HELP FOR PARENTS WITH STRONG-WILLED, OUT-OF-CONTROL CHILDREN AND ADOLESCENTS

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

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Handling Homework Hassles

Tired of arguing, nagging and struggling with your child to get him to do homework? Are you discovering that bribing, threatening, and punishing yield very few positive results? Here are 15 important tips that, if implemented in your home with consistency and an open heart, will reduce homework struggles significantly:

1. Allow kids to make choices about homework and related issues. They could choose to do study time before or after dinner. They could do it immediately after they get home or wake up early in the morning to do it. Invite them to choose the kitchen table or a spot in their own room. One choice kids do not have is whether or not to study.

2. Back up words with actions. Make it clear that choosing not to do study is choosing not to enjoy certain privileges. Say, “If you choose not to study, then you will choose not watch TV, listen to music or use the telephone. The choice is yours.”

3. Eliminate the word “homework” from your vocabulary. Replace it with the word “study.” Have a “study time” instead of a “homework time.” Have a “study table” instead of a “homework table.” This word change alone will go a long way towards eliminating the problem of your youngster saying, "I don't have any homework." Study time is about studying, even if you don't have any homework. It's amazing how much more homework children have when they have to study regardless of whether they have homework or not.

4. If Tip #1 does not work, then you may need to establish a study routine. This needs to be the same time every day. Let your kids have some input on when study time occurs. Once the time is set, stick to that schedule. Children thrive on structure even as they protest. It may take several weeks for the routine to become a habit. By having a regular study time you are demonstrating that you value education. Keep the routine predictable and simple. One possibility includes a five minute warning that study time is approaching, bringing their current activity to an end, clearing the study table, emptying their back pack of books and supplies, then beginning.

5. Help without over-assistance. Only help if your youngster asks for it. Do not do problems or assignments for kids. When your youngster says, "I can't do it," suggest they act as if they can. Tell them to pretend like they know and see what happens. Then leave the immediate area and let them see if they can handle it from there. If they keep telling you they don't know how and you decide to offer help, concentrate on ‘asking’ rather than on ‘telling’. For example: "Can you give me an example?" … "How could you find out?" … "What do you get?" … "What do you think the answer is?" … "What parts do you understand?"

6. If you want a behavior – you have to teach a behavior. Disorganization is a problem for many school age kids. If you want them to be organized, you have to invest the time to help them learn an organizational system. Your job is to teach them the system. Their job is to use it – and check occasionally to see if the system is being used. Check more often at first. Provide direction and correction where necessary. If your youngster needs help with time management, teach them time management skills. Help them learn what it means to prioritize by the importance and due date of each task. Teach them to create an agenda each time they sit down to study. Help them experience the value of getting the important things done first.

7. It's their Problem. Their pencils have to move. Their brains need to engage. Their bottoms need to be in the chair. It is their report cards that they bring home. Too many moms and dads see homework as the parent's problem. So they create ultimatums, scream and shout, threaten, bribe, scold, and withhold privileges. Have you noticed that most of these tactics don’t work? Our responsibility as moms and dads is to provide our kids with an opportunity to do homework. Our job is to provide structure, to create the system. The youngster's job is to use the system.

8. Most kids do not like to do homework. Children do not enjoy sitting and studying. At least, not after having spent a long school day comprised mostly of sitting and studying. So give up your desire to have them like it. Focus on getting them to do it.

9. Notice when your youngster completes homework. “I really like the way you’re getting your study time done. That’s what I expect from you.”

10. Replace monetary and external rewards with encouraging verbal responses. End the practice of ‘paying for grades’ and going on a special trip for ice cream. This style of bribery has only short term gains and does little to encourage kids to develop a lifetime love of learning. Instead make positive verbal comments that concentrate on describing the behavior you wish to encourage. For example: "All your letters are right between the lines. I'll bet your teacher won't have any trouble reading this." … "I notice you stayed up late last night working on your term paper. It probably wasn't easy saving that much to the end, but your efforts got it done." … "I see you got the study table all organized and ready to go early. Looks like initiative and responsibility hooked together to me." … "You followed the directions exactly and finished in 15 minutes."

11. State clearly how you expect study time to be done. Tell your youngster, “I expect you to do all your studies, every night. Under no circumstances will I tolerate you not doing study time.”

12. Talk to the teacher. If the problem continues, ask the teacher to back up your efforts by providing additional discipline for homework assignments not completed.

13. Consider drafting a “study time contract.” Make a written agreement with your youngster that states something like, “Each day you complete study time, you will earn one point. When you have earned five (or ten) points, you will earn a special privilege.”

14. Use study time to get some of your own responsibilities handled. Do the dishes, fold laundry, or write thank you notes. Keep the TV off! If you engage in fun or noisy activities during that time, kids will naturally be distracted. Study time is a family commitment. If you won't commit to it, don't expect that you kids will.

15. You cannot make anyone do study time. You cannot make your youngster learn. You cannot make him hold a certain attitude. You cannot make him move his pencil. But you can assist. Concentrate on assisting by sending positive invitations. Invite and encourage your youngster using the ideas above.

My Out-of-Control Teen: Help for Parents

Helping Children Through Divorce

The following suggestions can make the process of divorce less painful for children, teenagers, and families. Honesty, sensitivity, self-control, and time itself will help the healing process. Be patient! Not everyone's timetable is the same.

