Category: suicide

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

How to Handle a Child’s Mental Health Crisis

How to Handle a Child’s Mental Health Crisis

You can sense there will be a crisis long before it happens. You have days when you’re so concerned about your child and family (and work and responsibilities) that you can’t think straight.  You can’t even spend time on little things like chatting with a friend or reading a magazine.  Your intuition says it’s only a matter of time and you won’t be able to handle it.

Before this happens, make a Crisis Plan with these priorities in order:

  1. Safety for everyone comes first
  2. Stabilization and treatment for your child
  3. Stress reduction for the family afterwards
  4. Lessons learned

What constitutes a mental health crisis?

  • When something dangerous has happened or is likely to happen because of a child’s behavior, words, plans, or triggering events that they experience.
  • Anytime a child’s behavior leads to harm or imminent harm to the child or someone else (including pets), or significant damage to property. Harm also includes emotional harm, threats, running away to unsafe places or doing unsafe things.

Trust your gut and trust your intuition.

Examples of a crisis when you must act

  • Watch. Pay attention to evidence your child has plans for suicide, which may include seeking dangerous items; or making multiple references to hating life; or they have a worsening mental state, or there’s been a prior suicide attempt.  Try this: “Use the “S” word: talk openly with your child about suicide.”
  • Look for increasingly troubled behavior over time that leads to extreme behavior:  non-stop raging, assault, repeated running away, threatening, talking about strange things, or spending too much time alone.
  • Pay attention following a traumatic event, such as someone else’s suicide or a newsworthy major tragedy. These can trigger a child to act dangerously on thoughts they already have.
  • The child runs away while psychotic, or depressed, or with a dangerous person–perhaps another troubled child–or under the influence of drugs or alcohol.
  • Psychosis of any kind including hallucinating or hearing voices; odd ideas; extreme agitation, anxiety, or paranoia; or a belief they have special powers.

The Crisis Plan

Have a crisis plan for home, school, and any other place where the child spends time.  For some, it’s also the parents’ workplace.  If a child is in college, a student adviser or someone in the campus health clinic needs to be a contact for checking in on your child.

Plan A:  call 911. You will not be bothering the police or emergency responders!

Plan B:  Answer these questions

For a runaway.  Who gets on the phone to call 911, and who goes out to look for the child and bring him or her back without mutual endangerment?  Both should know how to work with police and other community members.  There is no waiting period in a missing person’s report.  Check this article for what to say in call and do when police arrive. “How to work with police once you’ve called 911.”

Note: children have been known to behave perfectly once the police arrive, and police sometimes implicate the parents as having the problem. Don’t let this bother you.  You have demonstrated to your child that you are willing to call the police, and you’ve asserted your authority.  You might point this out to them–another episode of extreme behavior will be countered with significant action on your part. Use a neutral tone and avoid making this sound like a threat!

Who else knows your child and is trustworthy: others parents, businesses, teachers, their friends?  Are any of them able to assist you with talking to your child or keeping them safe?  Can any them help you “hold the fort” while waiting for an emergency responder?  Build a support network in advance:

Who gets on the phone and calls for extra assistance?  And is there a list of phone numbers?  Does your town or city have a crisis response team for kids?  What about a crisis line run by the mental health authority?  Check.  They are there to help.

Who should be appointed to communicate with the child?  This should be a family member or friend or teacher that the child trusts.  Communication with the right person can solve things fast, but with the wrong person can backfire, even from a parent… perhaps especially from a parent.

Who should step in and break up a fight, physical or emotional?  And what specifically should they do or say to de-escalate a situation spinning out of control?  Think about this:  your troubled child can often tell you exactly what works best and what makes things worse.  Listen to them.  It doesn’t have to sound rational to you as long as it works.

How should a time-out work?  Who counts to 10, or who can leave the house and go out for a walk?  Where can someone run to to feel safe and be left alone for a while?  What are the emotional safety rules for when the time out ends?  How can you and your child trust each other enough not to upset a fragile stability?

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

Can a sibling stay at someone else’s house until things cool down at home?  Which house?  Sibling(s) can benefit from an escape to a friend’s house to protect them emotionally until a crisis has passed.  Ask them.

Teamwork

Think of your family and support network as a team that springs into action when someone sounds the Red Alert that your child is in danger.  Talk to family members and friends or neighbors ahead of time and give them an assigned role.  Let each should know they will be backed up.  This will be tremendously reassuring.  Your child’s crisis will be an upsetting event, but reasonable people will pull together when they know what’s going on and what they should do.  “Gang up on your kids:  Parent networks for tracking runaway children

Experiences and evidence shows that a rapid reduction of stress is effective at reducing the emotional wounds of a crisis.  Rapid cooling down of emotions, or “de-escalation,” is what prevents or limits the fallout from a crises.  You and your family can develop de-escalation techniques for bouncing back in tough situations.  The goal is “resilience.”  More than anyone, families with troubled children need resilience.

After the crisis

Everyone gets a mental health break.  This could be anything:  a day off, eating out, ice cream, going out for a movie…  Do something to get everyone back to an OK place and on their feet.  There should always be a reward for bravery, team work, and a job well done.

Next time it happens

There will be a next time.  A troubled child will be fine for many months and you’ll be so relieved, and then WHAM.  Use a previous crisis as a learning experience.  What can be done better next time?

Your long-term goal is to reduce crisis frequency over time, or prevent them from happening in the first place. 

Many parents have taken these steps to prevent a crisis or limit its severity.

  • Communicate directly with a police officer or precinct, school counselor, or juvenile justice official to explain your child’s legitimate mental health disability and your willingness to cooperate. Build a working relationship with them.
  • Locks on doors: a sibling can protect him or herself and their belongings; a parent can protect belongings, prescriptions, valuables, and money.
  • Track via technology – Track where your child goes and what they see online, and let them know you are doing this. This is legal.
  • Track via eyes and ears on the street – Befriend or build trust with your child’s friends, their parents, their teachers, neighbors, and businesses where they hang out.  Ask for a report if they see or hear something of concern. They may not be able to do anything but just report.
  • Search the child’s room for evidence of unsafe behavior, anything from razors for cutting themselves, harmful substances, porn, weapons, unusual ‘stockpiles’ of stuff (lengthy explanation goes here… just trust your gut if something is out of place). Room searches in your home are legal, but keep them secret and avoid acting on other things you find that aren’t 100% related to danger
  • Lock up dangerous items even though it’s inconvenient for you–kitchen knives, weapons, alcohol, drugs and prescriptions, matches, etc.
  • Lock up money, credit cards, and valuables. With money in hand, your child is on a path to victim-hood or association with people with criminal behavior. For example, they can buy drugs and alcohol from inappropriate people who then rob or assault them.
  • Confront people who undermine your authority. This is often a friend’s parents or other person who thinks you are abusing your child (because your child has told them so). They ‘rescue’ your child and offer safe harbor, and actively help them run away.  This is completely against the law, and they are subject to police action and criminal charges.  People who do this do not have your child’s safety in mind.

Extreme measures

There may be times when, for reasons of safety, you may to do things you are uncomfortable with while you wait for police, ambulance, or friends to arrive.  These are things parents have done in a crisis:  tackle a child and hold them down; or trick a child to get in a car and then have someone hold them down until they arrive at an emergency room (commonly needed in rural areas).  The way to avoid the risk of being charged by your child with abuse or assault is to have those open relationships with the authorities, teachers, and other parents who know your situation.  A letter from a doctor can be really important here.  I was glad I had one.

There will be fallout if you use force or trickery. Your child will not accept your reasoning or the necessity for your actions.  You can truly apologize for upsetting your child but without admitting guilt. Instead, ask what they want to happen next time they are in a crisis.  You should also honestly reassure them you will never use extreme methods again unless there is a safety issue.

To recap:

  • Trust your gut
  • Act immediately
  • Follow a plan that includes others working as a team
  • Take care of everyone afterwards
  • Prepare for extreme measures
  • Retain your authority as a parent by establishing supportive relationships.

You can handle this!

 

–Margaret

Your bullied child has legal rights to protection and safety

Your bullied child has legal rights to protection and safety

 

Edith Castro Roldán, Oscar Manuel Luna Nieto

Violence and Bullying at School

There was a time when bullying was not talked about or noticed.  Being bullied was explained away as a right-of-passage.  Finally, we hearing horror stories about bullied children, and speaking out as we remember our own awful experiences. The statistics are alarming.

According to the National Center for Education Statistics, during the 2013-14 school year 65% of public schools had recorded one or more violent bullying incidents. That year alone totaled about 757,000 incidents, which means there were about 15 crimes per 1,000 students during that school year alone. The schools record specific kinds of violent incidents and of those that occurred in 2013-14, 58% of public schools reported there had been at least one physical attack without a weapon or a fist fight. About 47% of the schools reported at least one threat of physical attack without a weapon.

