The Secret Next Door (Child on Parent Violence)

Annie watched in horror as Charlie, red-faced with rage, snatched a picture frame off a wall and slammed it against the bedpost. The glass shattered. He picked up a long shard and brandished it like a dagger. Stalking towards Annie, he growled, “I’m gonna kill you.”

This type of abusive behavior in relationships is far too common. 29% of women and 10% of men in the US will experience domestic violence in their lifetimes. Child protective services investigates more than three million reports of abuse and neglect annually. However, Charlie and Annie’s altercation isn’t included in either of these statistics.

That’s because Charlie is a 13-year-old boy. And Annie is his mother.

What the parents living next door may be hiding

Like Annie, I’m the mother of a son who acts out. Both our boys are products of the foster care system, adopted as toddlers, and who are diagnosed with Reactive Attachment Disorder (RAD) and Conduct Disorder (CD), serious behavioral disorders. They have both received medication and thousands of hours of treatment, but nothing has helped.

When Annie and I tell friends, family, and mental health professionals about our sons’ behaviors, we are met with disdain and disbelief. In the same way many sex abuse victims are treated, parents like us are blamed and shamed into silence. We have been forced underground, into private Facebook groups where we find non-judgemental support from thousands of other parents in similar situations.

Four years ago, Lillyth Quillan founded the online parent support group, Parents of Children with Conduct Disorder. She says, “More than 1,000 families have come together to share their stories; to know they are not alone. They are emotionally raw and shredded to the marrow at how they’ve been treated and not believed by close friends and family.”

How many families this affects

The general public assumes these situations, where children are violent towards their parents, are isolated to a handful of sensationalized episodes of Dr. Phil.

This is simply not the case.

While the anecdotal evidence of children with serious disorders abusing their parents is abundant, quantitative data is desperately lacking. This is why I recently surveyed more than 200 parents of children diagnosed with, among other behavioral disorders, RAD and CD. This type of informal survey is an invaluable way to begin to understand the scope of the problem.

According to my survey, Are You In An Abusive Relationship? more than 90% of the respondents are in chronically abusive relationships – and the abuser is their child.

  • 93% say their child threatens them, other family members, or pets with physical violence.
  • 65% say their child grabs, hits, kicks, or otherwise physically assaults them.
  • 71% say their child hides their behavior from others and blames them for their outbursts.

These aren’t merely numbers; each one is a tragic story. Here are just a few of the examples shared anonymously by survey respondents:

“My son purposely hurts the cat to get my attention.”
“My daughter attacked me with a steak knife.”
“My son choked me and broke my wrist.”

Anonymous parents

These findings show that it is alarmingly common for children with serious behavioral disorders to abuse their parents.

When children abuse their parents

Intentional Child to Parent Violence (I-CPV) is deliberate, harmful behavior by a child to cause a parent physical or psychological distress. These are purposeful behaviors intended to gain control over, and instill fear in, parents. I-CPV takes many different forms and varies in severity. It is often chronic and usually directed at the child’s mother figure. [1]

One surveyed mom has a moon-shaped scar on her forehead from her 14-year-old daughter grabbing her by her hair and slamming her face onto the stove. Another mom says her son tried to push her down the stairs and makes homicidal threats towards her.

Parents like these sustain physical injuries and may develop mental health disorders including PTSD. They are isolated from friends and family. Their marriages can become irreparably damaged. They frequently lose jobs and friends. Other children in the home suffer secondary, if not primary trauma.

Without highly specialized treatment, the child perpetrating the abuse will not get better. Far too often, it becomes necessary to have them institutionalized, or end up incarcerated, for the safety of their siblings, parents, and themselves.

Hypervigilance – and fear – are common for parents in these situations. One mom describes how, “Before my son was taken to the hospital, then jail, and then a treatment center, I had to sleep with my door locked and a chair jammed under the knob because he knows how to pick locks.” She suffers with PTSD after years of chronic abuse.

Why children abuse their parents

While there is no one clear “cause” leading to antisocial behaviors like I-CPV, there are a number of underlying factors to consider. Perhaps the most significant is “developmental trauma,” a term coined by leading expert, Dr. Bessel van der Kolk, MD. When a child is chronically neglected or abused at a young age, their brain development may be impacted, causing long-term issues sometimes including physical aggression. This is called Developmental Trauma Disorder (DTD) and is commonly diagnosed as CD or RAD.

While developmental trauma can explain much of RAD, not all children who are violent towards their parents have a trauma background. Some children from nurturing families are diagnosed with CD. Psychologist Stanton E. Samenow, PhD specializes in working with juvenile offenders and says early identification of emerging antisocial behaviors is key. He points to a study that found “aggression at age 8 is the best predictor of aggression at age 19, irrespective of IQ, social class or parents’ aggressiveness.” [2] He believes, regardless of environment and parenting, children become antisocial by choosing the bad behaviors that eventually become an entrenched pattern.

As a parent, I don’t believe these are mutually exclusive views and find both to be informative. My son has a history of developmental trauma. As a result he struggles with impulsivity, attachment, and cause-and-effect thinking. At the same time, his behavior is not involuntary. He is making a choice when he acts aggressively and knows right from wrong.

Why families can’t get help

Even once parents understand the complexity and seriousness of the abuse taking place, there is nowhere to turn for help. Unfortunately, the systems designed to protect victims of other types of abuse don’t have a mandate to protect the victims of I-CPV.

