Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common health concerns among school-aged children. ADHD can occur in both genders as well as in all ethnic and racial populations. Although it is diagnosed as much as nine times more often in males than in females, many researchers believe that it occurs equally in girls, but because females display more inattentive symptoms and fewer behavioral symptoms, they may never be diagnosed or may be diagnosed much later than males.
How do I know when to seek help?
There are two basic clusters of symptoms that characterize ADHD: cognitive symptoms are seen in inattention; behavioral symptoms are seen in hyperactivity and impulsivity. If your child displays many of the symptoms below or if your child’s teacher is concerned about similar patterns of behavior being present in the classroom, you should speak to a professional and consider the possibility of having your child evaluated for ADHD.
Signs of inattention:
- does not pay close attention to details or makes careless mistakes in school work
- is easily distracted from tasks or play
- is often forgetful or does not appear to listen when spoken to
- does not follow instructions, or fails to complete school work or chores
- has trouble organizing tasks and personal belongings
- avoids or dislikes activities requiring concentration, such as schoolwork
Signs of hyperactivity and impulsivity:
- has difficulty sitting still, often fidgets and squirms
- often talks out of turn or excessively in the classroom
- displays high levels of energy and activity, often engaging in risky behaviors
- interrupts frequently or intrudes into conversations or games
- acts or speaks impulsively
- displays immaturity in a variety of social situations
ADHD can affect families by straining sibling relationships; causing a child to underachieve in school, which may lead to failure and truancy; diminishing parental bonding and family cohesiveness; and creating marital stress, tension, and potential divorce.
Since ADHD causes repercussions in so many aspects of a child’s life and affects the entire family, several professionals may be involved in accurately assessing the disorder and developing an effective treatment plan. A skilled family therapist may be the best professional to coordinate the overall plan and provide ongoing therapy to family members. Additional professionals may include a special education person from the child’s school who would coordinate the school’s accommodation plan for the student; a pediatric specialist or child psychiatrist who would assess the need for medication; an educational specialist who would assist in providing academic and tutorial resources; and a psychometrist who would provide psychoeducational testing to determine the severity of the symptoms and the level of cognitive impairment (and who could also address the presence of learning disabilities, which are common among children with ADHD).
How do I distinguish between normal and problem behaviors?
Reports in the media of greatly increased rates of diagnosis of ADHD and the frequent prescribing of stimulants for children may lead parents to wonder if ADHD is being diagnosed properly. Are these diagnosed children simply exhibiting normal childhood behaviors? Aren’t many children extremely active, impulsive, or inattentive?
Each child’s range of behaviors must be evaluated according to their age and developmental maturity. For example, behaviors which may be normal in a 5-year-old might be viewed as problematic in a 10-year-old. The symptoms that support a diagnosis of ADHD are usually present in early childhood, though the inattentive symptoms may not be recognized until much later in a child’s life. Patterns of forgetfulness, disorganization, and overactive behaviors which would determine a diagnosis of ADHD occur more frequently and persistently, and create more problems in a variety of settings than behavior that is typical in a particular age group. Further information on exactly what ADHD is and how it differs from typical childhood behavior can be found in the resources listed at the end of this flyer.
How do I know that the diagnosis of ADHD for my child is correct?
A diagnosis of ADHD requires several steps and may take two or three visits to a qualified health professional. Information to support the diagnosis is collected from parents, teachers, health care professionals, and an interview with the child. The clinician who is assessing your child will also consider other possible causes of problem behaviors. Select a professional who specializes in working with ADHD and share your concerns. If you still question the diagnosis, get a second opinion from another qualified professional.
Does my child have to be treated with medication?
In treating ADHD, medication may be used to reduce hyperactivity and impulsivity, and to improve a person’s ability to concentrate and focus on activities and tasks. The effectiveness of the medication can help a child perform better in school, as well as in family and social situations. The first-line medications prescribed are the stimulants, which include Ritalin, Dexedrine, and Adderall. These have the most direct effect on moderating the ADHD symptoms and may be effective in up to 75% of ADHD children and adolescents. If these medications cause unacceptable side effects or are found to be ineffective, antidepressants may be prescribed, but often with somewhat less effectiveness. Improvement with the medication may be dramatic. However, medication does not cure the disorder; it controls the symptoms temporarily. Experts advise that medication is most effective when combined with therapy in order to improve self esteem, social skills, family relations, and academic performance. The use of medication without supportive therapy is less effective.
