Defying ODD: what it is, and ways to manage.

Parenting an ODD child or teen could be your hardest job ever.  Not only is it exhausting, but you must continually find the compassion and forgiveness to be nurturing, and the energy and doggedness to be consistent.

ODD is caused by abnormal electrical activity in the brain, it is not in the character or ‘soul’ of your child or teen, and not something they can control.  If your child could do better on their own, they would.  You are the one who can make the most difference.

If you think your child or teen has oppositional defiant disorder, this article is intended to give you a solid start on how to manage your child’s exasperating condition.  This information comes from psychiatric, psychological, and child behavior resources– information to help you work effectively with mental health providers or teachers.  You’ll need to ask focused questions to learn everything they know about ODD.  Professionals pay better attention to knowledgeable parents (which shouldn’t be the case, all parents deserve attention).  Go in armed with knowledge.

This is what ODD looks like.  The pinkish curving region in the center of the 3-D brain image below represents hyper-charged electrical activity in a 13 year old boy with severe oppositional defiant disorder.  This feature is typical of ODD, but also typical in individuals with obsessive compulsive disorder (OCD), “Road Rage,” pathological gambling, chronic pain, and severe PMS.

--From “Images Into Human Behavior - A Brain SPECT Atlas”, Daniel G. Amen, MD. Find out more at www.brainplace.com or www.amenclinics.com

The name of this region is anterior cingulate gyrus (ACG), and scientists believe this area is responsible for enabling a person to shift attention and think flexibly, traits which are deficient in ODD kids.  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, 4^th Edition,” published by the American Psychiatric Association, 2000.

There are two different medication approaches to ODD:  one treats it as a form of attention deficit disorder; and one treats it as form of depression and obsessive-compulsive disorder.

-         The attention definite approach may use Straterra (chemical name is atomoxetine), Ritalin (methylphenidate), Risperdal or risperidone (for patients with low IQ), and Depakote or divalproex (a mood stabilizer).

-         The depression & obsessive-compulsive approach may use serotonin-based antidepressants such as Prozac (fluoxetine), and Anafranil or clomipramine (used to treat OCD).

At the end of this article are a list of other medical conditions that can cause disruptive behavior.

Unfortunately, oppositional defiant disorder usually includes other disorders, so you may be coping with more than defiance.  Below are common disorders that combine with ODD:

• 50-65% of these children also have ADD ADHD
• 35% of these children 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 of these children have learning disorders

–From http://addadhdadvances.com/ODD.html,  Anthony Kane, MD 

Your child may need multiple medications and a large variety of approaches to therapy and behavior modification.  You will need patience as teachers, doctors, or specialists try different approaches until they discover one that improves your child’s behavior, so hang in there!

Some good news, if your child has these traits, it will be easier to improve or overcome ODD behaviors:

• 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.

You may have tried everything and nothing has worked.  People’s natural instincts for parenting do not work with an ODD kid—they need completely different techniques than ‘normal’ children.

How to reduce ODD behaviors

First, prepare yourself for the intensity of parenting a defiant kid because you are about to run a marathon.  Get enough sleep, maintain your other important relationships (spouse or partner, children, friends), schedule breaks or getaways, and guard your physical and emotional health.  Don’t expect quick results with these techniques; it may take weeks or months.

Parent management training – PMT is about parents gaining different skills, and is one of the most substantiated interventions in child mental health.  PMT helps parents establish a focused approach to consistency and predictability, and promote pro- social behavior in their child.  This is simply a matter of acquiring and practicing skills, a process not so different from that of learning a sport or a musical instrument.

Find something positive to do together.  Your child has normal needs for closeness and appreciation and joy.  Ask your child about their interests, and if their ideas don’t work for you, try new activities until one brings about a good chemistry between you and your child.

Praise is one of the most powerful tools for managing disruptive behavior.  Take responsibility to inject much needed positive energy into your relationship with your child or teen.  It’s likely that this relationship has been almost 100% negative, yes?

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)

More praise – ‘Catch’ them doing something good.  Offer praise and make it sound genuine even if they respond in anger, then let it drop.  Spend as much time praising as disciplining!  And don’t expect thanks, it’s not about you.

Active ignoring – 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 in a temper tantrum, or when whining or sulking, or when making continuous demands or loud complaints, etc.  Pretend you don’t care and even turn your back if possible.  Give attention only after the behavior is over.

–Find out more at http://www.sosprograms.com/chapters/p_eng_chapters/EngParents03.pdf.

Make the behavior uncomfortable for the child/teen.  Example:  If your kid swears, test them, “C’mon, you can do better than that, be creative, I’ve heard all those things before.  Don’t be a copy cat.”  They can become frustrated when they aren’t getting the reaction they want from you, and give up.  Example:  your teen refuses to get out of bed for school.  Don’t nag, just remove the blankets and set them far enough away that your child has to get out of bed to retrieve them.  (“Managing Resistance,” John W. Maag, jmaag1@unl.edu)

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. (“Managing Resistance,” see above)

Reverse psychology:  Yes, this works.  Example:  your child is bouncing on the furniture.  You turn on music and say “hey, try this, see if you can bounce to the beat, but I bet it’s harder to do on the floor.  This is a good kind of manipulation.

Surprise rewards – Reward appropriate behavior with something they already like (that is acceptable to you).  They are more likely to do a desired behavior if they expect something they want and aren’t sure when it will be offered.

At the end of this article is a list of things to do to make ODD worse.  Avoid these!

“Why should I have to do this when it’s my kid’s responsibility to behave?”

It’s your responsibility as a parent to do what you can to help your child be successful.  ODD is a ‘disability’ that can seriously affect their life and future.  I’ve seen highly intelligent ODD kids experience academic failure, or enough suspensions and expulsions to hold them back a grade, a can’t-win-for-losing consequence that worsens their behavior.  Wouldn’t this suck?

Warning, once you start enforcement, things get worse at first - Defiant behavior tends to increase once your family system is changing.  See this as a good sign—you are regaining your authority!  Your child’s backlash is a common human psychological response, and it’s called an “extinction burst.”  (see diagram below)  As parents change their approach to handling inappropriate behavior, the child becomes more defiant to test their resolve.  View this as predictable and plan ahead.  It won’t last and they will begin to comply with this one rule.  They then find another rule to defy and ramp up their defiance.  As you enforce it, they back off again, and the pattern continues until it’s just not worth it to defy rules anymore.

–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.

 

 

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How to make ODD worse

Treat your child like another adult who has an equal say in how things are done.  Treat your home as a democracy, where everything must be fair and equal.  Answer your child’s accusations by offering explanations that show how reasonable you are.