The threat of violence in today’s schools is real.
Are you and your child prepared?

Now is the time to prepare yourself and your child for school violence and bullying. Know what steps you need to take and educate your child about the situations presented and how to respond to bullying or school violence. Remember, knowledge is essential in protecting your children and yourself from being a victim of school violence.  Parents and teachers have options for stopping bullying.

There are several kinds of bullying in today’s advanced world. While technology may be a great advancement, it also has its downfalls. While there was a time you may have thought of bullying as taking someone’s lunch money, calling them names, or pushing them around, there are many other kinds of bullying in our technologically advanced age.

What Happens at School Happens in Cyberspace

There are many kinds of bullying that can happen at school. While physical bullying, verbal bullying, and vandalism and theft still exist, cyberbullying has made the news in recent years. Using social media, the bully or bullies will maliciously harass a student. This can be done by making derogatory remarks, abusing and belittling another student, or posting photos that are unflattering or compromising.

There have been many reports of cyberbullying in the news recently. There have been many cases in which a cyberbullying victim has committed suicide or the bully was criminally charged. One of the more memorable cases involved a 13-year-old named Megan Meier who hanged herself after being bullied by someone she thought was a boy she befriended online.

It was later learned that the boy was actually a former female friend, her friend’s mother, and their employee. Criminal charges were filed against the mother, Lori Drew, and she was found guilty of three charges. Later she was acquitted by a U.S. District Judge. Since then, there have been several other cases.

The bully may also play the victim
so he or she can get by doing more harm.

Reactive bullies will continue to taunt, tease, push, or hit others until the victim strikes out so they can then present themselves as victims and place the blame on others. There are many kinds of school violence and there are many causes for today’s unpleasant and threatening atmosphere in school settings.

Causes of School Violence

  • Students have a greater access to weapons, such as guns and knives.
  • Cyberbullying is much more common because of Internet access, cell phones, and tablets. Social media’s popularity plays a major role as well.
  • The environmental impact and its role, such as school environment, the existence of gangs, school size, middle schools, the community environment, and the family environment. Putting your child or teen in a positive environment in the community and home can play a significant role in helping them to avoid the dangers of violence.

The Signs Your Child is Being Bullied

Edith Castro Roldán, Oscar Manuel Luna Nieto

Parents should always be on the look for signs that a child is being bullied. While you may like to believe that your child would openly tell you if he or she is being bullied, that is not the case. Most children are embarrassed or ashamed of being bullied even when it is not their fault. There are several things to watch for that may indicate your child is being picked on by others.

  • Unexplained injuries.
  • Destroyed or lost books, clothing, electronics, or jewelry.
  • Faking illness or complaining of headaches and stomach aches.
  • Changes in eating habits.
  • Frequent nightmares or difficulty sleeping.
  • Not wanting to go to school or declining grades.
  • Avoiding social situations or loss of friends.
  • Self-destructive behaviors or loss of self-esteem.

The Results of School Violence

Bullying and violence can cause all kinds of physical injuries as well as emotional damage. Students can suffer anything from cuts and bruises to broken bones to lost teeth and frighteningly, even gunshot wounds and death. Make sure you seek treatment for your child if he or she has been a victim of bullying.

Emotional damage can last for years
after the bullying has been put to a stop.

Kinds of Bullying

As previously mentioned, there are several kinds of bullying

  • Physical Bullying – hitting, punching, fist fights
  • Verbal Bullying – name calling, making fun of another, cursing
  • Reactive Bullying – picking on others to get a reaction and then playing the victim
  • Cyberbullying – done through social media or text message
  • Vandalism and Theft – damaging or stealing the property of others

Regardless of the kind of bullying that your child has suffered, you need to make sure he or she gets the help that is needed. Seek professional counseling or therapy to help him or her overcome the emotional and mental damage.

Why Don’t Children Ask for Help?

You have probably told your child to come to you with any problems, but when it comes to bullying most children don’t tell anyone. Bullying makes a child feel helpless and insecure. They may fear telling will make them look weaker or be viewed as a tattletale. There is also the fear of backlash from the bully and his or her friends.

Being bullied can be a humiliating experience.

Children probably don’t want adults to be made aware of what is being said about them because they may fear the adults may judge them or punish them, regardless of whether what is being said is true or not. Bullied children fear rejection of their peers as well, and they may already feel isolated and alone.

Eddie~S, Bully Free Zone, CC BY 2.0

Ways to Prevent Bullying

There are ways to prevent bullying. Some of the more effective approaches include:

  • Establish a safe climate at home, in the community, and at school.
  • Learn how to be more engaged in your children’s school life. Building a positive school climate is detrimental in preventing bullying.
  • Assess bullying at your child’s school and understand how your child’s school stands in comparison to national bullying rates.
  • Talk with your child about their concerns, and be direct. They may think that getting parents involved may worsen the bullying, so be sure to reassure them that you’re there to help the situation.
  • Avoid being misdirected in bullying prevention and response strategies. Focus on your child!
  • Learn about bullying so you know what it is and what it is not. While many behaviors may be just as serious a bullying, some may require different responses than how you respond to bullying.
  • Speak with your children about bullying, and how they can stop it. An ounce of prevention is worth a pound of cure, and exposing children to ways to address a bully in their life can be extremely effective. It also opens the doors of communication so that a child can feel comfortable discussing it.
  • Encourage your child to seek friends for help in opposing a bully – peer pressure can be effective in getting bullies to stop their behavior.

Being aware of the situation and the warning signs are essential in helping to prevent bullying. Be proactive so you can address bullying issues right away.

Your Child Has Rights!

No one wants their child to be a victim of bullying. There are several things you can do to help your child avoid bullying or bring an end to it. Here is some legal information you need to know, so if the situation does arise the proper action can be taken right away.

Schools have a duty of care. If the school breaches their duty of care, you may be able to get compensation for any therapy bills, medical or dental expenses, or reimbursement for any out-of-pocket costs resulting from the altercation.

By Andrevruas (Own work) via Wikimedia Commons

Teacher and administrator intervention. Teachers are required to do any reasonable action to protect their students’ welfare, health, and safety. Their legal responsibilities focus on three sources:

  • Common Law Duty of Care
  • Statutory Duty of Care
  • The Duty Arising from the Contract of Employment

If the teacher or administrator does not step in to stop the fight before it happens, or during the actual fight, then they can be sued for breaching their responsibilities for duty of care. Be familiar with the school’s protocol and policies as each state has different laws and regulations and each school has a different educational code. Educate yourself!

Understanding Parental Liability

Parents of bullies are criminally liable for negligence in not maintaining control of their children’s delinquent acts. Parental responsibility statutes indicate that parents are not held responsible for their children’s acts, but of inadequately controlling their children.

A lawsuit can only be filed against a government entity (school) in instances where there is actual negligence and not intentional misconduct. In order to sue the school system because your child was bullied, you will have to prove the school system’s negligence for not addressing the problem that they were made aware of previously.

There are some instances in which you cannot sue a public school. The Federal Tort Claims Act (28 U.S.C.§ 2674) explains how there are some instances in which a public school can’t be sued. As an example, you can’t sue because of a school system employee’s official misconduct, but there is a fine line between negligence and misconduct in some instances. To clarify the details, you should consult with an attorney.

Getting the Evidence for a Case

If your child has been injured in a violent act at school, you may have a case against the school system or the bully and his family. There are several steps to gathering evidence for a case:

  • Discovery, which includes deposition, interrogatories, request for admission, “subpoena duces tecum
  • Subpoena
  • Witness of the incident
  • Exhibits, such as evidence, records, reports, video, photographs
  • Damages – medical and dental bills, therapy costs, receipts

If your child has suffered school violence or bullying, you should consult with an attorney. School violence can cause personal injury that has lasting effects. Protect the rights of your child!

by the Outreach Team at Disability Benefits Help

 

Personal Injury Law
Free evaluation

 


Sources:

https://nces.ed.gov/fastfacts/display.asp?id=49
http://www.crf-usa.org/school-violence/causes-of-school-violence.html
http://www.stopbullying.gov/at-risk/warning-signs/#bullied
http://americanspcc.org/bullying/schools/?gclid=CjwKEAjwrIa9BRD5_dvqqazMrFESJACdv27GeJ3suQOZda0rHDRSliByF3x6VxHg3GFRGH798o0uqhoCPCPw_wcB
http://www.nolo.com/legal-encyclopedia/suing-government-negligence-FTCA-29705.html
https://nobullying.com/six-unforgettable-cyber-bullying-cases/

Use the “S” word: talk openly with your child about suicide

Use the “S” word: talk openly with your child about suicide

Don’t be silent on the subject of suicide, even if there’s no evidence your child has considered it.  Bring it in the open, especially if you have a hunch something is wrong and they may have suicidal thoughts.  This article addresses:

  1. Why you should talk about suicide with your child
  2. How to respond if there’s been a threat
  3. How to respond if there’s been an attempt

Parents talk about many uncomfortable subjects with their child; and suicide must be one of them.

