Anger & Hostility in 13-14 Year Olds

Parent Q&A

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  • Intense emotional outbursts in 13 y.o. boy

    (7 replies)

    My son has always struggled with infrequent (every 6 -12 months) very intense emotional outbursts (primarily anger and frustration).  Over the last year they have become more frequent and intense - throwing things, breaking things that are important to him (a set of ear buds he had saved up to buy), yelling.  He just had the worst one yet, screaming for 40 minutes, throwing things, curling up into a ball in his bed with the pillow over his head for over an hour.  There is a history of mental illness in my family so of course I'm trying to manage my own fear.  Two questions 1.  can behavior like this be in the realm of "normal" (as loaded and absurd as that word can be), have you experienced this with a child and seen them grow out of it?  2.  We did work with a child therapist for many years but need to find someone else, any suggestions of a professional we could work with (we are in Marin)?  Thanks

    I'm so sorry your son experiences this. It has to feel frightening and awful. I'm so sorry you are experiencing this.

    This behavior is not healthy and it's important to work toward understanding the underlying cause of the behavior. Start with a good physical exam, then a neuro-psychological assessment. Consider parent or family therapy, in addition to whatever therapy may be recommended in the assessment. I'm sorry I do not have anyone in Marin to recommend. I'm in Silicon Valley. Well regarded organizations here are The Children's Health Council and Jewish Family and Children's Services (don't need to be Jewish to take advantage of their services). You can look at their websites for an idea of what to look for. You might also reach out to your local Parents Helping Parents support group for local support and recommendations.

    Do something kind for yourself today - you'll be better able to care for your son.

    Sadly for many kids adolescence brings on these emotional dysregulation episodes. I would find him a therapist as soon as possible. Additionally Family Therapy can also help. Just know you are not alone even though other parents are not talking about it it doesn’t mean it not happening. 

    That is rough and I have been there. My sister and I (we are 6 years apart in age) both went through something similar in middle and high school. Our outbursts were much more frequent though, and the triggers are still a mystery to this day. They were pretty intense. My sister once missed a flight because she was having a meltdown. Looking back, I have no idea how my mom handled this, but we did both grow out of it after a few years. Around age 14, my son started having occasional outbursts that were very intense and pretty of out character - one time he tried to get out of a slow moving car. It got a lot better around age 16 when he got his license and had a lot more control over his social life. Looking back, I think there was a lot of teenage hormonal stuff going on that he absolutely would not talk about, plenty of social anxiety, too much time online (socializing), anger, and his yearn for more control over his own life. He just had a meltdown for the first time in forever last week. It only lasted about ten minutes, nothing was damaged, and afterwards he told me “that was long overdue and I feel ten pounds lighter.” So I would say there is light at the end of the tunnel. Hang in there!

    Yes, our son has had some really scary outbursts over the years. I’ve worried for his mental health (and my own). At 14.5, he has much better control of his emotions.

    He still blows up, but it’s less frequent and he recovers more quickly. Therapy was somewhat helpful for him, but super helpful for us as parents. Wishing u and your son the best

    My kid sounds similar but if yours feels fine in between the 6 month outburst, maybe not. We avoided drugs (and it wasn't bad enough that anyone was suggesting it). Then, someone said to me that mental health issues should be addressed with the same seriousness as physical pain and I asked to try some meds. He started taking Zoloft a couple of years ago (maybe 10 or 11) and once it kicked in he said "I want to take this for the rest of my life." He used to say to me out of the blue "I feel angry for no reason." I can't imagine how terrible that feels, even if he wasn't having a major outburst everytime. I don't care if it's "normal" - I care that my kid feels ok. 

    I am so sorry you and your child are dealing with this. I’ve been there...... Given that you mentioned there’s a history of mental illness in your family, I would get him in with a good therapist and psychiatrist ASAP. Make sure you find someone who both you and your child feel comfortable with. Really research the psychiatrist. We have found someone absolutely amazing here in the east bay but I can’t make any recommendations for Marin, unfortunately. Sometimes if you find a therapist you really like, especially someone who does CBT and/ or DBT (which may be really good for helping him build skills to better regulate his own emotions), they will have some good psychiatrist recommendations for you. 
    wishing you peace and resilience


    It's really hard to tell what is "normal" in teens, but the good news is that most teenagers can benefit from the right therapist, whether they have mental illness or not. Since you are in Marin, I highly recommend that you check out two excellent clinics that offer Dialectical Behavioral Therapy (DBT) for adolescents there. You are luck to live in an area that has these resources. DBT can help with emotion dysregulation, which sounds like what you have described. I have talked to the clinicians at both DBT Center of Marin, and Mindfit DBT. I did intakes there, and if my kid had been more willing to commute from the East Bay, we would have used their services. We ended up with a great DBT practitioner in the East Bay. It does require quite a bit of committment from both the parent and the teen. Good luck!