Keep finding fault with your child and let them know about it over and over and over again.  If they do something positive, let them know it’s not enough.

Avoid thinking about your child’s unique needs or the challenges they face everyday, such as bullying at school, or fear of abandonment, or stress from a chaotic home.  Just pretend they have no reasons for their behavior.

Make a rule and only enforce it once in a while, or have the consequence come much later (Famous example: ”I’ll tell your father when he gets home.”).  Get angry about something, then direct your anger to your child and let them know it’s because of the stress they’ve caused you.

Don’t treat your child appropriately for his or her age.  Make long explanations to a three year old about why you’ve set a certain rule.

Persist with logical, rational justifications for your rules and expect your child to logically, rationally accept them.  What’s interesting to me when I see parents doing this is that their children can be quite young (4 or 5), too young to be reasonable in the first place, or they can be young adults (early 20’s) who have a long track record of doing things that don’t make sense. 

Keep trying the same things that still don’t work.  Like screaming.  (Don’t be embarrassed; we’ve all done this.)

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 stuck in paranoia:  “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.”

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Good luck with your ODD child.   I WISH YOU THE BEST!

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Medical conditions that can cause disruptive behavior like ODD:

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, rapid increases and decreases of blood sugar
5. Systemic lupus erythematosus, Wilson’s disease
6. 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.

Teachers and stigma – judging and blaming families

As parents of troubled children, we already know that our child’s disorder or behavior will not work in most classrooms.  No one needs to tell us this or explain why our child needs to change in order to learn–we already stay up at night worrying how our child or teen will make it in the world.  Most parents have tried everything:  we’ve looked for other educational options (which almost never exist or we don’t qualify), we’ve asked or pleaded for help, we’ve read books and scoured the internet for advice…  When nothing works, some parents and caregivers just give up and try to muddle through.

When it comes to working with schools, it feels like you can’t win for losing

Those parents who’ve tried everything become deeply frustrated and take it out on school staff.  This reaction makes sense when you’ve been there like I have.  I probably looked bad at meetings, angry, stressed, anxious, and confused—and that’s how I was treated.  I could sense staff assumed I was this way all the time and thus the cause of my child’s disorder.

Those parents who give up don’t show up.  They can’t face another school meeting to listen to the litany of their child’s problems, feeling nagged with advice given in a tone of impatience, never getting help, hope, or heard.  Not showing up also makes perfect sense.  Who wants another downer?  It’s best to stay home and conserve precious emotional energy.  These parents look apathetic and neglectful at best–I personally know a couple like this.  I’ve heard school staff wondering aloud if the parents were using drugs, abusive, or criminally neglectful.  They weren’t.

Teachers have the same paradoxical attitudes held by the public at large when it comes to troubled children.  They may try to be neutral when they work with parents, but underlying attitudes and feelings still come out:

-  We sympathize but you’re still to blame;

-  You can change things if you want to, but you don’t really care;

-  We know what your child needs, you don’t.

I truly believe teachers care about children and teens which is why they are teachers.  Their professional education centers on children’s development and learning, but not on the intricacies and psychology of family relationships or children’s mental health!  Their qualifications and license are for giving their students a quality education, not for doing social work with families.  Even if teachers recognize that families struggle with their child, there is still a sense that the cause of a student’s lack of achievement “sits squarely on the shoulders of parents”  who simply “don’t care.” *

* Taliaferro, JD; DeCuir-Gunby, J; Allen-Eckard, K (2009).  ‘I can see parents being reluctant’: Perceptions of parental involvement using child and family teams in schools.  Child & Family Social Work, 14, 278-288

> Find out more about this research at the Research and Training Center http://www.rtc.pdx.edu/ – “School Staff Perceptions of Parental Involvement,” August 2009, Issue #164 <

Mixed messages from schools

Teachers and schools give mixed signals to families, on the one hand encouraging parents to work with their child’s teacher, and on the other hand becoming “offended when… parents would take the side of their children or question a teacher’s assessment.” *  When it comes to mental health, teachers simply aren’t trained to recognize or diagnose disorders.

Parents with troubled kids in school have additional responsibilities, but their energy and time reserves are the lowest:  there are Child and Family Team (CFT) meetings, Individual Education Plan (IEP) meetings, waivers, Releases of Information (ROIs), and many communication attempts to follow through on these.

Teachers need to believe in the ability of parents to contribute to their child’s well being and understand parents’ need for support when children have mental or emotional disorders.  And “…schools must change practices so that information can be shared with a socially just approach.  Schools must meet families where they are rather than embracing misperceptions and stereotypes…” *

Let’s change this situation, and here’s how you can help

If you are a teacher, parent, or other education advocate, there’s a program available from the National Alliance on Mental Illness (NAMI) to develop understanding and partnership between schools and parents with troubled children.  It’s called Parents and Teachers as Allies.

This is an in-service mental health education program designed for teachers, administrators, school health professionals, families, and others in the school community.  The curriculum focuses on helping everyone better understand the early warning signs of mental illnesses in children and adolescents and how best to intervene, and how best schools can communicate with families about mental health-related concerns.

The program is also designed to target schools in urban, suburban, rural, and culturally-diverse communities.  The toolkit is being developed to be culturally sensitive and will include a Spanish language version.

For more information about this program, please contact: Bianca Ruffin, Program Assistant, Child & Adolescent Action Center, Email: biancar@nami.org, Phone:  703.516.0698

For men who raise troubled kids

Where are the men?

Every year, I attend several conferences around the nation that focus on the families, children, and policies associated with children’s mental health.  The majority in attendance are women.  As part of my job, I also attend many meetings on children’s mental health in social services organizations and advocacy groups where, again, the majority in attendance are women (often 100%).  I’ve facilitated family support groups for 11 years, open to the public, mostly attended by woman:  bio mothers, adoptive mothers, girlfriends, stepmothers, grandmothers, aunts, and sisters involved in caring for a troubled child.  Anyone else notice this?

<At the end of this post are studies and articles on the many benefits caring men provide to troubled children and teens.>

We need the men.  I know they are out there.  I know they are engaged in raising a troubled child and probably alone with their concerns.  They are not just bio fathers either, they are stepfathers, boyfriends, adoptive fathers, foster fathers, uncles, and brothers, but I’ll call them all “dads” here.

The recent national “Building on Family Strengths” conference in Portland, Oregon, had a presentation on the subject of dads helping dads.  It was the first time I attended a seminar where mostly men attended.  I asked the panel, founders of Washington Dads, www.wadads.org, “why hasn’t there been a gathering like this before?”  Apparently, panel members tried to find help and it wasn’t there, so they started a support organization for themselves.  They believe it’s the only one like it in the nation.