Don’t let suicide become a ‘sensitive’ subject.  Your child needs to hear about it from you.  They should feel safe talking about it.  Don’t expect them to bring this subject up.  They may fear you will overreact, and worsen their depression, or you could under-react or dismiss it because you’re uncomfortable.  Neither response helps.

Won’t this give my child ideas and encourage suicidal thoughts?

No.  Children usually know what suicide is and will have wondered about it—even young children. Ask what your child thinks. Children as young as 7 and 8 have asked about suicide or communicated they had suicidal thoughts.  Children as young as 10 and 11 have attempted or completed suicide.  The ages of highest suicide risk are between 10 to 24.

Talk with your child. Don’t leave him or her alone with thoughts or questions about suicide.

An 11-year-old boy died of suicide a couple of weeks before this article was written. There had been no prior signs.  He killed himself after receiving a prank text saying his girlfriend had committed suicide. He told no one beforehand.  His parents had no idea he was even at risk.

Why might my child become suicidal?

Mental health professionals assess risk by using the Biopsychosocial Model.  The more negatives in the biological, social, and psychological aspects of one’s life, the higher the risk of suicide or other mental health problems.

The major risks of suicide are in the central part of this diagram: drug effects, temperament, IQ, family relationships, trauma.

From Pinterest and the blog, Social Workers Scrapbook

What can you control and change at home?
What do you and family members need to reduce these risks?
Communicate about these with everyone. (Can be hard to do, but try.)

What can trigger suicidal thoughts?

Examples from two states that did the research:

Oregon: Survey results for an exceptionally high suicide rate among 10-24 year olds by population, 180 individuals in one year (“Suicide circumstances by life stage, 2013-2014”).

  • 62% – Current depressed mood
  • 53% – Relationship problems
  • 47% – Current mental health problems
  • 43% – Current/past mental health treatment
  • 42% – History of suicidal thoughts/plans
  • 31% – Recent/imminent crisis
  • 22% – Family relationship problems
  • 21% – Non-alcohol substance abuse problems
  • 8% – School problem

New York: Life situations of children completing suicide, 88 individuals; (“Suicide Prevention, Children Ages 10 to 19 Years”, 2016)

  • Feeling hopeless and worthless (often because of bullying at school, home, or online)
  • Previous suicide attempt(s)
  • Physical illness
  • Feeling detached and isolated from friends, peers, and family
  • Family history of suicide, mental illness, or depression
  • Family violence, including physical or sexual abuse
  • Access to a weapon in the home
  • Knowing someone with suicidal behavior or who committed suicide, such as a family member, friend, or celebrity
  • Coping with homosexuality in an unsupported family, community, or hostile school environmental
  • Incarceration (time in juvenile detention or youth prison)

What if my child has threatened suicide?

A threat opens a door for a discussion.  A good approach is to interview your child about their feelings, plans, needs, and reasons.  Listen earnestly without input.*  You might be surprised to find their problem is solvable, but their depressed mood paints it as hopeless.  Listening helps them get clarity and feel heard and respected.  Once you understand their problems, you assist them in identifying options and provide emotional support.

* I have a friend who worked for a suicide hotline, and he said the job wasn’t difficult at all.  He said, “All I did was listen and show understanding of their feelings and just let them talk. “

After a frustrating discussion about my teenage daughter’s suicidal threats, I gave up and said “No.  I’m telling you not to commit suicide.”  She was incredulous; “You can’t tell me what to do!  You can’t stop me!”  I responded, “Don’t commit suicide. You’re important to us.  You have important things to do in life.”  She made a few attempts in the following years (they were always public… as if she wanted to be discovered and prevented), and she always reached out to her family afterwards for support.  Did my words make a difference?

What if a threat is just for attention?

It’s hard to tell. It could be genuine  or manipulative.  Some children use threats to prevent parents from asserting rules.  Angry children, especially teens, use threats to blame and hurt parents emotionally.  If you think a threat is not genuine, open up the suicide discussion.  “Talk to me about this”, “It seems like an extreme reaction to something we can fix.” “What needs to change?”  “How can I help?”  Focusing on the threat will either expose the ruse or draw out important information for addressing an underlying problem.

What else can I do if my child threatens suicide?

  1. Observe and investigate.
  • Do they have access to unsafe objects or substances?  You can legally search their room.
  • Do they frequent unsafe places or spend time with people who encourage drug use?
  • Do they have extreme mood swings (up or down), or a chronic dark mood?
  • Do they take dangerous risks and seek dangerous activities?
  • Are there any other danger signs?
  1. Build a network of eyes–choose people who will observe your child and keep you advised of risk, e.g. a mature sibling, a teacher, your child’s friend or the friend’s parents, your child’s boyfriend or girlfriend, a relative, or a trusted person who knows your child.
  1. Make changes you have control over, and solidly commit to these changes. Bring the whole family along on the plan.  FOLLOW THROUGH.
  • In family life – reduce chaos, fighting, blaming, or bullying; express appreciation; neglect no one including yourself; create 2 – 3  house rules that are easy to enforce and everyone follows, even you.
  • In social and online life – learn as much as you can about the nature of your child’s relationships, whether romantic or social. Support them if they distress your child. Can they remove themselves from a toxic relationship? or cope effectively with anxiety? Can you help them address bullying at school or online?
  • Biological health – Sleep, Exercise, Diet.  Limit screen time at night because blue light inhibits sleep.  Pay attention to digestive health, which affects mental health. These are some natural approaches.
  • Psychological health – Ask a school counselor about your child.  Seek a working diagnosis and mental health treatment.  Help your child find outlets for personal self-expression:  journaling, music, art, poetry, or a website such as this one, where teens help teens.  Mind Your Mind is an excellent example.

What if my child attempted suicide?

He or she is still very fragile, even if in treatment!  They have taken the action, they’ve been there, and have the option for taking it again—a high percentage try againSuicide attempts are long-term emergencies. You need to be on alert in the following days, weeks, months, and possibly years.  In addition to intensive mental and physical health treatment, ensure your child gets regular deep sleep, exercise, and a good diet.  Ask them if they’ve had suicidal thoughts if you sense something is wrong.  Don’t be shy about checking in.

Pay attention to events that trigger suicide.

Check-in with your child when something traumatic happens or might happen, especially if someone he or she knows attempted or committed suicide, or a suicide was in a TV drama or covered in the news.  Triggers are an emergency, act immediately.

You have the power to prevent a child’s suicide.
Be strong. You can do this. 

Take care of yourself.

–Margaret

What to know about psychiatric residential treatment

What to know about psychiatric residential treatment

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

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

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

What to ask about the staff:

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

What to ask about programs:

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

Body health is brain health, and vice versa.

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

Is your child emotionally safe as well as physically safe?

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

What to ask about the business itself:

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

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

Good luck.

 

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

How to help your troubled teen after they turn 18

How to help your troubled teen after they turn 18

Most young people aren’t ready for adulthood by 18 years of age, but your troubled teen is especially unprepared. By 18, their legal status instantly changes to “adult” and they are free to fail at life’s countless tests. Your hands are tied and you can’t keep your son or daughter safe from themselves any more.

Pace yourself for a marathon

Your job as parent is far from over.  Parenting an 18+ year-old will feel the same as when they were 17 years 11 months old.  They’ve been behind their peers for a long time–emotionally or socially or academically. You’ve done everything possible to get them ready for adulthood, but they simply aren’t!  For troubled teens, the teen years last into the mid-20’s or longer. And this is really scary; suicide rates across all age groups are highest for people aged 16-24.  It’s the period of greatest stress, whether the person is suicidal or not.

Many people with disorders aren’t able to take responsibility for themselves until about the age of 30.

Over the past 16 years, I’ve asked this question of people with mental health disorders and addictions, or I’ve asked their parents, siblings, children, or their friends:  “At what age did (you, your loved one, friend) make the conscious choice to take responsibility for treatment?  When did you/they get a stable job, or live on their own, associate with healthy people?  I asked dozens of people. Their answer? Every single one told me they or their loved one didn’t turn things around until they were between the ages of 30 – 33In my experience, you start to see signs of awareness that they need help in the late 20’s, with limited attempts to face their problem.

True story: a co-worker once shared about his bipolar disorder and years of substance abuse.  I would never had guessed that this stable, wise person had had a troubled past.  I asked when he turned his life around; it was 30.  I asked what motivated him.  He said, “I couldn’t avoid it anymore.  I ran out of excuses.  I just hit rock bottom too many times.”

