Education and Counseling for Individuals Affected by Oppositional Defiant Disorder and ADHD

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Do we have to take him back?

Hi Mark,

Well, just to catch you up...M got out of the JJS on 1/3 and is in the intensive probation program. His PO has seen him 2x @ school and 1 home visit. He is supposed to go back to work and pay for the program ($90). He has called his manager (with MUCH arm twisting) but so far has not gone back. He has been to court last Thursday for his chewing tobacco possession and had a $55 fine imposed (Has yet to work this off also). He was re-instated on the wrestling team, and the DAY he found out he was back on he was a totally changed person. He was happy, interacting, talking about new semester classes/teachers, working out, etc. He has his first meet on Thursday and did excellent. We really thought he turned the corner. He has had his ADHD rx increased (new Dx 12/06), and the psychiatrist (and his counselor and the JSS counselor) all think he has depression and want him on antidepressants also. He thus far is not agreeable to taking them.

Friday I get a call from the Asst. Coach (who wasn't @ practice--home sick) that M was accused of putting marijuana in another teammates locker. He wants M to call to further discuss what happened. M was not home at the time--his first time out (his choice) with another wrestler to grab some dinner as they "Made weight" and were celebrating. He was home in an hour. I knew the other boy and was very happy that M finally was leaving the house. M has not had many phone calls and only 1 friend stop by Thursday (he is a boy husband and I disapprove of). He came over @ 10pm after this meet to show M his new car. He was in the driveway for only 5 minutes and he came in. M goes nowhere and no one over. He has had $45 in his wallet since he came home (Christmas money). I checked Friday after dinner and he had $30+ left. Point being he had very little opportunity to get the pot, unless from school and for free.

M did admit to "finding" a bag on the floor in the locker room and put it in the closest open locker. His story is that 1. he did not want anyone to get in trouble if the coaches saw it and 2. he would get blamed for it if they did see it because of his JJS hx.

Coach says the boy turned it into the Captain when he opened his locker, others around said M put it there, and still others are claiming M was taking it around saying "Do you want to buy a bag?" and acting as if he were holding a joint. He is OFF the team until further notice. I immediately called his PO and left a message. I am OK if M is really responsible but 2+2 just isn't adding up. M does admit the above but that's it. He has been dx with impulsive behavior. Since the incident he is back 180 degrees. He is sullen, alone, NO interaction, lack of desire/motivation for school (although going), bad attitude, etc.

He is not one to champion his own cause either (has never been good talking with adults). Just from our (husband and myself) observation of him these past few weeks, we can't believe he had more to do with the situation than he is admitting to. We will not however push the issue/"go to bat" for him because we are not sure and have learned about natural consequences (ie he should never have touched it in the first place). He is risking being suspended, violating probation, going back to JJS or being placed, etc. if he did what is being said. Up until now (less than 1 month) he has done nothing wrong. We don't know if the others are mad that he's back, has taken someones spot on the team, if they are covering for themselves, etc. So far, we have not heard from his PO, the school, etc. If he is found not responsible, he MAY be back on the team, but weigh in's are tomorrow so we would like to know ASAP what is to happen.

Mark, what does your experience and gut tell you? Also, I am finding it difficult to say something positive every day, and how do you do "something fun" when they don't want to engage?

Also, M turns 17 very soon and we hear this is a "gray age". What do you know about our responsibility as parents legally if he should leave again, not follow rules etc. Do we have to take him back? The only privileges he has left are PS2, I-pod, and PSP (TV in room but shares bedroom). Can't take much else away. We live in Michigan. To be honest, I would feel so much better if he could stay on probation until he is 18.

Thanks for your insight, I will keep you updated.



Hi J.,

I haven’t forgot about you. I’ve had a lot of emails to respond to, and I take them in the order they are received.

Re: what does your experience and gut tell you?

This is the season for you to LET GO. I would simply allow probation to take care of the discipline side of things. He will (eventually) receive a series of “natural consequences” since he has to answer to his PO.

Re: I am finding it difficult to say something positive every day, and how do you do "something fun" when they don't want to engage?

I’m sure it is difficult, but you should say something positive everyday anyway. If you can’t think of anything positive, make something up; feed him a line of bullshit. If you don’t “feel” like your comment is genuine or that your heart is in it - fake it! I’m sure he’s doing something right each day. He’s obviously very gifted in many ways.

As far as “fun” goes, this could be something as simple as popping a bag of popcorn in the microwave and the two of you stand there in the kitchen and eat it over some superficial conversation (e.g., “Whose going to win the Super Bowl …By how many points?”). You don’t have to go to great lengths here.

Re: What do you know about our responsibility as parents legally if he should leave again, not follow rules etc. Do we have to take him back?

You’re on the hook until he turns 18. Begin – now – to prepare for his launch (i.e., he needs to be thinking about where he’s going to live, what he’s going to do to pay bills, etc.). This conversation should begin today.

Mark Hutten, M.A.

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When Children Seem Unaffected by Discipline

Mr. Mark,

I wrote to you about a month ago very concern about the behavior of my 5 year old daughter. You responded very promptly to my e-mail. Thank you very much.

We adopted 3 siblings in March 2006. They are 2 twins boys 4 yrs. old and their sister 5 yrs. old. They are very bright, smart and intelligent kids and make us very happy. We haven't experience any educational problems with them. They go to daycare and have learned numbers and letters, shapes and colors at the same rate as the other kids in their school. I purchased and have read your e-book "My out of control child" and have found it very useful. You explain to me in your e-mail the behavioral problems that adopted children usually have because of the unknown medical history of their birth parents. I have tried your techniques and procedures explained in your book, but our daughter is still giving her teachers a lot of trouble at school to the point that they don't know what else to do.

When she is with us, she controls herself or at least follows directions, but we have to be with our eyes or her at all times. We praise them (4:1), caught them doing good, and I have a ticket system but nothing seem to work. At school she is always answering back, bossing around, disrupting class and for the last 2 weeks at nap time at school, she starts calling her friends names out loud to the point that they have to pull her out of the class because she doesn't let them rest. Some people tell me to ignore this and let the school deal with the behavior at school. But I just can’t seem to let that go. She knows they tell me about it every time she is been send to the office or put in time out and them talk about it like she is proud of what she have done. I feel that if I don't do anything about it she might think that it is O.K. to misbehave at school. I sit her at home to write numbers and letters and I have taken her toys, TV time and she has not come to family gatherings. Nothing works, she just doesn't seem to care about anything.

Please, guide me. Help me out and tell me what should I do. I'm very worried. In Sept. she should be going to public school and she might have a lot of trouble if I cant teach her good behavior from negative behavior.

Thank you so much for your help,



Hi N.,

If I heard you right, she behaves acceptably at home, but not at school. You will do well to take the lead by attempting to educate her teachers about ODD. I assume (which is dangerous of course) that her teachers are treating your daughter like they would any other girl. This, unfortunately, will continue to waste their time and energy.

