Category: teenagers

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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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


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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