Category: teenagers

Borderline children – how they function and how you can help

Borderline children – how they function and how you can help

Borderline personality disorder makes a child wonderful yet horrible; lovely yet vindictive; a great friend or manipulative bully; anguished or glowing with joy; self-hating yet self-important; self-centered but also charitable.

Are you ready to bang your head on a wall?  Are you praying for the day your child turns 18, when you can change the locks on your doors?  Children with borderline personality disorder (BPD) traumatize everyone around them.

Children with BPD genuinely believe others will abandon them, and this makes them do one of two things:

    1. Do everything possible to obtain and keep love and admiration;
    2. Or if they detect the slightest hint of disapproval, blame themselves or others so as to feel they made the decision.  This will disguise the horrible feelings of abandonment.

 

A borderline child can be very engaging and affectionate… sometimes at random and sometimes when they want something.  They will also turn on the charm as a way to embarrass you in front of others (such as in a meeting with a teacher or family counselor).  Since they seem so wonderful to other people, you may be judged because you get upset at your clearly wonderful child.  People often suggest that you take care of your own issues instead.

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

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

A study published in 2008 in Science showed that brain activity in people with borderline personality disorder was abnormal—their brains lack activity in the ‘cooperation’ and ‘trust’ regions, called the bilateral anterior insula.  People with borderline personality disorder do not have an internal, natural sense of fairness or social norms, and distrust is their default mentality.  Some suggest that borderlines do not receive the attention they need as an infant and toddler.  Early neglect is also a predictor of reactive attachment disorder, which has similar trust issues.

When playing a game that requires teamwork, the brain of a normal person shows activity in the bilateral anterior insula.
borderline brain
The brain of a borderline person showed no activity whatsoever during the teamwork game.

Another study reported, “The disorder occurs in all races, is prevalent in females (female-to-male ratios as high as 4:1), and typically presents by late adolescence.”  It is estimated 1.4 percent of adults in the United States have this disorder.  A different study reported that BPD occurs as often in men and women, and sufferers often have other mental illnesses or substance abuse problems.  (In my observations, teenagers with borderline personality disorder have many bipolar disorder symptoms.)

From infancy, those who were later diagnosed with borderline personality were more sensitive, had excessive separation anxiety, and were moodier. They had social delays in preschool and many more interpersonal issues in grade school, such as fewer friends and more conflicts with peers and authorities.

As teenagers, borderline children can be promiscuous; impulsive and assaultive; more likely to use drugs and alcohol; and more likely to cut themselves and attempt suicide.  “…research shows that, by their 20’s, people with the disorder are almost five times more likely to be hospitalized for suicidal behavior compared to people with major depression.”

screaming girl

Evidence for hope

“Borderlines have the thinnest skin, the shortest fuses and take the hardest knocks.  In psychiatrists’ offices, they have long been viewed as among the most challenging patients to treat.”

“…almost 20 years after the designation of borderline personality disorder, understanding and hope have surfaced for people with the condition and their families.  Advances have been made in recent years.  Researchers studied 290 hospitalized patients with the condition over a 10 year period:  93% of patients achieved a remission of symptoms lasting at least two years, and 86% for at least four years.” Published in The American Journal of Psychiatry, the research argues that once recovery has been attained, it appears to last.  (from “Trying to Weather the Storm”, by S. Roan, September 07, 2009, Los Angeles Times)

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

I recommend downloading this PDF file, “Using DBT Skills to Reduce Emotional Dysregulation and Reactivity in Children/Adolescents and Parents.”  It is lengthy, but provides a clear and straightforward set of slides with wonderful practical ideas that parents can implement at home.

Treatment

Psychotherapy is the primary treatment of BPD, and the gold standard is dialectical behavior therapy (DBT), which helps the person attain and maintain lasting improvement in their personality, interpersonal problems, and overall functioning.  It simply teaches coping skills so patients learn to control their emotions, calm down, and not destroy relationships. Medications support the therapy by reducing depression or anxiety and self-destructive behavior.

(from “What Therapy Is Recommended for Borderline Personality Disorder in Adolescents (13-17 years)?” by M. Muscari, 2005, http://www.medscape.com/viewarticle/508832)

When to hospitalizeemergency room

In an emergency, when your child has serious suicidal thoughts or an attempt, and/or is in imminent danger to others, or incapable of calming down and functioning.

