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September is Suicide Prevention Month

LGBT Teens, Bullying, and Suicide

What are the causes and how can we help?

In recent years we’ve seen a tragic number of gay teens,ending their own lives after enduring anti-gay bullying. Eighteen-year-old Tyler Clementi, 15-year-old Billy Lucas, and 13-year-olds Asher Brown and Seth Walsh were living in different corners of America—New Jersey, Indiana, Texas, and California—but each of them was subjected to the same kind of intolerance and cruelty, including a callous violation of their online privacy.

Suicide is the third leading cause of death among adolescents, and gay teens are 4 times more likely than straight teens to attempt suicide. Moreover, the pain gay teenagers feel when they are taunted affects others around them: During adolescence, the mantra is, “I want to be the same.” Teens feel a powerful need to fit in, and when they see a gay student getting bullied for some perceived “difference,” they worry that their own differences—and we all have them—will be targeted by bullies next.

I know that many parents find it difficult to discuss sexuality with their teenagers, but discussion is crucial if we want our children to develop healthy self-esteem, embrace their own differences, and accept what is different in others.

Here’s some information for parents to consider:

1. Teens who are “different” are at higher risk for bullying.

All teens want to be “normal” and fit in with their peers, hence differences in sexual orientation can attract harassment and rejection. According to a survey by the Gay, Lesbian, and Straight Education Network, approximately 90 percent of gay, lesbian, transgender or bisexual middle and high school students report being physically or verbally harassed in 2009. As parents, no matter what we believe (with respect to sexuality, religion, culture, politics), we are responsible for our kids’ behavior, and need to teach them to be intolerant of intolerance.

2. A teen who believes his or her sexual feelings are unacceptable to peers may be at risk for suicide.

Parents, teachers, and all caring adults need to be sensitive to teenagers who exhibit feelings of sadness, worthlessness, hopelessness, anxiety, irritability, rejection, and anger—all symptoms of depression, which is experienced by the majority of teens who attempt or complete suicide. Some parents assume that if they are tolerant of different sexual orientations, their children aren’t affected by the barrage of messages suggesting that it’s abnormal or immoral to be gay. Unfortunately, anti-gay rhetoric has extraordinary, insidious muscle in the cultural landscape, and gay teens are particularly vulnerable. Parents of gay teens are sometimes “the last to know” a problem is brewing.

3. An overwhelming majority of suicidal teens report feeling misunderstood by their parents.

It’s crucial for us as parents to start a conversation with our children, before they go through puberty, to discuss sexual feelings and tolerance of different sexual orientations. If your child is secretly feeling guilty or ashamed of the sexual thoughts he or she is having, you need to know this so that you can give reassurance that there’s nothing wrong with different sexual thoughts, or sexuality in general.

Teens who feel uncomfortable with their sexuality often suffer from low self-esteem, so it’s essential that we counter their feelings of distress with a very positive message of acceptance and love. Our teens need to understand that while we sometimes disagree with them—or simply have different feelings—we respect their beliefs and differences. We love them no matter what.

4. Parents need to monitor their teens’ lives on the Internet.

I’m reminded of a scene in the Facebook movie, The Social Network, in which Napster co-founder Sean Parker (played by Justin Timberlake) says, “We lived on farms. We lived in cities. And now we live on the Internet.” That means that, as parents and educators, we can’t tackle intolerance and bullying effectively unless we engage in Facebook, Twitter, and any other social media platform on which our kids interact.

Online bullies, not face-to-face with their victims, often fail to appreciate how devastating their words and actions can be. Mark Zuckerberg’s would-be girlfriend Erica makes this point in The Social Network when she tells him that saying something cruel to a person’s face is like using a pencil, but saying something online is like using a pen. We have to talk to our kids about the power and consequences of online behavior. And then, we need to teach them how to use social media as a tool for promoting tolerance, compassion, and social justice.

5. Parent-teen communication is our best defense against intolerance and teen suicide.

Believe it or not, teens want to spend time with their parents. We sometimes forget this as we watch them try to assert their independence, but studies repeatedly show that teens want to spend quality time with us—and when they do, they’re less likely to experiment with drugs, have sex at a young age, and engage in other risky behaviors. We have the opportunity to build our kids’ confidence and self-esteem, nurture empathy, and model an acceptance and appreciation of others.

However (and this is key), teens only want to spend time with their parents—and talk openly about what they’re really experiencing—when they believe their parents aren’t judgmental. Again, tolerance, respect, appreciation, love.

I’m encouraged by the fact that so many celebrities—from Cyndi Lauper and Ellen DeGeneres to Matthew Morrison, Jane Lynch, and the entire cast of Glee—are raising public awareness of anti-gay bullying and its links to teen suicide.

I hope you will join me in promoting tolerance to protect young lives. Please start right now by having a conversation with your child.