Most domestic violence shelters are for intimate partners, and, for example, offer no help to a mother whose son or daughter beats her. Advice commonly given to victims of domestic violence simply doesn’t work. Take for example the following from the online article, “What to Do if You Are in an Abusive Relationship“:

1. Talk with someone you trust
Parents are rarely believed by friends, family, teachers, and mental health professionals. Instead, they’re blamed for their child’s misbehavior and labeled bad parents. One mom says, “My son can be incredibly sweet and charming when he wants to be. My friends, his teachers – my own mother – don’t believe my 9-year-old son is dangerous because he’s so good at hiding his behavior.”

2. Call the police if you are in immediate danger
Parents receive little assistance from police, especially if their child is under the age of 16. They also hesitate to press charges knowing incarceration is not the “treatment” their child needs. One mother called 911 after her son beat her. The officer said to her son, “It’s okay, Buddy, you’re not in trouble. Let’s talk.” The next time her son beat her, she ended up in urgent care.

3. Make a plan to go to a safe place such as a shelter
Despite their child’s abusive behaviors, parents are still legally and morally responsible for them. Even if parents want to seek safety, their hands are tied. “If I were treated this way by a man,” says one mother, “I would have left long ago. But because this is my daughter, my options are limited.”

Unfortunately there are no good solutions for these parents, and no quick and easy cures for their children. Few therapists and mental health professionals are equipped to offer the highly specialized treatment needed. While there are promising advances in neuroscience, emerging treatments are not accessible for most families. They’re expensive, rarely covered by health insurance, and unavailable in most areas.

Out of all the families she’s worked with, Quillian says only one family has ever received appropriate treatment. “One. One family experiencing what I believe to be the absolute bare minimum of care. One.”

What needs to change

I-CPV isn’t merely talk-show fodder. It’s happening behind closed doors in your neighborhood. It’s happening in Annie’s home. It’s happening in mine.

While the US lags behind, there appears to be growing awareness of I-CPV in the UK where a new domestic abuse bill includes I-CPV. US citizens can support these families by asking their legislators to draft similar legislation which would not only provide legal remedies, but more importantly, facilitate funding for research, prevention and treatment.

We need viable treatment options for our children, as well as resources to combat the violence and destruction we face in our daily lives,. We need help and the support of our communities. That begins with a national dialogue about I-CPV and viable treatment options for serious behavioral disorders.

Parents deserve the same support and understanding that all victims of abuse deserve. Until then, they will suffer physical and psychological harm while their child faces a lifetime of relational, educational, financial, and legal struggles.

Parents in crisis can’t parent therapeutically – so stop expecting us to.

My teenaged son called this evening to explain that he’d cursed his teacher out and thrown his desk across the classroom. He was upset because he’d lost his school issued Chrome book because he’d taken it home (not allowed, and not his first time) and had pornography on it. I listened patiently without judgement. He explained how his elopement from school ended in an entanglement in a pricker bush and contact with a concrete culvert which scratched up his arms and legs. He was covered with bloody scratches and scrapes. I expressed empathy as I sipped my coffee. I offered encouragement when he said he was going to try to earn back the Chromebook and even said I’d talk to the school to ask for a clear plan to work towards that goal. I told him I was proud of this choice to make tomorrow a new day.

Today I was a therapeutic parent superstar and here’s why:

Had this situation happened when my son was still living at home, I would have gone nuts. I would have been throwing out consequences and yelling. My anxiety would have been through the roof. I would have been angry, embarrassed, frustrated, and overwhelmed.

Back when my son was living at home, our family was in crisis. The situation had grown toxic. It took several years of his being in treatment programs, and my being in therapy and educating myself, to begin to find a positive way forward.

Unfortunately, this is not uncommon. Adoptive and foster parents aren’t prepared for the early childhood trauma most kids coming into our families have experienced. We usually reach a crisis point before we learn about therapeutic parenting. By that time, we’ve become desperate and demoralized. Our mental and physical health is so degraded that we are barely surviving. Our kids are out of control. Our life is out of control. We can’t even manage to brush our hair in the morning much less use a calm and kind voice after our child spits in our face.

No doubt, our children need us to be that calm and steady, therapeutic parent, but at that point, we simply don’t have the capacity to do it. And given the our current relationship with our kids, it’s likely we aren’t even the best person to do it. Though few dare tell the shameful truth – we likely have come to a point where we really don’t like our kid. It’s a struggle to be nice to them. It’s difficult to not feel adversarial towards them. If we’re really being honest, some days we’re as out of control as our kids.

Unfortunately, few therapists understand this. They usually underestimate our child’s extreme behaviors and the level of crisis our family is in. They assume we have the ability to parent therapeutically and shame us if we don’t. For our families to heal and thrive, this is something that must be recognized and addressed.

The only clinician I know who is talking about this and teaching other clinicians about this is Forrest Lien of Lifespan Trauma Consulting. (If you are a parent, please follow him on social media to support his efforts on our behalf.)

Families in crisis do not have the capacity to parent therapeutically. This is why we must:

1) Get help to families before they are in crisis (this means pre-adoption training and post-adoption support),

2) Support parents and families in a holistic way. Help us get to a place where we can parent therapeutically.

3) Surround families who are in crisis with supports. Stop shaming us for being broken and demoralized. Give us a hand up.

Parents must be healthy and educated to parent therapeutically.