The messages – One panel member said men feel they are supposed to fix the problem, but they can’t and feel like failures.  Another said that “dads are often not the main caregivers, and perhaps they lack experience,” and after trying what they think will work, are at a loss when it doesn’t.  Another, “we want a quick fix, but a clear concrete fix will do… we want to know how to problem solve.”  That’s a big one, men fix things, they want to get together and hash out solutions.  “Men talk solutions right away instead of talking through emotions.”  They said men like rules or instructions such as Collaborative Problem Solving techniques, the use of technology, and carefully considered plans such as IEPs. 

In general, moms tend to feel guilty, but dads tend to be resentful:

• Of the public nature of the family’s problems
• Of mom’s leniency towards the child
• Of the over-the-top attention given to the child
• Of the loss of quality relationships with all family members

“We’ve been down on our knees in pain for our kids, and we’ve been trying to bring them into society, and it’s a long road.”

Dad’s emotions are there but expressed very differently.  “Some men need to vent aggressively… blow a gasket, but only other men are OK with this.”  Some want to reveal things to each other they wouldn’t share with their wife or partner; “men need to bond without women present” and with personal face-to-face contact.  Men tend to have custody issues too, and often face challenges to their rights to visit their children or maintain relationships with them.

Washington Dads Network – organized to empower fathers and other men who care for troubled children and teens. They want to see similar groups forming nationwide.

Gentlemen, trust me, moms want you to have support.  Form a group and get yourself some buddies.

Below are previously published articles on the influence of fathers on children’s mental health.  I could not find any articles about issues faced by many fathers, such as custody of the children, disagreements with mom, the influence of their decisions about treatment, or placement, or educational issues, or the need for support in tune with men’s particular cultural and social needs.

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Involvement of nonresident fathers may protect low-income teens from delinquency January/February 2007 issue of the journal Child Development

Many American children live without their biological fathers. A substantial proportion of fathers who live apart from their children have lost touch with them and therefore don’t provide consistent parenting. A new study has found that when nonresident fathers are involved with their adolescent children, the youths are less likely to take part in delinquent behavior such as drug and alcohol use, violence, property crime, and school problems such as truancy and cheating.

The study, by researchers at Boston College, is published in the January/February 2007 issue of the journal Child Development. The research was funded, in part, by the W.T. Grant Foundation, the National Institute of Child Health and Human Development, Office of the Assistant Secretary of Planning and Evaluation, Administration on Developmental Disabilities, Administration for Children and Families, Social Security Administration, and the National Institute of Mental Health.

Researchers looked at a representative sample of 647 youths who were 10 to 14 years old at the start of the study and their families over a 16-month period, gathering information from the adolescents and their mothers. The families were primarily African-American and Hispanic, and most lived in poverty.

Taking into consideration adolescents’ demographic and family characteristics, the researchers found that when nonresident fathers were involved with their children, adolescents reported lower levels of delinquency, particularly among youth who showed an early tendency toward such behavior.

They also found that adolescent delinquency did not lead fathers to change their involvement over the long-term. But in the short-term, as teens engaged in more problem behaviors, fathers increased their involvement, suggesting that nonresident fathers may be getting more involved in an effort to stem their children’s delinquency. This finding was most prevalent in African-American families and contrasts with the pattern in two-parent, middle-class, white families, where parents often pull away and become less involved in the face of adolescent delinquency.

“Nonresident fathers in low-income, minority families appear to be an important protective factor for adolescents,” said Rebekah Levine Coley, professor of applied development and educational psychology at Boston College and the study’s lead author. “Greater involvement from fathers may help adolescents develop self control and self competence, and may decrease the opportunities adolescents have to engage in problem behaviors.”

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Early Father Involvement Moderates Biobehavioral Susceptibility to Mental Health Problems in Middle Childhood

Boyce, W. Thomas; Essex, Marilyn J.; Alkon, Abbey; Goldsmith, H. Hill; Kraemer, Helena C.; Kupfer, David J.;  Journal of the American Academy of Child and Adolescent Psychiatry, v45 n12 p1510-1520 Dec 2006

[my summary in everyday English:  When fathers are engaged in nurturing and parenting a child from infancy, the child develops healthy responses to social situations when they reach the middle childhood years ~age 9.  The father’s engagement actually improves brain function on the emotional level and reduces activity in the stress area of the brain.  If a father is not involved, the child is at a high risk of behavioral problems.  Also, if a mother is depressed in their child’s early years, the child is at an ever higher risk of behavioral problems.]

Objective:  To study how early father involvement and children’s biobehavioral sensitivity to social contexts interactively predict mental health symptoms in middle childhood. Method: Fathers’ involvement in infant care and maternal symptoms of depression were prospectively ascertained in a community-based study of child health and development in Madison and Milwaukee, WI. In a subsample of 120 children, behavioral, autonomic, and adrenocortical reactivity to standardized challenges were measured as indicators of biobehavioral sensitivity to social context during a 4-hour home assessment in 1998, when the children were 7 years of age. Mental health symptoms were evaluated at age 9 years using parent, child, and teacher reports. Results: Early father involvement and children’s biobehavioral sensitivity to context significantly and interactively predicted symptom severity. Among children experiencing low father involvement in infancy, behavioral, autonomic, and adrenocortical reactivity became risk factors for later mental health symptoms. The highest symptom severity scores were found for children with high autonomic reactivity that, as infants, had experienced low father involvement and mothers with symptoms of depression. Conclusions: Among children experiencing minimal paternal caretaking in infancy, heightened biobehavioral sensitivity to social contexts may be an important predisposing factor for the emergence of mental health symptoms in middle childhood. Such predispositions may be exacerbated by the presence of maternal depression.

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Devoted dad key to reducing risky teen behavior – Moms help, but an involved father has twice the influence, new study finds  [EXCERPT],  By Linda Carroll, June 5, 2009

Teenagers whose fathers are more involved in their lives are less likely to engage in risky sexual activities such as unprotected intercourse, according to a new study.  The more attentive the dad — and the more he knows about his teenage child’s friends — the bigger the impact on the teen’s sexual behavior, the researchers found.  While an involved mother can also help stave off a teen’s activity, dads have twice the influence.

“Maybe there’s something different about the way fathers and adolescents interact,” said the study’s lead author Rebekah Levine Coley, an associate professor at Boston College. “It could be because it’s less expected for fathers to be so involved, so it packs more punch when they are.”