Consider psychiatric residential care when your child has persistent suicidal thoughts, is unable to participate in therapy, has a co-morbid (co-existing) mental disorder (e.g. bipolar, depression, narcissistic personality disorder), a risk of violent behavior, and other severe symptoms that interfere with living.

Other mental health supports your child may need:

  • Treatment for substance abuse.
  • Therapy that focuses on violent and antisocial behaviors, which can include emotional abuse or physical abuse, baiting, bullying, and sexualized behaviors.
  • Therapy that focuses on trauma and post traumatic issues.
  • Reducing stressors in the child’s environment.  Most children with BPD are very sensitive to difficult circumstances, for example:  an emotionally stressful atmosphere; internal and external pressures to succeed or change; inconsistent rules; being around others who are doing better than them.


What parents and caregivers can do

  • With a co-parent or support person:  Maintain a united front.
  • Communicate privately with each other to effectively set limits.  A BPD child will do everything in their power to split authority figures against each other!
  • Have each other’s back even if you’re not in full agreement.  Anything you say or do will be used against you.


Maintain family balance.

Keep things relaxed.  If you need to set boundaries and apply pressure, do it only to maintain  appropriate behaviors and reminders for self-calming.  Let other things go.

Use praise proactively.  Borderlines crave attention and praise.  When they deserve it, pour it on thick.  And pour it on thick every single time they demonstrate good behavior and positive intention.  One can’t go too far.  When an argument or fight comes up, search your memory banks for the most recent praiseworthy thing they did or said, and bring it up and again express your gratitude and admiration.  This does two things:  it reinforces the positive;  and it redirects and ends a negative situation.

Become skilled in Dialectical Behavioral Therapy (DBT).  It is the gold standard for treating
Borderline Personality Disorder.  It is the only therapy proven to promote genuine behavioral change and improve mental health.  You can ask questions or bring your child back to reality with the following examples
.

  • Did your friend really intend to upset you?  It sounds like they were talking about something else.
  • The delay wasn’t planned just to make you mad, perhaps you were just frustrated by being asked to wait, and it was no one’s fault.
  • The tear in your jacket isn’t a catastrophe.  It is easily fixed and I can show you how.

 

business card

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

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

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

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

knives in your heart
Never expose your heart like this!  Armor yourself. Visualize those knives as fluff balls. Visualize your child as a toddler with a just another temper tantrum.  You can handle it.

Address your own PTSD!  People who live with someone with BPD need help coping with bullying, wrenched emotions, and the instability that person brings into the household.  A parent or family member may need their own therapy, antidepressants, and self-care skills for reducing anxiety.

Self care for you and other family members

  • Three or more (very) deep breaths when stressed, the brain needs oxygen to begin a calming process.  Singing is a superb option.
  • Magnesium or Kava kava, these substances naturally help calm nerves
  • Sleep in dark, cold room is the best way to promote deep sleep. Avoid screen time an hour before bedtime.
  • An activity that feeds your soul, such as a hobby, a loving pet, a gripping novel, just playing
  • Direct support from a trusted friend–face-to-face is ideal, but calls, texts, and emails as needed are really helpful too.


Characteristics of BPD in adulthood, if untreated

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

Most challenging things:  Signs and symptoms of BPD may include significant fear of real or imagined abandonment; intense and unstable relationships that vacillate between extreme idealization and devaluation; markedly and persistently unstable self-image; significant and potentially self-damaging impulsivity (spending, sex, binge eating, gambling, substance abuse, and reckless driving); repeated suicidal behavior, gestures, or threats; self-mutilation (carving, burning, cutting, branding, picking and pulling at skin and hair, biting, and excessive tattooing and body piercing); persistent feelings of emptiness; inappropriate anger or trouble controlling anger; and temporary, stress-related disconnection from reality and paranoia.

Help your child with guidance and mentoring on each of these aspects… and be relentless!

