What Works for Troubled Teens?

NEWS: When kids have behavioral problems—but not severe disabilities—experts say the best treatment is not boot camp, but plain old family therapy.

By Maia Szalavitz

August 20, 2007

School of Shock School of Shock By Jennifer Gonnerman Food deprivation. Isolation. Electric shocks. Inside the taxpayer-funded program that treats American kids like enemy combatants. Sidebars • Nagging? Zap. Swearing? Zap: New York's Investigations of the Rotenberg Center • Why Can't Massachusetts Shut Matthew Israel Down? • The Cult That Spawned the Tough-Love Teen Industry • Experts on Self-Injurious Kids Challenge Dr. Israel's Methods » What Works for Troubled Teens? Photo Essay on the Rotenberg Center Primary Sources TOOLS E-mail article Print article BACKTALK E-mail the editor

The most effective treatments for troubled teenagers have these things in common: They use family-based therapies; they treat adolescents with empathy, dignity, and respect; and, except for very short periods of emergency stabilization, they keep teens at home.

Research has proven the effectiveness of a number of methods for treating youth with behavioral and other problems—including functional family therapy, cognitive-behavioral family therapy, and multisystemic family therapy (the latter, ironically, is available almost exclusively to kids in the juvenile justice system). All of them focus on improving communication between children and parents, setting clear boundaries, and ensuring that teenagers' developmental needs for increased freedom, social connection, and responsibility are recognized and met in safe and healthy ways. Inpatient treatment happens only on a short-term basis when a child is a threat to himself or others.

Since most problems involve fractured family relationships, recovery requires repairing those bonds—connections that can be harder to rebuild if a child spends years away from home. "Youth will modify their dangerous behavior in response to practical, problem-solving, behavioral therapies—if they feel respected and cared for by the therapist," explains Charles Huffine, a child and adolescent psychiatrist in private practice in Seattle.

Effective therapies also recognize that different problems require different approaches. What helps a kid with autism or Asperger's is different from what is needed for a child with conduct disorder or depression or drug addiction. Appropriate medication and talk therapies tailored to these conditions can make all the difference. Residential programs, on the other hand, are generally one size fits all, even while they claim to offer individualized care.

Huffine notes that getting youths to change their behavior often takes longer than parents realize (or hope for). He recommends avoiding programs that promise too much, as well as those that exaggerate the danger of problematic but common teen troubles such as poor grades, bad attitudes, and experimentation with drugs. "Such programs," says Huffine, "exploit parents who feel desperate."

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What are the 8 states, in addition to DC, that send children to the Rotenberg Center? It would help children's advocates in those states. Thanks for this important work.

Posted by:Elaine AlfanoAugust 20, 2007 6:06:40 AMRespond ^

(1) there aren't a sufficient number of skilled therapists to go around; (2) family therapy works if parents are willing to participate, even if it gets hard for them. Doesn't work so well if they refuse to participate ("nothing's wrong with me/us", "I don't need someone to tell me how I messed up") or try to sabotage the therapy.

Posted by:azuriteAugust 20, 2007 11:37:19 AMRespond ^

I retired from a Community Mental Health program that worked jointly with the Intermediate School District in the county to provide therapy and intense therapy and special education to severely emotionally impaired high school students. My role in this was to provide individual and group therapy at school and family therapy either in my office or at the family's home. This was an excellent program with very good results. The program no longer exists, it cost too much. It certainly did not cost $200,000 per year per student but it was more than regular special ed. I found that those parents who "worked" in family therapy got the best results for their kids. My philosophy was that they were not the problem but a big part of the solution. They were tired and worn out from battles from toddlerhood through junior high school. Many of the students had decent IQs but were saddled with learning disabilities that were never addressed nor compensated for. There appears to be a prevailing belief that neurological problems can be solved using the same methods that work with "normal" brains. So if they don't get it you just make them do it over and over again until they do. The students turn off, think they are stupid and become good at disrupting the class. That's how many boys (especially) got referred to our program. Those students with real psychological problems, including schizophrenics and bipolar clients were able to make great strides in an environment of respect, cooperation, clear boundaries and expectations. We did have one client with Aspergers but those with low functioning autism were treated at another center. Our students were integrated into 1 or 2 mainsteam classes before returning to their district high school to graduate. A great program with impressive results--gone-- because the state funding went away. Makes you wonder where our values really are.

Posted by:SallyAugust 20, 2007 2:22:29 PMRespond ^

This is another example of why we need a universalized health care system in the United States. We need to be able to take our kids to real doctors, and therapy programs need to be regulated.