By Harold S. Koplewicz, MD, Child Mind Institute



What to Do if You’re Worried About Suicide

A parent's guide to helping a child in distress

What do you do when you’re worried that a child might be feeling suicidal? First and foremost, it’s important that you talk to him about your concerns in a calm, non-accusatory manner. Sometimes when parents are very worried, they end up saying, “Don’t think this way,” or “You shouldn’t feel that way,” and they come across not as loving and caring, as intended, but as critical. Children respond negatively to that. So you really need to be as calm and non-accusatory as you can when talking to them.

Show the love

It may seem obvious to you that you love your children, and that they know you love them. But when they’re having a hard time, kids need to hear over and over again from you how much you love them, and how much you care about them. It’s not good enough to just say, “You know I love you.” You need to convey that in small and big ways. These days, we all have so many things we’re juggling that kids can end up unsure of where they fit in, and whether you really have time for them. Let them know how important they are to you.

Express empathy

It’s also important to validate a child’s feelings. You want to make statements that express empathy for her distress: “It sounds like that was really difficult.” “I know how painful that can be.” “I know what that’s like. I’ve felt that way.” Telling them not to feel that way, to “pull it together,” isn’t as helpful as saying, “What is it that you’re concerned about, and how can I help you?” If you’re really concerned about your child it’s important that you encourage him to get professional help, and that you convey that getting help isn’t weak, but something you would respect him for doing, and that you would work together to accomplish.

Prioritize the positive

Another important way to prevent suicidal behavior is to prioritize interacting with your child in positive ways. Some times we get into a sort of vicious cycle with a child. The child does something concerning; the parent gets critical; the kid does something more concerning; the parents get more upset. All interactions turn contentious. Interacting in positive ways means doing fun things together, hanging out and chatting about things that aren’t controversial, that aren’t difficult.

Minimize conflict

So choose your battles wisely with your kid. It’s part of normal development for adolescents to rebel, and you need to pick what you’re going to set limits about, and the rest of the time you want to focus on the positive connections. It also helps to try to increase your child’s involvement in positive experiences. Kids who are involved in a lot of engaging or fun activities tend to fare better. Your goal as a parent is to reassure struggling kids that they won’t feel like this forever, and you can help do this by promoting positive experiences. When kids feel suicidal it’s often because they feel hopeless and can’t imagine things being better.

Stay in touch

It’s also really important to monitor your child’s whereabouts when they aren’t with you, whether online or out of the house. You can’t stop your kids from texting and Facebooking and using Twitter. That’s normal social interaction at this point. So you need to get on Facebook yourself, learn how to tweet, learn how to text. And use those channels to stay on top of what your kids are doing.

Know your child’s friends

In the “real” world, it’s also critical to know your child’s friends—to have a good sense of who they are and to have a connection with them. Sometimes it’s harder the older your kids get, but it’s really important you do that. You should know the parents of their friends and be in touch with them, too. And you want to communicate regularly with your child’s school to ensure her safety and care in the school setting. Don’t hesitate to use the school and the people in the school as partners in your child’s care when you have concerns.

Talk openly

But again, the crucial first step: If you think your child might be suicidal, talk with him about it, ask him about suicidal thoughts. Sometimes people are afraid that if they talk about it it will make suicidal thoughts more real, and suicide more likely to happen. But the truth is that if a child feels that he has someone safe in the family that he can talk to, he feels better. He feels more understood. He feels like there’s more empathy for him. And that gives you an opening to explain the value of psychotherapy, and possibly medication for the feelings that are causing him so much pain.

By Nadine Kaslow, PhD, Child Mind Institute

August is Back to School Month

Helping Kids Back Into the School Routine

With praise, understanding, and some structure you can smooth out back-to-school jitters

As the summer comes to a close and school is getting back into session, here are a couple quick reminders to help make the transition from the beach to the classroom easier for you and your child.

Validation: Let your child know that his nervous or apprehensive feelings about the start of school are normal. All kids (and adults!) have a hard time getting back into the routine of the school year. The knowledge that he is not alone in this experience will help your child feel he’s being heard and understood.

Morning Routines: A common change that occurs as we begin the school year is a new morning routine. To help your child be successful, discuss what her morning routine will look like during the school year. This way, your child knows what will be happening and has clear expectations that are valuable to her under the time pressure of getting ready for school. Provide your child with simple, well-defined, and easy steps for her routine so that she has a clear idea of what you expect and so that it’s easy to follow along with you! Having an easy-to-reference schedule, maybe with pictures, can engage your child and provide a wonderful visual guide for what she needs to do next. Giving specific praise when she completes each lets her know that you love what you’re seeing. This will increase your child’s chances of success in the future, and helps build her self-esteem.

Homework: Another transition that can be rough after a summer break is homework completion. Like the morning routine, providing your child with a structured schedule can help him stay focused and motivated. Completing homework as soon as school is over and with continuous parental support will take advantage of the daylight hours and provide encouragement, motivation, and assistance when needed.  Snacks are a great way to keep your child’s energy up while he works through those tough math problems. Of course, some children have active schedules, with team sports, music classes, or afterschool clubs, which can make engaging in homework more difficult. Letting your child know that you understand the hard work he is putting in and being ready with frequent positive feedback for his effort can help motivate him to get homework done.