  • Chronic fear of abandonment which results in a constant search for companionship, no matter how unsatisfying.
  • Clinging and distancing: Disruptive relationships due to the person’s alternating clinging and distancing behaviors.  When clinging, they may exhibit dependent, helpless, childlike behaviors. They can over idealize the person they want to spend their time with, constantly seeking that person out for reassurance. When they cannot be with their chosen person, they exhibit acting-out behaviors, such as temper tantrums and self-mutilation. They distance themselves by being hostile and insulting, usually arising from discomfort with closeness.
  • Splitting: Splitting arises from the person’s inability feel people are safe, and is the primary defense mechanism in BPD. They view all people, including themselves, as either all good or all bad.
  • Manipulation: Separation fears are so intense that people become masters of manipulation. They will do just about anything to achieve relief from their separation anxiety, but their most common ploy is to play one individual against another.
  • Self-destructive behaviors: Threats are most often manipulative, but some acts can prove fatal.  Cutting is very common.  Suicide attempts are common yet often happen in relatively safe scenarios, such as swallowing pills at home while reporting the deed to another person.  Another behavior is to set up a scenario where they are victim so as to get attention and love.
  • Impulsivity: Extremely rapid shifts in mood can lead to substance abuse, binge eating, reckless driving, sexual promiscuity, and excessive spending or gambling.  These are similar symptoms of bipolar mania, but BPD behaviors happen for different reasons, usually in response to real or imagined abandonment.

You really can turn your child’s future around.

Visit the Facebook page for regular news and tips like in this article. 

How to manage defiance and oppositional defiant disorder

How to manage defiance and oppositional defiant disorder

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

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’s happening in their brain.  The pink color of this curving central region indicates intense electrical activity.  This is the brain scan of a 13-year-old boy with severe oppositional defiant disorder (ODD).  Hyper-charged activity in this region can also be responsible for obsessive compulsive disorder (OCD), unstoppable rages, pathological gambling, chronic pain, and severe PMS.

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

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

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

Typical traits of children with oppositional defiant disorder.

  • 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), Adderall (amphetamine) and Depakote or divalproex (a mood stabilizer).  This is not a complete list because new compounds are being formulated to reduce side-effects.

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

Treatment must also include holistic or ‘lifestyle’ approaches.

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

  • 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 oppositional defiant disorder

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

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

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

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

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 daughter’s beautiful hair being cut (she knew it would grow back, whereas a tattoo would be permanent).  The results were exactly what the mother wanted.  Her daughter totally butchered her hair, and the tattoo idea never came up again.

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

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

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

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

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

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

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

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

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

Call their bluff.

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

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

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

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 oppositional defiant disorder.  Some rebelliousness is normal for children.  It’s especially so if parents are over-controlling.

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

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

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

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

Two training approaches that help parents like you: 

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

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

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


If you would like to get ongoing updates on the latest news and research in child & adolescent mental health, follow my Facebook Page.

The Silent Suffering of Parent Abuse When Children Abuse Parents

The Silent Suffering of Parent Abuse When Children Abuse Parents

Parent abuse is real and serious.

This [edited] article is by Alicia Bradley, LCPC, who lives in the United Kingdom.  It is excellent and covers a serious and hidden subject that’s rarely addressed.  “How many people have heard of parent abuse? especially at the hands of teenage children with serious social and violence issues? Google it. You won’t find much, except on a few support sites.  Parent abuse is a form of domestic violence that results in physical harm, damage to property, job loss, PTSD, and family breakdown.”


What Is Parent Abuse?

We have all heard of child abuse and how children are damaged by this terrible behavior, and you only have to Google “child abuse” to find page after page of information, support groups, and advice on this subject, but, how many people have heard of parent abuse? especially at the hands of teenage children with serious social interaction and violence issues? Google it. You won’t find much, except on a few support sites.

screaming teenager

Parent abuse occurs when the child commits an act or acts against the parent through manipulation, control, and intimidation in order to exert control and have power over the parent. Parent abuse can take different forms, from physical, emotional, verbal, to financial abuse.  According to Barbara Cottrell in the book When Teens Abuse Their Parents, parent abuse can be defined as “any harmful act of a teenage child intended to gain power and control over a parent.” (It should be noted that children of any age (pre-teen or adult) can commit parent abuse, not just teenagers.)

For parents and families who share their home with abusive young people, there is virtually no support or protection. In both the UK and the US, the law is on the side of the child, not the parent.  Parents seeking help will instead get inappropriate advice or blame.  The parent is always under suspicion so they keep it secret.  “Domestic violence feeds on silence.”

