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

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Dealing with Defiant Children Who Refuse to Cooperate

"Any ideas on how to deal with a 7 y.o. son who does not do what he's told to do - even with the simplest of requests? He's the youngest of 4, and by far the most stubborn."

You have just told your youngster to do something (e.g., “Michael, turn off the TV and get ready for bed”), and he blatantly responds with something like, “No” or “You can’t make me.”

When defiant kids say, “You can’t make me,” they are asserting their control and challenging yours. They are silently hoping that you will rise to the challenge and try to control them. Like it or not, they are right. Parents can’t make children do anything against their will.

These kids are also upping the ante by challenging parents to come up with some consequence that will mean something to them. The “test” is to show parents their own powerlessness, and these kids will often laugh in the face of any consequences parents might use, even if at a later time they might wish they hadn’t.

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

How to get kids to cooperate:

1. Kids who ask something like, “What are you going to do about it?” are not so much interested in your answer as they are in trying to prove how incapable you are of controlling their behavior. A good response to this question might be, “You are trying to decide if it’s worth it for you. That lets me know that you are in control and are choosing whether or not to behave. That means you’re also choosing to accept whatever the consequences are.”

2. Rarely, if ever, tell the youngster what the consequences will be for non-compliance, because (a) it generally doesn’t make a difference to them, and (b) vague consequences can serve to keep them emotionally off balance. Kids who are defiant don’t like uncertainty, and they are often more likely to make a decision to control their behavior if they don’t know what will happen. You could say, “Because you are telling me you’re in control, and it sounds like you’re just trying to see what will happen, is it worth it for you to act-up just to see what the outcome will be?”

3. Remain calm. Parents who can't control themselves can’t control the youngster or be in control of a situation. Remember that while your blood is reaching the boiling point, your youngster's may be also. Once that happens your youngster is no longer thinking clearly. Most efforts at talking and teaching will be a waste of time and energy. Defuse the situation as calmly and rationally as possible. To find a compromise with your youngster that will get the situation under control is not giving up control. You don't have to win every battle to win a war. After the situation is finished and everyone is calm, there will be time to talk about the situation and to agree on a consequence for what happened.

4. Acknowledge your child’s upset feelings when he’s mad. For example, the parent can say something like, "Ouch! That hurt my ears. I don't scream at you like that, please don't scream at me. I can see you are really upset to use that tone of voice. What can I do to help you?”

5. You can consciously choose to avoid getting into a power struggle. You might generally agree with the youngster by saying something like, “You are absolutely right. I can’t make you. The only person who can control you is you. I hope you make a good decision for yourself.”

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

6. Avoid constant arguments and threats by using a system similar to the ones used in residential treatment programs. Set up a board that lists five or more levels of behavior and associated privileges. The middle level should be for acceptable behavior, next level up for effort at improvement, and highest level for exemplary behavior. The level below middle should be for demotion when the youngster misbehaves while the lowest level should be reserved for serious violations of house rules including not complying with the privileges associated with a certain level or demotion for misbehavior after being on the next to lowest level for prolonged periods. Here’s an example of this system:

Level 5—
  • Requirements: Helpful without being asked. Follows all rules. 
  • Privileges: 2 hours TV, 2 points/day, 1 hour video games, 1 hour later bedtime.

Level 4—
  • Requirements: Helpful when asked. Follows rules well. 
  • Privileges: 1½ hours TV, 1 point/day, 3/4 hour video games, 1/2 hour later bedtime.

Level 3—
  • Requirements: Good behavior. Needs reminders to complete chores and follow rules. 
  • Privileges: 1 hour TV, 1/2 hour video games, regular bedtime.

Level 2—
  • Requirements: Some misbehavior. Requires frequent reminders to complete chores and follow rules. 
  • Privileges: 1/2 hour earlier bedtime, 1/2 hour TV, no video games, must complete chores and schoolwork before play.

Level 1—
  • Requirements: Severe infraction of rules. Unacceptable behavior. Fighting. Refusal to cooperate after warnings. Not complying with privileges for level. 
  • Privileges: Grounded. No after school activities. No telephone. No plans with friends. No TV. Lose all points.


