Category: discipline

How to manage defiance and oppositional defiant disorder

How to manage defiance and oppositional defiant disorder

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

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

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

It is called the anterior cingulate gyrus (ACG), which allows a person to shift attention to different subjects and think flexibly–something defiant kids don’t do well.  Nor do they regulate emotions, something the ACG also does.  Children with a hyper-charged ACG have “a pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which 4 or more of the following are present:

  • Often loses temper
  • Often argues with adults.
  • Often actively defies or refuses to comply with adults’ requests or rules.
  • Often deliberately annoys people.
  • Often blames others for his or her mistakes or misbehavior.
  • Is often touchy or easily annoyed by others.
  • Is often angry and resentful.
  • Is often spiteful and vindictive.” 

–From the “Diagnostic and Statistical Manual of Mental Disorders, 4th Edition,” published by the American Psychiatric Association, 2000.

Typical traits of defiant children.

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

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

Two different psychiatric approaches to defiant behavior and ODD

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

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

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

Treatment must also include holistic or ‘lifestyle’ approaches.

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

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

Defiance and ODD often include symptoms of other disorders

  • 50-65% of defiant children also have ADD or ADHD
  • 35% develop some form of depressive disorder
  • 20% have some form of mood disorder, such as bipolar disorder or anxiety
  • 15% develop some form of personality disorder
  • Many also have learning disorders

Anthony Kane, MD 

Other conditions can cause defiant and disruptive behavior

  1. Neurological disorders from brain injuries, left temporal lobe seizures (these do not cause convulsions, no one can tell these are happening), tumors, and vascular abnormalities
  2. Endocrine system problems such as a hyperactive thyroid
  3. Infections such as encephalitis and post-encephalitis syndromes
  4. Inability to regulate sugar, resulting in rapid ups and downs of sugar in the blood
  5. Systemic lupus erythematosus, Wilson’s disease
  6. Side-effects of some prescription medications:  Corticosteroids (anti-inflammatory and arthritis drugs such as Prednisone);  Beta-agonists (asthma drugs such as Advair and Symbicort)
    –From Peters and Josephson.  Psychiatric Times, 2009
  7. Autism spectrum disorders
  8. PANDAS – an acronym for a strep infection-caused disorder that can make a previously normal child violently resistant.  (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections)
  9. Dehydration

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

  • A normal IQ
  • A first-born child
  • An affectionate temperament
  • Positive interactions with friends their age
  • Nurturing parents who can consistently set clear behavioral limits

–From the Journal of American Academic Child and Adolescent Psychiatry, 2002.  Author J.D. Burke.

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

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

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

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

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

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

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

ignore childActively ignore – This works for best with children between the ages of 2 and 12.  It involves purposefully withdrawing your attention away from your child when they are misbehaving, such as a temper tantrum, whining or sulking, baiting or teasing, or making continuous demands or loud complaints.  Pretend you don’t care and even turn your back if possible.  Give attention only after their behavior is ending or over.

Make the behavior uncomfortable.

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

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

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

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

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

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

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

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

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

Allow some aggression.  When it’s appropriate and safe, ask your child to do more of what they’re already doing so that they turn around and defy you by stopping the behavior. Example: your child refuses to take a direction and throws a book on the floor in anger.

  • Parent:  “There’s only one book on the floor. Here is another one, now throw this on the floor.”  (Child throws book down.)
  • “Here’s another one. Throw this down too.”  (Child throws book down.)
  • “And here’s another, throw this down, too.”  (Child stops throwing books in defiance.)

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

  • Teen:  “I hate you f- -king b- -ch!”
  • Parent:  “Sounds like you’re really angry.”
  • Teen:  “Shut up you stupid c – -t!”
  • Parent:  “Can you tell why me you’re angry so I can do something about it?”
  • Teen:  “Leave me alone f- -k face!  Stop patronizing me!”
  • Parent:  “OK, I hear you don’t want me to patronize you.  I feel this is stressful for both of us, so let’s take a break and talk about it later.”
  • Teen: F—k you!  I’m not talking to you ever.  (Well that’s not true, but they may ‘defy’ you by avoiding the behavior.) 

Call their bluff.

