Tag: troubled teens

Back to School: Tips for the Transition

Back to School: Tips for the Transition

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


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

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

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

To Disclose or Not to Disclose

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

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

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

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

How will you advocate for them?

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

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

Getting Clear on Brain Tasks

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

For Miranda, who is 13 and in middle school:

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

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

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

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

From the Flipside – Tips from a Teacher

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

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

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

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

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


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


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

Bringing it all Together

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

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


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

 

Marijuana is uniquely dangerous for troubled teens

Marijuana is uniquely dangerous for troubled teens

Marijuana’s effect on adolescents is more serious than many realize, especially for those with behavioral disorders.  This is no exaggeration; marijuana can lead to psychosis and long-term cognitive impairment for your troubled child.  Numerous recent research studies show that marijuana has a more damaging effect on the young brain than is generally understood. The THC in marijuana is psychoactive, which means it can affect your child’s unbalanced brain chemistry more than the general population. Serious depression, anxiety, paranoia, and psychosis can be triggered in children with latent psychiatric vulnerabilities. (Additional marijuana research going back to 2004 is at the end of this article).

Just because marijuana is plant-based does not mean it is safe.  It has dangerous side-effects like any other psychoactive drug.

Marijuana legalization has deeply concerned pediatric psychiatrists and other specialists in child, adolescent, and young adult mental health treatment.  Up until the their early 20’s, young people’s brains undergo radical changes as part of normal development.  Neurons are “pruned” to reduce their number (yes indeed, one can have too much gray matter to function as an adult). Pruning occurs rapidly in teenagers–think about it, in addition to puberty, a lot of nonsensical teenage behavior can be explained by this.  The THC in marijuana, the part responsible for the high, interferes with the normal pruning process.

When marijuana is ‘medicinal,’ a doctor determines a safe dose.  When it is ‘recreational,’ there is no such limit… teen users don’t realize there should be.

Let’s talk about a safe “dose,” which is different for each person.

THC is known to relieve anxiety in smaller doses and increase it in larger; this is due to its bi-phasic effects, meaning it can have two opposite effects in high doses. Furthermore, some people are genetically predisposed to experience anxiety with cannabis as a result of brain chemistry.”
–What are the Side-Effects of High THC Cannabis. Bailey Rahn, 2016

Recent evidence that marijuana leads teenagers to harder drugs

“The study of the lives of more than 5,000 teenagers produced the first resounding evidence that cannabis is a gate way to cocaine, amphetamines, hallucinogens and heroin.” Read the full story

“Teenagers who regularly smoke cannabis are 26 times more likely to turn to other drugs by the age of 21.  It also discovered that teenage cannabis smokers are 37 times more likely to be hooked on nicotine and three times more likely to be problem drinkers than non-users of the drug.”
–Steve Doughty and Ben Spencer, Daily Mail, London UK, June 7, 2017

Now let’s talk about long-term.  Our troubled children are already slipping behind their peers in important ways, which can include school; emotional maturity (certainly); and physical health (such as gut and digestive problems).   Marijuana will add to your teen’s problems by causing lethargy, impaired memory, and cognitive delays.

We can’t pretend or assume marijuana is safe anymore, regardless of its legality or medicinal uses.

I found this research result extremely worrisome:

“Increasing levels of cannabis use at ages 14-21 resulted in lower levels of  degree attainment by age 25, lower-income at age 25, higher levels of welfare dependence, higher unemployment, lower levels of relationship satisfaction, and lower levels of life satisfaction.”
–Cannabis use and later life outcomes.  Fergusson DM, Boden JM, Addiction;  Pp: 969-76;  Vol: 103(6), June 2008

I worked with adolescents in residential care and in the juvenile justice system who regularly used marijuana when they could.  A young man on my caseload grew noticeably depressed after he started smoking regularly, and his anxiety, irritability, and paranoia increased.  He said that smoking helped him feel better, but he couldn’t observe what I and other social workers observed over time. Smoking marijuana, ironically, was temporarily relieving him of its own side-effects.