A note about therapeutic parenting:

There are no perfect treatments for developmental trauma. My son hasn’t been able to access the highly specialized treatment he needs. My response to his phone call today doesn’t solve the problem – I realize that. However, consequences, though perhaps “deserved” won’t work, and will only further escalate my son. What I must do is choose the response that is most likely to move the ball forward. My goal is for him to remain in school and to not get kicked out of the group home. My goal is to de-escalate the situation. I highly recommend A to Z Therapeutic Parenting for practical information on therapeutic parenting.

The ugly truth about trauma

Warning: Graphic image

Because trauma from early childhood neglect and abuse is invisible to the untrained eye, we tend to imagine our children having only bruised and bleeding hearts.

In reality, some of our children have huge gaping trauma wounds. The gash is infected and oozing puss. It smells. It’s sticky and messy. No vital organ or system in our child’s body is safe from its insidious spread. As a result, our children can’t sleep or eat. They can’t learn. They don’t play nicely with others. Sometimes they spend days – years – delirious with fever and pain.

I’m sorry if this is disturbing, but that’s the point I’m making about trauma.

Our kids don’t know how to treat their own trauma gashes, but they’re afraid to let us help. They want us to just leave it alone and let it get better by itself. But trauma gashes, left to their own, can become life threatening or leave a mangled, ugly scar.

As parents we try to treat our child’s oozing trauma gash with bandaids, ice packs, and Neosporin. Afraid and in paid, they lash out at us like wounded animals no matter how lovingly we soothe and comfort. We explain the pain is only momentary, that we’re just trying to help the wound heal, but they fight to keep us far away.

Most trauma gashes need stitches or surgery. Our kids need highly specialized treatment that, more often than not, is unaffordable or inaccessible. And so, as parents, we just do the best we can with our inadequate home first aid kit.

Bruised and broken hearts can be comforted. And even trauma gashes can heal and fade with proper treatment and time, but they always leave a scar.

Learn more here:

Understanding the impact of childhood trauma
Raising a child with developmental trauma

Christmas Gift List for kids in Residential Treatment Facilities (RTFs)

It can be challenging to Christmas shop for kids who are living in residential treatment facilities (PRTFs, RTFs, or group homes). There are almost always restrictive rules about personal items along with special rules for Christmas gifts. For example, in most facilities electronics, candy, and hardback books are not allowed.

So what can you give your child for Christmas? Below is a list curated from parents who have successfully navigated the holiday season while their child is living in an RTF.

But first, here are some tips.

  • Gifts deemed inappropriate or against policy will likely be thrown away and not returned to you.
  • Most facilities do not allow wrapped gifts because they need to approve the items.
  • Often gifts must be dropped off on a specific day.
  • You may not be allowed to open Christmas gifts with your child. If this is important to you, ask their therapist about doing so during a family therapy session or home visit.
  • Kids in higher level facilities aren’t allowed to have “dangerous” item which may include shoe laces, belts, hard back books, calendars with staples, etc.
  • Ask the facility if your child will be getting additional gifts from local charities or the facility. As you shop, it can be helpful to know if you are supplementing gifts or supplying all your child’s gifts.
  • Plan for the gifts you buy to be lost or destroyed. Shop at Walmart and don’t give expensive gifts. Label what you can with your child’s name.
  • To successfully navigate Christmas gift giving with the least amount of frustration and waste, email your child’s therapist your planned gift list ahead of time for approval.

Christmas Gift List
(For kids in RTF)

  • Clothes
  • Pillow
  • Stuffed animal
  • Pajamas
  • Markers and coloring books
  • Dot to Dot books
  • Playing cards
  • Family Pictures
  • Art Supplies
  • Basket ball
  • Soccer ball
  • Foot ball
  • Journal
  • Hygiene supplies
  • Hair bands
  • Stickers
  • Pillow case
  • Picture book of “happy” memories
  • Paperback books
  • Crayons
  • Teddy bear
  • Gloves
  • Hat
  • Shoes
  • Puzzles
  • Funky Socks
  • Magic 8 Ball
  • Comic books
  • MP3 Player/iPod Shuffle with no internet access
  • Stationary
  • Legos
  • Crazy Aaron’s thinking Putty
  • Blanket – burrito etc
  • Posters
  • Calendar (no staples)

Please let me know your additional ideas so I can add to this list!

A few thoughts about realistic expectations…

Kids with developmental trauma, especially those diagnosed with Reactive Attachment Disorder (RAD) are likely to turn any situation into a power struggle, including their Christmas gifts.

Even if you give them a gift they’ve been asking for – that you know they’ll love – you can expect them to:

  • Tell the therapist they know you aren’t planning to give them any gifts because you don’t love them.
  • Complain to staff about the gifts they do get, and say they don’t like them.
  • Destroy the gifts even if they love them and desperately wanted them.

It may feel personal, but it’s simply how your child relates to the world because of the lasting effects of early childhood neglect and abuse. Unfortunately, you may end up feeling manipulated, lied about, coerced, and judged. It can be tempting to withhold gifts because of these behaviors or because your child is not cooperating with treatment, but that’s not a good strategy.

First, keep in mind that it will be very difficult to execute. Staff will likely compensate by giving your child extra gifts creating an opportunity for triangulation.

Additionally, your child’s therapist will almost certainly see your lack of gifts as a sign you are a cold, and unloving parent – and the focus of your child’s treatment will be side tracked.

