Helping Your Difficult Child Through the Tough Middle School Years

Moms and dads often become less involved in the lives of their kids as they enter the middle grades. But your child needs as much attention and love from you as she needed when she was younger—and maybe more. 

 

A good relationship with parents is the best safeguard the youngster has as she grows and explores. By the time she reaches the teenage years, you and she will have had years of experience with each other. The mother or father of today's little girl is also the parent to tomorrow's teen.

Your relationship with your youngster will almost certainly change after elementary school. In fact, most parents report that their child's behavior changed drastically (for the worse) once he or she entered the 7th grade. But, these changes can be rewarding and welcome if treated appropriately. 

 

==> My Out-of-Control Teen: Help for Parents with Difficult Preteens and Teens

 

As your middle school youngster makes mental and emotional leaps, your conversations will grow richer. As his interests develop and deepen, he may begin to teach YOU (e.g., how to hit a baseball, what is happening with the city council or county board, why a new movie is worth watching, etc.).

According to the research, when their difficult children enter middle school, effective mothers and fathers exhibit the following qualities:

1. Middle school kids need strong role models. Try to live the behavior and values that you hope your youngster will develop. Your actions speak louder than words. If you set high standards for yourself and treat others with kindness and respect, your youngster stands a better chance of following your example. As these children explore possibilities of who they may become, they look to their moms and dads, friends, well-known personalities, and others to define who they may become.

2. The middle school years are a time for exploring many areas and doing new things. Your youngster may try new sports and new academic pursuits and read new books. She may experiment with different forms of art, learn about different cultures and careers and take part in community or religious activities. Within your means, you can open doors for your youngster. You can introduce her to new people and to new worlds. In doing so, you may renew in yourself long-ignored interests and talents, which also can set a good example for your youngster. Don't be discouraged when her interests change.

3. Middle school kids need support as they struggle with problems that may seem unimportant to their moms and dads. They need praise when they've done their best. They need encouragement to develop interests and personal characteristics.

4. Middle school kids need moms and dads who consistently provide structure and supervision that is firm and appropriate for age and development. Limits keep them physically and emotionally safe.

5. When your kids behave badly, you may become angry or upset with them. You may also feel miserable because you became angry or upset. But these feelings are different from not loving your kids. Middle school kids need parents who are there for them—adults who connect with them, communicate with them, spend time with them and show a genuine interest in them. This is how they learn to care for and love others. Moms and dads can love their kids but not necessarily love what they do – and kids need to trust that this is true.

6. It is tempting to label all middle school kids as being difficult and rebellious. But these youngsters vary as much as do kids in any other age group. Your youngster needs to be treated with respect, which requires you to recognize and appreciate his differences and to treat him as an individual. Respect also requires you to show compassion by trying to see things from your youngster's point of view and to consider his needs and feelings. By treating your child with respect, you help him to take pleasure in good behavior.

7. We are not born knowing how to act responsibly. A sense of responsibility is formed over time. As kids grow up, they need to learn to take more and more responsibility for such things as: (a) admitting to both the good and bad choices that they make, (b) completing chores that contribute to the family's well being, (c) completing homework assignments without being nagged, (d) finding ways to be useful to others, and (e) taking on community activities.

There are no perfect mothers or fathers. However, a bad decision or an "off" day (or week or month) isn't likely to have any lasting impact on your middle school son or daughter. What's most important in being an effective parent is what you do “over time.”

==> My Out-of-Control Teen: Help for Parents with Difficult Preteens and Teens

Understanding Your Preteen's Behavior

Throughout our lives we grow and change, but during the preteen years, the rate of change is especially evident. We consider 11-year-olds to be kids, but we think of 16-year-olds as "almost adults" – a huge leap that happens in the space of only 5 years. We welcome the changes, but we also find them a bit challenging.

When kids are younger, it is easier to predict when a change might take place and how rapidly. But by the preteen years, the relationship between a youngster’s real age and his developmental milestones grows weaker. Just how preteens develop can be influenced by many things (e.g., genes, families, friends, neighborhoods, values, etc.).

Cognitive Changes—

The cognitive or mental changes that take place in the preteen years may be less easy to see, but they can be just as dramatic as physical and emotional changes. During adolescence, most teenagers make large leaps in the way they think and reason and learn. Younger kids need to see and touch things to be convinced that they are real. But in the preteen years, kids become able to think about ideas and about things that they can't see or touch. They become better able to think though problems and see the consequences of different points of view or actions. For the first time, they can think about what might be, instead of what is. A 5-year-old thinks a smiling person is happy and a crying person is sad. A 13-year-old may tell you that a sad person smiles to hide his true feelings.