1. Encourage children to openly discuss their feelings — positive or negative — about what's happening.

It's important for divorcing — and already divorced — parents to sit down with their children and encourage them to say what they're thinking and feeling. But you'll need to keep this separate from your own feelings. Most often, kids experience a sense of loss of family and may blame you or the other parent — or both — for what is going on in their lives. So, you'll really need to be prepared to answer questions your children might raise or to address their concerns.

Make talking about the divorce and how it's affecting your children an ongoing process. As children get older and become more mature, they might have questions or concerns that they hadn't thought of earlier. Even if it seems like you've gone over the same topics before, keep the dialogue open. If possible, sit down with the other parent and plan how you're going to talk to your youngster or kids about what is going on.

If you feel like you may get too upset, ask someone else (a relative, maybe) to talk to them. It's OK for children to see their moms and dads feel sad or upset, but getting very emotional can make children feel responsible for their parents' feelings. Group programs for children of divorce run by schools or faith-based organizations are an excellent resource for children and families who need some help to get through these early stages.

It's natural for children to have many emotions about a divorce. They might feel guilty and imagine that they "caused" the problem. This is particularly true for the many children who overheard their moms and dads arguing about them. Children and teenagers may feel angry or frightened, or worried about their future.

Although children may struggle with a divorce for quite some time, the real impact is usually felt over about a 2- to 3-year period. During this time, some will be able to voice their feelings but, depending on their age and development, other children just won't have the words. They may instead act out or be depressed. For school-age children, this is usually evident when their grades drop or they lose interest in activities. For younger kids, these feelings are often expressed during play, too.

It may be tempting to tell a youngster not to feel a certain way, but children (and adults, for that matter) have a right to their feelings. And if you try to force a "happy face," your children may be less likely to share their true feelings with you.

2. Keep adult conflict and arguments away from the children.

This is one of the hardest things to do. But it's important never to say bad things about your ex in front of your children, or within earshot. You'd be surprised at how good children can be to picking up on these things. Research shows that the single biggest factor in long-term adjustment for children of divorce is the level of parental-conflict they are exposed to. It puts children in really difficult positions if they want to or have to take sides, or listen to negative things said about one of their moms and dads.

It's equally important to acknowledge real events. If, for example, one spouse has simply abandoned the family by moving out, you need to acknowledge what has happened. It isn't your responsibility to explain the ex-spouse's behavior — but if your children want to ask you questions, it's important to answer as neutrally and as factually as possible.

3. Try not to use children as messengers or go-betweens, especially when you're feuding.

Even though it is tempting, don't use your children as messengers. There are plenty of other ways to communicate with your ex-partner. Also, resist questioning your youngster about what is happening in the other household — children resent it when they feel that they're being asked to "spy" on the other parent. Wherever possible, communicate directly with the other parent about relevant matters, such as scheduling, visitation, health issues, or school problems.

4. Expect resistance and difficulties as children adjust to a new mate or the mate's children.

New relationships, blended families, and remarriages are among the most difficult aspects of the divorce process. A new, blended family can add more stress for a while, and can cause another period of adjustment. Keeping lines of communication open, allowing one-on-one time for parents and children, and watching for signs of stress can help prevent problems developing.

5. Figure out how to reduce stress in your life to help your family.

Support from friends, relatives, church and religious groups, and organizations such as “Parents Without Partners” can help moms and dads and their children adjust to separation and divorce. Children can meet others who've developed successful relationships with separated parents and can confide in each other. Getting support can help parents find solutions to all kinds of practical and emotional challenges.

Whenever possible, children should be encouraged to have as positive an outlook on both parents as they can. Even under the best of circumstances, separation and divorce can be painful and disappointing for many children.

Moms and dads also need to remember to take care of themselves. Find your own way to reduce stress in your life by finding supportive friends and asking for help when you need it. Try to keep some old family traditions, while building new memories to share. Showing your children how to take good care of mind and body during difficult times can help them become more resilient in their own lives.

My Out-of-Control Teen: Help for Parents

Taming Temper Tantrums in the Strong-Willed Child

Moms and dads expect temper tantrums from a 2-year-old, but angry outbursts don't necessarily stop after the toddler years. Older children sometimes have trouble handling anger and frustration, too. Some children only lose their cool on occasion, but others seem to have a harder time when things don't go their way. Children who tend to have strong reactions by nature will need more help from moms and dads to manage their tempers.

Here are 20 "temper-taming tips” for the "strong-willed" child:

1. By the time you arrive at the scene of the fight, you may be at the end of your own rope. After all, the sound of screaming is upsetting, and you may be frustrated that your children aren't sharing or trying to get along. (And you know that this toy they're fighting over is going to be lost, broken, or ignored before long anyway!). In these situations, the best thing to do is for you to maintain your own self-control intact. Teaching by example is your most powerful tool. Speak calmly, clearly, and firmly — not with anger, blame, harsh criticisms, threats, or putdowns.

2. Create clear ground rules and stick to them. Set and maintain clear expectations for what is and what is not acceptable. You can do this without using threats, accusations, or putdowns. Your youngster will get the message if you make clear, simple statements about what's off limits and explain what you want him or her to do. You might say: "There's no yelling in this house. Use your words to tell me what's upsetting you."

