ODD/ADHD/Anxiety

Thanks, Mark. Our son is 16. He has ODD, comorbid with ADHD, anxiety, and dsygraphia. He is not abusing drugs, holds a part-time job and plays varsity soccer and JV tennis at his high school. His poor grades are 100% due to opposition to the system, complete lack of organization, difficulty paying attention, and lack of ambition. With his high intelligence, everything and everyone is "stupid" to him. He can out-think and out-smart most people he encounters and gets a thrill out of doing so. He would never tolerate tutoring or any kind of support from us, not even a "checklist" of things to turn in tomorrow. I'm looking for information about what is known about people with a profile such as his as they move into adulthood. Is there any literature or studies on this topic? What does your first-hand experience tell you? I just can't imagine him in a healthly, long-term relationship, but hope that I'm very wrong about that.

We have already looked into alternative schooling a bit, but in his mind, they all mean effort of one sort or another and, to him, effort is pointless. If he's going to do something he doesn't enjoy all day, he may as well be making money, so goes his argument. In any case, I don't plan on spending any time convincing him he should be in school in the fall. But, if he really means it, we'll make sure the rules for staying in our home are clearly spelled out.

In addition to my nagging worry about his long-term prospects, I would welcome suggestions you may have about how other parents move through the grieving process of not having the child they thought they had. And, finally, what is your recommended route for treating his anxiety? I believe that this plays a big part in his defiant behavior, because he is afraid of confronting a whole host of situations. Were he able to do so, his grades would be better, his self-esteem would be better, and we would be less frustrated with him on a regular basis. I'm just not sure how to go about getting treatment for that.... Doesn't that usually start with counseling.... Something we're avoiding at present because we're implementing your program.