Family therapists are well qualified to suggest the type of assessment and treatment which might be needed to help. Children who are successfully treated for the disorder live happier, more secure lives, and are better able to succeed in their educational and career goals. Adults who are successfully treated for the disorder are able to improve their marital relationships, parenting skills, social interactions, and career direction and success.
Curiosity surrounding sexuality is "normal" in the process of development. Beginning with exploration of the body, an infant or toddler will proceed on to questions such as "Where do baby's come from?" in elementary school and "What is happening to me?" as puberty begins. These curiosities serve as the foundation for further exploration as the body matures, sexual feelings arise and interest in sexuality is acquired. Fortunately for most, this aspect of development matures with desires, passions and behaviors organized by principles, values and social expectations into appropriate sexual behaviors. There are some, however, whose behavior exceeds the "norm" and extends sufficiently outside the realm of social mores as to draw the attention of state, clinical or legal entities. Offensive sexual behaviors range from sexual harassment (e.g., calling attention a person's body part.) to engaging in inappropriate and, at times, illegal sexual behaviors (e.g., exposing oneself to another). Adolescents may engage in sexual behaviors that, while socially and legally condoned (e.g., masturbation), may be considered immoral by family members. However, when sexual behaviors exceed social and legal boundaries, bringing these youth to the attention of the juvenile court, these youth are referred to as Juveniles who Offend Sexually (JwOS).
Can I Prevent Sexually Offensive Behavior?
A common question asked by concerned parents is, "Can I prevent my adolescent from engaging in sexually offensive behavior?" The answer to this is "yes," if parents are willing to invest in their child before he or she ever begins to occupy him or herself in offensive sexual behaviors. First, develop a positive and open home environment where adolescents feel safe approaching parents with concerns and questions. Second, while remaining calm, parents should be open and honest, listening effectively before responding so they know what their child is asking. Third, family members need to understand and eventually adopt a set of principles that will guide their decision-making. Parents who teach principles that they themselves adopt, such as honesty, trust, integrity, morality, chastity, fidelity and self-mastery through expectations, rules and behavior, help their adolescent put on "armor" that will protect the child in a society that floods the airways (e.g., TV, DVD, video games, music) with sexually implicit and explicit information. Fourth, help adolescents organize these principles into a mission statement, which will serve as their personal day-to-day motto, much the same as the Boy Scout motto, "Be prepared." Fifth, teach adolescents how to use the principles to make effective decisions when faced with difficult choices. Give them possible situations they may encounter and help them use principles to decide how to deal effectively with the scenarios. Sixth, be an adolescent's primary source of sex education. Put aside fears about talking about sexuality aside, pick up a sexuality book and learn how to present the information to a child in an age-appropriate manner. Seventh, monitor in a positive and considerate manner the movies children watch, video games they play, activities they are involved in with peers, jokes they tell that suggest insensitivity to sexuality or people, curfews and signs of substance use or abuse. Finally, encourage children to be good family and community citizens.
When Should I Seek Help?
It is important to know what "normal" sexual behaviors are to determine if a sexual behavior is inappropriate and offensive. When in doubt, parents are encouraged to seek out assistance to better understand if the behavior their adolescent is involved in is inappropriate and how best to handle it. With the current attitude in society about sexual behavior, it is important that any sexual behavior be given immediate and appropriate attention with the purpose being to:
- understand the reason the adolescent engaged in the behavior
- make a determination as to whether the behavior is morally or legally acceptable,
- initiate the appropriate level of intervention (home based, clinical or legal),
- strengthen the adolescent against repeating the behavior through ongoing personal interviews, monitoring activities and knowing where the adolescent is, keeping an open dialogue and developing a safety plan, and
- share the information, when appropriate, with the parents of other individuals involved so they can seek assistance for their child.
Parents are encouraged to "take their heads out of the sand" and understand and accept the seriousness of sexual behaviors. Seriousness can range from kissing tag, "playing doctor" and self-stimulation, to acting out sexually in an inappropriate manner based on age or maturity (a 7-year-old simulating acting out sexual intercourse), to subtle acts of sexual behavior imposed on others without permission (exhibitionism), to active forms of aggression such as the use of manipulation ("If you do this I will give you something or take something away?"), to coercion ("If you don't do this I will hurt you or your dog!") or force (using a weapon). While the previous examples demonstrate the range of sexual behavior that might be considered offensive, the following guidelines are suggested for parents to help them determine if their adolescent's sexual behavior is out of the ordinary:
- Age Difference. The greater the difference in age, the more likely the behavior will not be regarded as exploratory.
