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WHAT TO DO WITH A YOUTH THAT IS OUT OF CONTROL

OVER 50 REAL OPTIONS FOR PARENTS AND PROVIDERS

BY

James L. Schaller, M.D., M.A.R.

Child, Adolescent, Adult and Forensic Psychiatry

Hormone and Nutraceutical Consultation

www.personalconsult.com

 

 

 

CONSULTING PROFESSIONALS:

Thomas Pitt, Jr., Attorney at Law

Pitt and Pitt Law Firm

Former Judge for Chester County

Chester County, Pennsylvania



Barbara Tury, M.A.

Private Practice Therapist

Adolescent County Services Provider

Marisa Morelli, M.A.

Chester County Research Center

Educational Services Consultant

 

 

 

 

 

Copyright c 2000 James L. Schaller, M.D., M.A.R., P.C. Revision 16 5/02

Copies for educational use allowed for all authors above only. May be downloaded once per person.

 

Outline

  1. Definition: What is Out of Control Behavior?
  2. Sample Areas of Examination: Diagnosis, Causes, and Contributors
  3. Some Sample Areas of Evaluation
  4. Over 50 Treatment Options

What is Out of Control Behavior?

Degree of "wildness" is Important

1: Petulant -- raises voice, whiney, annoyed if limited.

2: Dramatic -- curses or verbally threatens parent, e.g., "you are a b----."

3: "Mild" Damage -- Verbal threats to kill self, others or animals. Or mild property damage, e.g., throws a book at the wall.

4: Active Gestures and Serious Property Damage -- punching holes in walls, smash windows and may hold threatening objects like a knife or hammer. No contact.

5: Minor Physical Harm -- pushing, slapping or hitting with hands/thrown objects without major injury.

6. Serious Violence -- Clear and serious intent to harm and injure, e.g., hitting a sibling with a baseball bat, punching in the face repeatedly.

(Adapted from Jerome Price, Power and Compassion)

 

 

What is Going On with Extreme Oppositionality or Antisocial Acts?

Many loved ones do not understand dangerous or illegal behavior in the youth in their life. Caretakers can be confused. What went wrong? What should be done? Even professional mental health workers and attorneys are not always sure of what to do. Therefore, we have written this brief article to help offer some causes and to orient you to possibilities for treatment.

Labeling a youth as a "loser," "sociopath" or "hopeless" when they commit destructive behaviors does not help us understand why the behavior is occurring. Therefore, careful probing of troubling behaviors needs to be done. The surface act can be quite different depending on the cause. For example, a child or adolescent who assaults someone because he is teased is different than a youth who fights for pleasure or because of paranoid feelings. In other words, it is important to probe for all possible causes of a child's problem behaviors, even ones that don't seem obvious on the surface.

Sample Areas of Examination: Diagnosis, Causes & Contributors

1. Bipolar mood disorder - Classically bipolar disorder was felt to be easy to diagnose--one season you were very depressed and the next you seemed inappropriately high (with poor sleep). However, research in recent years has shown that there are many presentations of bipolar illness, and it may manifest with chronic irritability, aggressiveness and dysphoria. Many researchers feel that bipolar disorder among the young can look like Attention Deficit Hyperactivity Disorder. A person with undiagnosed bipolar disorder can be aggressive and very impulsive.

2.Undiagnosed Dysthymia or Major Depression - depression in children is often missed, because irritability and hostility is more common than sadness. Occasionally, their irritability manifests as rage.

3.Inadequately Treated Attention Deficit Hyperactivity Disorder - it is very clear that ADHD needs to be fully treated in children with conduct disorder, because if it is not, these children will remain impulsive, disillusioned, oppositional and frustrated - traits that clearly worsen behavior.

4.Untreated Substance Abuse - drug and alcohol abuse can increase impulsivity, narrow social options to drug and alcohol abusing peers, and increase feelings of failure and alienation in school and home. Further, if substance abuse exists in parents, it needs to be treated, because it often promotes criminal behavior in children. Also, children abusing drugs should be treated specifically for their drug abuse, but they should also be evaluated to see if their drug use was an attempt to treat a psychiatric problem (depression, anxiety, etc.).

5.Mild Mental Retardation - since school, work and relationships require a great deal of cognitive skill, those with deficits are more likely to be aggressive because of their lack of coping skills and verbal skills, i.e., they "talk" with their fists or acts, because they are unable to express feelings. Also, children with mental retardation are more likely to do criminal acts to secure the "respect" and "friendship" of peers who may take advantage of them.

6.Learning Disability - children can have normal intelligence, but specific weaknesses in reading, math and other areas. Their sense of failure can provoke hostility and decrease motivation.

7.Undiagnosed mild psychosis - slightly eccentric or paranoid behavior in a child can be diagnosed as "antisocial" behavior in a growing adolescent. Many of these children have psychotic relatives, even if they do not have this themselves. Some of these kids hide their symptoms because "bad" is cooler than "sick". They may imagine insults and often feel they are being "looked at" in hostile ways.

8.Other Neurological Injuries - although many conduct disordered children do not have obvious neurological deficits, some have a history of illnesses, accidents or trauma that may have affected the brain in earlier years. Some patients report severe headaches, blackouts (not due to drugs) and dizzy spells.

9.Epilepsy - Most conduct disordered youth do not have a seizure disorder, yet it is often useful to do an EEG. Children with a history of a troubled pregnancy or delivery, trauma to the head or a serious major illness may have an area of excitability in the brain. A single "normal" EEG does not always rule this out.

10.Chromosomal - some genetic abnormalities are believed to possibly increase aggressive behavior. However, the more common genetic issue associated with conduct disorder is that it "runs in families". Meaning, children born with criminal fathers, but adopted by "stable" families, are more likely than average children to exhibit behavioral problems.

11.Serotonin Abnormalities - serotonin is one of the brain chemicals that effects emotions, aggression and impulsiveness. Some early research shows that violent and impulsive adult criminals have diminished levels.

12.Multiple Personality Disorder (MPD) or Dissociative Identity Disorder - While this old disorder was reintroduced into American culture with dramatic movies and books, the reality is that it is a recognized psychiatric disorder which now has a huge body of sophisticated research associated with it. It is presently seen as just one more "defense" that children use to ward off overwhelming experiences (like physical or sexual abuse). Some researchers have proposed that MPD can look like conduct disorder, because MPD sufferers are regularly called "liars," have episodic destructiveness, wander off and are moody.

13.Parental Strife - children are the weakest link in the family chain. Their poor impulse control and primitive emotional mastery make them prime candidates to "act out" the anxiety, losses, or chaos they feel in the family. Therefore, any efforts made to build sincere parental harmony, family harmony, and mastery of losses is helpful.