3. Encourage your youngster to take control. Compare a temper to a puppy that hasn't yet learned to behave and that's running around all over the place getting into things. Puppies might not mean to be bad — but they need to be trained so that they can learn that there's no eating shoes, no jumping on people or certain furniture, etc. The point is that your youngster's temper — like a puppy — needs to be trained to learn when it's OK to play, how to use all that extra energy, and how to follow rules.

4. Find a way to (safely) get the anger out. There may be no punching walls or even pillows, but you can suggest some good ways for a youngster to vent. Doing a bunch of jumping jacks, dancing around the bedroom, or going outside and doing cartwheels are all good choices. Or your youngster can choose to write about or draw a picture of what is so upsetting.

5. Help children put it into words. If your youngster is in the midst of an outburst, find out what's wrong. If necessary, use a time-out to get your youngster to settle down or calmly issue a reminder about house rules and expectations — "There's no yelling or throwing stuff; please stop that right now and cool your jets." Remind your youngster to talk to you without whining, sulking, or yelling. Once your youngster calms down, ask what got him or her so upset. You might say, "Use your words to tell me what's wrong and what you're mad about." By doing this you help your youngster put emotions into words and figure out what, if anything, needs to be done to solve the problem.

6. Help them label emotions. Help children get in the habit of saying what they're feeling and why — for example, "I'm mad because I have to clean my room while my friends are playing." Using words doesn't get a youngster out of doing a chore, but having the discussion can calm the situation. You're having a conversation instead of an argument. Praise your youngster for talking about it instead of slamming the door, for instance.

7. If it's uncharacteristic for your youngster to have a tantrum, on the rare occasion that it happens, all you may need to do is clearly - but calmly - review the rules. "I know you're upset, but no yelling and no name-calling, please" may be all your youngster needs to gain composure. Follow up by clearly, calmly, and patiently giving an instruction like "tell me what you're upset about" or "please apologize to your brother for calling him that name." In this way, you're guiding your youngster back to acceptable behavior and encouraging self-control.

8. Children that have learned that it's not OK to yell or hit or throw stuff when they're upset need other strategies for calming down when they're angry. Offer some ideas to help them learn safe ways to get the anger out or to find other activities that can create a better mood.

9. Learn to shift. Explain that part of calming down is moving from a really angry mood to a more in-control mood. Instead of thinking of the person or situation that caused the anger, encourage your son or daughter to think of something else to do. Suggest things to think of or do that might bring about a better mood. Your youngster may feel better after a walk around the block, a bike ride, playing a game, reading a favorite book, digging in the garden, or listening to a favorite song. Try one of these things together so you both experience how doing something different can change the way a person feels.

10. Listen and respond. Once your youngster puts the feelings into words, it's up to you to listen and say that you understand. If your youngster is struggling for words, offer some help: "so that made you angry," "you must have felt frustrated," or "that must have hurt your feelings." Offer to help find an answer if there's a problem to be solved, a conflict to be mended, or if an apology is required. Many times, feeling listened to and understood is all children need to regain their composure. But while acknowledging your youngster's feelings, it's important to make it clear that strong emotions aren't an excuse for unacceptable behavior. "I know you're mad, but it's still not OK to hit." Then tell your youngster some things to try instead.

11. Reacting to a child’s meltdown with yelling and outbursts of your own will only teach him/her to do the same. But keeping your cool and calmly working through a frustrating situation lets you show — and teach — appropriate ways to handle anger and frustration.

12. Regulating emotions and managing behavior are skills that develop slowly over time during childhood. Just like any other skills, your children will need to learn and practice them, with your help.

13. Remember that you're trying to teach your youngster how to handle anger. If you yell or threaten, you'll model and ingrain the exact kinds of behavior you want to discourage. Your children will see that you're so angry and unable to control your own temper that you can't help but scream.

14. See that children get a lot of physical activity. Active play can really help children who have big tempers. Encourage outside play and sports your youngster likes. Karate, wrestling, and running can be especially good for children who are trying to get their tempers under control. But any activity that gets the heart pumping can help burn off energy and stress.

15. Take a break from the situation. Tell your children that it's OK to walk away from a conflict to avoid an angry outburst. By moving to another part of the house or the backyard, a youngster can get some space and work on calming down.

16. To help tame a temper, try to be your youngster's ally — you're both rooting for your youngster to triumph over the temper that keeps leading to trouble.

17. Try to be flexible. Parenting can be a tiring experience, but try not to be too rigid. Hearing a constant chorus of "no" can be disheartening for children. Sometimes, of course, "no" is absolutely the only answer — "no, you can't ride your bike without your helmet!" But other times, you might let the children win one. For instance, if your youngster wants to keep the hide-and-seek game going a little longer, maybe give it 15 more minutes.

18. Try to be patient and positive, and know that anger-control skills take time to develop …and that just about every youngster can improve with the right parent-coaching.

19. Whether you're reacting to an occasional temper flare-up or a pattern of outbursts, managing your own anger when things get heated will make it easier to teach children to do the same.

20. While your own patience may be frayed by angry outbursts, opposition, defiance, arguing, and talking back, it's during these episodes that you need your patience most!!! Of course you feel angry, but what counts is how you handle that emotion.

As anyone who's been really angry knows, following sensible advice can be tough when emotions run high. Give your children responsibility for getting under control, but be there to remind them how to do it. Most children can learn to get better at handling anger and frustration. But if your youngster frequently gets into fights and arguments with friends, siblings, and adults, additional help might be needed. Talk with the other adults in your youngster's life — teachers, school counselors, and coaches might be able to help, and your youngster's pediatrician can recommend a counselor or psychologist.