A clarification about the two substances in marijuana – The plant Cannabis sativa has two chemicals of interest:

  1. Cannabidiol (CBD) = Medical marijuana:  the molecule is safe for a variety of treatments, such as relief of pain and nausea, and it is approved by the American Medical Association;
  2. Tetrahydrocannabinol (THC) = psychoactive “high”:  in those who are vulnerable it, triggers psychotic symptoms, paranoia, depression, anxiety, and memory loss.

Your troubled child’s future is already at-risk, why worsen it with marijuana use?

All children need the same warnings that we give about alcohol and street drugs to include marijuana.  Whether you live in a jurisdiction where marijuana is legal or not, teens can and will find it.  It may not be possible to completely prevent your troubled child from using, but your caring persistence can reduce or end its use.

Please share this information with other parents.  

–Margaret

Guns and Mental Illness: the Debate from a Parent’s Perspective

Guns and Mental Illness: the Debate from a Parent’s Perspective

Shortly after the tragic massacre of children in Connecticut, I wrote the following Letter to the Editor to the Oregonian, Portland’s main newspaper:

“Tragic shootings always raise the question, “Why?”, and the response often jumps to guns. Yet guns are tangential to the problem. Those of us with a mentally ill person in our families can answer “why.” We’ve witnessed the behaviors leading to a mental health crisis. There are always signs, but many don’t interpret or take them seriously until it’s too late.

“If you have a loved one at risk of harming themselves or others, but aren’t sure if it’s serious or real, trust your gut. Look for behavior changes that are abrupt or steadily worsen over time. Listen for statements that seem out of character Pay attention to significant overreactions to events or ideas. Never be afraid to ask directly, “Are you OK?” Don’t hesitate to seek help from mental health advocacy or support groups. Whatever the cause, mental illness is treatable; there is hope, and people who can help.”

A couple of weeks later, a reporter from the Oregonian contacted me to help with a story on mental illness in children.  She said she wanted this important longstanding issue brought back into the national discussion.

Perhaps we have finally reached a turning point?

 

Sandra Spencer, Executive Director for the National Federation of Families for Children’s Mental Health, met at the White House with Vice President Biden’s task force on gun control to ensure that the issue goes beyond just gun control.  The following is an excerpt:

“We must deal with the real issue that children do have mental health challenges and parents don’t have support or access to services without fear of losing their children to public scrutiny, bullying, discrimination and even institutionalization. …These children, youth, and families need to know where to go, which treatment is best, and how to access community support.

“The isolation parents feel because of their children’s behavior, due to mental illness, keeps them from reaching out or even knowing who to trust for help.  There should be national outrage at the number of young people who die each year by suicide and drug abuse, or the number of children with a mental health diagnosis that go untreated, and the lengths parents go to just trying to keep their children safe and out of trouble.  This has to change in our nation before we can adequately address the need for an improved children’s mental health care system”

The issue of gun control is important to work through, but not at the expense of mental health and the millions who continue to struggle—the families and their loved ones.  Not again.

 

Your comments are strongly encouraged.  What do other parents think?

–Margaret

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

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

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

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

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

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

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

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

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

How to work with the juvenile justice system:

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

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

Remove risks:

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

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

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

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

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

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

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

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

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

The people in the Juvenile Justice System

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

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

Challenges, risks, and potentially serious problems

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

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

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

–Margaret


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

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

Why teens run, and what you can do about it

Why teens run, and what you can do about it

It’s an emotional shock when your teen runs away the first time. Your feelings are complex:  anger at his or her rebelliousness; fear for his or her safety; shame that you may be called a “bad” parent or that your behavior caused your child to run.  Runaway teens also have complex reasons for running, and they may or may not be the parents’ fault.