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

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

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

extinction burst

–From “Behavioral Interventions for Children with ADHD,” by Daniel T. Moore, Ph.D., © 2001, http://www.yourfamilyclinic.com/shareware/addbehavior.html .  The author requests a $2 donation through PayPal to distribute his article or receive printed copies.

Some rules for you

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

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

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

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

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

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

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

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

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

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

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

Don’t jump to conclusions that demonize the child.  I often hear parents say:  “Why does he keep doing this?, or, “Why doesn’t she stop after I’ve told her not to, over and over again.”  Then they answer their own questions:  “It’s because he always wants his way,” or, “She’s doing this to get back at me.”  As they tell their story, I hear them taking things personally:  “He does this just to make me mad;” “She manipulates the situation because she wants more (something) and I won’t give it to her.”  Is this really what you want?

Two training approaches that help parents like you: 

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

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

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


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Mothers and Teenage Daughters: a School Counselor’s Story

Mothers and Teenage Daughters: a School Counselor’s Story

This article contributed by Benjamin Dancer.

I’m a high school counselor, which means I work with parents every day. Because I’ve made a career out of my work with adolescents, I see what a parent might be seeing for the first time. This includes a long list of unfortunate life events.

Back when we were teenagers, there wasn’t a massive network of servers positioned strategically across the globe to capture and record, forever, the embarrassment of our adolescent choices.

As a parent, I have a lot of empathy for other parents. It’s not easy, especially when you’re going through something for the first time. My life, on the other hand, is a little bit like Groundhog Day. In a sense, I’ve never left high school. Every school year I see the same things. Different kids, but the same behavior: alcohol, drugs, tobacco, bullying, kids running away from home, pregnancy and something new: sexting.

Take an adolescent boy with an underdeveloped prefrontal cortex, which by definition means he is incapable of fully contemplating notions such as consequence; take this teenager raging with sex hormones and give him a tiny device that he will carry with him everywhere, a device capable of sending messages instantly to anybody, anywhere in the world, and install a camera in that device. What do you imagine might go wrong?

facebook sextingWhen you and I were adolescents, we were no less reckless, no less idiotic with our choices, no less eager to use our bodies as grownups. The difference is that our stupidity has been forgotten by history. Back when we were teenagers, there wasn’t a massive network of servers positioned strategically across the globe to capture and record, forever, the embarrassment of our adolescent choices.  Sexting changes everything.

Over the last seventeen years in my work of mentoring adolescents and partnering with their parents, I’ve seen a lot of parenting styles. I’ve learned some important strategies in dealing with the situations teenagers present–strategies the average parent doesn’t have the time, through repetition, to learn. I feel confident telling you that there are some really good ideas out there. And some really bad ones, too.

Because I’m a writer, it occurred to me to write it down, what I’ve learned over the years. I’m a parent. I know it just as well as you do. We need a little grace in our lives.

Sexting book coverExcerpt from SEXTING AT SCHOOL:

The police called the sexting child pornography. So I understood Nicole’s concern: she wanted to talk to me about her daughter. Jessica was fourteen and three years younger than her boyfriend. He had been distributing images of Jessica through his phone. Nicole was worried; she was scared, and understandably so.

Jessica still thought she was in love.

“He calls her a bitch,” Nicole told me. “I read the texts. He says horrible things to her.”

“And she still wants to be with him,” I said.

The pain I felt for her was communicated in my voice. As a teacher, I see the scenario every year, but Nicole was experiencing this for the first time. Jessica was her daughter. Not long ago she was her baby. I could only begin to imagine the suffering the situation provoked. Nicole was in no position to hear how common this was.

Why do girls throw themselves at boys who treat them badly?

In Jessica’s circumstance there was a tremendous amount of grief. She had barely processed the loss of her dad. He was killed in an accident over the summer.

“I can’t stop her from being with him. I’ve tried. I took away her phone. I grounded her. She sneaks out of the house. I drop her off at school, and she ditches to be with him.” The mascara was now running beneath Nicole’s cheekbones, “Last night, she told me that she wished it was me who was dead. He was waiting for her out front. I saw her get into his car.”

sexting image“I can’t imagine what that’s like,” I told her. “I’m sorry.”

“Unless I physically restrain her, she will find a way to get back to him.”

I allowed for a long silence, as I thought there might be more Nicole needed to say.