Why does recovery take so long?

  1. Anosognosia “a deficit of self-awareness” caused by mental disorders.  They simply can’t tell they are different from anyone else, so they resist messages that they are.
  2. They get good at coping.  They squeak by, or use others, or depend on parents to rescue them.  They try to delay the inevitable scary thought that there really is something wrong with them.
  3. Their brain or emotional development is slower than normal people.  They may need an extra 10 years to go through the final maturation phase into the adult brain.

Because of their mental disability, a child over 18 needs better life management skills than their ‘normal’ peers because they have so much more to worry about.  Besides the usual adult responsibilities, they need self-discipline and self-monitoring for mental and emotional stability. They need to be continually alert to their states of mind–the same as someone who’s an insulin-dependent diabetic needs to continually check blood sugar.  They need to remember to take meds and stay in therapy.  They need to avoid or limit fun excesses their peers can get away with, e.g. parties with poor snacks and alcohol.  They must stick with a healthy diet, exercise, and investment in supportive friendships.  You know your child, all of this is hard for them!

How much to sacrifice and how much to let go?

Parents have a tendency to rescue their adult son or daughter when a crisis befalls because it’s so hard for the child to recover from set-backs.  But rescuing too much makes them more dependent on the parents (or adult siblings).  On the other hand, pressuring a troubled teen to be an “adult” when they are not ready push them to dependence on others who might make their life worse.  Pressure can motivate them to cope with drugs or alcohol, or take unnecessary risks, or give up.

True story:  I met a couple in their 70’s who’d rescued their troubled 34-year-old daughter her entire life, and faced cutting her off financially because they couldn’t afford it anymore. They were heartbroken to let her go, and painfully afraid she would become homeless or suicidal, and they deeply regretful they unwittingly undermined her capacity for independence.  Don’t let this happen to you.

You must transition away from “parent” to case manager, therapist, and mentor.

  • Case manager – This is the busy work.  You are the one to fill out forms, make appointments, provide transportation, ensure prescriptions are refilled and taken.  Follow-up on calls and emails regarding anything: banking, waivers, police reports, insurance, appointments, etc.
  • Therapist – This is actually easy if you can keep your thoughts to yourself.  You listen.  You acknowledge their feelings without rescuing them or smoothing over issues.  You ask probing questions so you can get data that will help you help them meet their needs.
  • Mentor – Start by building trust.  When they trust you they’ll listen, and when they listen you can teach them all the things they need to know to be independent (like the self-management skills in the paragraph above).  Mentoring also means setting boundaries and expecting better of them.

A major challenge is where they’ll live.

At home:  Can you bear the stress if they live with you? or if they leave your protection?  How do you help them move on?  If your troubled young adult child must live at home full or part-time, adjust your rules and expectations. Rules can include a requirement for ongoing mental health care. Your troubled child of 18 or more becomes your guest who stays at your invitation, or a renter who contributes to the household and follows the landlord’s rules.  On the other hand, you’ll need to step back and respect their privacy and acceptable choices and activities.  This may not be easy with someone 18–this means compromises and letting go of being the parent boss.

In an apartment on their own:  This is the preferred situation, but who will be ultimately responsible for rent and utilities?  Who can pay the deposit, usually the first and last month’s rent?  Should the manager/landlord know about their condition in case there are problems?  Problems include property damage, inappropriate visitors (drug users or sellers, couch-surfers, party animals), neighbor complaints.  In one parent’s case, both the local police and management company were notified and given both parents’ phone numbers.  It helped at first when there were complaints, but as the complaints and calls to the police continued, their child eventually evicted along with the others who camped out there.

With roommates or housemates:  I do not recommend this unless you are willing to move your child repeatedly.  Even if your child is not antagonistic–maybe withdrawn due to depression–it is very stressful for housemates.  Your frequent calls and visits for a check-in will also be stressful to them.  And what about these co-inhabitors?  Are they safe for your child to be around?  Will they victimize your child?

With a boyfriend or girlfriend: the same concerns apply as for housemates.  This living situation is only as stable as the partner.  Some couples stay in a parents’ basement.  This too is only as stable as the partner and the parents.  Consider that these living arrangements are temporary.  Good luck if they have shelter for a year.

In the eyes of the law, you are not responsible for them anymore.

You really aren’t.  In fact, you have the right to banish your 18 year-old from your home and change the locks on the doors.  Parents who do this are usually in fear for their physical and emotional safety–not because they don’t care.  If this describes you, it’s understandable and forgivable if you feel forced into this step.  But know this, things change.  Your adult child will change.  Banishment need not be forever.

At the age of 18, broad institutional supports kick in. (don’t you wish that were sooner?)

  • Once they turn 18, people with mental health problems are protected from discrimination in their job/housing/education by laws that protect all disabled.
  • Insurers are required to provide mental health care on par with all other treatments and services.
  • Adults over 18 are better supported by mental health organizations that offer support groups, referrals to safe housing or job opportunities, social connections with accepting peers, and legal and legislative advocacy.
  • Educational institutions have special departments solely for supporting students with disabilities, and that includes troubled young adults.

This 4 things are what your troubled teen needs to function after 18. They are based on long-term monitoring of 1000’s of others in their 40’s and 50’s with mental health challenges who did well in life:

  1. Ongoing support from family, friends, and institutions

  2. A job or continuing education

  3. Ongoing mental health care

  4. A safe living situation


Adjust your expectations for how quickly they’ll progress.

Parents of any ‘normal’ 18 year old also revise their relationship with them, becoming a mentor and peer rather than a parent.  What’s going to be tricky for you is avoiding a default role as ‘parent’–watch out for this!  What young adult wants their parents telling them how to live their lives (even if you’re right)?  If you want their trust–which you do–dial back your ‘parenting’ and remove the power differential it implies.

Keep up regular communications with your child even if they resist.  Do everything you can to build a and maintain a relationship even if it’s difficult.  If not with you, than with another mature adult who can mentor them.

–Margaret

Please comment.  Your thoughts and experiences help others who read this article.


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Bullying and how to stop it – for parents and teachers

Bullying and how to stop it – for parents and teachers

Most of us have bullied someone and have been bullied at some time in our lives. We have an aggressive trait that helps us stand up to a threat. We are emboldened to fight when we fear for ourselves or family, or simply when we’re “not going to take this anymore!” Mature people don’t do this without cause, but children and teens lack maturity and can engage in bullying throughout their school years. (Even the nicest children can bully another person.) Victims of bullying usually don’t have the power and skills to prevent it or to protect themselves.

“This is a huge problem in the schools… it’s particularly common in grades 6 through 10, when as many as 30 percent of students report they’ve had moderate or frequent involvement in bullying.”
–Dr. Joyce Nolan Harrison, assistant professor of psychiatry, Johns Hopkins School of Medicine.

Bullying occurs when others aren’t paying attention… or when there is an audience
In schools, bullies target victims where and when authorities can’t see, isolated but in crowds: hallways, the school lunch room, the playground or gym, and the bathroom or dressing room, not in plain sight of others who might report an incident. Or they have an audience that supports the bully or ignores the situation and doesn’t want to get involved… or tell.

Bullies target those they consider “weak” or simply “different”
What makes a target child “weak” could be so many things. Bullies seize on anything: a physical, emotional, or mental vulnerability–children with learning disabilities or autism spectrum disorders are often targets. But any “different” child is at risk: a child from another culture is different, a boy who seems effeminate or a girl who seems masculine. The list of reasons children are bullied is so long that it is impossible to proactively avoid attracting the attention of a motivated bully or bullies: physical features, small stature, younger age, shy or meek personalities, bad fashion sense (or perfect fashion sense), even being a Straight “A” student is cause for being victimized. A child’s family member might be perceived as an embarrassment that elicits bullying (a brother is in prison, a father lost his job). Or a child might be a member of a group that’s hated by the parents, who teach their child to hate the group. Some victims are chosen simply because they are at the wrong place at the wrong time:

A teen walks his usual route home from school. He is reasonably well liked but doesn’t stand out. Ahead are three troublesome youth he doesn’t know. No one is around. He’s still at a distance, but starts to feel uncomfortable. They stand side-by-side on the walk ahead of him and stare.

What would a street-wise kid do?

He crosses the street without breaking stride, but also watches them—they have to know he sees them. If he pretended to ignore them it could inflame their anger. They start taunting. Meanwhile, the teen has been thinking of ways to protect himself just in case: there’s a store is nearby or within running distance, there’s a neighbor who’s usually at home. If he has a phone, he pulls it out and is ready to dial 911. He stays alert and looks confident, and they eventually drop the effort and let him move on.