Help for Parents with Out-of-Control Children and Teens

Leaving Children Home Alone: Tips for Parents

Parents are naturally a bit anxious when first leaving children without supervision, but you can feel prepared and confident with some planning and a couple of trial runs.

Handled well, staying home alone can be a positive experience for children, helping them gain a sense of independence and confidence.

It's obvious that a 4-year-old can't go it alone, but that a 15-year-old probably can. But what should you do about those school-aged children in between? It can be difficult to know when children are ready to handle being home alone. Ultimately, it comes down to your judgment about what your youngster is ready for.

You'll want to know how your youngster feels about the idea, of course. But children often insist that they'll be fine long before moms and dads feel comfortable with it. And then there are older children who seem afraid even when you're pretty confident that they'd be just fine. So how do you know?

In general, it's not a good idea to leave children younger than 10 years old home alone. Every youngster is different, but at that age, most children don't have the maturity and skills to respond to an emergency if they're alone.

Think about the area where you live. In case of an emergency, are there neighbors nearby you know and trust to help your youngster? Or are they mostly strangers? Do you live on a busy street with lots of traffic? Or is it a quiet area? Is there a lot of crime in or near your neighborhood?

It's also important to consider how your youngster handles various situations. Here are a few questions to think about:
  • Can your youngster understand and follow safety measures?
  • Does your youngster follow your instructions about staying away from strangers?
  • Does your youngster know basic first-aid procedures?
  • Does your youngster make good judgments or is he or she prone to taking risks?
  • Does your youngster show signs of responsibility with things like homework, household chores, and following directions?
  • Does your youngster understand and follow rules?
  • How does your youngster handle unexpected situations? How calm does your youngster stay when things don't go as planned?

Practice first. Even if you're confident about your youngster's maturity, it's wise to make some practice runs, or home-alone trials, before the big day. Let your youngster stay home alone for 30 minutes to an hour while you remain nearby and easily reachable. When you return, discuss how it went and talk about things that you might want to change or skills that your youngster might need to learn for the next time.

Prepare for emergencies. You can feel more confident about your absence if your youngster learns some basic skills that might come in handy during an emergency. Organizations such as the American Red Cross offer courses in first aid and cardiopulmonary resuscitation (CPR) in local places like schools, hospitals, and community centers. Before being left home alone home alone, your youngster should be able to complete certain tasks and safety precautions, such as:
  • knowing how to work the home security system, if you have one, and what to do if the alarm is accidentally set off
  • knowing when and how to call 911 and what address information to give the dispatcher
  • locking and unlocking doors
  • operating the microwave
  • turning lights off and on
  • working the phone/cell phone (in some areas, you have to dial 1 or the area code to dial out)
  • knowing what to do if (a) a stranger comes to the door, (b) someone calls for a parent who isn't home, (c) the smoke alarm goes off, (d) there's a power outage, (e) there's a small fire in the kitchen, or (f) there's a tornado or other severe weather

Regularly discuss some emergency scenarios — ask what your youngster would do if, for example, he or she smelled smoke, a stranger knocked at the door, or someone called for you while you're gone.

Things To Do Before You Leave—

Even after you decide that your youngster is ready to stay home alone, you're bound to feel a little anxious when the time comes. Taking these practical steps can make it easier for you both:

• Set up a schedule for calling. You might have your youngster call right away if he or she is coming home to an empty house, or set up a time when you'll call home to check in. Figure out something that's convenient for both of you. Make sure your youngster understands when you're readily available and when you might not be able to answer a call.

• Make sure your house has everyday goods and emergency supplies. Stock the kitchen with healthy foods for snacking. Leave a precise dose of any medication that your youngster needs to take, but don't leave medication bottles out as this could lead to an accidental overdose or ingestion, especially if younger siblings are also present. In addition, leave flashlights in an accessible place in case of a power outage. Post important phone numbers — yours and those of friends, family members, the doctor, police, and fire department — that your youngster might need in an emergency.

• Be sure that you (a) create a list of friends your youngster can call or things your youngster can do if lonely, (b) leave a snack or a note so your youngster knows you're thinking of him or her, (c) make sure the parental controls and filtering systems are programmed for the Internet on your computer and on your TV, and (d) take up a schedule for your youngster to follow while you're away.

• No matter how well your youngster follows rules, be sure to secure anything that could be a health or safety risk. Lock them up and put them in a place where children can't get to them or, when possible, remove them from your home. These items include:
  • alcohol
  • car keys
  • guns (if you do keep one, make sure it is locked up and leave it unloaded and stored away from ammunition)
  • lighters and matches
  • over-the-counter medications that could cause problems if taken in excess: sleeping pills, cough medicine, etc.
  • prescription medications
  • tobacco

• Establish some special rules for when you're away and make sure that your youngster knows and understands them. Consider rules about:
  • answering the phone
  • getting along with siblings
  • having a friend or friends over while you're not there
  • Internet and computer rules
  • kitchen and cooking (you might want to make the oven and utensils like sharp knives off limits)
  • not opening the door for strangers
  • not telling anyone he or she is alone
  • rooms of the house that are off limits, especially with friends
  • TV time and types of shows

Things To Do When You’re Ready To Leave—

When you're ready to leave your youngster home alone for the first time, a few other steps can help both of you manage the transition:

• Don't forget that pets can be great company for children who are home alone. Many children feel safer with a pet around — even a small one, like a hamster, can make them feel like they have a companion.