- Aggressive Components Included in Sexual Behavior. When the sexual behavior moves out of the realm of "showing" and begins to include aggression (insertion of objects into the vagina or rectum) or coercion, the behavior must be regarded as offensive.
- Exploitative and Manipulative Behavior. When one person exploits or manipulates another to gain compliance to a sexual outcome, the behavior is regarded as offensive.
Where Do I Seek Assistance?
When sexual behavior is offensive, parents may find themselves experiencing a wide range of emotions, such as anger with the child, confusion about what to do, fear about the potential outcomes in a legal system or denial that their child could have done such a thing. While these emotions may govern initial parental action, it is important that parents seek out professional guidance to assess and make recommendations about what has occurred and what can be done. Professionals involved in helping with juveniles who offend sexually can be located in a variety of ways. Parents can contact a family therapist, their state's Department of Human Services, a social worker, a psychologist, a psychiatrist or members of the clergy. Many hospitals have staff that work specifically with youth and adolescents who act out sexually. Most counties have victim's advocates, and the local police or sheriff's department should also be able to offer assistance and guidance.
Negotiating the Legal System
If a child is referred to the juvenile court for sexual behavior, it is important for parents to understand their legal rights, as well as those of the adolescent. They should find an attorney who has handled these types of cases in the past.
What is Therapy Like?
When an adolescent is referred to the juvenile court for sexually offensive behavior, it is most likely that two clinical requirements will be imposed. The first, will be the completion of a psychosexual evaluation to help those examining the case a) determine the severity of the sexual behavior based on age, victim, location of behavior, etc., b) provide recommendations to the court and clinician who will provide therapy, and c) help determine the type of clinical setting in which the adolescent will be placed. The second requirement is to be involved in therapy. Regardless of the placement the adolescent is assigned, there are three types of therapy. Individual therapy will be used to address personal issues relating to the sexually offensive behavior, such as denial, victim empathy or relapse prevention. It may also address other psychological issues, such as depression, anxiety and conduct disorder. Group therapy is designed for the adolescent to meet with other youth who have also offended sexually. Group therapy includes education about sexuality and social skills and often includes the use of a workbook that becomes a basis for discussion. Family therapy is aimed at helping parents and family members understand what has occurred and how to prevent other incidents by strengthening all family members. Since the adolescent will most likely return home, it helps family members work out a safety plan, set realistic and age appropriate rules and expectations, and organize a democratic, principle-based decision-making system.
It is important for parents and families to understand and discuss sexual development and behavior as children develop from early childhood through adolescence. Unfortunately, many parents neglect to discuss sexual development and behavior with their children, or if they do, it is a one-time event. Providing sexual information (which includes not only anatomy and physiology, but also addresses relationship skills and laws governing sexual behavior) is developmental and needs to be presented at different ages based on what the child, youth or adolescent needs to understand in order to be aware of their sexual development, to master sexual impulses and to be appropriate in their sexual expression.
It is common for children and teenagers to display bouts of irritability, frustration, and disobedience over the course of their growth and development. For example, the 4 year old who throws a tantrum because she has to stop playing; the 8 year old who picks on his younger sister; the 13 year old who argues with her mother about going to a movie. Still, there are many families who struggle with child behavior that goes beyond stubbornness or occasional talking back. Some children and teens have such an inflexible and hostile nature and their behavior can be so uncooperative and defiant that they disrupt the functioning of whole households and classrooms, not to mention their own learning and well-being in relationships. One out of every ten children or teenagers displays this type of disposition and behavior with such regularity that they are thought to have Oppositional Defiant Disorder (ODD). According to the American Psychiatric Association, ODD is characterized by a chronic pattern of negativity, hostility, and non-compliant child behavior that is most often directed toward authority figures and has existed for at least 6 months. This behavior is severe enough that it interferes with everyday functioning at home and, in some cases, at school and other activities, and it stands out as more severe compared with children of the same age and developmental level.