14.Simple Dissociation Disorder - sometimes adolescents disconnect and regress under stress and seem explosive and out of character. Sometimes this is due to real or imagined abandonment, abuse recollections, or serious stressors that overwhelm a youth's coping capacities.

15.Post Traumatic Stress Disorder - if a child experiences or witnesses an upsetting event such as physical abuse, sexual abuse, an assault, a murder or a deadly fire, it can influence their functioning. The world has let them down and can hurt them or those they love easily. Such experiences of violence can lead to defiance, agitation, irritability and uncooperativeness.

16.Attachment Disorder-most youth desire closeness and yet fear the vulnerability of intimacy. Some who commit crimes against others may do so partly because the person is not someone they can connect with--at all. Connecting and being sensitive to others is partly associated with the ability to be close to others. If people feel like a piece of furniture to a youth, they may treat them poorly.

17.Conduct Disorder/Antisocial Personality-the official mental health diagnosis of conduct disorder is more than just a youth doing a few bad things, especially in response to a loss or abuse. It requires evidence of years of severe empathic failure and a wide range antisocial and cruel acts. Generally, the youth often feel no guilt for their offenses, not merely due to socialization from a cultural subgroup, but because they regard cruelty, hurting and violating others as trivial.

18.Peer Socialization-youth with a vulnerability or propensity to illegal acts may find others who share anti-social tendencies. However, peers can guide some youth and removing a child from friends at times is entirely necessary if their peers are seriously undermining the youth's behavior.

19.Social Incompetence or Social Learning Disability - in the same way as there are individuals with math difficulties, reading difficulties and dyslexia, there are also those with social learning disabilities who may act in socially inappropriate ways because they cannot read social signals. Such deficits can be from a neurological impairment, social anxiety or lack of training. Youth can be manipulated by peers into doing criminal activities in order to be accepted. Socially impaired or mentally retarded youth may not realize they are being scammed into the criminal act--doing it just to be accepted.

20.Vocational Incompetence-inability to function in a job can provoke some youth to try counter culture competence, e.g., acts that are illegal.

21.Cutting behaviors-a sign that part of the youth or child's defense's are profoundly overwhelmed. Such youth will often need ongoing therapy and at times at a frequency greater than once per week unless their problem is largely mania or depression which promptly resolves with treatment. If any other disorder is present, e.g., depression, mood changes before or during menses, or anxiety they should be treated fully and aggressively. But often medication cannot treat more than 30-50% of the disorder. Cutting is a special primitive defense that may be associated with very deep anger, an attempt to self sooth dysphoric and unpleasant feelings or memories by release of endorphins, an attempt to reconstitute themselves if "falling apart" by pain, and to get nurture (consciously or unconsciously).

22.Commonly Missed Health Issues--routinely we find missed Lyme disease, and even rare Ehrlichia infections. It is also common to find mixes of heavy metals missed by useless blood tests which do not appreciate the way metals "hide," e.g. mercury usually resides in fat like the brain, not in blood. Also, there is extensive research that nutrient deficiencies in the food of youth are a common occurrence and not a rare finding. Of course this is almost never accessed in medicine because of the cost and complexity. While it is rarely the sole cause of behavior problems it can make things worse. Poor nutrient levels found in body fluid evaluation, sometimes is due to antibiotic use. Good bacteria or Probiotics, are critical intestinal bacteria needed for absorption.

Some Sample Areas of Evaluation

1. Problem behaviors must be specifically defined. Details should include circumstances, antecedents, locations, the amount of control the child has, and whether the child "senses" the behaviors are coming on.

2. How do they regard their parents, other significant family members, pets, friends and teachers? Do they have a capacity for empathy? Are they annoyed by the way others "look at them"? Do they imagine insults? Are they close to any one? Do teachers feel your child is intentionally isolating themselves from peers? Do you and the teachers feel your child knows how to relate socially with adults, peers or younger children? How does your child treat his siblings (if applies) and other younger children?

3. What are the most serious illnesses, traumas and accidents the child has experienced? What are the important family events that might be affecting your child? In the past have there been any major falls or head trauma while playing? Major scars? Birth problems?

4. Is the child physically or sexually inappropriate?

5. Has the child ever had IQ or achievement testing to check for learning disabilities or broad mild mental deficits? Has the child ever had neuropsychological testing to locate subtle brain dysfunction? Has the child ever had a CT scan or MRI of the brain?

6. Has the child ever had an EEG? How many? Did any EEG's involve a holter monitor, which recorded continuously for at least a day?

7. What is the child's genetic family history? Does the child have siblings, parents, grandparents, great grandparents, uncles or aunts or any other relatives with depression, ADHD, schizophrenia, drug abuse, criminality, anxiety, or seizure disorder? Does the child remind you of anyone you know or have heard about in your family?

8. Has the child witnessed or experienced any major abuse? Has the child lost trusted caretakers?

9. Does the child sleep and eat normally? Does their leg jerk while sleeping? Do yhey snore? Do they feel rested after sleeping?

10. Do they have any friends who call or email?

11. Gather data from taped voice-activated phone calls, videotapes hidden in basement "hang out" areas, or SPECTOR computer recording devices. Spector records every image and message and email of your youth. "Privacy" is not something that exists if youth is in danger of destroying their life or others. For example, a minor has no expectation of privacy--in a legal sense--in their home, and they can be taped. Consult your attorney to see if your action is legal.

12. Drug screens can be done by purchased at the pharmacy or ordered by a physician. If checking for marijuana check for quantitative active metabolites--not a mere screen.

13. Does the child have problems with seasonal or environmental allergies? Do parents or siblings suffer with allergies?

14. What medical problems run in the family?

 

Over 50 Treatment Options

Some psychiatric disorders are fairly easy to successfully treat. Conduct disorder or chronic Oppositionality is not treated quickly or easily. Why? Because it is not really one disorder, it is a cluster of behaviors, which can have multiple major causes, multiple contributions to its continuance and multiple treatments. Below is a sample of treatment options. Choosing only one to the exclusion of others usually fails. Choosing a few modalities for only a brief time also often fails. Long-term treatment in multiple modalities offers a good chance of significant improvement. This is not meant to be an exhaustive explanation of all the options, since new options are often created each year that were not previously used, but it is to be a broad introduction to various options. The thorough evaluation of a conduct disordered child may require the contribution of more than two mental health professionals-some will be enlisted only as brief consultants and others will be involved in ongoing care.

1. Medication - medication is quite helpful for ADHD, depression, anxiety, bipolar disorder, paranoid behavior and aggression. Medicine also can be used for pure impulsivity, but usually it decreases impulsivity partly, not entirely. Medicine will usually not help a child develop empathy unless their lack of empathy is due to severe depression. Some youth are diagnosed with attention deficit disorder as children and poorly treated medically, and then as adolescents diagnosed as oppositional or conduct disordered--less flattering diagnoses.

