FAQs on Child and Adolescent Depression—

1. What causes depression in kids?

Depression is a complex condition that has no single cause. Both genetics and the environment can play a role, and some kids may be more likely to become depressed. Like in adults, depression in kids can be triggered by a medical illness, a prolonged stressful situation, or the loss of an important nurturing figure. Kids with behavior problems or anxious temperaments are also more likely to get depressed. Sometimes, it can be hard to identify any triggering event.

2. What are the signs and symptoms of depression?

Common symptoms of depression in kids and teens include those listed below. In “major depression,” five or more of these symptoms last for over two weeks, and cause difficulty in everyday life. In a less severe but more chronic condition called “dysthymia,” two or more of these symptoms are present, more often than not, for a year.

• Change in appetite, with associated weight gain, weight loss, or change in weight trajectory
• Decreased interest in or pleasure from activities, which may be associated with withdrawal and isolation from friends or after school activities
• Difficulty thinking or concentrating, which may correlated with worsening school performance
• Feeling or appearing depressed, sad, tearful or irritable
• Feeling worthless or guilty
• Increase in tiredness and fatigue, or decrease in energy
• Major changes in sleeping patterns, such as sleeping much more or less than normal
• Seeming physically sped up or slowed down
• Thoughts or expressions of suicide or self destructive behavior

In kids it is important to keep in mind that an increase in irritability or even complaints of boredom may be more noticeable than sadness. Physical complaints may also be prominent, particularly if the child does not have the habit of talking about how he or she feels. Suicidal references or threats in kids can be difficult to interpret, so they all must be take seriously and brought immediately to a doctors attention.

3. Will depression improve without treatment?

As mentioned above, different types of depression have different patterns of improvement. Dysthymia tends to be less severe but longer lasting. Major depression also may improve by itself, but if left untreated, it can have terrible consequences. During the time that they are depressed, kids may lose friends, disconnect from family, and fall behind at school. Depressed kids are more likely to try drugs or get involved in other problem behaviors. What’s worse, untreated depression can progress to the point where extreme hopelessness leads one to contemplate suicide. It is also important to note that, once someone has one episode of depression, they are more likely to get depressed in the future.

4. What should treatment consist of?

Evidence-based treatments for depression include both psychotherapy and medication. In milder forms of depression, it is reasonable to start with a psychotherapy, but treatment with a medication and psychotherapy should be considered for moderate to severe forms of major depression. Prior to the start of treatment, a physician will discuss risks and benefits, as well as how the treatment should be monitored.

5. Does psychotherapy work? How?

Several types of therapy can be used to help depressed kids. Below are some examples of how they work.

• Family Therapy focuses on helping the family function in more positive and constructive ways by exploring patterns of communication and providing support and education. Sometimes family therapy incorporates CBT and IPT principles described above. Family therapy sessions can include the child or adolescent along with parents, siblings, and grandparents.
• Group Therapy is a form of psychotherapy where there are multiple patients led by one or more therapists. It uses the power of group dynamics and psychoeducation to increase understanding of depression and foster improvement.

• Individual Therapy - Several types of individual therapy have been proven to be effective in depressed youth. Two therapies with the most evidence are Cognitive Behavior Therapy (CBT) and Interpersonal Therapy (IPT). CBT helps improve a child's moods, by examining confused or distorted patterns of thinking. CBT therapists teach kids that thoughts cause feelings and moods, which can influence behavior. During CBT, a child learns to identify harmful thought patterns. The therapist then helps the child replace this thinking with thoughts that result in more appropriate feelings and behaviors. IPT helps improve mood by improving interpersonal relationships. IPT therapists help depressed kids identify interpersonal events, and how these events affect their relationships, their moods and their lives. Through exercises such as talking and role-play, problematic relationships are more fully understood and addressed.
  

6. Are medications safe? Do they increase risk of suicide?

When prescribed responsibly and monitored carefully, medications are both safe and effective for the treatment of youth depression. There is most evidence for the safety and efficacy of fluoxetine or Prozac, a selective serotonin reuptake inhibitor, but there are circumstances when other medications can and should be used.

While medications have been associated with a small increase in thoughts of suicide, there is no evidence that antidepressants actually increase the risk of suicide. For moderate to severe depression, the potential benefits from medication treatment far outweigh the theoretical risks. For a complete discussion of the use of medication in childhood depression see http://www.parentsmedguide.org/pmg_depression.html.