Bullies punish kids who try to stop the bullying

Those who “snitch.” Victims who ask for help are often targeted by the bully more intensely, and often joined by associates who simply jump the bandwagon (curious behavior described as “the madness of crowds”). The culture of tweens and teens has low tolerance for those who tell on others. Those who join the bullying episode against the victim can do it without thinking, or perhaps they feel empowered to vent anger on someone, or just want to fit in.

Those who try to stop them. A heroic bystander steps in to stop a bullying episode and becomes the target themselves.

Those who want to leave the bullying group. Some kids have second thoughts and feel uncomfortable about the bullying and try to leave, but they can’t. Leaving attracts intense, relentless bullying for “voting with their feet”—this is a hallmark of gang behavior

Sadly, some children appear to “set themselves up” for bullying. This victim is a child with a fatalistic attitude and low self-esteem, who doesn’t recognize when others take advantage of them. They feel they must endure and don’t take steps to protect themselves out of excessive fear of drawing retribution. These are the kind of children who can become victims of physical or emotional domestic violence as adults.

Parents

If your child is a victim, be aware that they live between a rock and a hard place. Be careful that your involvement doesn’t make things worse for them

Armor your child with multiple skills
There is no one way to handle every bully situation so flexibility is key. Together, develop a list of multiple options:

  • Ask friends to accompany them
  • Go to a place where people are and find an adult to help. Walk the other way, walk down different hall, walk to other side of street, use a different bathroom.
  • Request loudly “LEAVE ME ALONE” when there’s an audience to witness the bullying, such as on a bus or standing in line.
  • Use body language to project a firm stance. This can be the way your child stands or the loudness of their voice when the bully is present to show confidence, alertness, and empowerment.
  • Let your child know you take them seriously and will do something about it. Give them emotional support.
  • Let your child know you will back them up by working with the school.
  • Use the situation as a learning opportunity to help your child develop a backbone and inner strength. Even with your support, this will not be easy for your child to handle. Be a model of strength and resolve rather than of vengeance or anger.
  • Consider mental health issues that might be making things worse for your child: ADHD, ODD, depression, bipolar disorder, borderline personality disorder, chaos and stress at home, PTSD, substance abuse, and others.

Help the bullied kids find each other. If there are a bunch of them together, they can stand the bully down. They don’t have to beat the bully up. They just have to say, ‘Why are you treating my friend this way?’ The bully will often move on… Parents can appropriately take matters into their own hands. You need to enlist the help of all the other parents of bullied children… Parents have to work as a group. One parent is a pain in the [butt]. A group of parents can be an educational experience for school authorities.”
–William Pollack, assistant clinical professor of psychiatry, Harvard Medical School

Don’t

  • Don’t tell your child to “let it go, ”or “it’s no big deal,” or “it happens, deal with it.”
  • Don’t tell your child to be tough. What does “tough” mean? What do you want them to do?
  • Don’t punish or dismiss a child who complains too much, or blame him/her for setting themselves up and asking for it. Ironically, a victim is sometimes treated as the problem child.
  • Don’t bully your child at home! Are you doing this? Think. Your child learns to accept the inevitability of bullying because he or she is accustomed to it at home.

How things can go wrong: A boy is in the shower after PE class and gets slapped on the butt most days. He is too proud/embarrassed to tell his parents, or he tells and they react poorly. Perhaps he’s blamed for not standing up for himself, or a parent shows up outraged at school and yells at the bully or school staff. Now the boy’s parent is the problem and may be suspected of bullying their child. Or school staff overreact with swift punitive actions to the bully. Time passes and the bully starts up again bit by bit, only much more subtly. The boy is afraid to report it again because the encounters are more secretive. The bully denies his behavior and recruits others to advocate for him. They jump on the bandwagon because they don’t know the history, and the boy doesn’t want to tell everyone he is being sexually harassed. It’s a vicious cycle.

Teachers and schools

“You can’t learn if you’re being bullied, if every day you’re frightened of how you’re going to be treated.”
–William Pollack, cited above

Teachers, pay attention to signs that there’s a skilled, secretive bully at the school.

  • Notice who others avoid.
  • Notice a child coming into the class who’s upset and ask them about it later, promise you’ll protect their anonymity if you can get them to reveal a bully, but don’t pressure them.
  • Observe the problem kid and their subtle interactions with others.
  • Allow a victim(s) to have distance from bully, permission to use a different bathroom, to have their desk placed farther apart, to have a locker farther apart, or even a different class if possible.
  • Inform the parents of your concerns in addition to the principle and school counselor.
  • Focus your behavioral interventions on the bully (not the victims)

Avoid diagnosing the situation. You are not the expert. You don’t know why a bully is a bully, or why a victim is a victim, or anything about their parents. Ensure a school counselor is involved in any discussion about how to manage a bully problem in the school.

Avoid jumping to conclusions! Your actions can unintentionally undermine or harm either the child or their parents. You don’t know until you know.

“Bullies are like the lion looking for a deer that’s left the herd,” says Patrick Tolan, director of the Institute for Juvenile Research at the University of Illinois. “They try to single out the weakest kid. The best way to stop this is to work on increasing inclusion by helping the bullied kids with social skills.”

Bullies are usually bullied themselves (see another article Bullies like their victims, are also at risk). Only very small percentage are sociopathic, or who are intrinsically cruel and without empathy, perhaps 1 in a 100. How do you tell? If someone sets a clear boundary with punitive consequences, the disturbed bully will relentlessly target a victim regardless of how much trouble they get in.

I wish to personally thank Barry Diggs, probation and parole officer for the Oregon Youth Authority, for his insights into bullying behavior, which helped me develop this article. Margaret

If you have helped a child effectively cope with bullying, please share your story in the Comments below so others can learn from your story.


Research

Bullying Linked to Violence at Home
April 2011

Bullying is pervasive among middle school and high school students in Massachusetts and may be linked to family violence, a new study finds. In a survey of 5,807 middle-school and high-school students from almost 138 Massachusetts public schools, researchers from the Massachusetts Department of Health and US Centers for Disease Control and Prevention found that those involved in bullying in any way are more likely to contemplate suicide and engage in self-harm compared to other students. Those involved in bullying were also more likely to have certain risk factors, including suffering abuse from a family member or witnessing violence at home, compared to people who were neither bullies nor victims.

Cyberbullying (this is a superb and comprehensive article by an expert on cyberbullying)

http://www.psychiatrictimes.com/display/article/10168/1336550?GUID=32E9A484-0468-4B38-8A03-0EE478D3256C&rememberme=1

Survey: Half of High Schoolers Report Bullying or Teasing Someone
“Ethics of American Youth Survey”, Josephson Institute of Ethics

Half of U.S. high schoolers say they have bullied or teased someone at least once in the past year, a new survey finds. The study also found that nearly half say they have been bullied during that time. The study surveyed 43,321 teens ages 15 to 18, from 78 public and 22 private schools. It found 50 percent had “bullied, teased or taunted someone at least once,” and 47 percent had been “bullied, teased or taunted in a way that seriously upset me at least once.” The survey asked about bullying in the past 12 months: 52% of students have hit someone in anger. 28% (37% of boys, 19% of girls) say it’s OK to hit or threaten a person who angers them. “There’s a tremendous amount of anger out there,” Michael Josephson says. (Founder of the Institute of Ethics)

Victims of Cyberbullying More Likely to Suffer Depression than Perpetrators:
ScienceDaily, September 2010

Young victims of cyber bullying, which occurs online or through cell phones, are more likely to suffer from depression than their tormentors, a new study finds. Researchers at the Eunice Kennedy Shriver National Institute of Child and Human Health Development in the US looked at survey results on bullying behavior and signs of depression in 7,313 students in grades six through 10. Victims reported higher depression than cyber bullies or bully-victims, which was not found in any other form of bullying. Researchers say it unclear whether depressed kids have lower self-esteem and so are more easily bullied or the other way around.

Cyberbullying Teens and Victims More Likely to Have Psychiatric Troubles
Archives of General Psychiatry, July 2010

Teens who cyberbully others through the Internet or cell phones are more likely to have both physical and psychiatric problems, and their victims are at heightened risk for behavioral difficulties, a new study finds. Researchers collected data on 2,215 Finnish teens 13 to 16 years old. The survey found that teens who were victims of cyberbullying were more likely to come from broken homes and have emotional, concentration and behavior problems. In addition, they were prone to headaches, abdominal pain, sleeping problems and not feeling safe at school, the researchers found. Cyberbullies were also more prone to suffer from emotional and behavior problems, according to the survey.