  • I am seeking support for my 14 year old son who absolutely hates school. He complains daily and is incredibly negative about anything school related. He is not interested in other activities. He loves nature and the outdoors and spends most of his summers backpacking but school is a challenge. He also has diagnized LD and has sought therapy on and off with no avail. He also tends to get into a negative spiral quickly and can have some emotional dysregulation. I am pretty desperate to get him the right help.  ANy advice would be appreciated. 

    It's great that your son loves nature and the outdoors.  Maybe there's a way to do more of that with you.  My son was similar, but in high school.  We did a neuropsych evaluation that found some ADD and moderate depression.  Anti-depressant helped with depression and social anxiety.  He had problems connecting with others due to the ADD, which made him hate school.  Long term therapy helped the most.  If you have a therapist you like and trust, who is very experienced (like 10+ years), and who specializes in children or adolescents, then I would help him enter therapy again, and see how it goes, it probably isn't for everyone.  (Our kid was older and saw a therapist who mostly saw adults.)  It was frustrating trying to do school with ADD.  Also our friend who hated school ended up going to Holden High in Orinda, which includes kids with LD, and he liked it.  Good luck to your son and you.

    I don't know if this program would be accessible to you as it's part of Tam Unified High School District in Marin, but it sounds great for someone who isn't that jazzed about traditional school and loves the great outdoors. It's called TEAM and it's a one-year outdoor backpacking-based independent study program for high-school juniors. It's free since it's part of public school, but I'm not sure if it's open to those outside the district. Anyway, worth checking out as we know several kids who did the program and it was life-changing.

    I agree w prior poster - depression is probably there - frustration around not succeeding. I cant advise on how to make him like school but I can make 2 solid suggestions - 1. act now, because the older they get, the more resistant they get. 2. consider joining Scouts - they have some excellent troops (do your research) nearby. It's super wilderness focused and you can go on some of the (many) weekend adventures. It will build his confidence and bring you closer. Best of luck

    In exploring all options, you might consider an outdoor focused boarding school with supportive services for LD. Note: not a therapeutic boarding school for kids with deeper problems who may have substance use or self-harming behaviors. The Dunn School is one in California. You might consider working with an educational consultant (see past posts for recommendations) to assist with assessing what's behind your son's distress around school, support with exploring options, and assistance with admissions should you choose to consider a path other than the local public school. 

Archived Q&A and Reviews


Very angry 13 year girl

May 2013

We would be very grateful for recommendations of a therapist/ life-coach or the like for our 13 year old daughter. She can be loving and is a great student. At the same time she is consistently very irritable and angry, cannot take in the enormous amount of love and support we give her, rejects most efforts to parent her, is resentful/ jealous of older sibling, has started to lie, and is both very rude and downright mean to the rest of the family. This has been the case for a number of years in spite of all the workshops, research, therapy etc. we've tried to date. . She is also very stubborn, powerful, and bright... has not spoken to her current therapist for many months such that we are thinking it's time to make a change. We are hoping that there is a skilled, mature, warm, strong, teen-girl savvy female therapist out there who might be able to help. Prefer in Oakland or Berkeley but all suggestions are appreciated. So much love and pain too

I'm sorry that you're having a hard time with your teen; I've got a 14-year-old daughter and agree that it's a roller-coaster. The only thought I wanted to share is: since this age is all about establishing independence and individual identity, it's possible that what she needs is less of the ''enormous amount of love and support'' you want to give her. I only know that with my daughter the more I can frame things as her decisions and her management of issues, the more I try to watch without actively trying to control, the nicer and happier she seems. (I don't presume to know your daughter or your situation at all: just a thought I had that I hope would be helpful for you to consider.) Anon 

13-year-old daughter's resistance and hostility

Feb 2011

My 8th grade daughter is with me every other week. Her father and I have been divorced and living in separate households for 2 1/2 years. Her visits, while I want to relish them as I so regret only being with her every other week, have been nightmarish and I find a feeling of dread bordering on depression creep up on me as her visit nears. She has ADHD, is often oppositional, which I don't often handle well, doesn't usually get invitations to hang out with friends on the weekend which means she's with me around the clock, and homework struggles make weeknights hell. Her father refuses to co-parent, is extremely lax about what she does after school, TV and Facebook time, homework and school work (plus he's a teacher), and he refuses to acknowledge how her ADHD is impacting her ability to focus in school and has undermined her willingness to give medication a try.