Bedtime: Bedtime is one of the hardest transitions. Children may be accustomed to going to sleep later and/or waking up later during the summer, so the new school schedule can be difficult to get acclimated to.  As with the morning routine, having a nighttime schedule can assist in creating a structure for your child. Set your child up for success with clear expectations, simple step-by-step instructions, and praise at the completion of each step. Additionally, visual reminders can help your child have something to refer to as she goes about her routine. Most kids want more time watching their favorite TV show or finishing that last level of a videogame, and setting time limits can be a great way to put a boundary around the winding down time that they need each evening.

By Lianna Wilson, MA, and Sarah Straus, MS - Child Mind Institute




Back to School Tips for Parents

Model confidence, create structure, and get to know the new teacher

Every child faces challenges when heading back to school. But back-to-school time can be exceptionally difficult for the 20 percent of children who suffer from a psychiatric or learning disorder.

The school environment demands many things that summer activities don’t — the ability to sit still; get organized; stay on task; and adapt to a new, highly structured daily schedule. School also requires kids to separate from their parents and interact with peers — enormously challenging tasks for any child with anxiety.

Here are six things parents need to know about starting school with vulnerable children:

1. Psychiatric health problems emerge at back-to-school time.

Children with special needs require a lot of help learning how to manage a new schedule. As a parent, you can ease your child’s anxiety by modeling confidence and calm behavior, and by imposing structure in family life (mealtime, homework, and bedtime routines).

But if your child shows signs of extreme anxiety and has unusual difficulties in school, you should immediately discuss your concerns with your child’s teacher as well as a mental health professional, someone who can advise on whether a child’s problems are normal and age appropriate or require further evaluation.

2. Kids’ brains are changing dramatically.

Profound changes occur in the brains of children, particularly as they enter their teens. The teen brain starts “pruning”—strengthening some synapses and eliminating many others. A temporary imbalance of this pruning in certain areas of the brain has been linked to teens’ erratic and risky behaviors, as well as the onset of anxiety disorders, depression, and substance abuse.

It’s important to keep communication open at this vulnerable time, when teenagers are starting to look like adults, and think they are adults, but may not have the skills to manage stress. If you haven’t already started setting time aside each day to talk to your child about challenges and new experiences at school, now is the perfect moment.

3. Anxious parents send anxious kids to school.

Anxiety disorders run in families. Plus, anxious people tend to marry other anxious people; children with two anxious parents are at especially high risk. But genetics are just one factor. Environment is another. Kids really are like sponges, absorbing the energy and adopting the behaviors around them.

One of the most helpful things you can do is model calm, confident behavior, particularly while helping a child get ready for school. A child usually starts school no calmer than her least-relaxed parent.

4. Teachers matter, maybe even more than you think.

Teachers get to know a child’s family through the child’s eyes, and they get to know how a child behaves without his parent present. This means parents can get all kinds of information about a child from his teacher—information about learning difficulties and peer problems as well as academic achievements and close friendships. Teachers are allies, and you should talk to them regularly.

Good questions to ask include: How is my child doing? Do you have any concerns about his social or academic skills? Do you think he needs my help with anything?

5. Homework time is crucial.

Young children with learning difficulties, as well as those without any documented problems, can benefit from their parents’ involvement during homework time. Parents should set aside time for a structured “homework session” each evening.

A good routine might start like this: Create space on a desk to work; help him clean out his backpack; review the day’s assignments; and discuss the homework as well as any questions about it. You can observe your child’s learning strengths and weaknesses this way while also reinforcing good study habits. Be positive and encouraging.

6. Don’t jump to conclusions.

Kids grow and develop at different rates. Ideally, a child will acquire various skills within expected time periods, but she may develop more quickly in one area than another. Parents often worry when, for example, one 5-year-old can read fluently while another can barely sound out words on the page. But a lag in one area of development doesn’t mean a child has a disorder. If you think there might be a problem with your child’s development, talk to her teacher. A seasoned teacher, with about 10 years of experience, can frame your child’s progress in relation to as many as 300 other kids. Good teachers are invaluable allies.

By Harold S. Koplewicz, MD, reprinted from Child Mind Institute

July is Purposeful Parenting Month

10 Tips for Parenting Your Pre-teen

How to stay close as kids move into adolescence

By Juliann Garey

It’s typically between the ages of nine and twelve that our cute, cuddly little children, once so willing to climb into our laps and share their secrets, suddenly want little or nothing to do with us. Your pre-adolescent is not the same person he was just a year or two ago. He has changed—physically, cognitively, emotionally, and socially. He’s developing new independence and may even want to see how far he can push limits set by parents.