You generally get what you pay for in medical care. Child and adolescent psychiatry is a significantly shortage specialty in medicine and so these physicians are often asked to do quickie evaluations. Some make diagnostic decisions in minutes, without looking at old records, without getting information on family genetics/ trauma's and stressors, or even talking to the youth. Other disorders that are present with attention deficit disorder are not carefully screened for and so youth with irritable depression may get better on stimulants temporarily, only to lose the benefit of this medication. (The point: depression, mania and anxiety disorders need to be treated before any ADD/ADHD treatment). Also, just merely refilling what the previous physician prescribed is not good medical care because youth change and with each new season the illness may look different. Many physicians are in love with the PDR and this causes them to start with doses that are too high. Others do not realize that some youth have livers that metabolize medications quickly and do not give sufficient doses.

A recent study on community psychiatry for youth report it is often ineffective and insufficient treatment.

2. Artificial Chemicals — most youth are not overly troubled by these chemicals. Yet forcing the body to remove these products from our body is a strain. We already know from extensive environmental toxicology data, e.g., EPA materials as early as the 1980’s, that we already have more than enough junk floating around in our bodies to remove -- usually has multiple industrial toxins. The point is simple. Do we really need our food to glow pretty red, green and blue? Many clinicians say this issue is foolish and "studies show that these have no effect." My impression of allergy research and artificial coloring data is that some small percentage of kids goes absolutely wacky when exposed to these chemicals. In behaviorally troubled youth in my practice I would put the number at 2-3%. It seems to be quite specific–a child can tolerate one coloring and not another.

3. Heavy Metal Synergy - we have found in over twenty patients that all patients have unacceptable heavy metals. Heavy metals may affect behavior. Most physicians routinely miss these, because common tests do not pick them up. Detecting requires a chelator to pull the metal from a hidden tissue to the type of sample. For example, mercury resides in fat and tissues. Most is not going to be found in blood or urine unless it is pulled out of. Further the lowest number of unacceptable heavy metals we have found is three. Meaning, that three metals are in the fully unacceptable range. In these "mild" situations 1 + 1 + 1 equals 10 in terms of behavior and concentration. Studies of mixed heavy metals do not exist to our knowledge. While some people have an end to their psychiatric and behavioral problems, most do not, and so this is not the full answer for the majority of youth.

4. Family Treatment - this includes parent training on how not to unwittingly reinforce poor behavior, e.g. by paying a child's fine for a third marijuana possession. It also helps parents develop positive reinforcement and negotiation skills, in addition to helping lessen reactive dialogue between parent and child.

Family treatment includes any support or care taking, e.g., a grandmother or aunt. As well, family treatment should include care of siblings not causing problems with their own problems, understandably caretakers are focusing all their energy on the troubled youth.

5. Problem Solving - in this treatment the child concretely looks at their problems, especially the causes and consequences of their acts. Alternate ways of acting are demonstrated in actual role-plays or imagined with real life situations. Problem Solving is important treating youth. Coping skills and the resolution of problems that seem easy to an adult, can overwhelm a youth. Issues and solutions will have to be repetitively processed and practiced at home and in therapy sessions. Once the youth has experienced some success with a solution, they are more likely to try it again and eventually continued success and reward will become a pattern.

6. Mentors - conduct disorder is more common in boys, especially boys with alienated father relationships. In fact, a male adolescent often can do better with a step-father than a female sibling. Meaning, if the initial alienation is worked through and the transition is handled appropriately, the son may benefit from the presence of his stepfather in the home, as long as he does not pretend to be a military father. Other "mentors" may also be helpful for the child to cultivate, e.g., coaches, uncles, or a favorite teacher or neighbor. In addition, sometimes the child will come to see their therapist as a mentor, and for some children this can be very useful, because a therapist may be seen as consistent, reliable and safe.

1) Big Brother Programs or Other Informal Programs help many youth. There is also a Big Sister program. However, at times the waiting list can be longer then is preferred. Other agencies like a church may have men willing to perform similar functions. While not a requirement, it helps at times to have someone who was once struggling with similar problems.

2) "Grandparent" Programs. Some informal ways of pairing up youth is to pair a youth with a grandparent figure. The senior get a boost from helping a youth, but the youth may benefit greatly from the experience. Mentoring programs of this type have proven to be successful with some youth. Pairing for any mentor relationship must be individualized.

7. School Outreach Programs - Many school districts sponsor activities after school, which are pro-social and have some monitoring. For example, YMCA after school programs, Families and Schools Together, and recreational clubs.

8. Individual Therapy for the Youth - Many therapists hang out a shingle declaring themselves experts in treating troubled children. They naively think it is easy. For example, in psychiatry, many claim to be "adolescent" psychiatrists who have never had specialty fellowship training in this field. An HMO will use adult psychiatrists to treat children if they are willing to do it. Ask a therapist how many years and how many youth the therapist has treated like your child. Board Certifications only test for minimal basic understanding and are often used by insurance companies to justify fast evaluations. A Board Certified Child Psychiatrist cannot carefully diagnose a youth in less than one to four hours.

1) Picking Criteria--Consider looking for a Child & Adolescent Psychologist or a Child & Adolescent Psychiatrist. Other mental health specialists pursue specialty training over many years and may also be helpful as therapists--just be up front and ask them about their experience. Also do not consider any therapy using a therapist who will not be around in a year. Therapists who are severely ill, moving, in training, going on a sabbatical, stopping work for child care or transitioning into research are not recommended as therapists. It is not helpful for youth who have attachment problems to lose their therapist and be "abandoned " by them. A year commitment is an absolute minimum. Inquire as to the arrangements typically worked out with HMO/PPO insurance companies. How many visits do they typically approve per year? Do not expect that your insurance company will support therapy, so make sure the "benefit" is clear. If a clerk gives you the wrong information they may deny their error later when you talk to a different clerk in the insurance company.

Ask your child's potential therapist what will happen if the insurance company cuts off coverage--can your child see the therapist at an agreed upon out of pocket fee?

Your child should have some choice in their therapist. However, if they dislike six reasonable likable people in a row, then they are likely being resistant. Behaviorally disordered youth generally prefer not to attend therapy.

Many conduct-disordered children have tough exteriors, but may show their vulnerabilities over time in a safe setting. While their trust is often hard to gain, it is not impossible, and over time may become more personable in a therapy relationship. If they come to value this relationship, they may develop more appreciation for the feelings and values of others. The problem for some conduct disordered children is that they may actively dislike therapy, devalue it, or be more charming than real. Another challenge is that children who do gain benefit from therapy, may actually be worse in the beginning, because it may raise feelings the child can only partly master. Many youth are very finicky about therapists and would rather do other "fun" activities. Discussing feelings and verbalizing them is often the opposite of acting out in a way that causes trouble.