Your daughter is not an emotionless robot who is immune to emotional pain. So I disagree with you when you say, “she doesn’t care about anything.” She has something that she really values – but it sounds like you haven’t found what that is yet. Find out what she really values. When you find it, it will be your greatest bargaining chip.

Here’s an example of what I’m talking about:

I had a mother who emailed me with nearly the same dilemma as you. She said she takes her son’s toys away, grounds him for 3 days with no TV, computer, etc. But “he doesn’t care.” All he did was sit on the floor of his bedroom and read comic books. He just hid out in his room and wouldn’t come out. BUT WAIT. He’s isolating in his room and reading? Then there you go! I had this mother ground him FROM his room – which he despised greatly because he didn’t want to be around anyone while on discipline. The mother literally locked him out of his room (except at night to sleep). After he completed his 3-day discipline, his “room privileges” were restored.

As cruel and unusual as it sounds, you have to find out “where it’s going to hurt” (i.e., what will evoke uncomfortable feelings in your daughter when she makes poor behavior choices). Then you implement that “place of pain” whenever she needs a consequence – but only for 1-3 days. I’m not talking about emotional abandonment here – I’m talking about providing direction and support.

She’s never going to work for what you want, but she will work for what she wants.

What does she like the most? Are you pouring on a lot of attention and intensity when things are going wrong? She is getting some kind of payoff for “non-compliance.” How can I be so certain of this? Because all behavior has a motive behind it. And that motive is usually to attract pleasure or avoid pain.

Below is a summary of all the assignments I gave you in the eBook. If parents do not implement most of these assignments, it is often the "kiss of failure." For example, the transmission in your car has hundreds of parts, but if just one little tiny part is not working -- the whole transmission does not work. The same is true with this "parent program." Omit just one strategy, and the whole plan runs the risk of failing.

1. Are you asking your daughter at least one question each day that cannot be answered with a simple "yes" or a "no" to demonstrate that you are interested in what is going on in her life? (page 20 of the printable version of eBook)

2. Are you saying to her "I love you" everyday and expecting nothing in return? (page 20)

3. Are you eating dinner together at least one evening each week -- either at home or out? (page 20)

4. Do you use "The Art of Saying Yes" whenever your answer is yes? (page 25)

5. Do you use "The The Art of Saying - and Sticking With - No" whenever your answer is no? (page 25)

6. Do you catch her in the act of doing something right at least once each day? (page 25)

7. Do you use the "When You Want Something From Your Kid" approach as needed? (page 31)

8. Do you give her at least one chore each day? (page 31)

9. Do you find something fun to do with her each week? (page 54)

10. Do you use the "I noticed ...I felt ...Listen" approach when something unexpected pops-up? (bottom of page 50)

11. When you are undecided about what to say or do in any particular situation, are you asking yourself the following question: "Will this promote the development of self-reliance in my daughter, or will this inhibit the development of self-reliance?"

If it is supportive of self-reliance, say it or do it. If it is not supportive, don't!

12. Is she EARNING ALL of her stuff and freedom? (see "Self-Reliance Cycle" - page 19)

If you answered "no" to any of the above, you are missing some important pieces to the puzzle. Most parents DO miss a few pieces initially -- you can't be expected to remember everything! But don't get frustrated and give up. We must be willing to hang in there for the long haul.

I'm talking about refinement here. Refinement is a necessary tool to use in order to truly be successful with these parenting strategies.

HERE IS THE GOOD NEWS: Parents who refine are, on average, 95% - 100% successful at getting the parent-child difficulties reduced in intensity and severity (i.e., the problems are easily managed).

The same can be true in your case. Don’t give up just yet. Please continue to refine by emailing me as needed over the next few months. Refinement is a process, not a one-time event.


Online Parent Support

Body Piercing and Peer Pressure

Hi Mark, the last time I spoke with you was on the 20th of November last year (titled "Desperate"). At that stage my son had left home and I was frustrated. Your words were of great comfort to me and I must admit at my lowest points, I referred back to that email for strength. Thank you for that.

During my sons three and a half months of living away from home, I have practiced your techniques whenever he was around. My son has now decided to come back home and live under our rules. I am excited about this and a little apprehensive. What I would like to know is how to slowly and inconspicuously get him away from the bad crowd he is now involved with. I do not want to scare him off as soon as he gets home and I know that I have to tread very lightly. The other area of concern is the body piercing which neither I nor my husband can stand. Should I just continue the "POKER FACE" and let him find his way or should I set the rules immediately?

To date, your course has been the only sensible approach to my children and I value your words immensely. Thank you once again! With great appreciation. Sincerely, S.


Hi S.,

Re: body piercing. I think you have bigger fish to fry than worrying about "body piercings." This issue falls into the "pick your battles carefully" file. You only have a limited amount of time and energy. Plus, body piercing is a phase. Unlike tattoos, one can remove ear rings, tongue studs, etc., when one outgrows the need to "stand out from the crowd" and to "look cool."

Re: hanging with a bad crowd. Don't be sooooo glad to have him back home that you over-indulge him for fear that he'll leave again. Having said this, negative peer association is a bit like the smoking issue. If a teen wants to smoke, the only way to get it stopped is to lock him in the basement (against the law). And the more the parent makes an issue out of smoking, the more attraction smoking has for the kid. Parents have no control over it - unless it occurs on their property!

Negative peer association is no different. When he's away from home, you simply cannot monitor effectively who he is hanging around. Even if you did come up with a seemingly rock-solid method for keeping tabs on his whereabouts, he would find a flaw in your method and exploit it. Parents have little control over negative peer association - unless it occurs on their property!

There are some things you can do to minimize the problem however:

You can't make peer pressure go away, but you can teach your son how to deal with it. Although we often think of peer pressure as bad, it is very likely that your son's friends have some positive influence as well.

Develop a good relationship. The stronger your relationship is with your children, the less likely they are to follow bad examples.

Teach your children to think when others try to get them to do something. Your children should ask themselves questions like: Is it wrong? Why do they want me to do it? Is it illegal? Why am I tempted to go along? Am I afraid that they will laugh at me?

Teach your children to decide for themselves whether something is right or wrong, helpful or harmful. Bring up examples of situations they may be in; then explore what might happen if they respond a certain way. Let them think about the consequences of their actions. If they have an uneasy feeling, something is probably wrong.

Sometimes children just need help getting away from a bad situation. Provide them with some responses they can use to resist peer pressure. Encourage them to avoid giving an immediate "Yes" or "No" answer when friends want them to do something questionable. They can buy time to make a good decision by saying, "Maybe later," or "I'll wait and see." Let them use you as an excuse: "I will be grounded forever if I try that."

Good luck …and stay in touch,


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Dealing With Running Away

Hi Mark, My 16-year old granddaughter (who lives with her father) runs away from home fairly regularly ...usually 3-4 days at a time. And we never know where she stays during these stints. What can her father do to prevent this? What should he do if she does take off again? It's starting to become a real problem. And I worry about her safety. Thanks, A.


