Is My Teen Out of Control?

Checklists Do Not Tell the Whole Story

Many websites provide checklists that supposedly help parents identify problems in their children. These checklists appear on referral sites, residential program sites, educational consultant sites and transport company sites. The checklists have been developed to guide parents to decide whether they have a "troubled teen" that needs help, that is, needs residential treatment.The answers are often supposed to be "yes" or "no." Questions such as: Does your teen…

• Have poor self esteem, lack of confidence?
• Have temper outbursts, poor anger control?
• Need extra supervision or control?
• Avoid participating in family activities and social events?

How and when should a parent use a checklist or more appropriately, how and when should a parent not use a checklist?

Parent should keep in mind that there are several important issues in answering questions about your child's behavior. A checklist is, at best, just a preliminary tool, just a rough idea of where there may be problems. If the child has significant problems, then the checklist must be followed-up with more discussion about the behaviors and what they really mean.

A checklist does not tell the whole story.

A checklist does not tell the whole story—it may give some clues or in fact, it may tell a distorted story. Here's why:

The items on the checklist that describe the behavior cannot determine if this is "normal" teen behavior or something more serious. All of the behaviors that may signal problems may also be examples of normal teen behavior. If your child has made a suicide attempt or is using hard drugs, then it is vital to seek immediate medical attention from a highly trained mental health practitioner in your community or within driving distance of your home.

As for other troubling behaviors, remember that teenagers are puzzling and different, and they change as they grow and develop. The sweet child of yesterday may not be so sweet today! To determine if these behaviors are bigger problems than "normal" teen behavior, let's look at what is missing on the checklists, using "a temper tantrum" as the behavior:

• How severe is the temper tantrum? Stomping the feet is very different from punching a hole in the wall! Interpretations of "a temper tantrum" can be very different.
• How recent is this behavior? Has he/she always had a temper or is it a new behavior—say in the last month or two?
• Do other people consider this behavior to be a problem? It is important to discuss your child's potentially problematic behaviors with someone else—out of the house. This could be a teacher, a guidance counselor, a religious leader, a scout leader—someone who knows your child and knows how he/she has been over a period of time.
• Does this behavior interfere with other things, like getting along with friends, doing OK in school?
• Is this one behavior or part of a longer list of behaviors that are troubling to you?

How you respond to a checklist may color the picture.

If you are very worried, frustrated, angry, confused, or emotional in other ways, you may see behaviors as more extreme than they really are. In other words, are you over-reacting and considering the behaviors as more serious than they are? Have you "reached the end of your rope?" Will things look better in a day or so?

Do you do a checklist or not?

You may decide that, despite the problems with checklists that you want to use this approach as a starting point. Remember that a checklist is a starting point.

You may decide that using a checklist has more problems than gains. If this is so, you should address your worries in a different way. Don't push the worries aside and do nothing.

With or without a checklist in hand, it's important to look further for answers, both for your child's wellbeing and for your own. First of all, it's important to find out if others see changes in your child the same way as you do.

Whom to ask? Don't rely on your own description of the problem alone. Talk to someone who sees your child in action, preferably someone who has experience with other youth of the same age—a teacher, guidance counselor, activities leader, pediatrician, child psychologist, or child psychiatrist. Do not rush into a residential program, such as a residential treatment program, a therapeutic school, or a wilderness program, but look for answers in outpatient, community-based services. Recognize that sending your child away in order to get help may build up strong resentments in your child. Rather than helping, this may be harmful to your child's wellbeing and to your relationship with him/her.

Residential programs may be helpful for some kinds of problems but you should be sure first that this is the best and only option because these may also have serious problems and you should be aware of these.

What are the potential problems with residential programs?

There is currently a strong effort to bring about improvements in residential programs, by professionals, former residents of the programs where they believe they were abused, parents who have had bad experiences, and by members of the residential program industry who would like to see better quality programming. Additionally, the Government Accountability Office has published three reports about programs in which youth have died and the US House Committee on Education and Labor has held two hearings on abuses in residential programs and has proposed legislation to address the serious problems of poorly run programs. The biggest problem for parents is understanding how to tell a good program from a bad program.

The serious problems that these groups are trying to address are:

• Most serious is that children have died in poorly managed programs. The studies by the Government Accountability Office have listed reasons for these deaths. They said, "We found significant evidence of ineffective program management...These ineffective managment techniques compounded the negative consequences of (and sometimes directly resulted in) the hiring of untrained staff; a lack of adequate nourishment; and reckless or negligent operating practices, including a lack of adequate equipment." 
• Also, programs that promise to be therapeutic and to help children recover from their emotional or behavioral problems use unproven techniques that may be destructive and harmful to some of their residents. An example, from a program that was recently shut down by the state that regulated it is that girls were made to dress up as prostitutes and give lap dances to the staff—presumably this "intervention" was to help them recognize that their sexual thoughts could lead to bad behavior.
• Some programs ask the parents to sign away their rights, which include giving up the right 1) to talk with their child without staff monitoring the calls, 2) to schedule visits to the program, or 3) to review the service plan and to judge whether progress has been made.
• Similarly, these programs ask the children to give up their rights 1) to phone home and have unsupervised conversations, or 2) to phone a child advocate or agency to report child abuse.
• Some programs require strenuous exercise, like long hikes with heavy backpacks, which is particularly dangerous for youth who are not in good physical shape and used to such exercise. Such activities are also particularly dangerous in extreme heat or cold for youth who are not in good shape and acclimated to the temperature or altitude, which may be different from his/her home environment.
• Some programs rate themselves as being certified or approved by organizations that really do not certify or approve. These are "membership" organizations where the program pays for membership. Membership in such an organization may be good—it allows the program access to professional information and conferences. However, these organizations do not profess to review, certify, or approve the programs.
• Some programs are licensed by the state in which they operate and/or are certified by national organizations that do this type of approval—such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the Council on Accreditation (COA), or the Council on Accreditation of Residential Facilities (CARF). Some programs are accredited by educational groups. Check with the approving body to be sure that the programs claims to approval are legitimate. Recognize that such approval is only part of the judgment of quality and some questionable programs do slip through.
• Sometimes "educational consultants" recommend programs to parents. This may be a helpful type of "approval" of the program, which the consultant has visited and knows well. Or it may be part of a "bounty" payment or "kickback" to the consultant to make referrals. You should ask about the consultant's relationship to the program, although the answer may not be as forthright as you would hope.
• Some programs recommend an escort service to get your child to the program. Recognize that such a service may use intimidation, physical force, handcuffs, leg irons, and other restrictive methods if your child resists going with agents.

If you strongly believe that a residential program is necessary to help your child, and you believe that you have exhausted all local options, and a person who knows your child well concurs, then it is very important that you investigate the program thoroughly. Any program that will not answer your questions on the above topics may be questionable.

Last updated 5/13/14