There are a variety of types of therapy. Some youth may benefit from talking one to one. Others may need a combination of therapies. Play therapy is something that many children and non-verbal adolescents respond to. Play Therapy can be part of the individual or family therapy process. Play therapy is a method of addressing issues through various methods of play. When looking for that experienced therapist, try to find one who is who is willing to be creative, consistent and who will look for alternative methods.

2) Feeling labeling is very critical to self-control and self-mastery. If a youth cannot identify what makes them angry, happy, sad or afraid, then they clearly could benefit from some emotional "literacy" or feeling identification training. Some youth before they even learn to identify what makes them feel a certain emotion, need to learn what the emotions are that they are experiencing. E.g. you ask a youth a question, "How are you? How was school today? Or how was practice today? They respond with the same," "It was fine". Many parents and practitioners will let it go at that and draw their own conclusions.

If you get a response follow it up. If they say they are feeling "bad" try to determine what is making them feel bad. Also, What is "bad?" Does that mean they are unhappy? Discouraged? Hopeless? Confused? Disillusioned? What is "OK?" Does this mean they are content? Excited? Hanging in there? The point here is that youth need to learn what feelings are, before they can begin to learn target what is causing them to feel a certain way. After learning to identify the feelings then the youth may begin to develop ways to express their feelings in less problematic ways. Expressing feelings may decrease the expression of violence or self-destruction.

3) Anger management training can be quite useful in youth who have moments of profound aggression triggered by stressors or annoyances. Sometimes these techniques give the youth a few well-rehearsed and over learned strategies to handle their rage that could be the difference between making a hostile remark and assaulting someone.

4) Conflict resolution training is also helpful in many of these youth. Resolving conflict is hard for many mature adults, let alone youth with poor emotional control. Training the youth that there are options beyond exploding verbally or physically is useful for them. Appropriate assertion is a skill that helps anyone and is not easily or quickly mastered. In these youth the main goal is teaching basic skills to prevent illegal or antisocial ways of resolving conflict, and then improving from this basic point. It may be a good idea to take this type of training along with the youth you are concerned about.

5) Abandonment feelings can trigger profound rage, destruction and illegal self-destructive behaviors. Such feelings need to be clearly addressed in therapy because if ignored they can cause very labile reactive acts. Abandonment issues are often not apparent to the youth or the caretaker, but only to a professional involved. The angry and negative behaviors that the youth demonstrates may just be the protective gear the youth employs to ward off the abandonment feelings.

9. Acute Emergency Hospitalization - generally children cannot be psychiatrically hospitalized for merely "juvenile delinquent" acts. They need to show clear suicidality, be assaultive, have psychosis, or marked impairment in functioning. Usually the youth has a psychiatric diagnosis, e.g., ADHD, Major Depression, Bipolar Disorder, unspecified psychosis or Oppositional Defiant Disorder.

Any child under the age of 14 (in Pennsylvania) who acts in a way that shows aggression towards another human being, demonstrates suicidality, cuts themselves, or unable to care for themselves due to psychiatric illness can be hospitalized in a psychiatric acute care unit. This is especially true if the child does more than speak about their intentions--"a furtherance of the act." However, if the child or adolescent speaks with significant suicidal or homicidal intent, then this may be all that is needed to hospitalize the child.

One should pay extremely close attention to the follow up to hospitalization. For example, is the day program that the child is referred to or the outpatient care that the child is referred to intensive enough? Often youth are discharged with the suggestion that they get follow up care consisting of one therapy session a week--commonly a pathetic and incomplete treatment.

The hospitalization rules in Pennsylvania are simple for children under 14 years of age. Any parent with legal custody of a child who is under 14 may hospitalize their child in a psychiatric facility against their will as long as the hospital and insurance company agrees the child is at risk. The form filled out is called a 201 in Pennsylvania and is used for parents admitting children under 14 or any voluntary admission regardless of age--children or adults.

If a child is 14 or older, then the parents can only have the child hospitalized in a psychiatric facility by getting the youth to agree to the hospitalization or by committing the child. A commitment requires that one complete a 302 form. At least one of the persons filling out the petition for commitment has to have witnessed behaviors that are dangerous to the child or to others--rumors carry no weight. The behaviors have to have occurred in the last 30 days.

A court hears a 302 commitment within five days of the petition. If you want to take out a 302 on your adolescent child, contact a crisis worker in the county in which the child lives. Crisis numbers are found in the Blue Pages of the phone book under the County Mental Health section. Typically, a county mental health crisis representative will tell you where to meet them--usually an Emergency Room at a local hospital, where they will go through what behaviors you feel are serious enough to necessitates hospitalization. Again, remember the child has to be in some danger for their own life, has shown aggression towards others, or is acting in a way that is reckless and may be hurting them, such as repeated running away, impulsive sex or reckless dangerous driving.

Many parents think that a psychiatric hospital will "fix" their child. It is possible to see major change if a youth is actively manic, psychotic or is cutting their body as a coping technique. However, the major goal of hospital psychiatrists and the paying insurance company is discharging your child with no dangerous suicidal or homicidal plans. Youth are often discharged with residual depression and even mild hallucinations. This represents the goal of almost all insurance companies to pay as little as possible for hospitalization. Also, because as profound cutbacks on daily payment, hospital services are minimal, so only expect the hospital to stabilize your child. Finally, a few hospitals are somewhat better than others, but none are exceptional.

10. Emancipation - in some situations parents (or a parent) feel they can no longer keep the older adolescent under their roof because of their severe behavior problems. Sometimes, the parent(s) and adolescent may agree to allow the adolescent to live on their own. (An attorney can discuss the mechanics of this process with you). Adolescents can be legally emancipated under specific conditions, e.g., age, pregnancy and employment criteria. We do not discourage or advocate emancipation, but merely inform you of this as an alternative. There are some children that require parental oversight and supervision, and there are some adolescents that blossom with independence and greater responsibility. Sometimes, they realize that their parents are better than many of the new adults in their life--like the landlord and maintenance staff who take a week to fix the plumbing or their new boss.

11. Giving Up Custody - some parents find a child's behavior is so chronically difficult that they release the child to the custody of the Department of Human Services. The goal of this act is generally to gain faster residential treatment and the preservation of home stability.

12. Your Support - caring for a child with behavioral problems is a challenge. After you have done all you can for your child, most parents need a double dose of self-care for themselves, especially if you have a child that won't change their behavior. Groups like Tough Love might be a support to you. No two people are identical--the same is true of groups. If you do not feel a fit in one, consider another. Also, consider your own therapy or couples therapy if needed.

