Dr. Douglas Riley's Parenting Toolbox
"Parents in Control of Children = Children in Control of Themselves"
1. How do I know when to take my child to see a psychologist?
All kids have problems from time to time, but if your child's problem seems to be getting in the way of an enjoyable life, either for your family in general or for your child, it is time to seek the help of a psychologist. If you feel like you are always walking on eggshells because of your child's anger or anxiety or depression, if you feel that there is too much yelling and arguing in your home, if your child seems to be struggling in school either academically or socially, if you and your spouse are at odds about how to raise your child, it is time to seek the help of a professional. It is always amazing to me how the very act of a parent bringing a child to see a therapist can make a difference. It acts as a real wake-up call for the child and he or she finally sees that there is an issue that must be dealt with. Many children, even the resistant ones, actually feel a sense of relief. It is a parent's job to provide structure, and when things are out of control, structure can often be achieved by seeking professional help.
2. My child/teenager refuses to see a psychologist. What do I do?
This is an easy one. You are the parent and he/she is the child. These roles are not negotiable, and your role as head of the family is not up for grabs. If after a period of time of trying to reason with your child, he or she is still rejecting reason and logic, or refusing to get in the car with you and go, there must be no more bargaining. The real problem in these situations is that the child has come to believe that he or she has equal decision-making power in your family, and can therefore resist you without any consequences. While there are many children and teenagers who actually ask to see me, there are just as many who assume this equality and come to the office kicking and screaming. Remember, it is your home, and you own everything in it. Your child's access to the good things in life is dependent upon him, or her, realizing who they are within the family power structure. If your child is destroying the harmony, for any reason, seek the help of a professional. Make the appointment, and then place firm restrictions on the child for making you miserable regarding the appointment.
First of all, calmly advise your child that he or she is not your equal in the family structure. This does not indicate that you will not treat him, or her, with dignity. It does mean that you do not have to explain yourself, and that it is perfectly OK if they do not like what you tell them they have to do. With this in mind, take the stance that until you are spoken to appropriately, there will be no access to the good things in life. Also indicate that once this changes, life will rapidly return to normal.
4. How do I know which psychologist to choose, and will my insurance cover services?
Ask your child's pediatrician for the names of some child psychologists in your area. I stress that you try to find someone who sees only children and teenagers because obviously, this indicates a real interest and expertise on the part of the therapist. Many psychologists will tell you that they work with children, when in fact they see a broad range of patients. My viewpoint is that it is better to see someone who deals with children all day long, because they are more likely to be attuned to what is really going on with your child. It is also helpful to call your school counselor and ask for names of child psychologists.
Most insurance policies cover mental health services. If you have a managed care policy, you must choose from a list of providers who work with that insurance company. If you are allowed to go "out of network" you may choose your own psychologist. In any event, there is usually a copay, and sometimes a deductible must be met. Many policies require "preauthorization." This means that you or the provider's office must call the insurance company to, in essence, register for the visits. Often, the insurance company will authorize a certain number of visits, and if any more are needed, the doctor's office must request them. It is a good idea to call the customer services phone number on your insurance card to find out exactly what your mental health benefits are.
Resist accepting simple answers to such an important question, such as all explosive children are just brats, or have not been properly disciplined, or simply need to be bargained with. I see many explosive children at my office who have siblings who are highly successful at home and school, which tells me that the parents have probably done the right thing. It is of vast importance to look beneath the symptoms – the explosions – to find the underlying cause. Consider reading my latest book, What Your Explosive Child Is Trying To Tell You, the first book to connect explosive behavior to its underlying, hidden causes. I offer consultations at my office, or by telephone, on this issue.
6. My child is having trouble in school. Can a psychologist help?
If the problem is academic in nature, a psychologist can help diagnose the problem and can help coordinate an effort between parents, child, and school. Testing is generally done to help with the diagnosis. I see many children who are having attention problems in school which prevent them from succeeding. I give a series of tests (about two hours in length) which help diagnose whether a child has ADD or ADHD. Testing to uncover other kinds of learning disorders is referred to as "educational testing." This is a very extensive battery of tests to determine why a child may be struggling in school and is something I wish every child could have. A well designed battery of tests uncovers a child's strengths and weaknesses which, in an ideal situation, could help determine how that child should be taught. It is also, obviously, a good indicator of what the child naturally excels at and can quite possibly provide a glimpse into the kinds of occupations a child might be channeled toward. Educational testing is expensive (about $800-$1,000) if it is done on an outpatient, private basis. In many cases the testing will be done by the school for free if the child is struggling. To get your school to consider testing your child, you must request a meeting to see if your child qualifies for testing. Some school systems will not test your child unless he or she is working at a level that is two years below children the same age. Others will agree to test more willingly. In some frustrating situations, a child may be doing relatively well in school grade-wise, but may be struggling mightily to do so, yet the school won't do the testing to find out why the child struggles. In these cases, parents sometimes elect to have a psychologist do the testing.
