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Raising a child or teenager with a psychological condition is a "perfect storm" of stress, sadness, and uncertainty. How can you find the best treatments and help your child overcome emotional, behavioral, and academic challenges-while keeping yourself and your family strong? As a parent, you may feel isolated and alone, but the reality is that a lot of families are in the same boat. Ann Douglas knows first hand just how daunting it can be. In this compassionate and empowering guide, she combines the vital lessons she has learned with vivid stories from other parents and advice from leading psychologists. Several record-keeping forms can be downloaded and printed for repeated use. The book cuts through the often-confusing clinical jargon and speaks from the heart about what matters most: the well-being of your child.
|Publisher:||Guilford Publications, Inc.|
|Product dimensions:||5.90(w) x 8.90(h) x 0.90(d)|
About the Author
Ann Douglas is an award-winning parenting writer and the mother of four children who have struggled with a variety of psychological problems--and are currently thriving. She speaks widely at health, parenting, and education conferences and hosts online conversations about parenting and mental health for a range of organizations. With acclaimed books including The Mother of All Parenting Books and The Mother of All Baby Books, Ann has helped hundreds of thousands of parents navigate the challenges and complexities of raising kids today. She lives with her husband and their youngest child in Peterborough, Ontario.
Read an Excerpt
Parenting Through the Storm
Find Help, Hope, and Strength When Your Child Has Psychological Problems
By Ann Douglas
The Guilford PressCopyright © 2017 Ann Douglas
All rights reserved.
Our instincts tell us when something's not right with our kids. We place a hand on a toddler's forehead if she seems more lethargic than usual and ask ourselves, "Could she be coming down with a fever?"
In the same way, parent intuition can alert us to the symptoms of a psychological problem. In this case, it's a child's behavior rather than a spike in temperature that causes us to become concerned. If only we had a mental health thermometer in our medicine cabinets.
"The doctor was amazed that I picked up on the signs so early," recalls Lisa, whose daughter, Laura, has been struggling with behavioral issues at home and at school and is currently awaiting diagnosis. "But she's my child and I know her better than anyone."
You may be reading this book because you're worried about your child. You may be wondering if the behavior you've noticed lately is something all children go through — or is it a symptom of something more worrisome? You may find yourself wavering back and forth on this question, sometimes thinking yes and sometimes thinking no, and sometimes feeling unsure. You may feel like your parent radar is permanently stuck in the worry zone, but you're not quite sure why.
WHY YOU MAY BE WORRIED
Those First Moments of Worry
Some parents can date their first nagging concerns back to when their children were still babies.
"With Aiden, I knew something was wrong from when he was an infant," recalls his mother, Tara. Aiden has since been diagnosed with autism and ODD. "He just never stopped crying. He would cry for 10 or 11 hours a day, every day. That continued until he was almost 1 year old. Doctors told me he was just really colicky. He was also really, really active; and the older he got, the more violent he got. He would throw himself into things: the couch, the wall, the floor."
Karen, whose son Spencer was diagnosed with pervasive development disorder not otherwise specified (PDD-NOS),* had a similar experience: "I remember Spencer being 8 months old and having tantrums that were so violent he would bang his head on the floor until he vomited. The more I tried to subdue him, the more his rage escalated. I knew that this was outside the range of normal. Our doctor brushed off my concerns by saying, 'He'll grow out of it.' Actually, he grew into it, and as he got bigger, the rage got bigger too." It was only after Karen insisted on a referral to a developmental pediatrician that things started to get better for her son: "He was the first person to agree that there might be an issue other than the terrible twos."
School-Related Worries and Concerns
Other parents don't notice any worrisome symptoms until after their child has started school.
"I first began to suspect that there was an issue when Will was constantly sent home from first grade for uncontrollable behavior," recalls Christine, his mother. "When Will was suspended in second grade for hurting another child, we knew for sure that there was an issue." A short time later, Will was diagnosed with severe ADHD and an anxiety disorder.
"Skyler had always been a happy child, but that changed fairly significantly when he ran into the 'wall' of the structure and expectations of school," recalls Leigh, whose son has been diagnosed with ADHD, anxiety, and depression. "The things he normally liked to do became frustrating for him and he retreated into himself. When forced to engage with others in a context in which he was uncomfortable, he would become quite agitated and respond in inappropriate ways. We sought professional help when Skyler was 6 years old. He had been suspended from school for an incident involving frustration tolerance and self-control and, as a result, he attempted suicide."
Some parents can pinpoint a particular event that seemed to trigger a child's difficulties. Kate remembers her son Tony showing signs of depression in the aftermath of his father's death. He was just 7 years old at the time. "He would cry at night, after the first year, that he was forgetting his dad."
More often than not, however, there isn't any clearly identifiable trigger. A cluster of worrisome symptoms develops over a period of time. Or a crisis occurs, demanding immediate attention.