Bullying And Being Bullied Linked To Suicide In Children
International Journal of Adolescent Medical Health; July 2008

Being a victim or perpetrator of school bullying, the most common type of school violence, has been frequently associated with a broad spectrum of behavioral, emotional, and social problems. According to international studies, bullying is common, and affects up to 54 percent of children. Researchers at Yale School of Medicine reviewed studies from 13 different countries and found signs of a connection between bullying, being bullied. and suicide in children. Suicide is third leading cause of mortality in children and adolescents. Lead author of this report, Young-Shin Kim, M.D. said “the perpetrators who are the bullies also have an increased risk for suicidal behaviors.”

Kids with ADHD more likely to bully
Linda Carroll, MSNBC, reporting on the Journal of Developmental Medicine and Child Neurology, February 2008

A new study shows that children with attention deficit hyperactivity disorder are almost four times as likely as others to be bullies. And, in an intriguing corollary, the children with ADHD symptoms were almost 10 times as likely as others to have been regular targets of bullies prior to the onset of those symptoms.

A study followed 577 children for a year. After collecting data on bullies and victims and identifying those children ADHD, there was a corollary between ADHD and bullying. Study co-author Dr. Anders Hjern, a professor in pediatric epidemiology at the University of Uppsala in Stockholm said “These kids might be making life miserable for their fellow students. Or it might turn out that the attention problems they’re exhibiting could be related to the stress of being bullied.”

Unfortunately, treating ADHD won’t remedy the bullying because drugs for the condition impact a child’s ability to focus, but not the aggression that leads to bullying, says Kazdin, a professor of psychology and child psychiatry and director of the Parenting Center and Child Conduct Clinic at Yale University, and president of the American Psychological Association.

Bullying Tied to Sleep Problems
Sleep Medicine, June 2011

Children who are aggressive and disruptive in class are more likely to have sleep-disordered breathing than well-behaved children, according to new research. Conduct problems, parent-reported bullying, and school disciplinary problems were all associated with higher scores on a measure of sleep-related breathing disorders, according to researchers. The study collected data from parents on each child’s sleep habits and asked both parents and teachers to assess behavioral concerns. The findings suggest that bullying may be prevented by paying attention to some of the unique health issues associated with aggressive behavior.

Coping with grief when a child loses their “self” or life due to mental illness

Coping with grief when a child loses their “self” or life due to mental illness

In the US military, the Purple Heart medal is awarded to a soldier who is wounded in battle, or who later dies of those wounds.

In the years of writing this blog, I have offered encouragement and hope for parents.  But hope and information cannot soften the impact of this horrible statistic:  The mortality rates of teens with mental disorders are 3 to 4 times more deadly than most childhood cancers, and the statistics only measure those deaths by suicide:  Mental illness more deadly than cancer for teens, young adults.

Death by suicide seems especially tragic because it appears to be a choice, and while we tell ourselves that mental illness is the cause, it’s not the same as a car accident being the cause or a tumor being the cause.  Unsuccessful suicide attempts are no less traumatic, like a cancer that keeps returning, because you can’t come to terms with a “maybe.”  A parent is held hostage by the anticipation of loss, a relentless moment-by-moment fear that your child will attempt again in the future until they are successful.  It’s an emotional ride one’s subconscious never ever forgets, and it becomes your PTSD.  You can carry it quietly with you for decades, until a sneak attack, when you find yourself overreacting to a news story, a scene in a movie, or a conversation with a friend.

My PTSD ambushed me once.  I was attending an evening class when suddenly a person next to me slammed down her cell phone, exclaimed “Oh my God!” and quickly grabbed up her things and dashed out.  I followed to check on her and see if I could help with something.  As she speed-walked to her car, she said her daughter had texted that she swallowed a poison because she was upset, but is now sorry and wants help.  I got back to the classroom in shock, trembling, and completely unable to focus.  It had been many years since I had received a similar message, but it felt like it had just happened again that moment.

You are not alone if you’ve ever secretly felt it would be a relief if your child ended their life, bringing peace to you both.  (And you wouldn’t be a bad parent, either)

There are other kinds of “deaths” to grieve

You face a death of hope when child with a serious mental disorder that takes a long slow trajectory through addictions, high risk behaviors, and falls apart in life’s many insults.  Families like ours bear witness but can’t intervene, or interventions don’t work.  All we can do is wait and hope and do what we can for our child, day by day, and banish thoughts of a different future.  I consoled myself with the knowledge that my child was getting by, and “getting b” was enough.

Another type of death caregivers face is the loss of their child’s “self” as they knew it, and their future as they imagined it.  A mentally ill child or teen can morph from a fresh young person in a world that is wide open to them, to a scary being we don’t recognize as our own and cannot understand–a stranger, a changeling, a flame snuffed out too soon.  It should not be this way.  It is unfair.  It is a tragedy.  You start healing the grief when you are able to make the commitment to do the best you can anyway.  YOU HAVE EARNED YOUR PURPLE HEART.

Any serious medical condition can devastate and traumatize a child’s family, but those with mental disorders impose a complicated trauma that’s hardly possible to resolve.  The following stories are actual examples.  Ask yourself:  how does one be a loving responsible parent in these situations?

–  When her daughter attempted suicide, an overwhelmed single mother discovered that her son had been sexually abusing and cutting her for 3 years, right under her nose.  The guilt she felt was quadrupled by the guilt laid on her by others.  She didn’t know how to go forward as a mother from here, after loving but failing both children.

–  A teen girl attempted to hang herself in a very public place, and many people found out before her parents.  The parents’ first trauma was the call from the emergency room, their second was from the shower of doubt others laid on them:  Where were you?  Why didn’t you help her before it got this far?  What did you do to drive her to this?

–  One couple devoted themselves to raising a difficult boy they adopted when he was 2.  At 9, after years of problems, he sexually assaulted a playmate, and they found themselves disgusted and repulsed.  The brokenhearted mother said she had long ago accepted that her boy would never be normal, but this was different.  She didn’t want him anymore.  She really really didn’t want him.  Some parents took their troubled children to Nebraska.*

You are not alone if you’ve ever secretly wanted to give your child away. You are not alone if you’re DONE.  (And you would not be a bad parent for thinking this.)

Consciously keep the good things alive.  Display photos of the real child you know or knew, the one without the brain problems.  Keep their writing or artwork or tests scored A+.  Other parents experiencing a loss do this, whether the losses are from death by disease, or death of self due to brain damage from an accident.  Speak often of the good things they were or are, as any proud parent might, keep the memories alive.

Get out of your trance and take yourself back to here and now.  When you notice yourself caught up in a train of thought and obsessing on your fear or paranoia, get back in the room—get back to driving that car or attending that meeting or straightening the house.  Get back to noticing the people you love, get back to making those helpful plans.  Central to the philosophy of dialectical behavioral therapy (DBT) is the concept of “Mindfulness.”

Remember this wisdom: take one day at a time.  You can handle one day, you can keep cool, do what must be done, feel accomplishment, in one day. Don’t think farther ahead.  Since you are the linchpin, the one holding up the world, you probably don’t have the luxury of taking a break, and may have to hold things together until there is time for your own healing.  The one-day-at-a-time approach is imperative.

When you’re leg is broken, you need a crutch.  When you’re heart and mind are broken, use the “crutch” of a medication for depression, anxiety, or sleep.  Do other healing things for yourself, whether exercise or therapy or asking for comfort from friends.  Acknowledge your wounds and admit this is too much handle.  You have earned your scars from bravery, so wear them as the badges of a hero.

A tragic event does not mean a tragic life.  I know a mother whose son completed suicide as a young adult in his 20’s.  She seemed remarkably cheerful and at peace with this.  She spoke lovingly of him often, and her email address comprised his birth date.  She continually did her grief work, was active in a suicide bereavement group, and often offered to visit with families facing such a loss.

— Margaret

*  In the United States in 2008, the state of Nebraska enacted a “Safe Haven” law to reduce the tragedy of infant child abuse and neglect.  The law allowed anyone to anonymously leave a child at a hospital with the promise that child would be cared for.  But something unexpected happened.  Parents from around the nation drove hundreds and hundreds of miles to leave their troubled older children instead.  Nebraskans eventually amended the law with strict age limits for infants only.

Brace yourself for borderlines

Brace yourself for borderlines

Borderline personality disorder is “All Of The Above”:  lovely and creative; manipulative and vindictive; tortured and anguished; glowing with energy and joy; self-hating, self-centered, perceptive and gifted, a victim… Without warning, a person can switch from one presentation to another.

Are you ready to bang your head on a wall?  Do you want to abandon your child in the wilderness?  Are you praying for the day they turn 18, when you can change the locks on your doors?  Children with borderline personality disorder (BPD) bring out the worst in everyone around them.

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

Yes, BPD kids really believe that others are out to get them, and that all their problems are someone else’s fault.  They are appalled that others mistreat them horribly.  They are insulted and defensive when they detect criticism, even when there isn’t any.  They can never be pleased, and it’s always about them.  Most exasperating for you, they turn from monstrous, to sweet and charming, and back to monstrous in an instant.