Why they run

Basic teenage development All teens go through a stage where they define themselves as unique, and start demanding two things: 1. freedom; 2. a say in their life.  These are necessary and important for maturity—some do it gracefully and some don’t.  Even teens with a mental illness will go through this normal phase.

Rebellion Most rebellious teens do not run away because they may have better survival instincts.  If a teen is emotionally behind their peers, using drugs or alcohol, and part of a risky crowd that encourages them and undermines their parents’ authority, it’s likely they’ll run.

Mental disorders Mental health problems magnify any or all negative aspects of rebellion and immaturity.  They also disrupt a teen’s thought patterns and cause irrational ideas and fantasies.  They have a high likelihood of running.

Family stress This is the biggest reason: “65% of youth reported running away because of family conflict.”* Think about what’s going on at home that a teenager can’t handle (they are not as strong as they act).  Is there non-stop fighting between members?  Are they being nagged or constantly criticized, and not shown support or love?  Like all children, teens still deserve support and love.  Are they being bullied, or physically or sexually abused?  *National Runaway Switchboard at 1-800-RUNAWAY

What you might observe that foretells running

  • Changes in behaviors or normal patterns mean something is wrong.
  • Teens who suddenly stop eating or begin to overeat, sleep all day or never sleep, spend all their time with friends, or never want to leave their room.  Sudden mood swings mean teens are unsettled and restless, and they’re not coping well with stress.
  • Outward rebellious behavior is often the start of trouble, but not always.  Inward rebellion is also a problem, such as depression and isolating from their family.
  • Falling grades, truancy, school behavior, and breaking house rules are all symptoms that your child is having problems.
  • Disclosure of intentions to run away.  Some teens will hint that they want to run away and some will outright threaten their family with running.
  • Expressing fantasies that they will ‘divorce’ their family.  Teens often believe they can be legally emancipated before age 18, skip high school and get a GED* and a job, and be free.  A juvenile court judge told me otherwise!  The legal test for emancipation is very restrictive.  *General Educational Development exam–a less valuable substitute for a high school diploma.
  • Accumulation of money and possessions. To survive, runaway teens need resources. Some prepare for their run by saving any money they receive.  They might keep a bag or backpack of clothes and food in the closet to make a quick escape.
  • Risky friends have a very powerful influence on the decision to run away.  Relationships like these almost always include substance abuse.  The risky associates include adults who undermine the parents, and who coach teens how to get away from home. They provide them with cigarettes and drugs, and possibly take advantage of them.
  • Full time access to unmonitored and unrestricted communication, and easy access to transportation, especially a car or an at-risk acquaintance with a car.

What to do if you suspect your teen might run away

“Clearly and calmly let your teen know you are concerned about them, and that their behavior makes you afraid they might run away from home. Invite them to talk with you or someone else about what is troubling them and be supportive of finding positive ways of dealing with their stress.”

Let them know you don’t want them to run away and you’re committed to helping the family work things out, and let them know you are concerned about their safety.

If your teen is intent on running away, give them the phone number of the National Runaway Switchboard* so that they can find safe options while out on their own.”  This does not mean you approve.  A good analogy is informing your kids about contraceptives even though you don’t want them to have sex.  *1-800-RUNAWAY

Give them some facts: Your teen should know the laws, and they should know about youth shelters.  This may help them recognize that you are concerned for their safety… just like you told them.

– – – – – – – – – –

Are you thinking about running away?

