Son getting excitement from the meltdowns...

Thanks Mark. I'm really excited about this program, and just watching the videos I did yesterday and doing the quiz has made me realize it's going to help immensely. My teens aren't out of control yet, but one of them certainly is an intense child and displays many of the traits you speak about. The explanation of that type of child getting excitement from the meltdowns is something I've thought for a long time but didn't know how to put in perspective. I am looking forward to this program and have already learned and implemented some of your ideas.

D.

Online Parent Support

Risperdol and the treatment of ODD...

Hello Mark, What do you know about Risperdol and the treatment of ODD?

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In choosing drugs for ODD, look for drugs that have been proven safe in children, have no long term side effects, and have been found in research studies to be effective in extremely aggressive children and adolescents or in Comorbid conditions which children with CD often have. Each drug has certain problems that need to be watched for. The current medical literature suggests three basic principles when using psychiatric drugs in children:

1. Start low

2. Go slow, and

3. Monitor carefully

Start low means that you do not start any of these drugs at the usual dose, or the maximum dose. When you have pneumonia, it can be a real emergency. You want to give people plenty of medicine right away, and if there are problems, then you reduce it. Unfortunately, many people use this same strategy in the medical treatment of ODD. The problem is that big doses can cause big problems, and when the problems affect your mind and personality, this usually means trouble for the person taking the medicines. So start with the lowest dose possible. For example, if you use a drug called Clonidine, for a boy about 60 lb., know that the dose that will probably work for most boys that size is two pills a day. If you gave him that to start out with, you might win and it would work. But if he happens to be sensitive to that drug, he could have big problems. Although they would be reversible problems, it would probably make most children and adolescents and or parents never want to take the drug again. So what do you do? Start with a half of a pill a day, about 25% of the usual dose. That way if the child is sensitive to the drug, it causes little problems. Many children respond to drugs at very low doses, far below the usual recommendations.

Re: go slow. ODD is not an acute illness. Less than 10% of the people I see with this need to be treated very quickly. Most people whom I see with this problem have had it for years. As a result, there is no need to increase the dose quickly. By going slowly, it is a lot easier to manage any side effects because things don't happen suddenly. Also, it is easier to find the lowest effective dose.

Re: monitor. For each of the medical treatments for ODD, there are specific side effects, which need to be checked regularly. Some common ones are monitoring weight so that people are gaining weight, watch for tics, watch for depression, checking blood pressure and pulse, checking blood tests and EKGs, and making sure parents know what the side effects are of the different medications. In this way, if there is a problem, you can pick it up early and avoid the horror stories, some of which are true, about the medical treatment of this problem.

The following are drugs which have been tested in adults and children who are violent and aggressive for a variety of reasons – from ADHD to brain damage, to Conduct Disorder, and of course ODD:

Atypical Antipsychotics—These drugs were first used for schizophrenia, and that is how they got this name. They are now commonly used for many conditions where people are not psychotic. As you can see, these are not benign medications. All of them can have serious side effects. As a result, they are not used for small problems.

Risperidone (Risperidal)—This drug was initially developed to be a safer drug for adult schizophrenia. It was then found to be effective in children with schizophrenia and other psychoses. Then it was found to be helpful in some children with Tic disorders. Based on those findings it has been used in Conduct Disorder and aggression. These studies are probably the most exciting news for the medical treatment of CD in 20 years. Risperidone is called Risperidal and comes in a variety of sizes; .25mg, .5 mg, 1mg, 2mg and liquid. It also helps Tourettes and psychosis. Usually this is given twice a day. This drug usually shows an effect within hours of a dose. There are more studies done on this drug than all the other atypical antipsychotics combined.

Olanzapine (Zyprexa)—This drug was recently approved for mania in adults. It has been studied less in children. However the early reports are positive. The usual dose is about 5-15 mg a day. It comes in 2.5 mg, 5mg and 10 mg. It is also called Zyprexa. It is more expensive than Risperidone and in adults is associated with more weight gain. This can be given once a day.