Posted by:HollyAugust 21, 2007 1:17:38 AMRespond ^

There are residential programs that do some good. However? They're focused on a real theraputic approach. Some of them DO use vigorous exercise- but physical pain for trivial infractions? NEVER. I attended one as a kid when my parents thought it would help my depression. (My very athletic dad, I suspect, felt I would be 'cured' if I just got more exercise- I've always been a bookworm) And it did teach me a lot- that my limits were a LOT further than I thought, that I was tougher than I thought- and that druggie boys from chicago and NYC were big wimps that could be terrified with stories aobut rampaging cows by a skinny little girl from Texas cattle country. (SUWS was the program I went to- if any parents are reading this and feel like JRC is justified for the 'high functioning'? Go research them and talk to them, they're one of the good ones, for the most part.)

Posted by:ChangerAugust 21, 2007 6:51:37 PMRespond ^

To keep your self out of the high risk group..do not lie to your parents. They will find out. You have already do planty you don't want your parents to know. Pick a low cost item and give that up with out the expense of others. Slowly admit you did see some beer cans piled high in some of the oictures from spring break, you just assumed she had seemed them too. But not a problem. WE ARE WORKING ON COLLEGE!!!

Posted by:Kenneth PenningtonAugust 21, 2007 8:39:34 PMRespond ^

I have posted an extensive response to Ms. Gonnerman's article in the forum under the main article at http://www.motherjones.com/news/feature/2007/09/school_of_shock.html Matthew L. Israel,Ph.D. Executive Director Judge Rotenberg Educational Center www.judgerc.org

Posted by:Matthew L. IsraelAugust 23, 2007 11:36:15 PMRespond ^

And for a fully formatted version of my response to Ms.Gonnerman's article, please see http://www.judgerc.org/ResponsetoGonnermanArticle.pdf Matthew L. Israel, Ph.D. Executive Director Judge Rotenberg Educational Center

Posted by:Matthew L. IsraelAugust 24, 2007 12:26:51 AMRespond ^

I have worked quite closely with a number of troubled children. Almost none of the programs which they attended included research based interventions, academic instruction sufficient to close the gap with their peers (lack of academic success is a BIGG reason for the hopelessness that leads to self-destructive behavior), or even good examples by staff who themselves adhered to societal norms, that troubled students need to address their issues. If you are a parent looking for a program for a child with PTSD or depression, make sure they use cognitive behavioral therapy (or for PTSD, EMDR). Also explore whether they will consider using propranolol (newly experimental off label use) if other methods don't resolve the issue. And find out whether the people running the program (and by this I mean those who are around when the senior staff goes home) are selected and sufficiently paid to attract people who themselves have self-discipline and live by high standards of integrity, and who care about the kids. Examine the school services --- often programs are staffed by teachers who have been discliplined in other settings, and/or who are burned out (because there are no parents around paying attention and screaming bloody murder), when this group of students need those who have the most content knowledge, the most up to date knowledge of interventions that work, and the most personal integrity and work ethic. Yes, there are really troubled children out there. But a national study of school discipline about ten years ago found that as many as half of the student's objectionable behavior was either caused or made worse by the school staff's response. So before placing the entire onus on a student, we really need to figure out what is triggering the behavior and why, and fix the underlying issue.