Thanks, as always,

C.

``````````````````````````````

Hi C.,

Re: Is there any literature or studies on this topic?

Yes:

1. Bardone AM, Moffitt TE, et al: (1998) Adult Physical Health Outcomes of Adolescent Girls with Conduct Disorder, Depression, and Anxiety. J Am Acad Child Adolesc Psychiatry 37(6):594-601.
2. Bird Her, et all (1993), Pattterns of Diagnostic comorbidity in a community sample of children aged 9 through 16 years. J Am Acad Child Adolesc Psychiatry 32:361-368.
3. Buitelaar JK (2000) Open-Label treatment with Risperidone of 26 Psychiatrically-Hospitalized Children ad Adolescents with Mixed Diagnoses and Aggressive Behavior. Journal of Child and Aadolescent Psychopharmacology 10 (1) 19-26.
4. Carlson, Caryn et al: Gender differences in children with ADHD, ODD, and Co-occurring ADHD&ODD identified in a School Population. J Am Acad Child Adolesc Psychiatry , 1997, 36(12):1706-1714.
5. Griffiths MD (1998) Dependence on Computer Games by Adolescents - Psychol Rep; 82(2): 475-80
6. Kavousssi RJ, Coccaro EF (1998) Divalproex Sodium for Impulsive Aggressive Behavior in Patients With Personality Disorder J Clin Psychiatry 59:766-680.
7. Kuhne M, et. al Impact of Comorbid Oppositional or Conduct Problems on Attention-Deficit Hyperactivity Disorder (1997) J Am Acad Child Adolesc Psychiatry 36(12);1715-1725.
8. Rachel G. Klein, PhD; Howard Abikoff, PhD, et. Al. (1997) Clinical Efficacy of Methylphenidate in Conduct Disorder With and Without Attention Deficit Hyperactivity Disorder Arch Gen Psychiatry.;54:1073-1080
9. Riggs PD, Mikulich LM, et. Al. (1997) Fluoxetine in Drug-Dependent Delinquents with Major Depression: An Open trial. Journal of Child and Adolescent Psychopharmacology 7: summer 87-95.
10. Singer MI, Slovak K, et al: (1998) Viewing Preferences, Symptoms of Psychological trauma, and Vioent Behaviors Among Children Who Watch Television. J Am Acad Child Adolesc Psychiatry 37(10): 1041-1048.
11. Harrell JS; Gansky SA; et al: (1997) Leisure Time Activities of Elementary School Children. Nurs Res Sep-Oct; 46(5): 246-53
12. .Wiegman O (1998) -Video Game Playing and its Relations with Aggressive and Prosocial Behaviour. Br J Soc Psychol Sep; 37 ( Pt 3):367-78
13. Behrman: Nelson Textbook of Pediatrics, 17th ed., Copyright © 2004 Elsevier p 663.
14. Croonenberg J, Joerg M et al: Risperidone in Children With Disruptive Behavior Disorders and Subaverage Intelligence: A 1-Year, Open-Label Study of 504 Patients J. Am. Acad. Child Adolese. Psychiatry, 2005;44(1):64-72
15. Disney ER, Elkins IJ, et al: Effects of ADHD, Conduct Disorder, and Gender on Substance use and Abuse in Adolescence. Am J Psychiatry 1999, 156:1515-1521.
16. Findling RL, Kusumakar V, Daneman D, Moshang T, De Smedt G, Binder C (2003), Prolactin levels during long-term risperidone treatment in children and adolescents. J Clin Psychiatry 64:1362–1369.
17. Findling RL, McNamara NK, et al: A Double-Blind Pilot Study of Risperidone in the Tretment of Conduct Disorder. J. Am. Child Adolesc. Psychiatry 2000, 39(4):509-16.
18. Kasen S, Cohen P, et al: Influence of Child and Adolescent Psychiatric Disorders on Young Adult Personality Disorder. Am J Psychiatry 1999, 156: 1529-1535.
19. Kuperman S, Schlosser SS, et al: Relationship of Child Psychopathology to Parental Alcoholism and Antisocial Personality Disorder. J Am Acad Child Adolesc Psychiatry 1999, 38(6):686-692.
20. Lavigne JV, Cicchetti c , et al: Oppositional Defiant Disorder With Onset in Preschool Years: Longitudinal Stability and Pathways to Other Disorders. J. Am. Child Adolesc. Psychiatry 2001, 40(12):1393-1400.
21. Renauld J, Birmaher B, et al: Suicide in Adolescents With Disruptive Disorders. J. Am. Child Adolesc. Psychiatry 1999, 38(7):846-851.
22. SCHUR SB Treatment Recommendations for the Use of Antipsychotics for Aggressive Youth (TRAAY). Part I: A Review J Am Acad Child Adolesc Psychiatry - 2003 Feb; 42(2); 132-144
23. Speltz ML, McClelllan J, et al: Preschool Boys with Oppositional Defiant Disorder: Clinical Presentation and Diagnostic Change. J. Am. Child Adolesc. Psychiatry 1999, 38(7):838-845.
24. Helgeland MI, Kjelsberg E, et al: Continuities Between Emotional and Disruptive Behavior Disorders in Adolescence and Personality Disorders in Adulthood. Am J Psychiatry 2005; 162: 1941-1947.
25. Johnson JG, First MB, et al: Adverse Outcomes Associated with Personality Disorder Not Otherwise Specified in a Community Sample. Am J Psychaitry 2005; 162:1926-1932.
26. Paris J: Personality Disorders over time: Precursors, Course and Outcome. Journal of Personality Disorders, 17(6), 479-488, 2003.
27. Reyes M: A randomized, double-blind, placebo-controlled study of risperidone maintenance treatment in children and adolescents with disruptive behavior disorders. Am J Psychiatry - 01-MAR-2006; 163(3): 402-10
28. Steiner H Divalproex sodium for the treatment of conduct disorder: a randomized controlled clinical trial. J Clin Psychiatry - 01-OCT-2003; 64(10): 1183-91
29. Wakschlag LS Is prenatal smoking associated with a developmental pattern of conduct problems in young boys? J Am Acad Child Adolesc Psychiatry - 01-APR-2006; 45(4): 461-7

Re: What does your first-hand experience tell you?

The long-term outcome for ADHD/ODD teens can be that they develop a Personality Disorder, which is one of the "labels" psychiatry uses to describe people who have traits in their personality that cause them major problems. These are not things that come and go but last for decades. A person's personality starts to form as a teenager, and that is when we see personality disorders start to form. We have all met people with these types of problems. They fit into a few big categories that have lots of different names.