13 Support Groups - The Internet has support group options. Locally, you can almost just pick up the phone book and locate a support group for any disorder or illness. There are a number of excellent support groups available to both the youth and to the caretakers. Support groups like C.H.A.D.D. (Children and Adults with Attention Deficit Disorder),

OCF (Obsessive Compulsive Disorder Foundation), there are groups for Conduct Disorder, and Anxiety Disorders. If you cannot locate one on your own call your local Community Mental Health Clinic, YMCA or Children and Youth Service and they will be able to provide you with some direction.

A support group can provide a chance for family and youth to gain support from others that are going through similar experiences. You may find that you can offer others advice while taking some from others.

14. Misplaced GradingImagine a setting where you are made to feel like a total loser almost every day. Some token positive comments come your way, but they are white drops of snow drowned in a sea of tar. A youth that is small, less socially mature, less coordinated, has a late or too early developing body, or struggles with making friends may begin to act out aggressively. Commonly, children are pushed forward in grade school and allowed to jump into the rat race far to early when they really should be still playing. A child who dislikes school needs some assistance promptly–why do they dislike it?

15. Wrap Around Services - Some children with severe behavioral needs can have a community mental health center or their insurance company provide intense outpatient services which include medication treatment, in-home behavior management, in-home therapy, parent training sessions and may even assist with keeping the child in school. Such services are very hard to get because of their large cost. One applies for them through ones local community mental health center. Medicaid funds it, and so your child will need to apply for a medical assistance card. Unfortunately, there may be a period of waiting to find staff to provide this service.

16. Partial Hospitalization - this is a highly structured school and psychiatric day hospital for those with severe behavioral programs that a regular school cannot handle. Children go home at night.

17. Residential Treatment - some children need 24 hour a day structure and cannot function at home or a regular school. They may need to live at a residential psychiatric facility. It is usually quite hard to get a child quickly into this type of facility. Generally, such psychiatric residential programs have educational programs. The child usually needs to apply for Medicaid (MA). No private insurance pays. Public school will pay if over a long time all other interventions fail, but there needs to be very serious functional and learning impairment. Also, juvenile courts do have access to some funds, which occasionally are available for placements. This form of treatment can be quite effective over time--if even only 30 % improvement per year.

18. "Private Schools"- elite schools only for very high functioning children can throw out your child in a day for anything they think is incompatible with their program and the safety and milieu of the campus.

Other types of private schools can have mixed children--some are brilliant but with trouble with subtle social skills, others are of average intelligence with a learning disability but who need special teaching styles. Others may be pleasant children but with I.Q.'s below average.

Just remember, any decision you make on a school placement is a trial run and not an eternal decision. The school can be changed. It is rare to find the best fitting school in a single year. Also, some adolescents need a therapeutic boarding school, not because their parents do not love them, but because the youth is out of control and needs intensive intervention.

19. Loss Anniversaries or Reminders — a child who has experienced loss, abuse, divorce or death around a certain time of year or similar events will possibly be difficult to manage in similar situations. The child believes "Here we go again." Of course they rarely speak of it this clearly. You have to be the detective. Traditional therapy options, grief groups, chats with a parent, etc. are all useful to more the losses into the past and healed.

20. Parental Marital Troubles - Parents with depression, severe anxiety, mania, substance abuse, or chaotic marriages should get their own treatment, because these problems can contribute to child behavior problems. Children commonly complain of their "parents yelling." Even youth that yell themselves seem to find the shouts of their parents a problem. Apologize and look at your own life and stress.

21. Behavioral Treatment or Manipulating Privileges- these structured treatments are useful in controlling behavioral problems, but require a great deal of work and consistency on the part of those responsible for the youth. For example, some youth have a great delusion that they have a right to special privileges, e.g. driving a car, car insurance, and extra spending money for pleasurable activities or unlimited access to their friends. While little is accomplished by locking youth in their room or grounding them for five years, nevertheless, when they are not functioning in school and refusing to comply with the most minimal requirements of the parental household they should lose something meaningful.

In this regard, it is useful to have a psychiatric evaluation by a child and adolescent psychiatric physician to make sure the behavioral disorder is not due to some subtle medical disorder such as mild Major Depression, mild mania, or one of many other subtle biological disorders that are not easy to identify.

22. Legal Education-it may be useful to have a consultation with an attorney so that the youth understands the law and the obligations that they have while they are living in the parental household.

23. Hormones - many parents joke about these causing all of their child's problems. And while both men and women and boys and girls can have problems enhanced by hormones, one can occasionally make interventions that may help. For example, our published material on bio-identical natural progesterone cream has shown that fluid retention in the brain by excess estrogen can cause incapacitating migraines and behavioral problems which can be successfully treated with transdermal cream. This treatment is used around the USA by many physicians. The cream uses USP FDA approved powders. However, it is not FDA approved and probably never will be, because there is no money to get approval for using bio-identical hormones for adolescents. I am talking with some companies about pursuing FDA approved production. You can also get some fair quality forms over the counter.

24. Outward Bound or "Boot Camps"- one occasionally hears of "miracles" performed on children who go to survival nature centers, places which usually have intense accountability, structure and opportunities to succeed (alone or as part of a team). It is important to research these programs, because they vary a great deal and are not necessarily regulated. Some children do seem to benefit from them. How long the benefit lasts, however, may depend on what services they have in place when they return home. Programs should have some access to basic medical care and be licensed.

Some of these types of programs require that the youth be court ordered to attend, so this would mean that you would need to be involved with the juvenile court system like Juvenile Probation or Child Protective Services. Others may be open to private admissions. It is important to note that if you approach this on a private basis, there is no way of forcing your child to complete the program. If you have the involvement of the court system, there will be a consequence for the youth if they are in breech of the order.

25. Parental Training-the most "impossible profession" is parenting. When a child is small they need very intense structure and yet when they enter adolescence they are supposed to have gradual amounts of "freedom." How to balance accountability and responsibility with privileges can be helped by having a parental therapy consultant to brainstorm with you on how to handle difficult youth. Obviously, no one replaces a parent's authority, but it can be helpful to have someone to discuss specific events and ways to handle them. It is often suggested that this person not be the youth's therapist since they will not be honest with the "parent's therapist". There are numerous parent training programs, behavioral management programs available in various modalities video, seminars, books, tapes, etc. They may be offered in churches, schools, YMCA, mental health facilities. These programs could be of assistance to you as a caretaker. It is important to remember that relying solely on one specific behavior plan, or parent training approach may not be the most effective treatment. Using a number of options at the same time may be best.

26. Group Therapy for Youth - It can have benefit in some areas, e.g., substance abuse and sexual abuse victims. Other youth benefit from a group firm on scamming behavior. Ultimately, motivation determines the benefit of group treatment. The treatment cost is usually lower than other treatments. Out patient "private" adolescent groups for behaviorally troubled youths are hard to find and their attendance is only fair. However, some youth do benefit from them. Some groups are mandated by courts, a probation officer, a residential facility or part of incarceration.

