Tips for Parents, Families, and Professionals

Parenting is often overwhelming. A good idea can become a good friend.

Handouts by Dr. Hall will give you hope, cheer, ideas, skills, and energy to keep you at the hard work of family change. Copy for non-profit use with credit to the author is granted without restriction.

Parenting for Conscience-Teenagers
School Avoidance and What Parents Can Do
Roots of Terror and What Parents Can Do
Parenting for Conscience-Children Zero to Five
Parenting for Conscience-Children Six to Twelve
The Art of Parenting Teenagers and Grand-Parenting Their Parents
Raising Healthy Teens Takes Courage and a Plan
Winter Blues

"Facts for Families" from the American Academy of Child and Adolescent Psychatry address over 80 specific problems.

Newsletter: Dr. Hall also writes a periodic e-mail newsletter on a parenting topic of current interest. Subscribe here


Handout #1
School Avoidance and What Parents Can Do
David C. Hall, M.D.

School should be a happy place for children to make friends, build their confidence, exercise their curiosity, and learn to learn so they may grow into competence and wisdom.

Sadly, that's not always the way it is. For some children new schools are frightening. A few experience school as a dreadful place where they are taunted and excluded. Children with special learning problems often feel pressure to perform in ways they simply cannot. Frustration erupts into arguments at home, missed school, poor grades, and falling self-esteem.

Here are five tips for parents of reluctant learners:

1) Sympathize with your children's fears. Listen carefully as they describe their frustrations. Ask them to be specific. What are they upset about or afraid of at school? Brainstorm with them ways they can act differently to make school fun again. Help them set regular routines for study, sleep, and fun.

2) Keep yourself calm. Monitor your own frustrations. Figure out if your child's difficulties are a passing phase or do they persist. What action do you need to take to feel you're being a good parent? Let your love and wisdom dictate your responses.

3) Visit school with you child. Talk with his or her teachers. Get a feel for the atmosphere your child experiences every day. Learn about the program your child faces and how you might help. For example, reading together at home, checking homework, providing needed materials, finding a tutor, encouraging friendships, and supporting after school activities.

4) Be a supportive and encouraging teacher with your child. Keep their learning experience enjoyable. Praise their exercise of curiosity. Start while your children are infants and help them learn the joy of discovery. Children who love to learn find ways to learn wherever they are.

5) Be alert for special difficulties your children may have in school. Do they need extra help to deal with math? Is their handwriting unreadable? Do they need extra time reading aloud with you at home? If they consistently fall behind in a subject, look into the possibility they have a special learning disorder. Children who feel overwhelmed with learning are at risk for giving up. Getting angry or frustrated with them will only make it worse. They need your help, patience, understanding, and love. And they may need outside help as well.

For further ideas talk with your child's teachers and school counselor. Talk with other parents. Check out your local library or bookstore for ideas. Some problems will self-correct. Others need you to intervene before they get worse. The sooner you figure out what's causing your child to avoid school, the sooner you can help her or him get back on track.

David C. Hall, M.D.
Child and Family Psychiatry

Author, Stop Arguing and Start Understanding: Eight Steps to Solving Family Conflicts, Montlake Family Press, September 2001. 1-888-565-3404

Top of Page


Handout #2
Roots of Terror and What Parents Can Do
David C. Hall, M.D.

Like it or not, we are immersed in a world where terror has always been a weapon of the weak and rageful. Over a million children are reported to Child Protective Services each year in the Unites States for suspected child abuse or neglect. Probably three times that many children face similar terror, but go unreported.

In the aftermath of September 11th many witnesses have reported hate crimes ranging from vulgar phone calls or catcalls to at least four murders within the following week.

What is this all about? Where does all this hatred come from?

First of all, I believe the cruelty unleashed in hate crimes comes from a sliver of the public and does not represent anything uniquely American. Bullies and tyrants populate virtually every culture on Earth - the perverted remnants of stolen childhoods (there have been fascinating exceptions for a time in Samoa and elsewhere).

In my thirty years of providing mental health care to thousands of individuals, I have yet to meet someone I believed was born evil. I have met and worked intensively with individuals who committed horrendous crimes of rape, battery, child molest, armed robbery, and murder. All of them knew the brutality of child abuse and neglect firsthand. Many shared with me their nightmares from childhood and their fantasies of revenge. Many of their lives were overwhelmed by mental disorders including depression, major mood swings, alcohol abuse, disabling learning problems, and unnerving post-traumatic stress symptoms.

What helped some of these people to establish caring relationships, often for the first time, was a combination of strict consequences for their crimes, a welcoming and respectful environment for exploring past emotional pain, and the steady, caring guidance of health workers willing to grant them a second chance. In response some family members were also able to participate in a healing process that included sharing openly their own emotional pain, getting help for mental problems of their own, and finding support for standing against coercive or secretive behaviors within the family.

Whole communities face abusive conditions at times. As a nation of immigrants, America has provided millions of people shelter from the storms of famine, religious intolerance, totalitarian brutality, and muzzled dissent. As a nation built on slavery, America has been a perpetrator of these same scourges on the conscience of humanity.

Our challenge now is to build a future based on respect for human rights, equality before the law, and generosity towards our fellow Earthlings. We drink the same water and breathe the same air. We need to share our stories with each other. We need to hold each other as precious even as we disagree with each other.

The cycle of abuse is predictable but not inevitable. Research shows that only half the children who are severely abused become abusers later on, although the other half suffer greatly and often become victims of abuse again.

The way out? We build a caring community that enforces physical and emotional safety, provides help for those burdened beyond their means, and creates an environment of "happiness, love and understanding" within which the scars of terror can be healed. We seek justice, not revenge. Accountability under law, not vigilante actions. Tolerance for speech that does not explicitly threaten others. Security measures built on information, not prejudice. Penal consequences built on necessary restraint and re-education, not retribution.