Are you worried about staying with a friend and getting your friend or their parents into trouble? Does it matter if you’re reported as a runaway or not? Deciding on whether or not to run away and where to go can be difficult. Here’s what you should know:

  • In most states it is not illegal to run away.
  • If you leave home without permission or stay away longer than you’re supposed to, and you are under the age of 18, your parents can file you as a runaway with the police.
  • If the police find you, you will be taken home or to police headquarters, and your parents will be called to pick you up.
  • If you are staying at a friend’s house or somewhere your parents didn’t give you permission to be, they can face possibly legal consequences.
  • If you are filed as a runaway, your parents can press charges against those allowing you stay with them or abiding you.
  • If you go to a youth shelter, generally they have to contact your parents within a certain amount of time to obtain consent for your stay.  Often, you are allowed to stay only 72 hours (3 days) before you must return home.  This gives you and your parents time to cool off.
  • If you are staying with a friend, in most cases the police are only allowed to do a courtesy check; which means they are not allowed to search your friend’s home without a warrant.
  • It is always best to check with your local non-emergency police hotline or legal aid when it comes to specifics because the law varies.

Hopefully the information listed here answered some of the questions you may have had. If not, you can give us a call and we can help.  1-800-RUNAWAY

(Parent: list the names and addresses of local youth shelters here—not adult shelters)

 – – – – – – – – – –

Get to know their friends and their friends’ parents.  If anyone who knows them is concerned about your child’s safety, they may help you if there’s a problem.  Other parents can keep an eye out for your child as well as their own.

Statistics indicate that most children stay in the same general area that they live in. Some go only as far as a friend or relative.  You must know where and be able to communicate with the responsible adults.

Get to know the at-risk youth

and adults that your teen associates with. “At-risk kids hang out together, they know each other’s stories (true or not), protect each other, and keep parents out of the loop.  What if parents got together too, shared stories, and supported each other?  Everyone has the same goal of protecting their child.  Kids’ unsafe plans and activities are no match for the many eyes and ears (and cleverness and wisdom) of all their parents combined.”  Gang up on your kids: Parent networks for tracking at-risk children

If your teen is staying at a friends’, this may be helpful.  You might negotiate with the parent for a friendly arrangement for ‘shelter’ until things calm down.  If you cannot communicate with this parent, they may be guilty of custodial interference.  This is illegal and should be reported to the police.  More often than known, some parents actively encourage other parents’ children to leave home, as well as provide them with alcohol and drugs.

What to do if they run

Notify the police and file a missing persons report.  If your teen has a mental disorder, bring this up on the call and be specific (he needs to take medications, she has a history of assaulting others, he has threatened suicide, she might be out of control and unable to respond if you shout at her…).

Are you worried that your police report will go on your child’s record?  Don’t.  Even if your child is charged and convicted as a juvenile, his or her record can be expunged (erased) at age 18 with good behavior.

The National Runaway Switchboard at 1-800-RUNAWAY operates a 24-hour confidential hotline for teens and their families. Leave a message with them for your child, www.nrscrisisline.org. They also provides bus tickets to get kids back home to their families

Spread the word among friends and your child’s friends that you reported your child, and ask them to ask your child to call or give a message to you if they see them.  Also spread the word that protecting a runaway is a crime.

Track.  “Friend” your child on Facebook, or find someone who can and will report to you.  Set your computer up to track and store web search history and email.  Search their room.  Get their cell phone contacts if possible, track their GPS location by cell phone, and get every address and phone number of every friend.  All of this is legal.

Investigate.  This is not a situation where you respect your teen’s privacy.  Besides tracking their activities above, drive around and look for them.  Be sure they and their friends see you because then the risky friends will avoid your child.

Check in with your child’s teachers or counselor for any information that might be useful.

Take care of yourself and your other children. This is a difficult time and you don’t have to deal with it alone. Turn to people you know and trust for support. The NRS is available 24 hours every day and offers information and support for parents too.

Ask yourself the hard questions:  Is life at home that bad?  Is there abuse (emotional or physical)?  What changes am I willing to make to reduce my child’s stress at home or at school.

Good news from statistics

  • 85% parents reported that the issues that led the youth to run away were somewhat, mostly, or completely resolved within a month.
  • Most parents reported that their youth used alcohol or other substances less once they returned (68%).
  • Most reported they engaged in physical fights less (64%).
  • Most reported they broke the law less (66%).
  • Of those who ran once, 75% did not leave home again.

