Hi Jeriby3,
In general, children such as yours with problems including lying, defiance, threats to harm herself or others, and impulsivity, are suffering from a combination of having experienced stresses in their lives which have been very difficult (often in infancy, toddlerhood, and later years) and the stresses can tend to be longstanding. ADHD (Attention Deficit Hyperactivity Disorder) is often diagnosed. In addition, children such as yours who can be very impulsive, after being disciplined, reprimanced, corrected, punished, yelled at, or simply experienced negative reactions from the adults in their lives often, tend to have low self-esteem, anger, and feelings of shame and worthlessness. They often feel "different" than other kids. The relationships between parents and children such as these can often become quite strained, even though their parents clearly love them very much, and the kids love their parents as well. The relationship interactions often become quite automatic, with both child and parent reacting to one another in very instantaneous and repetitive ways that trigger one another, and in which each feels misunderstood, frustrated, angry, and at wits end. Underneath their anger, children such as yours are usually desperate to succeed, to be praised, to be successful, and to feel loved and accepted (even though their parents do love them very much).They often become afraid to try to behave better or succeed however, and instead act negatively in order to establish a sense of safety; better to "fail" by choice, than to try to succeed and feel as if they've failed when trying their hardest. This captures the way some children such as yours can feel.
So, what to do about all of this? Firstly, if you haven't alreay done so, consider consulting with an experieced psychiatrist or psychologist who primarily specializes in working with children and their families. Ask for a thorough evaluation (see below). In general, both the parents as well as the children need to make changes, so most practitioners will work as often with family members as the will with your daughter. Be cautious of someone who just sees your daughter, or only prescribes medication as the only treatment. Medication for ADHD such as Vynase can work well for overactivity and short attention span, but more complicated behaviors such as lying or ingrained oppositionality don't change well with medications alone. The impact of
SSRIs such as
Zoloft for complex behavioral-emotional problems such as your daughter's can be quite limited, if they work at all.
Family oriented treatments are usually needed, and these might include parent guidance, individual therapy for parents, couples treatment, and family therapy. Treatment for your daughter might involve some individual sessions but also involve the practitioner being involved with the family, school and teachers.
Often, more than one provider is needed with a child such as yours, such as child psychologist, a family therapist and a psychiatrist.
To summarize, you might consider that your daughter have a thorough child psychiatric evaluation, which includes a family/parent assesment, as well as a psychological evaluation, that might include an IQ test, what is called projective testing, and if school performance is a problem, academic achievement testing.
After these evaluations, the providers should meet or talk together by phone, and optimally, talk with you about their findings from the perspectives of :
1. What family, social, life stress factors are contributing to your child's problems.
2. What genetic and biological problems might be contributing.
3. What psychological factors, such as your daughter's temperament, her personality, and her self-esteem, relationship skills with adults and peers, and her coping skills with which she handles stress and change, are related to the problems.
To find providers for your daughter, you could ask your pediatrician, school counselor, or local community mental health center.
Good luck, you clearly are working hard to help your daughter and are loving parents. Don't give up, problems such as these can be quite tough, but can improve.
-E. Seigle MD