The cognitive changes allow preteens to learn more advanced and complicated material in school. They become eager to gain and apply knowledge and to consider a range of ideas or options. These mental changes also carry over into their emotional lives. Within the family, for example, the ability to reason may change the way preteens talk to - and act - around their moms and dads. They begin to anticipate how their parents will react to something they say or do and prepare an answer or an explanation.

In addition, these mental changes lead preteens to consider who they are and who they may be. This is a process called “identity formation” and it is a major activity during the preteen years. Most preteens will explore a range of possible identities. They go through phases that, to a mother or father, can seem to be ever-changing. Indeed, preteens that don't go through this period of exploration are at greater risk of developing psychological problems, especially depression, when they are grown-ups.

Just as adults, who with more experience and cognitive maturity can struggle with their different roles, preteens struggle in developing a sense of who they are. They begin to realize that they play different roles with different people (e.g., son or daughter, friend, teammate, student, worker, etc.).

Preteens may be able to think more like grown-ups, but they still do not have the experience that is needed to act like grown-ups. As a result, their behavior may be out of step with their ideas (e.g., your daughter may participate eagerly in a walk to raise money to save the environment - but litter the route she walks with soda cans, or she may spend an evening on the phone with her best friend talking about how they dislike certain classmates because they gossip).

It takes time for preteens and their moms and dads to adjust to all these changes. But the changes are also exciting. They allow the preteen to see what he can be like in the future and to develop plans for becoming that individual.

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

Emotional Changes—

Most experts believe that the idea of preteens being controlled by their "raging hormones" is exaggerated. Nonetheless, this age can be one of mood swings, sulking, craving privacy, and short tempers. Younger kids are not able to think far ahead, but preteens can - and do, which allows them to worry about the future. Some may worry excessively about:

• being bullied at school
• drugs and drinking
• dying
• hunger and poverty in the country
• not having friends
• nuclear bombs and terrorists attacks on the country
• school violence
• divorce of their parents
• possible death of a parent
• appearance, physical development and popularity
• inability to get a good job
• school performance

Many preteens are very self-conscious. And, because they are experiencing dramatic physical and emotional changes, they are often overly sensitive about themselves. They may worry about “defects” that are very noticeable to them, but are hardly noticeable to others (e.g., "I can't go to the football game tonight because everyone will laugh at this monster zit on my forehead"). A preteen also can be caught up in herself. She may believe that she is the only person who feels the way she feels or has the same experiences, that she is so special that no one else (particularly her parents) can understand her. This belief can contribute to feelings of loneliness and isolation. In addition, the preteen’s focus on herself has implications for how she mixes with family versus peers (" I can't be seen walking around the Mall with my mom!").

Preteens’ emotions often seem exaggerated. Their actions seem inconsistent. It is normal for preteens to swing regularly from being happy to being sad, and from feeling smart to feeling dumb. In fact, some think of the preteen years as a second childhood. One minute, they want to be treated and taken care of like a 3-year-old. Ten minutes later they are pushing the parent away, saying, “Leave me alone.” It may help if you can help them understand that they are in the midst of some major changes that don't always move steadily ahead.

In addition to changes in the emotions that they feel, most preteens explore different ways to express their emotions. For example, a young girl who greeted friends and visitors with enthusiastic hugs may turn into a preteen who gives these same people only a nod of the head. Similarly, hugs and kisses for a mother or father may be replaced with a pulling away and an, "Oh, Mom!" It's important to remember, though, that these are usually changes in ways of expressing feelings and not the actual feelings about peers and family. (Note: Be on the lookout for excessive emotional swings or long-lasting sadness in your preteen. These can suggest severe emotional problems.)

Physical Changes—

As they enter puberty, preteens undergo a great many physical changes, not only in size and shape, but in such things as the growth of pubic and underarm hair and increased body odor. For females, changes include the development of breasts and the start of menstruation. For males, changes include the development of testes.

Preteens do not begin puberty at the same age. For females, it may take place anywhere from the age of 8 to 13; in males, it happens about two years later on average. This is the time period when young people’s physical characteristics vary the most within their classes and among their peers. Some may grow so much that, by the end of the school year, they may be too large for the desks they were assigned in September. Others may change more slowly.

