Understanding the Troubled Child or Teen: How Parents Cope

When adults decide to have a child, they do so with the expectation that the experience will be a positive one. Otherwise, who would choose to make such a decision that has repercussions that last for decades? For many parents, the parenting experience ultimately becomes what they had expected. Of course, everyone expects challenges and difficult stages, but countless parents find that the overall experience is one that is positive, beneficial, and loving. Unfortunately, other parents have parenting experiences that are far different.

As a psychologist who has worked in community mental health for almost two decades, I can share that some parents find themselves parenting children with extremely challenging emotional issues. More specifically, my work with a mental health threat assessment team that treated kids, teenagers, and young adults at risk for violence and other problems introduced me to many families who had the experience of managing a youth who presented a constellation of symptoms and behaviors that resulted in major family discord, school suspensions and expulsions, and even law enforcement involvement.

Possible diagnoses for children who do not follow the rules

Diagnostically, boys and girls who have such emotional problems have various diagnoses as outlined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, commonly referred to as the DSM (American Psychiatric Association, 2013). The children who have some of the most challenging oppositional personalities and behaviors receive a diagnosis of Oppositional/Defiant Disorder. This diagnosis includes some or all of the following criteria:

• Angry/Irritable Mood. Often loses temper; is often touchy or easily annoyed; is often angry and resentful;
• Argumentative/Defiant Behavior. Often argues with authority figures or, for children and adolescents, with adults; often actively defies or refuses to comply with requests from authority figures or with rules; often deliberately annoys others; often blames others for his or her mistakes or misbehavior;
• Vindictiveness. Has been spiteful or vindictive at least twice within the past 6 months.

The diagnosis of Oppositional/Defiant Disorder, however, does not capture the extent of all children or teenagers who present this type of pathology. In fact, some children who are oppositional and defiant but also present more severe behaviors may meet the criteria for Conduct Disorder which includes criteria outlined below:

• Aggression to people and animals. Often bullies, threatens, or intimidates others; often initiates physical fights; has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun); has been physically cruel to people.; has been physically cruel to animals; has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery); has forced someone into sexual activity;
• Destruction of Property. Has deliberately engaged in fire setting with the intention of causing serious damage; has deliberately destroyed others’ property (other than by fire setting);
• Deceitfulness or Theft. Has broken into someone else’s house, building, or car; often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others); has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery);
• Serious Violations of Rules. Often stays out at night despite parental prohibitions, beginning before age 13 years; has run away from home overnight at least twice while living in the parental or parental surrogate home, or once without returning for a lengthy period; is often truant from school, beginning before age 13 years.

It is important to note that Conduct Disorder can be diagnosed in children under the age of 10 (Childhood-onset type) and over the age of 10 (Adolescent-onset type).

A possible diagnosis of Antisocial Personality Disorder once the child turns 18

Oppositional/Defiant Disorder and Conduct Disorder are disorders that are diagnosed when the individual has not yet reached the age of 18, the societally accepted benchmark of official adulthood. Once the individual reaches the age of 18, provided that they still present similar behaviors, they may be diagnosed with what is called Antisocial Personality Disorder. This disorder falls under the category of personality disorders, which means that the pathology the young man or woman presents underlies the entire way they approach the world.

The diagnosis of Antisocial Personality Disorder includes the following criteria:

• A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years, as indicated by three (or more) of the following:
• Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest;
• Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure;
• Impulsivity or failure to plan ahead;
• Irritability and aggressiveness, as indicated by repeated physical fights or assaults;
• Reckless disregard for the safety of self or others;
• Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations;
• Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.

Each of these disorders is serious and concerning in its own right and has drastic implications for the degree of life success of the individual who presents the pathology. In addition, each diagnosis can have a tumultuous, if not catastrophic, impact on family members and overall home life.

The emotional and physical impact of these diagnoses on home life

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At home, parents of these children deal with challenges most parents could not fathom. In a word, living with a child who has these emotional issues can make life at home astonishingly challenging. Daily life can feel relentlessly frustrating, chaotic, and draining.

A child who is clinically diagnosed by a licensed mental health professional as oppositional, Conduct-Disordered, or even antisocial is simply not like the vast majority of other children. While it is normal for children or teenagers to display certain oppositional traits as they move through the developmental stages to the point of adulthood, the type of children who have the forgoing diagnoses present differently. At home, this child at, say, age 6, 10, 12, refuses almost all parental demands. They refuse to take a bath; they refuse to do homework; and they refuse to do chores. Most disarming to the parents of these children is the overall attitude they show their parents. These children talk to their parents in a way that would shock most parents. They are abrasive, controlling, and can be vindictive in a way you may never have seen before in another human being. These individuals have a personality orientation and defensive posture that means they can (almost) never see that they did anything wrong or take responsibility for their own behavior. With these children, there is rarely a sense of gratitude or appreciation. They need control and a sense of power above all else, and hate having to be indebted to parents or siblings for anything. With these children, their sense of entitlement is off-the-charts, with the child talking to the parents as if the child is the provider and the parent is the lucky recipient and ought to feel grateful for the chance to serve them.