Dad’s positive effect
Parental knowledge of a teen’s friends and activities was rated on a five point scale.  When it came to the dads, each point higher in parental knowledge translated into a 7 percent lower rate of sexual activity in the teen.  For the moms, one point higher in knowledge translated to only a 3 percent lower rate.  The impact of family time overall was even more striking. One additional family activity per week predicted a 9 percent drop in sexual activity.

Child development experts said the study was carefully done and important. “It’s praiseworthy by any measure,” said Alan E. Kazdin, a professor of psychology and child psychiatry at Yale University.

Why would dads have a more powerful influence?

“Dads vary markedly in their roles as caretakers from not there at all to really helping moms,” Kazdin said. “The greater impact of dads might be that moms are more of a constant and when dads are there their impact is magnified.”  Also, Kazdin said “when dads are involved with families, the stress on the mom is usually reduced because of the diffusion of child-rearing or the support for the mom.”

In other words, dad’s positive effect on mom makes life better for the child, Kazdin explains.

The study underscores the importance of parental engagement overall, said Patrick Tolan, a professor of psychiatry and director of the Institute for Juvenile Research at the University of Illinois in Chicago.  “For one thing, the more time you spend with them, they’re going to get your values and they’re more likely to think things through rather than acting impulsively.”

Coley hopes that the study will encourage both moms and dads to keep trying to connect with their teenage children, even as their kids are pushing them away.  “…it’s normal for teens to want to pull away from the family, [but] that doesn’t mean they don’t want to engage at all,”

Linda Carroll is a health and science writer living in New Jersey. Her work has appeared in The New York Times, Newsday, Health magazine and SmartMoney.

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The Father-Daughter Relationship During the Teen Years – Ways to strengthen the bond  [EXCERPT],  by Linda Nielsen

According to recent research and my own 30 years of experience as a psychologist, most fathers and teenage daughters never get to know one another as well, or spend as much time together, or talk as comfortably to one another, as mothers and daughters.  Why is this bad news?  Because a father has as much or more impact as a mother does on their daughter’s school achievement, future job and income, relationships with men, self-confidence, and mental health.

When I ask young adult daughters why they aren’t as comfortable sharing personal things or getting to know their fathers as they are with their mothers, most make negative comments about men.

• “Because he’s a man, he doesn’t want to talk about serious or personal things.”
• “Because men aren’t capable of being as sensitive or as understanding as women.”
• “Because fathers aren’t interested in getting to know their daughters very well.”

If a daughter grows up with these kinds of negative assumptions about fathers, she will not give her father the same opportunities she gives her mother to develop a comfortable, meaningful relationship. As parents, we strengthen father-daughter relationships by teaching our daughters how to give their fathers the opportunities to be understanding, communicative and personal.

Creating more father-daughter time alone – Regardless of a daughter’s age, the most important thing we can do is to make sure fathers and daughters spend more time alone with one another.  Since most fathers and daughters haven’t spent much time together without other people around, they might feel a little uncomfortable at first.  If so, they can start by taking turns participating in activities that each enjoys.  One idea:  The father could choose 15 or 20 of his favorite photographs from various times of his life — as a little boy, a teenager or a young man — and then use the pictures to tell his daughter stories about his life.  The key to the success of this father-daughter time is that they alone are sharing this experience.

Staying involved during dad’s absence - Teenage daughters and fathers can strengthen their relationship during dad’s absence through e-mails, letters, pictures and a touch of silliness.  Before dad departs, for one example, father and daughter can talk about how much their relationship means to each of them and agree to write or e-mail at least twice a week.

Linda Nielsen is a psychology professor at Wake Forest University in Winston-Salem, N.C. Her most recent book is Embracing your Father: How to Create the Relationship You Always Wanted With Your Dad. For more information on father-daughter relationships visit www.wfu.edu/~nielsen/.

Yoga – Safe and effective for depression and anxiety

"Meditating, it makes you calm, and calm. Om." Andre, 7

Yoga is being taught to and practiced by adults with mental and emotional disorders, including those who are developmentally disabled.  And relatively recently, it is being taught to children and teens with similar challenges.  According to people who suffer brain disorders, a session of yoga has more than physical benefits:

• Improving mood, and increasing self-esteem and energy
• Reducing anger and hostility, reducing tension and anxiety, and reducing confusion or bewilderment in developmentally disabled people

Yoga is simple:  a series of gentle poses, postures, stretches, and exercises that can be practiced by most people.  Yoga is safe and anyone can benefit for free.  And from 65% to 73%  report they have been genuinely helped by yoga practice.

There are a number of research studies showing that yoga qualitatively improves mood as self-reported by adult psychiatric patients (on evidence-based survey instruments, see below).  But yoga has also been shown to help children and teens with serious mental and behavioral disorders.  It is currently being taught in schools for special needs children (ex: Pioneer School in Portland, Oregon) and in psychiatric residential treatment programs for children.

At the end of this post are excerpts from 4 articles on the benefits of yoga for mentally or emotionally troubled people.

For more information on the practice of yoga specifically for troubled and traumatized children and teenagers, there are two organizations that provide yoga classes to help young people feel better, function better, and support their recovery.

The Flawless Foundation – “Creates and supports programs that enrich the lives of children who courageously face challenges of neurodevelopmental and psychiatric disorders on a daily basis.”  http://www.flawlessfoundation.org/

Street Yoga – Street Yoga teaches yoga, mindfulness and compassionate communication to youth and families struggling with homelessness, poverty, abuse, addiction, trauma,  and neurological and psychiatric issues, so that they can grow stronger, heal from past traumas, and create for themselves a life that is inspired, safe, and joyful.   http://www.streetyoga.org/

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The effects of yoga on mood in psychiatric inpatients

Roberta Lavey, Tom Sherman, Kim T. Mueser, Donna D. Osborne, Melinda Currier, Rosemarie Wolfe

Psychiatric Rehabilitation Journal, Volume 28, Number 4 / Spring 2005

Abstract

The effects of yoga on mood were examined in 113 psychiatric inpatients at New Hampshire Hospital.  Participants completed the Profile of Mood States (POMS) prior to and following participation in a yoga class.  Analyses indicated that participants reported significant improvements on all five of the negative emotion factors on the POMS, including tension-anxiety, depression-dejection, anger-hostility, fatigue-inertia, and confusion-bewilderment.  There was no significant change on the sixth POMS factor: vigor-activity.  Improvements in mood were not related to gender or diagnosis.  The results suggest that yoga was associated with improved mood, and may be a useful way of reducing stress during inpatient psychiatric treatment.

