distance.  Money doesn’t pour in to support the victim’s family or increase the availability and use of treatment.  And then there is this awful irony:  if vulnerable children hear the news of a peer’s suicide, it risks suicide contagion.

Maybe the activism of the student survivors in Florida are symbolically opening a door.

Dublin, Ireland, in 2014, irishtimes.com

Maybe there’s a way if victim’s families and friends are willing to tell their anguished stories, too.  I don’t know how it feels to be you–my child made suicide attempts but didn’t succeed (insert deep sigh of gratitude here).  How do you feel about telling your stories to cameras in a large group?  Could you carry signs with photos of your precious lost ones?  or bombard the Twitter-verse to get to the hearts of the public?

Be prepared for the next round of horror, and be prepared to go public.

Our mental health professionals have been warning the public and lawmakers about the magnitude of child suicide for years–the psychiatrists and psychologists and all the other caregivers.  But they use facts, which don’t count in the public eye, whereas personal stories do.

Your comments are encouraged.

–Margaret