The Frequency of Symptoms
It might not be the symptom alone but the frequency of the symptom that suggests a problem. For example, although many preschoolers are given to temper tantrums, the frequency and intensity of tantrums in children of that age may be a warning sign of a possible problem. A study published in a 2012 issue of The Journal of Child Psychology and Psychiatry reported that while 80% of preschoolers had thrown one or more temper tantrums in the previous month, fewer than 10% of preschoolers threw tantrums on a daily basis. What's more, the researchers found that there was more likely to be cause for concern if children had a temper tantrum when they were being cared for by an adult who was not their parent, if they destroyed objects during a tantrum, if there was no apparent reason for the tantrum, if the tantrum was prolonged, or if the preschooler became violent during the tantrum (hitting, biting, or kicking someone else).
A child who is experiencing severe tantrums may end up being diagnosed with an impulse control disorder. According to research conducted by the National Institute of Mental Health (NIMH), impulse control disorders have the earliest age of onset of all the psychiatric disorders, with onset typically occurring between the ages of 7 and 15. ADHD (which is also considered to be a neurodevelopmental disorder) tends to become a problem during the primary school years. ODD, conduct disorder, and intermittent explosive disorder (behavioral disorders) tend to show up a little later on, during the preteen and teen years. Note: Some children with extreme irritability and severe tantrums meet the criteria for a brand-new diagnosis — disruptive mood dysregulation disorder (DMDD). It was added to DSM-5 to describe children who would otherwise meet the criteria for a bipolar diagnosis except for the fact that they aren't subject to manias or hypomanias.
Anxiety disorders also tend to have their onset during childhood and adolescence, typically between the ages of 6 and 21. Phobias and separation anxiety disorder tend to be a problem for younger children, while other types of anxiety disorders, such as panic disorder, generalized anxiety disorder, and posttraumatic stress disorder (PTSD), tend to be more of a problem for slightly older children and teens.
Alison chose to seek help for her daughter, Charlotte (who was ultimately diagnosed with an anxiety disorder), after noticing a pattern of worrisome behaviors. "She had several symptoms that together made me concerned: a tendency to scratch at her face, nail biting, chewing at her clothes and anything else she could get her hands on, difficulty with separating at night, difficulty sleeping, difficulty sleeping on her own, and an unwillingness to participate in [Girl Scout] activities outside of the regular weekly meeting, even though she loves [Girl Scouts]."
Other types of disorders begin to show up during the teen years. Mood disorders become more prevalent starting in the early teens, and substance abuse disorders and eating disorders become more of a concern starting in the midteens. Psychotic disorders rarely occur before age fourteen but become significantly more prevalent between the ages of 15 and 17. And personality disorders, which involve an enduring pattern of distress and difficulty functioning, are typically diagnosed during adolescence or early adulthood.
Changes in Behavior
Joanne, whose son William has been diagnosed with major depressive disorder (MDD), a type of mood disorder, sprang into action after noticing some troubling changes in her son's behavior. "William started hanging around with a different group of friends," she recalls. "He came home drunk for the first time at age 15. His art and drawings were all of a sudden private. When I found his art book, I discovered that the drawings had become very dark; the style had changed completely. He was drawing faceless boys, cut and bleeding, decorated — I suspected — with real blood. He started writing out lyrics to sad and violent songs. He stopped being able to sleep at night or get up in the morning. He started challenging my husband at every turn. He stopped doing his homework. This all happened very quickly. He was not the same person. I took him to our doctor for an assessment."
Andrew, whose son David has been diagnosed with schizophrenia, recalls a similar downward spiral. "Around ninth grade, David began to skip classes. He was hanging around with a friend who seemed to have a disregard for adult authority. Later, we found out that substance use — marijuana, cough syrup concoctions — was also beginning to happen. Things went missing and were likely sold to get substances. In 10th grade, David became more angry and withdrawn. He was beginning to show signs of verbal aggression as well and this was quite disturbing as it seemed so alien in our household, given the values we tried to pass on as parents ... Around this time, there were also a couple of violent situations where David struck me in moments of conflict."
Sometimes the signs that a young person is struggling aren't immediately apparent. A young person may engage in self-harm without anyone knowing. Self-harm may involve self-injury (cutting, burning, stabbing, running out in front of cars), self-poisoning (overdosing on medication or consuming toxic substances), and risk-taking or otherwise health-harming behaviors (substance abuse, food restriction, unsafe sex).
Self-harm is more common than most people realize. A study of nonsuicidal self-injury rates in children and youth ages 7 through 16 found that 9% of girls and 6.7% of boys had self-injurious thoughts and/or engaged in self-injurious behaviors. The study, which was published in the July 2012 issue of the medical journal Pediatrics, noted that ninth-grade girls were most at risk and that they were most likely to resort to cutting themselves as a means of self-injury.
The incidence of suicidal thinking and behavior is even more disturbing. Researchers have found that one in four adolescents reports suicidal thoughts or attempts and that there is a peak in suicidal thinking between the ages of 14 and 18 years. And, tragically, those thoughts can all too easily translate to action: according to NAMI, suicide is the second-leading cause of death in young people ages 15 through 24 and the third-leading cause of death in children and youth ages 10 through 24.