“Does this explain why I can go from 0 to 60 in two seconds?”
–17-year-old girl when told she was diagnosed with borderline personality disorder

Especially confusing, a borderline teen can be very engaging and affectionate… sometimes at random, and sometimes when they want something.  They will also turn on the charm in a way to to embarrass you in front of others (e.g. family therapy).  Since they seem so wonderful to other people, you are asked why you get upset at your clearly wonderful child.  People often recommend that you take care of your own issues instead.

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

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

For goodness sake, why?

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.  Borderline personality patients do not have an internal, natural sense of fairness and social norms, and little to no level of trust.  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 the teamwork game, the brain of a borderline person showed no activity whatsoever.

Statistics

Another research study reported that borderline personality disorder occurs as often in men and women, and sufferers often also have other mental illnesses or substance abuse problems.  (In my personal observations over many years, teenagers with borderline personality disorder are often diagnosed with bipolar disorder.) 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.

In infants:  the children 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 jump between any behavior: extremely manipulative; more promiscuous; aggressive and impulsive; more likely to use drugs and alcohol; assaultive; and more likely to cut 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

Trying to Weather the Storm
Shari Roan, September 07, 2009, Los Angeles Times

“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.

“But almost 20 years after the designation of borderline personality disorder, understanding and hope have surfaced for people with the condition and their families.  Advances have been made in recent years.  Researchers from McLean Hospital in Massachusetts studied 290 hospitalized patients with the condition over a 10 year period:  93 percent of patients achieved a remission of symptoms lasting at least two years, and 86 percent 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.

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

Treatment

“What Therapy Is Recommended for Borderline Personality Disorder in Adolescents (13-17 years)?”(excerpt)
Mary E. Muscari, PhD, August 9, 2005, http://www.medscape.com/viewarticle/508832

Psychotherapy is the primary treatment of BPD, specifically long-term dialectical behavior therapy (DBT), which helps the person attain and maintain lasting improvement in their personality, interpersonal problems, and overall functioning.  DBT appears to be the most effective.  It focuses on coping skills, so patients learn to better control their emotions and behaviors. This may be complemented with medications that help with mood stability, impulsivity, psychotic-like symptoms, and self-destructive behavior.

There are several appropriate therapies in addition to DBT, and all share common elements:  1. The bond between the patient and therapist is strong.  2. Therapy focuses on the present rather than the past, on changing one’s behavior patterns now regardless of how patients feel about the past or if they see themselves as victims.

On DBT:  I recommend this straightforward self-help lesson to get started learning the concepts and skills:  http://www.dbtselfhelp.com/html/dbt_lessons.html.

When to hospitalize

  • In an emergency – when your child has serious suicidal thoughts or an attempt, and/or is in imminent danger to others.
  • In long-term 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), risk of violent behavior, and other severe symptoms that interfere with living.

Other treatment a borderline 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.
  • Therapy that focuses on trauma and post traumatic issues when an adolescent loses their sense of reality.
  • Reduce stressors in the young person’s environment.  Most adolescents with BPD are very sensitive to difficult circumstances, for examples: an emotionally stressful atmosphere at home; teasing in school; pressures to succeed or change; consistent rules; being around others who are doing better than them, etc.

What parents and caregivers can do

With a partner or spouse:  Maintain a united front.  Communicate continually to stay on the same page when managing your child and setting limits.  Have each other’s back even if you’re not in full agreement.  Always take disagreements out of earshot of your child.  Any disagreement they hear will be used against you.

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 DBT and help your child stay in the here and now.  Keep up the reminders that enable them to stay in the moment, to take those extra few seconds to think things through before reacting.

  • 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.

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

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

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

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

Other characteristics of BPD

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

Bad 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 severe dissociative symptoms or paranoid ideation.

  • Chronic depression: Depression results from ongoing feelings of abandonment.
  • Inability to be alone: Chronic fear of abandonment also leads to these adolescents having little tolerance for being alone. This results in a constant search for companionship, no matter how unsatisfying.
  • Clinging and distancing: Relationships tend to be disruptive due to the adolescents’ alternating clinging and distancing behaviors. When clinging, they may exhibit dependent, helpless, childlike behaviors. They over idealize he person they want to spend all 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. Distancing is characterized by anger, hostility, and devaluation, usually arising from discomfort with closeness.
  • Splitting: Splitting arises from the adolescents’ inability to achieve object constancy 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 these adolescents 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: The behaviors are typically manipulative gestures, but some acts can prove fatal. Suicide attempts are not uncommon yet usually happen in relatively safe scenarios, such as swallowing pills at home while reporting the deed to another person on the telephone.
  • Impulsivity: Poor impulse control can lead to substance abuse, binge eating, reckless driving, sexual promiscuity, excessive spending, or gambling. These behaviors can occur in response to real or perceived abandonment.

Drawn from:
Risk taking adolescents: When and how to intervene (excerpt)
David Husted, MD, Nathan Shapira, MD, PhD , 2004
University of Florida College of Medicine, Gainesville

–Margaret

Bullies, like their victims, are also at risk.

Bullies, like their victims, are also at risk.

It’s easy to understand what it’s like to be a victim, but don’t be surprised if your understanding of bully behavior is off base.  There are many myths about who bullies are and what makes them behave the way they do.

Profile of a young bully:  this is a child or teen with a positive self-image, strong self-esteem, and little anxiety.  They are driven by a desire to be in control and they cherish power.  They also have little empathy for their victims, and appear to derive satisfaction from inflicting physical or psychological suffering on others.  A bully will defend his or her actions by blaming the victim, saying that their victims provoked them.  A bully may also have poor self-control, and be depressed or stressed in some way.  They have difficulty making friends.  It’s not black and white however–victims can become bullies–any child, boy or girl, can be a bully or be bullied if the circumstances are right

If you and your child have been a bullying victim, you may hope bullies get their just desserts.  Well, they do.

Without intervention, bullying can lead to serious academic, social, emotional and legal difficulties, which can continue into adulthood.  Bullies are even at higher risk of suicide.(see the research studies at the end of this article).

What if your child is the bully?

Think about it.  Your child may be strong and motivated, they’re active, and yet they get into trouble a lot.  They complain how others make them mad or pick on them, and yet they don’t appear to have the fears and anxieties that their victims have.  If a teacher or parent tells you that your child is a bully, it can be huge shock, and your first reaction might be to defend your child.  Perhaps you can’t imagine the child you love is hurting others, or perhaps you’ve even encouraged your child to defend themselves against others.

If it’s hard to accept, take a moment and step back and think things through.  It may not be your fault, but as a parent, you have a responsibility to both your child and to their classmates (and their parents) to intervene to stop the behavior, and make it clear that bullying is not acceptable, and that it will not be tolerated or ignored.

What parents of bullies can do

Find out if anything is bothering your child and aggravating their internal nature to act out against others.  Is there something making them feel insecure or unhappy?  Are they being ignored at home?  Picked on?  Are there other family troubles they can’t cope with?  Ask them.  Then ask yourself two important questions:

  1. What can you and your family do to reduce stress in your child’s life;
  2. What values do you want your child to learn from you, such as respect for others and empathy for others’ feelings.

Maintain an atmosphere of love and calmness at home.  Don’t allow older siblings to tease a younger child, and don’t allow destructive criticism.  Work toward an ideal home environment that is a “haven of love” for all the family.  Yes, a haven of love, that’s what it says.

Have a plan before you talk with your child, and prepare to have an open conversation and to listen closely to your own child’s point of view.  Your job is to design some disciplinary action that fits the context of your lives.

Make it very clear that bullying and aggression will not be tolerated, and spell out the consequences for all bullying behavior.  It is important to be completely consistent so that the child understands exactly what will happen if he or she repeats this behavior.

Consequences could include the loss of privileges, and especially freedoms that allow them to bully others.  For example:  if your child is allowed out to play in the evening, and is bullying other children at this time, keep them indoors for a day or a week depending on how serious the behavior is or the age of the child.  Whatever you decide on, make it extremely clear and consistent.

Next, teach your child or teen different responses to things that make them aggress against others.  They probably don’t have social skills, or options, for handling situations that make him or her upset or angry.  Some examples:  avoid kids that irritate them, or “storm out” of a situation that’s escalating instead of fighting, or write down insults and keep them hidden instead of speaking them aloud, leave a situation and get physical exercise…

Then teach your child empathy, which can be learned.  Say to them: “All people deserve respect even if you don’t like them,”  “All people have value and feelings”, “All people are different, and they don’t have to be like you or act the way you want them to.”  Remind them of others who show kindness and respect to them.  If your child can be trusted, taking care of a pet is a good way to help him or her develop the skill of empathy.