“What did I do? What did I do wrong?”

I didn’t answer her question. And I didn’t dismiss it. I sat with her in it.

* * * * *

My role with Nicole is not all that different from my role with Jessica. It doesn’t matter whether you’re fourteen or forty, what you need is for someone to listen. What you need is for someone to understand.

Jessica and I talked later the same day.

“She went through my phone,” Jessica was angry. “She read my texts.”

I let her know that I understood her frustration.

“She won’t let me leave the house.”

“Why?”

“She’s trying to keep me from him.”

“Have you told her that you love him?”

“Yes.”

“And…?”

“She hates him. She doesn’t want me to see him.”

“Why does she hate him?”

At this Jessica paused. We had already talked about the pictures. She had told me stories about the boy. The way he had flaunted his sexual conquests. He was in my English class, and I had seen it firsthand: there were countless other girls.

After a long silence, she answered my question, “She thinks he’s not good for me. Is he?”mean boyfriend

It was ground we had already covered. In past conversations Jessica told me that she respects her mom for trying to protect her. I handed Jessica a box of tissues. She wiped the tears and told me, “No. He’s really, really mean.”

I listened to her cry for several minutes. I was thinking about her father. I knew the man well. I liked him. I was thinking about her mother. I was thinking about my own daughter.  It was true for all of us. What we need is empathy.

“I’m sorry,” I told her.  She questioned me with her eyes.

So I answered it, “I’m sorry you’re so alone.”

Jessica’s whole body shook when she sobbed.

* * * * *

no cell phoneThe last time Nicole was in my office she asked me if she should return Jessica’s phone. We had a similar conversation the day she asked me if she should call the police.

“What do you think?”

“I think Jessica needs to figure this out for herself. I’ve tried to protect her, but I can’t. I just can’t protect her from everything.”

“Does that mean you’ll give it back?”

“No. She’s not ready for that.”

“I don’t know the answers to the particulars,” I told Nicole, “but I know this. You’re a good mom. Jessica needs you right now. She needs you to be confident in your role.”

I saw the tears washing through the mascara, gave Nicole the box of tissues, and kept on going.

This is universal: the teenager wants desperately to have her independence, and she is terrified of it.

“Jessica loves you, and she knows that you love her.  Jessica is not aware of the fact that she is conflicted about this. She’s just a kid. As much as she pushes you away, she wants you to be strong, to love her.”

* * * * *

I talked to Jessica again a week later.

“Do you still see him?” I asked.

She was embarrassed, “Yeah.”

“Is he good to you?”

“Sometimes.”

“How about last night?”

She hesitated then said, “Last night he left me in a parking lot. I had to borrow a phone and call my mom to come pick me up.”

“Why’d he leave you?”

“To hook up with someone else.”

“Will you see him again?”

“Probably.”

“I have a vision for you,” I said.

Jessica smiled, like she had heard lines like that from me before.

But that didn’t deter me. I have an advantage over most parents of teenagers: I’ve made a career out of the adolescent. Their behavior can be alarming, infuriating and even demoralizing, but after seventeen years of guiding teenagers as they come of age, I have established proven routines.

I have a pretty good idea of how many repetitions it will take, of how many times I’ll have to say it before Jessica can even make sense of the words, of how many more times I’ll have to repeat it before she begins to adopt the language as her own.

So I told her again, “In my vision of your future, you will love yourself too much to let a boy treat you badly.”

* * * * *

BenjaminDancerThe story above is a composite of a dozen mothers and a dozen daughters I’ve work with over the years. In my FREE e-book, I analyze that narrative–elucidating what I believe to be the important parenting considerations.  

Find out more at: SEXTING AT SCHOOL, a FREE download at Goodreads.com, or if you’re feeling generous, you can buy it for $0.99 at Amazon.com.

About Benjamin Dancer:

Benjamin is a high school counselor at Jefferson County Open School where he has made a career out of mentoring young people as they come of age. He wrote the novels PATRIARCH RUN, IN SIGHT OF THE SUN and FIDELITY. He also writes about parenting and education. You can learn more at:

Website:      BenjaminDancer.com

Facebook:    https://www.facebook.com/benjamin.dancer

Twitter:        @BenjaminDancer1


Like this post or have a comment?  Please give it a rating (above) and share your thoughts. Your comments are helpful for other parents who read Benjamin’s article.  Thank you.