Quetiapine (Seroquel)—This drug is a little different than the above drugs as it seems to cause very little problems with things like tremor and stiffness. In adolescents it can lower the blood pressure so the dose has to be increased slower. The dosage range is 200-800 mg a day. There are only a few articles on its use in children and adolescents, but these have been quite positive for mood disorders. I do not know of any study on using in CD. It comes in a 25mg and 100 mg size and has to be given twice a day. It is called Seroquel.

Mark Hutten, M.A.

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He wants to take 2 days off of school next week to go hunting...

Hi,

I have been applying your techniques for about 5 weeks now and can say that things have definitely gotten better. We have had a couple moments but otherwise have been much happier and getting along great. I have read the emails regarding the poor grades and how I should let my son (14 yrs) take ownership of his grades and treat school like it's his job. I completely understand that and agree that the concept should work. I've been fighting with him for 4 years and gotten nowhere so it's obvious that I can't control the outcome. He thinks he can never do good enough for me. So I have told him that it is his job now and his future and he is in charge of it. He only has to live up to his own expectations.

Here's my question...he wants to take 2 days off of school next week to go hunting, a once a year opportunity. He says he will take care of making up all of the work that he will miss for those days ahead of time. I don't know if I should have a say in this or not if I am giving him the control. He has assignments that he missed and can't make up so I don't feel he should be taking time off. But since I've just given him the control and ownership should I let him prove to himself that he can take care of it and that I trust him to do it? The past assignments were missed while I was trying to be in control. Are these two separate things? Where do I draw the line and do I ever step in? Or do I completely give him the control? I understand missing school is not something that is acceptable but there are times when I can see exceptions. If he were pulling all A's and B's I wouldn't have a problem with it at all. I am just really confused about turning the ownership over at this point and where that leaves me with this decision.

Please help.

C.

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Hi C.,

This is a great question. Fortunately, the answer is an easy one.

"Schooling" takes place on multiple stages -- not just in the classroom. So this hunting trip will be much more of a learning experience for him than sitting in class. This is a wonderful opportunity to take education to a new, exciting level.

Let him go ...forget about the make-up work (that's his job).

Mark

P.S. As a former teacher, I would want him to go on the trip. And I would have him take pictures so he could give a report to the class regarding the trip.

Online Parent Support

Teens & Salvia: The New Drug of Choice

Hi Mark,

Things have been going better over this way with our 15 year old daughter. We've taken your advice and are trying to refine the techniques. Thanks for your previous help.

I do have a question and wondered if you had any insight. My daughter left a note from her boyfriend that she received at school laying by the computer last night. I found it this morning. He was talking about them experimenting with something called salvia.

I've been doing some research on this and it seems it is legal here in Indiana. I've discovered it is a hallucenogenic herb. Scary stuff.

From this note and the exchange of IMs I read this morning before I left for work, she seems to be struggling with this and does not want to do it. He stated he was going to try it and it was okay if she didn't.

A couple of days ago she asked about spending some time with this boyfriend and we did the "yes, but..." She fulfilled the but and now has our permission to spend time with him tonight. She is going to a friend's home after school today so I won't see her until she gets in tonight at her curfew.

Know anything about this salvia and its use with teenagers these days? What do you advise I do here?

Thanks,

G.

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Salvia divinorum, a green, leafy plant native to the Mazateca region of Mexico, provides its users with a short but intense hallucinogenic experience. A member of the mint family, it is not among the ornamental garden plants sold under the name Salvia at local nurseries.

The high is unlike that from LSD or psychedelic mushrooms, users say, nor is it anything like the experience of smoking marijuana. Salvia is not currently controlled by federal law, but dozens of states have moved to outlaw cultivation and sale of the plant, which is currently freely available for purchase on the Internet.

As an herb with psychedelic properties, Salvia divinorum is of pharmaceutical interest because of its uncommon affinity for opium/endorphin receptors—specifically the kappa opioid receptor. Most drugs with classical “psychotomimetic” properties, like LSD and MDMA, are highly selective for the 5-HT(2A) serotonin receptor.