Hi A.,

Too many teenagers run away 'from' something, rather 'to' something. Many teenage runaways leave home in search of safety and freedom from what they “consider” or “perceive to be” abusive treatment. Running away from home is usually a quick decision.

Each year, an estimated 1 million children, usually between the ages of 13 and 17, run away from home. The National Runaway Switchboard estimates that the average age has dropped from 16 years to 15 years, with 38% under the age of 14. While many children think about running away or may threaten to run away at some point during their childhood, for most children it never goes beyond a threat. Increasingly, younger runaways appear to be from well-meaning families, and parents are taken by surprise at their child's actions. However, 41% of the runaways who called the National Runaway Switchboard in 1997 indicated that "family dynamics" was the main reason for running.

Other concerns may be abuse, poor grades, social issues, and stress from conflicts at home or at school. Also, the breakdown in extended communities may be a factor. In previous generations, when family tensions flared, the parents and adolescent might get some respite care from a grandparent or relative who lived in the neighborhood. It wasn't unusual for the teen to stay with grandmother for a while. Unfortunately, few families today have those options available within their community.

There are several reasons children run away from home. Some do so because of an unstable family situation (divorce, a death in the family, sexual or physical abuse, or drug or alcohol problems in the parents). Some run away as a response to over-control, neglect, or conditional love. Some seek to wield power over, get undue attention from, manipulate, or punish their parents. Some suffer acute personal crises like pregnancy, substance abuse, or trouble with the law. Some are depressed, and some just seek adventure or are influenced to run away by their peers.

It may be helpful for parents to understand some of the warning signs that may appear in a pre-adolescent or adolescent who is considering running away. The three main causes for running away:
  • Frequent family fights. Some of the most common issues are about the teen's behavior, grades, friends, clothes, or staying out late.
  • Situations at home where the child feels unable to cope. Running away is usually a cry for help and may be the child's way of escaping abuse, a stepparent, or dealing with the breakup of the parents' marriage. These problems may be the most difficult for the parent to deal with because the parent may not acknowledge the seriousness of the situation.
  • Worries that the child is afraid to tell you. Troubles at school—including bullying, suspension or poor grades, anxiousness about peer issues, sexual orientation or pregnancy, and alcohol or drug problems—are not unusual concerns for students.

Other reasons for running away include the following:
  • For some it is fear of consequences for something they have done (bad grades, taking something that didn't belong to them, breaking up with a boy- or girl-friend, even deciding they are gay or lesbian is often a reason to run away.
  • For some reason, running away makes them feel free, unsupervised, no curfew hours, homework, dress code, eating habits.
  • For some teens, running away is a rebellion against adults and against authority.
  • One problem teenagers have at home these days is that both parents may be working. Mom and Dad aren't around much. They spend little time as a family. Absence of a parent does not make the heart grow fonder. Oftentimes a runaway will complain that he or she is not loved any more.
  • Some young people at risk of running away or becoming homeless are experiencing violence. When talking about their families, they describe being shouted at, sworn at, blamed for everything, scapegoated, hit, pushed, shoved and threatened by their parents or stepparents.
  • Sometimes the problem has to do with money. They can't wear expensive clothes like some of their friends. They can't buy tickets to concerts, or go on dates. For many teens economic obstacles are hard to deal with. They feel they are victims. They believe the outside world is better.

Transition times, such as moving to a new community or school, are high-risk times for students, and they may fantasize about their previous community or have romantic ideas about life on the streets. Other warning signs might include increased tension and decreased communication between the parent and child or the teen's withdrawal. These and other indicators of depression should be noted in the child.

For some parents, the first realization that there is a problem is when the adolescent runs away; for others, the child may threaten in anger to leave. The typical runaway will likely not stay away for long, typically 48 hours to 14 days. Also, very few leave their immediate community; they will usually stay with friends. Most runaways come home of their own accord. However, it is important that a threat to run away is not ignored.

What can parents do to make their children stay at home? One simple 'win over' gesture is to communicate, listen, help, understand and try to solve the problems patiently.

You can protect your child by providing a better quality of life at home. A loving and happy home atmosphere with good communication will help your child to feel secure, which will make them think twice before running away from home. Parents who care will also weigh their decision in the light of what is in the best interest of the children. Parents do not want there children to become neurotic and paranoid. Just take the time to show your child the love and affection that they deserve and need. By doing this you will not have to worry about your child being among the number of runaways in the world today.

Parents might respond to the child by listening to the child's concern and helping the child develop some strategies to cope with the problem. It may also be helpful to suggest talking with an empathetic third party such as a family friend, relative, or counselor. Reassuring the child that he is loved, and able to work through his concerns rather than running away, may help. If the child does leave, take the following actions:
  • Check with friends and relatives who are close to the child.
  • Don't be afraid to seek outside help from people who are not directly involved if it is easier for the child to talk to them.
  • If you are unable to contact your child, call the local police.
  • Make them feel it was worth coming home by listening and trying to understand their concerns, then seeing what can be done to change things.
  • When your child does come home, you may react with relief and then anger. However, let your children know that you are upset because you love them and are worried about their safety.

Working together to build communication and to improve the quality of the relationship between the parent and teen may be the most effective prevention for running away.


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What do I do with this?


Well I started Phase 1 and set the boundaries of curfew and homework requirements. All was going fine, to my surprise. Now the weekend, and Nicole wanted a friend to stay over. I thought well she has been home on time all week and has cleaned her room and done her homework, so alright. Saturday, she decides to go out with her boyfriend. She calls me at 11:50 pm to see if she can stay the night at his house. I said absolutely not! She is to come home by curfew. Well she still is not home and it is now 9:30 am. What do I do with this? 3 days grounded? What? Please help.


Hi D.,

Assuming she has returned home by now, issue the least restrictive consequence first (e.g., grounded for one evening with no phone privileges). If she refuses to accept the least restrictive consequence, then withhold all privileges and ground her for 3 days.

Most importantly, however, issue the following warning and be prepared to back-up your words with action: “If you choose to violate curfew and spend the night at your boyfriend’s again, you will choose the consequence. The police will be called, and I will file a run away charge with juvenile probation.”

Tough love,


Online Parent Support

Condom Use?


What are your views on teens having sex with condoms? I'm not sure where to go with this one as my 17-year-old daughter is wanting to have sex with her 18-year-old boyfriend (and probably already is) but does not want to go on birth control.

Thanks in advance,



Hi J.,

I'd like to share some data with you rather than give my personal opinion on the matter. One of our goals at Online Parent Support is ongoing research. Our recent project tried a number of recruitment strategies with varying degrees of success. Fliers were distributed by project staff in a few high schools and at a weekly summer street fair in downtown Indianapolis that attracts large numbers of teens, and by community agencies to their clients. The street fair recruiting, community service agency referrals, and focus group participant referrals (snowball method) were quite successful.

