Analysis of the strategies used by family members of violent children with severe mental illness


Research led by a University of Maine sociology professor explores how family members of children with severe mental illness and violent tendencies persevere through stressful situations.

In a recently published study, Karyn Sporer looks at the importance of positivity, education and community, and examines strategies family members identify as being helpful when challenged by stressors related to living with an aggressive child or sibling with severe mental illness.

“Our communities are poorly equipped to support not only the needs of persons with severe mental illness, but also the needs of their family members and family caregivers,” says Sporer, who adds the study focused specifically on the family members and how they remain “somewhat positive despite living in incredibly stressful and sometimes dangerous homes.”

Data from interviews with 42 parents and siblings of violent children with severe mental illness were analyzed to identify three primary strategies family members attribute to their ability to endure: gaining insight and knowledge, joining peer support programs, and identifying a silver lining.

Participants reported gaining insight and knowledge about mental illness and the mental health system by reading self-help books and doing research, as well as attending seminars, trainings and conferences.

Many participants said they sought self-education after feeling unprepared for the demands of caring for a person with severe mental illness, which they attributed to a lack of information provided by mental health practitioners.

Family members also relied on peer support as resources for guidance and encouragement.

Looking to others for support, whether online or in person, reduced feelings of isolation and helped participants manage their emotions by introducing them to a community whose members faced comparable adversities.

Challenged by acute and unpredictable aggression by their child or sibling with mental illness, participants shared stories of positivity and resilience in interviews.

It was through silver linings that participants credited, in part, their ability to persevere, the study found.

These “golden moments” often are ordinary occurrences for most families, such as watching a movie together or witnessing a child smile. Family members of aggressive persons with severe mental illness described these moments as rare, making ordinary moments extraordinary, the researchers say.

Giving attention to these strategies, the study determined, may prove beneficial for other family members and caregivers confronted by mental illness, violence and the complex mental health system.

The researchers recommend mental health practitioners help identify, locate and engage with the primary strategies to minimize family members’ sense of isolation and confusion, and improve knowledge about mental illness.

“Finding the “Golden Moments’: Strategies of Perseverance Among Parents and Siblings of Persons With Severe Mental Illness and Violent Tendencies” was published in the Journal of Family Issues.

A child who exhibits severe behaviors – self-injury, aggression and property destruction – presents a significant challenge for parents. In some instances, outbursts can be handled within the family; that is, the parents’ intervention may be enough to keep the child stable and the family secure. But in other cases, the behavior can be so extreme that parents need additional support.
We developed this guide to help families get the support they need. This guide will answer the following three major questions:
1. When should families seek help?
2. What should parents do when their child is exhibiting dangerous behavior?
3. Where can families obtain additional support?

When Should Families Seek Help?

Parents may be reluctant to seek outside support for managing their child’s behavior for several reasons:
• They may have become accustomed to the behavior over time (even though the child’s size and behavior has exceeded their ability to manage it);
• They don’t want to acknowledge that their child is dangerous because they know the behavior is not intentional;
• They are embarrassed and fearful of being blamed for being bad parents; or
• They are fearful of what will happen to their child if they report the behavior.

Signs to Seek Support

Families who find themselves in this situation live in a constant state of anxiety. These are signs that a family should seek outside support:
• A pattern of explosive temper tantrums resulting in dangerous behavior
• Physical attacks that can harm siblings or parents
• Threats or attempts by the child to hurt himself
• Use of weapons to threaten or hurt others
• Cruelty toward animals
• Setting fires or other destruction of property

There are public agencies that provide support to families facing these kinds of challenges. These agencies can help to develop in-home behavior support plans for the child and to identify additional support the family might need.

When Is It a Crisis?

When should parents call 911 to get help from the police? You should call 911 when your child’s behavior is beyond your ability to control it and the child is …
1. A danger to others—the child directs dangerous physical action at others.
2. A danger to him/herself—the child takes action with sufficient force to cause bodily harm.
3. Engaging in destruction of property that has the potential to be dangerous to self or others.

When you, your child or another person is in danger, call 911.

Whenever you call 911, be sure to inform the dispatcher that your child has a mental illness or developmental disability so that the officers who respond have this information before they arrive.

State specifically that your child is nonverbal if that is the case.

Some police departments have special Crisis Intervention Trained (CIT) officers who deal with people with mental illness or developmental disabilities.

What Should Parents Do When Their Child Is Exhibiting Dangerous Behavior?

While every situation is unique, there are patterns in behaviors, from the time of the “trigger” that sets off an outburst to the time the crisis is over and the child is in a recovery stage.

At the peak of the outburst, the child can become physically aggressive and/or dangerous.

The most important thing to remember throughout these stages is to stay calm and use a soft and steady voice.

For some children, irritability is connected to fear and anxiety.

If the child is getting upset but can still process simple verbal information, you can try what is called the Safety Script.

“This is a safe place and I won’t let anyone (hurt you, throw things at you, etc. …).

I can’t let you (hurt your sister, throw things …) because this is a safe place.”

The order of the sentences you speak is important so do not skip any part or rearrange the statements.

The first part calms the child if he/she is reacting out of anxiety, fear, or distrust.

This enables the child to “cool off” enough to hear the rest of the script.

Reassurance at the end will further calm fears.