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Practitioners using yoga therapy to mend bodies and spirits (excerpt)

By Michelle Goodman, The Seattle Times, January 11, 2006

As Tisha Satow stretches into the standing yoga pose known as Warrior II, she encourages her student Shaun, clad in sneakers, jeans and a Seahawks T-shirt, to adjust his feet.  Across from Shaun, fellow yogi Susan, who travels with a baby stroller occupied by three teddy bears, grips a metal folding chair for balance.

Welcome to yoga therapy, one of the newer recreational activities available to clients of Seattle Mental Health on Capitol Hill. Shaun and Susan, adults who live in group homes and are diagnosed as both developmentally disabled and mentally ill, are regulars in this class, taught weekly by Satow or one of her co-workers at the Samarya Center, a Seattle nonprofit organization devoted to providing yoga to everyone it can, regardless of health issues or finances.

What is yoga therapy? Simply put, it’s the adaptation of yoga breathing, stretching, even chanting techniques to help people with health issues alleviate pain, gain energy and basically feel a heck of a lot better. Who can benefit from it? Anyone from typical backache sufferers to the terminally ill.

“Science is beginning to catch up to this, is beginning to validate this,” says John Kepner, director of the International Association of Yoga Therapists, which has about 1,400 members worldwide.

For the Seattle Mental Health clients, who often attend less glamorous classes such as anger management and checkbook balancing, yoga seems a breath of fresh air. Shaun, who’s shy yet quick to share a laugh with his classmates, says he likes the stretching best. And Susan, who calls yoga “fun” and likes that it gives her a chance to “see people,” shows off her biceps after class so instructor Satow can feel how strong she’s getting.

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Yoga as a Complementary Treatment of Depression:  Effects of Traits and Moods on Treatment Outcome  (excerpt)

David Shapiro; Ian A. Cook; Dmitry M. Davydov; Cristina Ottaviani; Andrew F. Leuchter; Michelle Abrams

Abstract

Our preliminary research findings support the potential of yoga as a complementary treatment of depressed patients who are taking anti-depressant medications but who are only in partial remission.  In this study, participants were diagnosed with unipolar major depression in partial remission.  They took classes led by senior Iyengar yoga teachers.  Significant reductions were shown for depression, anger, anxiety, neurotic symptoms and low frequency heart rate variability.  Of those in the study, 65% achieved remission levels post-intervention.  Yoga is cost-effective and easy to implement.  It produces many beneficial emotional, psychological and biological effects, as supported by observations in this study.

Iyengar yoga classes typically involve sitting and standing poses, inversions (head stand, shoulder stand), breathing exercises (pranayama) and short periods of relaxation at the end of each class (savasana–corpse pose).  An important feature of participation in Iyengar yoga is sustained attention and concentration.  Iyengar theory and practice specifies asanas (poses, postures, positions), and certain asanas have been found to enhance positive mood in healthy (non-depressed) participants.

Previous research on the effects of yoga on mood in non-depressed healthy subjects, suggests the potential of yoga for use in the management of clinical major depression.  In a form of yoga (Hatha Yoga) that has a strong exercise dimension much like Iyengar yoga, subjects reported being less anxious, tense, angry, fatigued and confused after classes than just before class.

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How Hatha Yoga saved the life of one manic depressive.  (excerpt)

By: Amy Weintraub ; Psychology Today Magazine, Nov/Dec 2000

When Jenny Smith was 41 years old, her mental illness became so severe that she could barely walk or speak.  After days of feeling wonderful one moment and hallucinating that spiders and bugs were crawling on her skin the next, she landed in the hospital.

Smith is a victim of bipolar disorder, an illness characterized by oscillating feelings of elation and utter depression.  And though she had tried 11 different medications for relief, some in combination, nothing seemed to work.  Upon leaving the hospital, Smith was told that she could expect to be in and out of psychiatric hospitals for the rest of her life.  Soon after her release, Smith decided to learn Hatha yoga, which incorporates specific postures, meditation and Pranayamas, deep abdominal breathing techniques that relax the body.  As she practiced daily, Smith noticed that her panic attacks—were subsiding.  She has since become a certified hatha yoga instructor, and with the help of only Paxil, Smith’s pattern of severe mood swings seems to have ended.

Key to reaping Hatha yoga’s mental benefits is reducing stress and anxiety.  To that end, Jon Cabot-Zinn, Ph.D., of the University of Massachusetts, developed the Stress Reduction and Relaxation Program (SRRP), a system that emphasizes mindfulness, a meditation technique where practitioners observe their own mental process.  In the last 20 years, SRRP has been shown to significantly reduce anxiety and depression, and thus alleviate mental illness.

Research conducted by the National Institute of Mental Health and Neuroscience in India has shown a high success rate—up to 73 percent—for treating depression with sudharshan kriya, a pranayama technique taught in the U.S. as “The Healing Breath Technique.”  It involves breathing naturally through the nose, mouth closed, in three distinct rhythms.

According to Stephen Cope, a psychotherapist and author of Yoga and the Quest for the True Self, “Hatha yoga is an accessible form of learning self-soothing,” he says.”  Yoga students may also benefit from their relationship with the yoga instructor, Cope said, which can provide a “container” or a safe place for investigating, expressing and resolving emotional issues.

Stigma is prejudice, and harmful to children

Stigma victimizes the victimes

Stigmatization, blame, judgment… It only takes a few individuals to harm a child or family with their words, but it takes a whole society to allow it.  In this article, I’m going to present recent research on the negative stereotyping of families and children with mental disorders, and share stories from families I know.  I hope readers will be empowered to speak out against this form of prejudice and mobilized into changing our society’s attitudes.

Have you ever heard of a bake sale to help a child get treatment for a mental disorder or addiction?

Puckette©2008

Stigma takes many forms.

The most common scenario of stigma is when you are seen as a bad parent, perhaps even an abusive one, or your child is seen as stupid, spoiled, attention-getting, or manipulative.  Another form of stigma is having others show disrespect to parents who seek help from the mental health profession.  Psychologists are “flakes,” and families  who see them are “wackos.”  “Where’s your faith?”, some say, or “why don’t you quit making excuses for your child and give them real consequences?”

One of the more destructive forms of stigma is the condemnation parents receive when they “drug their child to fix them.”  Too many believe drugs turn children into “zombies” (see research study below).  Because of the stigma of treatment, I’ve seen many parents try every alternative treatment possible to help their child, only to have their child struggle year after year in school, fall farther behind their peers, make no progress in therapy, and other setbacks that medicines can prevent.  These parents cling to the belief that they are doing the right thing, yet some children really need medicines, and the drugs don’t turn them into zombies.  [In today’s treatment approaches, drugs are always considered a piece of the treatment puzzle, never the complete answer.]