Myths about depression

Myths often prevent people from doing the right thing. Some common myths about depression:

MYTH: It's normal for teenagers to be moody; Teens don't suffer from "real" depression. FACT: Depression is more than just being moody. And it can affect people at any age, including teenagers.

MYTH: Talking about depression only makes it worse. FACT: Talking about your feelings to someone who can help, like a psychologist, is the first step towards beating depression. Talking to a close friend can also provide you with the support and encouragement you need to talk to your parents or school counselor about getting evaluated for depression.

MYTH: Telling an adult that a friend might be depressed is betraying a trust. If someone wants help, he or she will get it. FACT: Depression, which saps energy and self-esteem, interferes with a person's ability or wish to get help. It is an act of true friendship to share your concerns with an adult who can help. No matter what you "promised" to keep secret, your friend's life is more important than a promise.

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School Refusal

Kids Who Won't Go To School—

School refusal occurs when a student will not go to school or frequently experiences severe distress related to school attendance. Comprehensive treatment of school refusal, including psychiatric and medical evaluation when appropriate, is important because studies show that psychiatric disorders are the cause for up to 46% of students who fail to complete high school in the United States. Parents can do several things to help their child who refuses to attend school and treatment may be necessary. With treatment, the rate of remission is excellent; approximately 83% of children with school refusal who were treated with cognitive therapy were attending school at 1-year follow-up. School refusal is considered more of a symptom than a disorder and can have various causes.

Going to school is usually an exciting and enjoyable event for young kids. However, for some it can cause intense fear or panic. Parents should be concerned if their youngster regularly complains about feeling sick or often asks to stay home from school with minor physical complaints.

Not wanting to go to school may occur at anytime, but is most common in kids 5-7 and 11-14, times when kids are dealing with the new challenges of elementary and middle school. These kids may suffer from a paralyzing fear of leaving the safety of their parents and home. The youngster's panic and refusal to go to school is very difficult for parents to cope with, but these fears and behavior can be treated successfully, with professional help.

Refusal to go to school often begins following a period at home in which the youngster has become closer to the parent, such as a summer vacation, a holiday break, or a brief illness. It also may follow a stressful occurrence, such as the death of a pet or relative, a change in schools, or a move to a new neighborhood.

The youngster may complain of a headache, sore throat, or stomachache shortly before it is time to leave for school. The illness subsides after the youngster is allowed to stay home, only to reappear the next morning before school. In some cases the youngster may simply refuse to leave the house. Since the panic comes from leaving home rather than being in school, frequently the youngster is calm once in school.

Signs of a psychiatric disorder called separation anxiety disorder can include the following:

• Excessive reluctance to be alone at any time
• Excessive worry about losing a parent; excessive worry that a parent might be harmed
• Persistent refusal to go to sleep without a parent or other caretaker present
• Repeated complaints of physical symptoms whenever the child is about to leave a significant parental figure
• School refusal

These behaviors must begin before the child is aged 18 years, must last for 4 weeks or longer, and must cause serious problems with academic, social, or other functioning in order to be called a disorder.

Some commonly cited reasons for refusal to attend school include the following:

• A death in the family of a friend of the child
• A parent being ill (Surprisingly, school refusal can begin after the parent recovers.)
• Jealousy over a new brother or sister at home
• Moving from one house to another during the first years of elementary school
• Parents separating, having marital problems, or having frequent arguments
• Parents worrying about the child in some way (for example, poor health)

Other problems at school that can cause school refusal include feeling lost (especially in a new school), not having friends, being bullied by another child, or not getting along with a teacher or classmates.

Kids with an unreasonable fear of school may:

• display clinging behavior
• display excessive worry and fear about parents or about harm to themselves
• fear being alone in the dark, or
• feel unsafe staying in a room by themselves
• have difficulty going to sleep
• have exaggerated, unrealistic fears of animals, monster, burglars
• have nightmares
• have severe tantrums when forced to go to school
• shadow the mother or father around the house

Such symptoms and behaviors are common among kids with separation anxiety disorder. The potential long-term effects (anxiety and panic disorder as an adult) are serious for a youngster who has persistent separation anxiety and does not receive professional assistance. The youngster may also develop serious educational or social problems if their fears and anxiety keep them away from school and friends for an extended period of time.