In the summer of 2007, the OPS HIV Prevention Studies Group conducted:

·10 individual interviews with parents
·21 focus groups with 166 teen participants of mixed ethnicity, segmented by age gender and sexual orientation
·30 individual interviews with teens
·3 parent focus groups, consisting of 22 parents

Our focus group research found that ethnically diverse teens had common interests and attitudes:

·Although youth knew where to get condoms and had tried them, few kept them handy.
·One consequence of unplanned sex was that condoms weren’t talked about and often weren’t used.
·Sex often “just happened.”
·Sexual activity and the opposite sex were very important.
·Youth cited drug and alcohol use as another reason for unplanned sex and not using condoms.
·Youth knew a lot about HIV but perceived little risk.

Our research offered much information on how teens viewed and used condoms:

·Although many in the target audience had already tried condoms, and may have used them sometimes, the audience saw many barriers to consistent use (such as a bad condom experience, the status of their relationship, other birth-control methods).

·The formative research, consistent with national data, suggested that incorrect condom use was an issue: complaints of leakage and slippage suggested that condoms were not being used correctly.

·Like the national literature, local research indicated that youth were not likely to use a condom with a steady partner, as a sign of trust or love. Yet the formative research showed that local teens considered a partner as “steady” after a short period of time and without clear risk assessment.

·Local research indicated that youth had unplanned sex for many reasons: sex with friends, denial of a possibility of having sex, or the influence of drugs or alcohol. In these instances, local research and national data suggested that youth were not likely to use condoms.

Research participants mentioned several benefits to condom use – benefits that were consistent with national research and program experience:

· A way to follow peer norms, which say that they should use condoms
· Ability to act on distrust of a partner
· Ability to attain future goals
· Feeling in control
· Feeling self-respect
· HIV prevention
· Pregnancy prevention
· STI prevention
· Worrying less

In addition to the focus group/interview research, staff compiled all the information they had collected from secondary sources into an “environmental profile” that included local, regional, and statewide data relevant to the target audience, such as:

· Demographic and lifestyle data
· Drug and juvenile justice data
· Health statistics (such as HIV testing, STI, birth, and abortion rates)
· School enrollment rates

The research report also included condom sales data for the city and listings of local youth development and youth-serving programs.


Online Parent Support

Am I delusional or insane for even considering this?

A new member of Online Parent Support writes:

"I've found your website out of sheer desperation (bet you've heard that a time or two). I'm the step parent of an 18 year old boy who has been diagnosed in the past six months as being bipolar. He is abusing alcohol (no drugs as far as I can tell) and most days he has no respect for authority of any kind. Curfews are non existent and he can't hold a job. He was recently kicked out of a private catholic school ...and attempted suicide in October by overdosing on his meds.

The dilemma, number one he lives with his mom ...and she is demanding that his father and I ...take him. He is taking his meds, but not going to the weekly counseling that was recommended. His mother doesn't enforce any rules because she is afraid of him (he's been known to knock holes in the walls with baseball bats but has never injured anyone). Number two, his father travels out of state most of the time and I would be the primary person responsible for him if he were to come live with us.

...Am I delusional or insane for even considering this? Is moving something that would send him off the deep end completely? I will tell you that his relationship with his father is strong and his father is the calming factor in his life, something he readily acknowledges."