Most importantly, your child will internalize feelings of rejection and this will not be a learning lesson no matter how well-intentioned you are. Jessie Hogsett, who was diagnosed with RAD as a child, reminds us that our child’s actions aren’t necessarily reflective of what’s going on inside. He says “I remember being in an RTF during Christmas. So lonely. And I felt totally unwanted. Horrible times. A gift would have made me feel wanted, special, and thought about.”

So, plop on your Christmas hat, sip a peppermint latte, and go shopping.

Joker: A warning we should heed

At my teenaged kids’ insistence, I took them to watch Joker in the theater, expecting a typical action-packed, comic book movie – not a genre I typically enjoy. Instead, I sat in the darkness, stunned to near-tears by it’s devastating portrayal of how early childhood trauma and untreated mental illness can spiral into tragedy. 

The poignant film explores the backstory of comic book villain Joker: a man named Arthur Fleck who has a disturbing past and a troubling present. It is a compelling and nuanced portrayal of untreated trauma and mental illness. 

Joker is incredibly violent and disturbing, certainly earning its R-rating, but at the same time reflects a reality we are already seeing in our society today. Early childhood trauma is at epidemic levels. Our mental health system is in disarray. We aren’t meeting the needs of the vulnerable around us and sometimes violence and tragedy are the price we pay as a society. 

There’s a huge amount of controversy swirling around the film and it’s portrayal of mental illness. After watching the movie, I believe the real controversy we should be focused on is why we don’t have affordable, accessible, effective treatment for mental illness and early childhood trauma!

*** Spoilers Below ***

In the film, Joker, we meet Arthur Fleck shortly after he’s been discharged from a mental health institution. He’s receiving mediocre city mental health services, living in poverty, and attempting to build a semblance of a life for himself.

While the film does not specify all of Arthur’s diagnoses, his symptoms include hallucinations, paranoia, delusions, and feelings of despair, loneliness, and worthlessness. Arthur’s one obvious diagnosis, Pseudobulbar Affect (PBA), fits of uncontrollable laughter, results in severe bullying. We also learn Arthur was abused and neglected by his mother during early childhood. This included severe head trauma as well as psychological and emotional abuse. Arthur has never been able to access the treatment he needs to manage his condition, much less heal, or thrive. He’s completely lacking social skills, unable to hold down a job despite his best efforts, and even with medication, unable to feel happy or optimistic.

Unfortunately, Arthur is not simply a far-fetched character. We have “Arthurs” living and breathing all around us – in our daycare centers, classrooms, workplaces, and neighborhoods. Early childhood trauma is a hidden epidemic affecting millions of people. While victims of early childhood trauma and/or people who have mental illnesses aren’t necessarily violent, the combination of untreated trauma and mental illness with psychosis can be dangerous. Furthermore, high-risk children are not receiving effective treatments in residential treatment facilities. They are aging out ill-equipped to function in the adult world and at high risk of criminal behavior and incarceration. Like Arthur, most of these individuals want to be happy. They want to have good lives. However, we, as a society, fail them by not providing effective, affordable, accessible treatments for trauma and mental illness. Like Arthur, these people struggle to navigate even the basics of life.

Arthur, though teetering like a wobbling house of cards, is trying to build a life for himself. He’s trying to find some happiness. But it’s obvious to the viewer that he simple doesn’t have the resources or skills to do so. And so begins Arthur’s devastating spiral that should be a warning for us all. 

  1. Arthur loses his services (therapy, medications, etc) due to city financial cuts.
  2. He’s fired from the job he loves – sure he made a mistake, but he’s given no mercy or compassion.
  3. He follows his dream to be a comedian, and falls flat. He’s mocked mercilessly.
  4. He’s physically assaulted for laughing (his Pseudobulbar Affect) and in self-defense shoots and kills two men on a train. In a panic, he kills another.
  5. He’s cruelly rejected by the man he believes to be his birth father.
  6. He learns his mother abused him as a child and anger that has been festering in his unconscious for decades surfaces.

The spiral tightens. Arthur is drawn to the rioters who praise him as a vigilante for the killing on the train (which was in fact, self-defense). He becomes more violent and murders several people. In his mind, his path has become inevitable as all other doors – all other options – have slammed closed in his face. 

Does this not reflect the crumbling path of so many young people in our society today? People who struggle on the edge of society: to hold down a jobs, to form relationships, to find their next meal, or place to sleep. This instability is the fate of so many people who have experienced early childhood trauma and/or are mentally ill because they are unable to access effective treatment and services. Is it any wonder that they are hopeless, desperate, and caught in a downward spiral? Is it any surprise that some end up engaging in criminal behavior? That some act out violently?

Towards the end of the movie, Arthur has fully transformed into the Joker. Wearing chalky make-up and a sardonic smile, he sits on a talk show stage and casually confesses to the train murders, Before shooting the talk show host point-blank in the face, Joker says, “I’ve got nothing to lose. Society has abandoned me.” And we can’t disagree: He has got nothing to lose. Society has abandoned him.

It only takes thumbing through the headlines to know that far too many of our most vulnerable have been abandoned by society and with nothing to lose have picked up guns and lashed out violently too. Read more about one recent incident here. This will continue until we prioritize affordable, accessible, effective treatment for early childhood trauma and mental illness.

NOTE: In case it wasn’t clear in this post, I am not saying that mental illness or childhood trauma lead to violent behaviors. What I am saying is that untreated mental illness and untreated childhood trauma can put people on a dangerous spiral.