The preteen years often bring with it new concerns about body image and appearance. Both females and males who never before gave much thought to their looks may suddenly spend hours primping, worrying and complaining about being too short, too tall, too fat, too skinny or too pimply. Body parts may grow at different times and rates (e.g., hands and feet may grow faster than arms and legs). Because movement of their bodies requires coordination of body parts, and because these parts are of changing proportions, preteens are often clumsy and awkward in their physical activities.

The rate at which physical growth and development takes place also can influence other parts of a preteen’s life. A 12-year-old female who has already reached puberty will have different interests than her peer who does not do so until she's 13. Preteens that bloom very early - or very late - may have special concerns. Late bloomers (especially males) may feel they can't compete in sports with more physically developed peers. Early bloomers (especially females) may be pressured into adult-like situations before they are emotionally or mentally able to handle them. 

The combined effect of (a) the age on the beginning for physical changes in puberty, and (b) the ways in which peers, parents, and the world around them respond to those changes, can have long-lasting effects on a preteen. However, some of these young people like the idea that they are developing differently from their peers (e.g., they may enjoy some advantages, especially in sports, over peers who mature later). Whatever the rate of growth, many preteens have an unrealistic view of themselves and need to be reassured that differences in growth rates are normal.

 

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

Raves and Club Drugs: Tips for Parents of Teens

Have you ever heard of “Raves”?  Raves are high energy, all-night parties that feature hard pounding techno-music and flashing laser lights. They are found in most urban areas and, increasingly, in rural areas throughout the country. The dances are held in clubs, abandoned warehouses, open fields, or empty buildings.

Raves are frequently advertised as “alcohol/drug-free” dances with hired security personnel. However, they are dangerously over crowded events where your teenager can be exposed to rampant drug abuse and a high-crime environment. Numerous overdoses are documented at these dances.

Raves are one of the most popular events where “club drugs” are distributed. Club drugs include Ecstasy, Meth and LSD – just to name a few. Because some of these club drugs are colorless, odorless, and tasteless, they can be added without detection to drinks (e.g., punch, root beer) by people who want to intoxicate or sedate others in order to commit sexual assaults.

Rave promoters capitalize on the effects of club drugs. Bottled water and sports drinks are sold at (often at inflated prices) to manage dehydration and hyperthermia. Pacifiers that prevent involuntary teeth clenching, chemical lights, menthol nasal inhalers, neon glow sticks and surgical masks are used to increase sensory perception and enhance the Rave experience. Also, “cool down rooms” are provided (usually at a cost) as a place to cool off due to increased body temperature of the drug abuser.

Here’s a list of the main club drugs currently in use:

1. Speed, Ice, Chalk, Meth, Crystal, Crank, Fire, Glass— A central nervous system stimulant, often found in pill, capsule, or powder form, that can be snorted, injected, or smoked. The drug’s effects:  Often results in drastic weight loss, violence, psychotic behavior, paranoia, and sometimes damage to the heart or nervous system. Displays signs of agitation, excited speech, lack of appetite, and increased physical activity.

2. Special K, K, Vitamin K, Cat Valium— An injectable anesthetic used primarily by veterinarians, found either in liquid form or as a white powder that can be snorted or smoked, sometimes with marijuana. The drug’s effects: Results in impaired attention, learning, and memory function. In larger doses, it may cause delirium, amnesia, impaired motor function, high blood pressure, and depression. Causes reactions similar to those of PCP, a hallucinatory drug.

3. Roofies, Rophies, Roche, Forget-me Pill— Tasteless and odorless sedative, easily soluble in carbonated beverages, with toxic effects that are aggravated by concurrent use of alcohol. The drug’s effects: Can cause decreased blood pressure, drowsiness, visual disturbances, dizziness, and confusion. Can cause anterograde amnesia, which contributes to Rohypnol’s popularity as a “date rape” drug.

4. Grievous Bodily Harm, G, Liquid Ecstasy, Georgia Home Boy— A central nervous system depressant that is usually ingested in liquid, powder, tablet, and capsule forms. The drug’s effects: Has sedative and euphoric effects that begin up to 10-20 minutes from ingestion. May last up to 4 hours, depending on the dose used. Overdose can occur quickly-sometimes death occurs. Slows breathing and heart rates to dangerous levels. Use in connection with alcohol increases its potential for harm.