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

When Defiant Teens Play One Parent Against The Other: Tips For Divorced Parents

Scenario: Kylee is 16-years-old. Her parents are divorced. She spends the weekends with her dad and stepmother. Unfortunately, her biological parents are not on the same page with respect to parenting styles and disciplinary techniques. Her mom is rather permissive (i.e., few rules, few consequences for breaking rules), but her dad is somewhat authoritarian (i.e., a lot of rules, serious punishment for breaking the rules).

One day before dinner, Kylee’s dad says, “Put your cell phone away. We don’t text while we eat!” Kylee’s retort is, “I don’t have to follow that rule …that’s not a rule at our house (mother’s house). I text whenever I want to at home!”

Then the arguing and yelling between father and daughter begins! You know the rest of the story…

Defiant teens know the value of playing their parents against each other. They learned a long time ago that just because dad has said “no” doesn’t mean mom won’t say “yes.” Many defiant teens of divorced parents constantly point out inconsistent enforcement of the rules by parents, and these teens use this as a rationale for their own behavior. What the defiant teenager is trying to do is make an issue of whether or not her divorced parents are consistent with the rules (rather than focusing on the real issue, which is whether she is choosing to follow or break the rules).

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

Unfortunately, many parents fall for this. There seems to be an irrational belief that if both parents treat the teenager the same way, she will behave. The total weight of the teen’s behavior is put on the parents, and the responsibility is built on enforcement rather than on compliance.

Although consistent enforcement does help keep the rule in the forefront, inconsistent enforcement neither causes nor excuses inappropriate behavior. The issue isn’t whether the parent is or isn’t being fair or consistent, rather the issue is that the teenager is violating the rule and is looking for someone else to blame.

While a certain amount of manipulation is normal in adolescence, if it occurs constantly, it may indicate underlying familial problems. Teens who frequently pit one parent against the other may be acting-out the tension they feel between their parents. That’s one reason this type of manipulation is especially common among children and teens whose parents are separated or divorced. In divorced families, parents are rarely on the same team, and defiant teens often attempt to use this fracture to their advantage.

Co-parents are often racked with guilt over the failed marriage and the back and forth position the children often find themselves in. Sometimes co-parents are insecure about the family dynamics and make it their goal to be the “favorite” parent. Because of this guilt and/or insecurity, it is very tempting for co-parents to try to please the teenager at all costs, becoming excessively indulgent and ignoring the other parent’s household rules.

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

On the other extreme, it is not uncommon for one parent to feel compelled to “lay down the law” in order to keep the teenager “in line.” In the case where one parent is tough and the other parent is soft, the teenager will automatically prefer the softer parent, which also causes huge riffs between the teen and her tougher parent.

Co-parents should work diligently at communicating reasonable expectations regarding routines and household rules in an attempt to get on the same page. If they can’t effectively communicate, or if their parenting styles are not even in the same book, let alone on the same page, they need to arm themselves with some appropriate responses to effectively combat the teen’s manipulative tactics. One way to do this would be to acknowledge to your teen that you understand that there are different rules at the other parent’s house, but while she is at your house, she must follow your rules – no exceptions.

Your teenager will be reassured when you fail the “test” she is putting you through (i.e., trying to guilt-trip you into being more like the softer parent). Children need to feel secure. Children seek predictable limits. It is safe to say that, if your teenager is constantly playing you against the other parent, she is feeling insecure and needs some reassurance that you care more about parenting her than you do about fighting with the other parent.


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

Teens Who Steal Prescription Drugs From Parents

 "We suspect our teen son has been pilfering my sleep medication (along with a couple other prescriptions). How should we approach this... we have no solid proof as of yet."

This is not an uncommon problem. You, the parent of an unruly teenager, may inadvertently be a big source of prescription medications he/she is using behind your back. More often than not, medicine cabinets are your teen’s “go-to” spot of choice. A whopping 61% of adolescents report that prescription medications are easier to get than illegal medications, and 41% of adolescents mistakenly believe use of medicines is less dangerous than use of illegal street medications.

One out of every two Americans is on prescription drugs. So these medications are readily available. People think they're safe because they're prescribed by a physician, and more adolescents are turning to the medicine cabinet to get their medications of choice.