Salvia is not one of these. Like ibogaine, another hallucinogenic shrub with a weak affinity for kappa opiate receptors, Salvia’s active ingredient--Salvinorin A--causes psychoactive effects not usually associated with stimulation of the brain’s internal opioid system. Previous research had identified a few such compounds, such as enadoline, which produced similar hallucinogenic effects.

The pharmaceutical industry has already taken a look at the kappa-opioid agonists in the ongoing search for new painkillers, and has so far discovered the usual psychedelic trap of too many unpredictable side effects for a commercial medication.

Classified as an “atypical” psychedelic, the salvia high is intense, dream-like, and short-lived, tapering off after about 30 minutes. An ounce of salvia in leaf form sells for as little as $40, but more concentrated liquid extracts sell for as much as $60 per gram.

Salvia’s addictive potential is low to nonexistent. No hallucinogen such as LSD or peyote has ever been found to be addictive in the classical sense.

Nonetheless, fearing that the inexpensive plant might become “the next marijuana,” as an Associated Press report put it last month, 24 states have passed, or are considering, legislation to restrict access to salvia. Elsewhere, sale of the drug has been restricted in Spain, Italy, Sweden, Belgium, Australia, and other countries. In the AP article, a Florida state legislator alleged—with unintended irony: “As soon as we make one drug illegal, kids start looking around for other drugs they can buy legally. This is just the next one.”

There are many reasons why Salvia divinorum is not likely to be “the next one.” According to drug expert Rick Doblin of the Multidisciplinary Association for Psychedelic Studies (MAPS), salvia “tastes terrible” and is “not going to be extremely popular.” The popular drug information site EROWID describes salvia as “more scary than fun” for many users, concluding that, whether smoked or swallowed, the plant is “aversive for many who try it.” Like ibogaine, salvia is no party drug. It can result in confusion, dizziness, depersonalization, and all the other hallmarks of a “bad trip.”

A related question is the extent to which kappa opioid receptor boosters might reduce the craving for addictive drugs. Ibogaine has been touted for having precisely this effect on heroin addicts and others. However, an early study of kappa opioid receptor-active compounds did not find any reduction in self-administration of cocaine.

The National Institute of Drug Abuse (NIDA) is studying salvia. The Drug Enforcement Administration (DEA), citing salvia as a “drug of concern,” is evaluating it.

My Out-of-Control Teen

Physically Abusive Daughter

Hello Mark,

What do I do when my daughter hurts me? When she does not like what I say she punches, has gone after me with scissors, pens and whipped me with coat hangers and throws things at me.

How do you handle this? Help

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Hi T.,

Although aggressive behavior such as hitting, screaming, and even biting is not seen as all that unusual from a youngster of one or two years of age, the same conduct in kids merely a year or two older is often seen as cruel and problematic. Controlling feelings and emotions is, however, a learned skill and can be very difficult to master (even for some adults!).

Staying calm and collected not only requires a fair amount of self-control and discipline, but also a basic understanding of appropriate social behavior and morality. Most kids under the age of five or six have a minimal comprehension of what exactly is socially acceptable, at least beyond pleasing Mom or Dad. Even then, some kids may find it difficult to control their temper and yet there is often a difference between a youngster who is deceptively ‘acting out' (which is rare, and often due to an unstable or unsafe home environment) and one who is simply trying to be assertive.

The majority of kids do not recognize their own strength or even the full consequences of their actions; and in a world where they are often being told what to do, where to go and how to behave, it does not seem all that unreasonable that they may sometimes need to speak out and be heard. Those school-aged kids who continue to act obnoxiously or aggressively may have never experienced the opportunity of being truly listened to in a loving environment. Listening, on the part of moms & dads involves not only hearing your kid's jokes and laughter, but perhaps more importantly hearing about those hurt, angered and unhappy emotions as well. So often, kids are not allowed to speak negatively, complain, or offer a difference of opinion and thus their feelings continue to build up until one day they may unintentionally vent or lash out. It is important to remember that hearing your kids out does not mean submitting to their every whim or desire.

