The blog post below was submitted by Dr. Rick Silver, Founder and Director of The THRIVE Center, located in Columbia:
The mother of a 20 year old patient had spent an hour with me in my office, explaining the details of her son’s developmental challenges over the past decade.
“I’m hoping you can tell us what’s wrong and what to do about it. He was always moody and has had rageful episodes since he was little. He doesn’t work, doesn’t go to school, has a limited number of real friends, and smokes a lot of weed. I just want him to act his age, to be responsible like his peers. That’s not unreasonable, is it?”
This mom was clearly struggling to find an answer for a son that did not fit the mold of a typical young adult – and had never fit the mold of a typical kid growing up.
Whatever this young man might become – with the right support and treatment – he was not yet capable of mustering the cognitive and emotional skills needed to be successful as a young adult. As painfully apparent as this might have been to me, the mom still held on to an image of her son as capable but willful: if he only tried, he could make it, just like his peers. Like many frustrated parents, she was taking a page from the Nike play book, hoping that “Just Do It” was a workable strategy for him.
Letting go of who we desperately want our children to be, of what we dreamed they would become, is one of the most difficult tasks for parents at this stage -- when children transition into young adulthood. Given all the uncertainty inherent in raising a child, our dreams serve an important psychological function, providing us with a sense of hope, of direction, of stability. Dreams keep us energized through the trials and tribulations of childhood, and are our guideposts for the future.
To see those dreams become hazy and unclear, to feel them fall apart, can be an experience that parents find frightening. In the face of forces beyond our control, we begin to feel powerless, and may react by blaming our children for what they are not doing – and in reality, cannot yet do. As we seek to control what cannot be controlled, we become angry – and the tension in the family mounts to unbearable levels. We feel ourselves running out of patience, out of resources – and even begin to wonder what it means to continue to love this troubled child – or if we really do love them.
In our heart of hearts, we know we will continue to love our children no matter what happens, to support them no matter what it takes. But in the face of these overwhelming challenges, how do we find the path that will help them heal and learn the requisite skills of adult life?
We must begin by looking not at our children, but by looking inward. As we review the evidence about our child’s capabilities and limitations, we must begin to ask: Am I setting realistic expectations for this stage in their life? Do I need to bring it down a few notches, back off a bit? Can I begin to accept that – even thought they might not be able to do what I think they should do right now – they are still capable of change, of learning?
Taking a term from dialectical behavior therapy, we must radically accept the reality of our child’s life: they are who they are, and moving them towards a healthier outcome will not be hastened by overly harsh control or excessive demands beyond their current capabilities. We cannot allay our fears by forcing them into the mold that we want for them. We cannot reconstruct our dreams for them by grabbing hold of their steering wheel and trying to dictate their destiny.
This process of letting go has several steps that parents typically go through. First, we must get clear and accurate information about who they are – how their brains work, how their psyches shape their choices and behavior. We can do this in several ways:
1. Neuropsychological testing, which helps define the cognitive and emotional strengths and weaknesses of our child
2. A good diagnostic workup from a psychiatrist or psychologist, who can pull together the testing information and clinical observations to begin to answer the question of why your child is stuck; and
3. Reading books and articles about the specific conditions that our child is dealing with – and how it is usually treated.
Second, we need to do our own emotional work – grieving the loss of the child we wanted and expected, and learning to accept the child who is actually before us. In addition to this emotional work, we need to explore more practical themes:
1. What role do we need to play as parents of an atypical kid transitioning to adulthood?;
2. How do we best communicate with them? What is the line between responsibly encouraging them and stepping back so they can grow into their own skins?; and
3. What are realistic expectations for them – who might they become, what limitations might continue to exist throughout their lives, and how long will it take to help them get to where they need to go?
Finally, we need to seek care from practitioners who understand this transition into young adulthood and the challenges that arise with atypical kids. Treatment may include – although it is not limited to -- such modalities as:
1. Medication Management – with a psychiatrist or psychiatric nurse practitioner;
2. Executive Function (ADHD) Coaching, to help them better organize their lives, stay on task and complete projects successfully;
3. Individual Therapy with a psychologist, social worker or licensed counselor, to help deal with the emotional issues that inevitably exist for the atypical kid;
4. Family Therapy/ Parent Support – to explore how family interactions and communications can better support the journey of the young adult to health; and
5. Substance abuse or video addictions treatment
Social skills support, life skills training, self-care training and emotional self-regulation approaches often come into play with this population.
The journey to reach autonomy and agency for the struggling to launch young adult is a long, difficult one -- for kid and parents alike. Although it is never easy or fast, it can be made far more bearable if we begin by setting realistic expectations based on clear data regarding our child’s capabilities and limitations. With that information, we can be more patient and compassionate as our children work to do their best. And together with them, we can forge a path that ultimately leads to successful independence.