Saturday, October 26, 2013

14 yr old breaks things, smacks mother

My husband and I have 3 daughters and we are raising 3 of my brothers children.  We are a poor but proud family that is in dire need of some serious help.  Our middle daughter, who will be turning 14 in November, has been seeing a developmental pediatrician at a local hospital. He has told us that our daughter suffers from ADD/ADHD combo, social and educational anxiety and oppositional defiance disorder.  I've tried all but 1 of the methods that he has offered and they are not helping.  Unfortunately we can't find a cognitive therapist that will accept her medical card and I honestly am at my wits end!!!  

We can't handle her any more and it is causing a lot of problems in our home.  One minute she is the sweetest most helpful person and in the blink of an eye, she's throwing things, breaking things, yelling and screaming.  My husband tries to get control of her but all it does is cause fights and things end up broken and holes in the walls. Just tonight she broke a fairy figurine that my aunt gave me and she upset her dresser, put a huge hole in her wall and she smacked me so hard on my bare chest and neck that it left a welt.  

The other kids are on edge and scared when she starts to act out and I'm ready to have a nervous breakdown. Our daughter is at her wit's end too.  She just left a few minutes ago to go to my mom's house for a few days.  My mom just texted and told me that our daughter was very upset and said that she feels like she really needs help and that she has prayed to God and asked him to help her.  She's like a yo-yo!  When she's with my mom, she says she feels she needs help, but when she is home with us, she thinks she's fine and refuses any help.  

I have thought several times about having her admitted to a major psychiatric hospital.  She has been to the ER at our local hospital and admitted at the local psychiatric unit a few times.  I don't know if putting her in a psychiatric unit would help resolve the issues or not.  I guess what I'm hoping for, is that you might know of something we might be able to do, or somewhere we might be able to take her, to help our daughter take control of her anger and help us all to be a family again.

Wow, you have been though a lot at home and have tried getting her professional help.  Yes, ongoing outpatient therapy with someone trained in dealing with anger issues is a good idea.  The psychiatric hospital you mention might help too, especially if she continues to be out of control and physically endangering family members.  One question I have is about the diagnosis.  The way you describe the intense and rapid changes in mood make me wonder if pediatric bipolar disorder has been ruled out.  There are medications especially helpful for bipolar disorder if she were to have that condition.  Maybe ask your pediatrician, or check with a psychiatrist who sees teenagers to help decide about the diagnosis.  

The fact that your daughter said recently she wants help (at least when she was with your mom) is a good sign.  You would want to talk with her at times when she is reflective and wants help, and talk about strategies she could develop to recognize and head off her angry outbursts.  The second half of my parent's manual outlines strategies you can teach your daughter.  These are cognitive behavioral strategies, which is what your doctor recommended.  The first step is to develop your child's observation skills.  I explain in the manual how to help your daughter identify when her anger is rising, and to identify some of her triggers.  Then she would try different calming strategies.  It is hard work to identify triggers and to intervene early enough to head off an outburst.  But if your daughter is motivated, it would be a good time to try some of these strategies. 

See if she will let you work together.  Explain you would be the assistant coach, who might notice triggers and help her develop calming strategies, but that she would be the head coach and could decide whether she agrees or not.  The more you can get her thinking about the triggers and alternative strategies, the more likely she will be able to slow down her impulsive outbursts.  It will not always work out because anger is a powerful emotion, and when in full force, it is hard to get the rational part of our brain to act.  But at early stages, when a trigger is just beginning, it is easier to head off anger.  So one key is early identification of situations that cause frustration or disappointment for your daughter.

If one cause of the outbursts is arguments with you or her father, then you would work on teaching your daughter about different points of view and ways to compromise.  There are sections in my manual about how to help children recognize that there are different ways of looking at things.  Often new information about other people's motives help children to see others (you and your husband) as benign and as trying to help them.  Many teens think their parents are just trying to manipulate or control them, and that perception makes their anger worse. You want your daughter to see that there are different ways of looking at things, and that you are not trying to manipulate her.  For example, parents' rules about curfew are intended to help children to stay safe and to get to sleep at a reasonable hour.  Many teens think parents are trying to prevent them from having fun with their friends.  Once teens understand there are different ways of looking at curfew, there is a chance they will react less angrily and learn to compromise.

Lastly, if your daughter can calm down at your mother's house, this might be a good place to start with a family discussion about the strategies I outline in the manual.  Your mother could be in on the discussion if your daughter is less likely to explode in her presence.  Sometimes having a neutral party present helps teens to think about things rather than react emotionally.  All the best, Dr. Dave Gottlieb 

1 comment:

  1. I wanted to add a comment about how to handle a teen who hits a parent or breaks things of value. For younger children, you can bear hug them to try to prevent physical harm, but teens are usually too big to hold when they are angry. I would recommend talking with the teenager when everyone is calm and explain that hitting and pushing are extremely dangerous because someone could fall and smack their head for example. You could add that you understand your teen gets real angry sometimes and that it is not easy to exercise control at those times, but you feel your son or daughter can stop from harming people. Mention that there are verbal alternatives including screaming.. While not ideal, shouting and even saying bad words do not cause physical harm. (Once the hitting is under control, you can work together on controlling swear words, or whatever is especially inappropriate language.) You want to draw a line for now at physical harm. Explain that there will be serious consequences in the future whenever your teen acts in a physical way to hurt someone. If and when your teen becomes physical, do not talk about the consequence then, because he or she is overheated and will likely escalate if you mention a punishment at that time. But later when everyone is calm, explain briefly what the punishment will be (something your teen will miss for a few days, or for whatever time period you feel will make an impression, but not for so long that the teen has no motivation to try to exercise self control in the coming days). Over the next few weeks, see if there is a decrease in physical acting out. If not, you may need to change the consequence to try to grab your teen's attention. You want you teen to think before he strikes out that this is not worth it!