This is a tough issue. First of all, you have to determine why your child is getting targeted. If it seems to be a one time event, as painful as it is, it happens to most of us at one point or another. If he is being constantly bullied by others, there are a number of things to examine. If your child is unusually small, looks different, or acts different than his or her peers, dresses in an odd manner, or is markedly shy, they may be seen as a "safe target." As strange as it may seem, unusually large children may also be seen as a target for other kids who are out to prove how tough they are. In either regard, you do not want your child to be viewed as a safe target. While you should certainly demand that your school maintain a safe atmosphere for your child, and deal decisively with bullies, it is equally important that you help your child make the necessary changes. Martial arts training will instill a sense of self-confidence and strength in a child, and in all of my years of working with children I have never personally seen it turn a child into a bully. Deep involvement in group-based activities also gives a child a sense of competency and acceptance, whether these group-based activities are athletic or not. It is exceedingly important to not let your child be "brittle," the type of child who cannot participate in the typical roughhousing that children do. There is a certain amount of bumping, banging, pushing, and shoving that comes with being a kid, particularly with boys. This is one of the prime reasons boys need a hands-on, deeply engaged dad or male figure in their lives. If you see that your child is becoming depressed due to the bullying, consider purchasing a copy of The Depressed Child.
8. Why is my son still wetting the bed, or still wetting or soiling his pants?
Bed wetting and wetting/soiling clothes are two separate issues for children who do not have developmental issues. Bed wetting is completely involuntary. It may be caused by a number of issues, including psychological stress and worry. However, other prominent causes have little to do with stress, such as development and maturity, deep sleep, bladder tone, and level of fluid intake in the evening, particularly products containing caffeine. The website webmd.com is an excellent source of information on the various medical, behavioral, and motivational topics related to bed wetting.
Children who do not wet the bed, but who have bladder and bowel accidents during the day are frequently so involved in play, or other activities, that they simply put off going to the bathroom until it is too late. It is important to ask them if their bodies were trying to tell them to go, and they waited too late, as opposed to their bodies giving them no signal what-so-ever and all of a sudden they simply soiled their clothes. Children with the latter issue should be examined by their pediatrician, as some medications can interfere with the body producing bladder and bowel signals or alerts for the child to "go." In the case of the busy child who just waits too long, you can try a series of strategies that go from gentle to intense. The most gentle is to have your child be responsible for his soiled clothes and for cleaning himself before he goes back out to play. You can add praise or stickers or other prizes to reinforce his success. You can also put him on a "potty schedule," in which he has to try to go every two to three hours. If this does not work, you can clean your child following his accidents, using a cold wash cloth in order to reduce any of the reinforcement value of being cleaned up by others. Remember, however, prior to moving to any intense strategy, it is extremely important to make sure that there are no medical or psychological causes behind your child's difficulty staying dry, and to make sure that your child's soiling problem is not being caused by medications that he or she is taking.
9. Tell me about psychological tests and how they can be useful to my child.
There are tests that help assess depression, anxiety, general outlook, personality, intellectual strengths and weaknesses, ability to concentrate, memory functions, and so on. Since it is sometimes difficult to get a child to open up about his or her real concerns, testing can be a real time-saver and can provide a platform for the psychologist to work from. Psychologists are trained in using a wide variety of tests. Once your psychologist understands the concerns that you have for your child, he or she may recommend to you that testing will be helpful to plan treatment, or to rule out various concerns, or to assess progress.
10. Does my child need medication for behavioral problems?
Medication may be useful for a variety of issues. Most psychologists have not been trained in pharmacology, and are not licensed to write prescriptions for medication. Their training is in behavior modification, cognitive therapy, testing or a variety of other approaches. Your psychologist may have an interest in medication, and may be knowledgeable about it in a general way from having worked with individuals and their physicians regarding depression, anxiety, bipolar disorder, and ADD/ADHD. However, medication questions are best reserved for your pediatrician or physician or a child psychiatrist.