5. Ecstasy, E, X, XTC, Adam, Clarity, Lover’s Speed— An amphetamine-based, hallucinogenic type drug that is taken orally, usually in a tablet or capsule form. The drug’s effects: Enables dancers to dance for long periods of time. Increases the chances of dehydration, hyper tension, heart or kidney failure, and increased body temperature, which can lead to death. Lasts 3-6 hours. Long-term effects include confusion, depression, sleep problems, anxiety, paranoia, and loss of memory.

6. Acid, Boomers, Yellow Sunshines— Hallucinogen that causes distortions in sensory perception, usually taken orally either in tablet or capsule form. Often sold on blotter paper that has been saturated with the drug. The drug’s effects: Long-term effects may include persistent psychosis and hallucinogenic persisting perception disorder, commonly known as “flashbacks.” Causes dilated pupils, higher body temperature, increased heart rate and blood pressure, sweating, dry mouth, and tremors. Can cause numbness, weakness, and nausea. Are often unpredictable and may vary depending on dose, environment, and the user.

Effects of stimulant club drugs include:

• Convulsions
• Dehydration
• Extreme rise in body temperature
• Grinding teeth
• High blood pressure
• Impaired speech
• Increased heart rate
• Insomnia
• Uncontrollable movements

Effects of sedative/hallucinogenic club drugs include:

• Confusion
• Decreased heart rate (except LSD)
• Drowsiness
• Intoxication
• Nausea
• Respiratory problems
• Slow breathing
• Tremors

Effects common to all club drugs include:

• Psychotic behavior
• Panic
• Loss of memory
• Hallucinations
• Euphoria
• Depression
• Anxiety

Drugs, traces of drugs, drug paraphernalia, pacifiers, menthol inhalers, surgical masks, and other such items should be considered indicators of drug use. If you suspect your teenager is using drugs, monitor his or her behavior carefully. Confirm with a trustworthy adult where your teenager is going and what he or she is doing. Enforce strict curfews. If you have evidence of club drug abuse, approach your teen when he or she is sober, and if necessary, call on friends and family members to support you in the confrontation.

Once the drug problem is confirmed, seek the help of a therapist or drug counselor. If your child is under the influence of drugs AND immediate intervention is necessary, consider medical assistance. The county mental health society, school counselors, rape counseling centers, organizations such as Alcoholics Anonymous and Narcotics Anonymous, members of the clergy, hospital substance programs, and doctors stand ready and waiting to provide information and intervention assistance.

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

Teenage Daughters Who Are Always In “Crisis Mode”

Every little thing seems to set your teenage daughter off lately, and the more you try to help, the more she yells and slams her bedroom door. So, for the fatigued mothers and fathers out there, here are some tips for parenting teenage girls who seem to always be in crisis mode:

1. Become informed about today’s adolescent girl culture and issues (e.g., pressure toward sexual activity, oral or otherwise).

2. Don't try to minimize here multiple crisis episodes by saying something like, “One day you'll see how silly you have been acting.” Just listen and empathize. Part of being a teenage girl is feeling things intensely, so what may seem like no big deal to you is very important to her. Put yourself in her position, because after all, you were once there yourself.

3. Endeavor to remember how being 16 was for you. Did you feel ugly, fat, or lonely? Did you feel like your parents simply did not “understand”?

4. Figure out how to rescue your daughter from the claws of her social media addiction (e.g., texting, Facebook, Twitter, etc.).

5. Find and retain the guts to parent wisely, even though your daughter may profess to hate you at the moment.

6. Implement a family code of values that largely involves giving to others, not just taking.

7. Instill a desire for involvement (e.g., sports, hobbies, academics, volunteering) – anything that gets her off her cell phone and into the minds and hearts of others.

8. Learn to listen effectively even though your teenage daughter may seem to be unreasonable, bull-headed, or just downright selfish.

9. Don’t trivialize the importance of things in your daughter’s life. What happens is that teen girls feel misunderstood, and eventually they will stop telling parents anything. For example, right now, it is the most important thing in the world that her best friend is flirting with her boyfriend, and you need to take it seriously.

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

10. Pick your battles wisely, letting the little stuff go while digging your heels in on the bigger issues.

11. Use the art of well-placed humor. When it comes to parenting teenage daughters, it’s funny how humor can motivate them when more negative tactics don’t. Being playful when attempting to diffuse a “crisis” can be very effective. It keeps parent-child conflict from turning into a contest of wills. Humor takes us to a whole different level of consciousness and helps break the negative mood – not just for teenagers, but for parents too.  Humor helps parents get themselves out of a reactive state.