Signs of Parent Abuse by a Teenager

crying motherParent abuse is a form of domestic violence that results in physical harm, damage to property, job loss, PTSD, and family breakdown. It is usually perpetrated by a child in their teens who displays the following behaviors towards parent(s) and members of their family.  Signs include:

  • Threats of and/or physical violence including hitting, punching, kicking, pushing, slapping, biting, hair pulling with or without weapons or objects.
  • Screaming, swearing, and name calling
  • Intimidation
  • A constant refusal to do what has been asked (going to bed, coming home, asking friends to leave, cleaning up after themselves, not attending school/college/work), or contribute to the household, or participate in normal family activities.
  • Bullying by text or phone
  • Stealing money or property or misuse of parents credit cards/phones/computers
  • Deliberate damaging of property
  • Threats of or actual violence to pets or other children of the household as a way of intimidation
  • Emotional blackmail, such as threatening to accuse the parents of abusing them, or actually doing so
  • Drug/alcohol abuse in the home
  • Belittling parents in front of friends/other family members/public.
  • Willful drug abuse in front of family/friends
  • Other illegal activity

This abuse often occurs at school too, where students abuse their teachers and other students.  It occurs in other relationships too, when a teen abuses or bullies another adult or acquaintance.

beaten mother

Those suffering from parent abuse have experienced physical harm resulting in medical or mental health treatment or even  death; there’s damage to property, theft, or bullying other family members.  Quite often, the child who is abusing the parent does it willfully and for enjoyment.  The ability for empathy and compassion may be not well-developed they impacted by  mental disorders or psychological disturbances.

The law is almost always on the child’s side, but there is little to protect parents from children who abuse their parents. In the UK and US, you as a parent are legally responsible for that child.  There aren’t social services or legal protections for parents unless the child has a long history of repeated offenses of violence involving the police that has been reported and documented.  Schools often expel teenagers with behavioral issues, but for the parent… now what?  Expulsion protects the public but the parent is still very much at risk.

teen bullyParent abuse is not restricted to certain social groups; it can affect single and two-parent families equally. It is usually the mother or the primary caregiver who is targeted, but other children in the family and fathers suffer too.

What Causes Teens to Abuse Their Parents?

It is difficult for parents to recognize they are being abused, or admit they are being abused.  Most blame themselves and are therefore reluctant to seek help.  Yet many people (most?) consider parent abuse to be the result of bad parenting, neglect, or the child suffering abuse themselves. However, many teen abusers have had a normal upbringing and have not suffered from these issues.  Other factors contribute to children abusing their parents, such as undiagnosed mental illness.  Additionally, if the child sees domestic abuse happen in the household, they will be more likely to continue such behaviors.  Parent victims of domestic violence are often re-victimized by their own children.

Psychological Effects of Parent Abuse

girl hittingParents who are exposed to abuse from their child are affected in many ways, with many psychological issues as a result of the abuse. They can lose their ability to control the household and protect everyone else—all family members are victimized just like in any situation with domestic violence between adults.  They develop PTSD, depression, and suffer from lack of sleep and constant fear anxiety.

Giving into the child’s demands and abusive tactics can,
paradoxically, be easier to handle than the severe backlash
they’ll face by standing up for themselves.

10 Steps for Dealing With an Abusive Child

Do not allow yourself to suffer in silence; confront this problem for everyone’s sake, including your abusive teen.  You have little choice but to take back control!  Do not give your power away any more; you really can put a stop to abuse.