When fears persist the parents and child should consult with a qualified mental health professional, who will work with them to develop a plan to immediately return the youngster to school and other activities. Refusal to go to school in the older youngster or adolescent is generally a more serious illness, and often requires more intensive treatment.

Excessive fears and panic about leaving home/parents and going to school can be successfully treated.

Although young kids usually find going to school fun and exciting, 1 in 4 kids may occasionally refuse to attend school. Such behavior becomes a routine problem in about 2% of children. Many kids with school refusal have an earlier history of separation anxiety, social anxiety, or depression. Undiagnosed learning disabilities or reading disorders may also play a significant role in the development of school refusal.

Parents or other caregivers can do several things to control school refusal before it becomes a routine, troublesome behavior.

• Firmly getting the kid to school regularly and on time will help. Not prolonging the goodbyes can help as well. Sometimes it works best if someone else can take the kid to school after the parent or caregiver says goodbye at home.

• It truly helps to believe that the kid will get over this problem; discuss this with the kid (the parent or caregiver needs to convince himself or herself of this before trying to convince the kid).
  

• Listening to the kid's actual concerns and fears of going to school is important. Some of the reasons for refusing to attend school may include another kid at school who is a bully, problems on the bus or carpool ride to school, or fears of inability to keep up with the other students in the classroom; these issues can be addressed if they are known. On the other hand, making too big a deal of school refusal may promote the kid's behavior to continue.
  

• Supportive counseling is often made available at school in these circumstances so as to minimize reinforcement of school avoidant behaviors and to prevent secondary gain from school refusal and should be encouraged for any student who wishes to have it. If the kid simply refuses to go to school, some parents have found that decreasing the reward for staying home helps, for example, do not allow video games or television, or find out what work is being done in the school and provide similar education at home, when possible. This is especially if the "illness" seems to disappear once the kid is allowed to stay at home.

• The parent or caregiver should reassure the kid that he or she will be there upon the kid's return from school; this should be repeated over and over, if necessary. Let the kid know that the parent or caregiver will be doing "boring stuff" at home during the school day. Always be on time to pick the kid up from school if you provide transportation rather than a school bus.
  

• Whenever events occur that could tend to cause students to miss school (for example, traumatic events such as terrorism, school shootings, or other traumas) all attempts should be made to help students return promptly to school and to help them to feel safe at school.
  

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Psychiatric Medication (Meds) For Kids And Teenagers

Part I: How Meds Are Used

Meds can be an effective part of the treatment for several psychiatric disorders of childhood and adolescence. A doctor's recommendation to use medication often raises many concerns and questions in both the parents and the youngster. The physician who recommends medication should be experienced in treating psychiatric illnesses in kids and teenagers. He or she should fully explain the reasons for medication use, what benefits the medication should provide, as well as possible risks and side effects and other treatment alternatives.

Psychiatric medication should not be used alone. The use of medication should be based on a comprehensive psychiatric evaluation and be one part of a comprehensive treatment plan.

Before recommending any medication, the child and adolescent psychiatrist interviews the youngster and makes a thorough diagnostic evaluation. In some cases, the evaluation may include a physical exam, psychological testing, laboratory tests, other medical tests such as an electrocardiogram (EKG) or electroencephalogram (EEG), and consultation with other medical specialists.

Meds which have beneficial effects may also have side effects, ranging from just annoying to very serious. As each youngster is different and may have individual reactions to medication, close contact with the treating physician is recommended. Do not stop or change a medication without speaking to the doctor. Psychiatric medication should be used as part of a comprehensive plan of treatment, with ongoing medical assessment and, in most cases, individual and/or family psychotherapy. When prescribed appropriately by a psychiatrist (preferably a child and adolescent psychiatrist), and taken as prescribed, medication may reduce or eliminate troubling symptoms and improve the daily functioning of kids and teenagers with psychiatric disorders.