Aside from releasing pent up emotions, kids who behave aggressively may also do so because they have been rewarded for the conduct. Moms & dads may have hoped to raise a youngster who is strong and able to stand up for him- or herself in rough situations. More commonly, moms & dads may have inadvertently reinforced the aggressive behavior through attention. Indeed, even nagging or punishing kids for acting aggressively can make it more likely that they will act that way in the future. Imagine, if you will, a youngster quietly piecing a puzzle together or even playing a video game. He/She has almost completed the puzzle/game but cannot get the final pieces/play to come together. Throughout this quiet half an hour the parent has been around but has said absolutely nothing. Nothing, that is until the youngster becomes obviously frustrated and throws the puzzle/game across the room and begins screaming or swearing loudly. At this point the parent intervenes by reprimanding the youngster and sending him/her to their room. It would appear that the parent has done everything appropriate in this situation, except for the fact that the only attention this youngster received during the time period was negative. If this is commonly the case, the youngster may begin to feel that any attention is better than no attention and as a result may continue to act out disruptively in daily activities. When dealing with aggressive kids, it is worth the effort to praise even the smallest attempt at proper behavior, while paying very little if any attention to negative conduct. Praise can be a very strong motivator.

It is also important to remember that behavior can be very difficult to change and that it takes a lot of patience. Turning an aggressive youngster into a non-aggressive youngster will not happen overnight, and the odd outburst may even occur once the behavior has seemed to restore itself.

In dealing with aggressive kids, regardless of their age, here are a few suggestions to consider:

· STAY AS CALM AS POSSIBLE—No matter how agitated, upset, or aggressive your youngster becomes, it is much easier for them to relax if you are also at least somewhat calm. Despite your own concern, do not try to rationalize with them until they have calmed down. Try sending them into their room, or if you have to take yourself out of the situation and stay in your own bedroom or bathroom. If they become overly violent or aggressive you may need to take drastic measures. Call the police if necessary, but stay calm. The more aggravated your youngster sees you become the more power he or she has gained over you and the more likely he will be to repeat the behavior.

· REWARD GOOD BEHAVIOR—Although some moms & dads may see rewards as a form of bardering or bribery, it does not have to be that extreme. It also can work really well for older kids who in no other way seem to want to stop their aggressive tendencies. Offering your kids well-deserved praise, a play at the park, or an opportunity to play at a friends house for proper conduct can work wonders. The key is to inform them of what is first expected, to reward them soon if not immediately after they obey, and to always withhold any and all rewards if they do not obey. So for example, if your youngster has made it through a shopping trip without any yelling, crying, or hitting, you may want to stop at the park with them on the way home as a thank you. Offering them the park the next day is already too late as it gives them the chance to act inappropriately in the mean time. For rewards to work effectively they also cannot be given to your kids if they have not done what was expected of them. Toys can be used as well, but they are not advised and it is always best to start off small otherwise your youngster may be asking for things each and every time he or she behaves. The best kind of reward is praise. Kids need to know their moms & dads are proud of them.

· KNOW YOUR YOUNGSTER'S TEMPERAMENT—Everyone is born with a unique temperament or personality. Some people tend to be more reserved or timid, while others are always outgoing and spontaneous. Similarly, some kids tend to be more outwardly assertive and aggressive and others less so. Knowing your youngster's personality allows you the advantage of foresight. If your youngster does not do well with unexpected occurrences, try to keep his or her day routine. Use the insight.

· KNOW THE TRIGGERS—Whether it be rush hour traffic or spilled juice, everyone has those things that really aggravate or irritate them, and kids are no different. While they may not be as great at expressing what upsets them, things like a late meal, a missed soccer game, or even a forgotten bedtime story can really agitate kids and make them angry. Knowing that your youngster becomes easily upset under certain circumstances allows moms & dads or care-givers to avoid or work around these situations -- or at the very least, be prepared for them. It might be helpful to keep a journal to figure out what times of day or what occurs prior to each time your youngster becomes upset. If mornings are difficult for your youngster, perhaps allow them some extra time to wake up or do not ask a whole lot form them at this point in time. If not being allowed to purchase a toy from the store usually sends them into a tantrum, warn them ahead of time or if possible just leave them at home.