Signs and symptoms of ODD:
- Act angry or resentful toward others
- Deliberately try to annoy or upset other people
- Be touchy or easily annoyed by others
- Lose his or her temper and throw tantrums
- Argue with adults
- Actively defy or refuse to comply with adults’ requests or rules
- Act spiteful or seek revenge on others
- Blame others for his or her mistakes or misbehavior
The exact cause of ODD is not known. Research suggests that it evolves out of a complex interaction of many different factors related to the basic biological, psychological, and social nature of the child and his or her relationships with the family and other environments, such as school. Also, it is not uncommon for children with Attention Deficit/Hyperactivity Disorder (AD/HD), depression, or anxiety to display symptoms of ODD.
Effect on Families & Relationships
Parenting a child with ODD can be a tremendous challenge not only because he or she may seem so willing to defy adult authority, but also because intervention strategies that work with most children, such as time-outs, removal of privileges, and grounding, often do not work with ODD. Studies actually indicate that these children may not respond well to punishments. Other studies have found that children and teens with severe cases of ODD and/or aggression may feel threatened by situations where there are unclear messages, rules, or expectations, which can trigger hostile reactions. In addition, they often have poor frustration tolerance, which only makes it more difficult for them to get through situations where they feel uncomfortable, threatened, or where they may see little pay-off for their efforts. The result of these factors are children and teens who seem to be easily annoyed or angered, yet are difficult to soothe and calm. This pattern of behavior can leave many families feeling powerless, as if they have to “walk on eggshells” out of fear that one wrong move can cause a serious tantrum. It can also leave the child or teen feeling isolated, anxious, and unsure of herself as others anticipate her irritability and explosive behavior even before it occurs. They likely will be aware of any feelings of disappointment and resentment that other family members feel toward them due to their oppositional and defiant behavior. Unfortunately, it is not enough to help change the behavior.
Parenting Tip: Be Decisive
It is easy for parents who feel like they have to walk on eggshells to become wishy-washy; they are often unsure of when, where, and how, to give directions or enforce rules with their children and teens. However, wishy-washiness can actually be a trigger for ODD behavior. It is important to be decisive! Most parents with children and teens with ODD have learned the hard way that it is much better to say “no” than to say “we’ll see” if “no” is the answer they really mean. The child may throw a tantrum with either response; however, telling the child “we’ll see” only heightens the intensity of her reaction because it gives her hope that she can still get what she wants. She is then likely to badger the parents until she gets her way or is finally told “no,” with the meltdown that follows being even more intense. So, go ahead and say “no” and stick to it; your child will learn over time that you mean what you say and that goes a long way to curbing anxiety and increasing compliant behavior. This also applies to setting plans for any activity, such as going to school, taking a trip, or running errands. Be clear about what is going to happen and alert and prepare the child before any changes to the plan take effect.
When to Seek Help
It may never be too soon to seek help for your child or teen if they are displaying the type of behavior associated with ODD, as it can be difficult to know whether it is a part of typical development or a problem that needs treatment. The more frequent and severe your child displays the symptoms listed above, the more likely there is to be intense family conflict and the more likely he or she is to have problems with peers, have difficulty maintaining friendships, and suffer academic problems.
The key to successful interventions for ODD is parent involvement. It is critical that parents be firm and consistent not only with their discipline strategies, but also with the love and acceptance in their responses to the child. The most effective interventions are considered to be those that emphasize Parent Training, which provide a framework for understanding the nature of ODD in children and teens and help reinforce specific parenting skills, as well as teach creative strategies for managing ODD behavior. Parents who are not able to respond to ODD behavior in a manner that can calm and soothe the child only add fuel to the fire. It is a lot to ask of a parent who is constantly under attack from oppositional behavior to react calmly, and it probably seems impossible if you are feeling demoralized and exasperated. This is why it is often a good idea to seek the help of a mental health professional, such as a marriage and family therapist (MFT), who can not only help you learn strategies to confront this kind of extreme behavior, but also learn ways of coping with the stress of parenting in the face of such difficult circumstances.
How MFTs Can Help
MFTs can be a source of significant support and direction for those struggling with a child with ODD. An MFT can help strengthen your parenting techniques as you adapt to meet the challenges presented by ODD. MFTs are specially trained to improve the emotional connectedness and harmony among family members. This is a critical point of intervention, as it is important to have emotional resources and support when dealing with high-intensity, high-demand behavior.