Here are the five classes of prescription medications teens get most often in their own homes:
  • Cough medications: Contain DXM, which acts in way that is similar to morphine. They can cause respiratory depression, brain hemorrhage, nausea, and vomiting, and prompt thousands of emergency room visits each year.
  • Narcotic pain relievers: Excess use can cause respiratory depression, even coma and death. Mild use can cause constipation, depression, and problems concentrating. These are the ones most commonly used by adolescents.
  • Sedatives/tranquilizers: Such as Valium, can cause impaired coordination, which can be a real danger if someone is driving. They can also cause drowsiness and depression.
  • Sleep Aids: Such as Ambien, have a high potential for use (even in grown-ups), and there are reports that adolescents use it recreationally because they get a "high" by trying to fight the sleepy feeling -- and can have visual hallucinations.
  • Stimulants: Such as Ritalin, can cause nervousness, insomnia, and toxic psychosis. They can be used by grown-ups and adolescents trying for what they perceive as better concentration.

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

The risks of adolescent prescription drug use are momentous, yet few grown-ups in a position to take action against them have realistic grip on this new frontier of adolescent crime. Not only do drug companies deceive the public to make a buck, but they influence the judgment of many physicians, paying them well to give speeches and sales pitches promoting their medications to other physicians.

From 2000 to 2005, drug maker payments to psychiatrists rose more than six-fold, to $1.6 million. During those same years, medications of anti-psychotics for kids in the Medicaid program rose more than nine-fold. It is sad, yet self-evident, that the politics of money have long infiltrated the offices of many of those who should be defending adolescents from prescription drug use. The fact is that whether people use their medications legally or not, the company still makes money on every tablet.

The culture growing between teenagers who use prescription medications is poignantly different from that around other drugs. First, know that these medications are much cheaper than most other drugs, and many adolescents get them for free, from medicine cabinets, peers, or their own prescribed medications (e.g., Ritalin). The price for a tablet of the most commonly used drug medications ranges from 3 to 6 dollars, with prices getting cheaper in bulk. OxyContin and other stronger medications can be a little more. Prices vary based on availability and on how many milligrams are in the dose. What this means is that not only can teens often afford to take them every day, but they do not have to buy them to try them since the low cost makes many happy to share.

The issue of prescription drug use is not new, so why has it been sidelined for so long, and why has the threat been growing so much faster in recent years? First consider that tablets and capsules have a connotation of safety, especially for naïve, risk-taking teenagers. The primary reasons for this connotation are because tablets and capsules are easier to take than smoking marijuana or drinking liquor and are professionally manufactured in a lab. They are easily available, comparatively cheap, and inconspicuous to carry around. Furthermore, most adolescents see them being used legally, often by their moms and dads.

An adolescent might easily say to his/her mother or father, “If you can take them, why can’t I? We do it for the same reasons.” Perhaps this is part of what many moms and dads misinterpret about adolescent drug use. Much more often than a parent might think, adolescents are abusing prescription medications not to get high, but rather to be less depressed, less stressed-out, more focused, or better rested. If moms and dads are not drawing the line, then how will their kids learn to?

Direct-to-consumer drug advertising was approved by the Food and Drug Administration in 1997. Since then, most people have come to take it for granted that their lives will be flooded with ads for prescription medications. These ads do not take a medical degree to understand, yet many of the products they advertise do. Someone who is nineteen now was nine when the floodgates opened. The result is that ever since today’s adolescents have been aware of prescription medications, their understanding of them has been largely shaped by the drug companies.

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

It should be no surprise that so many adolescents now believe the industry message that “tablets and capsules offer a cure for any ill.” Which ones to take, many ads suggest, is largely a matter of personal choice. Many teenagers come to view school-related stressors as a series of problems that can be solved with tablets and capsules. Being an adolescent can mean being fixated on personal problem. Unfortunately, many adolescents have not realized that using prescription medications only brings them more difficulty.

With other drugs, like marijuana and cocaine, adolescents often have to look around quite a bit to find a dealer, who also routinely sells prescription medications, often importing them in quantity from countries like Mexico that allow you to buy anything you like over the counter. Yet the primary means of trafficking prescription medications, especially for adolescents, is through social networks (e.g., peers and classmates). The effect of adolescent's sharing and trading medications at little or no increased price, is that drug dealers often can’t make as much money on these medications as they can on others for which they completely control the supply.

The multitude of ways adolescents take prescription medications and mix them with other drugs making "cocktails" demonstrates how their uses lead straight to even more destructive drug habits. All three major categories of used drugs can be easily crushed and snorted, making the sensation more instant and overwhelming, and very often leading adolescents to seek out cocaine and speed. Opiates and CNS depressants are frequently crushed and smoked, often with marijuana. The injection of Opiates and CNS depressants among adolescents, by crushing them and mixing the powder with water, is also growing. The trend is especially alarming given some of these medications similarity to heroin, especially OxyContin.