The place to start? In our own homes with our own children. We provide consistent and reliable love and understanding. We listen wholeheartedly trying to know the emerging person who is our child. We set firm and caring limits on our children's dangerous and hurtful activity. We celebrate their curiosity even when it's inconvenient. And we make sure our own emotional and spiritual needs are being met.

David C. Hall, M.D.
Child and Family Psychiatry

Author, Stop Arguing and Start Understanding: Eight Steps to Solving Family Conflicts, Montlake Family Press, September 2001. 1-888-565-3404

Top of Page


Handout #3
Parenting for Conscience-Teenagers: The Art of Losing Gracefully
David C. Hall, M.D.

You've survived your child's early and middle childhood, hopefully with many enjoyable moments. Now you face the intimidating teen years. With all the pain of adolescent moodiness-irritability, indifference, withdrawal, defiance, rudeness-and all the risks of adolescent testing-drugs, sex, violence, crime, runaways, cars-you ask, How am I going to stay sane?

Mission: To raise a strong, happy, competent, loving adult.

Strategy: To model what you want--stay loving, patient, determined, good-humored, and learn to listen with your whole being.

1) Parenting is difficult.
- Remember this, so you'll be ready for how hard you must work sometimes.

2) Right from conception, treat every child with love and respect and give them choices you define as safe and appropriate.
- Children develop self-esteem by learning from mistakes for which they are accountable.

3) Be ready and be steady with a sense of humor.
- Your teenager's task is to challenge your authority; your task is to validate that your authority is evenhanded, compassionate, and firm on core values.

4) Learn about the risks your child faces and how other families have survived them.
- Teenagers face real world risks, maiming or killing some of them, so talk with school authorities, your child's friends, other parents, your own parents, your doctor, your minister, and anyone else you think can help.

5) Keep faith with your child and with your own good parenting.
- You've built a relationship of love and respect over many years. Let it help you now. Don't give up on it.

6) Honor your own best judgment.
- Sometimes your teen will come up with harebrained ideas, or selfish ones. Set firm limits for your household that say "I love you all" and stick to them. When it's the right time to say "No," say it firmly. Love doesn't bend for devious, hurtful, or selfish impulses.

7) Limit your battles to ones vital to individual and family safety and health.
- Say "yes" whenever you can. Mean "no" when you say it. Keep your decisions clearly based in the best interests of both your teenager and the family.

8) Choose tactics that reinforce respect and dignity for all parties.
- Try to accommodate any legitimate interest your teenager wants to pursue. If you need to say "no," help your teen come up with an acceptable alternative. And always leave room for saving face.

REMEMBER: Your surest way to gain and keep your teenager's love and cooperation is your love and respect for your teenager and yourself. If you've been supporting your child's budding ability to make good choices all along, your task will be somewhat less traumatic. If you need to repair damage done earlier, face it squarely, admit to yourself and your teenager any mistakes you have made, and correct them openly. You're setting the model for honest recovery from the inevitability of mistakes.

You cannot show too often that you love your child and that you are proud of her or him. Just remember to keep it honest. When you are displeased, communicate your displeasure in a civil and straightforward way that engages your child's ability to acknowledge misconduct or mistakes and to make amends.

Time to seek help: When you consistently model the love, honor, and respect you want from your teenager and your teen is unable to return it, it's time to seek help. When your teenager becomes depressed, intoxicated, withdrawn, or too angry to talk, and the behavior lasts for more than a few days, it's time to seek help.

Two common times for trouble: 1) One reliably difficult time for families arrives when children reach the developmental stages when the parents had a difficult time with their own parents. The unconscious recordings of these earlier difficulties easily get replayed a generation later with the once traumatized child now playing the role of parent. 2) A second predictably difficult time is when a child who has been very close emotionally to one or both parents begins to emancipate. This child may well need to create more havoc to deal with his or her own distress over severing the close ties that were so important only months ago. Neither of these two circumstances require professional help if the parent involved sees her or his way to keeping a calm and loving response to the provocations.

If you do need help, ask someone you trust for suggestions. Check my web site at http://www.FamilyHealing.com for additional help.

Good luck!

David C. Hall, M.D.
Child and Family Psychiatry

Author, Stop Arguing and Start Understanding: Eight Steps to Solving Family Conflicts, Montlake Family Press, September 2001. ISBN 0-9710500-0-7
Orders: 1-888-565-3404 or your local bookstore

Top of Page


Handout #4
Parenting for Conscience-Children Zero to Five: Nurturing Curiosity and Civility
David C. Hall, M.D.

Parenting is difficult.

Parenting for conscience requires that parents are reliably loving and non-violent right from conception. There is nothing about parenting that is effortless or altogether predictable. So expect to work at it steadily and teach your children to do the same.

When the Nisqually Earthquake hit on February 28, 2001, I was sitting at my computer and felt the floor rise suddenly about 8 inches. Fortunately my office building could sway and not break.

Good parenting through the first five years creates the emotional equivalent of a shock-resistant foundation for our children. It starts with a healthy pregnancy and a healthy mom at childbirth. New parents face persistent, intense demands from their infant. The most demanding time in the family lifecycle for the energy required of parents comes with the second and third child under school age, when children need continuous attention.

The strongest of parents will feel overwhelmed at times. A reliable team of helpers is essential-a cooperative partner, extended family, available neighbors, co-operative daycare arrangements, PEPS* partners, and any other arrangement with safe and reliable people who will lend a hand at critical times. Single parents are particularly vulnerable to isolation and exhaustion.