11. My spouse does not want to bring our child to see a psychologist, but I do. What can I do about this?
The last thing you should do is argue over the issue in front of the child. Do not let your child or teenager see that his or her actions are managing to split the parents over how to handle the situation. Children always need to see a united front from the parents. Talk about the issue of taking your child to see a professional in private. If no compromise is possible, this may in itself indicate that marital counseling may be useful for the parents.
12. My child hates school and sometimes has panic attacks over it. What should I do?
The thing you should not do is allow the child to avoid school. Though it will be painful to force your child to go to school when he or she is crying, complaining of stomachaches, headaches, the inability to breathe, etc., your child must be lovingly and firmly forced to attend school. It is at this time that you should also seek the help of a professional who can uncover the anxiety that is leading to the behavior.
13. Why do I feel like I'm always walking on eggshells with my son or daughter?
There could be a number of possibilities. You may be going through the snarly behavior with your children that I refer to as "painfully normal." They may be pushing the limits in all directions in order to find their own strength as people, and parents (mothers in particular since kids typically feel so safe with them) are the logical first targets. There are other reasons for children to be cranky and explosive, however, and this is where your reading and the help of a child psychologist can be invaluable. Depressed children can be cranky. Anxious children do not like anything unexpected to happen, and try to exert high levels of control over everyone. They blow up when things don't go their way, and make everyone around them feel tense. Children with the early signs of bipolar disorder can be easily set off. You can see why it is important to educate yourself about oppositional defiant disorder, child depression, anxiety, and explosive disorders, and to seek appropriate help.
14. Is it normal for siblings to argue all the time? My children are driving me crazy with all of the bickering.
If your children are driving you crazy, you must put a stop to the behavior by putting a stop to their access to the things that they value, like toys and electronics games, telephones, computers, snacks, favored clothing items, money, transportation, and privileges. It is normal for there to be some arguing, but parents should expect to have a peaceful existence in their own homes. The problem comes when parents allow the behavior to go on for too long, and it becomes ingrained. Do not allow your children to disrupt the peace and harmony of your home. Implement some of the strategies discussed in The Defiant Child.
15. Why is my teenager always so depressed and angry?
The teen years are a time of intense questioning about one's own worth. Not every kid has a strong self-concept, even ones who are doing well in all aspects of their lives. There are other reasons to consider: drugs, over involvement with a boyfriend or girlfriend, academic stress or fears of failure, rejection by peers, or depressed mood.
16. What should I do if I think my child is using drugs or alcohol?
I have seen drug and alcohol use bring good kids down so fast it is breathtaking. There is no good reason to tolerate drug and alcohol use. It shreds motivation and creativity, stifles learning, and leads kids to believe that their peers who are involved in their studies and in sports are "lame" or "uncool." If you suspect your child is using drugs and/or alcohol, give your child one of the tests out on the market that can be found at drug stores. Most of them are pretty reliable. Do not tell your child beforehand that you are going to test him or her. Just do it. If your child throws a fit because you are "invading their privacy," hang tough. It is your right and duty as a parent to ensure your child's safety and wellbeing. If the test turns out positive, take your child to a professional who specializes in drug and alcohol use. I am also a big believer in parents banding together to protect their children. I tell parents who know their child is using drugs or alcohol to call the parents of the child's friends and inform them so that all parents can be on the lookout.
I am currently treating a young man who was responsible for an automobile accident that killed his best friend. Alcohol was involved. The incident has forever damaged the lives of many, and he will have the burden of these memories for the rest of his life. It is a nightmare you do not want to invite into your life. Do not be one of those do-nothing parents who closes his or her eyes and looks the other way saying, "Oh, all the kids do it sometimes."
Attention deficit hyperactivity disorder is a real thing. Some children are primarily inattentive in the classroom, some are primarily hyperactive, and some are both. Boys seem vastly more likely to have it than girls, although a second way of looking at it is to point out that most girls who have it have the quiet, inattentive version and are not bouncing off the walls like their male counterparts.