Another special type of group involves social skill training in which children are matched according to approximate age and ability to relate. Social interaction is taught just like Math or English. Generally, the more hands on experience the more it will apply outside the class. Imagining difficult situations with new appropriate and successful strategies can also be used. For example, Joe imagines appealing to his mother for a later curfew instead of kicking the trashcan in frustration.

27. Psychological testing-Tests such as the MACI, MMPI-A in adolescents or the MMPI-2 and the MCMI-III in youth 18 or older are designed to test motivation, deceit, defensiveness, carelessness and psychiatric illness. These tests have a significant amount of research supporting their reliability, especially if the youth does not just fill in circles sloppily. If they do just fill in the circles the tests will catch this lack of focus.

28. Adoption issues - One of my old mentors said years ago that she had never met an adopted child that did not have some struggles with being adopted. I increasing think this is true. Parents and adopted youth that ignore the meaning of being adopted might be better served with exploring, in a safe and slow way, any good or bad feelings they have about being adopted. At times, troubled youth react to their adoptive parents as if they are "rejecting" and "do not care." They sometimes make these comments to parents who are amazingly accepting and caring. So whom are they really talking to?

29. Using an Attorney to Set Up a Negotiated Treatment - This would specifically involve having an attorney negotiate with the Probation Department and/or the District Attorney reasonable consequence for behaviors. For example, if a child steals your credit cards or your car you could simply report them to the police and let the District Attorney become involved. Another way, however, is to have your attorney negotiate with you and the child what is an appropriate consequence and then present this to the District Attorney, where the child agrees to perform community service, agrees to have court mandated outpatient treatment, or some other consequence that is felt appropriate by the parents for their child's behavior. This gives more control to the parents, and can be a win/win situation all around, in which there is an early intervention for a child before they become even more troublesome. Parents can shape the appropriate consequence that they feel is therapeutic.

It is important to be clear on boundaries with the lawyer. Meaning, are they representing you or the child? Discuss this with your attorney since this is delicate and challenging for the attorney involved.

Also, while there may be no other option, if you involve the probation department you may be locking the youth into years of accountability. Probation officers may be slightly hopeful, cynical or in the middle. They have a hard job. After years being lied to and disrespected repeatedly, they can get frustrated. Ideally, they hold the youth to reasonable standards of behavior without resentment.

30. Mediation- if you do not want to spend the cost of using an attorney, you might find using a trained mediator helpful. A mediator would act as a neutral party and help negotiate an intervention plan for youth and caretakers to follow; this agreement could also be submitted to the family court as a possible enforceable plan if it becomes necessary. For the caretakers using a mediator can be empowering, and for the youth it can be a way to assure them that they are being heard as well. Of course use of a mediator depends on how severe the issues are with the youth. This can be successful in some cases.

31. Family Court Interventions in which the child is declared incorrigible and probation officers hold the child accountable for their behaviors. Through this court, there can be commitments to drug and alcohol facilities for treatment of habitual substance abuse. It can also mandate probation oversight and drug testing that is supervised. Further, the court can mandate outpatient treatment.

Do not assume that when a youth is involved with Family Court and mandated to participate in treatment, that the youth will abide by the court order. Many youth continue to be resistant and some may suffer severe consequences for violation of the order. For others the threat of more severe consequences is enough to get them to make some changes.

32. Psychiatric and Legal Involvement in Appropriate School Care - many children act out, at least in part, because of a school program which does not fit the to the learning problems and the behavior problems of a youth. For example, at times a child with a ninth grade vocabulary can be expected to perform at a twelfth grade level. This sets the child up for profound demoralization and potential acting out in school. School cannot be a place where your child is made to feel repeatedly like a "loser."

Parents should consider reading Negotiating the Special Education Maze, Third Edition, by Winifred Anderson, Steven Chitwood, and Deidre Hayden ( Woodbine House Press). There may be times in which an attorney and psychiatrist intervene and make recommendations, along with free community advocates with specialization in special education to ensure that the school is complying with the law. Laws such as IDEA, 504c and the American Disabilities Act can ensure that learning is not exasperating. Generally, we suggest having an individualized educational plan (IEP) consultant from outside the school to review the plan along with any psychological testing that was done to make sure the very best IEP was done to match the psychological needs of the child. Some youth also need specialized psychological behavioral assessments to conform uncontrolled behavior to school appropriate behavior. Like a learning problem assessment, this report is written by a school psychologist and is the foundation for parents, key school staff and the youth to devise a program to improve behavior in school.

It is very hard for some schools to comply with the laws, since these laws are fairly rigorous and require great skill in tailoring education to each individual child. The money to provide compliance with the law may come up short according to some educators. Therefore, some school's struggle to follow through with what is best for a behaviorally disruptive child. However, in all things we believe the child's best interest should be put first and usually there is a need for advocacy and extensive communication with the school in this regard.

In addition, schools need to contribute information to the initial assessment and the ongoing assessment. Teachers should work fairly closely with parents, and also have periodic contact with the mental health workers helping the child. Further, some behavioral plans will require regular input on behavior noted by teachers. Appreciate your child's teachers when they provide regular feedback, since it is a lot of work, and you certainly want them to continue valuable communication.

33. Children and Youth - this agency is meant to protect youth from abuse and {neglect} of many kinds. Like all agencies their motivation is quite variable and often based on the staff assigned to your case. They may become involved for a number of diverse reasons: significantly hitting your child to control them, if your child assaults someone else and the other child's safety is in jeopardy, or because a parent refuses to take a youth home from a treatment facility because they disagree with the insurance company and treating team that the youth is "better." Incorrigibility is another reason an agency like this may become involved.

34. Living with Another Relative - occasionally families have a relative that both the youth and the parent(s) trust and who has better chemistry with the youth. At times this person may serve as a good short or long tem solution to the strife in the home. It is suggested that parents discuss this option with a therapist to clarify how the mechanics of this "boarding" with a relative or family friend will specifically be designed.

35. Detoxification limits - some children are not able to process the thousands of new synthetic chemicals they are exposed to every year. I have been partially involved or monitored businesses, schools and homes needing to be shut down or cleaned up because of off gassing of formaldehyde and benzene, or unusual mold spores or fungus. I once read a scientist mock this entire notion saying that humans have always had to detoxify substances. Certainly true, but many factors have changed: synthetic petroleum based chemicals are often made not to be easily degraded, we do not have enzymes that easily remove them, we are often in short supply of nutrients and detoxification substances, e.g., glutathione or selenium, which help remove pesticides and other foreign chemicals. An example might be the way the liver handles our own natural testosterone and methyl testosterone. Our own natural hormone is usually easily removed without any fuss. The methyl testosterone has been implicated as causing liver cancer and death. A youth that paints a bedroom and then walks past a yard with weed killer on it and then has a personality change for a week may have something going on in this area.