One group is people who are strange, different, and keep to themselves. This is called cluster A. Another group is people who are dramatic, have lots of mood problems, are forever getting into trouble, and whose lives are quite mixed up. This is called cluster B. They are often very difficult to get along with over the long run. Another group are people who are withdrawn, scared, and have to do things a certain way. This is called cluster C. When any of these problems screw up people's relationships, ability to work, get them in trouble with the law, or make them miserable, we call it a personality disorder.

Recent studies have shown that children who have certain psychiatric problems are much more likely to get personality disorders as adults. Children who have multiple psychiatric problems are even more at risk. Children who have ODD are about four times more likely to have a personality disorder when they grow up, that is about a 15% chance. If they already have some signs of personality disorder as a young teenager, they are 25 times as likely to have a personality disorder as adults. What this tells us is that the longer these problems go on in childhood and as teenagers, the more likely they are to lead to personality disorders as adults.

There are two types of Personality Disorder in Cluster B, which are especially associated with ODD/CD. These are Borderline Personality Disorder and Antisocial Personality Disorder.

Borderline Personality Disorder is called this because patients have many traits from different psychiatric disorders. They have very unstable moods, like bipolar disorder. They often have strange experiences, like people with schizophrenia. Their relationships with others are usually quite unstable. They often don't have much of a sense of who they really are or where they are going. They often cut themselves. Most of the people with this problem are female. If you have ODD/CD and are female, you have approximately a 15% chance of getting this.

Antisocial Personality Disorder is basically a continuation of Conduct Disorder. People with this problem continue to not respect the rights of others or their property. They continue to get in fights or worse. They often are stealing or cheating. Usually they are involved with the law. They have extremely high rates of substance abuse and high rates of suicide and other unnatural causes of death. This is primarily a male diagnosis. Almost 20% of teenagers with ODD/CD with have Antisocial Personality Disorder as a result.

If you have a personality disorder as a teenager, by the time you are a young adult, here are the chances that these bad things will happen to you:

1. Difficulties with interpersonal Relationships 20-30%
2. Ending up with other Psychiatric problems 35-40%
3. Having at least one of the above bad outcomes 70-80%
4. Having at least two of the above bad outcomes 50%
5. Make a suicide attempt- 6-10%
6. Not get as far in school as you should have been able to 25%
7. Serious assault on another 25-35%

Some personality disorders are much more likely to improve over time. After 15-25 years, only about 10% of adults who had Borderline Personality Disorder continue to have it. That means 90% got over it. Antisocial Personality disorder tends to improve, too. However, about 25% of people with Antisocial Personality Disorder die prematurely. Of those that do not die, most are better, but few have recovered completely.

Re: I would welcome suggestions you may have about how other parents move through the grieving process of not having the child they thought they had.

This is covered in the eBook (Session #1 – online version).

Re: …what is your recommended route for treating his anxiety?

Parents can help their teen in these ways:

• Continue to provide structure, stability, and predictability. Within reason, stick to the same rules, boundaries, roles, and routines.
• Encourage your teen to participate in activities normally enjoyed. Support involvement in positive and pro-social activities (e.g., sports, volunteer work, church).
• Encourage your teen to talk about what he or she is going through, and be willing to listen. Don't just jump to conclusions and give advice. Depending on the situation, your teen may not want advice -- just to be understood. Even if a problem seems small to you, it may be a major concern for your child. Minimizing a problem or saying "you'll get over it" is not helpful. It gives the message you don't understand or are not willing to listen.
• Model effective stress management and coping skills.
• Offer reassurance, encouragement, and support. Be willing to provide verbal or physical comfort, but don't be discouraged if your teen rejects your effort or is irritable. These are normal reactions to stress. Be patient and let your child know you're available if he or she needs you.

Teens can decrease stress with the following behaviors and techniques:

• Avoid excess caffeine intake, which can increase feelings of anxiety and agitation.
• Build a network of friends who help you cope in a positive way.
• Decrease negative self-talk. Challenge negative thoughts about yourself with alternative neutral or positive thoughts. "My life will never get better" can be transformed into "I may feel hopeless now, but my life will probably get better if I work at it and get some help."
• Develop assertiveness training skills. For example, state feelings in polite, firm, and not overly aggressive or passive ways ("I feel angry when you yell at me" "Please stop yelling").
• Don't use illegal drugs, alcohol and tobacco.