What's the answer? Take good care of yourself. Your ability to carry out the demanding tasks of parenting young children depends on your getting enough sleep, exercise, healthy food, companionship, and restorative recreation. This means building a team of people who can take care of your children on a regular basis so you, the parent, get time away for yourself.

Once you are well cared for, you are ready to give your best to nurturing your children.

Here are the Five Basic Skills of Good Parenting, which will help you to nurture within your children the solid foundation they will need to become loving and civil despite life's many quakes.

Basic Skill #1: Talk Lovingly to Your Infants and Listen Lovingly to Your Children

Communicate your love in everything you say and do. Your children are precious and will bring you many of life's greatest joys if you treasure them constantly. From the day your babies arrive, talk lovingly to them. Sing to them. Tell them how wonderful they are. Read to them. Play soothing music for them. Tell them how much hope you hold for their future. They will understand the love in your voice and the warmth in your holding. Accept the strain and exhaustion of raising your baby as part of your decision to become a parent. A steady diet of love and appreciation is just as important as food for a growing infant. Once your children begin to talk, listen with your whole self to understand what they try to say. Give them new words and new ways to say what they want.

Basic Skill #2: See Through Your Children's Eyes

As they grow, develop your ability to see complaints and conflicts as your children see them. That way the responses you give will show you understand and thereby you nurture their souls. At the same time you will be modeling behavior that will be the backbone of their social competence. When your child cries, gets angry, or complains loudly, do your best to imagine what words they would need to tell you and offer those words. When you succeed in seeing events as your child sees them, you also get to see yourself more clearly and catch your own mistakes. Children by nature will try to communicate honestly unless they learn honesty doesn't work or, worse, that it backfires. Praise them for telling the truth as they see it. That way they can learn from their mistakes. And they can learn to take responsibility for decisions they make.

Basic Skill #3: Model Love and Respect

Flip Wilson was a very funny man who created a female comedy character named Geraldine, whose favorite line was "What you see is what you get!" Keep in mind that what your children see you do is what you're likely to get back from them. Treat them with dignity from the very start and they will treat you with dignity for the rest of your life.

Basic Skill #4: Do What Your Heart of Hearts Tells You Is Right We all have to answer to the mirror. When you look at yourself in the morning, do you like the person you see? Are you happy with the parenting decisions you have made recently? Deep down you must believe in what you do as a parent or you and your children will crash into a very painful wall of misunderstanding. It's not only important to be loving and respectful because love and respect model the behavior we want in return, but also because they wear better on our consciences than irritability, complaining, intimidation, or trying to please someone else.

Basic Skill #5: Persevere and Enjoy Your Children

You've accepted by now that parenting is difficult. No matter why you chose to jump into the storm-tossed ocean of parenthood, you're in it now. As you accept where you are and learn the skills and perspectives to navigate in this difficult environment, you'll grow stronger and more comfortable. There may be periods of greater behavior problems as your children move through difficult stages of development or run into complications of illness, family legacies of pain, or cultural temptations. Stay loving and supportive and look for the love and humor that even infuriating situations can provide. The prize of good parenting is the lifelong love and connection with your children and theirs. Treasure it as you go.

David C. Hall, M.D.
Child and Family Psychiatry
http://www.FamilyHealing.com

Author, Stop Arguing and Start Understanding: Eight Steps to Solving Family Conflicts, Montlake Family Press, September 2001. ISBN 0-9710500-0-7
Orders: 1-888-565-3404 or your local bookstore

Top of Page


Handout #5
Parenting for Conscience-Children Six to Twelve: It's a Wonderful Life (Sometimes)
David C. Hall, M.D.

Parenting is difficult.

Parenting for conscience requires that parents are reliably loving and non-violent right from conception.

You've invested your heart and soul in loving and guiding your infant-toddler-preschooler. When your child finally goes off to school, you get a breather. This begins the often wonderful stage of child development when friendships take root, skills grow daily, character deepens, understanding explodes, and self-awareness goes from one extreme to the other from six to twelve. It's also the most common time for parents to divorce, sibling rivalries to get hurtful, oppositional behavior to escalate, moodiness and anxieties to emerge, and the real world to intrude with its many complexities and contradictions.

Your challenge as a parent through these years is to enjoy teaching and taxiing your children as they participate in a variety of activities. They need your steady, good-humored support to succeed in school, with friends, in building their skills, and in engaging the wider community.

Gentleness and Tenacity

Your own gentleness and tenacity are your greatest allies in nurturing conscience in your children. When children misbehave, I try to remember Jesus' words from the cross, "Father, forgive them, for they know not what they do." (Luke 23:34) When your children choose to break the rules or to act selfishly, they are testing themselves and you or simply doing the best they can with inadequate skills. Be gentle in your response and firm in your expectations that they improve their skill and understanding, so the next problem will be a new one, not a repeat.

Here are nine suggestions to massage their budding consciences:

1) Encourage Humor. Find the funny bone in you and your children. Model good sportsmanship. Teach them how to tease you lovingly and to see conflict and disappointment from odd angles that mix humor into the pain.

2) Recruit Allies. My 18 month-old grandson has taken to saying "Help!" when he gets stuck trying to climb stairs or extract a toy from the toy box. Your spouse or partner, grandparents, siblings, fellow parents, neighbors, daycare, babysitters, support groups, teachers, coaches, youth workers, your family doctor, and specialists if you need them-they can all provide soul-saving help. Organize a village around your family to help you weather the storms of child rearing.

3) Treasure Your Children. They are the most precious investments in your portfolio. Love them lavishly both in giving to them what you want them to have and in setting safe limits that will protect their self-esteem. Don't let yourself strike them with words or anything else. Even at their most unruly, remember that well-loved children will always return that love if they can. If they cannot, you should seek professional help.