· EXPRESS YOURSELF—Be sure to give your kids the chance to see all of your own personal emotions. Modeling appropriate behavior should not be equated with hiding your feelings or fears from them. It is important for your kids to see that you are also human, and that it is possible to have the esteem and self-control to act rationally even when feelings may not be.

· BE A ROLE MODEL—This is perhaps the hardest part of being a parent or caregiver. Role-modeling your own behavior can be difficult even in the easiest of times, but particularly if arguing or fighting is a common occurrence in your household. Nevertheless, you should not expect from others that which you cannot put forth yourself. Even the odd volatile joke or sarcastic remark can be misinterpreted by kids, so watch not only your actions but also your words. Being a role model not only involves controlling your own emotions, but also teaching your kids how to express theirs — both good and bad— appropriately. Modeling support and compassion for others is an important beginning place, so you may want to volunteer some of your time. Simply bring your neighbor some fresh cut flowers or a fruit basket to say "hello". Visit sick kids in the hospital. Work at the food bank with your kids over the Christmas holidays. Be the kind of person that you would like your youngster to grow up to be.

· AVOID PHYSICAL PUNISHMENT—It can be very easy to become angered and even outraged at a misbehaving youngster, especially an older one who probably should know better. Just be cautious of how you express your feelings, because the kids are always watching and learning from you. Yelling or hitting an already angered and destructive youngster seems only to up the anti. If you expect your kids to act responsibly and calmly, be sure to do so yourself. And remember, even a ten or twelve year-old girl or boy is still a youngster. Kids do not form intent the same way adults do and often have little desire to hurt or upset you. They merely need to express themselves and have not yet learned to do so in a socially acceptable manner.

· UNCONCERNED KIDS— As a final note, if your youngster tends to be destructive often and does not seem to benefit from appropriate parental intervention, or actually seems to enjoy harming others, please seek professional advice.

Mark Hutten, M.A.

My Out-of-Control Teen: Help for Parents

Should Parents Reward Good Grades?

Mark:

I am in Week 2 and I am already seeing improvements in my daughter! We have a long way to go, but she didn’t get this out of control overnight. So I have a question ...my daughter just came home with 100% + bonus points on a Social Studies test that she normally wouldn’t have studied for and would have probably gotten a C or D. Molly is almost 14 and in 8th grade. She calls to tell me the good news and then asks me what her reward will be. I was not sure how to answer that. I told her she should just be happy with her performance (which she is), but she still keeps pushing for a reward. Should I give her something? She proposed we eat out at her favorite restaurant. I didn’t want to make the reward food, since she is overweight already.

You advice is appreciated.

Thanks!

J.

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Hi J.,

Typically we neither reward good grades nor punish bad grades.

Why? Because a built-in reward/consequence system is already in place.

The "reward" (after receiving a good grade) is the satisfaction a child feels by being successful ...the consequence (after receiving a bad grade) is the disappointment a child feels by doing poorly. Even though they may not admit it, all children feel a sense of disappointment when they receive a bad grade -- although they talk themselves into believing that the 'D' or 'F' is no big deal.

Another reason we don't reward good grades is because the parent's "reward" is usually a poor reinforcer. For example, if you said, "I'll take you out to eat if you get 100% + bonus points on your Social Studies test" ...do you think she would work hard to get the grade? I don't think so.

You DO want to reward her, but with acknowledgment and praise -- not with over-indulgence.

When can you use "eating out" as a reward? She can earn the money to buy her own meal by doing extra chores.

Having said all this, if she brings home a great report card (e.g., all 'A's and 'B's), then it's O.K. to "pull a surprise" (i.e., you can take her out to eat -- but with no reference to the grades).