  1. If you are suffering from parent abuse, you must recognize that you are not at fault and do not deserve this, as with any form of abuse. Speak to a friend, or contact a domestic violence support group. Seek professional help.
  2. Calmly confront the child about their behavior and tell them you will not tolerate it anymore. Explain that what they are doing is abuse (and brace yourself ahead of time because their backlash could be fierce). You will have to communicate this many times so that they will eventually hear you.  It doesn’t mean they’ll have any intention of stopping, but it prepares them to expect what you’re about to do next.
  3. Remove all privileges, rights to cell phones, computers, video games, money, etc. and refuse to be a taxi service. Set boundaries and punishments and enforce them.  Be careful, if the child makes homicidal threats don’t hesitate to call the police and get them to an emergency room for a psychiatric evaluation!  Remember the definition of a mental health emergency: the person is “a danger to themselves or others.”
  4. If your teen runs, report them to the police immediately, and report anyone who is harboring your runaway. (Anyone who protects runaways from parents is guilty of the crime of custodial interference.)  Sometimes police intervention is enough of a wake-up call for your teenager and reduces the severity of abuse or leads to stopping it.
  5. abusive son in courtIf you feel that you can still communicate with your child, seek mediation with a counselor or other professional, and explain that you will not tolerate this behavior in the session. You want someone else to hear this.  Lay down some ground rules.  Take a hard stance and tell your child that if you are hit again, you will call the police and have them arrested. Don’t call their bluff, do it. They need to see that you mean business. If your child physically harms you, steals from you, or damages property, involve the police immediately and PRESS CHARGES!  Sometimes getting law enforcement and the juvenile justice system involved is the only way to get professional help for abusive teenagers.
  6. Try not to retaliate by hitting back unless in absolute self-defense, and disarm them if they come at you with a weapon. Abusive teens have called the police themselves, or other sympathetic adults, to report you have hit or abused them, and the law will come down on their side first. You can be prosecuted for hitting your child, and your child can be removed from your care as can any other children in your household. Don’t be reluctant and call the police immediately (!), get it on record.
  7. Get help and support from other parents who understand and will support you without judgment.
    a—In the UK contact Parentline Plus, an organization dedicated to helping parents. They can be reached at 0808 800 2222. Visit their website and look on the message boards for help and support groups in your area. They often run groups which offer practical support and tips for parenting difficult teens.
    b—In the US you can call the National Domestic Abuse Hotline at 1-800-799-SAFE (7233).  Also look for a StandUp Parenting support group in your area.  Their website is standupparenting.org/.
  8. Approach your child’s school and have your child referred to children’s mental health services, or refer them yourself, informing them that you are suffering parent abuse.
  9. Keep a journal of events, with dates, times, etc., or a video diary, and film your child when they are abusing you (you can use your mobile phone or digital camera). Often, when faced with media of their own behavior, it can shock them into accepting help from professionals.  (I’ve personally seen videos work very, very well –Margaret)
  10. You cannot do this alone!  Involve others who will help you.  Seek help from extended family and friends to see if they can offer to give you respite by taking the child from you for a few days.  Get therapy for yourself and your family.  You are all paralyzed by suffering–it’s serious and can affect all of you for years.

If you’re a victim of abuse by your child, take Ms. Bradley’s advice and take action.  –Margaret

Resolving Parent Abuse

furious boyHopefully, you found some strategies in this article to help you deal with abuse from your children. There is a light at the end of the tunnel, and there are solutions that can stop the violence from continuing. Stay strong and be vigilant and plan ahead for self-protection. If you love your child, love yourself. They need you to be OK.

Be strong.  Be courageous.  You can do this.

Note from blog owner:  I made edits for length or clarification, and added additional information.  This is a link to the original published article by Alicia Bradley LCPC.
—Margaret


Do you have a story of abuse?  Do you have questions or need support from others?  Add your comments.  Other parents out there know what it’s like, and they care.

School Shootings, Guns, and Child Mental Illness

School Shootings, Guns, and Child Mental Illness

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

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

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

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

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

Child deaths by suicide in the U.S.:

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

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

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

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

Parkland, Florida, image from metro.co.uk

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

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

Dublin, Ireland, in 2014, irishtimes.com

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

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

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

Your comments are encouraged.

–Margaret

The Dysfunctional Family and the “Black Hole” Child

The Dysfunctional Family and the “Black Hole” Child

Many families living with the proverbial “black hole” child start to cope in unhealthy ways. Everyone gradually alters their normal behavior to avoid stress, frustration, anxiety, or anger, but these behavioral accommodations actually make things more chaotic. It’s unintentional, but parents, siblings, extended family and friends take on psychological roles, and the resulting dynamics are harmful. This is the “dysfunctional family,” and these are some common roles:

    • Protector is the emotional caregiver and defends the child regardless.
    • Rulemaker wants Protector to stop enabling the child and set boundaries.
    • Helper smooths over conflict, calms others, and sacrifices for others.  They become “parentified,” and miss important childhood experiences, like play.
    • Escapee stays under the radar for safety, and finds ways to stay away from home to avoid the stress.
    • The Neglected shows a brave face but hurts. They need nurturing but don’t ask for help because the parents are so distracted.  They become depressed.
    • Fixer has all the answers and keeps trying to make everyone do things ‘right’.  They repeatedly jump into everyone’s lives and stir up chaos.
    • Black Hole Child devours everyone’s energy, and gets trapped in their own black drama. For complex psychological reasons, they learn to manipulate, split family members against each other, and blame their disorder for behaviors they can control. Due to insecurity, they act out repeatedly to test if those they depend on still care.