Hi L.,
I can't give you a simple, short answer for this one. The diagnosis of bipolar disorder in youth is often quite difficult, because the symptoms typically do not follow the symptoms and course of adult bipolar disorder. There is symptom overlap with several other more common childhood disorders. Also, many of the bipolar symptoms may be viewed as "normal but more extreme" childhood behaviors and emotional reactions. Underdiagnosis of childhood bipolar disorder has been noted by researchers, as has been underdiagnosis of many of these children's parents who are also bipolar.
Bipolar disorder is a severe mental illness manifested by recurrent episodes of depression, mania, and/or mixed symptom states. The expression of these symptoms (extreme shifts in mood, activity level, and behavior) significantly interferes with the child's functioning in the important arenas of his/her life - home, school, and peer interactions. In contrast to adult patients, children and some adolescents show a much greater percentage of mixed symptoms, expressing both depressive and manic behaviors at the same time (agitated dysphoria) or rapidly fluctuating moods.
Children may be irritable and hopeless, but also show increased recklessness and agitated thoughts and behavior simultaneously. Children most commonly present with a mixed and dysphoric picture, characterized by frequent short periods of intense mood lability and irritability, rather than classic euphoria - a picture of periods of hypomania interspersed with periods of dysphoria.
Up to 80% of children and adolescents who have bipolar disorder show complex cycling patterns, characterized by brief manic periods lasting four or more hours. Clearly defined episodes are less common. Most commonly seen is a mixed affective state without clear changes in eating and sleeping. Bipolar disorder beginning in childhood or early adolescence may be a more severe illness than in older adolescent or adult onset disease. Early episodic mood and energy symptoms/behavior seem to be at the core of an emerging bipolar disorder over an average interval of 10 plus years, as found in a study by Egeland.
In late adolescents with bipolar disorder, the most common mistaken diagnoses are schizophrenia (in up to 50% of cases) and conduct disorder. Attention deficit hyperactivity disorder has been the main differential problem in prepubertal and early adolescent patients. This differential problem is due to the high prevalence of coexisting ADHD among childhood onset bipolar disorder patients and from the overlap of certain DSM4 criteria for mania and ADHD (hyperactivity, distractibility and impulsivity).
Geller's research has demonstrated that although irritability is one of the most frequent symptoms of mania/hypomania at all ages, it is of little help in the differential diagnosis of children because of its ubiquity across childhood diagnoses (mania, major depressive disorder, ADHD, autism, and oppositional defiant/conduct disorders). Only a small percentage of children with irritability will have mania. Co-occurring irritability and elation is very frequent in both child and adult bipolar disorder.
There has been much controversy over the differentiation of mania from ADHD. The response or lack of response to stimulants is not diagnostically helpful. Geller found that of symptoms used to try to differentiate youth with ADHD from those with bipolar disorder, elated mood and grandiosity were symptoms best able to distinguish between the two groups. With bipolar disorder, hyperactivity may be more episodic. However, ADHD may be an initial manifestation of mania and is often comorbid with mania in children. A longitudinal study showed 98% of manic youths to also have ADHD.
Twenty-two percent of youth with ADHD met the criteria for mania. Prepubertal onset bipolar disorder is a nonspecific chronic rapid cycling mixed manic state that may co-occur with ADHD and conduct disorder or have features of ADHD and /or conduct disorder as initial manifestations. There is evidence that the high rate of comorbidity of ADHD with bipolar disorder may be an age dependent child manifestation that will decrease with age. The onset of bipolar disorder in those patients with a history of ADHD is between 11 and 12 years of age, according to several studies.
A developmental age specific view should be assumed when considering bipolar disorder in children and early adolescents, as most youth do not present with adult-like onset - i.e. people who have been functioning well until the abrupt onset of marked mania, which is responsive to treatment, and is followed by well-being between episodes.
Clear cut episodes are much less common in youths. There has been a shift of thinking from a "classic adult presentation" to a developmentally defined bipolar variant syndrome when considering children and young adolescents. Key features of this variant include a characteristic presentation of chronic mixed mania or continuous rapid cycling, marked irritability as the main mood abnormality, extreme and prolonged tantrums ("affective storms") and the frequent comorbidity of ADHD.
Many children who develop bipolar disorder develop a depressive disorder first. Of youth with major depression, 20-30% go on to develop mania. Psychosis is uncommon in prepubertal major depressive disorder, but delusions are a predictor of switching to mania in adolescent major depressive disorder.
Depressive symptoms include persistent sad or irritable mood, loss of interest in activities once enjoyed, significant change in appetite or body weight, difficulty sleeping or oversleeping, physical agitation or slowing, loss of energy, feelings of worthlessness or inappropriate guilt, difficulty concentrating, and recurrent thoughts of death or suicide. Early onset depressive disorder is associated with up to three times greater risk of bipolar disorder compared to adults.
Manic symptoms include severe changes in mood (either extremely irritable or overly silly and elated); overly inflated self-esteem, grandiosity; increased energy; decreased need for sleep (the ability to go with very little sleep); increased talking- talks too much, too fast, and changes topics too quickly; cannot be interrupted (pressured speech); distractibility (attention moves constantly from one thing to the next); hypersexuality (increased sexual thoughts, feelings or behaviors; use of explicit sexual language), increased goal directed activity or physical agitation; and disregard of risk (excessive involvement in risky behaviors or activities).
Pediatric mania can be difficult to diagnose. The major complicating difficulties in the diagnosis of pediatric mania are its overlap with ADHD, aggression, and conduct disorder, its overlap with substance abuse disorders, its association with trauma and adversity, and its response to treatment, which is atypical by adult standards.
Mania in children is seldom characterized by euphoric mood: the most common mood disturbance is severe irritability with "affective storms" (prolonged and aggressive temper outbursts). This type of manic irritability is severe, persistent, and often violent. In between outbursts, these children are described as persistently irritable or angry. Manic children often have a decreased need for sleep - not insomnia but an ability to function well on less sleep than normal. These children frequently receive a diagnosis of conduct disorder. Aggressive symptoms may be the primary reason for the high rate of psychiatric hospitalizations in manic children. Mania is often an antecedent and is strongly associated with substance use disorders, as well as a high risk for cigarette smoking.
Studies of prepubertal onset mania report high rates of comorbidity with several disorders, including anxiety disorders, oppositional defiant disorder, and conduct disorder. Mania at any age is frequently comorbid with severe anxiety. An association between early onset bipolar disorder and comorbid substance dependence and alcohol abuse has been described in young adolescents. Kovacs and Pollack found that the presence of comorbid conduct disorder in manic youths heralded a more complicated course of the bipolar illness.
The co-occurrence of mania and pervasive developmental disorders has been reported in the last few years. Children and adolescents with bipolar disorder almost always have other psychiatric disorders.
The incidence of mania appears to increase at the onset of puberty. The prevalence of mania during late adolescence is estimated to approximate that in adulthood. The prevalence of mania in childhood may be increasing. Earlier onset of bipolar disorder in successive birth cohorts has been reported.
Geller found that children are incapable of many manifestations of bipolar symptoms described in adults. She reports that five behavioral symptoms of childhood/early adolescence (which she views as equivalents of adult manic behavior) aid in correctly diagnosing childhood bipolar disorder. These manic symptoms, which do overlap with ADHD, are elation, grandiosity, flight of ideas/racing thoughts, decreased need for sleep, and hypersexuality (in the absence of abuse or overstimulation). She found that these five symptoms provide the best discrimination of childhood/early adolescent bipolar patients from uncomplicated ADHD patients.
Irritability, hyperactivity, accelerated speech and distractibility are very frequent in both childhood/early adolescent bipolar disorder and ADHD and are not useful in differentiating between these two diagnoses. Geller also found, however, that children and early adolescents with bipolar disorder have high rates of comorbid ADHD. Mixed mania (simultaneous mania and depression) is highly prevalent in childhood bipolar disorder. Mixed mania has been associated with worse outcomes in adults with mania.
The highest rates of onset of bipolar disorder for both males and females have been reported to be between 15 and 19 years of age. In the United States, half of the cases of bipolar are identified before 20. In the U.S., it is estimated that one third of persons with bipolar disorder receive treatment.
Many children with bipolar disorder are described by their parents of having had a difficult temperament in infancy. Great caution should be used in making a diagnosis of bipolar disorder in a young child with no family history of a psychiatric illness because of the difficulties in the diagnosis of young children with this disorder.
Bullying may be a developmental age specific manifestation of grandiosity. (Children who bully behave as though the rules and the law does not apply to them, similar to grandiose behaviors in older people.) About one-third of children with major depressive disorder develop bipolar disorder. Children with bipolar disorder who have histories of major depression often experience the onset of major depression before the onset of mania. Delusions are very uncommon in prepubertal bipolar patients.