• Exercise and eat regularly.
• Learn practical and effective coping skills. For example, break a large task into smaller, more attainable tasks.
• Learn relaxation exercises (abdominal breathing and muscle relaxation techniques).
• Learn to feel good about doing a competent job rather than demanding perfection from yourself and others.
• Rehearse and practice situations, which cause stress. One example is taking a speech class, if talking in front of a class makes you anxious.
• Take a break from stressful situations. Activities like listening to music, talking to a friend, drawing, writing, or spending time with a pet can reduce stress.

Mark

re: "I cannot allow the violent behavior to continue..."

Mark, Well, M______'s final court date was set for this Thursday (we were told by the PO she was recommending release from probation). We have had some difficulties over the past 5 months he was in the intensive probation program, but we felt we were handling them well. M______ was even accepting our consequences better with less/minimal anger.

Or so we thought. We had a family graduation yesterday that M was told about at least a month ago. He was told to not schedule himself to work. His g'friend was invited. (The graduates sister was also planning on asking him to be an usher at her wedding in July so he knew it was important to be there). Well, he has 2 jobs. He was scheduled to work. His Dad (friend of the manager) arranged for M to have the day off. M needed the income to pay off his debts (he pays his own car insurance, overages on his phone, and now a "bad driver fee" from a recent speeding ticket. He also is in dept for gas money). His Dad and he agreed on a yard project for the equivalent hours/money. He was to perform the work Sunday before the graduation. He also has been told if he cannot pay his insurance/phone bill by the due date, he loses them until paid. He passed the due date, but was given until the end of the month.

M slept in until almost noon. Not motivated to start the yard project. Told he was not using the car until job was done (this would have settled the amount owed, but not gas debt or "bad driver" fee). He was "on call" at the other job. He has NEVER had to work on a "call in" day. He tells his Dad (I'm out) that he has to work. Dad says no your not. M insists. Dad says no car use. I come home and back up Dad. M starts to insist on taking the car. We still say no. He then proceeds to put his head (then foot/fist) through the drywall. There are now 9 holes in 4 different rooms in the house. 2 of these were repaired/painted less than 6 months ago from previous damage. Police called. PO called and left message (this was a Sunday). I called this job and let them know M would not be in to work there anymore. Police talked with M. He calmed down by the time they arrived. We (parents) chose to let PO/referee handle it (court already scheduled Thursday). He was told to give up phone (finally did) by us as he lost the privilege of using/having it due to behavior. 

 

==> Join Online Parent Support

He was told to stay home, he said he was just going to cool off for 15-20 minutes (we were told by counselor and PO to let him do this when angry). Well, you guessed it, he met up with another boy we/courts have forbid him to see and he came home 2 1/2 hrs later (cannot prove he was with this boy, but only one on his phone call record). He was home by 7pm and curfew is 9:30. He/husband/I did not go to graduation. (Older and younger sons went). Took computer and PSP when gone. When he came home he was still doing things--dumped a whole pitcher of water on the floor (stating filling the dog's bowl but obviously doing on purpose), ripped up all my mail (bills) that were on the table ready to be mailed, started to rip up younger brothers "thank-you cards" from his birthday, eating/making mess in the bedroom, sleeping in younger brothers bed and wouldn't get out, etc. Was told his consequence would start when he began to follow the house rules.

Did go to school this am (I drove--don't feel I should but only 6 more days for this year and I don't want him to blow his grades [all A's and B's]).

He also stated this morning we would not see him until 9:30pm tonight when his curfew was when he was told to come straight home from school and call on the house phone (refused a ride home from me). Still awaiting the PO to call. Don't believe he will get off probation now (we don't want him to). He is in an intensive probation program. He feels that the court will not keep him as he is 17. We do not want him in our home any longer. We have tried your program, the intensive probation, a therapist, and it seemed like we were making progress and now this (we were feeling pretty good actually). We are in debt over this child and will take a few thousand dollars to fix our home, but are willing to shoulder more financially for a program for him as we don't think he can/should stay in our home.

I know that I'm venting, and sorry, but do you think he will be placed in a long-term program or will we have to allow him to stay? This began at 15 and now he's 17 and 4 mos. If he does stay, how do we work the program? I do not think he should have a cell phone, lap-top, or use of a car AT LEAST until his debts are paid (and now this includes house repair). We don't owe him these things and he certainly has not earned them. He can earn land line phone privileges and being able to go out. I cannot allow the violent behavior to continue. Other children in the home are being affected by this.

Any information/advice would be great.

Thanks.

J.