If this is your family, it’s not your fault. Forgive yourself and everyone else. Families living with an alcoholic or addict behave similarly, but they have specialized 12 Step programs like Al Anon and Narc Anon to help them become functional again.  Their 12 Steps would help you too!  I’m not aware of a similar 12-Step approach specifically for families living with mental illness, but I strongly recommend a support group.  Look for one near you (in the US or Canada) at the National Alliance on Mental Illness (www.nami.org) or the Federation of Families for Children’s Mental Health (www.ffcmh.org).

For a child to be well, each person around the child must be well.

First:  A stress relief meeting.  Meet together without the “black hole” child present… now is not the time to include them.  Meetings might be held with the guidance of a family therapist or support group to keep emotions safe. The goal is to ease everyone’s fears by bringing them out into the open. Each member vents their true feelings.  Brace yourself.  You may hear upsetting things, but once feelings are out in the open people will feel better.  There will be more problems to solve, but now everyone knows what they are.  No more secrets.  All everyone needs is to feel heard and understood.  Clearing the air helps people move on.

It is a relief to tell your story and have someone listen and understand.

Check in with family members (perhaps not the troubled child yet… use your best judgment).  Ask everyone how they‘re doing. What is working well? and what isn’t?  Be prepared to hear more complaints and venting.  Just listen and ask clarifying questions until they get it out of their system. (It’s like vomiting, and feeling so much better afterward.)  Brainstorm solutions together.  Ask for ideas on what needs to happen differently.  You don’t need to agree or comply, just listen.

At some point, the troubled child’s own opinions and needs need to be woven into the new family system.  This can be very tricky.  If you feel things will get out of control, get help from a therapist or counselor for yourself or for your family.  The methods for doing this are too lengthy for covering in this article, but you can find out more by exploring books or websites on family interventions for an alcoholic or addict.

Warning:  Once family teamwork improves, prepare everyone for an explosive defiant backlash. This is actually a good sign, so plan for it in advance.  It is a sign you are regaining your authority.  Visualize standing shoulder-to-shoulder to keep everyone safe while the child explodes.  Stick together.  The child may blow-up multiple times, but stick together.  The explosions fall off over time.  This article explains the reasons for these explosions, called “Extinction Bursts” by psychologists. They are the  final act of defiance when limits are firmly enforced and the child loses power.

Ultimate goal:  The child’s behavior improves!  The child stabilizes; they are surrounded by a caring but firm team that locks arms and won’t be shaken by chaos. Surprisingly, this actually helps the child feel more secure and less likely to cause distress.

How it might unfold:

  • Protector steps back; cares for themselves; and accepts that Rulemaker has some legitimate reasons for boundaries.
  • Rulemaker steps in to help Protector as needed and gives them a break. Rulemaker and Protector work out acceptable structure and make two to three simple house rules for everyone that are fair and easily enforced.

Rulemaker and Protector also make two to three simple agreements between themselves.  Number one:  no fighting or disagreements in front of the child.  Next, checking in with each other and agreeing on a plan or strategy.  Ideally, their relationship improves, and trust and safety is reestablished.  This can happen between parents who are divorced too.

  • Helper gets a life of their own, accepts they are not responsible for everyone, and is encouraged to spend time with supportive friends or doing activities they really like.
  • Escapee and The Neglected need lots of support and comfort and emotional connection to a nurturing adult. They are at risk of mental health problems in the future, especially depression and addiction.  They may suffer from PTSD as adults, from enduring years of emotional distress or neglect. Both may need mental health treatment such as therapy and relaxation skills.
  • Fixer: withholds judgement and realizes there are no simple answers. Their education or experience does not necessarily apply to this family. They should ask how to help instead of trying to make people change, and they should be gracious and supportive.

Helping a troubled child means helping the family first, and family teams are the best way.  As each member strives for a healthier role, each gets support from other family members and hears things like, “Atta girl!”, “You rock!”, “Go Mom!”. Teamwork creates therapeutic homes and strong families. Research proves that strong families lead to better lifetime outcomes for the child.

–Margaret

Your comments, questions, and stories are encouraged because they help others


If you would like to get ongoing updates on the latest news and research in child & adolescent mental health, follow my Facebook Page.

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.

marijuana infographic

Please share this information with other parents.  

–Margaret

What will happen in your troubled child’s future?

What will happen in your troubled child’s future?

Are you scared for your child’s future? Is he or she is falling behind? On a scale of 1 to 5, where 1 is “Normal” and 5 is “Worst Case Scenario”, what will your child’s future adulthood look like?

