Category: borderline personality disorder

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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Take this parenting skills test if you have a troubled child

Take this parenting skills test if you have a troubled child

So how are you doing in your difficult parenting job?  Score your parenting skills on a test designed for parents of children ages 11-15.  This is intended for parents of ‘normal’ children, so you may skip 5, 6, and 7. (If you are brave, have someone else score you too and compare results.)

Parenting Skills Test – printable form

Don’t be hard on yourself if you score low.  Only a “perfect” parent will have an excellent score… and they wouldn’t need to read this blog!

What did you learn?  What are the skills where you scored lowest?  Focus on them.  Troubled kids need to be parented differently.  What you’ve learned by watching skilled parents may not apply to you.  You might be thinking:  “I agree these are good parenting skills, but practicing them is impossible with my child. They hate/defy/scream/fill-in-the-blank constantly.” Suggestion:  Work on one skill at a time, and take the test again in few weeks to see if you’ve improved your score. 

Be and kind forgiving of yourself if you score low

When my child was young and I was stressed, I would have had a low score and fallen in the “Keep trying” group.  My child’s mental health so poor, and she was so at-risk, I could only focus on safety and live one day at a time.

Why 3 of the items don’t apply for parents with mentally ill children, IMHO

#5  “I let natural consequences do the teaching whenever feasible.”  In my case, natural consequences could always be serious and unsafe.  This would have been very unwise.
#6  “I am confident my child has everything she/he needs to make good decisions.”  No way.  They cannot make good decisions when they are irrational–that’s the problem.
#7  “I allow my child to do his/her chores without reminding.”  I gave up on chores.  It was one battle I didn’t have to fight.  It was much easier doing them myself and knowing they’d be done.

Please add a comment if you have found other skills to be effective,

–Margaret

What to know about psychiatric residential treatment

What to know about psychiatric residential treatment

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

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

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

What to ask about the staff:

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

What to ask about programs:

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

Body health is brain health, and vice versa.

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

Is your child emotionally safe as well as physically safe?

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

What to ask about the business itself:

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

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

Good luck.

 

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

Support Your Child or Teen’s Recovery From a Disorder or Addiction

Support Your Child or Teen’s Recovery From a Disorder or Addiction

What recovery looks like – A person with a mental or emotional disorder who is in “recovery” lives a normal life and aren’t affected by their disorder.  They look and act normal.  At the very least, they have stable relationships, a steady job, a place to live, a regular diet, cleanliness, and regular mental health check-ins.  Recovery is maintained when the person pays attention to themselves and notices if their symptoms are starting, and then takes action to stop the symptoms.

Recovery is like the alcoholic who stops drinking–they still have an addiction, but they stop using.

What your child will need to sustain recovery as an adult:

INSIGHT  +  STABILITY  +  RESILIENCE

Insight – self awareness

Insight allows a child to recognize they have a problem, and choose to act to avoid the problem.  If insight is not possible, they need a toolbox of options that help them to respond appropriately, instead of reacting to chaotic messages in their brain. Knowing and admitting they have a problem, or knowing techniques for avoiding problems, are very powerful skills they need as adults.

Stability– fewer falls or softer falls

Your child is like a boat that’s easier to tip over than most other boats; any little wave will capsize them, and everyday life is full of waves, big and small.  Your job is to notice when the troubled child is starting to capsize and show them how to right the boat, or if that doesn’t work, how to use the lifesaver.  Eventually, your child will learn how to sense when trouble is coming on, avoid the thing that causes problems, and ask others for help.  Sense it.  Avoid it.  Ask for Help.

Resilience– bounce back when they fall

Troubled children have a much harder time bouncing back from problems.  They have extreme responses to simple disappointments like breaking a toy, or poor grades, or something as serious as the parents’ divorce.  Some even fall apart in joyous times because the emotional energy is too much!  You must be acutely aware of this–they will not get back on track by themselves.  Don’t worry that helping them will spoil them or “enable” them.  Eventually they will learn from you how you do it.