Conduct Disorder (CD) – Early detection

First published by Milk & Hugs, and republished with permission.

The Worry…

Early childhood is a wondrous time of life, for both children and parents. Watching young minds form and bodies grow is one of the true joys of parenthood. As parents, we want the best for our children. We have dreams of who they will become, the type of life they may have. Ultimately, we want the best life for our children. What happens when our child is ill or has some sort of problem? We want to fix it. We are proactive and determined to find the solution.  But what happens when our child is still very young and our concerns sound vague (and perhaps a bit ridiculous) even to ourselves? How do we respond to the pediatrician who gives us that patronizing smile while telling us the child is just being a child, we are worrying over nothing, the child will “grow out of it.”

The first thing to know is to always trust your instincts, whether your child is 2 minutes or 20 years old. Instincts have served us well from the beginning of time and will continue to do so. It doesn’t matter if the child in question is your first or your fifth, trust your instincts.

What is normal?

Some things children will grow out of as they develop and mature. Toddlers are very self-centered and their demands on our time and attention are unlimited. Eventually toddlers grow into more reasonable beings as they learn how to express themselves. They learn it is much more fun to play with another child and share toys than to hoard all of the toys for themselves. They learn that hot stoves burn and that burns hurt. They learn that “no” actually has meaning and isn’t just a weird sound mom or dad makes all day.  

Between the ages of birth to four or five, a lot is going on developmentally. While that is wonderful, it can be a confusing time for parents. What is “normal” childhood behavior and what should be of concern? How do we bring it to the attention of others without sounding paranoid? Hopefully, this article will provide a few answers for parents of young children who are dealing with some behaviors that are the cause of concern.

…but is it really normal?

We’ve all heard the horror stories surrounding “the terrible twos.” This phase of your child’s life can actually span anywhere from a year old to as much as 30 months old. Tantrums can occur for numerous reasons and may include whining, crying, screaming, hitting, kicking, biting, and throwing things. A study published in 2003 suggests that nearly 75% of tantrums last five minutes or less. Most children under the age of five have one to three tantrums a day with varying degrees of severity. How do we know when to be concerned?

Donna Christiano’s recent Healthline article mentions these indicators as reasons for concern:

  • tantrums that consistently (more than half the time) include hitting, kicking, biting, or other forms of physical violence toward the parent or caretaker
  • tantrums in which the child tries to injure themselves
  • frequent tantrums, defined as tantrums that occur 10 to 20 times a day
  • tantrums that last longer than 25 minutes, on average
  • an inability of the child to ultimately calm themselves

Children with these behaviors may have conduct disorder. Learn more about Conduct disorder here.

When other parents talk about Conduct Disorder

In addition, parents from an online Conduct Disorder support group have described the tantrums more as “rages” due to the level of anger and violence the child displays. One mother states that her 3 year old daughter will scream, hit walls, hit other people, bite, kick, and destroy whatever she can get into her hands, for hours on end.

Parents in this same support group have provided a list of other behaviors they noted in their young children which were causes for alarm:

  • deliberately cruel to people or animals
  • early sexual aggression (age 2 and above)
  • manipulative (age 3 and above)
  • flat affect
  • superficial charm (age 4 and above)
  • inability to relate actions to the consequences that follow, such as time out
  • discipline causes further rage in the child, has no effect on behavior

What can you do?

What can you do if your child exhibits some of these more extreme behaviors? The first thing is to document the behaviors in a notebook or journal that is used exclusively for this purpose. Note the behavior, total elapsed time of the behavior (if a tantrum/rage, state the total time from beginning until the child is calm), date and time of the event. Also document your actions/responses.

Try to remove emotion and extra information from the list. It’s difficult to notice these specifics under stress but at least make note of the time, you can document the rest later. You are gathering documentation that will be much needed further down the road. At the beginning of the notebook, write down when these behaviors first began (age or date if you remember). Most of the time it has been so gradual that you cannot put an exact date to the first unsettling event but you can likely pinpoint an approximate age. Physicians like to see six to eight weeks of data. This can be difficult to do if your child is having 10 – 20 tantrums/rages per day. Do the best you can while remembering that documentation is your friend.

The Doctor Visit

After you have several weeks of information, take your child to his or her pediatrician. In a calm and confident manner, state what behaviors are of most concern to you. Have a list prepared and bring your notebook with you. Be concise and do not use vague language; no sort of, kind of, maybe, like, etc. Always speak with authority with regard to your child’s behaviors. Speaking in this manner shows that you are not an insecure parent who just needs a little patronizing from your child’s pediatrician.

Remaining calm indicates that you’re not some hysterical parent in over his or her head. Knowledge and a confident attitude are part of your tools to utilize in order to obtain an appropriate response from your child’s doctor. If you do not receive the assistance you need or feel that your concerns have been brushed aside, ask for a second opinion. Keep looking for answers and help until you find it.


What is Conduct Disorder?

I stand in the bathroom stall of the courthouse, texting a friend. “I can’t do this,” I write and lean my head against the cold partition of the stall.

“You’ve got this,” she replies. “Breathe, Honey.”

I hear the restroom door open and a singsong voice I recognize as my daughter, Debbie, quietly calls my name. I quickly pull my feet up, trying to be invisible. “I know you’re in here, you stupid bitch. Come out, come out, where ever you are.”

My breath halts and my pulse pounds in my ears. Be still, be quiet, I think. Maybe she will go away.