When bipolar disorder begins before or soon after puberty, it is often manifested by continuous rapid cycling irritable and mixed symptoms, which may co-occur with disruptive behavior disorders. The rate of ultradian rapid cycling (mood disturbances occurring within 24 hours) is about 75% in bipolar children/early adolescents, much greater than in adult bipolar patients.
The ultradian rapid cycling (mixed state) is one in which children switch in and out of depression, irritable mania with explosions and euphoric "silly" mania unpredictably throughout the day, almost every day, with very little time spent in a regular age appropriate mood state. Despite this sort of chronicity, these children also are characterized by mood reactivity, and therefore may not show the abnormal moods the same way in all settings. Mixed mania, rapid cycling, and a chronic remitting course of illness has been reported in over 70% of prepubertal children with bipolar disorder.
In adolescents hospitalized with depression, several predictors have been reported to increase the likelihood that a patient will develop bipolar disorder - symptoms of psychomotor retardation, psychotic features, pharmacologic hypomania, and a family history of bipolar disorder. Although there are limited data on predictors of bipolar disorder in children, Post found that children who exhibited a combination of three or more of the following five symptoms - short attention span, grandiosity, irritability, racing thoughts, and suicidal gestures - had an 80% chance or more of developing bipolar disorder.
Psychotic features are a sign of more severe forms of depression and bipolar disorder. In bipolar disorder in children, psychotic symptoms are usually grandiose delusions, but can be mood incongruent hallucinations and paranoid delusions.
When psychotic symptoms are present in children and adolescents with mania, they are often misdiagnosed with schizophrenia. Schizophrenia is more likely to have an insidious onset, with no rush of speech or ideas or the engaging quality of mania and less likely to have a family history of mania. Patients with psychotic features are less responsive to treatment for bipolar disorder and depression.
The frequency of both bipolar disorder and major depressive disorder is elevated among the parents and relatives of childhood onset cases. For both bipolar and major depression, nongenetic factors interact with inherited vulnerability to determine the disorder.
Identification of an affective disorder in a child predicts the occurrence of both affective disorders and alcoholism in extended families. Conversely, paternal alcoholism influences the risk of offspring affective disorder. Therefore, the clinician who is caring for a bipolar child must look closely for parental psychopathology and/or alcoholism, which should be addressed with appropriate referrals. The clinician needs to continuously update the family history of the bipolar patient, as usually the parents are still within the age range of risk of developing a mood disorder.
Mania in childhood is associated with greater familial loading for affective illnesses than adolescent bipolar disorder. The risk of bipolar disorder in children in families with a strong family history of bipolar illness is high - about 40% in those with an affected parent and 25% in those with an affected second degree relative. Currently, there is no biological marker for either the genes associated with the major affective disorders or for the disorders.
Children with mania do not appear to grow out of it. Compared to adults, adolescents with bipolar disorder have a more prolonged early course and are less responsive to treatment. Mixed and rapid cycling presentations, which are more common in early onset cases, have a far more pernicious course than those with purely manic episodes. Adolescents with bipolar disorder have higher rates of completed suicide compared to those with unipolar depression.
Suicide is more common in mixed than manic presentations and increases with the severity of depressive symptoms. Important predictors of suicide include: a major depressive episode, comorbid substance abuse, past suicide attempts, a family history of major depression, and treatment with tricyclic antidepressants. Among adolescents, once bipolar is present or about to be, the risk of suicide attempts and completion rises dramatically. Manic symptoms and rapid cycling often trigger the suicide behaviors. Comorbid substance abuse and the availability of weapons further increase the risk.
Symptoms of mania can result from a variety of medical conditions, including prescription drug use (steroids, antidepressants, stimulants), neurologic disorders (head trauma, multiple sclerosis, temporal lobe seizures), systemic disorders (hyperthyroidism, porphyria) and substances of abuse (amphetamines, cocaine).
Symptoms of mania must also be distinguished from typical childhood behavior, including bragging, reckless behavior, overactivity and imaginary play. Also, the hypersexuality associated with mania can mimic the self-stimulatory and sexual acting out behaviors associated with children who have been abused or have witnessed adult sexual behavior.
There is a risk of overdiagnosis of bipolar disorder in children with conduct disorder and ADHD. The Mania Rating Scale (Fristad, Weller and Weller) has acceptable validity and reliability and can distinguish between manic and hyperactive children.
Prepubertal mania may follow a chronic course, characterized by high rates of relapse, psychiatric hospitalizations, chronicity, and the need for several medications (polypharmacy). Bipolar disorder is generally thought to be less responsive to treatment in adolescents than adults. Although the primary treatment of bipolar disorder is pharmacotherapy, individual and family psychoeducation is essential.
A good treatment plan generally includes medication, psychotherapy for the child, multi-family psychoeducational groups for the child and family, peer support for parents, and accommodations at school. Comprehensive psychosocial treatment is essential in the long term clinical management of children diagnosed with prepubertal mania. There is currently no standardized psychosocial treatment for early onset bipolar disorder, although this is currently being studied.
The treatment of ADHD in early onset bipolar disorder is controversial. Concern has been expressed about the use of psychostimulants to treat ADHD in children with mania and these drugs' potential risk for triggering affective episodes in vulnerable children. Clinical experience to date, however, suggest that stimulants, in combination with one or more mood stabilizers, may be safe and effective in the treatment of children with mania complicated by ADHD, and may result in improvement of the ADHD.
The use of mood stabilizers and antipsychotics in children and adolescents with bipolar disorder has increased significantly over the past decade. It is common practice to have patients continue on medications for some time after remission.
Several classes of psychotropic drugs have mood stabilizing properties, including lithium, valproate, carbamazepine, atypical antipsychotics (risperidone, olanzapine), and antiepileptic drugs (oxcarbazepine , clozapine, quetiapine, ziprasidone and aripiprazole). Data from recent studies suggest that many children and adolescents with bipolar disorder may require treatment with both mood stabilizers and an atypical antipsychotic to achieve a full response.
The atypical antipsychotics appear to be the most effective medication in stabilizing symptoms of childhood mania. Selective serotonin re-uptake inhibitors can cause activation that can be confused with mania or ADHD in children with bipolar disorder. Because additional medication for ADHD and depression may activate mania, these medications must be used cautiously, watching for exacerbation of mood instability in these patients.
A combined pharmacotherapy approach is often necessary to address the complicated comorbid clinical presentation. Neither antidepressant drugs or stimulant medications, with or without the concomitant antimanic drugs, predict recovery or relapse in these patients. Bipolar patients with comorbid substance abuse tend to have a less favorable response to medication treatment, specifically a poor response to lithium, than those without comorbid substance abuse.
In some cases, a less demanding academic course may be necessary on a temporary basis for these patients. Be sure to read the page in the eBook on this ==> CLICK HERE to go to that page. Children and adolescents who have difficulty managing their frustration in school may need special arrangements so that they do not disrupt others (allowing them to have a personal space which they can retreat to when necessary or allowing them to run laps around the school when they feel emotionally overwhelmed).
Bipolar disorder is a chronic, not uncommon disorder, with onset often beginning in childhood. Recurrence is common. Early onset mood disorders are often associated with an increased risk of developing other psychiatric disorders, substance abuse, and suicide and with poor academic, work, and social functioning. Studies have shown that children and early adolescents with bipolar disorder have a relatively poor outcome, compared to patients with adult onset bipolar disorder.
Intact families with positive interaction styles and less family dysfunction are associated with better outcomes in these patients. Low maternal warmth significantly predicts relapse after recovery. Psychiatric disorders among parents not only predicts the development of this disorder, but is associated with poor prognosis. More frequent episodes, increased severity, (particularly suicidality and psychosis) and comorbid disorders are likely to lead to fewer recoveries, longer episodes, and increased rate of recurrence.
The course of bipolar disorder in children and adolescents is typically a relapsing recurring illness with a substantial morbidity. Rates of relapse are quite high. Early onset bipolar illness has been associated with greater familial loading than adult onset illness, poor treatment response, and frequent recurrence.
A U.S. self-help organization, The Child and Adolescent, has a website for parents, which offers helpful information to families raising children or teens with early onset bipolar disorder.
This may be more info than you needed, but I felt it important to err on the side of giving you too much than not enough so you can make an educated decision on this very important matter.
Keep me posted on any new developments. And good luck. This will be a tough road, and you will need a lot of outside support from as many different sources as possible.