4) Share Your Stories, Share Yourself. As your children grow, tell them your family stories and your own story. Let them get to know you as a real person in the real world. Share your successes and shortcomings, embarrassments and triumphs, hard work and how you play. Help them to understand and respect the decisions you have made to become the person you are both as a parent and as a citizen of the world. This builds a bridge to friendship that will help you survive their teenage emancipation struggles and still love each other as adults.

5) Teach Discipline and Build Self-Esteem. Effective self-discipline is essential to good self-esteem. Children learn to manage their own emotional excesses by internalizing their parents' discipline of those excesses. As difficult as it becomes to set firm and effective limits on our children's excesses, it must be done, and done lovingly. Children are spoiled by the absence of appropriate limits on their selfishness, not by any excess of love. Giving in to tantrums only reinforces the child's fear of being out of control. Model firm restraint by insisting on time-outs and other proportionate consequences, followed by a discussion on better ways to get what they want. Enfold them in honest and loving relationships, so they know what they are missing when they hurt other people.

6) Monitor Violence. Unfettered access to violent video games or other violent media numbs our children to the real damage violence does to human relationships. Watch and play with your children so you know the intense allure of these media. Then talk with them about what violence means in real life. One 10 year-old told me his video game that had him dismember an enemy wasn't violent, "because there isn't any blood." Children become agitated by viewing violent material and are more likely to act violently after viewing such material. "[With violent video games we] are teaching children to associate pleasure with human death and suffering. We are rewarding them for killing people. And we are teaching them to like it," according to Lieutenant Colonel David Grossman, a former Army psychologist.*

7) Privacy-We All Need It. As children become self-aware and sensual, parents need to provide safe boundaries for personal hygiene, modesty, body contact, and sexual talk. Privacy for children means giving them defined space and time they can control. Healthy parents set the limits of safety and acceptable behavior and allow their children to make choices within those boundaries. Very early on, children develop preferences about eating, sleeping, playing, and cuddling. Each affirmation of a child's choice reinforces his or her confidence in making other choices. Your ability to enjoy your children's exercise of these limited freedoms validates their joy and self-assurance. And it reinforces the right you have for privacy from them.

8) Inspire Your Children's Imaginations and Reach. The more support and opportunity children receive for constructive, creative adventure, the less parents will need to intervene to constrain unruly behaviors. This means giving extra parental time on the front end of their adventure planning. In child rearing, the rule is "pay me now or pay me later." Spend your time encouraging positive activities or you'll spend it undoing trouble later on. As they get used to creating their own dramas, your children will need less direction from you. Making time to help them create positive habits of play will make later discipline less necessary, less frequent, and less confrontational. Beyond keeping your children busy, you can encourage them to use their imaginations to try out far-fetched ideas for the fun of it. There is no need to limit their ideas about what is possible-other than basic concerns for safety. Let them dream. In later discussions we can add our ideas about what reality allows in case our children haven't already figured this out for themselves. Healthy children have rich imaginations and many ideas about what they want. Find ways to say "yes" that allow them to proceed with safety and enthusiasm.

9) Expect Excellence and Appreciate What You Get. The secret to instilling in our children a lasting standard of excellence is to combine an expectation of excellence with appreciation for whatever they actually do. When you always give them credit for what they have done, you encourage them to try again and continue to improve their performance.

The corollary is to keep school enjoyable and exciting. Help your children to judge their performance against their own abilities and accomplishments more than against others. Praise their accomplishments and provide help as they ask for it.

Every child's level of excellence is different. Setting expectations tailored to each child honors the child's individuality and shows that child care. Excellence is not an absolute. You may have a child who is musically talented, a pretty good soccer player, or clearly slower than most other children. Each child needs to find his or her own level of comfort and competence and pursue it for the pride that comes from setting a goal and reaching it.

David C. Hall, M.D.
Child and Family Psychiatry
http://www.FamilyHealing.com

Author, Stop Arguing and Start Understanding: Eight Steps to Solving Family Conflicts, Montlake Family Press, September 2001. ISBN 0-9710500-0-7
Orders: 1-888-565-3404 or your local bookstore

Top of Page


Handout #6
The Art of Parenting Teenagers and Grand-Parenting Their Parents
David C. Hall, M.D.

Parenting is difficult.

Parenting teenagers at times seems impossible. The times we live in make it even harder.

For many families the most dramatic years arrive with middle school and junior high. Fourteen and fifteen year olds can be the biggest snots in the world and the most charming, lovable and sexy as well. It can be a grand entrance for some kids into the dazzling and dangerous world of adults.

Think about it. What have our kids watched on TV and movies and played on their video games all these years. Now they have the physical, emotional and intellectual capacity to try on some of these roles. And they have the need to do it their own way.

We made them do it our way all these years, because we were bigger, stronger, and more persistent. Now the tables have been reversed and it's our turn to get bossed around.

If we parented them wisely and lovingly up to this time, they will use their newfound power wisely and lovingly on us. If we didn't, we're in for a dose of our own medicine, or we will have to escalate to ever greater levels of intimidation or violence.

Grandparents can play a key role. We've been through the mill once already and hopefully we learned from it. We know where the pitfalls are and we figured out many of the problems our children now face with their children. What we can offer now is steady, non-judgmental support, respite for our grandchildren's parents, and carefully timed talks with our children about problems we see and how they might handle them differently.

Keep in mind, our culture is now so intrusive, sexualized, sensationalized, violent, and amoral as it's portrayed in our media, parents, grandparents, and the communities we belong to become the only reliable sources of consistent love, respect, and moral guidance. Each new generation grows up with greater access to information they are not able to handle alone. It's up to parents, grandparents, and the loving communities we create to provide safe and loving guidance as our children and grandchildren learn.

