Understanding and Surviving Your Defiant Child

It begins with the mindset.


If in your mind your child or teen is trying to control you, your home, your family, your life, I truly believe you are losing the battle.

If in your mind your child or teen is trying to gain control of his or her life, is struggling to interpret their world, is feeling overwhelmed due to lack of acquired reasoning skills or deficits in communication, well, now you’re talking.


Looking at the behaviors with a different set of eyes sometimes leads to out of the box thinking and problem solving.  Try starting with the belief that behind every behavior is a cause, a reason and try to identify what that trigger is.  Do not assume that your child does not want to be cooperative try instead to assume they don't have the tools to think on that level or to collaborate in problem solving.

Do you see your child as an under achiever?  Do you see your child as being lazy, immature, stubborn, unmotivated?  Do you see your child's behaviors as a burden on your family?

Remember the eyes are the window to the soul and they mirror our feelings and emotions.  Chances are if its in your eyes it's also in their view. Negativity breeds negativity so if what you are doing is not working try to turn it around.  See them with a different set of eyes.


No child wants to fail.  No child wants to struggle in school, at home, with friends and in life.  They just don't , as Dr Ross Greene says "If they could they would".  I think many times these negative behaviors are a defense mechanism to keep the world from seeing how much they are struggling.  The behaviors are a bravado to hide their pain.


Dealing with a raging, defiant, cursing, threatening, hostile, nasty, dark, violent, incorrigible child is horrible.  It is absolutely exhausting and one of the hardest things parents of children with mental illness or poor regulation will ever have to deal with.  It is so explosive in nature.  It can be so random and unexpected and yet predictable and unavoidable.  It takes every ounce of restraint not to lose it at times.  As absolutely draining and painful as it is to deal with these kids - imagine being that kid.

Imagine being that out of control.  Imagine being afraid of your own actions.  Imagine being disoriented and confused either during a rage or afterwards.  Imagine feeling like a failure everywhere you go.  Imagine having no friends.  Imagine hurting people you love and having no way of stopping it.  Imagine being in that much pain.
As horrible as it is for the parent, imagine how terrifying it is for the out of control child or teen.


I know, you are reading this and saying ,well he/she doesn't look terrified or afraid.  To that I say look a little deeper.  Start from scratch and reassess the situation.  What the hell - what you are doing now isn't working or you wouldn't be reading this so what do you have to lose?


Without going into a long drawn out explanation let's just start with the understanding that there is a physical as well as emotional change that occurs during these rages or behaviors, flight or fight as most people call it.  The adrenalin is pumping that cortisol is rising and you have a chemically hormonally imbalanced mess on your hands.  Everything is distorted and amplified its like a Mack truck is coming right at them. Everything around them seems like danger and a threat. Ill show my age here by saying it reminds me of Lost in Space the television show "danger danger" for Will Robinson.  I digress. The key is to head off that chemical pituitary adrenal response before it hits because once its started - watch out!


Take a look at your expectations, are you setting the bar too high?  Is the child impaired and struggling to the point that for a while, whether short term or a bit longer perhaps expectations should be dropped completely?  Often when kids are this out of control and in a chronic state of chaos they need to calm and regulate.  It's not the time for demands but the time for fostering a calming state to regulate the physical and emotional kid.

Go back to the beginning, put on your detectives cap and start looking for causes of the childs frustration.  Mental illness is an umbrella for the reason many of these kids are so severely impaired but underlying are the triggers and causes that exacerbate the behaviors.  Many of these kids have overlapping issues or disorders so leave no stone unturned.  Look into any sensory issues - look into learning disabilities - look into organic basis such as endocrine or other health causes - look into hearing problems - vision problems - neurological problems - the list goes on and on.  Medications can cause slight to severe side effects check if a new med be involved? Is it Anxiety based? Anxiety and social phobia are horrible and very real in children.  Anxiety in children and teens is under recognized, unaddressed and often not validated but merely chalked up to teen "drama". This just creates even more anxiety and embarrassment.  It is a daunting task to unravel but when you find that needle in the haystack it is well worth it.


Consider social deficits as not all kids acquire social skills naturally.  Is your child being bullied or singled out by another child or a teacher?  Is your child misunderstood and labeled a bad kid, the weird kid, the loner?  Is your kid always getting detention, punishments or having things taken away.  Maybe, just maybe, your child is being beaten down by the world they live in.Unintentionally but inadvertently their world is spinning out of control and their self image and self esteem is shot.


Pushing these kids down further into the abyss does not work.  Negatives do not work.  Punishments and limit settings do not work.


Raise these kids back up.  Finding what they are good at and focusing on that, giving them a sense of pride and accomplishment, having their back and advocating for the positives in these kids is the way to start. To be clear, I'm not talking about enabling bad behavior here that is another blog all together.  Im talking about acknowledging the negatives, addressing the negatives but focusing on the positives.