Margaret

Is my teen ‘normal’ crazy or seriously troubled?

Is my teen ‘normal’ crazy or seriously troubled?

girl in rear view mirrorA high percentage of teenagers go through a rebellious or ‘crazy’ phase that is normal for their age and brain development. The difference between normal teen-crazy and truly troubled behavior is when the teenager falls behind his or her peers in critical areas.  At a bare minimum, a normal teen will be able to do the following:

  • Attend school and do most school work if they want to;
  • Have and keep a friend or friends their own age who also attend school;
  • Develop a maturity level roughly the same as his or her peers;
  • Exercise self-control when he or she wants to;
  • Demonstrate basic survival instincts and avoid doing serious harm to themselves, others, or property.
  • Enjoy activities that interest them.

boy in baseball capIt is normal for many teens to be inconsistent, irrational, insensitive to others, self-centered, and childish.  Screaming or swearing is normal–regard this the same as a toddler temper tantrum.  Outlandish imagination and ideas are normal in the adolescent phase too. These are behaviors that crazy teens grow out of unless something else is holding them back.  What you’d call troubled behavior, the kind that necessitates mental health treatment, is a matter of degree.

This is your challenge:  How do you tell the difference?  Troubled teens with mental disorders have the same challenging behaviors as ‘normal’ crazy teens… How do you know if they need serious mental health treatment?  Look for pervasive patterns of social and behavioral problems that stand out against their peers, patterns which persist or occur in different settings Look back at how long these patterns have been occuring.  Are the patterns repeating themselves, or are behaviors increasingly worse? Do you You your troubled teen is slipping behind and won’t grow out of it.

screaming boySigns of abnormal behavior

A sudden change in behavior.

  • An abrupt change in friends and interests, and loss of interest in things your teenager used to enjoy.  This might indicate the onset of a serious mental illness or drug use or both.
  • Unusual ideas, or obsessive beliefs, or unrealistic plans, see:  “Unsettling: what psychosis looks like in children and young people.”
  • Others think there is something abnormal about your child.  (e.g., your child’s friend comes forward, their teacher calls, other parents keep their children from your child, or someone checks to see if you’re aware of the nature of his or her behaviors).


Unsafe behaviors
 (“Unsafe” means there’s a danger of harm to themselves or others, property loss or damage, running away, seeking experiences with significant risk (or easily lured into them), abusing substances, and physical or emotional abuse of others.)

  • If a troubled teenager does something unsafe to themselves or others, it is not an accident, but something impulsive, intentional, and planned.
  • They have a history of intentional unsafe activities.
  • They have or seek the means to do unsafe activities.
  • They talk about or threaten unsafe behavior.


How psychologists measure the severity of a child’s behavior 

“Normal” is defined with textual descriptions of behaviors, and these are placed on a spectrum from normal to abnormal (or “severe emotional disturbance” – SED).  Below are a few examples of a range of behaviors in different settings.  These descriptions are generalizations and should not be used to predict your child’s treatment needs, but they do offer insight into severity and the need for mental health treatment.

School behaviors

Not serious – This child has occasional problems with a teacher or classmate that are eventually worked out, and usually don’t happen again.

Mildly serious – This child often disobeys school rules but doesn’t harm anyone or property.  Compared to their classmates, they are troublesome or concerning, but not unusually badly behaved. They are intelligent, but don’t work hard enough or focus enough to have better grades. They could use help from a school counselor, teachers, and possibly a therapist for themselves or the family.

Serious – This child disobeys rules repeatedly, or skips school, or is known to disobey rules outside of school.  They stand out in the crowd as having chronic behavior problems compared to other students and their grades are poor even if they’re very intelligent.  This child needs mental health or substance abuse treatment.

Very serious – This child cannot be in school or they are dangerous in school.  They cannot follow rules or function, even in a special classroom, or they may threaten or hurt others or damage property.  It is feared they will have a difficult future, perhaps ending up in jail or having lifetime problems.  If they cooperate, this child requires intensive mental health and or substance abuse treatment.

Home behaviors

boy looking right

Not serious – This child is well-behaved most of the time but has occasional problems, which are usually worked out.