Medication may be prescribed for psychiatric symptoms and disorders, including, but not limited to:

1. Anxiety (school refusal, phobias, separation or social fears, generalized anxiety, or posttraumatic stress disorders)-if it keeps the youngster from normal daily activities.
2. Attention deficit hyperactivity disorder (ADHD)-marked by a short attention span, trouble concentrating and restlessness. The child is easily upset and frustrated, often has problems getting along with family and friends, and usually has trouble in school.
3. Autism-(or other pervasive developmental disorder such as Asperger's Syndrome)-characterized by severe deficits in social interactions, language, and/or thinking or ability to learn, and usually diagnosed in early childhood.
4. Bedwetting-if it persists regularly after age 5 and causes serious problems in low self-esteem and social interaction.
5. Bipolar (manic-depressive) disorder-periods of depression alternating with manic periods, which may include irritability, "high" or happy mood, excessive energy, behavior problems, staying up late at night, and grand plans.
6. Depression-lasting feelings of sadness, helplessness, hopelessness, unworthiness and guilt, inability to feel pleasure, a decline in school work and changes in sleeping and eating habits.
7. Eating disorder-either self-starvation (anorexia nervosa) or binge eating and vomiting (bulimia), or a combination of the two.
8. Obsessive-compulsive disorder (OCD)-recurring obsessions (troublesome and intrusive thoughts) and/or compulsions (repetitive behaviors or rituals such as handwashing, counting, checking to see if doors are locked) which are often seen as senseless but which interfere with a youngster's daily functioning.
9. Psychosis-symptoms include irrational beliefs, paranoia, hallucinations (seeing things or hearing sounds that don't exist) social withdrawal, clinging, strange behavior, extreme stubbornness, persistent rituals, and deterioration of personal habits. May be seen in developmental disorders, severe depression, schizoaffective disorder, schizophrenia, and some forms of substance abuse.
10. Severe aggression-which may include assaultiveness, excessive property damage, or prolonged self-abuse, such as head-banging or cutting.
11. Sleep problems-symptoms can include insomnia, night terrors, sleep walking, fear of separation, anxiety.

Part II: Types Of Meds

Psychiatric meds can be an effective part of the treatment for psychiatric disorders of childhood and adolescence. In recent years there have been an increasing number of new and different psychiatric meds used with kids and teenagers. Research studies are underway to establish more clearly which meds are most helpful for specific disorders and presenting problems. Clinical practice and experience, as well as research studies, help physicians determine which meds are most effective for a particular child. Before recommending any medication, the psychiatrist (preferably a child and adolescent psychiatrist) should conduct a comprehensive diagnostic evaluation of the child or adolescent. Parents should be informed about known risks and/or FDA warnings before a child starts any psychiatric medication. When prescribed appropriately by an experienced psychiatrist (preferably a child and adolescent psychiatrist) and taken as directed, medication may reduce or eliminate troubling symptoms and improve daily functioning of kids and teenagers with psychiatric disorders.

· ADHD Meds: Stimulant and non-stimulant meds may be helpful as part of the treatment for attention deficit hyperactive disorder (ADHD). Examples of stimulants include: Dextroamphetamine (Dexedrine, Adderal) and Methylphenidate (Ritalin, Metadate, Concerta). Non-stimulant meds include Atomoxetine (Strattera).

· Anti-anxiety Meds: These meds may be helpful in the treatment of severe anxiety. There are several types of anti-anxiety meds: benzodiazepines; antihistamines; and atypicals. Examples of benzodiazepines include: Alprazolam (Xanax), lorazepam (Ativan), Diazepam (Valium),and Clonazepam (Klonopin). Examples of antihistamines include: Diphenhydramine (Benadryl), and Hydroxizine (Vistaril). Examples of atypical anti-anxiety meds include: Buspirone (BuSpar), and Zolpidem (Ambien).

· Antidepressant Meds: Antidepressant meds may be helpful in the treatment of depression, school phobias, panic attacks, and other anxiety disorders, bedwetting, eating disorders, obsessive-compulsive disorder, personality disorders, posttraumatic stress disorder, and attention deficit hyperactive disorder. There are several types of antidepressant meds. Examples of serotonin reuptake inhibitors (SRI's) include: Fluoxetine (Prozac), Sertraline (Zoloft), Paroxetine (Paxil), Fluvoxamine (Luvox), Venlafaxine (Effexor), Citalopram (Celexa) and Escitalopram (Lexapro). Examples of atypical antidepressants include: Bupropion (Wellbutrin), Nefazodone (Serzone), Trazodone (Desyrel), and Mirtazapine (Remeron). Examples of tricyclic antidepressants (TCA's) include: Amitriptyline (Elavil), Clomipramine (Anafranil), Imipramine (Tofranil), and Nortriptyline (Pamelor). Examples of monoamine oxidase inhibitors (MAOI's) include: Phenelzine (Nardil), and Tranylcypromine (Parnate).

