Treatment & Management for Disobedient Children

"I need advice on what to do with my son who has been diagnosed with oppositional disorder!"

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.

==> Help for Parents with Oppositional Children and Teens

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.

==> Help for Parents with Oppositional Children and Teens

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.

==> Help for Parents with Oppositional Children and Teens

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.

==> Effective Disciplinary Techniques for Defiant Teens and Preteens

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.

Online Parent Support

Educating Your Child About S e x

Answering children's questions about sex is one of the responsibilities many mothers/fathers dread most. Otherwise confident parents often feel tongue-tied and awkward when it comes to conversations about sex. But the subject shouldn't be avoided. By answering children's questions as they arise, parents can help foster healthy feelings about sex.

Q & A: Educating Your Child About Sex

1. At what age should females be told about menstruation?

Females (and males!) should have information about menstruation by about age 8, some of which may be provided in school. Instructional books are helpful, but moms should also share their own personal experiences with their daughters, including when their periods first started and what it felt like, and how, like many things, it wasn't such a big deal after a while.

2. At what age should nudity in the home be curtailed?

Families set their own standards for nudity, modesty, and privacy. Although every family's values are different, privacy is an important concept for all children to learn. Moms and dads should explain limits regarding privacy the same way that other house rules are explained — matter-of-factly — so that children don't come to associate privacy with guilt or secrecy. Generally, they'll learn from the limits you establish for them.

3. Is it OK to use nicknames for private parts?

By the time a youngster is 3 years of age, mothers/fathers may choose to use the correct anatomical words. They may sound clinical, but there is no reason why the proper label shouldn't be used when the youngster is capable of saying it. These words — penis, vagina, etc. — should be stated matter-of-factly, with no implied silliness. That way, the youngster learns to use them in a direct manner, without embarrassment. In fact, this is what most parents do. A Gallup Poll showed that 67% of parents use actual names to refer to male and female body parts.

4. To what extent can mothers/fathers depend on schools to teach sex education?

Moms and dads should begin the sex education process long before it starts in school. The introduction of formal sex education in the classroom varies; many schools start it in the fifth or sixth grade. Some of the topics addressed in sex-ed class may include anatomy, contraception, sexually transmitted diseases, and pregnancy. Parents should be open to continuing the dialogue and answering questions at home. Schools tend to teach mechanics and science more than values. This is an area where parents can and should have something to teach.

5. What do you tell a very young child who asks where babies come from?

Depending on the youngster's age, you can say that the baby grows from an egg in the mommy's womb, pointing to your stomach, and comes out of a special place, called the vagina. There is no need to explain the act of lovemaking because very young children will not understand the concept. However, you can say that when a man and a woman love each other, they like to be close to one another. Tell them that the man's sperm joins the woman's egg and then the baby begins to grow. Most children under the age of 6 will accept this answer. Age-appropriate books on the subject are also helpful. Answer the question in a straightforward manner, and you will probably find that your youngster is satisfied with a little information at a time.

6. What should you do if you catch children "playing doctor" (i.e., showing private parts to each other)?

Children 3 to 6 years old are most likely to "play doctor." Many mothers/fathers overreact when they witness or hear of such behavior. Heavy-handed scolding is not the way to deal with it. Nor should parents feel this is or will lead to promiscuous behavior. Often, the presence of a parent is enough to interrupt the play. You may wish to direct your youngster's attention to another activity without making a lot of fuss. Later, sit down with your youngster for a talk. Explain that although you understand the interest in his or her friend's body, but that people are generally expected to keep their bodies covered in public. This way you have set limits without having made the youngster feel guilty. This is also an appropriate age to begin to talk about good and bad touch. Tell children that their bodies are their own and that they have the right to privacy. No one should touch children if they don't like it or want it. Tell them that if anyone ever touches them in a way that feels strange or bad, they should tell that person to stop it and then tell you about it. Explain that you want to know about anything that makes your children feel bad or uncomfortable.

7. What sort of "sexual" behavior do young children exhibit?

Toddlers will often touch themselves when they are naked, such as in the bathtub or while being diapered. At this stage of development, they have no modesty. Their mothers/fathers' reaction will tell them whether their actions are acceptable. Toddlers should not be scolded or made to feel ashamed of being interested in their bodies. It is natural for kids to be interested in their own bodies. Some moms and dads may choose to casually ignore self-touching. Others may want to acknowledge that, while they know it feels good, it is a private matter. Moms and dads can make it clear that they expect the youngster to keep that activity private. Parents should only be concerned about masturbation if a youngster seems preoccupied with it to the exclusion of other activities. Victims of sexual abuse sometimes become preoccupied with self-stimulation.

8. When do children start becoming curious about sex?

Kids are human beings and therefore sexual beings. It's hard for mothers/fathers to acknowledge this, just as it's hard for children to think of their parents as sexually active. But even infants have curiosity about their own bodies, which is healthy and normal.

9. When should mothers/fathers sit children down for that all-important "birds and bees" talk?

Actually, never! Learning about sex should not occur in one all-or-nothing session. It should be more of an unfolding process, one in which children learn, over time, what they need to know. Questions should be answered as they arise so that children' natural curiosity is satisfied as they mature. If your youngster doesn't ask questions about sex, don't just ignore the subject. At about age 5, you can begin to introduce books that approach sexuality on a developmentally appropriate level. Moms and dads often have trouble finding the right words, but many excellent books are available to help.