Mildly serious – This child has to be watched and reminded often, and needs pushing to follow rules or do chores or homework.  They don’t seem to learn their lessons and are endlessly frustrating.  They can be defiant or manipulative, but their actions aren’t serious enough to merit intensive treatment, though a school counselor or private counselor would be very beneficial.

Serious – This child cannot follow rules, even reasonable ones.  They can’t explain or take no responsibility for their behavior, which can include damage to the home or property, or harm to themselves or others.  They need mental health treatment or substance abuse treatment.

Very serious – The stress caused by this child means the family cannot manage normally at home even if they work together.  Running away, damaging property, threats of suicide or violence to others, and other behaviors require daily sacrifices from all.  Police are commonly called.  This child needs intense psychiatric treatment and/or substance abuse treatment, and likely residential treatment.

Relationship behaviors

somber boyNot serious – The child has and keeps friends their own age, and has healthy friendships with people of different ages, such as with a grandparent or younger neighbor.

Mildly serious – This child may seem extra immature.  They will argue, tease, bully or harass others, and most schoolmates avoid them. They are quick to have temper tantrums and childish responses to stress that always require extra attention from parents and caregivers.

Serious – The child has no friends their age, or risky friends, and can be manipulative or threatening. They can have violent tendencies, poor judgment, and take dangerous risks with themselves and others.  They don’t care about others’ feelings, or may readily harm others physically or emotionally.  This child needs therapy and psychiatric mental health treatment or substance abuse treatment.

Very serious – The child’s behavior is so aggressive verbally or physically that they are almost always overwhelming to be around.  The behaviors are repeated and deliberate, and can lead to verbal or physical violence against others or themselves.  This child needs intensive psychiatric and/or substance abuse treatment.

Pay attention to your gut feelings.

If you’ve been searching for answers and selected this article to read, your suspicions are probably true.  Trust your intuition. Most parents have good insight into their child.  If you’re looking for ways to “fix” or change your child, there just aren’t any easy methods or medications or therapies to do this except over time.  Treatment means multiple life changes in addition to medication and therapy, and these can include help for insomnia, a change in diet, treatment for digestive system problems, and household changes to reduce stress.

Mental illness is serious and recovery is a long slow process.  It is  understandable if you want them to recover quickly–your stress can be intolerable.  Avoid pushing for recovery because it will only stress your child and lead you to disappointment.  Instead, cooperate with professionals (teachers, treatment providers), and prepare yourself for a parenting marathon.  What’s the best way to prepare?  Work hard on your own mental health and wellbeing.  Lower your expectations for steady progress.  This advice and wisdom from other parents may help you face this daunting task.

boy in plaid shirtEarly treatment, while your troubled teenager is young, can prevent a lifetime of problems.  Find a professional who will take time to get to know your child and you and the situation, and who will listen to what you have to say–a teacher, doctor, therapist, psychiatrist or other mental health practitioner.

–Margaret

Your comments are encouraged.  Your story helps others who read this article.


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“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.”

ARE YOU OVERREACTING?

ARE YOU OVERREACTING?

Your child’s incessant problems and scares can literally give you symptoms of PTSD and anxiety disorder that you can’t control.

Like many parents, you might go to extremes to control situations so they won’t get out of hand. You don’t intend overreacting, but so much frustration has built up that any little irritation sets you off like rocket.  You’re battling to make things stop now.

Overreactions are emergency alarms without the emergency.

You can’t see it coming, but then it happens.  In an instant you are on an unstoppable mission to fix, contain, punish, or halt anything that upsets your sense of well-being, imagined or not. Overreacting is a sure sign of stress and that you need a break!  Overreactions may also come from the anger of losing the day you planned, or the life you planned and came to expect.

Dad, project strength on the outside, even when you don’t feel it on the inside. Relieve your tension later, away from the family or co-workers, by doing something physical, for example.

If you are overreacting to gain control, you are actually losing control.  Your parenting choices need considered, thoughtful decisions instead of an automatic 911 call. When your blood boils, you’re not aware how your behavior creates a toxic environment around you and the rest of your family… nor how it worsens a troubled kid’s behavior.