``````````````````````````````````````````````

Hi J.,

Just think how bad things might have been had you not used some of your new parenting strategies.

First of all – great job! You are really working the program. It’s tough – I know.

As I’m sure you know, your son needs to help pay for the damage.

Don’t worry about cell phones and laptops right now. Let’s step back and look at the bigger picture. In the bigger picture, (a) you need to have your son living elsewhere – soon, and (b) he needs to have the ability to live out in the real world. Thus, your mission at this point should be to begin making plans for his launch.

Mark

==> Join Online Parent Support

She had the most amazing temper tantrum...

Hi Mark, Another question from Australia (I have SO many questions)! M__ and I are in the process of starting up some chores and allowing A__ to earn some money from the non-mandatory ones. We thought we'd have a rule where the mandatory ones had to be done first and then there would be the capacity to earn money from other chores. If the mandatory ones are not done, then there is no pocket money for the week. Is this OK? Can we put a caveat on her spending like no lollies, fizzy drinks or junk food-her behavior is so much worse if she has these things-she can buy books, toys clothes or save some for example?

More...

re: "Granddaughter is possessed by a demon?"

Dear Mark. On trying your technique for my granddaughter B__, my daughter found some good responses - as I previously mentioned. However, after a couple of weeks B__ got worse, far worse. Now she simply takes off and we don’t hear from her for days. Although only 14 she gets around seemingly without money. My daughter has taken all her clothes from her so she cannot go out, but even then B__ finds something and clears out. She has become more violent with her mother. Currently, B__ has been at large for two days with only the bare clothes she was in and without money.