10. Why Do Kids Need to Know About Sex and Sexuality?

Understanding sexuality helps children cope with their feelings and with peer pressure. It helps them take charge of their lives and have loving relationships. It also helps protect them from sexual abuse — and from becoming sexual abusers. Home can be the most meaningful place to learn about sexuality. We can help our children feel good about their sexuality from the very beginning. Then they will be more likely to trust us enough to ask questions about sex later on in life. Young people are less likely to take sexual risks if they have:

• a connection to home, family, and other caring adults in their community, school, or religious institution

• a positive view of sexuality

• a sense that their actions affect what happens

• clarity about their own values and an understanding of their families’ values

• information that they need to take care of their sexual health

• interpersonal skills, such as assertiveness and decision-making abilities

• self-esteem and self-confidence

11. When's the Best Time to Start Talking with My Kids About Sex and Sexuality?

It's best to start as soon as kids begin getting sexual messages. And they start getting them as soon as they're born. Kids learn how to think and feel about their bodies and their sexual behavior from things we do and say — from the way we hold them, talk to them, dress them, teach them the words for their body parts, give them feedback on their behavior, and behave in their presence. But don't worry if you haven't started yet. It's never too late. Just don't try to "catch up" all at once. The most important thing is to be open and available whenever a youngster wants to talk.

12. How Do I Start a Conversation About Sex and Sexuality?

Some moms and dads look forward to talking with their kids about the wonders of human reproduction and human sexuality. But many find it difficult to talk about important topics like relationships and sex and sexuality. The good news is that, if we pay attention, we can find many everyday moments in our lives that can prompt conversations about these topics:

• Models in print ads or on billboards may make us think about and question our own bodies and body image.

• Our favorite TV show may feature a character going through puberty.

• Our neighbor or friend may be pregnant.

Some moms and dads call these “teachable moments.” Take time to recognize the teachable moments that give you opportunities to talk about sex and sexuality with your youngster. Spend a week or so noticing how topics you‘d like to discuss come up in your family’s everyday life. Think about what you might ask your youngster about them to get conversations going. And think about your own opinions and values about these topics, and how you can express them clearly to your youngster.

After you’ve thought about what you want to say on a subject, use the next teachable moment that comes up. The first few times you do this, kids may be cautious and ask, “Why do you want to know?” Or they may search for an answer they think will please you. It may take several tries before you can speak comfortably together.

13. What If I’m Uncomfortable Talking About Sex with My Children?

Don’t let fear get in the way. Being open and available about subjects such as sex and sexuality can be challenging. Some common fears that many parents have are:

• Encouraging sexual experimentation. There is a myth that information about sex is harmful to kids and that it will lead to sexual experimentation. The fact is that our kids won’t be more likely to have sex if we talk about it. In reality, children who talk with their parents about sex are more likely to postpone having sex.
• Feeling as though talking won’t make a difference. Kids look to their moms and dads to teach them about sexuality. Most young people prefer to hear about it from their parents than from other people. In fact, young adolescents place parents at the top of their list of influences when it comes to their sexual attitudes and behaviors.
• Feeling embarrassed. It’s very common for parents or kids to feel embarrassed when talking about sex and sexuality. The best way to handle it is to admit how we’re feeling — we can simply say, “I might get a little tense or uncomfortable during this conversation, and you might, too. That’s okay for both of us — it’s totally normal.”
• Looking dumb. Many of us weren’t taught about sex and sexuality, yet we may feel that we should know all the answers. But if our kids ask us about something we don’t know, we can simply say, “I don’t know. Let’s find out together.”

14. What Should I Tell My Kids — And When?

Kids have different concerns about sex at different ages. They also have different abilities to understand concepts — and different attention spans. If your five-year-old asks, “What is birth?” you might answer, “When a baby comes out a mother’s body.” If your 10-year-old asked the same question, your answer would have more detail, and might begin, “After nine months of growing inside a woman’s uterus …” Preteens and teens often spend a great deal of time wondering if they’re “normal”. We can help them understand that it is "normal" for everyone to be different. In fact, the most important lesson we can share with our children is just that — being different is normal. When deciding how much detail to give, moms and dads can rely on what they already know about their youngster’s level of understanding. Reading about what kids need to know at different ages could help you decide what is age-appropriate. Reading tips for talking with your kids about sexuality and how to answer their questions also may be helpful.

15. What are some ways to get “the conversation” started?

Sometimes asking your youngster a question is a great way to open up a conversation. Here are a few questions you might ask:

YOUNG KIDS—

• Your aunt is pregnant. Do you know what that means?

• Do you know why girls look different than boys?

• Do you know the names of all your body parts?

PRETEENS—

• At what age do you think a person should start dating? Have any of your friends started dating?

• Do you think girls and boys are treated differently? (If yes …) How?

• People change a lot during puberty. What have you heard about the changes of puberty? How do you feel about going through puberty?

TEENS—

• At what age do you think a person is ready to be a parent?

• At what age do you think a person is ready to have sex? How should a person decide?

• How have you changed in the last two years? What do you like and what do you not like about the changes?

==> My Out-of-Control Teen: Help for Parents