Cognitive-Behavioral Therapy for Bipolar Disorder (Ramirez Basco & Rush) should be required reading for any psychotherapist or client who is diagnosed with Bipolar Disorder. The “Common Symptoms of Mania” and “Common Symptoms of Depression” are two tables I usually give to clients and their loved ones. I find that they can be very helpful starting points for developing early detection protocols for relapse. You can view these tables at no cost through Google Books but I highly recommend purchasing the book as it is full of great information and insight.
Adolescence is one of several critical developmental stages we go through during our life time. Much focus has been made on this stage of development due to the volatility (biological, familial, social) it carries. Given the tasks associated with this stage in relation to individuation, identity, social development, physical development and achievement, it is fair to assume that teen behaviors may sometimes appear confusing and strange. These behaviors can present significant challenges for parents of teens who struggle with ADHD, Anxiety, Depression, Oppositional Defiant Disorder (ODD) or other mental health issues. The presence of a mental health issue can lead to school avoidance, isolation, anger, substance abuse and a host of other problems that may be misinterpreted as defiant in intent. We run the risk of sticking the defiance label on all of these behaviors as a result of how we are influenced by the larger culture’s narrative surrounding adolescence.
For example, anger issues and overt rebellion may not necessarily be the product of ODD and treating defiance in a manner consistent with this assumption (emphasizing boundaries, dispassionate consequences) may feel harsh and confusing to the teen who may be struggling with depression, bipolar disorder or significant familial issues. Instead of influencing positive behavior change, this type of parenting intervention may make the problem worse. Many times defiance is a symptom of an underlying issue; anger and irritability is a common symptom of mood disorders. School avoidance and rigidity is a common feature of many anxiety disorders. The natural dynamic of the family and changes within the family system can also play a role in amplifying or mitigating the severity of the issue. What may make the situation even more confusing is that the teen may minimize or maximize the impact the family system has in influencing their thoughts, emotions or actions for several reasons.
This is not to say that clear boundaries and consequences are not necessary, I wrote about the risks associated with using parenting techniques focused on empathy and understanding with teens who present with ODD last October. At that time I argued that regardless of where the behaviors are coming from it may be appropriate (sometimes) to go the route of emphasizing consequences and boundaries initially but then shift as the defiant behaviors lessen and the presence of more biologically based symptoms arise or become clearer; which I still believe holds true.
The reality is that parents may have to adjust their parenting styles several times during the course of adolescence, regardless of whether their teen struggles with a mental health issue or not. It involves a shift in thinking from a position focused solely on principle to one that also includes questions surrounding effectiveness. This does not mean that parents of struggling teens are “bad” or “ignorant” nor does it demonstrate a lack of love or compassion. It is a matter of learning when to use their natural skill set in managing the issues driving the behaviors and when to pull a skill from a way of thinking about a problem that may be different and unfamiliar.
Over the next few weeks I’ll be writing a bit more on parenting approaches specific to different types of issues. There will be some overlap across these issues but also some distinct differences. The take away from this post, I hope, is that defiance is not necessarily evidence of ODD; the behaviors that appear defiant need to be understood within the larger context and with the teens understanding of that context in mind. The overall approach in addressing these issues will always attempt some balance between accountability, compassion and understanding. The challenge is in deciding where to come from in a given situation and what the response should look like.