A mother’s story about her experience with stigmatization:

This mother lost her best friend of 20 years because the friend got tired of hearing the mom talk about her very troubled 10-year-old son.  In frustration, the friend wrote her a letter saying the mom was neurotic, and that she should quit trying to control her son, that her son’s behavior was a cry for help.  The friend said she needed to set her son free and get help for her emotional problems, and that she wasn’t going to “enable” this mom anymore by being her friend.  The mom was stunned and hurt by the letter.  She intellectualized that she didn’t need a friend like this, but her heart was nonetheless broken by the betrayal.  The son turned out to have brain damage from a genetic disorder and it was getting worse.

What you can do when someone makes thoughtless remarks, lectures you, or avoids you because of your child

From my blog post November 2008:

http://raisingtroubledkids.wordpress.com/2008/11/25/ideas-for-what-to-do-when-youre-blamed-and-judged/

First, resist defending yourself; it can attract more unwanted attention and disagreement.  You don’t have the time or emotional energy to explain or teach someone who will challenge everything you say.  Do everything you can to avoid people like this—many have had to cut off some family members and friends, and even their clergy or religious communities.

My story:  when my child was diagnosed with a serious mental disorder, I stood up in front of my church congregation, explained what was happening, and asked for prayers for my family.  At the end of that service, people started avoiding me.  There were no more hello’s.  There wasn’t even eye contact.  The abrupt isolation from people I knew was devastating and I stopped attending.  What did I say?  Why did this happen?  I thought if my child had a ’socially-acceptable’ cancer others would know what to do or say to ease the isolation and grief.

Second, actively seek out supportive people who just listen.  You need as large as possible a network of compassionate people around you.  You may be surprised how many people have a loved one with a mental or emotional disorder, and how many are willing to help because they completely understand what you’re going through.

Third, politely and assertively say thanks but no thanks.  Try something like this:  “Thanks for showing interest, but we are getting the help we need from doctors we trust.” Or simply, “please don’t offer me advice I didn’t ask for.”  No apologies.

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Public Perceptions Harsh of Kids, Mental Health (excerpt)

May 1, 2007   (USA TODAY)

Though the subject has been analyzed in adults, until now there has been limited research illuminating how the public perceives children with mental disorders such as depression and attention deficit disorders, according to experts from Indiana University, the University of Virginia and Columbia University.  The findings are published in the May 2007 issue of Psychiatric Services.

The study, based on in-person interviews with more than 1,300 adults, indicates that people are highly skeptical about the use of psychiatric medications in children.  Results also show that Americans believe children with depression are more prone to violence and that if a child receives help for a mental disorder, rejection at school is likely.

“The results show that people believe children will be affected negatively if they receive treatment for mental health problems,” says study author Bernice Pescosolido, director of the Indiana Consortium for Mental Health Services Research, in Bloomington.  “Nothing could be further from the truth.  These misconceptions are a serious impediment to the welfare of these children.“

According to the study:

• those interviewed believed that doctors overmedicate children with depression and ADHD and that drugs have long-term harm on a child’s development.  More than half believed that psychiatric medications “turn kids into zombies.”
• respondents thought children with depression would be dangerous to others; 31% believed children with ADHD would pose a danger.
• Respondents said rejection at school is likely if a child goes for treatment, and 43% believe that the stigma associated with seeking treatment would follow them into adulthood.

Pescosolido and her colleagues say such stigma surrounding mental illness — misconceptions based on perception rather than fact — have been shown to be devastating to children’s emotional and social well-being.

Population studies show that, at any point in time, 10% to 15% of children and adolescents have some symptoms of depression.  About 4 million children, or 6.5%, have been diagnosed with ADHD, only 2% less than the number of children with asthma.

“People really need to understand that these are not rare conditions,” says Patricia Quinn, a developmental pediatrician in Washington, D.C.

To banish the stigma linked to mental health problems in children, the public has to get past labels and misconceptions, Pescosolido says.   Normalizing these conditions would help too, Quinn says.  “We need to view depression and ADHD like we do allergies,” she says. “They are very treatable.”

Don’t let siblings lose their childhood

       Siblings suffer when a brother’s or sister’s chronic behavior overwhelms the family.  Usually parents are too stressed and exhausted to give them attention.  Their needs are overlooked because their brother or sister demands so much.  ‘Normal’ siblings can be very negatively affected and start to have trouble in school, troubled behavior of their own, and emotional scars that affect them in the future.

The Siblings’ Bill of Rights The right to our own life outside the family The right to have our own concerns acknowledged The right not to be “perfect” to compensate for our troubled sister or brother The right to be treated as fairly as our troubled sister or brother The right to a safe environment The right to have our own friends and spend time with them The right to helpful information about our troubled sibling The right to be supported in our choice of future, and to pursue our future without continually caring for our troubled brother or sister The right to one-on-one time with our parents-caregivers The right to have our achievements and milestones celebrated The right to have our needs and opinions included in our sibling’s treatment plans. From the Sibling Support Project – a national effort dedicated to the life-long concerns of brothers and sisters of people who have special health, developmental, or mental health concerns.  http://www.siblingsupport.org/

       Here’s my advice upfront:  Find ample time to put the siblings first.  You cannot let your difficult child rob them of their childhood, their need to grow and be social and do well in school.  Your other children will be part of their brother’s or sister’s life forever, and they will need to be strong and supportive when the troubled one needs help as an adult.  To the parent or caregiver, this is for you:

       “Most siblings of people with psychiatric disorders find that mental illness in a brother or sister is a tragic event that changes everyone’s life.  Strange, unpredictable behaviors in a loved one can be devastating, and your anxiety can be high as you struggle with each episode of illness and worry about the future.  It seems impossible at first, but most siblings find that over time they do gain the knowledge and skills to cope with mental illness effectively.  They do have strengths they never knew they had, and they can meet situations they never even anticipated.”  — National Alliance on Mental Illness (NAMI) July 3, 2001  www.nami.org

Sibling quotes – I once asked several young people about their experience living with a brother or sister with a mental disorder, and this is what they said:

“I escaped, I left in my mind.  I wouldn’t let anything bother me.  I dropped compassion and pretended nothing happened, I tried to forget about my family.”  Her sister was diagnosed with schizoaffective disorder at age 15.

“All I did was try to get away when she blew out.  Then I got jealous of all the time my parents spent on her and not the rest of us.  Now I just let them handle it and I take my younger sisters away to protect them but they still hear the noise so I help them feel safe, but it’s hard sometimes.”  Her sister was diagnosed with bipolar disorder at age 9.