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Ground him FROM his room...

Hi Mark!

I just downloaded your book and plan on start reading it this afternoon. I do have a couple of questions. I have a 14 year old son. He is ADHD. I guess he is really just a typical teenager-back talk, not doing what he is told, slacking on his homework, etc. He isn't "out-of-control" in the sense of drugs, alcohol, etc. His father died as a result of a car accident right before he turned three.

I remarried two years later. My husband treats and loves him as if he was his own. We have a daughter who is six. There is a lot of jealous there (mostly from our son). We try to treat them equally but, it doesn't seem to matter what we do. Also, I honestly don't know what kind of punishment to give him if he does misbehave. During the school year he doesn't have t.v. or video games during the week and he isn't too social so I really feel that there isn't anything to "take away" from him or ground him from doing. Do you have any suggestions? He has a tendency to either stay in his room or stay in the den away from us. I really want this to change. I am really thinking that if he wants to watch t.v. or a movie that he needs to watch what the family is watching. He doesn't watch anything really violent or play violent video games but I think he is picking up stuff off shows that are supposed to be "PG-14" but is probably still to old for him to watch.

And, one last thing, we have a cat. I probably never should have gotten her. I had to put my other cat to sleep last year and within 2 months I was yearning for another cat. I thought that she would be something that the kids and I would enjoy and like having in the house. He pesters her to death. He doesn't physically hurt her but he constantly picks her up, hugs on her, lifts her in the air, etc. We have talked until we are blue in the face. The poor thing goes and hides in her litterbox to get away. I have gone so far as to contact the people that I got her from so they can take her back. I feel guilty because I don't want to give her back but we cannot continue to yell and scream and he not stop bothering her. We have a golden retriever also but he is big enough to get away and lets him know to stop.

Well, any suggestions that you may have will be greatly appreciated. I look forward to reading your book and am in hopes that out of all the things that I have read and tried that this will be the answer.

Thanks so much!



Hi J.,

The best thing to do at this point would be to digest most of the material in the eBook. Many of your immediate questions will be answered there.

In the meantime, in those cases where the only thing a child enjoys is hiding in his bedroom, a very effective consequence is to ground the child FROM his room. Look at his room as just another privilege that can be taken away whenever he needs a consequence. (As a footnote, he really should have one hour of T.V. and/or video game privileges through the week -- as long as it can be monitored by an adult.)

Re: the cat. I think the best course of action would be to give the cat up for adoption. Your son knows he can push your buttons when it comes to mistreating it – and he will continue to do so as long as the cat is in the home.


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Let him suffer the consequences...?

I read the comments about children not doing well in school. The understanding I get from that is not to push and nag them to do homework. Let them suffer the consequences. So does that mean that if he has a test to study for, or an assignment due that I should let him do whatever he wants and other than the schoolwork? He would rather sit in front of the game cube and play all night long if I let him. Do I take the gamecube away from him for 3 days? Could you please reply back to me by e-mail. Thanks. G.


Hi G.,

If poor academic performance is an ongoing source of parent-child conflict - AND if your son has a history of poor academic performance, then you will do well to follow the advice in the eBook.

Should you let him do whatever he wants? No.

Set aside a 1-hour block of time (e.g., 7:00 PM to 8:00 PM five days a week) for him to do homework. He can choose to do homework, or he can choose to NOT be able to play his Game Cube. Let him decide.

If he chooses NOT to do homework for that hour, he does NOT have access to Game Cube or any other toy – but, after one hour, he can play again.

School/homework is your son’s job. The more you take responsibility for it, the less responsibility he will take.


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Elite Family Specialists CIC

Dear Mark,

Many thanks for all the information you have sent to me this has been extremely helpful to both my colleague and myself as we have recently set up our own company dealing with early intervention.

This is a relatively new concept in the U.K. and we have found your perspective on this matter to be more advanced and if you have any more information you feel would be of relevance to ourselves we would appreciate your input.

We look forward to hearing from you in the near future.

Best Regards,

for Elite Family Specialists CIC

Dee Bracken
Tel. 0191 516 0167 Mob. 07721619818

My ODD Child

Hi N.,

Please look for these arrows below: ====>

On Jan 9, 2008 2:28 PM, N. wrote:

Good afternoon,

I purchased your e-book last night, and as I am reading it, it seems to be more appropriate for teens. (I just started looking thru).

===> There are some age-specific parenting strategies, but as long as your child is living in your home, 98% of the techniques will apply regardless of age.

2 yrs ago our dream of becoming parents became true through adoption when we were match up with 3 adorable siblings. Our daughter is 5yrs and her twin brothers are 4. We are blessed, they are adorable children, but we are having behavioral problems with our daughter. She seems to be able to control herself when we are at home or when ever I'm around (I 'm very firm with them and one way or another she seem to listen to me) but the minute I leave her side she becomes in a little devil. At school she is driving everyone crazy. And the worst is that the twins are starting to pick up some of her bad behavior.

She lies, and lies and even when we confront her with the true, she will not give in admitting the truth, answers back, don't follow orders, disrupt the class and is very "bossy". I don't know what to do any more because she doesn't mind or care for time outs, or taking privileges out from her; playing time, movie time, tv time or toys away.

===> She may not care when things are taken away, but she enjoys having her things returned. Follow the method in the eBook for this.

We are taking her to therapy once a week and here she was diagnosed with ODD but that doesn't seem to be helping at all.

===> Therapy will be a waste of your time and money. It is just another "traditional" parenting strategy that has little or no effect with ODD kids. Stick with the strategies in the eBook.

We have been following 1-2-3- Magic, but it doesn't work with her behavior. I find my self getting very angry, disappointed and hopeless.

====> Be sure to read (and listen to the audio files) in the Anger Management Chapter (online version).

I want to enjoy time with her and not feel that she is manipulating us. Unfortunately we don't have any past medical or family history of our children. Please help me out !!!!! And guide me to what direction I should follow?

====> Normal, healthy mothers - even the very young ones - rarely give up their children for adoption. Over 90% of adopted children come from very young mothers who, too often, also have a drug/alcohol addiction of some kind. In addition, many of these mothers who gave their child up for adoption have significant mental health issues ( e.g., ADHD, Bipolar Disorder, etc.). So it's a fairly safe assumption that your adopted daughter will also have some mental health issues - as well as have a genetic predisposition to drug addiction.

It will be terribly important for your daughter's teacher to educate herself about how to relate (and influence) a child with ODD. If she doesn't take the time to adopt some different teacher-student interactions with your daughter, the problems will continue.


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Daughter Refuses To Attend School Regularly

Mark: I need help. We (my ex-wife and myself) cannot get our daughter to go to school. When she lived with me she missed nearly all of her freshmen year. She is a sophomore at Anderson High School. She has missed most of this year. She claims that she is sick all the time. However, it seems funny to me that she is never sick on the weekends nor was she sick during Christmas vacation. It is apparent to me that she just doesn't want to go to school. She has been to the Anderson Center. We have went to court where the Judge awarded my ex-wife temporary physical custody of my daughter. Now that she lives with her, my ex has the same issues that I had with our daughter. She just will not go to school on a regular basis. Please advise what can we do to resolve this issue. All I want is for my daughter to be in school to get her education. Sincerely, T.