• You might have an older teenager or a friend of the family come over to stay with your youngster. Don't call that person a "babysitter" — tell your youngster that the person is there to keep him or her company. You might also want to let your youngster invite a trusted friend of the same age to come over, and propose this as a trial run for later solo stays. Be sure to let the friend's moms and dads know that you won't be home.

So cover your bases and relax. With the right preparation and some practice, you and your youngster will get comfortable with home-alone days in no time!

Help for Parents with Out-of-Control Teens

How To Discipline Your Toddler

Your toddler tests your nerves because he is testing boundaries all around him. Every day, little by little, he is mastering new abilities and accomplishing new feats, and is anxious and excited to use these skills. Sometimes it's tough to reel in a toddler, but it can be done. And setting rules and limits now — when your youngster is learning what behaviors are acceptable — will help prevent bigger problems down the road.

Here are some ways to help you keep your youngster on the right track:

1. If your roving toddler does head toward an unacceptable or dangerous play object, calmly say "No" and either remove your youngster from the area or distract her with another activity. It's important to not spank, hit, or slap your youngster. At this age, children are unlikely to be able to make a connection between the behavior and physical punishment. The message you send when you spank is that it's OK to hit someone when you're angry. The American Academy of Pediatrics (AAP) discourages spanking, which is no more effective than other forms of discipline, such as timeouts.

2. If you need to take a harder line with your youngster, timeouts can be an effective form of discipline. A 2- or 3-year-old who has been hitting, biting, or throwing food, for example, should be told why the behavior is unacceptable and taken to a designated timeout area — a kitchen chair or bottom stair — for a minute or two to calm down. As a general rule, about 1 minute per year of age is a good guide for timeouts. Shorter timeouts can be effective, but longer ones have no added benefit and can sometimes undermine your efforts if your youngster gets up (and refuses to return) before you signal that the timeout has ended.

3. By now, you've figured out that your toddler wants to explore and investigate the world. Toddlers are naturally curious, so it's wise to eliminate temptations whenever possible. That means items like TVs, phones, and video equipment should be kept out of reach, as well as choking hazards like jewelry, buttons, and small items that children can put in their mouths. And always keep cleaning supplies and medications stored safely away where children can't get to them.

4. When it comes to discipline, it's important to be consistent. Moms and dads who don't stick to the rules and consequences they set up don't have children who do either. For example, if you tell your toddler that a timeout is the repercussion for bad behavior, be sure to enforce it. Only issue warnings for things that you can follow through on. Empty threats undermine your authority. And don't forget that children learn by watching adults, particularly their moms and dads. So make sure your own behavior is role-model material. When asking your youngster to pick up toys, you'll make a much stronger impression if you've put away your own belongings rather than leaving your stuff strewn around the room.

5. Even the most well-behaved toddler can have a tantrum from time to time. Tantrums are common during toddlerhood because children can understand more than they can express and this often leads to frustration when they can't communicate their needs. Toddlers get frustrated in other ways, too, like when they can't dress a doll or keep up with an older sibling. Power struggles can ensue when your toddler wants more independence and autonomy too soon. The best way to deal with tantrums is to avoid them in the first place, whenever possible. Here are some strategies that may help:
  • When children are playing or trying to master a new task, offer age-appropriate toys and games. Also, start with something simple before moving on to more challenging tasks.
  • Make sure your youngster isn't acting up simply to get attention. Try to establish a habit of catching your youngster being good ("time-in"), which means rewarding your little one with attention for positive behavior.
  • Know your youngster's limits. If you know your toddler is tired, it's not the best time to go grocery shopping or try to squeeze in one more errand.
  • Give your toddler control over little things. This may fulfill the need for independence and ward off tantrums. Offer minor choices that you can live with, such as "Would you like an apple or banana with lunch?"
  • Consider the request carefully when your youngster wants something. Is it outrageous? Maybe it isn't. Choose your battles; accommodate when you can.

If your youngster does throw a tantrum, keep your cool. Don't complicate the problem with your own frustration. Children can sense when moms and dads are becoming frazzled and this can just make their frustration worse. Try to understand where your youngster is coming from. For example, if your youngster has just had a great disappointment, you may need to provide comfort.

Ignoring the outburst is another way to handle it — if the tantrum poses no threat to your youngster or others. Continue your activities, paying no attention to your youngster but remaining within sight. Children who are in danger of hurting themselves or others during a tantrum should be taken to a quiet, safe place to calm down.

Some children will have a hard time stopping a tantrum. In these cases, it might help to say to say, "I'll help you settle down now." But whatever you do, do not reward your toddler by giving into desires. This will only prove that tantrums are an effective tactic for getting what he or she wants. Instead, verbally praise your youngster for regaining self-control.

As their language skills improve and they mature, children become better at handling frustration and tantrums are less likely. If you're having difficulty handling you youngster's temper tantrums or have any questions about discipline, ask your doctor for advice.

