Never Give Up

One in 10 children suffer from mental disorders ranging from depression to schizophrenia. Less than one out of three will find help. 
                                                     [A new report by the U.S. Surgeon General]

By: Michael G. Conner, Psy.D, Clinical, Medical & Family Psychologist

Finding help for families, teenagers and children can be a challenge. But there is good news. Information and referral systems are available from our schools, medical offices, news magazines, the yellow pages and even the Internet. Many parents are finding help and discovering resources by asking family, friends and their co-workers. In fact, information and referrals based on a personal recommendation is a great way to find help.

Unfortunately, finding help for children and families has become more difficult than finding help for most adults problems. For instance, health insurance has many restrictions that limit who you can see and what services they can provide. Most of the problems that families and children face are not covered and only certain diagnoses will be treated. Public programs across the country lack adequate funding. The schools have programs, but they desperately need more staff and money to meet the demands that currently exist. There are many private counselors who work with children, but there are only a few who work with families and children who have serious behavioral and emotional problems.

The consequence when children donít get the help they need can be tragic. Parents and families give up when they donít know what to do, when they are discouraged and when they lack adequate information. Finding and getting help means you need to get oriented and understand the problems and potential solutions.

Behavior Problems. In order to deal with a problem it will help a great deal if parents can describe the problem in terms that may lead to a solution. Here are the problems that I see parents and their children facing. Many of these will surface in small children or they may not appear until children become teenagers.

  • - Social withdrawal and isolation

  • - Refusal to go to school

  • - Demanding and selfish attitude

  • - Disregard for rules, responsibilities and family functioning

  • - Poor study behavior and skills

  • - Unfocused or disruptive behavior in classroom

  • - Grades and school performance dropping

  • - Erratic or emotionally unstable behavior

  • - Poor hygiene and grooming

  • - Behavior is disrespectful or defiant

  • - Involved in high risk and reckless activities

  • - Using alcohol or other drugs

  • - Skipping school

  • - Stealing or theft

  • - Destructive, threatening or violent behavior

  • - Self-harming or suicidal behavior

Typical Causes. It takes time for problems to become critical, life threatening or intolerable. At some point, one can trace the cause to one or more factors. A pattern of problems will usually occur over time before a problem becomes a crisis. Identifying these factors can help characterize the evolution of a problem or a crisis, the appropriate response and the potential solution that may be necessary.

  • - "Brittle" or fragile emotional temperament

  • - Social demands exceed current ability

  • - Peer and social pressures

  • - Failure to provide rules, discipline and a bonded relationship with a child

  • - Parental divorce or separation

  • - Family conflict and discord

  • - Neglect or abandonment

  • - Traumatic experience

  • - Undiagnosed medical or psychological problem

  • - Untreated parental alcoholism, drug abuse or mental disorder

  • - Alcohol and other drug use

What are the Solutions?. The first step is to define the problem and a potential cause. After that, you need to explore potential solutions. There are at least several dozen potential solutions to any problem. That is a lot to consider. Unfortunately, access to many of these resources may depend on the parentís employment benefits and their income. Many public programs have waiting lists and may exclude children if the problem is not severe enough. Exclusion from public programs does not mean the problem is minor. Many programs are full and can only take children with more severe problems. The following is a partial list of potential solutions.

  • - Self-help

  • - Parenting education and training

  • - Individual counseling and therapy

  • - Group counseling and therapy

  • - Parenting consultation and advice

  • - Family counseling and therapy

  • - Increased parental involvement and supervision

  • - Tutoring

  • - Special education programs

  • - Change schools

  • - Outdoor activities or adventure programs

  • - Move to a new area

  • - Parenting by other family members

  • - Foster care

  • - Health and human service case management

  • - Private school

  • - Day treatment therapy program

  • - Boarding school

  • - Therapeutic boarding school

  • - Residential treatment program

  • - Medication intervention

  • - Psychiatric hospitalization

  • - Police or law enforcement response

Diagnosis can be misleading. There are many ways to define problems. One of the least useful and potentially harmful is to rely entirely on a diagnosis. A diagnosis alone can be misleading. Many problems are not solved because the problem was diagnosed, the underlying problems were missed or ignored, and the diagnosis suggested an approach that was inadequate and unfocused.

A diagnosis can create a false sense of certainty. Why? Because the diagnostic procedures used in mental health are not much more sophisticated than one used to diagnose a headache or a stomach ache. For instance, there are many forms of headaches and stomach aches. There are many things that can cause a headache - a tumor, tension, injury, eye strain, diet, disease, flu, allergies, a cold or bacterial infections etc..

In mental health, no matter how rigidly we use diagnostic criteria, or how sophisticated the interview process, we are still looking at patterns that have many origins. There can be many sources and causes for a particular problem Ė especially family problems that involve children. A traumatic experience can result in many different problems. The behaviors associated with attention deficits and hyperactivity can be caused and maintained by many things. As a result, there are many potential outcomes and approaches, and these can vary with each family, their beliefs, values, attitudes, culture, ethnicity and their resources.