Footsteps approach as door after door of the stalls bang open. I quake in fear as the steps come nearer until I see her shoes in front of my door. 

“You can’t hide forever,” Deb says in a lilting, singsong voice. She quickly tells me how plans to murder me and what she will do with my body before setting it and my home on fire. She reminds me that she has had months to perfect her plan, while in juvenile detention, without my interference. 

I don’t respond.

Tiring of her game, Deb’s voice acquires the hard edge I’ve come to associate with rage. “Get out here, you bitch. I hate you. I want to see you scream as you die. Your precious boy will die, you will all die.” I cower behind the door as her diatribe continues; the words increasingly vulgar.

Suddenly the door into the hall opens and a new voice speaks. “Deb, are you in here?”

I hear Deb whisper, “Shit.” Then she begins to sob. 

“Baby, what’s wrong? What happened?” I recognize the newcomer as Deb’s caseworker.

Still sobbing, Deb says, “I saw Mommy come in here. I just wanted a hug. She hates me.” She wails and sobs as though her world has just ended. “Why doesn’t she love me, Miss C?” 

Debbie is only 14. Debbie has Conduct Disorder.

What is Conduct Disorder?

The DSM-5 (the manual used by mental health professionals to make diagnoses) defines Conduct Disorder (CD) as “a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated.”

Children with Conduct Disorder (CD) may exhibit behaviors such as:

  • bullying, threatening, or intimidating others
  • initiates physical or verbal altercations
  • physically or verbally cruel to others
  • physically cruel to animals
  • steals
  • forces someone into sexual activity or is sexually aggressive
  • frequently lies
  • deliberately sets fires or destroys property
  • lack of empathy
  • lack of remorse
  • grandiose thinking
  • highly manipulative
  • rages (or “tantrums”) lasting 25 minutes or more
  • inability to learn from mistakes
  • lacks critical thinking skills/has difficulties understanding abstracts
  • shallow affect
  • superficial charm/has a public and private demeanor
  • lack of fear

Recent scientific studies indicate CD is in part due to abnormal brain activity, as well as an under development of the amygdala and prefrontal cortex. The amygdala is known to be responsible for controlling aggression as well as the perception of emotions. The prefrontal cortex handles executive functions such as controlling short-sighted or reflexive behaviors in order to plan long-term goals, make informed decisions, and exhibit self-control.

But what does all of this really mean?

In simple terms it means that the child with Conduct Disorder has a brain that is structurally different from that of a neuro-typical child. Because of this difference, the child with CD does not respond to rules, discipline, and societal norms the way a typical child does.

Conduct Disorder is evidenced by some, or all, of the behaviors listed above. The spectrum of behaviors is wide and varies between mild to severe. The tendency to lie, manipulate, and gaslight are strong and seemingly innate behaviors.

Standard parenting techniques are not effective. Discipline, rewards for good behavior, star charts, and other techniques fall short of managing behaviors long- term. Conduct Disorder transcends race, ethnicity, environment, location, and socioeconomic backgrounds. Unlike attachment disorders CD is not always due to trauma, abuse, or neglect. However, many children diagnosed with Reactive Attachment Disorder (RAD) at younger ages are ultimately diagnosed with CD as teenagers. CD can manifest at 2 years old or 15 years old, and any age in between.

There are an estimated 7 million children in the U.S. alone with Conduct Disorder. This translates into approximately 1 in 10 children affected.

For families affected by CD, it can mean very little in terms of treatment. Children with Conduct Disorder do not respond well to traditional talk therapy. In general, these children will use the counselor to further manipulate caregivers. Some go so far as to employ triangulation, in which the counselor becomes the unwitting accomplice of the child to further demoralize caregivers. Medication cannot relieve the symptoms of CD but it may be prescribed for co-morbid diagnoses such as ADHD.

At present there are very few viable inpatient treatment centers for children with Conduct Disorder. Many programs state that CD is treated at their facility, however most apply standard practices toward the treatment of other mental illnesses to CD. This is highly inappropriate and may lead to further issues for both the child and family living with CD.

Often, families feel vilified and become isolated due to the harsh judgment they face. Family and friends lack understanding of what is happening and drift away, unable to provide support for something they seldom witness. Parents beg doctors and mental health professionals for help, only to be mocked and treated with derision. The community, hearing of the child’s disrespect and abusive nature when the police are called, make assumptions about the parents: too lenient, too strict, not enough activities, too many activities, set boundaries, spank him/her, it’s all because of poor parenting, they say. All this does it further isolate families who are living in a constant war zone, created by someone they love and for whom they are legally responsible. Love does not cure Conduct Disorder (CD), nor does being a model family.

If there are no treatment options available, what can be done?

Fortunately, CD is being researched more in recent years. Unfortunately for those living with CD, viable treatment options are still years in the making. The founders of Compass for Conduct Disorder realized the need for community support programs, resources for parents/caregivers, and early childhood detection and intervention.

Compass for Conduct Disorder is a nonprofit organization whose goal is to provide resources, services, and hope for those living with CD. In addition to a parent/caregiver support group, Compass also provides an information and awareness group, parent advocacy, crisis buddies, the Compass Peer Network for professionals to exchange information relating to CD, and an awareness raising campaign. In the planning stages is the Compass Child and Family Support Center, which will be geared toward children ages 2 to 5 showing early signs of Conduct Disorder, and their families.

If you have a child with Conduct Disorder, Compass for Conduct Disorder is a place to find support, resources, and community.