12. Promote a sense of spirituality (not necessarily religious, but moral in nature) which will assure your daughter of a lifetime of direction even though there will be lots of curves in the road.

13. Realize that "thin" is in, whether it’s healthy or not, even if you disagree.

14. Only have rules that are fair, clear and capable of being followed consistently.

15. Some “crisis-mode behavior” is minor and doesn't need to be addressed. It may be difficult not to call attention to each and every deep sigh, eye roll or under-the-breath muttering, but these types of behaviors are often best quelled by simply ignoring them. In time, your daughter will stop these types of behaviors if she consistently fails to get a rise out of you. More serious negative displays (e.g., destruction of property or physical aggression) should never be overlooked, but addressed quickly and completely.

16. Try to understand how your adolescent girl perceives and defines her world.

17. Understand the lure of alcohol and drugs – and find out what you can do to better “chemical-proof” your daughter.

18. Understand your daughter’s quest to be her own person, within the constraints of tremendous peer pressure to conform to often arbitrary rules and regulations.

19. When your daughter shifts into crisis mode, don't confront her in the heat of the moment. Allow for a general "cooling down" period. Give your daughter time by herself in her bedroom. Gauge the amount of time for a cool-down by waiting 1 minute for each year of the daughter’s age (e.g., if she’s 15, wait 15 minutes). This brief period gives her time to decompress, and gives you time to gather your thoughts before discussing her “issues” in a calm and effective way.

20. When your daughter is calm, discuss the problem(s) that seem to be upsetting her. Make sure you do so when you're on the same physical level (e.g., if your daughter is sitting down, you sit down too). Let her talk as much as she is willing. Really listen, without forming in your mind what you will say in response. When she is done, consider what she has said before responding. If you need extra time to think about it, let her know. When you do respond, do so with compassion and reassurance while acknowledging your feelings about the fact that there seems to be a lot of “drama” nowadays.

 

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

Understanding Self-Injury in Distressed Teens

Self-injury among teens is common – and the rate is increasing. This behavior is more common in adolescence than previously thought. Although it is important to assess the associated risk of suicide, self-injury is generally used to cope with distressing emotions, especially anger and depression.

Many therapists have encountered teens that have harmed themselves, but denied suicidal intent. Recent studies have found that one-third to one-half of teens in the U.S. have engaged in some type of self-harm. Self-harming behavior is a considerable problem for therapists, not only because of the obvious danger of the client harming himself/herself, but also because of the difficulties in ascertaining whether the teen was trying to commit suicide.

Self-injury intended to inflict pain on oneself most commonly includes the following:

• Banging walls
• Breaking bones
• Burning
• Cutting
• Hitting
• Ingesting toxic substances
• Interfering with healing of wounds
• Pinching
• Punching objects to induce pain

Self-injury typically begins in mid-adolescence. Adolescents who injure themselves are often impulsive, engaging in self-injury with less than an hour of planning. They commonly report feeling minimal or no pain. Once started, self-harm seems to acquire addictive characteristics and can be quite difficult for the teenager to discontinue. While some studies indicate that self-injury is more frequent in females than males, other studies indicate that there are no consistent gender differences.

Self-injury frequently occurs in teens that, at other times, have contemplated or attempted suicide. Thus, there is a significant risk of suicide and suicide attempts among young people that engage in self-injury. One recent study found that 70 percent of adolescents engaging in self-injury had made at least one suicide attempt – and 55 percent had multiple attempts. However, the non-suicidal and suicidal cases serve distinctly different purposes. Some clients report that they hurt themselves in order to stop suicidal ideation, or to stop themselves from actually attempting suicide. Consequently, self-injury without suicidal intent may be a morbid form of self-help.

Until recently, self-injury was seen as primarily associated with the following three specific psychiatric diagnostic categories: developmental disabilities, eating disorders, and borderline personality disorder (BPD). Self-injury occurs in roughly 15 percent of kids with developmental disabilities, especially profound and severe mental retardation. Among adult females, self-injury accompanies up to 35 percent of those diagnosed with anorexia nervosa, bulimia nervosa, and other eating disorders; girls with anorexia nervosa also tend to engage in self-injury more than those without the eating disorder. Repetitive self-injury is so common among people with BPD that BPD is the only clinical diagnosis in the DSM for which self-harm, whether suicidal or non-suicidal, is a symptom. However, no studies have examined the prevalence of self-injury among boys or girls exhibiting borderline personality symptoms.