It is my strong belief that a number of things must be ruled out before an ADHD diagnosis should be made, and this is where testing can be helpful. First, anxiety can look like ADHD. Many children are so full of anxiety that they cannot stay focused in school. Second, allergies to foods and other substances can look like ADHD and must be ruled out. Does your child have frequent stomachaches, headaches, sniffles and runny eyes, ear infections, sleep problems? Does your child seem to crave certain foods like caffeine, peanut butter, milk, sugar, and drinks with red dye? Do yourself a favor and check out a book on food allergies and do some experimenting on your own.
Medication should only be used after all other possibilities have been exhausted, and is typically proscribed by your pediatrician, family physician, psychiatrist or neurologist. Common stimulant medications used to treat ADHD are Concerta, Adderall, Ritalin, and Metadate. Strattera is a non-stimulant. I have seen some remarkable results come from medication whereby a child can go from getting in trouble constantly in school and home to being very successful in school and home. Keep in mind that many ADHD kids have no friends because no one wants to be around them because of their impulsivity and tendency to get into trouble in the classroom. In some cases, medication can give them back their lives. I will also add that you should see a marked difference if your child is on the right medication and dosage. I see little reason to use medication if the change in your child is only marginal. You may wish to seek alternative treatments, such a behavior modification, or biofeedback-based treatments.
It is also important to note that some kids seem to grow out of their ADHD characteristics as they mature – some people believe as many as 40 percent. Others learn to make themselves focus and compensate for their natural distractibility and mind that is attempting to go in seven directions at once. I also often wonder if it is really allergies that they are growing out of, but I am not a nutritional expert on this. In any event, if your child is on medication, I think it is prudent, from time to time, to take your child off the medication to see if there is a noticeable difference.
18. Should I let the school and teachers know that my child has ADHD?
There are multiple opinions on this. Many parents are afraid that their children will get pigeon-holed by their school if they get identified with any issue that can influence their learning, and expectations for them will be lowered. Most teachers, however, have enough college-level and in-service training about issues related to learning that they realize there is no correlation between IQ and ability, and ADHD. The advantages of alerting your school are that you can ask for a 504 plan, which will mandate that your child be allowed to sit in the front of the classroom, and away from disruptive peers. Some children with ADHD benefit from taking tests in a quiet area, or with expanded time limits. In general, the benefits of alerting your school outweigh the dangers.
19. My child has been put on a lot of medications by a psychiatrist, but my child is still having problems. What should I do?
I am a child psychologist and as such, I believe that it is important to try to deal with a child's issues first using counseling, behavior modification, cognitive therapy, and reward systems. Children are, thankfully, moldable, and this is precisely the time to deal with problems before it is too late. When all of the psychological techniques have been exhausted, then medication can prove to be a helpful option.
However, I have seen far too many young children on multiple medications who end up worse than they were to begin with because of the side-effects of the medications. Keep in mind that most psychological diagnoses like bi-polar disorder, major depression, and obsessive-compulsive disorder should not be diagnosed in children without absolutely ruling out other causes for their behavior, and if medication is to be used it makes sense to work with a physician who is exceptionally careful and not too eager to try out the latest theory of combining medications on your child. Make sure to do your research on the medications before you agree to let your child use them, and keep in mind that each child will respond differently.
If you allow your child to act as if he or she is your coequal, bargain with them, let them pull you into arguments, and feel like you have to explain yourself to them, the answer to this is "Yes!" They are a product of their environment, and you have much work in front of you to turn them around.
If you have not made the mistakes noted above, chances are there are other things driving your child's bad behavior, from mood to stress to allergies to deeper personality characteristics. While there will still be much work to do, you have every reason to remain optimistic.
21. My child throws explosive horrible tantrums and is about to be kicked out of school or daycare. What do I do?
The mothers who call my office who seem to be the most distraught are the ones who are dealing with the tantrum throwers. These tantrums can be severe with hitting, kicking, biting, and such a horrible array of symptoms that it almost appears that the child is, in the words of many parents, "possessed." The reason it is so frustrating is because the child is so out of control that the parent is frightened. Also, these children can make a parent lose control themselves in an effort to stop the tantrum, and this only fuels the fire. Many mothers end up having to quit their jobs because their children are getting kicked out of daycare situations and are time after time being suspended from school because of these severe tantrum episodes. Many parents and teachers mistakenly consider these kids "brats" who are simply throwing fits because they do not get their way. It is crucial that the parent learn the underlying reason for the tantrum, for nine times out of ten there is a real reason.