What he may not know is that he needs you as much as ever, because a strong parent-child relationship now can set the stage for a much less turbulent adolescence. But it won’t be easy, because you as a parent need to respect your child’s need for greater autonomy in order to forge a successful relationship with this “updated” version of your kid.

We asked some experts for tips to help you keep the channels of communication open between you and your pre-teen—and have a smoother transition into the teen years.

1. Don’t feel rejected by their newfound independence. It’s appropriate for kids this age to start turning away from their parents and relying more and more on friends, but parents can take their pre-teen’s withdrawal as rejection. “All too often parents personalize some of the distance that occurs and misinterpret it as a willful refusal or maybe oppositional behavior,” says Catherine Steiner-Adair, a Harvard psychologist, schools consultant, and author of The Big Disconnect.

Beware of trying to force information out of a resistant tween. “This is a time when children really start to have secrets from us,” says Steiner-Adair, “and parents who have a low tolerance for that transition — they want to know everything — can alienate their children by being too inquisitive.”

2. Set aside special time with your child. It’s often tough to get pre-teens to open up and talk. Laura Kirmayer, a clinical psychologist at the Child Mind Institute, suggests establishing a special period of one-on-one time once or twice a week that you spend with your tween, where you’re providing undivided attention ,and you’re not working or texting at the same time,

In doing this you’re not only improving your relationship, you’re also teaching interpersonal skills that are going to be crucial in the future. “That quality time is really key,” Kirmayer says, “and it’s something that we might overlook because our kids might be saying they don’t want it and be pulling away. And we might unintentionally collude with that tendency.”

3. Try the indirect approach. When they were younger you could ask direct questions. How was school? How did you do on the test? Now, the direct approach — carpet-bombing them with questions about school and their day — doesn’t work. Suddenly that feels overwhelming and intrusive. And it’s going to backfire.

If anything, says Kirmayer, you have to take the opposite approach and position yourself as mostly just a listener: “If you actually just sit down, without questions, and just listen, you’re more likely to get the information about your child’s life that you’re wanting.” Kirmayer says this approach gives kids the message that “this is a place where they can come and talk, and they have permission to say anything that they’re thinking or feeling.” Sometimes you’ll be able to help and give advice—but don’t try to step in and solve all their problems. Other times you’ll just be there to empathize with how hard it is to deal with whatever they’re going through.

4. Don’t be overly judgmental. “At this age your children are watching you very astutely to hear how judgmental you are,” advises Steiner-Adair. “They are taking their cues on how you talk about other people’s children, especially children that get into trouble — how that girl dresses, or that boy has good manners or bad manners. And they are watching and deciding whether you are harsh or critical or judgmental.”

She gives the example of the parent who says, “‘I can’t believe she posted this picture on Facebook! If we were her parents we’d be mortified.’ Or ‘I can’t believe he sent that YouTube video around!’ They are commenting on behaviors that need commenting on, but the intensity and the rigidity of their judgment is what backfires.”

Related: How Using Social Media Affects Teenagers

5. Watch what they watch with them. Beginning in middle school, watching the stuff that your child wants to watch with him and being able to laugh at it and talk about it is an important way to connect and to be able to discuss subjects that would otherwise be taboo. “Don’t get too intense in how you critique the values,” says Steiner-Adair.

It’s our job as parents, she adds, to help both boys and girls recognize how the media instills the gender code — the barrage of cultural messages that tell kids what it “means” to be a boy or a girl—and to help them identify when something crosses the line from teasing to mean. But tread lightly and use humor.

6. Don’t be afraid to start conversations about sex and drugs. The unfortunate reality is that kids are starting to experiment with drugs and alcohol as early as 9 or 10. And according to Kirmayer, “Sexual development is a big part of this age, and it’s when we first start to see eating disorders arise, so these are key years for us to be building a strong foundation and giving them developmentally appropriate information.” Kirmayer suggests providing your tween with information and resources without the pressure of a big “talk.”

She recommends books like The Boy’s Body Book (by Kelli Dunham) and, for girls, The Care and Keeping of You (by Valarie Schaefer) to introduce sexual development and Ten Talks Parents Must Have With Their Children About Drugs and Choices (by Dominic Cappello) to bring up the subject of drugs.

Reprinted From Child Mind Institute



Five Tips on How to Be a Purposeful Parent

1. Take time to listen. Adolescents do not always want advice. Parents can discuss solutions rather than deliver lectures, and use reassurance, encouragement, and support instead of offering unsolicited advice. It is not helpful when parents respond to their adolescent's concerns by minimizing what the young person is feeling or saying, "you'll get over it."

2. Be aware of where adolescents are and what they watch. When adolescents are not at home or school, parents should know where they are. Also, restricting adolescents' viewing of R-rated movies, which frequently glamorize alcohol and tobacco use, is an effective step parents can take to reduce the likelihood that their adolescent will abuse substances.