“…We are all born with an innate capacity for resilience, by which we are able to develop social competence, problem-solving skills, a critical consciousness, autonomy, and a sense of purpose.”

“Several research studies followed individuals over the course of a lifespan and consistently documented that between half and two-thirds of children growing up in families with mentally ill, alcoholic, abusive, or criminally involved parents, or in poverty-stricken or war-torn communities, do overcome the odds and turn a life trajectory of risk into one that manifests “resilience,” the term used to describe a set of qualities that foster a process of successful adaptation and transformation despite risk and adversity…”   http://www.athealth.com

Mental illness is more deadly than cancer for teens, young adults

Mental illness is more deadly than cancer for teens, young adults

Why isn’t everyone more upset?

A disease is killing our children and it’s more deadly than cancer and leukemia!  Did you know it was mental illness?

Out of curiosity, I did some research on child mortality rates from various causes because I wanted to know how death from mental illnesses compared with other fatal illnesses of childhood and adolescence. The results were astonishing, unexpected, and disturbing.

Look at the highest bars in this graph. They are 3-4 times the height of average cancer and diabetes rates in children. There are gaps in the available data, but this simple comparison is disturbing.

* The starting point for the mortality rates of medical illnesses was the website for the Center for Disease Control and Prevention www.cdcp.gov  in Atlanta; the starting point for the mental illnesses was the website for the National Institute for Mental Health, www.nimh.gov.

** The suicide data was from those with depression, bipolar disorder, schizophrenia, and psychotic disorders-unspecified.  (Suicide from other mental health causes, such as borderline personality disorder and co-morbid substance abuse is also prevalent, but I could not find data for children to young adult age ranges.)

On suicide:

  • It’s often normal for children and young people to think about suicide, but just in their imagination. They might consider it during some painful time in their lives, but there are no plans made or steps taken.  When the difficult times are over, they don’t think about it any more.
  • Young people with early onset mental illness can’t endure much stress; thoughts of suicide recur over time, starting as early as age 6 or 7.  These children are vulnerable to repeated intrusive suicidal thoughts because they live with a combination biological, psychological, and social/relationship causes (called “biopsychosocial”).  More about this is explained here: “Use the “S” Word: Talk with your Child about Suicide.”
  • There are ‘fast’ and ‘slow’ suicides in young people.
    • The ‘fast’ ones are 1) direct self-harm that has been planned, or 2) spur-of-the-moment suicide due to an extreme emotional reaction to a single intolerable event (examples: a boyfriend/girlfriend or best friend dies; a teen has a serious fight with a parent and (without planning) wants to ‘get back’).
    • The ‘slow’ suicides result from a persistent pattern of harmful behaviors that eventually lead to death.  Young people struggling with anorexia can die by heart failure or other causes due to their weakened body.  Others abuse substances and/or participate in extremely risky activities that expose them to multiple lethal situations:  overdose, criminal environments, disease.

The chart above screams out for a changes in attitude, policy, and investment in children’s mental health treatment and suicide prevention.  I had no idea that death rates from mental illness could be 3 to 4 times higher than most cancers and leukemia.  It is imperative that young people with mental health issues receive as aggressive and sensitive treatment as is expected and demanded of medical systems that treat cancer in children.

 

Parents: talk about this. Talk to your child; share it on social media; and talk to mental health organizations about what you can do.

The data on mortality rates for mental illnesses was difficult to find, and it required searches in many different medical journals and websites.  I chose to use the data on cancer, leukemia, and diabetes because the mortality rates from these are high and because deaths from all other causes were insignificant by comparison (motor vehicle accidents are the one exception).  In this graph, the death rates for cancer and leukemia are averages for the different forms of each, and in the medical journals they were presented together.

I welcome additions or corrections of this data from any other sources, and encourage readers to investigate this for themselves.

–Margaret