The job of parenting is too demanding, too exhausting, and too complicated for anyone to be able to do it well alone. Be humble, determined, and resourceful and you have a much better chance. As a grandparent, be available, supportive, loving, and tolerant. That way the next generation gets a solid foundation for caring and respectful relationships for the rest of their lives.

David C. Hall, M.D.
Child and Family Psychiatry, www.FamilyHealing.com

Author, Stop Arguing and Start Understanding: Eight Steps to Solving Family Conflicts, Montlake Family Press, September 2001. 1-888-565-3404

Top of Page

"Facts for Families"

Experts from the American Academy of Child and Adolescent Psychatry created a series of copyrighted brief issue summaries titled "Facts for Families". Here are six of them.

CHILDREN AND DIVORCE
BULLYING
CHILDREN WHO WON'T GO TO SCHOOL
NORMAL ADOLESCENT DEVELOPMENT
STEPFAMILY PROBLEMS
ADHD

You can access more than 70 other "Facts for Families" directly at The American Academy of Child and Adolescent Psychiatry  

Top of Page


Facts for Families: CHILDREN AND DIVORCE
No. 1 (10/92) (Updated 8/98)

One out of every two marriages today ends in divorce and many divorcing families include children. Parents who are getting a divorce are frequently worried about the effect the divorce will have on their children. During this difficult period, parents may be preoccupied with their own problems, but continue to be the most important people in their children's lives.

While parents may be devastated or relieved by the divorce, children are invariably frightened and confused by the threat to their security. Some parents feel so hurt or overwhelmed by the divorce that they may turn to the child for comfort or direction. Divorce can be misinterpreted by children unless parents tell them what is happening, how they are involved and not involved and what will happen to them.

Children often believe they have caused the conflict between their mother and father. Many children assume the responsibility for bringing their parents back together, sometimes by sacrificing themselves. Vulnerability to both physical and mental illnesses can originate in the traumatic loss of one or both parents through divorce. With care and attention, however, a family's strengths can be mobilized during a divorce, and children can be helped to deal constructively with the resolution of parental conflict.

Parents should be alert to signs of distress in their child or children. Young children may react to divorce by becoming more aggressive and uncooperative or withdrawing. Older children may feel deep sadness and loss. Their schoolwork may suffer and behavior problems are common. As teenagers and adults, children of divorce often have trouble with their own relationships and experience problems with self-esteem.

Children will do best if they know that their mother and father will still be their parents and remain involved with them even though the marriage is ending and the parents won't live together. Long custody disputes or pressure on a child to "choose sides" can be particularly harmful for the youngster and can add to the damage of the divorce. Research shows that children do best when parents can cooperate on behalf of the child.

Parents' ongoing commitment to the child's well-being is vital. If a child shows signs of distress, the family doctor or pediatrician can refer the parents to a child and adolescent psychiatrist for evaluation and treatment. In addition, the child and adolescent psychiatrist can meet with the parents to help them learn how to make the strain of the divorce easier on the entire family. Psychotherapy for the children of a divorce, and the divorcing parents, can be helpful.

Top of Page


Facts for Families: BULLYING
No. 80 (03/01)

Bullying is a common experience for many children and adolescents. Surveys indicate that as many as half of all children are bullied at some time during their school years, and at least 10% are bullied on a regular basis.

Bullying behavior can be physical or verbal. Boys tend to use physical intimidation or threats, regardless of the gender of their victims. Bullying by girls is more often verbal, usually with another girl as the target. Recently, bullying has even been reported in online chat rooms and through e-mail.

Children who are bullied experience real suffering that can interfere with their social and emotional development, as well as their school performance. Some victims of bullying have even attempted suicide rather than continue to endure such harassment and punishment.

Children and adolescents who bully thrive on controlling or dominating others. They have often been the victims of physical abuse or bullying themselves. Bullies may also be depressed, angry or upset about events at school or at home. Children targeted by bullies also tend to fit a particular profile. Bullies often choose children who are passive, easily intimidated, or have few friends. Victims may also be smaller or younger, and have a harder time defending themselves.

If you suspect your child is bullying others, it's important to seek help for him or her as soon as possible. Without intervention, bullying can lead to serious academic, social, emotional and legal difficulties. Talk to your child's pediatrician, teacher, principal, school counselor, or family physician. If the bullying continues, a comprehensive evaluation by a child and adolescent psychiatrist or other mental health professional should be arranged. The evaluation can help you and your child understand what is causing the bullying, and help you develop a plan to stop the destructive behavior.

If you suspect your child may be the victim of bullying ask him or her to tell you what's going on. You can help by providing lots of opportunities to talk with you in an open and honest way.

It's also important to respond in a positive and accepting manner. Let your child know it's not his or her fault, and that he or she did the right thing by telling you. Other specific suggestions include the following:

Ask your child what he or she thinks should be done. What's already been tried? What worked and what didn't? Seek help from your child's teacher or the school guidance counselor. Most bullying occurs on playgrounds, in lunchrooms, and bathrooms, on school buses or in unsupervised halls. Ask the school administrators to find out about programs other schools and communities have used to help combat bullying, such as peer mediation, conflict resolution, and anger management training, and increased adult supervision.

Don't encourage your child to fight back. Instead, suggest that he or she try walking away to avoid the bully, or that they seek help from a teacher, coach, or other adult. Help your child practice what to say to the bully so he or she will be prepared the next time.

Help your child practice being assertive. The simple act of insisting that the bully leave him alone may have a surprising effect. Explain to your child that the bully's true goal is to get a response.

Encourage your child to be with friends when traveling back and forth from school, during shopping trips, or on other outings. Bullies are less likely to pick on a child in a group.