Online Parent Support

Treatment & Management for Disobedient Children

OPPOSITIONAL DEFIANT DISORDER (ODD) is defined as a recurrent pattern of negativistic, defiant, disobedient, and hostile behavior toward authority figures that persists for at least 6 months. Behaviors included in the definition include the following:

• actively defying requests
• arguing with grown-ups
• being resentful, spiteful, or vindictive
• being touchy, easily annoyed or angered
• blaming others for one's own mistakes or misbehavior
• deliberately annoying other people
• losing one's temper
• refusing to follow rules

OPPOSITIONAL DEFIANT DISORDER is usually diagnosed when a youngster has a persistent or consistent pattern of disobedience and hostility toward moms and dads, educators, or other grown-ups. The primary behavioral difficulty is the consistent pattern of refusing to follow commands or requests by grown-ups. Kids with OPPOSITIONAL DEFIANT DISORDER are often easily annoyed; they repeatedly lose their temper, argue with grown-ups, refuse to comply with rules and directions, and blame others for their mistakes. Stubbornness and testing limits are common, even in early childhood.

The criteria for OPPOSITIONAL DEFIANT DISORDER are met only when the problem behaviors occur more frequently in the youngster than in other kids of the same age and developmental level. These behaviors cause significant difficulties with family and friends, and the oppositional behaviors are the same both at home and in school. Sometimes, OPPOSITIONAL DEFIANT DISORDER may be a precursor of a conduct disorder. OPPOSITIONAL DEFIANT DISORDER is not diagnosed if the problematic behaviors occur exclusively with a mood or psychotic disorder.

Prevalence and Comorbidity—

The base prevalence rates for OPPOSITIONAL DEFIANT DISORDER range from 1-16%, but most surveys estimate it to be 6-10% in surveys of nonclinical, non-referred samples of parents' reports. In more stringent population samples, rates are lower when impairment criteria are stricter and when the information is obtained from both parents and educators, rather than from parents only. Before puberty, the condition is more common in boys; after puberty, it is almost exclusively identified in boys, and whether the criteria are applicable to girls has been discussed. The disorder usually manifests by age 8 years. OPPOSITIONAL DEFIANT DISORDER and other conduct problems are the single greatest reasons for referrals to outpatient and inpatient mental health settings for kids, accounting for at least half of all referrals.

Diagnosis is complicated by relatively high rates of comorbid, disruptive, behavior disorders. Some symptoms of Attention Deficit Hyperactivity Disorder (ADHD) and Conduct Disorder overlap. Researchers have postulated that, in some kids, OPPOSITIONAL DEFIANT DISORDER may be the developmental precursor of conduct disorder. Comorbidity of OPPOSITIONAL DEFIANT DISORDER with ADHD has been reported to occur in 50-65% of affected kids.

In some kids, OPPOSITIONAL DEFIANT DISORDER commonly occurs in conjunction with anxiety disorders and depressive disorders. Cross-sectional surveys have revealed the comorbidity of OPPOSITIONAL DEFIANT DISORDER with an affective disorder in about 35% of cases, with rates of comorbidity increasing with patient age. High rates of comorbidity are also found among OPPOSITIONAL DEFIANT DISORDERs, learning disorders, and academic difficulties. Given these findings, kids with significant oppositional and defiant behaviors often require multidisciplinary assessment and may need components of mental health care, case management, and educational intervention to improve.

Risk Factors and Etiology—

The best available data indicate that no single cause or main effect results in OPPOSITIONAL DEFIANT DISORDER. Most experts believe that biological factors are important in OPPOSITIONAL DEFIANT DISORDER and that familial clustering of certain disruptive disorders, including OPPOSITIONAL DEFIANT DISORDER and ADHD, substance abuse, and mood disorders, occurs.

Studies of the genetics of OPPOSITIONAL DEFIANT DISORDER have produced mixed results. Under-arousal to stimulation has been consistently found in persistently aggressive and delinquent youth and in those with OPPOSITIONAL DEFIANT DISORDER. Exogenous factors such as prenatal exposure to toxins, alcohol, and poor nutrition all seem to have effects, but findings are inconsistent. Studies have implicated abnormalities in the prefrontal cortex; altered neurotransmitter function in the serotonergic, noradrenergic, and dopaminergic systems; and low cortisol and elevated testosterone levels.

Clinical Course—

In toddlers, temperamental factors, such as irritability, impulsivity, and intensity of reactions to negative stimuli, may contribute to the development of a pattern of oppositional and defiant behaviors in later childhood. Family instability, including economic stress, parental mental illness, harshly punitive behaviors, inconsistent parenting practices, multiple moves, and divorce, may also contribute to the development of oppositional and defiant behaviors.

The interactions of a youngster who has a difficult temperament and irritable behavior with moms and dads who are harsh, punitive, and inconsistent usually lead to a coercive, negative cycle of behavior in the family. In this pattern, the youngster's defiant behavior tends to intensify the parents' harsh reactions. The moms and dads respond to misbehavior with threats of punishment that are inconsistently applied. When the parent punishes the youngster, the youngster learns to respond to threats. When the mother or father fails to punish the youngster, the youngster learns that he or she does not have to comply. Research indicates that these patterns are established early, in the youngster's preschool years; left untreated, pattern development accelerates, and patterns worsen.

Developmentally, the presenting problems change with the youngster's age. For example, younger kids are more likely to engage in oppositional and defiant behavior, whereas older kids are more likely to engage in more covert behavior such as stealing.