Creative things other parents did that worked

True story.  A father made business cards to give to everyone who was ever in contact with his 15-year-old daughter.  It had her photo, contact information, and the message that he and her mother loved (name) and wanted to ensure her safety and appropriate behavior.  He made a point of personally visiting with her friend parents where daughter went.  She hated her dad for this, but never ran again, and every time she visited a friend, the parents always reminded her to call her own parents and report her whereabouts

True story.  Two 13-year-old girlfriends decided it would be fun to run away and party.  During the week they went missing, their frantic mothers collaborated on a ‘full court press’ to notify others and get their daughters back safe and sound.  They printed flyers with photos of their daughters, their phone numbers, and offered a $25 reward, no questions asked.  These were given to the police, posted at school, at youth shelters downtown, and at business hangouts the girls were known to frequent (a mall, a fast food place, a big box retailer).  Both girls were eventually returned safe and sound, and they were really angry.  Apparently, street kids and risky adults spurned the girls because of the flyers, for fear of attracting the attention of law enforcement.

–Margaret

 

Do you have a runaway story?  Please comment on what worked to return your child, or what didn’t work.  Thank you.

ADHD kids become troubled adults

ADHD kids become troubled adults

I confess I used to think attention deficit disorders were not as serious as other disorders.  I was so wrong.

Sure, teens with attention deficits had problems, but they didn’t compare with the disabling and dangerous problems resulting from bipolar or schizophrenia.  ADHD kids seemed more ‘functional’ to me and treatments seemed to work better.  They were also friendly and funny.  While other families with mentally ill children talked about psychotic breaks, suicide, and panic attacks, I heard parents of ADHD kids talk about frustration and daily calls from school.  Heck, kids with ADHD could attend school!

“Genius by birth; slacker by choice.”
–seen on a T-shirt

I confess, I thought ADHD symptoms made a person interesting, and fun and creative (true), but my perception changed radically when I found research on children with ADHD who were tracked from childhood to adulthood.  These studies revealed deeply unsettling news—the consequences of ADHD can be quite serious.

Barkley, RA “Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment,” 1998.

Adults with ADHD have a higher risk of developing other psychiatric problems, being victimized and incarcerated, and facing lifetime struggles with education, employment, and relationships.  Summaries from 10 research studies on the long-term prognosis of ADHD are found at the end of this post.

People with ADD and ADHD have so many gifts!

When I attended a children’s mental health conference, a workshop was lead by a panel of young people with with ADHD.  They were articulate about their experiences and needs, answered questions, and interacted appropriately with audiences.  So many strengths!  Young people with other disorders can be challenged by the cognitive and emotional demands of these tasks.  I learned a lot.

Parents need the support to address the basics:  behavior at school and home, school attendance and educational attainment, self-esteem, and self-actualization.  In addition to medical/medication treatment as recommended, parents need to know how to teach self-calming skills so their child can effectively control impulses.

Check out this article:  “Understanding and supporting a child with ADD or ADHD.”

Little things start adding up – Without skills (and/or medication), a person with ADHD slips up on life’s daily little challenges–losing, forgetting, neglecting, overreacting, disappointing others, and undermining themselves in a thousand different ways.

Dependence and resentment – I’ve noticed that those with ADHD seem to find or attract others they can depend on to help them function, but their “caretakers” (spouse, friend, co-worker) and family pay a price.  A person with ADHD can resent their dependence on others, or become so dependent that others resent them.
 
Unfinished business – Those with ADHD drag unfinished projects with them indefinitely, keeping them in an actual or metaphorical garage full of costly unfinished projects.  Little repairs become big expensive repairs through lack of maintenance.  Bills don’t get paid, licenses don’t get renewed, debtors get away with never paying them back.
 