36. Pro-social "Thrill" Activities - some research points to temperaments that need "danger" or adrenalin rushes to feel normal or content. Such youth need to be guided to thrills that are not illegal or dangerous like stealing, impulsive sex, and fighting or illegal drugs. "Risky adventure activities" may be helpful for them. Examples might include scuba diving, military training, high platform diving, challenging Outward Bound programs, tandem skydiving, whitewater rafting, racecar driving training, and contact sports such as football, rugby, fencing or martial arts. Balancing safety and "thrill" will be a challenge.

37. Reverse Mentoring - sometimes youth that do aggressive or illegal acts will go out of their way to prevent younger children from doing them. On occasion, having a youth "mentor" a younger child may cause the troubled older youth to rise to the occasion and behave like a serious pro-social adult. While this should be supervised, it can work on occasion, and build the self-esteem and competence of both involved.

38. Community Service - a youth that is acting "anti-socially" may benefit from mandated pro social behavior. Depending on who is overseeing this service, it can be punitive or creative. Probation departments can have individuals picking up highway trash and walking long distances. Generally, youth dislike this service. Other sample community programs may involve Habitat for Humanity or nursing home visitation, which may offer feelings of competence and cause the youth to feel appreciated. Community service projects also can give youth the opportunity to pay restitution, and the chance to experience various vocations like landscaping, painting, carpentry, working with children, or the elderly. An opportunity they may not have had otherwise.

39. Victim-Offender Mediation - often youth who violate another person by robbery, physical or sexual assault or other major violations do not appreciate the feelings and personhood of the victim. These programs are meant to humanize the victim. The youth experiences their victim as a clear person, not merely an object or a thing. The Offender is exposed to the full magnitude of their acts. This type of treatment can be a powerful healing tool for both victims and offenders. For the youth that have offended this provides them with an expanded opportunity to look at remorse and empathy, and may initiate a process that may stop them from becoming adult offenders.

40. Nutritional Optimization - research over the last five years has shown that vascular disease starts as early as the age of two. This may impact behavior to some unknown degree. Further, a number of essential nutrients are shown in various studies to be depleted in behaviorally troubled youth. For example, American diets are grossly excessively filled with omega 6 fatty acids, and very low in omega 3 fatty acids. Omega 3 fatty acids are structural fats in the brain--like calcium and magnesium is needed for bone. Supplementation with omega 3 fatty acids helps the functioning of "healthy infants" and a wide array of psychiatric patients. Further, some youth are excessive carriers of certain toxins. Urine analysis after an oral chelator can diagnosis this problem. It is not entirely clear how many troubled youth have nutritional or toxin problems which contribute to their behavior problems. Likely, most youth do not have behavior problems caused purely by these factors, but it probably worsens the behaviors of a number of troubled youth. Some youth may have major problems from antibiotic use in which the critical three pounds of essential nutrient absorbing bacteria, i.e., their good bacteria or probiotics, are dead. They are replaced with excesses of unhelpful bacteria and fungus, which block absorption. We have documented in over 15 youth that their low levels of blood nutrients was due to poor intestinal flora from advanced research stool cultures.

41. Intervention for Behavior or Drug Abuse - there are many styles for intervention meetings. Generally they follow a few basic principles. First, significant others in the youth's life meet and discuss behavior that they feel are destructive. Individuals agree that the youth's behavior requires a formal intervention that has not responded to comments by one or two people. Individuals close to the youth who want to see them change are invited to come. Sometimes each writes a brief one-page letter about what they have witnessed in the person's personality and drug abuse behavior. Most emphasize the love they have for the youth, their observations in frank reality about what they have seen in terms of destructive behavior and/or substance abuse, and a pre agreed plan for treatment. If you have never been involved in an intervention you might want suggestions or even the presence of a certified addiction counselor (C.A.C.). The main goals are communication of love, sharing concrete concerns clearly without hostility and a pre determined treatment plan that fits the youth.

42. Addictions Programs - are available to help with issues from smoking cigarettes, to gambling and sex addictions. You can find assistance with substance abuse, overeating, etc. They're residential treatment centers and outpatient treatment facilities. In addition, there are support groups that assist anyone that may be dealing with an addiction.

43. Computer Accountability Crime and Chaotic Behavior - Most youth engage a great deal of denial as to their behavior. Computer chat rooms, emails and other computer data can re recorded exactly by a special program called Spector. Spector is a program you can install on a computer to records exactly what appeared on your computer screen while you were not using it. For once you will have the exact record of activities and chat room conversations used on your computer. Proof of illegal or self- destructive activities are there in black and white and cannot be refuted. You do not have to wonder if your youth is engaged in certain activities--you will have their exact words. Other programs like this one are regularly being promoted. Talk to a trusted computer expert for the newest and most useful program for your goals. Privacy is a good thing–even for kids. Yet, if serious issues make you feel the youth is going to get into big trouble, liberty may have to take a backseat to intervention and prevention.

44. Spirituality - since the beginning of humanity the creature-Creator relationship has been relentlessly useful in helping individuals overcome their failings and weaknesses. A few concerns can arise in those who have new improved behavior due to connection with God. First, peaceful and warm feelings that are often expressed in this new relationship will usually come and go. They may go for long periods of time. Someone comforted by sensations may find that God is more than a drug or a peaceful sensation. God will not necessarily stop the consequences of their actions, jail, suspensions, detentions or physical injuries. Loved ones and friends alienated will often not be quickly won back--if at all. Isolation from people, places and things that foster spiritual growth often means such faith will be short lived.

Finally, it is easy when experiencing a "high" spiritually to feel superior to others and to think they have little to teach. True spirituality can come with enthusiasm but youth should not assume they are changed fully; they are filled with the same character weaknesses and vulnerabilities as before. If they think the good sensations of their faith with be all the new foundation they need they are merely narcissists honoring their own spleen. Youth new to faith need caring guides who are gentle, honest and approachable. Finding such people may take quite some time depending on a number of factors.