Praise and positive reinforcement are actually crucial.  Catch your child being good and offer praise as immediately as possible.  Being “good” might be about being kind, but it might also be about avoiding confrontation even if they get angry or aggressive in their thoughts but not their actions.

Allow your child or teen to earn rewards and privileges.  For a child, keep track with a calendar and stickers so that you and your child can measure each positive behavior, and then celebrate and reward it accordingly.

Let the school know what you are doing to work with your child, and ask for staff help and ideas for consistent consequences at school.  Let other parents know as well.

If bullying or other aggressive behaviors persist even after working with your child or teen, seriously consider professional mental health treatment.

Some statistics on risks to bullies

One study showed that 60% of boys who were identified as bullies in grades 6 through 9 had at least one criminal conviction by age 24 years, and between 35% and 40% of these children had three or more criminal convictions by that same age.

Much bullying occurs in schools.  Dr. Joyce Nolan Harrison, assistant professor of psychiatry at the Johns Hopkins School of Medicine said, “Studies show [bullying is] particularly common in grades 6 through 10, when as many as 30% of students report they’ve had moderate or frequent involvement in bullying,” she says.

According to international studies, bullying is common and it affects from 9% to 54% of all children.  In the United States, many believe bullying can push victims to acts of violence, such as the Columbine High School massacre.

Children with attention deficit hyperactivity disorder are almost 4 times as likely as others to be bullies.  And, in an intriguing corollary, the children with ADHD symptoms were almost 10 times as likely as others to have been regular targets of bullies prior to the onset of those symptoms, according to the report in the February 2008 issue of the Journal Developmental Medicine & Child Neurology.

If you are the parent of a victim

If schools don’t have the resources to deal with bullying, parents need to take matters into their own hands.  Enlist the help of all the other parents of bullied children.  “Parents have to work as a group,” explains Dr. William Pollack, professor psychiatry at Harvard Medical School.  “One parent is a pain in the [butt].  A group of parents can be an educational experience for school authorities.”

One thing you shouldn’t do, Pollack says, is call up the bully’s parents.  “You have no idea of what is going on in that kid’s home,” he says.  “He may get hell for bullying your kid — or he may be told to keep it up.”

Armor your child by describing ways they can protect themselves.  Avoid the places where bullying happens (bathroom, lunch, playground) or always bring a friend.

Help the bullied kids find each other.  “If there are a bunch of them together, they can stand the bully down,” Dr. William Pollack says.  “They don’t have to beat the bully up.  They just have to say, ‘Why are you treating my friend this way?’  The bully will often move on.”

Inform teachers and school staff in writing of your concern, or volunteer in your child’s classroom(s).

– – – – –

Bullying and suicide. A review.  (excerpt)
Authors: Kim, Y.S.; Leventhal, B. International Journal of Adolescent Medical Health; pp: 133-54;  Vol(Issue): 20(2), 2008

Researchers at Yale School of Medicine believe they’ve found a connection between bullying, being bullied, and suicide in children.  Bullying, the most common type of school violence, has been frequently associated with a broad spectrum of behavioral, emotional, and social problems.  This paper provides a systematic review of 37 studies, from 13 countries, that were conducted in children and adolescents, and that examined the association between bullying experiences and suicide, with an emphasis on the strengths and limitations of the study designs.  (Suicide is third leading cause of mortality in children and adolescents in the United States of America and around the world.)  Despite methodological and other differences and limitations, it is increasingly clear that any participation in bullying increases the risk of suicidal ideations and/or behaviors in a broad spectrum of youth.

Not just the victims were in danger: “The perpetrators who are the bullies also have an increased risk for suicidal behaviors,” said lead author, Dr. Y.S. Kim.

Many adults scoff at bullying and say, “Oh, that’s what happens when kids are growing up,” according to Kim, who argues that bullying is serious and causes major problems for children, and that it should be taken seriously and addressed.

Email: young-shin.kim@yale.edu

– – – – –

Kids with ADHD more likely to bully  (excerpt)
By Linda Carroll, MSNBC contributor Jan. 29, 2008 URL: http://www.msnbc.msn.com/id/22813400/

For one year, a study followed 577 children in the 4th grade, in a community near Stockholm.  The researchers interviewed parents, teachers and children to determine which kids were likely to have ADHD.  Children showing signs of the disorder were then seen by a child neurologist for diagnosis.  The researchers also asked the kids about bullying.

“The results underscore the importance of observing how kids with ADHD symptoms interact with their peers,” says study co-author Dr. Anders Hjern, a professor in pediatric epidemiology at the University of Uppsala in Stockholm.  These kids might be making life miserable for their fellow students.  Or it might turn out that the attention problems they’re exhibiting could be related to the stress of being bullied.

“You can’t learn if you’re being bullied, if every day you’re frightened of how you’re going to be treated,” says William Pollack, an assistant clinical professor of psychiatry at Harvard Medical School.

As for the bullies, they often need help with other issues, Pollack says.  “It’s not uncommon, for instance, to find that the aggressor is acting out because he’s depressed.  And often, the kids who are doing the bullying have been bullied themselves,” he adds.

Unfortunately though, treating ADHD won’t remedy bullying because “drugs for the condition impact a child’s ability to focus in school but not the aggression that could lead to bullying,” says Kazdin, a professor of psychology and child psychiatry and director of the Parenting Center and Child Conduct Clinic at Yale University, and president of the American Psychological Association.

Bullying happens most at school.  The best solution for bullying is for schools to develop programs that help both the bullies and the bullied, experts say.

– – – – –

Hyperactive Girls Face Problems As Adults, Study Shows (excerpt)
by Nathalie Fontaine, René Carbonneau, Edward Barker, Frank Vitaro, Martine Hébert, Sylvana Côté, Daniel Nagin, Mark Zoccolillo and Richard Tremblay, March 2008, Journal Archives of General Psychiatry, and ScienceDaily (Mar. 20, 2008).

A 15-year longitudinal study found that girls with hyperactive behavior (restlessness, jumping up and down, a difficulty keeping still or fidgety), and girls exhibiting physical aggression (fighting, bullying, kicking, biting or hitting) were found to have a high risk of developing adjustment problems in adulthood.

Young girls who are hyperactive are more likely to get hooked on smoking, under-perform in school or jobs and gravitate towards mentally abusive relationships as adults, according to a joint study by researchers from the University de Montréal and the University College London (UCL).

The study followed 881 Canadian girls from the ages of six to 21 years to see how hyperactive or aggressive behavior in childhood could affect early adulthood.  The research team found that one in 10 girls monitored showed high levels of hyperactive behavior.  Another one in ten girls showed both high levels of hyperactive and physically aggressive behavior.

According to UCL lead researcher, Dr. Nathalie Fontaine.  “This study shows that hyperactivity combined with aggressive behavior in girls as young as six years old may lead to greater problems with abusive relationships, lack of job prospects and teenage pregnancies.”

“Our study suggests that girls with chronic hyperactivity and physical aggression in childhood should be targeted by intensive prevention programs in elementary school…  Programmers targeting only physical aggression may be missing a significant proportion of at-risk girls.  In fact, our results suggest that targeting hyperactive behavior will include the vast majority of aggressive girls,” said Dr. Fontaine.

“We found that about 25 per cent of the girls with behavioral problems in childhood did not have adjustment problems in adulthood, although more than a quarter developed at least three adjustment problems,” researcher Richard Tremblay said, noting additional research is needed into related social aggression such as rumor spreading, peer group exclusion.  “We need to find what triggers aggression and how to prevent such behavioral problems.”

– – – – –

Bullying and Suicide
Psychiatric Times. Vol. 28 No. 2   February 10, 2011

Childhood and adolescent bullying is recognized as a major public health problem in the Western world, and it appears to be associated with suicidality. Recently, cyberbullying has become an increasing public concern in light of recent cases associated with youth suicides that have been reported in the mass media.  Victims of bullying consistently exhibit more depressive symptoms than nonvictims; they have high levels of suicidal ideation and are more likely to attempt suicide than nonvictims.  Studies show that bullying behavior in youth is associated with depression, suicidal ideation, and suicide attempts. These associations have been found in elementary school, middle school, and high school students. Moreover, victims of bullying consistently exhibit more depressive symptoms than nonvictims; they have high levels of suicidal ideation and are more likely to attempt suicide than nonvictims.

The results pertaining to bullies are less consistent. Some studies show an association with depression, while others do not. The prevalence of suicidal ideation is higher in bullies than in persons not involved in bullying behavior. Studies among middle school and high school students show an increased risk of suicidal behavior among bullies and victims. Both perpetrators and victims are at the highest risk for suicidal ideation and behavior.