Guide your child to his or her gifts
From personal experience with ADHD children and adults, I know they can love, be affectionate, funny, generous, highly creative, and show empathy for others.
Think of careers your child or teen might pursue that require creativity, energy, and enthusiasm.  Introduce them to experiences that challenge them, and ignore the myth that they can’t focus or that they mess things up, not true.  ADHD kids readily focus on projects they enjoy, demonstrate mental nimbleness with complexities, multitask with accuracy, and shine in emergencies, whether debugging software, making music, or even doing surgery.
Q:  “How many kids with ADHD does it take to change a lightbulb?”
A:  “What was the question again? I saw something shiny.”

A personal rant:  I’ve read articles that question the existence of ADHD or criticize parents who get medication for their son or daughter.  Prejudice against this disorder and parents is sadly common. Public misinformation and controversy over ADHD and medication negatively influences parents’ decisions.

Some think ADHD is an excuse for bad parenting, or treatable with natural substances or meditation, etc.  Parents don’t cause ADD, ADHD.  And while non-drug options help, results can be marginal and short-lived.  I know parents who cling to pseudo-treatments that fit a personal philosophy, but can’t admit when they’re child’s symptoms aren’t improving. If a non-drug remedy is effective, this will be the proof: the child keeps up with their peers at school, exhibits behaviors typical for their age, and is able to learn some self-control.

At another extreme, some parents want a “quick fix” with pills. Or, if parents are happy with the results of the right medication, they overlook their child’s discomfort with side effects, or worse, they overlook how their home environment aggravates distraction and chaos. A pill will partially compensate for bad parenting and a crazy-making household, but that child does not deserve the burden.


High School Students With ADHD: The Group Most Likely to…Fizzle

 Breslau J, Miller E, Joanie Chung WJ, Schweitzer JB.Childhood and adolescent onset psychiatric disorders, substance use, and failure to graduate high school on time. Journal of Psychiatric Research.  Jul 15 2010

 Adolescents with attention deficit/hyperactivity disorder (ADHD), conduct disorder, or who smoke cigarettes are least likely to finish high school (HS) on time or most likely to drop out altogether, researchers at the University of California, Davis, School of Medicine (UC Davis) have found.

Lead investigator Joshua Breslau, PhD, ScD, medical anthropologist and psychiatric epidemiologist reported that of a total of 29,662 respondents, about one-third (32.3%) of students with combined-type ADHD were more likely to drop out of high school than students with other psychiatric disorders. This figure was twice that of teens with no reported mental health problems (15%) who did not graduate. Students with conduct disorder were the second at-risk group (31%) to drop out or not finish on time. Cigarette smokers were third in line, with a staggering 29% who did not finish high school in a timely manner.

Educational achievement squelched in children with ADHD
Newsletter – NYU Child Study Center, New York, NY, February 2009
Attention Deficit/Hyperactivity Disorder (ADHD) is one of the most common disorders in childhood and adolescence, with prevalence estimates ranging from five to ten percent.  Children with untreated ADHD drop out of high school 10 times more often than other children.

Adult psychiatric outcomes of girls with attention deficit hyperactivity disorder
American Journal of Psychiatry, January 2010
Researchers studied age 6 to 18-year-old girls with diagnosed ADHD and followed up after 11 years.  Conclusions:  By young adulthood, girls with ADHD were at high risk for antisocial, addictive, mood, anxiety, and eating disorders. However, ADHD medications appear to reduce the prevalence of multiple disorders at least in the short-term.  These findings, also documented in boys with ADHD, provide further evidence for negative long-term impacts ADHD across the life cycle.

Brain abnormality found in boys with attention deficit hyperactivity disorder
Journal of Abnormal Psychology, March 2009
Researchers trying to uncover the mechanisms that cause ADHD and conduct disorder found an abnormality in the brains of adolescent boys suffering from the conditions. The research focused on two brain areas, the “mid brain” striatal, and cerebral cortex.  The mid brain motivates people to engage in pleasurable or rewarding behavior.  The cortex notices if an expected reward stops and considers options. However, this doesn’t occur as quickly in boys with ADHD or conduct disorders.  Instead, the mid brain region keeps trying for rewards, which is a quality of addictive behavior.