Parents need more than a diagnosis. It helps to understand a problem in a manner that can tell us how a potential solution may work. Itís not enough to say that a child is depressed and they need to talk to a counselor. A child who is living in an abusive home may be depressed and emotionally withdrawn, but they donít necessarily need therapy to express their emotions. The family may be the more important focus and the most important part of the solution.

Counseling and Therapy. Counseling and therapy is a mixed bag as far as solutions go. There are more than 200 types of counselors and therapists. Trying to find the right one can be overwhelming or end up a waste of time. There is also a great deal of similarity between some counselors and some therapists. Counseling is not therapy. Counseling usually results in a realization, a plan or a decision. A therapist provides an environment of activities that bring about change Ė almost like exercise.

There are no simple words of advice or a formula that will absolutely insure that your family or child will find the right person. Trial and error may be required. But there are four guidelines that have been shown to increase the likelihood of success.

- Become invested. Educate yourself, gather information and become actively invested in understanding the problem and selecting a counselor or therapist.

- Learn how it works. Donít select a particular counselor or therapist unless you believe they can clearly describe the problem, how their approach to therapy or counseling works, and how that approach will resolve the problem.

- The relationship heals. The relationship you and your child have with a counselor or therapist as well as their approach are equally important. Work with people you and your child trust, like and believe is competent.

- Get references. Ask for the names of other parents or professionals who can recommend a potential counselor or therapist. There is no better reference than a credible recommendation and past success with similar problems.

Medications. The use of medication can present a real solution and a real problem for most parents. Medications can have a powerful effect on the mood and behavior of children. For parents who have tried "everything else", medications can make the difference between a life lost and a chance to become a reasonably successful adult.

There are certain realities when one decides to use medication. For one thing, psychiatric medications for behavioral and mental health problems will treat the symptoms and not the cause. Medications do not cure psychological, emotional and behavioral problems. Psychiatric medications that are used to treat depression, anxiety, mood swings, attention deficits, hyperactivity and disorganized thinking always affect another part of a childís body and brain. These "side-effects" are not clearly understood and the long term impact on growing children is still uncertain. Law suites are surfacing and legislators are proposing legislation to address recognized dangers in the wrongful medication on children.

While one should be cautious about the use of medications to treat behavioral problems, there is certainly a place for these drugs. In severe cases, and cases where parents cannot afford therapy and special schools, medications can bring hope to an otherwise hopeless situation. In some cases, children may require medication to simply participate in school, family activities and counseling or therapy. More importantly, a childís personality and attitude in life will be damaged if that child is left in a depressed, anxious or otherwise dysfunctional state for an extended period of time. Medication can be a "life boat" and deterrent against psychological and social trauma that come from serious but temporary problems that would otherwise destroy a childís attitude toward life. But before you start any medication, ask your pharmacist for information on the side effects.

The Power of Parenting and Family. Parents and family members can have the most powerful impact of a childís behavior, attitude and approach to life. Put simply, children are persuaded and impressed by the people they spend the most time with and the people who matter most. That should be the childís parents and family. Why? Because a therapist can only provide an exceptional environment, relationship and activities for an hour or so a week.

Individual counseling and therapy may not be enough for most children - especially if that child is facing social pressure, temptations, painful experiences and inappropriate role models during the remainder of the week. In most cases, individual therapy or counseling without parental or family involvement is not enough.

In some cases, therapy and counseling can result in a child developing unrealistic expectation of their parents and family. It is easier to be a therapist than it is to be a parent. This is why family education and involvement in counseling and therapy may be essential. Therapy and counseling should never replace the essential role of parents or a family. It should support those roles. But if parents are unwilling or unable to become involved with their child or in therapy, then therapy can provide the support that some children desperately need.

Peers and Social Pressure. At a very early age, many children are profoundly influenced by their peers. It has been repeatedly observed in social science that children learn behaviors and will adopt the attitude of children they are emotionally bonded with. As children begin to bond with other children, they seek approval, advice and even direction for their life. The struggle for independence and separation from parents is a natural process. However, problems will invariably surface, attitudes may become hostile, and values can become lost when parents become less involved with their children. Social pressure is a powerful tendency for children to imitate and adopt the behavior and emotional sensitivity of others. Children begin to think the way they talk with their friends. Children tend to become what they think about. 

Dr. Conner is a clinical psychologist who completed a research and training fellowship in graduate medical education and health education. He provides training, evaluation and intervention services for adults, families and youth. He is a Board Certified Expert in Traumatic Stress, Emergency Crisis Intervention, Emergency School Response and Sports Psychology. This article is also available at www.CrisisCounseling.Com. Dr. Connerís practice is located in Bend Oregon and he can be reached at 541 388-5660, or .