“To me, it was a death.  The brother I knew and who was so much like me in so many ways had died, and I didn’t know who this person was who was living in my house anymore.”  His brother was diagnosed with schizophrenia at age 18.

       Share these messages with your other children, which might help them learn to live with or accept the behavioral disorder of their troubled brother or sister:

• “You cannot cure a mental disorder for a sibling.
• No one is to blame for the illness.
• No one knows the future; your sibling’s symptoms may get worse or they may improve, regardless of your efforts.
• If you feel extreme resentment, you are giving too much.
• It is as hard for the sibling to accept the disorder as it is for you.
• Separate the person from the disorder.
• It is not OK for you to be neglected.  You have emotional needs and wants, too.  The needs of the ill person do not always come first
• The illness of a family member is nothing to be ashamed of.
• You may have to revise your expectations of your sibling.  They may never be ‘normal’ but it’s OK.
• Acknowledge the remarkable courage your sibling may show when dealing with a mental disorder.  Have compassion, they suffer and face a difficult life.
• Strange behavior is a symptom of the disorder.  Don’t take it personally.
• Don’t be afraid to ask your sibling if he or she is thinking about hurting him- or herself.  Suicide is real.
• If you can’t care for yourself, you can’t care for another.
• It is important to have boundaries and to set clear limits.  You should expect your sibling to show respect for others.
• It is natural to experience many and confusing emotions such as grief, guilt, fear, anger, sadness, hurt, confusion, and more.  You, not the ill person, are responsible for your own feelings.
• You are not alone.  Sharing your thoughts and feelings in a support group has been helpful and enlightening for many.
• Eventually you may see the silver lining in the storm clouds: your own increased awareness, sensitivity, receptivity, compassion, and maturity.  You may become less judgmental and self-centered, a better person.”

Excerpted from “Coping Tips for Siblings and Adult Children of Persons with Mental Illness.”  NAMI, 2001, www.nami.org

Bullies, like their victims, are also at risk.

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

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

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

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

What if your child is the bully?

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

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

What parents of bullies can do

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

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

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

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

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

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

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

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

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

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

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

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

Some statistics on risks to bullies

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

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

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

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

If you are the parent of a victim

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

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

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

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

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

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Bullying and suicide. A review.  (excerpt)

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

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

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

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

Email: young-shin.kim@yale.edu

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

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

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

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

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

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

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

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Hyperactive Girls Face Problems As Adults, Study Shows (excerpt)

by Nathalie Fontaine, René Carbonneau, Edward Barker, Frank Vitaro, Martine Hébert, Sylvana Côté, Daniel Nagin, Mark Zoccolillo and Richard Tremblay, March 2008, Journal Archives of General Psychiatry, and ScienceDaily (Mar. 20, 2008).

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

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

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

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

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

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

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Things that protect troubled girls from delinquency

 

Both boys and girls get in trouble with the law.  Boys are in the majority for arrests for crime, but statistics indicate that girls’ arrests are increasing:  “…between 1996 and 2005, girls’ arrest for simple assault increased 24%.”  Of 1528 girls studied over a period from 1992 and 2008, 22% committed serious property offenses and 17 % committed serious assaults.  (Girls Study Group, U.S. Department of Justice, 2008. www.ojp.usdoj.gov).

  

Troubled girls easily become criminal, but also risk being a victim

 

Girls who have behavioral disorders, from addictions or past trauma or emotional disorders, begin to have delinquent or criminal behaviors as early as middle school!  What makes a girl’s criminal activities different from boys is that they put themselves at high risk of being victimized themselves.  How can a parent or caregiver prevent their daughter from engaging in criminal behavior, and trapping themselves in a social world where their stresses and disorders can worsen?

 

The Girls Study Group quoted above studied which factors protected girls from becoming criminal, or helped them stop and reengage in activities that improve and stabilize their lives.  Protective factors did not prevent all criminal activity however, yet the first one has been shown to be the most effective.

 

• Support from a caring adult.  THIS IS THE SINGLE MOST IMPORTANT FACTOR in preventing girls from criminal activities of any kind.
• Success in school helped prevent aggression against people, but not property crimes.
• “Religiousity,” or how important religion was to troubled girls, meant they were less likely to be involved with drugs.

These are risks to girls that are different from boys: 

    

Early puberty, especially if the girl has a difficult family and comes from a disadvantaged neighborhood.  Biological maturity before social maturity causes more conflicts with parents and more negative associations with older boys or men.

 

Sexual abuse, which girls experience much more than boys, including sexual assault, rape, and harassment.  But abuse of any kind affects both boys and girls equally.

 

Depression and anxiety, which girls tend to suffer more from than boys.

 

Romantic partners.  Girls who commit less serious crimes are influenced by their boyfriends.  But for serious offenses, both boys and girls are equally influenced by a romantic partner.

 

Once she’s regularly breaking rules, it’s not easy to turn things around for a troubled girl.  It requires constant, persistent efforts to:

• Keep her away from risky associates.
• Keep her in school and up with studies. 
• Keep telling her what’s great about her, what’s special, what’s powerful and good.

If you are a parent or caregiver, and you are lucky enough to have a strong mentoring relationship with your troubled daughter, keep it up despite any occasional law-breaking activities.  She’ll need consequences, but they should be obstacles to overcome rather than punishments—such as earning back privileges by having good behavior for a period of weeks or months.

 

If you don’t or can’t have a mentoring relationship, find out who can (or already does).  Admit you might not be the sole support for her success, and work in partnership with a caring adult.  Find out who believes in her already.  Find out who she asks for help if she’s feeling fearful or down about herself.  Listen to her if she talks about someone she’s grateful for for helping her through difficulties.  Girls respond really well to someone who believes in them.

 

 

Teen girls can be turned around and it’s always worth the effort.  She might be hard to take sometimes, but find something, anything, that’s good about her and let her know.  Over time, you’ll start noticing more and more great things about her, and then she’ll start noticing them too.

 

BEFORE

 

AFTER

Gang up on your kids: Parent networks for tracking at-risk children.

 An article in the local paper told the story of a mother who desperately tried to get help for her son to keep him out of a gang.  Yet he became a victim of a drive-by shooting and was in intensive care for days, but he lived.  In the article, she said something I’m very familiar with; she said other parents never told her what they suspected, nor let her know if her son was at their house when he ran away.  Just knowing her son’s whereabouts could have helped her intercept dangerous activities.  Like her, I never got information from other parents who might have been (or should have been) concerned about my child.  Why didn’t other parents stay in touch and help each other control their children?