Kids with ADHD more likely to bully, and those pushed around tend to exhibit attention problems
Developmental Medicine & Child Neurology, February 2008
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.  Bullies were the kids in class who couldn’t sit still and listen, didn’t do their homework and were almost constantly in motion.  Children with ADHD symptoms make life miserable for their fellow students, and they too can develop attention problems related to the stress of being bullied.

Girls’ hyperactivity and physical aggression during childhood and adjustment problems in early adulthood:  A 15-year longitudinal study.
Archives of General Psychiatry, March 2008
Girls with hyperactive behavior such as restlessness, jumping up and down, and difficulty keeping still or fidgety, and girls exhibiting physical aggression such as fighting, bullying, kicking, biting or hitting, all signs of ADHD, were found to have a high risk of developing adjustment problems in adulthood.

Teen’s inattentive symptoms may determine how long they stay in school
Forum for Health Economic & Policy, November 2009
Poor mental health of children and teenagers has a large impact on the length of time they will stay in school, based on the fact that at conception there are differences in genetic inheritance among siblings. This study provides strong evidence that inattentive symptoms of ADHD in childhood and depression in adolescents are linked to the number of years of completed schooling.

Children with ADHD more likely to participate in crimes
Yale School of Public Health and University of Wisconsin at Madison, October 2009
Children with ADHD are more likely to participate in crimes such as burglary, theft and drug dealing as adults.  Those who had attention deficit hyperactivity disorder as children were at increased risk of developing criminal behaviors.  Researchers said one reason is that children with ADHD tend to have lower amounts of schooling.

ADHD may affect adults’ occupational and educational attainments
Journal of Clinical Psychiatry September 2008
Adults who have ADHD generally have lower occupational and educational attainments as adults than they might have reached if they didn’t have the disorder, at least compared to what attainments would have been expected given their intellect.  “Educational and occupational deficits… are a consequence of ADHD and not IQ,” lead researchers Dr. Joseph Biederman said. The finding strongly underscores the need for “diagnosing and treating ADHD to avert these serious consequences,” he said.

Attention-deficit/hyperactivity disorder (ADHD) in the course of life.
European Archives of Psychiatry and Clinical Neuroscience, September 2006.
ADHD is a pervasive disorder that extensively impairs  quality of life and that can lead to serious secondary problems.  Long-term studies have demonstrated that the disorder is not limited to childhood and adolescence. The clinical experience indicates substantial difficulties for adults whose ADHD is not diagnosed and treated, and they often create extensive costs for the welfare system. The evidence-based psychiatric treatment available is highly effective and inexpensive.

70% of crystal meth (methamphetamine) inpatients had ADHD
Journal of  Addiction Disorders. 2005, and the blog: Adult ADHD Strengths.
Methamphetamine-dependent inpatients were screened for childhood attention deficit hyperactivity disorder (ADHD), and of the participants, 70.6% screened positive for ADHD and reported significantly more frequent methamphetamine use prior to baseline.  ADHD participants exhibited significantly worse psychiatric symptomatology.  At a three-week follow-up, all who didn’t complete treatment screened positive for ADHD.

Youth with mental disorders demand rights!

Youth with mental disorders demand rights!

Troubled young people have rights, and a national organization is there to support them. Youth ERA (Mission:  “Youth ERA works to empower young people and create breakthroughs with the dedicated systems that serve them.”)  Youth ERA offers peer support, social and educational support, and advocacy for youth with brain disorders.  The Oregon Chapterin  partnership with Portland State University, wrote a Youth Bill or Rights for teens to young adults between ~16 to mid 20’s.  As you can see in the Rights document below, they believe youth should be allowed to guide their mental health treatment, and receive respectful, humane care.