Looking at it, no matter what age, like teaching skills to a baby.  You teach them one at a time, in this case usually in order of importance.  Break the behaviors or issues down specifically sometimes even broken down into several segments for the same issue. You do not need to telegraph that you are working on these issues with a defiant child, do it in a subtle way and let them feel the empowerment of succeeding. Instead of pointing out when they get it wrong point out when they get it right. You cannot fix all issues at one time, take behaviors one at a time until mastered or significant improvement is made then move on to the next.


Be a role model - a human role model with human flaws.  When you make a mistake or hurt someone apologize.  When you are stressed out and frustrated say so and let your kids see how you manage stress in an appropriate way.  When frustrations and disappointments happen in your life, if appropriate, let them see that life has its ups and downs and how to pick up and move on. Be an obstacle mover in your life and in theirs.


As I started this blog..... It begins with the mindset.  It also ends with the mindset.


Next time your child or teen is raging and out of control, the next time they are cursing and having a melt down.... step back..... take a breath..... do not react.   Walk away if you have to but make your mindset compassion.  Realize that this is the WORST possible time to communicate your expectations or to have any kind of meeting of the minds. This is the WORST possible time to lay down your parental authority. This is the time to model behavior by staying calm and speaking calmly.  It is not the time to argue your point whether you are right or wrong. It is not a time of rational thinking.  It is the time to let this struggling kid know you "get them".  It is the time to say "I'm sorry you are having such a hard time"  "I see you are really struggling - Im sorry you are hurting"  "Maybe we can find a way to work together to solve this"  "I love you"  I know..... It is hard, very hard.  When you have a spitting mad verbally or physically abusive kid in your face it is the last thing you want to say but you need to break the pattern and build trust.

If you over react they will come right back at you.  If you are calm and reasonable sooner or later - yeah I know sooner or later is usually not soon enough - they will begin to see that they can trust you to be calm, collaborative and ACCEPT them.


The less you talk the more you will have to listen and when listening with compassionate and new ears you just may hear where all this anger and pain is coming from.  By listening and asking them what they are feeling and not TELLING them or assuming what they are feeling, you are giving them the best gift a parent can give by teaching them the skill to communicate and work together to compromise and problem solve. You are teaching them how to communicate their feelings and frustrations in an appropriate and productive way.

I think ultimately, and equally important is to give our kids the tools to self calm and regulate.  This is a really frustrating world and when combined with a disorder or situational circumstance they need to learn to calm and reason.  In order to learn those skills they need to know how "THEY" calm.  Teaching them breathing and muscle relaxation when they are in a calm state is great but I really feel that everyone finds their own way to calm.  Get your child to a place in themselves to identify how they calm, be it with music, video games, running, climbing, pacing, reading help your child or teen find their calm.  Yes I said video games, I don't really care what it is as long as it is safe and not harmful to anyone else.  They need to find their own way. It is not so much the action that is important but the way they will learn the feeling of calming and the benefit of self relief of the escape from the anxiety.   It is not only needed now when you are ready to jump out a window but it is what they will need to live a productive and happy life long after these adolescent years are gone.


Sometimes giving control and teaching control puts you in the drivers seat. 

Potpourri

Potpourri, I have always loved that word. The word congers up wonderful thoughts of bountiful fragrances, a palette of beautiful colors and a feeling of tranquility. It brings back memories of my grandmothers house with little aromatic bowls that gave her home its signature scent. It is a wonderful word.

The word potpourri has several definitions. The first, as I mentioned, is an aromatic mixture of dried herbs, spices and flowers. It also, in present day use, describes a miscellaneous collection or medley. The etymology of the word is French pot pourri, literally, rotten pot dated back to 1749.

When using the word Potpourri in reference to the child with a mental illness it takes on a whole new meaning. Professionals use the term "co-morbidity". I think I like "potpourri" better. Co-morbidity is the term used for multiple disorders. It is "literally a rotten pot".

Comorbidity makes for high rates of misdiagnosis among these children. It is rare that you find a child with just one disorder. Tourette Syndrome, OCD, ADD, PDD, Autism, Depression, Bipolar disorder the list goes on and on. Often times these children have one or more additional disorders which not only makes the diagnostics more difficult, but the treatment pure trial and error.