Posted by:Rosemary N. PalmerAugust 24, 2007 5:35:34 AMRespond ^

There is a much varied difference in working with "troubled teens" and people that are severly disturbed; (for example if someone bangs their head 20 times and doens't know that its going to injure them) than the treatment would obviously be quite different. You have to use some plain old fashioned common sense. And, as I read the different blogs and responses; I haven't seen that. Unfortunately; there isn't enough love to wish all of this away. If it did, the parents would be eternally grateful. I have also read about exploiting parents, from what I have seen this is just ridiculous. Parents of these kinds of children whether young or old are overwhelmed; yes; and are they desperate ? Of course, but they struggle with these decisions and they certainly want to do the best they can for their kids they don't just want to hide their loved ones away and never see them get better or have a better quality of life; they recognize that- when they go from doctor to doctor; facility to facility; hospital to hospital and they offer no reasonable solutions. The parents know exactly what they are getting into; on another note, I don't want somebody else telling me what I can and cannot do with my child, especially when it comes to treatment. Since the parents know best; let them decided; you underestimate the concerns of the parents when you do that. One should know that we are not talking about depression; or lack of family therapy, its much, much more than that. I have read that people say we should find the cause of what "triggers" these behaviors. These are people who act out no matter how much love, attention, counseling you give them. They are not fully aware of what they do. But remarkably, The Judge Rotenberg Center has found a good program to do just that. A therapist simply is not going to help; nor is a medical doctor, nor is a mental health progam. (Although they work in conjunction) This simply is not the answer. You have to only see one of these students there to grasp what I am talking about. This center takes the most severe cases I have seen and with remarkable results. It's a pity what a one-sided article can cause. I have to touch upon the cost because its a point of contention with some folks; This amount is including the best of care; doctors; specialists; food, residential care, (full time) meaning all day all nite. schooling, clothes, etc. Some of the students have been there for years. Think about what it would cost to hire someone to watch your child 24/7?. Not a healty aware child; someone that demands your full attention on a minute to minute basis. A lot of the direct care staff works with one student so its one to one for the most part; except when the group is together and even then they are solely responsible for that one individual; what an awesome responsibility. These students are given a plan geared for them; that they seem to understand. They have boundaries and know that if they have a bad behavior they will be discplined; and thats just what they need.The next day everything is forgotten and another day begins with the same goals and boundaries. If they behave well, they get all the rewards they want; and then they think that well next time; If I don't bang my head till it bleeds; I can get that toy I want. The concept is simple and it works. Why are people afraid to do this to their own kids; who are healthy and are fully aware of what they are doing. There is a good structure here and I hope that the students do not suffer from the lack of knowledge about the school.

Posted by:TeriAugust 29, 2007 9:46:58 AMRespond ^

Great article! Most important things which troubled teens need is support from parents. Schools, camps and programs are available for teens help. Parents can sarch troubled teens schools using troubledteensguide.com.

Posted by:ChadAugust 29, 2007 1:06:40 PMRespond ^

Thanks You... for information. I can find one good schools for troubled teens. http://www.restoretroubledteens.com

Posted by:MonicaAugust 29, 2007 1:09:25 PMRespond ^

i need help i can not take much more i am not a person to easy cry but my son has pushed the final button this time and i cried out of being mad.

Posted by:patAugust 30, 2007 5:06:34 PMRespond ^

i am sorry i can't fully agree with this article we the parents have been in therapy with our trouble teen for almost two years and she continues to act out she still refuses to follow any of the house rules we have tried every thing the therapist recommented and nothing seens to work we too are at our wits end and we have worked with cmo and outpost therapy and counslers and professional spychologist

Posted by:donnaSeptember 8, 2007 5:51:07 PMRespond ^

thanxs for the info about having a troubled teen. Nad how to deal with a trouble teen. Agian Thanks for the information about and what to do with a troubled teen or a depressed teen. Now I can look a school for my trouble teen.

Posted by:unknowSeptember 10, 2007 6:48:05 AMRespond ^

I think 3 things really works for troubled teens. Boarding Schools Residential Treatment Center Summer Programs

Posted by:Troubled TeensSeptember 15, 2007 11:37:51 PMRespond ^

http://www.troubledteensguide.com is really good website to find options that works for troubled teens.

Posted by:TroubledTeensSeptember 15, 2007 11:38:50 PMRespond ^

I agree family based therapies are a piece to the puzzle. As the parent of a troubled adolescent, the family in conjunction with a residential treatment placement, that specializes in DBT, and unfortunately meds also need to be a piece of our puzzle. My son is 17, so family therpay helps but he also needs the DBT component to help teach life schools and the medication to help his thought process. In my opinion, another CRUCIAL component are state wide services for kids and families in need. Our case became extreme as we were placed on waitlists for programs because of the need for so many of today's kids needing services.

Posted by:LisaSeptember 21, 2007 9:01:44 AMRespond ^

i'm a teen and i think this is not the most beat way i think givving us more freedomand being less judgmentle would help bunches and if it is owr friends you dont like dont go to us about it we are tottily biest we'll defend our friends talk to theyr parents....