Being a teenager and raising a teenager are individually, and collectively, enormous challenges. For many teens, illicit substance use and abuse become part of the landscape of their teenage years. Although most adolescents who use drugs do not progress to become drug abusers, or drug addicts in adulthood, drug use in adolescence is a very risky proposition. Even small degrees of substance abuse (for example, alcohol, marijuana, and inhalants) can have negative consequences. Typically, school and relationships, notably family relationships, are among the life areas that are most influenced by drug use and abuse. One of the most telling signs of a teen's increasing involvement with drugs is when drug use becomes part of the teen's daily life. Preoccupation with drugs can crowd out previously important activities, and the manner in which the teen views him or her self may change in unrealistic and inaccurate directions. Friendship groups may change, sometimes dramatically, and relationships with family members can become more distant or conflictual. Further bad signs include more frequent use or use of greater amounts of a certain drug, or use of more dangerous drugs, such as cocaine, amphetamines, or heroin. Persistent patterns of drug use in adolescence are a sign that problems in that teen's environment exist and need to be addressed immediately. What causes adolescent substance abuse?
There is no single cause of adolescent drug problems. Drug abuse develops over time; it does not start as full-blown abuse or addiction. There are different pathways or routes to the development of a teen's drug problems.
Some of the factors that may place teens at risk for developing drug problems include:
- insufficient parental supervision and monitoring
- lack of communication and interaction between parents and kids
- poorly defined and poorly communicated rules and expectations against drug use
- inconsistent and excessively severe discipline
- family conflict
- favorable parental attitudes toward adolescent alcohol and drug use, and parental alcoholism or drug use
It is also important to also pay attention to individual risk factors, including:
- high sensation seeking
- psychological distress
- difficulty maintaining emotional stability
- perceptions of extensive use by peers
- perceived low harmfulness to use
How do you know when to seek help?
The earlier one seeks help for their teen's behavioral or drug problems, the better. How is a parent to know if their teen is experimenting with or moving more deeply into the drug culture? Above all a parent must be a good and careful observer, particularly of the little details that make up a teen's life. Overall signs of dramatic change in appearance, friends, or physical health may be signs of trouble.
If a parent believes his or her child may be drinking or using drugs, here are some things to watch for:
- Physical evidence of drugs and drug paraphernalia
- Behavior problems and poor grades in school
- Emotional distancing, isolation, depression, or fatigue
- Change in friendships or extreme influence by peers
- Hostility, irritability, or change in level of cooperation around the house
- Lying or increased evasiveness about after school or weekend whereabouts
- Decrease in interest in personal appearance
- Physical changes such as bloodshot eyes, runny nose, frequent sore throats, rapid weight loss
- Changes in mood, eating, or sleeping patterns
- Dizziness and memory problems
What kinds of treatment will work?
Evidence shows that certain forms of family therapy are the most effective treatments for drug problems. A qualified Marriage and Family Therapist can evaluate and assess a teen's substance abuse problem, and will then provide appropriate treatment for the adolescent, which may include outpatient therapy or therapy in a residential treatment facility. Therapy will focus on a number of important life areas of the teen, in addition to his or her relationships with parents. It is essential for parents to be involved in the teen's treatment. Relationships are a critical ingredient to combat a teen's drug problems.
How can I help my teen avoid substance abuse?
Parents and guardians need to be aware of the power they have to influence the development of their kids throughout the teenage years. Adolescence brings a new and dramatic stage to family life. The changes that are required are not just the teen's to make; parents need to change their relationship with their teenager. It is best if parents are proactive about the challenges of this life cycle stage, particularly those that pertain to the possibility of experimenting with and using alcohol and drugs. Parents cannot be afraid to talk directly to their kids about drug use, even if they have had problems with drugs or alcohol themselves. An excellent resource on how to talk to kids about drugs is Parents - The Anti-Drug (www.theantidrug.com). Parents are encouraged to give clear, no-use messages about smoking, drugs, and alcohol. It is important for kids and teens to understand that the rules and expectations set by parents are based on parental love and concern for their well being. Parents should also be actively involved and demonstrate interest in their teen's friends and social activities. Spending quality time with teens and setting good examples are essential. Even if problems such as substance abuse already exist in the teen's life, parents and families can still have a positive influence on their teen's behavior.