All this and the normal separation process that happens at this age is just about breaking my heart. I had a very close relationship with my mother, was an eager-to-please child for the most part, did well in school-no one had to ask me to do my homework, and I had good friends and a social life. I think these difference make parenting her all the harder.

I have been in touch with all her teachers to support her getting her homework done, but honestly, with her resistance and hostility, just asking about her homework sets the stage for an unpleasant evening. She either outright lies, doesn't know or doesn't care about the assignments, or a combination of all three.

I can go on, but I think those of you who have had or are having similar experiences get the picture.

I would like to know how other families have handled these issues and would like referrals to supportive services. Also, what to do when your child is resistant to getting help and equates your trying to help them with your saying they are stupid (I have repeatedly told her she is very smart which is true, but she needs help focusing).

I live in Berkeley, so referrals to therapists, etc. who live in this part of town would be great. Thanks.

My heart goes out to you! I am married with a noninvolved spouse. My daughter is a great student, BUT CONSTANTLY breaks rules and I fear is becoming promiscuous. So, I give a consequence for each rule infraction. I tell her what rule she has broken and give the consequence. The first time, the consequence is little more than nominal, but not too strict. The second infraction, much, much stiffer consequence. No arguing, no emotion, you broke this rule, here is the consequence. In the past, I've asked her what should your consequence be? Never has an answer. Now, 8 months later, today she for the first time, told me the consequence and it was pretty stiff! Yeah! She does not take responsibility. Now, she is starting to take it. anonymous

Check out a wonderful program that empowers girls called; Girl Ventures in San Francisco. They have special 2-week programs each summer. She's at a perfect age for Project Challenge'' and there are wonderful young women that run the programs.

In the meantime, set a structure in your home for the important things, curfew, phone usage, homework, chores, and under no circumstance allow her to disrespect you. If you are uncertain about a decision say '' I can't give you an answer until I think about it'. Don't allow her to push or manipulate you. Even if you are feeling unsure, address her with confidence and be consistent. There's nothing worse for her than you being a soft touch or letting her wear you down. Find a good behaviorist in your area and work with them. The biggest thing about her behavior is how you react. Once you change your behavior she won't like it, but she will respond. You can't do anything about the Dad but you can learn to set limits for yourself. The best you can do for your child is to learn how to parent her. ADHD kids are tough and you will need to learn what she needs. Anger and reactive behavior doesn't work in any scenerio. It causes explosiveness. Practice calm, assertive and most of all consistent. It means sometimes saying the same thing over and over and often with a smile until they know you are not going to budge. It's not going to be easy but it will get you further in the long run. Good Luck. Jan

Dear Sad Mom, I hear your pain and frustration and believe that, while what I have to say can't help in all your challenges, at least I may offer a way to relieve one of them. I am referring to the issue of homework. As one who works in the school system in Special Ed. I can tell you that if your daughter is diagnosed as having ADHD, then she is entitled, at the very least, to a 504 plan (see previous discussions about 504 on BPN). With such a plan, she should be able to receive reduced and/or modified homework (and even classwork, if they do it right). You should have input into the plan. It is possible she would even be entitled to special ed. services, but she has to be struggling academically pretty significantly. But either way, you could and should be able to significantly reduce and modify her homework. (Even without a 504 or an IEP, try talking with her teachers). Homework has become way too overwhelming and stress producing compared to how it used to be, and there are several movements afoot to abolish it altogether. Perhaps you can get your daughter's school to screen that wonderful new documentary ''Race to Nowhere.'' Even if you didn't have an uncooperative ex-spouse and a daughter with ADHD, the level of stress that schools put on kids and families these days, FOR NO REASON AND TO NO PROVEN BENEFIT!, is outragious and ought to be challenged and changed. Best of luck! Fellow sufferer of mother-daughter angst!