Adding to the confusion are the subgroups within the disorder. An example: A child with Tourette syndrome with severe exacerbation of tics or ocd symptoms after a strep or viral illness would be considered for a diagnosis of PANDAS or PITANDS as their subgroup. A test to identify the D8/17 marker would be performed. Treatment would be initiated. Seems simple, but it is not. There are subgroups within even this subgroup. Example: some children with PANDAS or PITANDS have different presentations. There is a subgroup that only have exacerbations after viral illness and others only after bacterial. Some respond to antibiotic treatment and some do not. On the autistic spectrum, there are some children who while with fever have significantly reduced symptoms. Dr Andrew Zimmerman at John Hopkins has done studies on these children and its relationship to the release of cytokines. Some of these children respond to augmentin - a preparation of amoxicillin and the potassium salt of clavulanic acid - rather than its base component amoxicillin alone,others do not. It is an eclectic puzzle. A potpourri.

Treating the child with multiple disorders, a potpourri, is a daunting task. Sifting through the symptoms to label the disorder is sometimes futile. It is understandably necessary for insurance coding but often times serves no purpose. Treating the symptoms is key. Looking at the child as a whole instead of a diagnosis, I feel, often times serves the child better. We are all complicated creatures but the child with a mental illness is like a convoluted bowl of emotional potpourri.

The Medication Roller Coaster

The Medication Rollercoaster –Updated Version

The Medication Rollercoaster – Original publishing 1/1o

Let me start by saying I am not a doctor or a medical professional – I am a mom – a mom who has been there.
The decision to medicate your child is a very personal and heart wrenching one for many parents.
Whether the child has a mental illness or a physical one the stress and anxiety is the same.The difference is in the stigma. Would you give your child insulin if diabetic, chemo for cancer, anticonvulsants for epilepsy? Of course you would. What many people do not understand is that mental illness can be fatal. It can be severe and debilitating.
Does your child have a physical illness that requires medication? Do you lay awake at night worrying about the side effects?

Medicating a child is tough. It is draining and takes an informed, observant and stable parent to monitor.

I will discuss it all on The Coffee Klatch  and will provide resources to help you gain some control over the stress involved with medicating a child.

Here is an outline of the topics we will be discussing in detail on the show:

First thing any parent should do is google a drug interaction checker and bookmark it. I use http://www.drugs.com/drug_interactions.html

Second thing any parent should do – buy a journal – journal every day several times a day if needed

Write down the medication - generic or brand - dosage - dates increased or decreased - reactions and side effects

You are your childs medical historian – be accurate and be consistent – it is amazing what we forget under stress

With possible medication trial and errors it is important to have a record for yourself and the doctor

Do your homework – when discussing medications with your childs doctor ask about all possible side effects

Discuss titrating and weaning. Discuss test dosing. Discuss doctors availability in event of a problem

Discuss blood work prior and during medication use – discuss heart or other pre-required testing

Discuss what is considered an ample period of time to decide if the medication is helping

Discuss your feelings and anxieties about medicating the child – do not be intimidated or pressured

Discuss the fact that you will have to do some research on the medication and make an informed decision.

If your childs doctor is pressured for time let him know that you will come back to discuss the issue

If your childs doctor does not provide you with the time – get a new doctor.

Titrating – when starting a child on a medication here is the golden rule – START LOW AND GO SLOW

Make sure that the pill or capsule that your child is taking is not time released and can be split before breaking

If the pill is time released see if there is a standard form of the drug to use for a day or two as a test

Having a bad reaction to a med is horrible – better it be six hours than 24 or more

Purchase a pill splitter they can be found at any pharmacy

Purchase a weekly pill box – yup like the old ladies have – this will help you remember if you gave it or not

Always keep a few pills in your purse – in the event that you are out at medication time

Although many medications have therapeutic levels there is no harm in starting low and going slow to get there…..

That is of course unless there is an acute life threatening crisis

Weaning off medications – take it even slower especially with antidepressant meds. Never stop antidepressant meds suddenly if they have been on board for a while

Some children especially those with PDD and other autistic features tend to be micro-responders.

I have found many drs tell you to increase the meds during exacerbations, I have found the opposite.

Use your intuition and gut – a moms gut is worth more than people give it credit

During exacerbations Temple Grandin had observed that she needed to lower her medications instead of increase them

All meds are not made the same – be careful of switching to generics or even the other way around

Take note when you switch brands of meds for changes in your child.

Over the counter meds MUST be checked on the interaction checker – MUST – I have provided a resource on FB

Herbs MUST be checked with the interactions checker – also provided resource on FB (including teas)

Many drugs cause vitamin deficiencies – especially stimulants - do your homework

Even if a medication cocktail is inevitable always insist on starting one at a time to not confuse the issue

If your child is on a medication requiring blood level tests – GET THERE – do not say tomorrow

Blood level tests are required for a reason – to check organ functions or to ensure safe levels – GET THERE

Be careful not to let the child get dehydrated as the concentration of the drug can increase

Be careful of grapefruit and other known foods that interact with many drugs also resource provided on FB

If you have a spouse or a partner – get on the same page – if you cannot agree seek consultation.