Recent research calls into question the assumption that teen self-injury is primarily limited to young people with developmental disabilities, eating disorders, or borderline personality disorder. Psychiatric conditions that are specifically associated with self-injury in teens include internalizing disorders (e.g., depression, posttraumatic stress disorder, generalized anxiety), externalizing disorders (e.g., conduct disorder, oppositional defiant disorder), and substance abuse disorders. There is a strong link between self-injury and maltreatment in early childhood, especially sexual abuse.

About 50% of young people who engage in self-injury may not meet criteria for depression, anxiety, eating disorder, substance use disorder, or other major psychiatric disorders. In fact, self-injury appears to be a common psychiatric symptom found in a variety of disorders, as well as being found in teens without a specific psychiatric diagnosis. It seems more useful to understand self-injury in functional terms rather than as a distinct diagnosis, because a separate diagnostic category is not well supported by current research findings.

Some teens who engage in self-injury have elevated rates of emotional reactivity, intensity, and hyper-arousal. Interpersonal processes associated with self-injury include increased use of avoidant behavior and decreased emotional expressivity. Adolescents who self-injure are more likely to report being bullied by peers and experience discomfort regarding their sexual identity. A recent study also found an association with Goth subculture and self-harming behavior among adolescents. Knowledge of self-injury in peers is a risk factor for self-injury due to an apparent “copy cat” effect, and there has been an increase in publicity about this behavior. A variety of internet websites and chat rooms provide information – and even encourage self-harming behavior.

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

The major purpose of self-injury appears to be affect regulation and management of distressing thoughts. For example, in one study of high school kids, 55 percent of those who engaged in self-injury indicated their reason for self-injury was, “I wanted to get my mind off my problems,” while 45 percent asserted, “It helped me to release tension or stress and relax.” When a child feels overwhelmed by negative feelings, self-injury can be an effective, although harmful, strategy to stop or reduce these negative thoughts and emotions.

Adolescents that engage in self-injury demonstrate higher levels of physiological arousal during a stressful task compared with teens without self-injury. This finding is consistent with primate research. For example, monkeys engaging in self-harm (usually self-biting) have a blunted cortisol response to mild stress when compared with controls. After experiencing a stress-induced escalation in heart rate, these monkeys appear to use self-injury as a coping strategy to decrease arousal. In turn, the self-injury is associated with a rapid decrease in heart rate.

Self-injury may also regulate emotions by increasing the affective experience. The teen may have the subjective experience of being emotionally “numb” or “empty” or feeling disconnected with others. Self-injury may help the young person to gain a sense of control, to feel excitement, or to stop dissociative experiences. Self-injury may also give the teen the experience of being “real.”

Self-injury may serve interpersonal functions for the teen. It may elicit positive reinforcement in the form of attention from others (although many who injure themselves do so in private and do not tell others). Self-injury may also help the teen to avoid difficult situations. The threat of self-injury may cause parents to decrease interpersonal pressure or to stop attempting to get the child to complete his or her homework, chores, or other tasks.

Treatment—

Self-harm in the teenage years has only recently been recognized as a commonly occurring phenomenon. Consequently, there are few randomized, controlled trials for the specific treatment of self-injury. In grown-ups, the therapeutic intervention with the most research demonstrating efficacy in reducing self-harming behavior is dialectical behavioral therapy (DBT). DBT uses a combination of individual and group therapy to teach skills in emotional regulation, interpersonal effectiveness, distress tolerance, core mindfulness, and self-management. The intensive treatment requires the therapist to be on call for these clients at all times. DBT has been adapted for teens with features of borderline personality disorder, with the additional expectation that the group therapist is on call at all times for the mom and dad of the client. The clinical and financial demands of DBT have led to applications of less intensive treatments to reduce self-injury, but these treatments are still under study.

Treatment is based on a thorough psychiatric evaluation, with a focus on safety issues, suicidal risk, and clarification of comorbid psychiatric conditions. Treating self-injury involves determining the needs that the behavior fulfills and helping the teen devise other, healthier ways to meet those needs (e.g., if self-injury helps a teen to calm down, the therapist will help to find techniques that may provide the same result).