45. Praise vs. Castration - oppositional youth can be infuriating. Loved ones can become easy fatigued and become unable to ever encourage a youth who is engaging in mixed behavior. The false delusion of some caretakers is that if you encourage the good or "required" acts of a child, they will stop doing them and push you further. Generally, most people are drawn to their areas of competence, and praising a child for good does not mean you surrender meaningful standards, e.g., for a sane curfew. In most situations one can adhere to the 4:1 rule. Unless your child is an ax murderer you should be able to find four positive things to say about them for every one criticism. If you cannot find anything positive about your child than look at your attitude toward them. Is your heart bitter? Resentful? Have you gone unappreciated for your suffering? Does encouraging this child feels insane? If you do not encourage your youth they will slowly disconnect from you and find someone or something who will encourage or nurture them. Encouragement can be the foundation of reasonable and even firm discipline and structure. Encouragement can be a tool for building self -esteem and self-efficacy. When you are worn out with your child it is easier to criticize than to look for that moment of praise that can be given. If you cannot find that one thing to praise or encourage your child with then it is likely past time for you to get help for yourself as well.

46. Pro-social groups - as much as possible it is helpful for youth to be in therapeutic pro-social communities. Such communities are profoundly diverse and can include the families of extended relatives, sports teams, church, skill acquisition centers or clubs organized around the youth's interest(s).

47. Major on Majors and Prioritize - depending on the cause(s) of a youth's behavior problems it is important to decide the deeply critical changes that should be made. Often this initially means the youth is not self-destructive and does not have the ability to hurt others. After "life and limb" are safe most caretakers set up other functional goals, e.g., get off probation, decrease fighting, work part time.

Generally, look to the youth's largest obstacles to functioning at school or vocation and in relationships. Can they function in the huge realms of work/school and loving relationships? A youth should be able to relate legally and appropriately to authorities, peers, individuals of both genders, and those who are weak and younger. Do not get distracted by cultural trivia or family tradition if these areas listed above are not in order. Setting too many goals or expectations demoralizes and says, "give up--the carrot is forever unreachable."

48. Empty Power Playing - Some parents, caretakers and teachers can trap themselves by setting up a standard for a youth that they do not yet have the capacities to do or refuse to do. Often a punishment is linked to this oppositionality and is not carried out. Did not make a consequence you do not have the means or will to enact. Consistency is another important factor or youth can learn how to manipulate the situation even more. Pick a couple key behaviors to correct that are very serious and design a moderately fairly brief consequence. "If you are not home for your curfew, you lose the car a day for every hour late." No example is accurate because each youth and family is very unique."

49. Scare Tactics- the meaning of a scare tactic is simply introducing a youth to what possible outcomes are if they do not begin to conduct themselves in a manner, which is acceptable to the community in which they live. For instance, taking a boy who is starting to steal to visit a detention center or a jail, and let him see men in prison, talk to the staff; let him see what it is really like inside those walls. Take your truant, rebellious daughter to a visit at boot camp, or outward-bound program. Let her watch the video of the program and see the tents where she will sleep, and the bathrooms where she cannot put on makeup or use a blow dryer because there is no electricity. Take your sexually active teen that won't use protection to a day care center, or sign them up for nursery duty at church. Don't forget about letting them visit an infant with AIDS or serve dinner at a hospice program where people are dying of AIDS. These types of tactics can give youth a dose of reality, enough for them to want to avoid these types of consequences. For others, they don't think that this will be their reality and they will continue displaying their negative behaviors.

50. Personhood Awareness - often youth can be very narcissistic and have little true appreciation for the hurt they may cause their parents. It is useful for parents in a clear and straightforward way to express the feelings of anger, hurt, and disappointment caused by a child's behavior. Do not be overly dramatic and make your comments finite--try not to continually discuss for a week. For example, "Paula when you steal my credit card I feel angry and sad. I am your parent and it seems you are treating me as just a source of money."

Siblings and peers who have been hurt by the youth are also a good source of provoking some awareness in youth. One youth coming to another peer and being able to identify how he was hurt or angry can make a strong impact. E.g. " I trusted you at my house, with my stuff, it made me feel used and angry when you stole my CD, all you had to do was ask me if you could borrow it." "You did not even ask me if you could use me as an alibi, my mom thinks I am lying to her now because you were not here, and you told your parents you were, thanks a lot!"

"Peer pressure" is normally thought with a negative connotation, but here you can see how it may have a positive impact."

51. Correct & Stop Emotional Incest - In a troubled or alienated marriage, a parent can commonly be tempted to express hostility about the other parent to their child. This is often too intense for children and they may resent both of their parents for this situation and act out. It is almost the norm in divorcing couples to make comments that are adult stress level comments. The child cannot handle both their own grief and a parent's also. Seek out adults to assist you with adult fears and loneliness, and keep the boundaries between the generations.

52. Military Training - Some oppositional and troubled youth do very well in the military. They do well with the structure and accountability. We generally suggest talking to at least four people in that branch of the service and keeping years of contracted obligation to a minimum. A youth who reports any mental health evaluation may not be accepted in.

53. College and Graduate Students hired Part-time - Occasionally older students can assist in modeling appropriate behavior and give you time out of the home. If the youth is difficult, be up front about difficult behaviors.

54. Rescuing and Spoiling — Currently it is hard to find children to do odd jobs in some locations. Perhaps this is because many are doing a hundred activities and school is harder than when I was a boy. However, some youth just do not have any training in work. Work is an acquired skill and taste. We do not all just naturally do it. Usually, the more you do it–within reasonable limits–the more natural it seems. Also, some youth are not rewarded for their behavior. They are rewarded merely for breathing. Teach kids that love and affection is free and some modest and thoughtful gifts around the holidays are free, but that other things are generally earned. Earned by work, honesty, kindness, character and effort in school or at home. Something you want reinforced.

55. Give Emotional Energy - Get thrilled about your children’s life and let them see your thrill. If you do not they may seduce your emotional energy by negative acts to get your passion.

56. Narcissistic Interests — All my children have interests in things I am not particularly interested in. Some of their interests actually turn me off a bit. Tough. One needs to develop a taste for things that your kids think are special. Easy examples would be different priorities about sports, school, cars, clothes, relatives, play activities, TV shows and spiritual worship styles, etc. Sometimes you may be faced with evaluating an interest that comes with baggage. An activity might be somewhat dangerous. A legitimate activity might be accompanied with friends that you feel are a bad influence. These decisions take some careful reflection, have no easy answers, and I will leave to your parental wisdom. In all things, merely love your child and there is nothing wrong with telling them you are setting a limit but you might be wrong in doing so. Such humility may reduce resentment and shows you are not merely out to control but to value them. If you are getting nagged, tell them they can revisit the issue at a certain set point in the future, i.e., in a month, season or year, or after certain other goals are achieved.

Conclusion

Developing a remedy for a youth that is out of control can be difficult and exhausting. Every year there are new "Miracle cures" that appear claiming they will make the difference, these cures become the "Newest Rage". What is significant to remember is that it is not just one person, or one modality that will help guide your youth, but several. While involved in the challenge of diagnosing and treating the youth in your life, seek assistance for yourself. Caretakers often make the mistake of trying to handle it alone because they are too embarrassed or proud to admit that they can't do it themselves.


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