Website: www.compassforcd.org
Facebook: @CompassforCD
Twitter: @CompassforCD
Compass Cares: A Conduct Disorder Support Community
Compass for CD Information and Awareness


Karen Huff is the mother of four children, one of whom has Conduct Disorder.

She is the President for Compass for Conduct Disorder and an admin for the Compass Cares support group, as well as for the Compass for CD Information and Awareness group. 

Connect with her on Facebook and Twitter.


Yoga at school may help your child, but what about mine?

Recently I’ve seen several headlines about schools who are introducing yoga as a way to address student behaviors. The West Fargo Pioneer explains this way:

Behavior issues stem from a multitude of reasons. However, studies show that students today are more likely to experience trauma and have mental health needs, increasing the likelihood of classroom disruptions and behavioral issues. 

In a classroom of 20, one or two students on average will be dealing with serious psycho-social stressors relating to poverty, domestic violence, abuse and neglect, or a psychiatric disorder, according to the Child Mind Institute.

This type of stress can shorten periods of brain development and limit brain growth in early years, making it harder for students to regulate emotions and concentrate on learning. 

And while schools can’t control students’ experiences outside the classroom, they can help students learn how to cope with stress and regulate emotional outbursts. Social-emotional curriculum aims to help students recognize and deal with emotions and tackle the increased presence of stress and trauma.

It’s absolutely true that every classroom has children who have experienced trauma. Early childhood trauma is an epidemic. It’s absolutely true that these experiences affect a student’s ability to learn and cope in school. It’s also absolutely true that some students will benefit from yoga. It will help by,

  • Reducing stress
  • Improving concentration
  • Increasing self-esteem
  • And more…

This is why PBS suggests Managing School Stress by Bringing Yoga Into the Classroom. And Education Week applauds Ditching Detention for Yoga: Schools Embrace Mindfulness to Curb Discipline Problems.

Great ideas, however news articles like these give the impression that yoga is an inexpensive, quick fix for childhood trauma. For kids on the moderate to severe end of the spectrum, this simply isn’t the case.

Here’s the problem

Many kids with developmental trauma are so dysregulated they cannot follow instructions or calm themselves enough to even choose to participate in yoga. A 10-year-old who flips desks, curses at the teacher, and fights with other kids is likely not able to safely or effectively participate in yoga.

Furthermore, kids who have extreme behaviors and emotions may be extremely disruptive during yoga activities. This can cause other students to be unable to focus and benefit from the exercises. A 6-year-old who refuses to follow instructions, pesters other kids, and runs around in circles, will disrupt the entire atmosphere.

If a child has a cold, a spoonful of honey does wonders. However, that same spoonful of honey is not able to cure a child who has strep throat. Here’s the ugly truth about trauma: Some kids who have experienced trauma have needs far beyond what a spoonful of honey can heal. Without comprehensive and specialized treatments, these children are unlikely to benefit from yoga at school. They probably won’t even be able to successfully participate.

I cringe at the “yoga in school” headlines because they minimize the devastating, often debilitating, effects of trauma on our kids. Most people who read the articles, or just skim the headlines, will assume childhood trauma is easily treated.

Don’t get me wrong – I applaud schools incorporating yoga into their curriculum and behavior programs because it can be helpful to so many children. However, yoga cannot curb extreme behaviors caused developmental trauma. It is a far more complicated and challenging issue.

Let’s get our kids to a healthy place where they can benefit from yoga. You can help by learning how trauma effects kids and sharing our video to help raise awareness for the need for accessible, affordable, and effective treatments.

Weekly Roundup, Sunday Sep 15, 2019

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Here’s what “trauma informed” looks like…
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Here’s what “trauma informed” looks like…

Due to startling research on the impacts of Adverse Childhood Experiences (ACEs) on children, there is emphasis on “trauma informed care” in many sectors – education, childcare, health care, justice, and more. Far too often, however, trauma informed care is little more than a buzzword. In fact, many community resources exacerbate problems for families in crisis.

Over the last few months, my family has benefited greatly from several examples of truly trauma informed care. Let’s take a look at what “trauma informed” really looks like.

Leaving class to call home

My 12-year-old son Brandon recently lost his father under traumatic circumstances. As a result, he constantly worries about my safety. I receive these types of text from him multiple times a day:

Sometimes he’s texting from a friends house, sometimes just upstairs in his bedroom. If I don’t immediately see the text and respond, he becomes panicked. This posed a serious problem with the start of school where he has to leave his cell phone in his backpack.

When I explained the situation to the school counselor she immediately put in place a practical, trauma-informed solution: Brandon’s teachers have been instructed to give him a pass to Student Services whenever he asks for one. He’s then allowed to go into the office and make a short call home to check on me. While this could be viewed as disruptive, it is no where near as disruptive as his anxiety mounting for hours until it becomes debilitating. This way he checks in – 5 minutes – and is able to go back to learning. Shout out to @nwsarts

Protecting siblings from viewing an arrest

As my kids sat eating snacks at the kitchen table, I had no idea the police were on their way to my house to arrest my 17-year-old son Devon on outstanding assault charges.

When the police arrived they pulled me aside and explained they were about to arrest Devon. Then the officer added, “Do you have a place you can take your other kids so they don’t have to see their brother arrested? We’ll wait for you to take them.” Dazed, I took Devon’s siblings next door.