By definition, self-harm refers to hurting oneself to relieve emotional pain or distress. The most common forms of this behavior are cutting and burning. The least common forms of self-harm include pulling out bodily hairs, punching walls, and ingesting toxic substances or sharp objects.
Many adolescents today are struggling to cope with extreme levels of stress in school, in their families, and in their peer relationships. Some of these youth are overscheduled and being hurried through their adolescent years by parents and peers alike. Teens have become vulnerable prey to our highly toxic, media-driven world. Being in front of a computer or TV screen for close to six hours a day has become business as usual and more important than spending time with family and friends. Adolescent girls are constantly being bombarded by images in the media about how they should look and act. Especially for young women, failure to live up to these idealized images can lead to developing an eating disorder and/or engaging in self-harming behavior as a form of self-punishment.
What Causes Adolescent Self-Harming Behavior?
Like substance abuse, adolescent self-harming behavior has no one single cause. It cuts across all cultural and socioeconomic levels. We do know, however, that more adolescent females engage in this behavior than males, and that self-harming adolescents are rarely suicidal. Most of these adolescents are seeking quick relief from emotional distress.
One major reason why adolescents gravitate towards self-harming behaviors is the endorphin effect. When adolescents cut or burn themselves, endorphins are quickly secreted into their bloodstreams and they experience a numbing or pleasurable sensation. For some of these youth, cutting or burning themselves numbs away unpleasant thoughts and feelings or they feel "high" from the experience. Like addiction to a particular drug, the endorphin "high" provides fast-acting relief for adolescents from their emotional distress and other stressors in their lives.
Other important reasons as to why teens engage in self-harm include:
- Feeling emotionally disconnected from or invalidated by their parents
- Wanting to "fit in" within a particular peer group that encourages and rewards self-harming behavior
- Feeling emotionally dead inside or feeling invisible in their parents' eyes. Self-harm makes them feel alive inside and helps confirm their existence in reality.
- For girls, self-harm may be used as a coping strategy with overly demanding parents, especially in situations where the father is the dominant voice when it comes to discipline and decision-making
How Do You Know When to Seek Help?
Since adolescents often engage in self-harming behaviors in privacy or with their friends, parents may not be aware that this problem exists. In addition, parents also need to be aware that there is a big difference between self-decorating and self-harming behavior. It is a popular fad among youth today to body pierce and tattoo as a form of self-decorating. Teens who self-harm are seeking relief from emotional distress, they are not self-decorating.
Here are some signs that might indicate that a teen has a problem with self-harming behavior:
- Cut or burn marks on their arms, legs, and abdomens
- Finding knives, razor blades, box cutters, and other sharp objects hidden in the teen's bedroom
- Regularly locking herself or himself up in the bedroom or bathroom following a bad day at school, negative encounters with peers, and family conflicts for lengthy periods of time
- The family physician, a teacher, or other adult observes cut or burn marks, or that the teen appears to be regularly removing bodily hairs
- The teen's peers cut or burn themselves.
- Reports from a sibling indicating that he or she found blood encrusted razors or caught the teen in the act of self-injuring
What Kinds of Treatments Work?
By far, the most effective treatment for adolescent self-harming problems is family therapy. A skilled family therapist will be able to help improve family communication, teach conflict-resolution and problem-solving skills, and help foster more meaningful and closer relationships between parents and teens.
Skill-building groups can be helpful to self-harming adolescents as well. A good group should teach teens effective tools for managing their moods, challenging unhelpful thinking, visualization and meditation skills, and healthy activities to better manage stress.
How Can Adolescent Self-Harm be Prevented?
Parents play an integral role in preventing their teens from engaging in self-harming behaviors and from joining an unhealthy peer group, where this problem may be the glue that keeps them together. At home, parents can make spending time together as a family a priority. Parents can put the teen in charge of selecting and planning a weekly family outing. The family mood needs to be more calm and inviting for the teen. When conflicts do erupt or crises occur, family members should work together as a team to solve these situations. Teenagers need to feel a sense of place in the hearts and minds of their parents. They need to feel appreciated and know that their parents will be there for them unconditionally. It is the parents' responsibility to create firm boundaries between their work and family lives.