By the time they are school aged, kids with patterns of oppositional behavior tend to express their defiance with educators and other grown-ups and exhibit aggression toward their peers. As kids with OPPOSITIONAL DEFIANT DISORDER progress in school, they experience increasing peer rejection due to their poor social skills and aggression. These kids may be more likely to misinterpret their peers' behavior as hostile, and they lack the skills to solve social conflicts. In problem situations, kids with OPPOSITIONAL DEFIANT DISORDER are more likely to resort to aggressive physical actions rather than verbal responses. Kids with OPPOSITIONAL DEFIANT DISORDER and poor social skills often do not recognize their role in peer conflicts; they blame their peers (e.g., "He made me hit him.") and usually fail to take responsibility for their own actions.

The following 3 classes of behavior are hallmarks of both oppositional and conduct problems: (1) noncompliance with commands; (2) emotional overreaction to life events, no matter how small; and (3) failure to take responsibility for one's own actions.

When behavioral difficulties are present beginning in the preschool period, educators and families may overlook significant deficiencies in the youngster's learning and academic performance. When many kids with behavioral problems and academic problems are placed in the same classroom, the risk for continued behavioral and academic problems increases. OPPOSITIONAL DEFIANT DISORDER behavior may escalate and result in serious antisocial actions that, when sufficiently frequent and severe, become criteria to change the diagnosis to conduct disorder. Milder forms of OPPOSITIONAL DEFIANT DISORDER in some kids spontaneously remit over time. More severe forms of OPPOSITIONAL DEFIANT DISORDER, in which many symptoms are present in the toddler years and continually worsen after the youngster is aged 5 years, may evolve into conduct disorder in older kids and teens.

Treatment & Management—

Given the high probability that OPPOSITIONAL DEFIANT DISORDER occurs alongside attention disorders, learning disorders, and conduct disturbances, an evaluation for these disorders is indicated for comprehensive treatment. Pharmacologic treatment (e.g., stimulant medication) for ADHD may be beneficial once this is diagnosed. Kids with oppositional behavior in the school setting should undergo necessary screening testing in school to evaluate for possible learning disabilities. With the multifaceted nature of associated problems in OPPOSITIONAL DEFIANT DISORDER, comprehensive treatment may include medication, parenting and family therapy, and consultation with the school staff. If kids with OPPOSITIONAL DEFIANT DISORDER are found to have ADHD as well, appropriate treatment of ADHD may help them to restore their focus and attention and decrease their impulsivity; such treatment may enable their social and behavioral interventions to be more effective.

PARENT MANAGEMENT TRAINING is recommended for families of kids with OPPOSITIONAL DEFIANT DISORDER because it has been demonstrated to affect negative interactions that repeatedly occur between the kids and their moms and dads. PARENT MANAGEMENT TRAINING consists of procedures in which parents are trained to change their own behaviors and thereby alter their youngster's problem behavior in the home. PARENT MANAGEMENT TRAINING is based on 35 years of well-developed research showing that oppositional and defiant patterns arise from maladaptive parent-child interactions that start in early childhood.

These patterns develop when moms and dads inadvertently reinforce disruptive and deviant behaviors in a youngster by giving those behaviors a significant amount of negative attention. At the same time, the parents, who are often exhausted by the struggle to obtain compliance with simple requests, usually fail to provide positive attention; often, the moms and dads have infrequent positive interactions with their kids. The pattern of negative interactions evolves quickly as the result of repeated, ineffective, emotionally expressed commands and comments; ineffective harsh punishments; and insufficient attention and modeling of appropriate behaviors.

PARENT MANAGEMENT TRAINING alters the pattern by encouraging the mother or father to pay attention to prosocial behavior and to use effective, brief, non-aversive punishments. Treatment is conducted primarily with the moms and dads; the therapist demonstrates specific procedures to modify parental interactions with their youngster. Parents are first trained to simply have periods of positive play interaction with their youngster. They then receive further training to identify the youngster's positive behaviors and to reinforce these behaviors. At that point, moms and dads are trained in the use of brief negative consequences for misbehavior. Treatment sessions provide the parents with opportunities to practice and refine the techniques.

Follow-up studies of operational PARENT MANAGEMENT TRAINING techniques in which moms and dads successfully modified their behavior showed continued improvements for years after the treatment was finished. Treatment effects have been stronger with younger kids, especially in those with less severe problems. Recent research suggests that less severe problems, rather than a younger patient age, is predictive of treatment success. Approximately 65% of families show significant clinical benefit from well-designed parent management programs.

Regardless of the youngster's age, intervention early in the developing pattern of oppositional behavior is likely to be more effective than waiting for the youngster to grow out of it. These kids can benefit from group treatment. The process of modeling behaviors and reactions within group settings creates a real-life adaptation process. In younger kids, combined treatment in which moms and dads attend a PARENT MANAGEMENT TRAINING group while the kids go to a social skills group has consistently resulted in the best outcome. The efficacy of group treatment of teens with oppositional behaviors has been debated. Group therapy for teens with OPPOSITIONAL DEFIANT DISORDER is most beneficial when it is structured and focused on developing the skills of listening, empathy, and effective problem solving.