“YOUTH ERA BILL of RIGHTS  –  We believe that all youth should have the following rights in their mental health care:

1) Youth have the right to be leaders of their psychiatric treatment plans.

Youth should be informed of the possible side effects of medications, how long recommended medications take to go into effect, and the possible long-term effects of recommended medication. Service providers should work with youth to explore possible alternatives to using psychiatric medication before medication is given. Communication between youth and all medical providers should be collaborative, clear, and with limited use of medical terminology.

2) Youth have the right to evaluate their mental health services.

Mental health counselors, social workers, psychologists, and other service providers should provide opportunities for youth to evaluate the satisfaction of their services throughout the duration of care in a respectful and non-threatening manner. This includes evaluation of the relationship with the provider, counseling plans, and implemented treatment models.

3) Youth have rights to services that are as noninvasive as possible.

When youth are transitioning into new services, mental health programs should strive to make the transition as accommodating as possible for the youth. Youth should be consulted on the ways they would like to end their relationship with the current provider and whether they would like the current provider to share their file with their new provider. Providers should share if there will be any changes in the costs of services and/or insurance coverage.

4) Youth have rights to get treatment from trained, sensitive providers.

Youth should have access to mental health professionals that are familiar with the unique needs and challenges of youth with mental health needs. All mental health professionals should have specialized training that fosters positive youth development and support. Youth mental health service consumers should be included in the creation and implementation of these trainings.”

This document was created and signed in 2009 by 30 mental health service-experienced youth gathered in Portland, OR, from the following states: California, Hawaii, Idaho, Illinois, Kentucky, Maine, Massachusetts, Missouri, Michigan, New York, North Carolina, Oregon, Texas, and Washington.

Youth ERA rights are similar to the “Mental Health Consumer Rights” developed by adult mental health consumers, which is appended at the end of this article.

Parents should support these rights

I say “bravo,” these are appropriate and necessary–anyone receiving treatment must be comfortable and safe with care providers, and treated with dignity and respect, period  But I’d like to see something similar for parents and caregivers, too, who also participate in treatment and need to feel respected and heard.

 – – – – – – – – – –

Adults with mental illness had already developed a bill of rights for the same reasons as the youth–to receive sensitive, humane services and participate in all aspects their treatment.

Adult Consumer Bill of Rights – for adults in mental health service systems

  1. Information Disclosure:  Consumers have the right to receive accurate, easily understood information and may require assistance in making informed health care decisions about their health plans, professionals, and facilities.
  2. Choice of Providers and Plans:  Consumers have the right to a choice of health care providers that is sufficient to ensure access to appropriate high-quality health care.
  3. Access to Emergency Services:  Consumers have the right to access emergency health care services when and where the need arises.
  4. Participation in Treatment Decisions:  Consumers have the right and responsibility to fully participate in all decisions related to their health care.
  5. Respect and Nondiscrimination:  Consumers have the right to considerate, respectful care from all members of the health care system at all times and under all circumstances. An environment of mutual respect is essential to maintain a quality health care system.
  6. Confidentiality of Health Information:  Consumers have the right to communicate with health care providers in confidence and to have the confidentiality of their individually identifiable health care information protected.
  7. Complaints and Appeals:  All consumers have the right to a fair and efficient process for resolving differences with their health plans, health care providers, and the institutions that serve them, including a rigorous system of internal review and an independent system of external review.
  8. Consumer Responsibilities:  In a health care system that protects consumers’ rights, it is reasonable to expect and encourage consumers to assume reasonable responsibilities.

The federal Substance Abuse and Mental Health Services Administration (SAMHSA) established the Consumer Bill of Rights Workgroup to promote and implement the Presidential Advisory Commission’s Consumer Bill of Rights and Responsibilities in health care. http://mentalhealth.samhsa.gov/consumersurvivor/billofrights.asp

 

–Margaret