3. Take concrete steps to help adolescents avoid illicit drug use. Being home at key times of the day (such as in the morning, after school, at dinner time, and at bedtime) and reducing access to illegal substances in the home both help. Parents should also: 1) explain why drug use is harmful; 2) communicate their expectations and rules relating to the use of drugs; 3) check in with their adolescent on a regular basis; 4) get to know their adolescent's friends; and 5) communicate with their adolescents to find out whether he or she is making healthy choices.

4. Eat dinner as a family. By eating meals with their adolescents and helping them to stay active, parents can help teens to eat a nutritious diet and to exercise regularly.7,8 However, eating dinner as a family has also been linked to a host of other positive outcomes for youth, including higher academic performance and improved mental health, compared to adolescents who did not have family meals.9

5. Pay attention to your own wellbeing. Parents, especially if they are single parents, should not neglect their own care. They should include physical activity, a healthy diet, and plenty of sleep into their daily routine. Parents should also arrange time to do activities they enjoy alone or with close friends.

From U.S. Department of Health & Human Services



Create a More Positive Home Life

To celebrate Purposeful Parenting Month, parents can do a variety of simple and easy things to create a more positive and loving home life. Remember, the best times are when you make time, making every opportunity possible to spend time with your children, savoring each moment as a treasure! Before you know it, they’ll be all grown up and moving on with their own lives.

Don’t make the all-too-common parenting mistake of thinking that earning a living and providing a home for your children is more important than spending time with your children. You can’t bring back those lost years, so don’t skimp.

  1. Tell your children you love them, and do it often.
  2. Find at least one thing your child has done right each day.
  3. Celebrate the uniqueness of all family members.
  4. Create a safe environment for the entire family.
  5. Grab every opportunity to spend unstructured time.
  6. Plan fun family activities. Turn off the T.V.! Get organized!
  7. Teach values. Learn the value of delegating responsibilities.
  8. Establish family traditions.

From Telling It Like It


Ask an Expert

Do you have a question about your child’s emotional or behavioral issues. Please send us your question and one of our staff experts will respond.

Q. We have an almost 10 year old son who tends to get upset on an almost daily basis about small matters such as which car we ride in, where we eat if we go out, which we activity we choose, if he isn't first at something etc. He seems to be able to control his anger. He is never angry or upset at school or other activities involving his friends. He seems to direct it mainly at home with us or his younger brother or sometimes even with his grandma. He runs away from us, refuse to get in a car, throw things around, yells at us or becomes non-verbal, just making sounds towards us or repeats no over and over. Eventually, he calms down and apologizes for his actions and behavior but it is not long before we are dealing with it again. Daily life with him can be difficult. Do you have any suggestions or methods to help us work through this? Sometimes we feel embarrassed to take him places with us because of his behavior.


A. First of all, it sounds like you have a good sense of the context in which the behaviors are occurring.  One key is determining what motivates or triggers the behaviors.  In some cases you may be able to remove or modify a triggering event and in other cases you may want to develop an incentive to help your son overcome his barrier(s) to complying with your request.  Another important concept that can be applied in many situations is the notion of “contingency reinforcement”, which means if there is something a child wants such as a new toy or access to a desired activity, then it can only be provided “contingent “ upon something they do or do differently first.  For instance, if they wanted to stay up later to watch a special show on TV, a parent may grant the request only if their room is picked up.  This technique can be expanded to an “if /then practice”, such as “if you want to go out and play then you need to finish your homework.  We have had a lot of success with a book called, “Win the Whining War & Other Skirmishes – A Family Peace Plan” by Cynthia Whitham in our in-home behavioral modification program here at Child & Family Center.  You can still find used copies on Amazon for under 10.00 and it is full of techniques, such as I have highlighted above, as well as when and how to apply consequences, plus some clear guidelines for limit setting and the use of incentives/rewards.  I have recommended this book to any parent who has asked for help and hope you find this helpful.


Q: Since my daughter turned 14, we haven’t been getting along. We used to talk a lot, spend time together and have fun. Over the past year she seems angry all the time, doesn’t talk with me and is very defiant. Her grades have dropped and when I tried to speak with her about them, she became hostile and defensive. She refuses to complete her chores and when I try to ground her, she leaves the house. Last week she ran away for 2 days. Yesterday the school called to inform me that she has been ditching her classes. I’m afraid to confront her for fear that she’ll run away again.

A: It sounds like your daughter’s behavior is escalating, so stepping in immediately is crucial for her own safety. Addressing teen’s problematic behavior is very tough for parents, but necessary. The significant change in her behavior is very tough for parents, but necessary. The significant change in her behavior and attitude may indicate that she is using drugs or alcohol. It would be worthwhile to continue to look for the behavioral and physical signs of drug use. The internet is an excellent resource for such information. More immediate is addressing the running away. It is important that you call the police and file a run away or missing person report insuring that you get a police report number. Secondly, call the parents of every friend your child has and request that your child not be allowed to stay the night. Contact the school and ask that you be notified the moment your child appears on campus. Keep in mind that though we do not have the power to control our children, we can take steps to provide for their safety and we do certainly influence their behavior. As far as her other defiant behaviors, it sounds like some structure needs to be put in place in the way of setting up house rules and natural consequences. Especially for the strong-will teen, the removal of ALL privileges for a 24-hour period is effective as a consequence of violating any house rules. Setting up this kind of system is going to require follow-through and consistency on your part.