The reality of the ongoing prescription swap-meet between adolescents has long-term implications for the mental health of many children who may grow up without learning how to make themselves feel healthy without illegal medications. Another alarming trend with prescription medications is that females are more likely to use them than males. The National Survey on Drug Use and Health reported in 2002 that 4.3% of female adolescents reported abusing prescription medications in the last month in comparison to 3.6% of male adolescents. The disparity is likely due in part to the propensity of many adolescents to pop tablets and capsules to lose weight. The effect prescription medications have on one's judgment can interact with eating disorders to raise a host of fresh health threats. What many moms and dads find most painful about adolescent prescription drug use is that, because most adolescents are always willing to sell-off a few tablets and capsules, many more kids are in effect becoming drug dealers.

The growing amount of medications in more homes means, not only that they are more easily available to adolescents, but also that they may feel more commonplace and safe to adolescents. A consequence of this is that many adolescents are happy to play physician for their peers. Teens crudely mimic their physicians’ behaviors, using phrases such as, “All you have to do is try a little more or a little less, or you can always switch to something similar.” It is normal to hear adolescents express this attitude saying something like, “I don't think it is wrong -- when I have the prescription medication I know a friend needs to make them feel better, I give them a tablet or two.”

The universe of available prescription medications is too great for almost anyone to keep close track, especially with the astronomical number of new medications and generics introduced every year. Yet a practical understanding of the tablets and capsules most often popped is vital for moms and dads to fight back.

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

What can parents do?

Putting medications under lock and key seems obvious, yet use usually gets started because moms and dads don't. In addition to this practice, count your tablets and capsules, keeping a sticky note on the bottle where you can initial and write the number of tablets and capsules left every time you take some. This practice may sound like a lot of paperwork, but it is a clear signal to adolescents that you are constantly vigilant on the issue, and it should help provide a deterrent.

Ask your physician if your medications are often used and how, so that you know the symptoms. Most drugs will not get you high or serve adolescents' perceived self-medication needs. If this is the case with your medications, you should be open with your adolescent about it, joking "you would not get a rush from taking my heart medication -- I sure don't."

It's not just prescription medications, but over-the-counter as well that moms and dads need to focus on. Talk to your kids. Let them know that, just because they're prescribed by a physician, doesn't mean they couldn't be deadly.

Once you have taken the initial steps to become more informed, and to secure the drugs in your home, considering how to discuss the issue with your family is the next move. Begin by listening. Just starting a general conversation on prescription medications can illuminate your adolescent's tendencies before you clam them up with warnings and rules. Once you have learned your adolescent's honest opinions on the issue, set clear expectations with your adolescent, letting them know that under no circumstances should they ever take drugs without your knowledge. Let them know that if they ever feel curious about whether they would benefit from taking drugs that you would love to discuss it with them and the family physician or counselor. Your kids tune you out when you lecture them, so use teachable moments to get the message across instead (e.g., organizing the bathroom, swinging by the pharmacy).

Prescription drug use has been played down for so long that reaching out to the community for support is even more critical than with other drugs and liquor. If you are the only person in their life concerned about it, it is much easier for adolescents to discount your warnings. Making sure that your adolescent's physician is actively addressing the issue when he or she talks with your adolescent is vital. Next, meet with the adolescent's school counselor, nurse, and principal, to hear what they have to say about the issue in your adolescent's peer group. Make sure that the most current information is included in your adolescent's health class and that all moms and dads are being asked to lock-up and count their tablets and capsules.

It is highly unlikely that you can prevent your adolescent from being exposed to prescription drug use. The question is how you can help him/her to think critically and respond confidently. If your adolescent is showing a special curiosity about prescription medications, it usually means that he/she at least has peers who are abusing them. When you observe this curiosity, satisfy it with the facts. Let him/her know that taking a tablet one can’t identify or wasn’t prescribed is like playing Russian roulette.

The risks of overdosing, date rape, and taking a tablet that kills you are things that too many moms and dads as well as adolescents are not talking about. Experimenting with and becoming dependent on prescription medications is a swift path to the people, situations, and other medications that are even more dangerous for adolescents. Times are changing, and so are the cultures and methods of prescription drug use.


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

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