Always start a new medication on a Saturday if possible so that you can observe the child

If the child needs to take medications at school make an appt with the school nurse – discuss your child

Ensure that the child will be in a comfortable environment and not be embarrassed or stigmatized.

Are the drugs unaffordable for your family – there are programs that can help with providing medications

Call the pharmaceutical company manufacturing the drug to ask for assistance to see if they have a program

Be very very careful with clinical trials – parents get desperate to help their children- remember they are trials.

Don’t be afraid or embarrassed to ask for help yourself. If you are feeling overwhelmed say so.

 Seek out a support group – check out online forums – read parent reviews such as remedyfind.com or healthrevolution.com

Give yourself a break – this is not easy – be pro-active and you will have a lot less to lose sleep over.

So welcome to the medication rollercoaster – it’s gonna be a wild ride. ~Marianne

Update: Summer adjustments – School breaks and trials

Summer break is notoriously a time that parents wait to try to add or remove a medication their child is taking.

Starting up and weaning off medications is tough – very tough. The withdrawal can be severe and going slow is just as important when removing a medication as it is adding. There are several schools of thought regarding summer breaks from medications.Some psychiatrists believe that during the summer months medications for attention, mostly stimulants, can be given a break especially if weight loss has occurred. Others feel that it is like removing glasses from a child that needs them and feel that the stimulants often help with social interactions as well as academic performance and should therefore remain.

Dr Duncan McKinlay renowned psychologist, author of Nix your Tics and creator of the documentary Lifes’ a Twitch” feels that there is a risk to stopping a medication that is working as the child may not have the same positive reaction once restarted. I have heard this from several other professionals as well as parents who have found that the results once had are much lessened when reinstituted.

In the end, it is a parents choice. Being a parents choice does not mean that a child (if old enough and has the ability to self advocate) should not have some say as well. Before making any changes set up an appointment with your childs prescribing physician and discuss the pro’s and con’s. Let your child talk about how the medication makes him/her feel. What symptoms are the most problematic and if they feel improvement or impairment from the medication. As said, ultimately it is the parents decision but having your child participate and understand the changes will only make the rollercoaster ride easier for all. Another positive in having the child participate is that often times what may appear to be one behavior or emotion is really something else and in discussing the pro’s and con’s and targeting symptoms a clearer picture may emerge.

Once referred to as a “medication holiday” is another of the many stressors a parent medicating their child needs to consider carefully. Starting and stopping medications whether for summer break or any other reason is stressful for the child and the parent. The “Honeymoon” period is another term thrown around for the initial period of time that a medication is new to a child system and showing much improvement only to lessen in effect after a few months and there is a need to be adjusted. Keep in mind that an adjustment does not always mean an increase. For many kids, especially those on the spectrum often less is more. Many of these kids are micro-responders and have better results with an eigth of what other children may be able to tolerate.

Above I am speaking of medications that DO NOT stabilize mood as they should never, I repeat, NEVER be removed if a child is stabilized. I am talking about stimulants and other medications not used for depression or mood stability.

For the child who is not finding stability on their “medication cocktail” summer is often the time of trials. Many parents wait for summer, to try different medications so they can monitor closely and give the child time to adjust and go through the physical side effects. It, if an option, is a great idea.

As any parent who has been through the process of starting a medication knows, there are some rough days even with medications that eventually will help and whose side effects will abate. Nausea, lethargy, headaches, body aches, brain fog, cognitive dulling, agitation are just to name a few of the possible side effects that a child may have therefore not having to “perform” in a school setting during a trial is very advantageous.

If you are considering a medication change for your child, if you have been waiting for summer or any other school break, plan carefully. Consider a shorter summer camp or a later start. Give your child the best possible chance to adjust and function through the trial in hopes of giving them a better quality of life.

The title of this writing – “The Medication Rollercoaster” for the rest of this blog is deceiving.

Alternative approaches need to be planned and considered for summer and school breaks as well. Even natural, homeopathic or holistic approaches have side effects and can be draining on a child.

Many parents wait to try an alternative approach and wean their child off medications during the break. This is a great idea. The ten week period gives you enough time to wean off – incorporate vitamins or other therapeutic trials and have time to reintroduce the medications if it is not successful.

DO NOT UNDER ANY CIRCUMSTANCES add any herbal or homeopathic products to medications without speaking to your prescribing doctor and doing your OWN homework as well. Make sure to check your Drug Interaction Checker and check out all possible drug to herb or homeopathy interactions. They are significant and there are many.

Drug herb interaction checker

http://www.prohealth.com/library/showarticle.cfm?libid=13668

Drug – Vitamin depletion chart http://www.pharmacistelink.com/naturalmedicine/pdfs/P4880x1204DrugChart.pdfWishing you all a safe – happy – healthy summer.