Q: I’m so terribly frustrated with my 16 year-old son. Over the past few years he has progressively become more disrespectful, hostile and stays to himself. His grades are dropping and I’m worried that he might be using drugs, especially since he stays out with his friends all night. Every time I try and talk to him, he just gets angry and defensive. Grounding him doesn’t seem to work, he just leaves the house anyway. What should I do?


A: Drug use is a serious teen problem and can cause significant ramifications. Spotting drug use is about noting major and persistent changes in your child. Look at any changes related to his choice of friends, school performance and attendance, attitude, changes in eating or sleeping habits, withdrawing from family, and changes in appearance. For your son’s own safety, this must be addressed with him. Convey a zero tolerance policy regarding drugs. Tell him that you are willing to do whatever it takes to protect him which may include contacting law enforcement (if you find drugs in his possession for example) removing ALL of his privileges for a few days, constantly supervising him and knowing where he is at all times. These strategies are difficult to follow through with, however if he does not cooperate, taking ALL of his privileges away and being consistent with this practice can be very powerful in shifting his behavior. Privileges can include car, phone, TV, computer, cell phone, stereo and video game us. Other privileges are money, going out, friends coming over, headphones, skateboard, etc. Keep in mind that though we cannot control our teen’s behavior, we can heavily influence it. It is also helpful as parents that we educate ourselves about drugs and usage. For example, learn about the physical and behavioral signs of drug use along with information regarding the various paraphernalia associated with different drugs. Having a support system is crucial.


Q: How do I get my child to open up to me more and tell me what’s going on?


A: One of the things that you want to try is to use the communication skill of reflective listening. The main idea behind this approach is to let the child know that you are truly listening to them and are interested in what they may be feeling or thinking. You don’t have to agree or disagree with them necessarily, but simply communicate to the child that they are being heard and understood.

The way reflective listening is used is to reflect back to the child what you hear them say or the nonverbal body language that you observe. You want to use the following phrase in communicating reflective listening: “It seems that you are (a feeling) because (the reason or situation).” For example, “It seems that you are upset because you had a bad day at school today,” or “It seems that you are angry because you can’t go to the movies today.” By attempting to identify what the child feels you let them know that you care and are available to them. They may then choose to disclose more about why they may feel a certain way and what happened. Sometimes the child may not want to talk to you at that moment, but will choose to come back to you and talk at a later time. The important thing is that you let them know that you are approachable and truly care about what they are thinking and feeling. This opens up the door between yourself and your child to a lifetime of positive communication.


Q: My teenager plays soccer and practice is every evening. He’s home from school for a couple of hours before I get home from work, then either I take him or he drives the car to practice. Just about everyday when I come home the house is a mess! Dirty dishes and food in the kitchen, the TV is on, backpack, papers, books, shoes and clothes are all over. I’ve asked repeatedly for him to clean up the kitchen and any mess he makes by the time I get home from work so I don’t have to do it after he goes to practice. I’m frustrated and tired of arguing. Grounding him for the weekend doesn’t seem to matter. I’m at my wits end.


A: It sounds like the problem has become a power struggle, which you definitely want to stay out of! Also, you own this problem because your rights are being disrespected. So – what are the consequences that fit with the misbehavior? If you come home to a mess, try using an “I” statement, “When I come home to a mess, I feel discouraged because I have to clean up a mess I didn’t make. Your teen might jump in with, “No problem, I can drive myself to practice and that will save you time.”

However, in order to have the privileges of driving the car you need to be responsible. His part of being responsible is cleaning us his mess. Stay respectful. Using a friendly tone, let your teen know; “In order to have the privilege of driving the car I need you to clean up your things at home, otherwise when I come home I’ll have to clean up.” “I’ll tell you what, you clean up your things before I get home and you can drive the car to practice or I clean up your mess, I can’t take you to practice and you can’t use the car. Which do you prefer?” Be firm and kind. Don’t fight. Respect their choice. Your teen may choose the consequences to see if you mean what you say. Simply say, “I see you’ve decided” if you come home to another mess. That means you clean up and he doesn’t go to practice. Keep your voice and facial expressions matter-of-fact. Stay calm – don’t get into the power struggle. Follow through. Consequences work but they take time. Your teen may be testing your limits to see if you’ll give in.