One way to help foster more meaningful connections between parents and teens is to share family stories. Parents should share with their kids what their struggles and high points were in adolescence. They can also share with their teens any important words of wisdom and stories that their own parents shared with them when they were growing up.
Self-harming behavior can be dangerous, particularly if the youth is abusing alcohol and other drugs. Parents need to take a firm stance and set consistent limits with these behaviors. Parents also need to model for their teens' responsible use of alcohol and healthy ways to manage stress.
It is a parent's right to meet their teen's friends, as well as their parents, and voice your concerns when warranted. Should a parent discover that their teen is engaging in risky and dangerous behavior such as self-harm, they should rest assured that a family therapist will be able to skillfully assist the family and teen with this serious issue.
Many adolescents today have problems and are getting into trouble. After all, there are a lot of pressures for kids to deal with among friends and family. For some youth, pressures include poverty, violence, parental problems, and gangs. Kids may also be concerned about significant issues such as religion, gender roles, values, or ethnicity. Some children are having difficulty dealing with past traumas they have experienced, like abuse. Parents and their teenagers are struggling between the youth's wanting independence while still needing parental guidance. Sometimes all these conflicts result in behavior problems.
Any number of isolated behavior problems can represent adolescent problems and delinquency-shoplifting, truancy, a fight in school, drug or alcohol ingestion. Sometimes, kids can't easily explain why they act the way they do. They may be just as confused about it as the adults, or they simply see delinquent behaviors as appropriate ways to deal with what they experience. Parents and loved ones may feel scared, angry, frustrated, or hopeless. They may feel guilty and wonder where they went wrong. All these feelings are normal, but it is important to understand that there is help available to troubled kids and their families.
How do you know when to seek help?
What are the signs of trouble? Many adolescents get into trouble sometimes. A big question for parents (whether they be "traditional," single, step, or grand-parents), though, is how to know when a youth is headed for more serious problems, or when bad behavior is just "a kid being a kid." Try to focus on patterns rather than an isolated event. In other words, does the behavior happen repeatedly despite efforts to change it?
The patterns signaling the need for help include not only deviant behaviors by the adolescent, but also the presence of other problems in the family or tensions at home. For example, problems in the parents' marriage or frequent fighting or hostility among the family members can also be involved in the youth's behavior problems. The problem behaviors and other family issues can interact and feed off each other, so that it is hard to tell where it started.
Of course, there are also some obvious signs that indicate the need for immediate and effective intervention, including violence against other persons or animals, or when peers are involved in destructive processes (crime, truancy, drugs). Or, a parent may simply have an instinctive feeling that something serious is happening. An important first step to find out what is going on is to try to talk to the adolescent and other family members about what is happening, possible reasons, and potential solutions. Others who know the adolescent and family, like teachers or caregivers, may also be able to provide information about the youth's mood or behaviors outside of the home to help assess the severity of the problem.
Many factors put youth and families at risk for juvenile delinquency, though they do not necessarily cause delinquency. Such factors include youth attention and hyperactivity problems and learning disorders, volatile temperament, and even the early onset of puberty and sexual development. All these factors affect the way an adolescent feels and acts and also how peers, family, and society view the adolescent. Similarly, parental problems, such as depression, substance abuse, and domestic violence can interact negatively with a youth's developing path of delinquency. Rather than causing delinquency, factors such as these tend to place youth at increased risk, intensify the downward spiral, and in turn add to the difficulty in changing these processes for the better.
What kinds of treatments will work?
Once you have determined that you and your loved ones need help, there are many kinds of treatment that you should explore. First, there are popular group-based, residential, and "life-experiential" options, like survival camps, boot camps, and "scared straight" programs, which have had some limited success. Research indicates that the most effective treatments, even with very difficult youth, are programs and treatments that are family-based and multisystemic. That means treatment that involves the adolescent and his or her family, and that also addresses other aspects of their lives, such as the school system, the neighborhood, peers, juvenile justice system, and even employers. In other words, it is treatment that focuses on all the parts of the youth's life that shape how he or she views the world, emphasizing family and parental support.
Treatments that focus on the family can also be useful in helping adults develop their parenting skills, deal with stress, and work on marital relationships. Many parent aids have demonstrated promising positive results. Professionals, such as family therapists, are there to help the adolescent and family gain understanding of the relationship dynamics and background issues that may be influencing the problem, and come up with solutions.