We have had the police looking for her on the previous occasion and probably will have to do the same again. My daughter took B__ to the police station where B__ was given a real dressing-down, but she refused to look the officer in the eye and during the time she turned and said to her mother, “I f.....-well hate you.” I understand that this type of behaviour is becoming frequent around Australia, especially with young girls in that age bracket. I don’t know much about this, but if someone said to me that B__ is possessed by a demon, I could well think that true. Do you have any comments on the above? My compliments. ~ A.C.

```````````````````````````

Hi A.,

When parents begin to implement appropriate discipline for broken house rules, some children may respond by threatening to runaway from home if they do not get their way. Some do run away. If this occurs, parents should defuse the situation, but NOT threaten or challenge the child.

==> Join Online Parent Support

For example: Daughter, you know that I cannot control you. And if you really want to run away from home, I cannot stop you. I cannot watch you 24 hours a day, and I can’t lock you up in the house. But no one in the world loves you the way I do. That is why we have established these house rules. Because I love you, I cannot stand by and watch you hurt yourself by _______________ (e.g., not going to school, using drugs or alcohol, destroying house property), and running away from home will not solve the problem. You and I know it will only make matters worse.

Teens who run away are not bad. They have made a bad decision. They got themselves caught up in pressures that they felt the need to escape from. Instead of facing their problem and solving it, they chose to run from it. We need to teach our teen how to face their problems, even if the problem is us. When they have the right tools to fix some of the things that may be going on in their lives, the pressure lessens, and there is no more need for them to escape.

Every teen either has tried or knows another teen who has run away. I haven't met a teen yet who didn't know of someone's experience of running away. This can be a real problem, considering most teens will glamorize the experience.

Parents of teens who run away are not bad parents. You cannot lock them in. As much as you would like to build a wall around them, it is their choice whether or not to walk out the door.

If your teens runs:

• Call the Police, IMMEDIATELY! Don't wait 24 hours, do it right away.
• Ask investigators to enter your child into the National Crime Information Center (NCIC) Missing Persons File. There is no waiting period for entry into NCIC for children under age 18. You should have something like this in Australia.
• Get the name and badge number of the officer you speak with.
• Call back often.
• Call everyone your child knows and enlist their help.
• Search everywhere, but do not leave your phone unattended.
• Search your teens room for anything that may give you a clue as to where he went.
• You may also want to check your phone bill for any calls they may have made recently.

==> Join Online Parent Support

When your teen comes home:

Take a break from each other. Do not start talking about it right away. Your emotions are too high at this point to get anywhere in a conversation. Go two separate directions until you both have gotten some rest.

Ask and Listen. Why did they leave? You may want to evaluate a rule or two after speaking with them, but do not do so while having this talk. Tell them you are willing to think about it, and you will let them know.

Tell them how you felt about them going. Let them know that they hurt you by leaving. Let them know that there isn't a problem that can't solve. If they ever feel that running away might solve something, have them talk to you first. You could always offer other choices, so they can make a better decision.

Get some help. If this isn't the first time or you have problems communicating when they get back, it's time to ask for help. This could be a person that your child respects (e.g., an aunt or uncle), or you may want to seek professional help.

Mark Hutten, M.A.

==> Join Online Parent Support

He has become desperate when he wants to do something and does not have access to a car or cell phone...

Hi S.,

== > I’ve responded throughout your email.

Dear Mark

First off, thank-you for your ongoing support. In reading the letters you get from parents, it is amazing to me that you respond to each individual question. It is clear that you really believe in what you are doing.

You told me to toughen up lately and I have…believe me.

Our situation is that our son has had his car taken away due to skipping classes at school and most recently his cell phone was canceled, as we currently pay for it and his bills have doubled the last few months. He has become desperate when he wants to do something and does not have access to a car or cell phone. (You know, the Boredom thing). He does not have a job so has to do chores for money and that is a struggle.

Question: How do I respond to my son when I tell him no to making an exception to a consequence and he calls me a dumb bitch, and “am I not embarrassed to be the stupidest person alive” ect.......? I currently put on my poker face and tell him that he does not need to speak to me this way, however, this does not stop him from doing this on a daily basis. Is there a better way for me to handle this? He always apologizes after and says he doesn’t mean it, but the behavior continues.

== > Please refer to the strategy entitled “When You Want Something From Your Kid” (in this case, to stop calling you a “dumb bitch”), which is located in the Anger Management Chapter (online version of the eBook).

Question: I know it is not healthy to resent him, and I don’t, however, when he yells profanity at me and then ten minutes later, asks what I am doing today as if nothing happened, how would you suggest I respond? I am confused to the message I should be sending.

==> His yelling, profanity and name-calling need a consequence. Refer to the strategy listed above.

Question: He is constantly telling me his friends do not have things taken away and that he is the laughing stock of the school as he has had his car and cell phone taken away. Of course, I know that he is aware of the consequences for his actions as we have a contract with him. I am sure he does not tell his friends the full story. How do I respond to his comparison to friends and other families without nagging or repeating myself?

== > I wouldn’t respond at all. I could be wrong here, but I’m getting the impression (given your questions) that your son is continuing to successfully push your buttons / get a reaction out of you / get you to engage in “debate” / get your intensity. Simply issue the consequence, then put on your poker face and either ignore him – or take a time out from him in some shape, form or fashion.

Mark

My Out-of-Control Teen

She has walked out again even though I said that she was grounded...

Hi Mark, We seemed to be moving along ok (not great) in the last few weeks. About 3 Saturdays ago, my daughter went out (with permission) but never came home until 7 am the next morning. She was not contactable on the phone (claims her mobile phone battery was dead) and we had no idea where she was. We called her boyfriend, George, and even he didn't know her whereabouts. 

 I believe they had a fight and this is usually how these incidents start. She was grounded for 3 days, which didn't work because she refuses to comply with the grounding. It ends up being a joke because whenever we say that it will start from day 1 if it is not adhered to, she just scoffs at us. We then took away all her clothes and make up but she started coming in and taking my stuff. I tried to put away as much as I could so she started getting things from her friends.

Last night (Saturday) she was at her boyfriend's house. His father has told her not to come there so he rang me as soon as she showed up. He has told her repeatedly not to go there and has asked me to keep her away. She does not respect anybody's wishes. Anyway, I went over to pick her up. I started talking to George and she slipped out the door and we couldn't find her. She spoke to George on the phone but wouldn't tell him where she was. 

==> Join Online Parent Support

 So really, nothing happened except that she was found out. She refused to answer my calls all night and then her phone was off because she says her battery died. We've told her many times in the past, just let us know where you are and who you're and we need to know what time you'll be back. She finally came back at 2.20 am. This morning when we said we wanted to talk to her, she was rude and just said "get over it" and walked off. She has been grounded for 3 days with no phone and computer privileges as well.

She promised that she would never do this again. She has walked out again even though I said that she was grounded and if she left then it will have to start from day 1 again. She kept walking without looking back. She refuses to take any responsibility for her bad behaviour. We have tried the assignments and it seems to get better but then when things don't go how she wants them to, she starts up again.

What is the next step? She never lets us know where she is or whom she's with. She's 16 but seems to only hang around with older boys who have cars. Every time I ask her what time she'll be back, she always says, I'll be back when I'm back. I don't know because I don't know what I'll be doing. When I say, then I'll tell you that I expect you to be back at this time, she never comes back at that time. She just doesn't care.

Please advise what we do next. Thank you, J.