  • Do you worry even when things are fine?  Do you find things to worry about that aren’t problems?
  • Are you so stressed and traumatized that you just can’t stand it anymore and want the behavior to stop immediately, yesterday?
  • Is every little minor thing a reason to pull out the heavy artillery?
  • Do you overwhelm difficult situations with your own anxieties or explosions?

It’s common for parents with really difficult kids to get stuck this way, so forgive yourself if you overreact, and stop and look at what this does to your relationships and interactions with your troubled child.

  • Do you stop eating, or start drinking, when your stress is just an overreaction to a situation you’ve already handled?
  • If you’ll do anything to make your child stop a challenging behavior, might you go too far with little things? Will you call the police because they slammed the door?
  • When others hear you constantly complaining, might they consider that the problem is you?
  • Do you mirror your child’s bad behavior to show them what it looks like? Are they interpreting this the way you hope, or are you lowering yourself?
Mom, you know this helps no one. You have every reason to “lose it” but find a safer way to relieve tension. Get away occasionally, or distract your worries with friends or an activity you enjoy.

Overreactions sabotage opportunities for improvement. They terrify everyone , and your family starts to hide things from you, or downplay things, just so you won’t overreact or worry yourself to death. When family members feel a need to keep secrets, the isolation feeds your worry. Members will smooth over problems or distract you with lightness to counterbalance your fearful or explosive state of mind. Now you are less in control and receive less of the support you need for your own well-being.

If you feel paralyzed by worry or lash out as a way of coping, you are disabling yourself stress and/or depression. Before you completely lose control and your self-respect and parental authority, take care of yourself and get help for both your physical and emotional exhaustion. Check in with others and ask them if you are thinking clearly or realistically.

You must be emotionally centered and healthy or you will never be able to help your child become healthy.

Remember, your child and family need you to be 100% together.  Let some things go for the greater peace.  Center yourself so you can notice when your child is doing well and offer praise.  When centered, you are flexible, patient, compassionate, and forgiving.   This draws people towards you, to look after you and care for you.  Go ahead, aim for sainthood.  Just starting down that path would relieve everyone else’s stress over you.

–Margaret

Your rights as the parent of a teen with a mental disorder

Your rights as the parent of a teen with a mental disorder

Parents have more rights than they think.

In a previous blog article on the subject of parents rights, I described how parents can be shocked to learn that their troubled teenager has the right to refuse treatment, Balancing teen rights with parent rights when the teen has a mental disorder.

What if your teen refuses treatment?  They get worse. Over months and years, if your child experiences serious symptoms of the disorder, such as schizophrenia, depression, or bipolar disorder, their brain loses cognitive function just as in Alzheimer’s disease.  Breaks in treatment means loss of brain function, and they become more vulnerable to multiple hospitalizations.  A troubled teenager can refuse treatment for any reason, and explaining the mental health risks to a person clouded by anxiety, depression, mania, or paranoia goes nowhere.

If a teenager had any other illness besides a behavioral disorder, refusing or withholding treatment would be considered child abuse and grounds for removing the child from the home.

Laws in many countries err on the side of protecting a person’s civil rights, but a teenager is not ready to take the responsibility that goes with these rights.(An excellent website on pertaining to Special Education Law is Wrightslaw. Click on “Topics from A to Z.”)

What if you’re teen becomes involved in crime?

  • For safety and health reasons, you have the right to search your teen’s room and remove or lock-up risky items like drugs, weapons, razors, pornography, or anything negatively affecting health. Be careful: this can destroy trust if done inappropriately. Inform your teen only if you find and remove unsafe items but otherwise leave everything else alone!
  • You can set any curfew time you think appropriate, and you do not have to adhere to curfew times used by law enforcement. Suggestion: compare with other parents’ curfews. Your teen will more likely follow rules that his or her peers follow.
  • You can monitor everything in your home, and on your computer and phone. You can limit cell phone services, and get GPS tracking on the phone and in the car. Prevention is more effective if your teen is informed about this, and it prevents others from taking advantage of your child, too.
  • You can report your concerns to anyone: teachers, other parents, and the local police precinct.
  • You can search for your child by calling other parents or businesses, or visiting their friends’ homes, or searching public places where your child might be.
  • You can and should call the police if your child runs away, or if your child is being harbored by someone who wants to ‘protect’ them. It is illegal to harbor runaways and those who do are subject to criminal charges.
  • You can and should notify anyone who encourages your teen to run away or who takes your teen with them without your permission, that this is custodial interference and subject to criminal charges.