· Antipsychotic Meds: These meds can be helpful in controlling psychotic symptoms (delusions, hallucinations) or disorganized thinking. These meds may also help muscle twitches ("tics") or verbal outbursts as seen in Tourette's Syndrome. They are occasionally used to treat severe anxiety and may help in reducing very aggressive behavior. Examples of first generation antipsychotic meds include: Chlorpromazine (Thorazine), Thioridazine (Mellaril), Fluphenazine (Prolixin), Trifluoperazine (Stelazine), Thiothixene (Navane), and Haloperidol (Haldol). Second generation antipsychotic meds (also known as atypical or novel) include: Clozapine (Clozaril), Risperidone (Risperdal), Quetiapine (Seroquel), Olanzapine (Zyprexa), Ziprasidone (Geodon) and Aripiprazole (Abilify).

· Long-Acting Meds: Many newer meds are taken once a day. These meds have the designation SR (sustained release), ER or XR (extended release), CR (controlled release) or LA (long-acting)

· Mood Stabilizers and Anticonvulsant Meds: These meds may be helpful in treating bipolar disorder, severe mood symptoms and mood swings (manic and depressive), aggressive behavior and impulse control disorders. Examples include: Lithium (lithium carbonate, Eskalith), Valproic Acid (Depakote, Depakene), Carbamazepine (Tegretol), Gabapentin (Neurontin), Lamotrigine (Lamictil), Topiramate (Topamax), and Oxcarbazepine (Trileptal).

· Sleep Meds: A variety of meds may be used for a short period to help with sleep problems. Examples include: Trazodone (Desyrel), Zolpidem (Ambien), Zaleplon (Sonata) and Diphenhydramine (Benadryl).

· Miscellaneous Meds: Other meds are also being used to treat a variety of symptoms. For example: clonidine (Catapres) may be used to treat the severe impulsiveness in some kids with ADHD and guanfacine (Tenex) for "flashbacks" in kids with PTSD.

Part III: Questions To Ask

Medication can be an important part of treatment for some psychiatric disorders in kids and teenagers. Psychiatric medication should only be used as one part of a comprehensive treatment plan. Ongoing evaluation and monitoring by a physician is essential. Parents and guardians should be provided with complete information when psychiatric medication is recommended as part of their child's treatment plan. Kids and teenagers should be included in the discussion about meds, using words they understand. By asking the following questions, kids, teenagers, and their parents will gain a better understanding of psychiatric meds:

1. Are there any activities that my child should avoid while taking the medication? Are any precautions recommended for other activities?
2. Are there any laboratory tests (e.g. heart tests, blood test, etc.), which need to be done before my child begins taking the medication? Will any tests need to be done while my child is taking the medication?
3. Are there any other meds or foods, which my child should avoid while taking the medication?
4. Are there interactions between this medication and other meds (prescription and/or over-the-counter) my child is taking?
5. Does my child's school nurse need to be informed about this medication?
6. How long will my child need to take this medication? How will the decision be made to stop this medication?
7. How will the medication help my child? How long before I see improvement? When will it work?
8. Is this medication addictive? Can it be abused?
9. What are the side effects, which commonly occur with this medication?
10. What do I do if a problem develops (e.g. if my child becomes ill, doses are missed, or side effects develop)?
11. What is known about its helpfulness with other kids who have a similar condition to my child?
12. What is the cost of the medication (generic vs. brand name)?
13. What is the name of the medication? Is it known by other names?
14. What is the recommended dosage? How often will the medication be taken?
15. Will a child and adolescent psychiatrist be monitoring my child's response to medication and make dosage changes if necessary? How often will progress be checked and by whom?