Are these children angry? Where does the entitlement come from?

To some extent, perhaps a bit of the problematic behavior can be attributed to a parenting approach that has become either avoidant or enabling. Any objective adult who witnesses some of the shocking behavior this type of child engages in would, from a common-sense perspective, shriek in horror. Witnesses might understandably wonder, How could you let your child talk like that? Accordingly, they may subscribe to social conventions which include a reaction like the following: If my child did that, I would [insert any number of consequences]. The reality, however, for parents with this type of child is that they are trying to manage something that feels impossible. As a psychologist myself, I know that there are no perfect interventions to manage a child who simply doesn’t value mutual kindness, treating others with respect, and the most important social convention of all: following rules.

Children or teenagers who are highly oppositional, Conduct-Disordered, or antisocial don’t care about following any type of rule, whether at home, school, a friend’s house, or anywhere else. What I have found with such children is that they, at root, have a personality and general outlook on life where they live only in the present moment and don’t think about the future. It's not that they don't envision a happy life as an adult; it's that thinking about the future in a tangible, what-it-will-look-like-specifically way is not something they think about. They live mostly in the present moment as opposed to thinking about how what they do in the present moment could translate to the future. Children who don't follow the rules often have a self-destructive orientation, and they may be destructive with others and with objects, facilities, anything as well.

For parents dealing with children who present this type of pathology, they should not focus on trying to figure out where this personality orientation comes from. The focus should be two-fold: doing what you can to link the child to the best mental health treatment and supervision possible, and protecting your own and your family’s mental health and overall home life as well as possible.

Mental health treatment for the child

If you have a child who does not follow the most basic rules at home, at school, or in other social environments, I will underscore what you probably already know: weekly therapy and/or case management is necessary. Mental health treatment for youth is tailored based on the intensity of services needed. Children who present the type of problem behaviors discussed in this article need an intensive level of mental health treatment. Various regions refer to the levels of treatment differently, but the point is that the child should be receiving one session per week with a therapist at an absolute minimum. In addition, school staff must be intimately involved. Because these children often get in more trouble as they get older, teachers, guidance counselors, and principals are often involved because school staff as whole understandably acknowledge that this kind of behavior cannot take place without consequences in a school setting.

Obtaining cognitive and emotional testing

Most, if not all, children who present these troubling behaviors should have what is called an Individualized Educational Plan (IEP). If you are concerned that your child is not following the most basic rules that will be required to function as a teenager, young adult, and adult, you should speak to school staff and ask that your child be tested for what is often referred to as Emotional Disturbance. If your child is tested and it is determined that the child meets this eligibility, such eligibility is crucial because it means that the school district may be able to pay for a much more intensive level of mental health care. Specifically, school districts often will pay for residential mental health treatment, ranging from weeks to months, depending on the need.

The emotional needs of other children in the home

The parent’s ultimate responsibility is to protect their children. For the child who has been diagnosed with these issues, seeking an intensive level of treatment – even if that means residential care – may feel heartbreaking and is certainly guilt-inducing. Yet for some children, it is precisely these measures which show that you are being a good parent by setting your child up with the highest level of supervision possible. For any other siblings remaining at home, setting the child up with intensive or residential services is necessary to protect the mental health of those still at home. Parents with such children cannot forget the following expression: The squeaky wheel always gets the grease. Make sure to talk with the siblings about what effect the other child’s behavior has had on them.

The emotional needs of the parents

If you are a parent who has parented a child with this set of unique emotional issues, I know that you have suffered. I have barrels of empathy for you because your parenting experience has been harder than most. There are, without question, parents of children with other significant issues that can relate more than you may know. For example, parents of children with severe or terminal medical illnesses face their own intense challenges. Parents who have children who experience early-onset psychosis or who lie at the extreme end of Autism Spectrum Disorder deal with challenges every day that test the adults’ mental and physical limits. Most importantly, you must remember as a parent that you are not alone, and you can keep going. I want to emphasize, however, that the goal is not simply for you to survive. You deserve to have as good a life as possible, even with your parenting challenges. To do so, you need your own set of services and life supplements.

What parents need for themselves

One outlet that parents in such circumstances have found helpful in the past is something that you can add to your weekly life in the future. Joining an organization like the National Alliance for the Mentally Ill can help. This is an organization that offers support groups to individuals who have a mentally ill family member. Put in perspective, going to your child’s school’s holiday party and having another parent tell you “Enjoy every minute of parenting” won’t help. But talking to other parents who have children who have other emotional challenges can remind you that there is a community of parents out in the world who, like you, have had to learn how to navigate parenting and a home life that is different. In addition to support groups, talking to a therapist of your own – even if just for a few sessions here and there – can make all the difference in the world. Finally, remember the necessity of self-care. Self-care includes a limitless range of activities that focus on relaxing and comforting your mind and body. Whether it is a vacation, a warm bath, ten minutes in the morning of quiet, going to bed early, or another activity that soothes you…do it. You don’t just deserve it; you need it so that you can do more than simply survive your life.