Hi T.,

Going to school usually is an exciting, enjoyable event for children. For some it brings intense fear or panic. Parents should be concerned if their child regularly complains about feeling sick or asks to stay home from school with minor physical complaints. Not wanting to go to school may occur at anytime, but is most common in children 5-7 and 11-14, times when children are dealing with the new challenges of elementary and middle school. These children may suffer from a paralyzing fear of leaving the safety of their parents and home. The child's panic and refusal to go to school is very difficult for parents to cope with, but these fears and behavior can be treated successfully, with professional help.

School refusal is:
  • equally common among boys and girls and is most likely to occur between age 5 to 11
  • highest when schools reopen after summer
  • defined as the behavior of resisting or refusing to attend a specific class or to stay in school for an entire day
  • may be accompanied by one or more of the following behaviors: complaints about stomach pain, headache, or nausea before or during school; crying before and during school; frequent visits to the school nurse; temper tantrums; specific fears; anxiety or sadness

School "refusers" tend to:
  • feel that others see them in a negative way
  • become unduly self-conscious and avoid social situations in which they fear others may criticize them or make fun of them behind their back
  • have negative and troublesome relationships with their peers
  • get teased by mischievous children or harassed by a bully
  • be reluctant to go to school because of an appearance and self-esteem problem, or social "image" problem prompted by a school rumor or being let down by a friend
  • be depressed and experience significant difficulty in getting up and getting out of bed in the morning.

Refusal to go to school often begins following a period at home in which the child has become closer to the parent, such as a summer vacation, a holiday break, or a brief illness. It also may follow a stressful occurrence, such as the death of a pet or relative, a change in schools, or a move to a new neighborhood.

Children with an unreasonable fear of school may:
  • feel unsafe staying in a room by themselves
  • display clinging behavior
  • display excessive worry and fear about parents or about harm to themselves
  • shadow the mother or father around the house
  • have difficulty going to sleep
  • have nightmares
  • have exaggerated, unrealistic fears of animals, monster, burglars
  • fear being alone in the dark
  • have severe tantrums when forced to go to school

School refusers otherwise tend to be compliant, well-behaved, and academically smart kids. Unlike truants, they stay home only with their parents' knowledge. Generally, they have a close relationship with one or both parents. Overall, they are good kids. So the question arises why does a child who wants to comply with the parents' wishes and be good, drive them nuts in the morning when it's time to get ready for school?

Children refuse to go to school for a reason, and we parents should determine what that reason is.

Such symptoms and behaviors are common among children with separation anxiety disorder. The potential long-term effects (anxiety and panic disorder as an adult) are serious for a child who has persistent separation anxiety and does not receive professional assistance. The child may also develop serious educational or social problems if their fears and anxiety keep them away from school and friends for an extended period of time.

When fears persist the parents and child should consult with a qualified mental health professional, who will work with them to develop a plan to immediately return the child to school and other activities. Refusal to go to school in the older child or adolescent is generally a more serious illness, and often requires more intensive treatment.

Excessive fears and panic about leaving home/parents and going to school can be successfully treated.

For children who refuse to go to school in order to avoid a difficult social encounter, teach them effective social behaviors such as, learning to say "no" assertively, seeking help from adults, and making new friends. Seek help from school authorities if there is a genuine concern for the safety of your child.

Don't make staying home more rewarding than going to school. Eliminate or reduce all incentives for staying home. On the contrary, attach rewards and incentives to going to school and staying there throughout the school hours.

Having investigated the possible causes and offered your support as a parent, you may have to "push" your child out to school. You may have to learn to ignore the tantrums, complaints, and the pleading to "let me stay home just for today."

Children who are clinically depressed or who suffer from an anxiety disorder need professional help. Some medications cause sluggishness and may make it difficult for a child to be alert and active in morning. In such event, consult your doctor.


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She moved out...

Dear Mark,

Well, my daughter turned 18 and she did move out with her boyfriend and his mother. I heard she did not go to school today. I am wondering what responsibility do I have with her still in school? Maybe this is the wrong question to ask, but I am trying to make sense of this.

I want you know that I did say they could date, but she would still have to obey our guidelines in our home. She didn't think she could do this, so she wanted out. Thank you, M.


Hi M.,

I think it's good that she's out - that's o.k. for everybody. She doesn't have to attend school at her age - it's optional. She'll eventually realize she needs to at least get a GED. She won't want to work at McDonald's her whole life.

Look at her as more like an adult friend now (rather than your "pain-in-the-ass" daughter).


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Insecure Attachment

Hi L.,

Please look for my comments where you see these arrows: =======>

Dear Mark,

I'm writing again about my adopted girl now 14 years old. As you know we have been having problems with her since she was around 10. We have been through the whole counseling routine, where she manipulates and all, but now are involved in a so called family counseling service and for the most part I think they have been very good at not letting her call the shots and call her on things they see, instead of everything being the parents fault.

I not saying we haven't made mistakes, the main one being as parents we do disagree on some of the accepted behaviors. Since we cannot agree on how to discipline even when we agree on the rules, this has left her open to manipulate one of us, usually my husband.

She basically knows what I will accept and since I have tried to remove the emotion from my statements and have tried to put the ball in her court as far as relationship goes, she has been better with me, but then sets her sights on my husband. He can't do what I do, he states he just has to be himself and if he cares about someone he can't pretend he doesn't when they are making mistakes or hurting his feelings. I get this too but that doesn't help her.

============> Keep in mind that a weaker plan supported by both parents is much better than a stronger plan supported by only one.

Her latest psychological evaluation states her diagnosis as insecure attachment. Different from RAD I'm told but very difficult to find information on.

===========> “Insecure attachment” is a “problem with relationships” – it takes two people (e.g., child and parent). “RAD” is a disorder within the child. The purpose of labeling a parent-child relationship “insecure” is not to blame parents who love and intend the best for their children, but may be products themselves of insecure attachment, trauma or depression. Separation can also be a factor that contributes to insecure attachment. Insecure attachment and the developmental disruptions they can cause are often passed from one generation to the next unless steps are taken to repair what has been damaged. And it sounds like you are helping with “repair.”

She is very bright and is a good student who likes school and did excel at athletics until recently when she seems to exhibit very little interest into things she used to at least do and enjoy. She seems perfectly happy to spend as much time at home being non-compliant and lie in front of the TV.

===========> Watching TV doesn’t involve “relationship” – thus it is a “self-soothing” behavior for her to engage in. (She could be out doing worse things.)

My instincts tell me to not get involved with the sports situation as long as school is going well, and we have the other issues at home to deal with and let the natural consequences occur with sports but my husband feels she is wasting so much talent and ability and this could only help her in her future. My question is how far should we go to encourage her in sports and should she earn it and could you please check on some information for me of her new diagnosis.

==========> Go with your instinct. I think you have bigger fish to fry than worrying about sports. Encourage? Yes. Insist? No. If she decides to pursue sports, the “practice” that comes with any sport will be how she earns it.


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