Hi. Your situation sounds all too familiar. I have two teenagers with ADD/ADHD and had a uncooperative, in denial type husband for many years. My daughter (now 19), in particular, had a lot of issues. I finally found help in these ways: First, I decided to take initiative without trying any longer to involve him and gain my husband's consent. Second, I got her therapy with a wonderful therapist named Jesse Cohen. We have Kaiser and Jesse works with teens primarily through a program for teens struggling with depression there. But she also has a private practice. You could try reaching her by calling the Kaiser Child Psychiatry Dept. Also, get yourself therapy and, if possible, meet with a therapist together once in awhile. If she's unwilling to get therapy, focus on changing her school environment. I finally sent my daughter to a school called Tilden Prep in Albany. It is a highly individualized program that works very well for kids with attention issues. It gave her confidence academically which was huge for her and I wish that I had sent her there sooner.

I don't know what kind of school your child is currently attending, but I would NOT send her to Berkeley High School, if you can avoid it. There are huge temptations for a girl like her there that are unhealthy and dangerous. If you have no choice, there are some helpful adults I could put you in contact with and you might consider putting her in a small school like AHA.

There is hope. After my daughter received therapy, some short term medication (which is necessary, I believe, for many kids either for the long term or short term), and a new school environment, and some maturity that, thank God, time mercifully provides, she finished high school, and is now working full time. She plans to go to community college in the fall and has, if not her pre-adolescent mother adoration, a sensible and more pleasant attitude. I no longer dread parenting her, which I did for a few years. Also, and do not trivialize this,TAKE CARE OF YOURSELF! Find time to be a happy person with interests and activities outside of parenthood. I was consumed with worry and allowed my problems to become my identity for too long. This only makes things worse. If you are happy and can deal with her calmly, she will do better. Good luck, and remember, this, like everything, is temporary. Feel free to contact me.

13-year-old's daily rages, may be bipolar - boarding school?

Sept 2006

Since fourth grade we've been trying to deal with a kid who is very angry on a daily basis, who steals, lies, does whatever possible to stir up trouble within our family. We've seen a host of mental health professionals: psychiatrist, evaluator, therapist, group therapist, family counselor, peer counselor, pediatrician specializing in ADHD, tried Depakote and Zoloft, spent thousands of dollars and seen no change or improvement in his behavior. (All of these appointments were researched and made by me; my husband has no faith in mental health professionals and I have to admit none of them so far have been effective.) At this point, I'm ready to get my son out of our home and into a boarding school or therapeutic boarding school. My husband doesn't want to send him away. I realize he's only 13 and that's really young but our family life is hell. He's not ''happy'' unless he's making everyone around him miserable, his daily rages make me cower, literally, and I have no idea what steps to take to change things. I'm open to advice but am especially hoping to hear from parents who have been through this. Could a boarding school improve my son's outlook and behavior or will it make him even harder and less cooperative? Anonymous

If your son has any chemical dependency issues (they can hide it well), that would be the first thing to deal with. We did the wilderness program route first - which changed things a lot for about 3 months, and now after major problems have cropped up again, we have our daughter in a local residential chemical dependency treatment program. She has lied, done poorly in school, run away, shoplifted, stolen a car etc... She is also a wonderful, smart and charming young woman who I miss terribly at this point in time. Our family is pretty functional. We have all done individual therapy and therapy as a family. Issues outside the home have included a father that left the state 8 years ago and a grandfather who molested her. Your son could be hiding a big secret that he is afraid to tell you or? I personally don't think these things spring out of nowhere, although there are weaknesses that get passed down in families like alcoholism. Good luck anon

If you even slightly think that your son may be bi-polar, I suggest you find a psychiatrist that specializes in this illness. Many regular psychiatrists don't know nearly as much as a specialist and sometimes are known for prescribing medication that acutally makes the bi-polar worse. I suggest calling Terrance Ketter who is the head of the bi-polar clinic at Stanford. If he doesn't treat adolescents, he will know who the experts are at Stanford who do work with this age group. I wish you the very best Annon.