Posted by:vanityOctober 6, 2007 8:39:37 AMRespond ^

I was reading about self-injury a while back (looking for ways to stop minor cutting). I read a comment by one girl who broke her own bones. She was not diagnosed with any mental illness, but was severely abused, both physically and emotionally. This is actually common to self-injury. Invalidation seems to be universal--the single most common experience of people who self-injure is the experience that their thoughts, feelings, and experiences are meaningless, irrelevant, incorrect, wrong, or diseased. A website run by a psychologist described at length the forces that can lead to self-injury in more or less anyone. Then there was a very brief paragraph about self-injury and other mental illnesses. What the entirety of the paragraph came down to is that people with "mild" mental illnesses might self-injure for some of the same reasons others do (the paper used to term "normal people") but folks with mental retardation or forms of autism or other things might be positively reinforced by the attention that they recieve. That was it. No studies were cited, no speculation on other reasons for self-injury in autistics or what the paper referred to as "retarded clients," nothing about people with schizophrenia react to society. It is as if he did not even pause to consider that people with mental retardation or autism or other "severe" mental conditions may recieve far more invalidation than those with "mild" or no disorder at all. It did note that those with "normal" intelligence that get treated like six-year-olds experience this as invalidating, but the fact that the same treatment of someone with a "severe" mental illness could be experienced the same way was never acknowledged. It talked about the stereotype of silf-injurers being "attention-seeking" then went on to apply that very same stereotype to people with mental illness. In the face of such deep prejudice, it is no wonder that self-injurious behavior can become so severe in people who recieve such labels. We want to believe that western society is as good as it can be. In a way, that is simply a form of laziness, because as deeply entrenched as prejudice can be, it can still be overcome and nearly eradicated.

Posted by:TacitusOctober 7, 2007 5:08:10 PMRespond ^

Teri--some people self-injure as a means of regulating sensory input. The answer is not punishment, it's to develop strategies for dealing with a very confusing and overloading environment! It can be hard to do that with someone who doesn't speak, but that's exactly why people like you should stay in the office. By the way, do you really believe that someone perceived by others as not being sufficiently aware is getting all of their relationship needs met? Do you think someone who does not rely on speech to express their feelings gets those feelings validated? A different approach is needed, obviously, than with someone with different needs, but your way is NOT it.

Posted by:TacitusOctober 7, 2007 5:18:42 PMRespond ^

HOW DOES A PARENT KNOW IF THEY'RE GETTING THE RIGHT HELP FOR THEIR STRUGGLING CHILD? If you have a troubled teen and you want help--How do you know where to go to get the right therapy? How do you know if a therapy, program, or school (A) can help your child, and (B) is safe? How can you be sure a program or therapy is right for your child's and family's particular needs? You may need a Treatment or Education Consultant that knows the programs and the process for getting the right help for your family and for your child. A Treatment or Education Consultant is a firm staffed with objective clinicians who have deep experience in the teen behavioral health industry--people that know the therapies, schools, and programs; and a child's and family's needs; AND are NOT biased by programs' promises, web sites, and brochures. Basically professionals that go to programs and look under the sheets to make sure they're legitimate candidates to help specific family and teen behavioral health issues. Teen180 is one of these firms with associated licensed clinicians (LCSWs, etc.) Go online for teen180.com or call us at 801.226.2470 and ask for Star.

Posted by:Star HallOctober 11, 2007 4:58:40 PMRespond ^

is there any places that make you take a grade level test before going to the next grade

Posted by:michaelOctober 15, 2007 7:34:39 AMRespond ^

how

Posted by:derekOctober 15, 2007 7:35:53 AMRespond ^

uhhh i guess thats so rude of them and it makes no type of sense to tell you the truth

Posted by:Memeriolo SantanaOctober 22, 2007 3:08:40 PMRespond ^

shut the [deleted] up you dont know [deleted] you [deleted]ing jerk

Posted by:meriolia santanaOctober 22, 2007 3:09:45 PMRespond ^

is group counseling more or less aeffective than individual counseling

Posted by:luther dayNovember 23, 2007 10:04:22 AMRespond ^

Great article with wonderful insight. To find out more and get great teen help options for a troubled teen, go to: http://www.cthorg.com This is a place that certifies all teen help programs to ensure that credible resources are offered.

Posted by:John ValdezJanuary 3, 2008 6:25:02 AMRespond ^

Tacitus- just saw your response; let me explain; first of all it’s not my way; I simply agree with the treatment plan at the school; from what I have observed. You say that some people self injure themselves as a means of regulating sensory input. ? This all sounds good but what does this mean? These students injure themselves in peculiar - not the norm ways; we are not talking about someone that is depressed and cuts themselves, I guess, you don’t understand; unless you see the type of people that go to the school, I suggest you go to the JRC website and see the before and after videos; this will help you understand. And what the heck do relationship needs have to do with 24/7 care? We are talking about saving lives here; being in a relationship is not possible for these types of cases at all. Their very survival is getting through a day not banging their heads against a wall 50 times or more. This isn’t about teenagers just acting out; its much more than that. You mention punishment; again you are inaccurate. Punishment doesn’t really apply here. The students are rewarded when they behave and are not self-injurious. If they have a “bad” day; they are dealt with lots of compassion; time outs and encouragement from the staff. Keep in mind a “bad” day; doesn’t mean they are bad; it means that their self-inflictions resurface and depending upon the student and the circumstance they get positive reinforcement to get them through it. I have never seen anyone “punished” when I was there at least. You mention that I should stay in the office; you should stay out of the medical books; before you give free advice.