`````````````````````````

Hi J.,

As adults, we have learned to face whatever problems are before us and meet them head on in an attempt to solve them. However, teens may not have that skill and may feel overwhelmed, scared or confused. Running away is an attempt at resolving or escaping from some problem. Finding out what that problem is offers the first and most important step in preventing a teen from leaving home by running away.

Teens may use running away as a means of getting attention, resolving an argument or even as an attempt to make their parents feel guilty or scared. Yet, too often parents take light of what their teen states regarding running away. If your child is threatening to run away, take time to consider what the underlying problem might be. If your teen threatens to run away, don't be intimidated. Let her know that you’ll call the police and speak to each and every one of her friends’ parents in order to find her. Let her know that you will do whatever you have to do to get her back – no matter where she goes.

What you don't do in trying to prevent a teen from running away is almost as important as what you should do. As teens have usually already made up their minds regarding what they feel they must do, the next steps taken can often be critical. Telling your teen to go ahead and run away because you know they will be back or telling them that their reason for wanting to run away is not a very good one are two things you do not want to do. As there are too many dangers in today's society to take a chance that a teen may not make it back home makes the theory of reverse psychology very risky.

==> Join Online Parent Support

If you tell your child that their reason for wanting to run away is not valid, you’re missing the point. Your child evidently thought it was a good reason. It is better to listen to your child's concerns and take appropriate steps to solve those concerns. In addition, personal attacks on your child's character – stating that they will never amount to anything if they think they can just run away from their problems – will add to his/her resentment. Criticize the behavior, not the whole being of the person.

Explain the dangers of running away. Although most teens will come home after a short period of time on their own, there are some that do not – or cannot. Use news reports of runaway children as an opportunity to teach ahead of time how serious and dangerous running away from home is. Don't worry that you might give your child ideas she otherwise wouldn't have – you won't.

Share how you feel about running away. Use statements such as: “Most kids don’t run away from home, but when they do, it is often because there is a serious problem at home, and the child does not believe he can talk things over with a parent. I want you to understand you can always talk to me. And I want you to understand that running away is very dangerous.”

When a teen threatens to run away it may not be in spite, in anger or in retaliation – it may just be the only solution the teen can find for an undisclosed problem. Talking about the reasons why a teen may want to leave the security of their home may offer insight into how to keep them there – safe and sound.

If your child does bring up the concern, take it seriously and empathize when appropriate. Knowing the underlying cause of the situation leading up to the want to run away from home can help a parent prevent it from happening.

Mark Hutten, M.A.

==> Join Online Parent Support

What the Future Holds for Oppositional Defiant Teens

Hello again Mark, Things are going significantly better... We have been trying your 3-part mantra: poker face, repeat the rule/plan/consequence, no emotion. Not always successfully, but better every day. I'm still very much grieving the child I will never have and would welcome ideas about how to move through this. But, my bigger question for today is, what is the outlook for teens with Oppositional Defiant Disorder as they move into adulthood? I'm especially concerned that my son is in for a life of turbulent and broken relationships and will likely have trouble holding a job. I guess I do have another question. Upon receiving his grade card today for the end of his sophomore year, our son declared that he is not a good match for public school and that he will not be going to school in the fall (reminder that his IQ is in the 140s, he scored 32 on the ACT as a sophomore but also has ADD and dysgraphia). Could it be that in his case he really isn't ever going to "succeed" in the system we call public school? And, what is an appropriate response when our child says he wants to quit school? As always, thank you.

Click here for the answer...