 

At-risk kids hang out together, they know each other’s stories (true or not), and protect each other, and parents are out of the loop with their families.  What if parents got together too, shared stories, and supported each other’s goal of protecting their child from themselves?  Kids’ unsafe plans and activities are no match for the many eyes and ears (and cleverness and wisdom) of all their parents combined.

 

How to track at-risk kids and join forces with other parents:

 

Go on the Web, check out Facebook and MySpace, and look for your child’s page and the pages of his or her friends.  The police do this all the time; it’s one of their main investigative tools!  It’s amazing what they share with each other over the web:  photos, favorite places and people, favorite activities (even illegal ones), and other incriminating information.

 

Contact the parents or caregivers of your child’s friends, by phone or email anytime you find out that their child or teen was with your own child while doing unsafe activities.

 

I did this.  Some parents were thrilled to find support, but a couple were angry with me at first.  After all, I was delivering bad news.  They defended their child, or accused my child of telling stories.  I just said, “I thought you’d want to know.  My kid is in trouble for this, but you may want to know your kid was involved too.”  It took some backbone to stay online, but they eventually calmed down and expressed disappointment in their child.  They often hadn’t suspected anything.  Then I asked if we could join-up and inform on each other’s kids because I wanted to know about the safety of my own.  Always, I received a strong yes.

 

Compare notes and share news about friends, friends of friends, which houses were dangerous (e.g. adult not at home, or adult provides drugs or alcohol), which places they hang out, and who might victimize them or be victimized by them.

 

Call a teacher and ask who your child hangs out with at school, or if they know another parent who is worried about their kid, call that parent and make a pact to keep each other informed.  Whether they help you or not, at least they know someone’s watching and paying attention.

 

True story – One mother I know recruited a “spy network” with her son’s friends’ parents and with employees of businesses he regularly frequented, such as a skateboard shop near his school and a coffee house.  She was able to keep track of where he was if he ignored her curfews, and inform the community police of adult associates (usually 18-24) who were known to provide drugs, alcohol, and cigarettes to youth.  Her information helped empower other parents who hadn’t known what to do, but were then able to restrict their teen’s activities away from home and make it uncomfortable for unsafe people to associate with them.

 

True story – A father I met took the “spy network” idea a step further and had contact cards, like business cards, which he gave away to police, teachers, other parents, and anyone he met who knew his daughter.  The contact cards basically said “Please help us keep Kari safe and call us, her parents, anytime she is at the following places [ … ] or doing something you believe is inappropriate.  Thank you very much for your help.  We will keep your calls confidential from our daughter.”  Then the card gave the parents’ names, number, and email address.  This greatly limited their daughter’s contact with unsafe or inappropriate friends and adults, because they knew they might be watched and reported if she was around.  Surprisingly, this attention improved the girl’s progress in family therapy, as she stated she felt more like her parents cared.

 

Word gets out quickly among the groups of at-risk kids and the adults who enable them.  If you let enough people know that they may be watched when at-risk kids are around, then they will avoid these kids and even ask them to leave their company.  Don’t forget:  you are smarter and more experienced than young people.  You, as a parent, are not alone with your concerns about your child.

 

Reach out to the other parents in your community.  You will be surprised how many will thank you.

Troubled Teen Industry – Legislation to stop abuse in boarding schools and camps

There is good news about stopping abuses in the Troubled Teen Industry.  Today, February 11, 2009, a committee in the House of Representatives voted to present a bill, H.R. 911, to the House for a vote.  You may be interested in the remarks made by the committee chair below.

 

SEE MY PREVIOUS POST ON THIS SUBJECT FROM JAN 26, ‘09:

with tips for how to check if a program is legitimate.

 

(excerpt)  Remarks of the Honorable George Miller Chairman, House Education and Labor Committee regarding the Stop Child Abuse in Residential Programs for Teens Act Wednesday, February 11, 2009.  H.R. 911

 

Today, our committee considered legislation to stop child abuse in residential programs for teenagers and ordered it reported to the House.  It builds on a two year investigation into the shocking abuse and neglect of teens at residential programs across the country.  The Government Accountability Office uncovered thousands of cases and allegations of child abuse in recent years at teen residential programs, including therapeutic boarding schools, boot camps, wilderness camps, and behavior modification facilities.  A number of these cases resulted in the death of a child. Our committee heard stories about program staff members forcing children:

 

-  to remain in so-called “stress” positions for hours at a time;

 

-  to undergo extreme physical exertion without adequate food, water, or rest;

 

-  to stand with bags over their heads and nooses around their necks in mock hangings;

 

-  and to eat foods to which they are allergic, even as they get sick.

 

Bob Bacon, whose son Aaron died after being deprived of adequate food and water at a wilderness therapy program, told this committee last year, “The stories of Aaron’s death and the others who have died, or survived the abuses of these programs, are chilling reminders of the dangers of absolute power, and point out the extremely high risks we take in allowing these programs to operate without strict regulation and oversight.”

 

We heard from parents of children who died preventable deaths at the hands of untrained, uncaring staff members.  We heard from adults who attended these programs as teens about the physical and emotional abuse they witnessed and suffered.  We also learned about the weak patchwork of regulations governing teen residential programs.

 

Parents often send their children to these programs when they feel they have exhausted their alternatives.  They trust that these programs and their staff will be able to help children straighten their lives out.  In far too many cases, however, the very people entrusted with the safety, health, and welfare of these children are the ones who violate that trust in some of the most horrific ways imaginable.  The GAO informed us about programs’ irresponsible operating practices that put kids at risk, and about the deceitful marketing practices that programs use to lure parents desperate for help for their kids.  We know that there are many programs and people around the country who are committed to helping improve the lives of young people and who do good work every day.  But unfortunately, it can be extremely difficult for parents to tell the good programs from the bad.

 

H.R. 911 requires the U.S. Department of Health and Human Services to establish minimum standards and to enforce those standards. Ultimately, however, states will be responsible for carrying out the work of this bill:

 

-   within three years, set standards and enforce them at all programs, both public and private.

-   standards will include prohibitions on the physical, sexual, and mental abuse of children.

-   …will require that programs provide children with adequate food, water and medical care.

-   …require that programs have plans in place to handle medical emergencies.

-   include new training requirements for program staff members, including training on how to identify and report child abuse.

-   set up a toll-free hotline for people to call to report abuse at these programs.

-   create a website with information about each program, so that parents can look to see if substantiated cases of abuse have occurred at a program that they are considering for their kids.