If your child becomes withdrawn, depressed or reluctant to go to school, or if you see a decline in school performance, additional consultation or intervention may be required. A child and adolescent psychiatrist or other mental health professional can help your child and family and the school develop a strategy to deal with the bullying. Seeking professional assistance earlier can lessen the risk of lasting emotional consequences for your child.

Top of Page


Facts for Families: CHILDREN WHO WON'T GO TO SCHOOL (Separation Anxiety)
No. 7 (Updated 11/98)

Going to school usually is an exciting, enjoyable event for young children. For some it brings fear or panic. Parents have cause for concern when their child regularly feels sick from tension, "plays sick" or with minor physical complaints wishes to stay home from school. Not wanting to go to school is most common in children 5-7 and 11-14, times when children are dealing with the new challenges of elementary and middle school. These children may suffer from a paralyzing fear of leaving the safety of their parents and home. The child's panic and refusal to go to school is very difficult for parents to cope with, but these fears can be treated successfully, with professional help.

Refusal to go to school often begins following a period at home in which the child has become closer to the parent, such as a summer vacation, a holiday break, or a brief illness. It also may follow a stressful occurrence, such as the death of a pet or relative, a change in schools, or a move to a new neighborhood.

The child may complain of a headache, sore throat, or stomach-ache shortly before it is time to leave for school. The "illness" subsides after the child is allowed to stay home, only to reappear the next morning before school. In some cases the child may simply refuse to leave the house.

Children with an unreasonable fear of school may:

feel unsafe staying in a room by themselves
display clinging behavior
display excessive worry and fear about parents or about harm to themselves
shadow the mother or father around the house
have difficulty going to sleep
have nightmares
have exaggerated, unrealistic fears of animals, monster, burglars
fear being alone in the dark, or
have severe tantrums when forced to go to school

Such fears are common among children with separation anxiety disorder.

The potential long-term effects (anxiety and panic disorder as an adult) are serious for a child who has persistent fears and does not receive professional assistance. The child may develop serious educational or social problems if away from school and friends for an extended period of time.

The parents and child can benefit from seeing a child and adolescent psychiatrist, who will work with them in an effort to immediately return the child to school and other important daily activities. Since the panic comes from leaving home rather than being in school, frequently the child is calm once in school. Refusal to go to school in the older child or adolescent is generally a more serious illness, and often requires more intensive treatment.

Unreasonable fears about leaving the home and parents can be successfully treated, and parents should not hesitate to seek professional help. The child's physician can refer the parents to a child and adolescent psychiatrist.

For more information see Facts for Families #4 "The Depressed Child," #8 "Children and Grief," #47 "The Anxious Child," and #50 "Panic Disorder in Children and Adolescents."

Top of Page


Facts for Families: NORMAL ADOLESCENT DEVELOPMENT
Middle School and Early High School Years
No. 57 (5/97)

Parents are often worried or confused by changes in their teenagers. The following information should help parents understand this phase of development. Each teenager is an individual with a unique personality and special interests, likes and dislikes. However, there are also numerous developmental issues that everyone faces during the adolescent years. The normal feelings and behaviors of the middle school and early high school adolescent are described below.

Movement Towards Independence

Future Interests and Cognitive Changes

Top of Page


Facts for Families: STEPFAMILY PROBLEMS
No. 27 (Updated 11/99))

With the high incidence of divorce and changing patterns of families in the United States, there are increasing numbers of stepfamilies. New stepfamilies face many challenges. As with any achievement, developing good stepfamily relationships requires a lot of effort. Stepfamily members have each experienced losses and face complicated adjustments to the new family situation.

When a stepfamily is formed, the members have no shared family histories or shared ways of doing things, and they may have very different beliefs. In addition, a child may feel torn between the parent they live with most (more) of the time and their other parent who they visit (e.g. lives somewhere else). Also, newly married couples may not have had much time together to adjust to their new relationship.

The members of the new blended family need to build strong bonds among themselves through:

While facing these issues may be difficult, most stepfamilies do work out their problems. Stepfamilies often use grandparents (or other family), clergy, support groups, and other community-based programs to help with the adjustments.

Parents should consider a psychiatric evaluation for their child when they exhibit strong feelings of being:

In addition, if parents observe that the following signs are lasting or persistent, then they should consider a psychiatric evaluation for the child/family:

Child and adolescent psychiatrists are trained and skilled at providing comprehensive psychiatric evaluations of both the child and family.

Most stepfamilies, when given the necessary time to work on developing their own traditions and to form new relationships, can provide emotionally rich and lasting relationships for the adults, and help the children develop the self-esteem and strength to enjoy the challenges of life.

Additional/related Facts for Families, #24 "Know When to Seek Help for Your Child," #1 Children and Divorce," #52 "Comprehensive Psychiatric Evaluation," #8 "Children and Grief," and #66 "Teens with Stress." Your Child (1998 Harper Collins)/Your Adolescent (1999 Harper Collins)

Top of Page


Facts for Families: CHILDREN WHO CAN'T PAY ATTENTION/ADHD
No. 6 (Updated 5/99)

Parents are distressed when they receive a note from school saying that their child "won't listen to the teacher" or "causes trouble in class." One possible reason for this kind of behavior is Attention-Deficit Hyperactivity Disorder (ADHD).

Even though the child with ADHD often wants to be a good student, the impulsive behavior and difficulty paying attention in class frequently interferes and causes problems. Teachers, parents, and friends know that the child is "misbehaving" or "different" but they may not be able to tell exactly what is wrong.

Any child may show inattention, distractibility, impulsivity, or hyperactivity at times, but the child with ADHD shows these symptoms and behaviors more frequently and severely than other children of the same age or developmental level. ADHD occurs in 3-5% of school age children. ADHD must begin before the age of seven and it can continue into adulthood. ADHD runs in families with about 25% of biological parents also having this medical condition.