Q: I’m a single parent with three kids (ages 17,14 and 7). My 14-year-old son and I are fighting constantly and I’m so worn out and frustrated in trying to communicate and discipline him. Nothing is working. I’ve tried to talk to him, ground him, threatened to call the police, and so on. Progressively, over the past year or more, he is acting disrespectful, withdrawn, refusing to attend school some days, and hanging around the wrong crowd. Now his grades are going down and he doesn’t seem to care. He stays out after curfew and fights constantly with his younger brother. Our entire family is stressed out.


A: Generally there are two kinds of kids: compliant and strong-willed. Strong-willed children require different parenting than the traditional approach. Children benefit from ongoing structure, supervision, and natural consequences. Strong-willed children benefit particularly by having clear house rules and consistently applied consequences if not followed. House rules can include: completing chores & homework, attending class, compliance with curfew, not arguing with siblings or parents, being respectful to people and property, no drug use, etc. They really ought to be tailored to your household’s needs. Focus on any behaviors that you would like increased in your child. It is easier to increase wanted behaviors than to decrease unwanted behaviors. Also the house rules should be specific behaviors, not attitude. Choose your battles wisely. House rules ought to be conveyed clearly as well as the consequences For strong-willed children, a short term removal of ALL privileges on a consistent basis is most effective in influencing their behavior. A 24-hour period is sufficient. Privileges can include money, TV, phone/cell use, computer/video games, going out, stereo use, car, etc. Follow-thru and consistency are crucial.

We also have to keep in mind that we do not control our children, however we have tremendous influence over them. You can even tell them this. It tends to disarm power struggles. Parents also have to be willing to call the police when children run away, become violent, or threaten suicide. Active supervision involves knowing who, what, where, and when regarding your child’s whereabouts. Random spot checks are important as to testifying to their location. Parenting can be very difficult, especially with strong-willed children and a lack of ongoing support for the single parent. Mental health consultation may serve as a support and may be necessary as well.


Q: What are my homework responsibilities as a parent if my 15-year old will not do homework on his own or refuses to do his homework?


A: Parents are the key to making homework a positive experience for their children. Therefore, if you are…making homework a top priority at home, providing necessary supplies and quite environment, setting aside a time everyday when homework should be done, providing encouragement and support, helping your child go to the library when necessary, not allowing your child avoid homework and working together with your child’s teacher…you are off to a great start!

So what happens if your student will not complete his homework assignments despite your best efforts? The answer is to start small as you explore your alternatives. First begin by making sure that you have stated clearly that you have an expectation that homework will be completed. For example, “I expect that you will try your best job on each homework assignment and that all homework assignments are completed before bedtime each night.” You can monitor your son’s efforts by checking and signing completed homework each night.

If clarification does not resolve your issue, you can support your words through action by giving your son choices with your words. For example, “You can choose either to do your homework or lose these privileges__________(fill in blank with important pastimes of your son, things he engages in even without reward).” Giving choices sends messages of respect to your son and communicates that you expect him to cooperate. If your son still chooses not to complete his homework, he can also be aware that he is choosing to lose certain privileges. After three homework assignments have not been turned in, or turned in incomplete, have the teacher contact you. Keeping open communication and working together with your son’s teacher will confirm to your son and the teacher that you are serious about this issue. In addition, the more your son’s teacher understands that you are being consistent and will impose a loss of privileges when necessary, the more likely you are to engage his or her cooperation in investing extra time and attention in your child (unfortunately, time is a luxury teachers do not often have).

Once you have earned the teacher’s support you can use a homework contract or schedule a problem-solving conference. Keep in mind that the goal is for your son to succeed and that change and improvement take time, and therefore it is important to notice and encourage your child’s positive efforts. Look for any chance you can to tell your son that you have noticed improvement. Finally, if despite all of this your son still chooses not to complete homework assignments you must ask yourself, “Who does this problem belong to? Me? Or my son?” In other words, who “owns” the problem? If your rights are not being disrespected, no one can get hurt, no one’s belongings are being threatened, and your child is not too young to be responsible for this problem, then it is time for your son to own this problem. The important thing to remember is that the person who owns a problem is responsible for solving it. This may mean that your son may earn a few “F’s” on his way to becoming responsible. The point to take home is that it is not your responsibility to pass your son’s classes for him…he is in school…not you!


Q: About six months ago, as part of my fourteen-year olds treatment for moodiness and depression, I agreed to have him take antidepressant medication. After a few months, he was much better and is doing very well, but now I’ve heard and read that the medication might make him feel suicidal. What should I do?


A: Many parents and doctors share your concern. Most parents have a very difficult time agreeing to treatment for their children that includes psychiatric medication, and now you have to decide if your teenager should remain on the medication given the potential serious side effect.

Let’s examine the facts that should help in making your decision:

  1. First, and foremost, childhood depression is, often, a very serious illness. It frequently goes unrecognized, and even when identified, the child may not receive adequate treatment. Suicidal thoughts are a symptom of depression and depression is one of the strongest risk factors for suicide. It may be difficult to determine whether suicidal thoughts in a depressed person are due to the illness itself or the medication.