Treatment with psychiatric meds is a serious matter for parents, kids and teenagers. Parents should ask these questions before their child or adolescent starts taking psychiatric meds. Parents and kids/teenagers need to be fully informed about meds. If, after asking these questions, parents still have serious questions or doubts about medication treatment, they should feel free to ask for a second opinion by a child and adolescent psychiatrist.

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How to talk to your teenager—

But first, be a better listener…

Have you ever talked on the telephone while watching TV, folding clothes, or surfing the Internet? Have you ever felt that the person you were talking to was nodding and saying "uh-huh" in appropriate places but not really listening to you? The message conveyed in these examples is that the listener has higher priorities than giving full attention to the speaker. That message can make the speaker feel unimportant, frustrated, and hurt.

Good listening is one of the most important skills we as moms and dads can develop. We want to strengthen our relationships with our teenagers, and one of the best ways to do this is through our active, caring listening. Our undivided attention to what our teenagers are saying tells them that they are important to us. It shows that we value them as individuals; we care about them and every part of their lives. Also, we can teach them to be good listeners by modeling good listening skills.

What To Know

Be prepared to drop what you are doing when your kid wants to talk, even when it is not the most convenient time for you. A kid or teen may finally get up the courage to discuss a tough problem, and you don't want to miss the opportunity to connect with him through active listening.

What To Do

Ask open-ended questions. Avoid asking questions that can be answered with a yes or no.

Be interested and attentive. Look into your kid's eyes while she is speaking. Forget about the telephone, the television, and whatever else you were doing—just listen!

Don't interrupt. Sometimes, as moms and dads, we want to jump into the conversation with an opinion or a solution before letting our kid finish talking. By being an active listener, we can help him work through an issue on his own instead of solving the problem for him.

Don't talk down to your kid no matter what his age. You probably know more than he does from experience alone, but don't use this knowledge to discount his opinions. Don't say, for example, "You're only 14. What do you know about…?"

Follow-up. Try to remember and ask about issues or events your kid talked about a day or two earlier. This shows her that you were listening and are concerned about the outcomes.

Give your kid active feedback while she is speaking—nodding, giving verbal responses such as "I see," etc. When she has finished speaking, ask clarifying questions or restate what she's said. If she is telling you something she is enthusiastic about, for example, try to respond with similar enthusiasm.

Name the feeling You can help your kid clarify his feelings through your active feedback by restating his thoughts or asking questions. This can help him deal with a problem or tackle a difficult task. He can clarify, for example, that he's avoiding his homework because he's afraid he can't do the math. Facing this fear will help him overcome it.

Watch for nonverbal messages. Posture, eye contact, and energy level—these can all be clues to your kid's true feelings. She may tell you school is going okay but her nonverbal messages may tell a different story.

Communication Barriers and How To Overcome Them

Talking to your preteen or teenager sometimes can be a bit difficult. Maybe you start to chat with your kid and you get a "look" that immediately stops conversation. Or, maybe your kid wants to talk to you, but you're focusing on paying the bills and are not giving him your full attention.

Studies show, however, that talking to your teenagers does have an impact, so it's important to make the effort to really communicate. Here are some common communication barriers and how to overcome them. Remember, not all of these will work in all situations, and sometimes you'll need to keep trying. Put in the effort—the reward will be a better relationship and improved communication with your kid.

1. Blaming or preaching: Instead of saying things that make your kid feel bad ("You're so stupid for doing that," or "I said so, that's why"), try using constructive "I" messages like "So, what I hear you saying is…" Offer advice and suggestions: "Let's consider what your options are and figure out the best solution…"

2. Criticizing: Let your kid know that you respect her feelings and that what she has to say and how she feels are important. Even if you think a problem is minor, for example, if your kid is upset because his friend wouldn't sit next to him, it's a big deal to him. It's hard to open up sometimes and if you make your kid feel uncomfortable, chances are he will simply avoid having honest conversations with you.

3. Interrupting: Let your kid talk without interrupting her—you will have your turn to speak. This lets your kid know that you are interested in what she is saying.

4. Not creating a comfortable environment in which your kid can talk: Select a good time to talk to your kid—right after school or basketball practice might not be the best time to start a dialog. Let your kid have a snack or take a few minutes to rest, and then start the conversation.

5. Not paying full attention to your kid: Turn off the TV or radio. Make eye contact with your kid—sit next to him if you need to.