A child with ADHD often shows some of the following:

trouble paying attention

A child presenting with ADHD symptoms must have a comprehensive evaluation. A child with ADHD may have other psychiatric disorders such as conduct disorder, anxiety disorder, depressive disorder, or manic-depressive disorder. Without proper treatment, the child may fall behind in schoolwork, and friendships may suffer. The child experiences more failure than success and is criticized by teachers and family who do not recognize a health problem.

Research clearly demonstrates that medication can be helpful. Stimulant medication such as methylphenidate, dextroamphetamine, and pemoline can improve attention, focus, goal directed behavior, and organizational skills. Other medications such as guanfacine, clonidine, and some antidepressants may also be helpful.

Other treatment approaches may include cognitive-behavioral therapy, social skills training, parent education, and modifications to the child's education program. Behavioral therapy can help a child control aggression, modulate social behavior, and be more productive. Cognitive therapy can help a child build self esteem, reduce negative thoughts, and improve problem solving skills. Parents can learn management skills such as issuing instructions one step at a time rather than issuing multiple requests at once. Education modifications can address ADHD symptoms along with any coexisting learning disabilities.

A child who is diagnosed with ADHD and treated appropriately can have a productive and successful life. If a child shows symptoms and behaviors like those of ADHD, parents may ask their pediatrician or family physician to refer them to a child and adolescent psychiatrist, who can diagnose and treat this medical condition.

For additional/related information see other Facts for Families: Learning Disabilities (#16), Conduct Disorders (#33), Manic-Depressive Illness in Teens (#38), Questions to Ask about Psychiatric Medications for Children and Adolescents (#51), Comprehensive Psychiatric Evaluation (#52).

Top of Page


Raising Healthy Teens Takes Courage and a Plan

Raising Healthy Teens Takes Courage and a Plan

David C. Hall, MD

 

If you want healthy teenagers, start with a drug- and smoke-free pregnancy and a loving early childhood. Get all your children lovingly through their first six years of life and the traumas of teen-hood will remain manageable. You don’t have to know all there is to know about it to be a good parent. But you do need a plan and the courage to carry it out.

 

The elements are seemingly simple: love your children unconditionally, understand their individual natures, take good care of yourself, connect with a loving community, and be humble in the face of a glorious, violent, often unknowable world. The challenge is to do these things consistently throughout their lives. The more chaotic your own life, the more important it is to create loving order for your children.

 

Stop Arguing and Start Understanding: Eight Steps to Solving Family Conflicts is a step-by-step approach to these issues and how to pursue them successfully. You start by taking responsibility to see that the outcomes you want are achieved. Learn about your children and their problems. Hone your parenting skills to reinforce the outcomes you want. Train yourself to be loving, firm and effective. When you need help, search it out. Join the community around you and seek the comfort of family and friends. Stay true to your core values and beliefs and humble in the face of a task too big for any individual. And never give up.

 

Parenting teenagers will invariably challenge even the best of parents. Paradoxically, the strengths teens will need to succeed in this complex and demanding world are the very strengths they will use to drive us crazy. They build their skills and confidence through escalating contests with us, the people they trust the most to love them despite their defiance and misbehavior. If we lose our own restraint, good humor, and clarity about what’s most important, then their emancipation is compromised and our parenting tasks grow more frustrating and unsatisfying.

 

The art of parenting teenagers is the art of losing gracefully. As the father of two boys with all the advantages a parent could wish for, I learned they could beat me in many different ways. When one son turned twelve, we ran a 440 yard dash and I beat him by ten yards. In the rematch a year later he was twenty yards ahead after the first hundred yards. Two years later he was strong enough to snap me in half. My other son called me from an emergency room. His girlfriend had overdosed after a physical fight and he was talking with the police because he had hit her back. Both sons have let me know over the decade and a half since their middle teens that their parents had only the slimmest notion of what they were up to back then. And yet they both love their parents dearly and are beautiful, responsible adults. So what was the secret?

 

We loved them intensely, gave them as much responsibility as they could handle (and occasionally more), used discipline to educate rather than punish, and helped them whenever they asked for it.

 

So here’s the plan. (You’ll have to provide the courage.)

 

1) Keep your sense of humor.

Humor helps to keep our conflicts in perspective, and to not take ourselves any more seriously than necessary.

What were your own teen years like? What stunts and tug-a-wars did you pull on your own parents? The idea is not to keep your teens from doing something you don’t think they should do, it’s to keep them from suffering permanent harm. Anything short of that can be laughed at as a brush with catastrophe that didn’t happen.

Regina runs away to a friend’s house because she doesn’t want her parents telling her she can’t see her boyfriend. How can her parents respond so mutual respect grows and defiance becomes less necessary? First, they can appreciate that she isn’t in her boyfriend’s car enroute to Las Vegas. Then they can celebrate that someone else is going to have to put up with her for a while.

 

2) Respect your teenager’s efforts to individuate into a complex, tempting, sometimes emotionally treacherous world. 

Regina’s parents can start by respecting her motives and judgment. It’s understandable that she would want freedom to see her boyfriend. Remember, Shakespeare’s Romeo and Juliet were only fourteen years old. Seen from her perspective, running to a friend’s house may actually be a pretty good choice. She goes to a safe place. She puts distance between herself and her parents. She lets her parents know she’s serious about her independence and gives them a chance to think things through. And she stands up for herself, an essential skill if a teen is to navigate successfully through middle school and beyond. She could have taken a wide range of more dangerous steps to prove that her parents are not in control. If her choices have exposed her to serious risks, then tighten the leash, ground her, and spend time listening carefully, so you have an idea how she is thinking about her dilemmas. And let her know in every way you can how precious she is in your lives and how glad you are that she wants to become her own person. Sadly for some families, the parents don’t get it the first or second time, they become more dictatorial or even abusive rather than understanding, and their teen is forced to more extreme and dangerous behaviors just to prove they cannot be controlled—in the long run a lose-lose outcome for parent and teen.