Hi. I am experiencing with my daughter the same behaviour you are describing with your son. The behaviour has been always it is just more loud and intense now that she is a teenager. We are looking at Sensory Deprivation Disorder which basically means she is incredibly sensitive to incoming noise and light and cannot process too many verbal or nonverbal messages quickly. It makes for very defensive and angry reactions. An occupational therapist is helping her find practical ways to deal with this disorder as their are no drugs that really help anonymous

There are no magic bullets, but I think Dr. Mitchell Corwin can be helpful. He can provide assistance in both genetic nutritional testing (available thru Lafayette office) and helping parents choose appropriate therapy by differentiating what is emotional, neurological and learning problem. Dr. Corwin does something called applied kineseology, which I cannot explain - but call him. He has worked on both my children and my husband and myself and we have all found him helpful for various issues. Health Medicine Institute 3799 Mt Diablo Blvd (adjacent to Lafayette Reservoir) Lafayette CA 94549 (925) 962-3799 x310 Berkeley Office (across from Claremont Hotel) 2914 Domingo Ave Berkeley CA 94705-2454 (510) 845-3246 infolist[at]

I am the mother of a very tricky child. We did a lot of alternative things to help. Through my experience, I ended up becoming a Jin Shin Jyutsu practitioner which deals with harmonizing energy in the body. The children that I work with have all improved in their behavior. Sometimes other things can be a factor and other alternative practitioners that I work with can come in to help. It sounds really, really frustrating. Feel free to call if you would like more information. Good luck Leah (510) 525-5080

It sounds like a very difficult time you are having, and I certainly hope things get much easier for you. I have expereienced some similar things with our 13 year old son. Things are better now, though not perfect. A couple of things that seemed to help were omega 3 fish oil (Ultimate Omega by Nordic Naturals--it is more concentrated that other fish oils) and EM Power Plus, a vitamin-mineral supplement made in Canada and used for a variety of mood disorders, and other mental health issues. You can find the fish oil at a good natural foods store and EM Power Plus on the internet at Best of luck to you anon

A therapeutic boarding school can be very helpful when other options have been exhausted (and exhausting!). However it is critical to choose the right place, since there are lots of places and even ones that other parents might recommend might not be appropriate for your son. I suggest you contact Bodin Associates . It is worth the price for their extensive experience and intimate knowledge of something like a hundred programs around the US. Robert

I think a real 'marker' of your son's condition is the way you clearly have to walk around on eggshells, just to co-exist. Because he's really young still, a special school, that is kind but firm and clear about boundaries, as well as helpful with regard to acceptable/unacceptable behaviors can make an ENORMOUS difference.

Because of the possibility that he would need to attend such a school that is not here in the Bay Area, it would be my advice to consult with the Bodin Associates in Lafayette. They specialize in just the situation you are experiencing. Been There, Done That - with Relative Success anonymous

for the mom with a possibly-bipolar, acting-out son:

my son fell apart in high school, and i can definitely relate to wanting to find some relief from the rages, acting out, all the drama in the family.

my husband and i also had a lot of anxiety and differences of opinion about what would help. far before i was willing to consider sending my son away, my husband was talking about that. i had to try various other things -- and it sounds like you have tried many things already.

have you considered consulting an educational therapist? we used bodin associates in lafayette [i think they also have an office on the peninsula], and it made a world of difference having outside people assess the situation and make a variety of recommendations.

bodin has lots of contacts will all sorts of programs -- local and away. we appreciated that the counselor we worked with had visted every place she recommended we consider, and knew people there. the assessment of our son was very individualized -- even though he was not very cooperative, they got records and talked to a lot of people who had worked with us and our son.

the whole process was kind of scary, but not as scary as continuing to live in the disaster our lives had become, and worrying constantly about how much worse it could get. [and it was really bad by the time we went to the consultant -- our son had 3 ER visits for substance problems in the previous year, and an involuntary psych commitment; he was nasty, and regularly went into rages where he tore up the house -- threatening us, kicking holes in walls, breaking things; was escorted home by police and detained by transit police; had bombed out of rehab; run away from home overnight a couple of times; stole from us; was caught with paraphrenalia at his new school; etc.]

the educational consultant recommended that we start with a very good therapeutic wilderness program -- not a boot camp, but a place where the kids learned self-reliance and to begin talking about stuff. even my son thinks that program was excellent. the staff was well trained. he was seen by a great therapist weekly; we exchanged mail via fax weekly; and his dad and i talked to the therapist for an hour weekly. after a few weeks, when he'd calmed down and adjusted, he had a battery of psychological tests. between that excellent report, his work with his group and his therapist, we got a better picture of what would help him along.