Obstacles to Treatment—

OPPOSITIONAL DEFIANT DISORDER and other conduct problems can be intractable. Despite advances in treatment, many kids continue to have long-term negative sequelae. PARENT MANAGEMENT TRAINING requires parental cooperation and effort for success. Existing psychiatric conditions in the parents can be a major obstacle to effective treatment. Depression in a mother or father (particularly the mother) can prevent successful intervention with the youngster and become worse if the youngster's behavior is out of control. Substance abuse and other more severe psychiatric conditions can adversely affect parenting skills, and these conditions are particularly problematic for the moms and dads of a youngster with OPPOSITIONAL DEFIANT DISORDER.

In situations in which the moms and dads lack the resources to effectively manage their youngster, services can be obtained through schools or county mental health agencies. Many states have effective "wrap around" services, which include a full-day school program and home-based therapy services to maintain progress in the home setting. Thus, effective treatment can include resources from several agencies, and coordination is critical. If county mental health or school special education services are involved, one person is usually designated to coordinate services in those systems.

Help for Parents with Oppositional Children and Teens

Rape: What Parents Need To Know

As a mother or father, how can you support a daughter who has been raped? Here are some important tips you'll need to help your youngster:

It can be hard to help a daughter who's keeping a secret from you. Pre-adolescents and adolescents often turn to their peers to discuss deeply personal issues — and, unfortunately, something as serious as rape is no exception.

Perhaps your daughter fears you will get angry, thinking she "brought it on" in some way; perhaps you don't openly discuss sexual issues and she would feel uncomfortable telling you.

Whatever the reason, reaching out to your daughter — and keeping the lines of communication open — are crucial to your relationship. Let your youngster know, often, that you're there to listen and want to know if anyone ever harms her.

Someone who's been raped might feel angered, frightened, numb, degraded, or confused. It's also normal to feel ashamed or embarrassed. Some people withdraw from friends and family. Others don't want to be alone. Some feel depressed, anxious, or nervous.

Sometimes the feelings surrounding rape may show up in physical ways (e.g., trouble sleeping or eating). It may be hard to concentrate in school or to participate in everyday activities. Experts often refer to these emotions — and their physical side effects — as rape trauma syndrome. The best way to work through them is with professional help.

If your daughter has confided in you that she is the victim of rape, it's important to seek medical care right away. A doctor will need to check for sexually transmitted diseases (STDs) and internal injuries.

Most communities have local rape hotlines listed in the phone book that can counsel you about where to go for medical help. You also can call the national sexual assault hotline at (800) 656-HOPE. Most medical centers and hospital emergency departments have doctors and counselors who have been trained to take care of someone who has been raped.

Your daughter should get medical attention right away without changing clothes, showering, douching, or washing. It can be hard not to clean up, of course — it's a natural human instinct to wash away all traces of a sexual assault. But being examined right away is the best way to ensure proper medical treatment.

Before the exam, a trained counselor or social worker will listen to your daughter discuss what happened. Talking to a trained listener can help your daughter release some of the emotions associated with the experience and start to feel calm and safe again.

The counselor also might talk about the medical exam and what it involves. Each state or jurisdiction can different requirements, but steps in the medical exam are likely to include:
  • A medical professional or trained technician may look for and take samples of the rapist's hair, skin, nails, or bodily fluids from your daughter's clothes or body.
  • A medical professional will examine your daughter internally to check for any injury that might have been caused by the rape.
  • A medical professional will test for STDs, including HIV/AIDS. These tests may involve taking blood or saliva samples. Although the thought of having an STD after a rape is extremely scary, the quicker one is diagnosed, the more effectively it can be treated. Doctors can start your daughter on immediate treatment courses for STDs, including HIV/AIDS, which can help protect against developing these diseases.
  • If you think your daughter has been given a rape drug, a doctor or technician can test for this, too.
  • If your daughter is raped, a medical professional may treat her for unwanted pregnancy, if she chooses.

Even if your daughter doesn't get examined right away, it doesn't mean that she can't get a checkup later. A person can still go to a doctor or local clinic to get checked out for STDs, pregnancy, or injuries any time after being raped. In some cases, doctors can even gather evidence several days after a rape has occurred.

Seeking immediate medical attention is recommended not just to ensure your daughter's health and safety, but also to provide documentation if you and your youngster decide to report the crime.

Medical tests provide the evidence needed to prosecute the rapist if a criminal case is pursued. If you don't decide to report it, you could change your mind later (this often happens) and having the results of a medical exam can help. Keep in mind, the statutes of limitations on rape only give a person a certain amount of time to pursue legal action, so be sure you know how long you have to report the rape. A local rape crisis center can advise you of the laws in your state.

If your adolescent has been raped and chooses not to let you know, be aware that laws in some states don't require moms and dads to be notified if an adolescent under age 18 has called a rape crisis center or visited a clinic for evaluation.

Those who have been raped sometimes avoid seeking help because they're afraid that talking about it will bring back memories or feelings that are too painful. But this can actually do more harm than good. Seeking help and emotional support through a trained professional is the best way to ensure long-term healing. Working through the pain sooner rather than later can help reduce symptoms like nightmares and flashbacks. It can also help someone avoid potentially harmful behaviors and emotions, like major depression or self-injury.

Rape survivors work through feelings differently. Ask your daughter what sort of counseling is preferable. Some victims feel most comfortable talking one-on-one with a therapist. Others find that joining a support group where they can be with other survivors helps them to feel better, get their power back, and move on with their lives. In a support group, they can get help and might help others heal by sharing their experiences and ideas.

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