  2. Current research recommends psychotherapy, medication, or a combination of both as treatment for depression in children as well as adults.

  3. All of the commonly prescribed anti-depressants may relive mood and anxiety symptoms that accompany depression and impair children’s ability to function socially and academically.

  4. All of these antidepressants as well as most psychiatric medications may cause “behavioral” side effects in children and adolescents: irritability, restlessness, and activation or “hyper” behavior.

  5. The Food and Drug Administration (FDA), after reviewing the research and two days of hearing in September 2004, decided to place a strong warning on all antidepressants citing an “increased risk of suicidal thinking and behavior” in children and adolescents taking those medications. In the research the FDA reviewed, of 4400 depressed patients, 4% of those who took active medication experienced suicidal thoughts or suicidal “behavior” companies with 2% who received a placebo (inactive) medication. No “completed” suicides occurred in these studies.

  6. The warning suggests tracking children closely when they begin medication for the development or worsening of “anxiety, agitation, panic attacks, hostility, impulsivity, restlessness, and excessively elevated mood.” Competent care has included this advice and concern since these “newer” antidepressants appeared.

  7. Most children develop these adverse side effects in the early week of treatment.

So, what should you do? Certainly consult with your child’s doctor in assessing the benefits and risks of any treatment. If you son has not experienced the serious side effects, has been taking the medication for several months, and is doing well, he should, most probably, continue on the treatment, but, again, discuss this with his doctor.

For those of your reading this column, whose children have recently begun treatment, you and your doctor will need to closely monitor her for any changes in behavior. Discuss the risks with your daughter and ask whether she is experiencing any suicidal thoughts or urges. Let her know that she should come to you if she ever starts having such thoughts. With your doctor’s help, you and your daughter should develop a safety plan that may include another adult in your daughter’s life to whom she can turn if she is thinking about suicide. The FDA warning recommends weekly doctors visit for the first month after beginning treatment, two visits in the second month, and monthly thereafter. Please discuss this schedule with your doctor and agree on a visit schedule that fits your resources and allows close treatment supervision.

Be on the lookout for any behaviors that appear for the first time after beginning medication, seem worse, or worry your child or you. These may include new or more thoughts of suicide, self injurious behavior or suicide attempt, new or worse depression, new or worse anxiety, or feeling very agitated or restless. If any of these occur, contact your doctor right away.


Q: My six year-old’s first grade teacher told me my son was having difficulty paying attention and sitting still in class. She said I should have him evaluated. What should I do?


A: Since most, if not all, children are squirmy and no child maintains complete attention all the time, you should not assume your child has any “disorder” until you gather more information. You can then decide the sort of evaluation you will need to determine what the teacher’s observations may mean for your child’s social and academic well-being.

Ask the teacher to be more specific. Is the difficulty she describes “getting in the way” or not? For example, is your child’s academic “performance” at grade level? Does he seem to be underachieving? Does he have learning strengths or weaknesses, or is there difficulty “across the board?” Does “difficulty sitting still” mean merely fidgeting in the seat or actual inappropriate walking around the class? Is your child’s behavior disruptive? Has he been asked to leave the room or sit on the “bench?” Is he able to play cooperatively at recess or lunchtime, or does his over-activity isolate him from his peers?

“Watchful waiting” may be sufficient at this point if your son is progressing academically, has good peer relationships, and is “manageable” at home. If, however, your son is experiencing troubling difficulty in school, at home, or with friends, you should consider following through with the teacher’s recommendation.

Depending on the extent of your child’s problems, a thorough initial evaluation might include a medical/developmental history, a family history of academic or emotional difficulties, a physical examination and routine lab work, an assessment of academic achievement, an assessment of social development and current peer relationships, a systematic symptom review using teacher and parent rating scales, and an in-office interview and behavioral/emotional assessment with your child. “High Tech” studies, such as brain scans or EEGs, are not useful in the absence of obvious physical neurological symptoms or suspected neurological illness.

Of course, since I am a Child and Adolescent Psychiatrist, I believe someone in my field is best suited to provide this evaluation. A primary care doctor, pediatrician, clinical psychologist, or other mental health practitioner may “do the job” as well depending on their experience, available time, and the nature of their practice.

You want this evaluation to tell you if any further testing is necessary, such as more formal testing to rule out a specific learning disability. You want a diagnosis, or, as is often the case, an explanation of diagnosed conditions that occur together in young children with these problems. You want to know if you and the school are managing your child’s difficulties appropriately, and you want to know the benefits and costs/risks of recommended treatment including educational interventions, psychotherapy, and medications.

Attention-deficit Hyperactivity Disorder (ADD or ADHD) is the most common diagnosis for children with your son’s difficulties. Much controversy surrounds the diagnosis and treatment of this condition. I will discuss this controversy, fact and myth, in a subsequent article. Stay tuned…