This chart depicts a spectrum of outcomes of mentally ill children when they become adults.  No matter how ill your child is, if he or she gets support and treatment early, their future adult life could end up in the NORMAL column, and out of the RED column.  A network of family, friends, and professional staff can keep them from the worst-case scenario in the far right column, and move them in the direction of normalcy.

“Wellbeing” is possibly the most important.

This is a checklist of childhood problems that lead to poor future outcomes as adults.  Jump on them one by one.

  • Friend problems:  they have inappropriate friends, or no friends, or they mistreat friends (and siblings).
  • Behavior problems:  they do or say disturbing things (swearing, hurting, breaking, manipulating, sinking in depression, attempting suicide…). Everyone is stressed.
  • School problems:  disruptive behavior; poor grades (or a sudden drop in good grades); bullying or being bullied.
  • Health problems:  physical health problems become mental health problems, and vice versa:
    • trouble with sleep
    • digestive system and gut problems
    • poor diet and lack of exercise
    • epilepsy or neurological disorders
    • hormones during puberty
    • substance abuse.
Age 16, starting mental health treatment

We designate legal adulthood between the ages 18 and 21.  That’s too young.  Many normal healthy young people at this age are immature and irresponsible, but your son or daughter may lag well behind them.  Your child may need support and rescuing well into the 20’s or early 30’s–this is not unusual.

You’ll survive the marathon of tough years by pacing yourself, finding support for yourself, and protecting your mental health.

There is reason for hope.  Your child may take many horrible directions in their teens and 20’s, and you may feel hopeless about their future, or helpless as you witness their life nosedive.  If you can hang on and marshal support, your child will find a circuitous path to recovery.  It will have sharp turns and back steps and falls, but they’ll find it… and enter stable adulthood.

Age 20, after consistent mental health treatment

Some parents and families have seen the worst.  They’ve endured violence due to their child’s addiction; sat in court when their son or daughter was convicted of a crime; or they waited in the Emergency Room when their son or daughter was admitted for psychiatric care.  They also lived to see their child achieve the sanity to finish their education, support themselves, develop good relationships, and get that future you always wanted for them.

How two parents handled a “worst case scenario” and supported their child’s wellbeing:

These are true stories of mothers who stuck by their very ill adult children and provided what little they could to bring a bit of wellbeing.  These mothers found some peace by simply doing what they could.  Their child still had hope.

One had a grown son with schizophrenia and a heroin addiction who lived in squalor in supported housing.  He spent all of his disability assistance money on heroin and nothing else.  Her efforts to help him met with verbal abuse and threats of violence, and she feared for her safety.  What could she do, witness his slow suicide by starvation or overdose?  She arranged to visit him once a week in the parking lot, and brought 2 sacks of groceries in the trunk of her car.  He was to come out and get the groceries while she stood at a safe distance.  This worked.  He was still verbally abusive when he got the groceries, but he got food and she stayed safe.  Did he have wellbeing?  Was his life humane?

He lived indoors
He had enough food and clothing
He had encounters with social services and police, which led to some health care
A support system was available if he was ready for help.

One had a son addicted to methamphetamine who was lost to the streets. One day, she discovered a nest of old clothes and rags in an overgrown area behind her garage, and instinctively knew it was from her son.  “Good,” she thought, “He’s alive; I can keep him safe.”  She rarely saw him come and go, but she replaced the rags with clean blankets and a sleeping bag, and put out food for him, and provided a tent.  She couldn’t free her son from addiction, but she could keep him safe from the streets and its desperate people, and fed and sheltered in a way he accepted.

Like in the previous story, her son had a modicum of safety and support, and ongoing monitoring if he was ready for help.

 

–Margaret

Please share your story.

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

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

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

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

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

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

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

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

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

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

Why might my child become suicidal?

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

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

From Pinterest and the blog, Social Workers Scrapbook

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

What can trigger suicidal thoughts?

Examples from two states that did the research:

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

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

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

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

What if my child has threatened suicide?

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

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

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

What if a threat is just for attention?

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

What else can I do if my child threatens suicide?

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

What if my child attempted suicide?

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

Pay attention to events that trigger suicide.

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

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

Take care of yourself.

–Margaret

Take this parenting skills test if you have a troubled child

Take this parenting skills test if you have a troubled child

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

Parenting Skills Test – printable form

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

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

Be and kind forgiving of yourself if you score low

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

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

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

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

–Margaret

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