Involving parents in the support and treatment of teens who engage in self-injury is also very important. Poor communication with parents has been associated with suicide in some teens. Improving the parents’ understanding of self-injury can be useful in decreasing conflicts. It can be helpful for the parents to learn de-escalation strategies and expand listening and communication skills. Mothers and fathers can also help with safety plans and practicing problem solving skills.

Medication for self-injury should primarily focus on any underlying psychiatric disorders. Currently, there are no specific medications approved for the treatment of self-injury. Since depression and anxiety often accompany self-injury, identifying and treating these disorders should be a top priority. Concerns about an increase in suicidal thoughts with teens using antidepressant medication should be reviewed with the client and his/her parent(s). While the protective effects of antidepressants appear to outweigh the risk of increased suicidal thoughts, medications should be monitored regularly.

 

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

Safe Driving for Your Adolescent

Learning to drive is a major rite of passage for adolescents – and their moms and dads. It's a time of exciting possibilities and achievements. It's also a time of high risk. Driving is fatal for almost 50,000 Americans every year.

Young people between the ages of 16 and 25 have the highest rate of auto-related deaths, even though individuals in this age group may be bright, skilled, and have great reflexes. A collision is the most likely tragedy to kill or cripple an adolescent.

Distractions are a problem for everyone, including adolescents. Using cell phones for talking, texting, email, or other Internet use is a proven cause of accidents – and must be strictly avoided. Vehicles have many important safety features (e.g., seat belts, shoulder straps, headrests, air bags, padded dashes, safety glass, collapsible steering columns, anti-lock brakes, etc.), but even with safety equipment, reckless driving is still a real danger to adolescents.

All new drivers should take a driver's education course. These courses have been proven to reduce accidents, but they are not enough. Adolescents often believe that serious accidents will not happen to them; however, these young people can take steps to change the odds in their favor.

Adolescent-related driving deaths frequently occur in the following situations:

• With recreational driving. For the first 3 to 6 months after getting a license, new drivers should try to get experience driving to school and work, not for fun.
• When not buckled-up. Use safety gear.
• When drowsy. Anyone who is sleepy should stop driving until fully alert. Sleepiness may cause even more accidents than alcohol.
• When driving with friends. Adolescents are safer driving by themselves or with family. They should drive as much as possible with an experienced driver who can help develop good driving habits. As tempting as it may be, new drivers should wait until they have a consistent, safe driving record before taking friends as passengers. Friends, to the new driver, are a big distraction and liability – and this liability often extends to the parent.
• When distracted. Using cell phones for any reason, eating, drinking, or putting on makeup while driving is dangerous for all drivers.
• After the use of marijuana or any other illegal drug or any prescription drug that is sedating. Drugs can be just as dangerous as alcohol.
• After drinking alcohol. Drinking slows reflexes and impairs judgment. These effects happen to anyone who drinks. So, NEVER drink and drive. ALWAYS find someone to drive who has not been drinking -- even if this means making an uncomfortable phone call.
• After dark. Automatic reflexes and driving skills are just developing during the first months of driving. Darkness is an extra variable to cope with.

Moms and dads should discuss "driving rules" with their adolescents and help their new drivers stick to them. An excellent method to stimulate discussions and set expectations is to draft a "driving contract." This contract should list the rules and consequences of breaking the “driving rules.” Be sure to state in the contract that the mother or father has the final say. Consider all of the issues above when drafting the contract.

Moms and dads should encourage their adolescents to call “without consequence” rather than get in a car with a driver who has been drinking. If parents discover that their son or daughter has been driving and drinking, they should ask the State to suspend that adolescent’s license until age 18. In many states, the mother or father must sign for an adolescent under 18 to get a driver's license. At any time before the 18th birthday, the parent can refuse responsibility, and the State will take the license.

These suggestions are not intended to be a punishment for your teenager, but to prevent accidents, life-long disability and death. Your child is worth far more than the inconvenience and hassle and a driving contract. Your teenage can set an example for his or her peers on how to drive responsibly. And he or she might even save a life!

 

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

Sex Education and Your Adolescent

Sex education basics may be covered in health class, but adolescents might not hear or understand everything they need to know to make tough choices about sex. That's where parents come in. Awkward as it may be, sex education is your responsibility. By reinforcing and supplementing what your adolescent learns in school, you can set the stage for a lifetime of healthy sexuality.

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