What to Do at the Peak of the Crisis

1. Send others away from the area.
2. Call for help (call a family member who can help or call 911).
3. Remove dangerous objects or attempt to get the child into a safer room.
4. Don’t try to discipline; don’t use words, don’t try to reason.
5. Stand at least one leg length away from the child. Instead of standing face-to-face, stand to the side (L-shape) of your child. This stance is non-confrontational and non-threatening.
6. Remain in control; stay calm and quiet. Allow yourself to disengage emotionally, and don’t take the behavior personally.
7. Be flexible; your child cannot.
8. Use a pillow or cushion to protect yourself if the child strikes or hits.
9. Take deep breaths to help you stay calm.

Do not try to restrain your child UNLESS the behavior is a clear danger to you or to the child. Physical intervention increases aggressive behavior and can inadvertently cause injury to you or to the child.

What to Do Immediately After the Crisis

When the peak of the crisis has subsided, the child is in a recovery mode.

At this stage, the child is physically exhausted, emotionally drained, and fragile.

Another outburst can easily occur during this time.

Maintain a soft voice and tone and a calm demeanor.

Provide space.

Redirect the child to a pleasant activity.

This is NOT a time to teach or reprimand.

Do not discipline or refer to the rage behavior. Ensure that any tasks assigned are at or below the child’s functioning level.

The child may want to withdraw or sleep—that’s OK.
During an outburst, the thinking part of the brain tends to shut down.

Before or after a crisis, you can help reactivate that part of the brain and get the child back into his or her ‘thinking brain’ to do increasingly complex tasks.

For example, have him or her sort a deck of playing cards by color.

Then, depending on the age and functioning, have them sort by suit, then number, etc. This gradually shifts the brain from reacting to thinking, while the calm, tactile experience of the cards and the repetition may be soothing to some children.

This kind of activity (quiet, simple, then increasingly complex) might also help defuse mounting tension before the outburst occurs.

Understand that if your child is taken to the hospital, he will not necessarily be admitted.

But if he is, he will likely be released within a couple days. During that time, you must identify support for your child’s re-entry into the household.

Contact one of the public agencies suggested in the following pages for additional help. This might include counseling for you and other family members to help you prepare for your child’s return. This support can also include ongoing counseling for your child, support for your other children, and a support person in your home for limited hours to help you deal with the behavior.

Dealing with behavioral outbursts is exhausting. Take time for yourself to regroup. Remain calm and quiet for a while. Engage in an activity that is calming for you—read a magazine, listen to music, watch a television program or take a short walk. Remember: you didn’t cause this.

Anticipate Difficult Situations and Prepare Your Child

It is important to recognize and prepare your child for difficult situations. Common triggers are:

  • Transitions: Make sure that time signals are given to help smooth transitions. For example, transitioning from watching television after school to having dinner; leaving home to get into the car to go somewhere; stopping a game to take a bath.
  • Environments that overwhelm the senses: Teach the child about his sensory needs and what he can do to help himself in situations that are overwhelming. Teach the child appropriate ways to escape or avoid these situations.
  • Difficult social situations: Teach your child what to do in situations that are difficult, and practice the appropriate responses through role-playing.

Teach Your Child Appropriate Ways to Escape

Knowing appropriate ways to escape is a coping skill everyone uses.

  • Teach your child appropriate ways to ask to leave when feeling overwhelmed, upset, or anxious, and practice the request using role-play. (Coping skill)
  • Identify a predetermined place where the child can choose to go cool down, and allow that choice. (Coping skill)
  • Develop a plan for an activity to take his mind off a problem when upset (Coping skill). Suggestions might include:
  • Taking time out alone—wrapped up in a blanket, or hiding in an enclosed place, or in the car (if safe)
  • Drawing or writing down emotions
  • Physically letting off steam, such as using a punching bag or a pillow to cry and scream
  • Using games, fidgets, books, etc.
  • Using a soothing sensory technique, such as looking at something calming, doing a heavy muscle activity (such as jumping, running), or listening to something soothing
  • Deep muscle pressure. This is calming to some children; others respond to light stimulation like running their hands through sand or water or lightly stroking or scratching their skin
  • Teach the child about negotiation. For example, “Is there anything we can do so you can stay and . . .?”
  • Teach your child to think of feelings as signals, not problems in and of themselves. “What is this feeling telling you/us? What should happen next”

Understanding the Rage Cycle and Ladder of Risk

Although each child differs, parents will recognize the pattern of behavioral outbursts or the rage cycle.

It begins with the trigger and then moves through predictable stages.

While the stages can vary in length, there is a predictable evolution to the cycle as outlined in the following.

Rumbling: Once an event has occurred that serves as the trigger for a behavioral outburst, the rumbling stage begins. This can include arguing, shouting, muttering under the breath, breathing hard, pacing, or rocking. In some cases, the child can be redirected at the early stage of rumbling.
In other cases, the rumbling stage accelerates and intensifies to become rumbling stage 2, which accelerates to become the full rage outburst.

Peak: At the peak of the rage cycle, the child is likely to become physically aggressive toward others, toward himself, or destructive toward property. Remember, at this point, the child is irrational and is unable to process language, even to respond to commands. The priority at this time is maintaining safety – for you and the child.

Recovery: After the peak of the rage subsides, the child is emotionally and physically drained. However, during this time, the child is fragile and another peak outburst can be easily triggered.

More information: Karyn Sporer et al. Finding the “Golden Moments”: Strategies of Perseverance Among Parents and Siblings of Persons With Severe Mental Illness and Violent Tendencies, Journal of Family Issues(2019). DOI: 10.1177/0192513X19860170

Journal information: Journal of Family Issues
Provided by University of Maine


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