when our son was ready, my husband and i attended a ''transition camp'' -- an overnight trip to the wilderness with other kids [and parents] who were ''graduating.''

the educational consultant was in close touch with us and our son's therapist during the wilderness program, and came up with a lot of good recommendations about what to do next. we chose a therapeutic boarding school that was really good for our son's needs. he is not as enthusiastic about that choice, but it was really good for him -- he completed high school there, learned a lot, had a lot of fun, was able to keep up with his interest in music. he became himself again, only more mature. now he is a functioning, working adult of 19, a decent guy and holding his own. [we had expected he'd be in college, and i think one day he will be -- but he's alive and doing well, and we feared quite a lot that we would lose him, in the dark days.]

long story -- but try an educational consultant. they have so much more access to options than we mere mortal parents do, and it is truly a relief finding some options anonymous mom

You wrote that your son's ''daily rages make me cower, literally...'' So I have to say this first:

If you feel that your child *may* be a danger to himself or others (you included) get in touch with a mental health professional immediately.

I can't judge the situation from here and realize this may sound alarmist. But I am absolutely serious. Given your child's age, the issues of violence and suicide are absolutely real. As someone once said to me, ''it may only be a slight risk, but no one is only slightly dead.''

Now to where I began writing: I deeply sympathize with your plight. I have personal experience with your situation. This parenting experience is terrifying, baffling, emotionally exhausting and endlessly painful. What follows is based on knowledge I'd rather not have acquired. Please bear with its length if you can.

The problem with this kind of advice is the implicit assumption that one knows enough to offer specifics. I will try only to offer information, point out some relevant considerations, and describe what I believe is the best way to get help. There are no absolutes. Every step, every decision, is a judgment call. In particular cases, everything I will say could be dead wrong. With that caveat, here is my advice:

Sending your son to a boarding school will not solve his problems. To do so may be necessary, for reasons of safety or the well-being of your family as a whole. But regardless of where he is, your son's central issue is diagnosis. And placement decisions warrant caution. A wilderness program, for example, could be great for a kid with one set of problems but horribly destructive for a different one.

Thus, diagnosis is the first and critical step. But diagnosis means much more than labeling with a DSM-IV number. It requires a proper understanding of the individual child and the surrounding circumstances, careful observation, and thoughtful, experienced insight.

Without proper diagnosis, treatment is nothing but a random shot in the dark. ''First, do no harm,'' is the physician's maxim for very good reasons. Keep it foremost in your mind. With your child, compassion and tenderness is more likely called for than is ''tough love'' or blind adherence to social norms about how to raise children.

I know you've tried to crack this problem, and I know the financial and personal costs involved, but I strongly believe that you should try again and take a systematic, committed approach to diagnosis and treatment. To me, the fact that you've already tried so much only means that you face a tough problem, need excellent help and need to stay with it over time.

The situation you describe could have many origins, some psychiatric, some not -- an example of the latter is that the impact of neurocognitive or ''learning'' problems could lead to a secondary psychiatric condition like anxiety. Treating the anxiety is a palliative that alone doesn't solve the problem. These conditions are very difficult to understand, and understanding develops over time. Thus, it is better to stick with one team than to keep trying new players. Now some specifics:

1. ''Bipolar disorder'' is not the question, nor is it the answer. At best it is a mere label of convenience, as are all DSM-IV categories. These problems are not one-dimensional. They may involve genetic, biological, physiological, cognitive and social factors. That's why a really good diagnostic team is essential.

2. Fish oil? Please... Your child's life deserves more than voodoo medicine and home remedies. A supplement, maybe... An answer? No way.

3. This IS rocket science. You need to find and work with a team of two highly skilled and specialized professionals: a clinical psychologist and a psychiatrist.

4. The clinical psychologist is critically important to diagnosis -- even more than the psychiatrist. That is where to begin. Psychiatrists have a valuable set of skills and knowledge, but they aren't the best place to begin in the search for understanding. That's why in-patient units (like UCSF's Langley-Porter Institute) use a team approach that places the psychologist on an equal footing with the physician.

5. Treatment: I'm certainly not prescribing. All I can say is this... good treatment plans are multi-dimensional. In serious cases, mental health treatment includes a mix of individual and family therapy as well as medications, if called for. When physiological, neurocognitive or learning problems are involved, other components are needed as well.