Posted by:TeriJanuary 29, 2008 1:05:16 PMRespond ^

Family therapy is an effective program for troubled teen. Family therapy is suitable if teen don’t have severe disabilities. Residential programs are also effective because they provide individualized care.

Posted by:NeviaFebruary 27, 2008 3:31:02 AMRespond ^

Boarding schools are more effective for troubled teens. Your site is really helpful for the parents of troubled teens who are searching for a good boarding school in which they can enroll their child.

Posted by:JessicaFebruary 28, 2008 12:04:04 AMRespond ^

Family therapy is more effective for those teens that are facing bipolar disorder. Bipolar disorder is a behavioral problem and boot camp is not a suitable treatment option for it. Behavior of troubled teen is changed by family members very soon.
http://www.troubledteensearch.com/

Posted by:JessicaMarch 5, 2008 2:04:53 AMRespond ^

Private Boarding Schools are a good option for struggling teens. They provide a creative and challenging environment and help child to grow well physically, emotionally, and spiritually. These schools help students to develop a good habit of getting into discipline.

Posted by:CatherineMarch 7, 2008 2:12:29 AMRespond ^

This is really a good and appreciable information about struggling teens and their treatment options. I found it very helpful for helping struggling teens.

http://www.troubledteensguide.com/

Posted by:JackMarch 8, 2008 12:50:16 AMRespond ^

When kids have behavioral problem and not disabilities, then military schools are the best option for them. These schools do not provide any kind of treatment but have strict rules and regulations and teach discipline to their students.
http://www.teenageproblems.net/

Posted by:NeviaMarch 8, 2008 3:21:40 AMRespond ^

Parent’s negligence towards child’s activities can cause serious problems in the future. There are many treatment options for your struggling teens such as wilderness programs, residential therapeutic programs, boarding schools etc.

http://www.troubledteensguide.com/

Posted by:JackMarch 10, 2008 4:07:03 AMRespond ^

Does any one know about teen 180, is it good

Posted by:crystalMarch 11, 2008 2:52:26 PMRespond ^

< A HREF=http://www.troubledteensearch.com/>Learning disability is an important issue as most of the parents don't have much knowledge about this. They think that their child is not concentrating in studies. Information given in the article is very useful for parents whose teens are not doing well at schools.

http://www.troubledteensearch.com/

Posted by:jessicaMarch 11, 2008 10:19:43 PMRespond ^

Private schools are a good decision by the parents of troubled teenagers. They teach them discipline, build self-confidence etc. This site is providing step by step information of how you can save your troubled teen.
http://www.restoretroubledteens.com/

Posted by:CatherineMarch 17, 2008 1:29:01 AMRespond ^

Troubled teens need more care and love from parents. Good parenting is essential for troubled teens. A lot of centers are running for the struggling teens. With academics they also offer therapeutic programs to students. Only parents can help their teen and also help them to overcome their problems.
http://www.restoreteens.com/

Posted by:jeniferMarch 17, 2008 11:09:57 PMRespond ^

Boarding Schools prove as good help option for troubled teens with different issues such as suicide, runaway, depression, behavioral problem,pregnancy etc. These teens live in a 24 hour supervision of teachers. They show good rates of improvement in their problems.
http://www.restoretroubledteens.com/

Posted by:Nichole213March 18, 2008 1:51:13 AMRespond ^

many services are available for troubled teens but the best is schools for troubled teens. I have researched on internet and find http://www.troubledteensguide.com where parents can find best schools and camps for troubled teens

Posted by:Teens AdviceMarch 22, 2008 1:29:51 AMRespond ^

I have got good information about various types of schools for troubled teens with professional answers to all teen issues from
http://www.troubledteensearch.com

Posted by:JohnApril 17, 2008 4:07:50 AMRespond ^

Are you a parent who is frustrated with your troubled teenager? Projectme offers a unique solution to problematic teenage behavior. please visit us at www.projectme.info

Posted by:DanielApril 17, 2008 6:59:23 AMRespond ^

my 13 year old needs a reality check!

Posted by:NATASHIAApril 26, 2008 3:39:43 PMRespond ^


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