Mark Hutten, M.A.

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Re: Children Adjusting To Mom's New Parenting

Hi K.,

== > I’ve responded throughout your email below:

Hi Mark,

I love your program and have started using it on my 2 boys aged 5 and 8.

I have learnt that I am a severely overindulgent mother, a bit of a shock to the system.

I have started the poker face and staying extremely calm, a thing I use to do and yes back then my children where well behaved.

LOL

My 8 yr old son is a gifted child. I have problems with his inability to accept that others cant do things the way he can.

He constantly puts down his little brother, is rude to others, defiant and extremely competitive. I believe that this shows low self-esteem.

I have started the chores with lots of refusal, so he has lost the things he loves.

Yes things have got a lot worse, as you mentioned they could but now he is crying and all emotional when things go wrong, instead of blaming others and abusing people.

I wonder is this a new way of trying to get me to back off and change my mind.???????

== > Partially …mostly he’s confused about your different parenting …this is his way of adjusting.

Prior to this we had a huge outbreak of throwing and hitting things which isn’t his usual way of dealing with things. Normally he would be extremely abusive and defiant. Amazingly enough I stayed calm and waited it out …. acombined time of over 6 hrs of hysteria in 2 days.

Quite proud of myself.

He is shocked that I am no longer arguing or repeating myself and the louder he gets the quieter my voice becomes.

My 5 yr old has got into a habit of bad language and hitting when things don’t go his way, probably because his brother is very good verbally and that’s his way of equaling things.

I started with the 24hrs of losing things, then went to 48hrs …this was then started again because of hitting and kicking… so 5 days in all.

Is this 2 long for a 5yr old ????

== > Close, but not quite. 7 days would be too long.

My 5yr old loves the thought of “I have EARNT something,” he’s very impressed by it.

Both my boys are extremely well behaved at kinder & school, it’s just with ME.

== > Children don’t mind showing their “ugly side” (as I call it) to the person they trust the most. This would be you. They can behave poorly in front of you because they are comfortable with you.

PS I have always been very involved in their lives and had always done what was in week 1 activities.

I do play a lot with my children… Do you think taking my time (e.g., playing games) away from them when they haven’t been respectful towards me is to tough a consequence ??? Doing this would upset them greatly.

== > It is a tough consequence – perhaps the toughest. But that’s o.k. Playing games with mom is a privilege – not a right.

I would appreciate your thoughts about the emotional way my 8yr old is reacting and you thoughts on the time with my 5 yr old.

== > I think the best thing I need to say at this point is for you to slow down a bit. I want to do what is in your family’s best interest. Thus, the best advice I can give you at this point - since you just got started with the program - is to simply work through the four-week sessions. Only do one session per week – nothing more! If we try to implement a bunch of new parenting changes too quickly, it will backfire.

I’m not trying to avoid answering questions. However, since most of the problems you talked about in your email will be addressed directly in the eBook (mostly in the Online Version), and since the program is designed to take baby-steps toward change, I would encourage you to resist your impulse to leap through the program in search of the “magic bullet.” Instead, enjoy the process of working through each session – one session at a time. The results you so desperately desire will come independent of your striving for them. Patience is “key” right now.

Rest assured, you WILL get the answers you need to be successful with this program, but when the timing is right. I would like to save you from rushing into things, and then failing. Is this O.K.?

Your oldest son is 8-years-old. It has taken 8 years for the problems to get to this point. So it is going to take at least a few weeks to get the problems reversed.

We must implement change gradually because change is tough. People don’t like change, and kids will totally reject parenting changes if they occur too fast. (This isn’t to say that you won’t notice any improvements in your child’s behavior fairly quickly though.)

As you work through the program, email me as needed for clarification about the strategies outlined in the eBook. Then after the four-week program - after you have digested most of the material - email me again with a specific question regarding any parent-child difficulty you may still be struggling with.

Thank you for being patient with the process. The reward will be well worth the effort.

Mark

P.S. Be sure to watch ALL the Instructional Videos [online version of the eBook].


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