 

3) Reframe problems in ways that give everyone positive choices.

Do you have any idea how difficult it is to succeed as a teenager these days? If your child isn’t doing well in school or keeps friends you don’t trust, ask yourself why. Why is he not motivated? What’s missing or what’s getting in the way? Put yourself in her shoes and see if you can figure out the pressures and temptations that she faces. Frame problems in ways that create positive solutions for you and them.

It is a fundamental task of adolescence to test personal boundaries, to test their own skills and strengths, and to test the wider world for its true dangers and possibilities.

The more successfully we managed our own adolescence, the more likely we have useful guidance for our own teenagers. Otherwise, we need to look for new ideas that have a better chance to help them than our strategies did for us. Think positively. Every problem has a potential solution. Look at the situation in ways that give you new perspectives and positive ideas to try. Humor works by reframing a situation in unexpected ways. You can also be deliberate in taking new approaches, including granting your teens greater responsibility, providing enhanced positive incentives to cooperate, providing more consistent discipline, and just plain listening to learn how they see and feel about their lives.

 

Gerard’s grades have been slipping for a year. He spends more time playing video games and instant messaging than on his homework. He says he’s getting his work done, but his last report card says he may fail two classes. He’s been hanging out more by himself than with friends recently and staying up to all hours of the night.

 

Maybe Gerard is just being lazy, but it still begs the question, Why? Perhaps he is being bullied, getting depressed, or finding new interests that trump school for now. Maybe he’s too distractible to keep up with the accelerating pace of his schoolwork. Or maybe he’s fallen in love. Might now be a good time for him to experiment with shifting his focus away from school and/or parents and family? What does he hope will happen as he pursues his current course? What’s the most serious harm he might face? What might he learn by taking responsibility for the outcome of his own decisions? If you don’t trust that he can take care of himself in his current environment, what help does he need from you or others? What will it take for him to accept help? Here again is a prime time to listen to him in order to understand what sense he makes of his situation. Parents can be uniquely effective in helping their teens to see problems in new ways that create more useful approaches to problems, that is, unless your teens have tuned you out for being overly anxious, controlling, impatient, judgmental, or not listening.

 

4) Be steady in your love, positive in your expectations, and firm in your discipline.

A key way to share love is to listen—intently with a goal to see it and understand it the way your teenager does. It requires of you time, patience, and heartfelt respect for your teen’s efforts to deal with the world the way she finds it. Our teenagers need our love, our encouragement, and our wisdom in the form of safe boundaries and timely availability. You child doesn’t become a different person when puberty takes her into adolescence. You already know the child’s strengths and shortcomings. Use this knowledge to adjust your expectations and discipline for the adolescent’s growing abilities and curiosity. Use your own experience of adolescence as a map. Set expectations together that define both what she wants from her adolescence and how she will achieve it. Share with her what you wanted as an example for conversation, then listen intently when she shares what she wants. The more you discuss it over time, the more developed the ideas will become. What she believes she wants at thirteen doesn’t limit what she may want at sixteen or nineteen. It’s a stepping stone that helps her arrive where she wants to be. Your role as parent is to help her to stay on track and to do the hard work it takes to reach meaningful goals.

 

5) Check out your understanding with other parents and available authorities.

When your own map isn’t helping, or you don’t trust the map you’ve developed with your teenager, then ask others with experience for their input.

The time may well have arrived for Gerard’s parents to talk with his teachers, and perhaps the parents of his friends. Does he have friends at school? How are they doing in school? Is anyone giving him a hard time at school? A bully, a girlfriend, or someone else? Is he having trouble sleeping or feeling unduly tired during the day? Is he worrying more than usual? Or is he just tired of you trying too hard to parent him?

Parenting can become an exceedingly lonely project. The more you connect with others who understand, the more support you will experience and the better able you will be to keep crises within manageable bounds. It’s always helpful to run your perspectives and ideas by other people. That way you can hear yourself as you tell your story and they can give you an outsider’s feedback as a check on the inherent tendency we all have to think we must be right.

 

6) Keep your sense of humor.

If God had meant it to be easy, we’d have been given fully grown, independent, God-fearing children. So much for wishful thinking.

 

7) If all else fails, ask for help.

Accept responsibility to make your parenting satisfying. Don’t let the challenges beat you down. If that happens, ask for help. No shame, no blame, just let people know you’re in over your head right now and need someone to give you a hand. Ask a family member or a friend, ask other parents, ask your doctor or your pastor. Join a parenting group. Join a church or Scouts or Campfire or an Anonymous organization or a community sports program. Or start your own parent group, book club, parents’ night out, or neighborhood potluck.

Good luck.

 

 

Top of Page

WINTER BLUES

Mid-winter feels awful when bad weather and low school grades collide with seasonal blues and cabin fever.

Here are a few tips to get you through:

1) Take a no-fault approach to solving problems

2) Get outdoors. Notice the crocuses already coming up (your doctor will tell you to walk a half hour every day for your health)

3) Have a family meeting about school work, study routines, and priorities for the coming term (set a positive, hopeful tone)

4) Re-commit to kindness and calm in dealing with each other

5) Plan breaks from your stressful routines that allow for fun together

6) If your student needs extra help, get it for them

7) And remember, keep school fun. Learning is a lifelong enterprise.

8) If your depression is severe enough to interfer significantly with school, work, friends, or family, then seek your doctor's help. Antidepressant medications can help within one to two weeks.

Top of Page