Remember to praise your kid when she demonstrates good listening skills. It's just as important to develop these skills in your kid as it is in you!

Empathic Communication

Effective communication—the sharing of ideas, opinions, and information—helps you to build bonds with your kid. Doing this right with your kid will encourage positive behaviors in him, help to build trust, and create a more peaceful atmosphere in the home. Not getting this right, however, could cause frustration in your kid and stress in the family.

What To Know…

Does what you say to your kid encourage her to behave in ways that please you? If you don’t like your answer to this question, check your day-to-day dealings with your kid.

You may not be getting the response you expect from your kid if:

• You act like a bully toward your kid.
• You allow your kid to break rules without consequences.
• You always answer her question “why do I have to?” with “because I said so.”
• You ask your kid to do more than he is able to for his age.
• You complain about what your kid is doing wrong, but never praise her when she does something well.
• You give too little instructions.
• You give too many instructions at a time.
• You let your kid call the shots every time and never take charge.
• You never admit to being wrong.
• You never take the time to explain “why.”
• You use silence to show your disapproval.
• Your kid sees you doing the actions that you tell her not to do.

What To Do…

Sending mixed or unclear messages when you talk with your kid could hurt your kid’s self-esteem and open the door to problem behavior. There are ways to talk with your kid more effectively and build a stronger bond with him—

• “Because I say so” is not the best answer—explain the reasons why.
• Be careful about asking too much—because of age or ability a kid may not be able to do some tasks well. Especially for new tasks, give detailed instructions for the chores you want the kid to do.
• Be specific—don’t leave things open to interpretation.
• Do not ask something of your kid you are not willing to do yourself—don’t yell at your kid for lying and then ask her to lie to someone for you.
• Do things together—use these opportunities to talk with and learn about your kid.
• Expect set-backs—but deal with them as soon as they happen. Talk about things that you don’t like about your kid’s actions. Find a solution together, even when discipline is involved.
• Give a little—your kid is still learning, and your responsibility is to teach with understanding.
• It’s ok to negotiate sometimes—it teaches your kid the benefits of “give and take” which he may find useful later in life.
• Reward your kid for doing well—praise for a job well done will make your kid feel good about herself and eager to please you in other things.
• Some decisions need time—your kid will see that you care about what he cares about by giving serious thought to issues that are important to him, before just saying “no.”
• Talk with your kid and not to or through him—this means listening as well as responding.
• Treat your kid with respect—don’t yell at your kid and call her names. She will only learn from your example. Speak to your kid in the same manner you would like her to speak to you.
• You’re the grown-up—have the final say about important decisions, but explain to your kid the reasons why you have made the decision.

Having adults in the “take charge” role makes teenagers feel secure and adds to their mental well-being. However, teenagers who think they are not being treated fairly by adults could become angry and mistrustful of authority. Such teenagers are more likely to be influenced by peers to be involved in unhealthy behaviors, like alcohol, drug, and tobacco use. Good adult/kid communication can go a long way in deterring unsafe behaviors and influencing the choices teenagers make for a lifetime.

I Statements

Healthy communication is critical to relationships, but is especially important between moms and dads and teenagers. Is your kid listening? Does she understand you? Is your message really getting through? Showing your kid how to communicate is part of parenting, but it becomes especially difficult in times of conflict.

One way to communicate with your kid is by using feeling language or "I" statements—a way of expressing how you feel about a situation without placing blame or drawing a defensive or argumentative response from your kid.¹ Saying "you did this wrong" or "you did that bad thing" often makes people feel angry and hostile. "I" statements can help you communicate your feelings to your kid in a way that makes him likely to respond with respect. "I" statements also provide teenagers with clear, direct messages and help them understand that their actions have effects on other people. Here are a few examples:

• When you scream loudly, I feel upset because it hurts my ears.
• When you try to talk to me when I am on the phone, I feel annoyed because then I have to try to listen to more than one person.

"I" statements also can be used to express positive feelings:

• When you do your homework, I feel proud because I think that school is important.

To begin using "I" statements, follow a basic format of three parts:

1. When… (provide nonjudgmental description of behavior)
2. I feel… (name your feeling)
3. Because… (give the effect the behavior has on you or others).

Using "I" statements may feel awkward at first, but with a little practice, it will become a regular part of your communication style.

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