What if your child’s mental health provider doesn’t share information you should know as the parent?

“Communication between providers and family members needs to be recognized as a clinical best practice.”*

  • You have the right to contact any mental health professional directly, and provide information relevant to your child, your family (e.g. marital conflict), and your family’s needs (e.g. bullied siblings). The professional can legally receive and document this information, but may not be able to discuss it with you.
  • You have the right to communicate freely and openly with a practitioner or teacher about anything you both already know—no confidentiality exists.
  • You have the right to schedule your own appointment with a professional without your teenager, and ask for information about how to get help for yourself and your family, and what kinds of help you may need.
  • You have the right to information about your child’s diagnosis and behavioral expectations, the course of your child’s treatment, and how you should interact with your child at home.
  • You have the right to a second opinion. And you have the right to change treatment or refuse treatment based on that second opinion.
  • You have to right to participate fully in medical decisions about your child. For example, you have the right to ask a doctor to stop or change medication or treatment that is creating behavior problems or side effects, which harm your ability to manage your teen.
  • You have the right to “information about the treatment plan, the safety plan, and progress toward goals of treatment.” *

What if your child’s provider claims they must keep all information confidential to protect patient privacy?

“While confidentiality is a fundamental component of a therapeutic relationship, it is not an absolute.”*

“Medical professionals can talk freely to family and friends, unless the patient objects after being notified of the intended communication. No signed authorization is necessary.”

–Susan McAndrew, Deputy Director of Health Information Privacy, U.S. Department of Health and Human Services

Teachers and mental health professionals have leeway with confidentiality.  Professionals often misunderstand the Health Information Privacy and Accountability Act (HIPAA), which defines what must be kept confidential. Many also misunderstand the Family Educational Rights and Privacy Act (FERPA) and state laws that govern confidentiality, so they tend to err on the side of confidentiality. However, the American Psychiatric Association states:

“Disclosures can sometimes be justified on the grounds that they are necessary to protect the patient. For instance, it is generally acceptable for a psychiatrist to warn a patient’s family or roommate when the patient is very depressed and has voiced suicidal thoughts”* or plans to harm others.

Professionals should provide explicit information about safety concerns: such as the warning signs of suicide; the need to adhere to medication and other treatment; an explanation of how your teen’s disorder can impair judgment; an explanation of reasons the teen must avoid substances like alcohol and drugs (including some over-the-counter drugs); and the need to remove the means for suicide, especially firearms, sharp objects, matches, chemicals, etc.

How doctors and therapists manage confidentiality

Their basic philosophy is to do what is in the best interest of their patient. For example, if the teen is in an abusive family situation or seeking care only on the condition of confidentiality, their privacy will be protected. “The default position is to maintain confidentiality unless the patient gives consent… However, [family members or friends] may need to be contacted to furnish historical information…” If the practitioner determines that the teen is (or is likely to become) harmful to himself or herself or to others, and will not consent, then they are… “justified in breaking confidentiality to the extent needed to address the safety of the patient and others.
–The American Medical Association, 2001, “The Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry.”

A good professional will be honest with your teen, and tell them that they will communicate with parents based on what they already know. They will also tell your child that suicide or violence risk will always be communicated to you and/or an emergency medical service. From everyone’s perspective “It is always better to defend an inappropriate disclosure than to defend a failure to disclose with bad outcome (e.g. injury or death).”

Giving a teenager with behavioral problems the rights to make critical medical decisions is too risky!

I hope that families and mental health advocates can someday agree on how to maintain civil rights without letting a person control their future when they are not in their right mind. Until then, work with the system as best you can. I find that teachers and practitioners do their best to help families despite the restrictive civil rights and confidentiality mandates.  Good luck.

 

* Reference“The Clinician Should Maintain a Confidential Relationship With the Child or Adolescent While Developing Collaborative Relationships With Parents, Medical Providers, Other Mental Health Professionals, and Appropriate School Personnel,” developed by Jerry Gabay JD and Stewart S. Newman MD. The authors would like to acknowledge the support of the Oregon Council of Child and Adolescent Psychiatry for their support of this effort.

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.