These statistics may leave you feeling frightened and helpless — but you don't have to feel that way. There are things you can do to reduce the likelihood that your child will attempt suicide. The most powerful things you can do are to consistently stress how much you value your child's life (sometimes suicidal people think they will be doing friends and family members a favor by taking their own life because they feel that they have become a burden to others), help your child develop resiliency and coping skills (be in good physical and psychological health, know when and how to ask for help), and help your child develop a solid network of support (support from family and friends, access to community supports). Don't be afraid to talk to your teenager about suicide for fear of planting the idea in his head. He will be safer if he knows that he can come to you to talk about whatever is on his mind, even his darkest and most despairing thoughts. Besides, not talking about suicide doesn't make suicidal thoughts go away. It simply drives those thoughts underground.
Dawne knew it was time to act on the nagging doubts she had been harboring for a while about her son Peter's behavior when he threatened to harm himself. Peter was subsequently diagnosed with a nonspecific pervasive personality disorder with some characteristics similar to Asperger syndrome (a condition now diagnosed as autism spectrum disorder), as well as anxiety. "When he was nine, he had a really bad meltdown in which he threatened to cut his throat with a knife," she recalls. "That's when I knew he needed help. I called a number for a counseling service I had been considering and, when I told them what he'd said, they told me to take him to the hospital right away."
When Others Raise the Alarm
Sometimes, it's a third party who alerts a parent to the fact that there's a serious problem.
That's how Micheline discovered that her son Sean, who has been diagnosed with ADHD after an earlier diagnosis of anxiety and OCD, had been cutting himself. "When he was 13, we were called by the principal, who indicated she had heard from a friend of Sean's that he was cutting the tops of his thighs. We looked him over and were heartbroken. There were several fresh marks as well as scars."
THE FEELING THAT SOMETHING IS WRONG
Sometimes it's our own nagging feeling that something isn't right that motivates us to dig a little deeper — to find out what's really going on.
That's how things played out for Lily and her daughter, Asia, who was ultimately diagnosed with borderline personality disorder (BPD): "One evening, my daughter was supposed to be at a friend's house and I was planning to go out for dinner," Lily recalls. "For some reason — perhaps I'd forgotten something — I returned home. As soon as I got in the house, I had a feeling my daughter was there and that something was terribly wrong. Perhaps I'd heard something without being conscious of it, or perhaps 'mother's intuition' really exists. Either way, I started searching for her — searching rooms and then, when I didn't find her, searching under beds and in closets. I found her in a closet, covered in her own blood. She'd been slashing her arms with a knife after someone she thought was a friend had rejected her. She wasn't crying, just trembling like she was chilled, in shock. That was when I knew that we needed help. Before then, she had told me about her feelings of hopelessness and anxiety, and I had chalked it up to being a teenager — partly because I had experienced the same feelings at the same age. It would be another couple of years before I realized that I was mentally ill as a teenager as well. In those days, it was just called rebellion — being a bad kid."
It's hard not to blame yourself if you feel like you missed some clues that might have encouraged you to seek help for your child sooner rather than later. It may be helpful to remind yourself that you did the best you could with the information you had at the time. What more can we ask of ourselves, really?
As these stories suggest, the symptoms of mental illness are different in children than they are in adults and can differ depending on age and stage of development. Children are constantly changing — and their circumstances are constantly changing too. A lot of teenagers who wouldn't meet the diagnostic criteria for any disorder still manage to exhibit a lot of very worrisome symptoms — symptoms that may ebb and flow as a child matures or situations change. This can make it difficult to pinpoint the nature of a particular mental, emotional, or behavioral disorder in a particular child. Below are some symptoms you should be alert to.
If your parent radar is telling you to be concerned, then some follow-up is called for. While you are the expert on your own child, other people have expertise, experience, and perspectives that might be helpful too. What you're looking for is evidence that your child's behavior is interfering with her ability to function — and what you're witnessing goes beyond a single bad day.
WHAT CAN YOU DO IF YOU ARE WORRIED THAT THERE MAY BE A PROBLEM?
Talk to Other People
You might want to start with other people who know your child well: this could include other family members, your child's teachers or coaches, and close friends of the family — people whose opinion you trust. Ask if they have noticed the same or other worrisome symptoms or behaviors in your child. You can start these types of conversations with a simple question, such as "Do you think I need to worry about Jason's temper tantrums?" or "Do you think I should be concerned about Rachel's crying spells?"
Excerpted from Parenting Through the Storm by Ann Douglas. Copyright © 2017 Ann Douglas. Excerpted by permission of The Guilford Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Table of Contents
Introduction I. The Challenge and Your Child 1. Parent Radar 2. Obtaining a Diagnosis 3. Starting Treatment 4. Advocating for Your Child II. You and Your Child 5. Stress Management and Coping Skills 6. Parents Can Make a Difference 7. Calming the Raging Storm III. Your Family 8. Family Matters 9. Lifestyle Matters IV. Your Community 10. Working with Your Child’s School 11. The Friendship Department 12. Finding Community V. Recovery and Beyond 13. Daring to Dream Again 14. Creating a Better System Epilogue: After the Storm Appendix A: Glossary Appendix B: Resources Appendix C: Directory of Disorders