Part I
General Issues: Parenting the Mentally Ill Adolescent
(cont'd from September 4th, 2011)
Wendla A. Schwartz, MD
How to Use this Book
This book can be read straight through as one might read a novel. Although that task may be daunting, it could also prove informative. The book is equally useful as a reference. Chapters can be read as individual bits and topics chosen from the Table of Contents or Index as needed. I recommend rereading when support or refresher is desired. The Resources section is a list of references I have used often with my own patients and which, at the time of this writing, I felt comfortable sending on to you. Please use them liberally as no single resource (i.e. this book) can provide near enough information to a family facing these challenges.
It should be noted that no one book can address all the issues confronted by families coping with any one of the above diagnoses. No such attempt is made here. Parenting the Mentally Ill Adolescent is but one volume meant to assist parents who may be struggling to determine when it is time to seek professional help and then to offer some interventions to alleviate various struggles that may arise. The interventions suggested have been developed over my 20 years observing and working with psychiatric patients and their families. These are the actions I found to be most "tried and true." My families have come back often to report these particular suggestions as helpful regardless of diagnoses. So, they are presented here, in hopes you will find them helpful as well.
The book is written in three parts.
Part I. General Issues: Parenting the Mentally Ill Adolescent
This section begins with a brief summary of brain biology geared toward the educated but, non-biologist parent. The section seeks to provide a foundation upon which a parent might best understand their child and the significance of the adolescent years ahead of them. The next seven chapters explore common areas of concern for parents of mentally ill teens. Each of the seven chapters focuses on one major area (i.e. home and family, academics, drugs and alcohol etc…) Within each chapter multiple subtopics are introduced. For example The Home and Family Chapter is subdivided as follows:
- Rules and Responsibilities
- Manners and Courtesy
- Privileges
- Money
- Sibling Relationships
In addressing the topics, I attempt to answer the questions: What is typical for a teenager with this issue? What is atypical and more likely to be related to mental illness? What should a parent do if they are concerned that the behavior is atypical? In other words, given the world we live in and the nature of teenagers as highly variable and constantly changing anyway, how does a parent know what a “typical teenager” looks like? In a clear, and easily understood manner behaviors are listed and discussed. Summaries of typical and atypical behaviors are printed as lists in yellow boxes throughout the text for easy reference. Examples of common parental concerns include:
• Is it normal for my teenager to refuse to come out of her room all the time?
• How angry is too angry?
• Do all the kids really smoke pot?
• Why does she always tell me everything is fine?
• How come I used to know what's going on and now everything is a secret?
• How many friends is the "right" number."
• How come my kid has 900 Facebook friends but nobody ever comes over?
• How come my neighbor’s kids don't get into trouble for driving too fast?
Teenagers struggling with mental illness face the same issues as any other teenager (emerging sexuality, academic pressures, hormone overload, parent conflict and a society obsessed with youth, beauty high speed technology and 24 hour connectivity). Illness notwithstanding, parents will need to continue to provide guidance; structure, limits, consistency and foundation as teens will continue to push, cajole, irritate, challenge and demand their independence throughout their adolescent years. Additionally, teenagers with illness are often handling difficult situations with an out of control central nervous systems, mood swings or depression, poor coping skills, social alienation, and possibly limited cognitive skills and concrete thinking. They may have more severe issues such as paranoia, suicidal thoughts, violent tendencies or thought disturbances further complicating their ability to function within the already challenging world of teenagers. They may be on medications that result in side effects such as daytime somnolence (sleepiness), insomnia or agitation. All of these issues affect a child’s awareness of environmental influences and their responses to those forces. The result is a child who may or may not respond to standard parenting techniques in reliable and predictable ways. Parents often become frustrated with friends, family, professionals and the thousands of pages of literature available offering advice and guidance of a somewhat generic variety. It doesn’t work. They’ve tried it. What they need is a specific reference. One that addresses parenting a child who is both a teenager AND a child with an illness. That is what I have attempted to provide here.
Part II, Special Topics: Parenting the Mentally Ill Teen in the Context of More Severe Issues
In the second section I continue to explore issues that tend to be of grave concern to the parents of mentally ill teenagers. Although less common than those in Part I, these tend to be more severe and generally require a higher degree of vigilance in detecting as well as a more rapid intervention once detected. Part II consists of three chapters: Suicidally and Self Injurious Behavior, Defiance, Aggression and Violence and Other Problems. Chapter 9 Suicidality and Self-Injury is focused on aggression toward self and and Chapter 10 Defiance, Aggression and Violence is focused on aggression toward others. I chose to give a significant amount of attention to both of these topics because of their direct affect on the child and family and also because of the particular parenting skills required in handling an adolescent with these behaviors. Chapter 11 considers several other issues often faced including antisocial behavior, truancy, general defiance of authority and treatment noncompliance.
Part III, Moving Forward: Evaluation, Treatment and What You Need to Know
This section is dedicated entirely to providing additional reference information to parents. Sections on the psychiatric evaluation, psychiatric medication information, educational and psychological testing are provided. My focus in Part III was not to provide an exhaustive index of all things psychiatric, but rather to supply basic information regarding subjects I am asked about most often in an easy to access format. The section on Psychiatric Evaluation can be used to direct parents in choosing to have a psychiatric evaluation or in better understanding the process of evaluation once one is under way. Sections on lab tests, medications and various psychoeducational and educational testing products are provided to assist parents who are trying to understand more about evaluations or treatments possibly being suggested for their own teenagers.
This text will be published in sections over the next several months on this blog in the hopes that it will provide ongoing support and information for families in need.
No comments:
Post a Comment