Once I recovered from the shock of the arrest, I was deeply grateful to the officers. They realized the potential for secondary trauma and were proactive in preventing that. They could have just swept in and handcuffed Devon. Instead, they were trauma informed and acted in the best interest of the whole famiy. Shout out to @CMPDnews

A private place to eat

Food issues are extremely common for kids who have been abused or neglected. My adopted daughter Kayla, now a teenager, has always struggled eating in front of other people. This poses a significant problem in school as she cannot concentrate when she’s hungry. In addition, during basketball season this can become a serious health concern.

Instead of diminishing this very serious concern, my daughter’s teachers have gone out of their way to create an accommodation that is both practical and helpful – one that is truly trauma informed. Kayla is allowed to eat her lunch in one of the teacher’s classrooms. As a result, she gets the daily calories she needs to thrive in school. This has been a simple and effective way of removing a barrier to Kayla’s academic success. Shout out to @LNCharter and @corviancourier

Each of these solutions is straight-forward. Simple even. So what makes them truly trauma informed?

  1. They recognize the underlying trauma
  2. They don’t minimize the issue
  3. They are practical and effective

Families like mine need more community resources who are educated about developmental trauma and willing to implement practical, sensible, trauma informed solutions that will enable our kids grow and thrive.

Weekly Roundup, Sunday Sep 8, 2019

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How to SURVIVE in an active shooter situation

I recently attended Active Survivor Training (also called Active Shooter training) with my children. What we learned was invaluable and, as our personal story shows, the lessons can be used in real-life situations.

To survive and active shooter situation you cannot count on law enforcement. You must act.
A Study of Active Shooter Incidents between 2000-2013

These types of incidents are not just happening in schools. They are being perpetrated by disgruntled employees, happening at our local Walmarts and more. This is why I encourage everyone to contact their local police department and sign up for this type of training.

Here’s some of what I learned:

You can’t count on law enforcement to save you.

  • Over 60% of active shooting situations are over in less than 5 minutes
  • On average, police take 5 minutes to arrive on scene
  • On average, SWAT takes 50 minutes to arrive on scene

To survive, YOU must take action.

What you should NOT do

Previous active shooting situations have been studied in detail and the findings are clear: Hiding, negotiating, and playing dead will get you killed.

  • Shooters know people “play dead” and target them
  • Shooters go in with the goal of killing as many people as they can and know they won’t make it out alive so negotiating or pleading is futile
  • Shooters look for people who are hiding and they end up being sitting ducks

What you should do

Your goal in an active shooter situation must be to survive until law enforcement arrives. Remember, on average this takes 5 minutes or more. Here are the three strategies that give you the best chance of survival:

Run

If possible, ALWAYS run. This gives you the greatest chance of survival.

  • In every situation know where the exits are
  • Call 911 only when you reach safety
  • Never go back

Remember, it takes time to call 911 and provide information, and even longer for law enforcement to respond. These seconds count so always run to safety first before calling.

Barricade

Hiding or playing dead is not enough to save you from an active shooter. You must actively barricade yourself in a room while waiting for law enforcement.

  • Lock the door FIRST
  • Use furniture, cords, etc to barricade the door
  • Do NOT remove barricades. Not for other potential victims or even law enforcement*

*Once the police are on scene they will find a way to get into the room. Take no chances.

Remember, active shooters want to kill as many people as possible. If a door not easily breached they will quickly move on so even a simple barricade can be effective.

Attack

When in close proximity to a shooter, the best strategy may be to attack.

  • Use deep breathing to ensure you have all your facilities about you
  • Anything can be used as a weapon – throw a stapler, cell phone, or trash can
  • Grab the gun with both hands to either jam it or delay the shooter

Remember, you may not be able to ultimately wrestle the gun away or stop the shooter. However, you may be able to distract them or delay to allow law enforcement to arrive. It may be your only and best chance of survival.

While these strategies all come with inherent risks, previous shootings have been studied in detail. The FBI and other law enforcement groups have found that the likelihood of survival dramatically increases for people who run, barricade, or attack.

Other tips

  • Stanch bullet wounds with tampons, teeshirts – anything is better than nothing.
  • Use a belt or cord to tie a tourniquet above a wound. Tighten until the bleeding stops.
  • When police arrive drop any weapons and put your hands up.

In real life…

Like most people, I never imagined this type of tragedy could happen to me. However, recently, my sister and I were in a life or death situation with a gun (you can read more details of our story here). Fortunately, my sister had been through Active Survival Training.

An “active shooter ” is defined as someone who wants to kill as many people as possible. Based on this definition, our situation did not involve an “active shooter,” but the strategies from this training were effective.

My sister instructed our teenaged children to run, and as a result:

  1. All three of our kids safely escaped
  2. They were able to call 911 and get us help

She also knew our best chance of survival was to attack. She and I both wrestled for the gun, and as a result:

  1. We bought ourselves time for law enforcement to arrive
  2. The scene was disrupted and our attacker moved out into open space where he could be confronted by law enforcement.

Ultimately, these active survival strategies saved our lives.

Remember, in an active shooter situation your goal is to survive while you wait for law enforcement:

Run.

Barricade.

Attack.

Survive.

Related Posts:

My Response to the Parkland Shooting

Image credit: https://charlottechamber.com/clientuploads/publicpolicy/PDFs/ActiveSurvivalHandout.pdf


I learned this valuable information and more from Charlotte Mecklenburg Police Department’s Active Survival Training which I attended on 9/4/2019.