6. Don't rule out medications just because you've tried some that didn't help. Meds are no panacea, but can be tremendously helpful. Even moderate improvement in your child's condition can make a huge difference in your life and his. But your physician, if competent, will be cautious. A medication regime frequently involves several drugs, and getting the dosages and balance right is complex. Watch closely for side effects. Remember also that the right meds prescribed for the wrong condition can exacerbate rather than alleviate symptoms.

7. Educational consultants? Yikes! This is way premature for the reasons above. Beyond that, and without commenting specifically on the one(s) mentioned (of whom I have no personal knowledge), I advise you to be cautious. I've heard more than one story about consultants who knew less than the parents who were paying them.

8. ATesting is the clinical psychologist's job, not that of an educational consultant. It is folly to rely on an ed consultant for diagnostic work.

9. I suspect your child may be having problems in school. Ask your school district for an evaluation of your child for special ed. You have that right even if he is in a private school. If you disagree with the district's evaluation you have the right to an independent evaluation at the school district's expense. This is a little-known right, but important for diagnostic as well as financial reasons. Special ed professionals will admit -- off the record -- that they don't have the tools or the time to do a full evaluation in difficult cases. Since an evaluation and simple report by a clinical psychologist runs $1500 to $3000 and up (well worth it), you may as well get the district to bear some of the burden. You've already spent tens of thousands, I suspect.

10. Some fear that special ed status stigmatizes their child. I disagree -- the impacts on self-esteem and social relationships of the problems that get children to special ed are far more harmful than any stigma that results. Special ed is by no means a perfect system, nor is it easy to navigate, but you can get significant financial help, including payment for a residential placement, if you work your way through the system. Here too, a clinical psychologist can help tremendously.

Finally, I can't say strongly enough how important it is to get top people on your child's team, especially given your description of the situation. Here are some recommendations to get you started. These are people I know and have confidence in. Obviously, there are others:

Clinical psychologists: Michelle Horton, Ph.D. (985-2958); Terry Doyle, Ph.D. (594-1926).

Psychiatrists: Robert Epstein, M.D. (848-0900); Shane MacKay (540-1746).

If it would be helpful, you may contact me through the Parents of Teens moderators -- Anonymous for now.

anonymous for now has a lot of thoughtful points.

one point, though, was a ''yikes!'' about finding an educational consultant. i'm one of the parents who suggested an educational consultant, and it was truly a turning point for us.

but i want to clarify, that is not where we started -- i made that suggestion because the parent asking about options for her son had already tried a lot of things. we tried talking to teachers, a family therapist, adolescent rehab, a new school that was very focused on students. we found a great adolescent psychiatrist -- but could not find a way to make our son go see that great doctor.

a year's worth of self-help yielded: 3 ER visits, one involuntary psych hospitalization, failing grades in 2/3 of our very bright son's classes, a 30 day inpatient rehab, his failing the outpatient rehab followup, several brushes with the police, being caught with paraphrenalia at his new school, being fired from the band he founded with good friends some years earlier, etc. the screaming. the holes in the walls. stuff he stole. the runaways. it was a complete nightmare. and i have a smart, very decent kid -- he lost himself, and we could not bring him back without serious help.

we turned to educational consultants when we had no more decent options, and it opened doors. we could not even get a good assessment of what was going on with our son, because he would not comply or cooperate on an outpatient basis. and our family life was in flames for quite a long time -- the worst part lasted a full year, even with the best interventions we could invent and patch together.

there is no down side to talking with an educational consultant. they have heard it all. there is no way for parents to easily navigate the local or away options without some help from people who know about programs -- and one piece of the programs they can suggest involves getting a handle on diagnosis.

to answer another issue -- the ed consultants do NOT do diagnosis themselves. they can recommend appropriate people, or see that a kid gets the appropriate evaluation at where ever he or she goes.

my own son had two kinds of very excellent evaluations at his therapeutic wilderness camp, where he spent 9 weeks -- one from a therapist who saw him weekly, was in close contact with the people who saw my son constantly, and also consulted with us -- and probably the best psychological evaluation based on testing that i've ever seen [and i see quite a few in my work]. the wilderness place was extremely supportive. i still feel that we could have struggled for years more, and never gotten as decent an assessment at home. my son, too, feels the therapeutic wilderness experience was really, really good for him -- he sees it more as a chance he had to grow and to believe in himself. [he was NOT happy about going there, but was VERY happy with how far he had come by the time he left, 9 weeks later.] anonymous mom