A child with life-threatening illness can galvanize a family, even a whole community, to pull together to help her get the best care possible. But when children have psychiatric disorders, the effect is often, sadly, different.
Children with mental illnesses can put great strain on their parents, especially when their disorders manifest in impulsivity, defiance, exhausting rituals or all of the above. Tantrums, meltdowns or aggression towards playmates can alienate other families, making you feel isolated. A disruptive child can seem to use up all the oxygen in the home, leaving you with little time or energy for each other. Sometimes parents disagree about the diagnosis, or the kind of treatment a child needs. Sometimes one parent is obsessed with helping the child, and the other feels left out. The result is marital discord, which all too often leads to divorce.
This is why it's critical for parents of a child with a serious psychiatric disorder -- from ADHD to autism to OCD -- to get the child evidence-based treatment as soon as possible. But it's also why, as parents, you must not lose sight of your marriage itself and let it become a casualty of a child's illness.
The difficulties may begin as soon as the diagnosis, as the two of you react differently to the reality of having a child with a serious disorder.
"Often you get a more stoic, less emotional parent -- usually the man -- while the woman is grieving more openly," says Dr. Laura Marshak, a marriage counselor and the author of "Married with Special-Needs Children: A Couple's Guide to Keeping Connected." "Very often, the mother goes into overdrive, where every waking moment gets devoted to learning more, to finding services, to connecting with other mothers. It becomes consuming. At that point, couples often get divided."
The divide can get wider with the demands of care. Dr. Amy Keefer of the Kennedy Krieger Institute works extensively with the families of children with autism, who need intensive therapy for the best outcome. "I often see a division of labor because the therapy and needs of providing care for the child are greater than those of a typically developing child," Dr. Keefer says. "Sometimes one parent takes over that responsibility and manages it just themselves. And that sets up all kinds of difficulties in the marriage."
So what can you do to maintain a strong relationship and do the best you can for your child?
First, protect your marriage by creating space for it. Dr. Marshak advises couples to set aside time every day when they are not "Mom" and "Dad." "Devote 20 minutes a day where you only focus on each other, and there's no talk of children," she advises.
I couldn't agree more. When I see a couple with very difficult child, I write out on a prescription pad the words ,"4 hours in a motel." My clients often laugh, but I tell them I'm serious -- and I am. I find it's absolutely crucial for them to take a break from the challenges of parenting and see each other as people. If couples with typically developing children need things like "date nights" to keep their relationships alive, parents of children who are unusually needy or disruptive need and deserve it even more; they need time to be together without talking about the child.
Second, protect your marriage, as well as your child, by getting a diagnosis you both trust. When you're not confident that you know what's behind a child's disruptive or dysfunctional behavior, you can't be confident in the treatment. Both of you need to identify the behaviors that are worrying you and causing problems for your child; both of you need to have contact with the clinician doing a diagnostic evaluation of your child; and both of you need to participate in the decision about the course of treatment.
Third, your marriage will fare much better, and your child will do better, if you are on the same page about limit-setting and discipline. Anxious or impulsive children become more anxious and impulsive when they get conflicting signals about what's expected of them -- and what they can get away with -- from parents and other significant adults in their lives. They worry more, act out more and have more tantrums.
Years of experience with what we call "Parent-Child Interaction Therapy" (PCIT) have shown that parents who are consistent in how they react to children's behavior -- with positive reinforcement for desired behavior, and predictable consequences for undesired behavior --can have a huge impact on reducing disruptive behaviors.
This not only helps kids improve their behavior; it also gives parents confidence about their parenting skills, which in turn helps them feel less stressed, and less at odds with each other. More than one couple has told me that the training saved their marriage. And that's good news for children, too. The stronger and healthier you are, the better chance they have of getting what they need.
For more information on issues like these, visit www.ChildMind.org.
Follow Dr. Harold Koplewicz on Twitter: www.twitter.com/DrKoplewicz
Jenna McCarthy: Did You Say Something, Dear?
Need Strong Advice about marriage and mental illness ...
Influence of mental illness on marriage, reproduction, and ...
Parents for whom sleepovers are a fantasy and babysitters elusive sometimes get so desperate that a divorce with shared custody begins to seem like the only chance *ever* for a break. This might sound perverse but sadly, it is true.
Please keep shouting out some help and support to family members of mentally ill kids, Dr. K.
She is also aware that while her husband gets too little attention from her, he doesn't seem to recognize that her burden makes it impossible for her to receive anything like the attention and understanding a wife of a healthy child can expect. I admire that she can make the distinction between her marital obligation and her responsibility to and for her child.
Her husband has threatened divorce and she responds, "You promised." She tells me that she cannot respect that kind of selfishness on his part. They used to be great friends, have seen each other at their heroic best and their very worst. I have an idea her strength is what keeps him going, and what keeps her going is, well, who knows?
It is lovely advice to tell parents not to lose their relationship, but it isn't always possible.
I think conversations is always the best way to know what both sides thoughts are and what each believe are the best solutions. If the problem isn't honestly stated though, no real solution will come out of that conversation. The divorce threats by the husband are in my opinion immature, but so is her "You promised" response. They both need a lot more engagement with each other. I hope she realizes that unfortunately a marriage where one person isn't happy will never be a happy one, and for the sake of both moving on could be the best way forward (not without giving it their best shot though). Personally speaking, I would stand by my wife through this difficult process, and remind her I'm there for her and the child, but she has to give her husband more attention, make love to him and have a good conversation after.
Mental illness in children may be over-diagnosed in some cases, but others are truly ill -- ignore it at your peril. My (now ex) husband is the eternal optimist to the point of being a pollyanna, and is totally of the "snap out of it" and/or "everything's fine, don't get excited" philosophies. Neither are helpful when your child is sick and struggling.
I wish people would stop carrying on about the horrors of medicine and pharma and realize that the brain can get ill just as any other organ of the body can, and just because treatment is still inexact, it's unfair to dismiss the illnesses as "not real" or a conspiracy perpetrated by the medical profession.
Yours is an attitude of blame and defeat.
Hyperfocus and attention to advocacy and educating oneself is essential especially when the child's mental illness is severe. We have a child with anxiety, panic, mood and personality disorders. Combined they led to suicidal ideation, self-harming behaviors and quick-cycling, irrational moods. It has been crisis management here, and has eased only because we focused tremendous personal energies into identifying resources to help our child.
And the solution to a strained relationship is not so easy as Rx "get a room." If I've learned anything from my experience it is that I must take care of myself before I can be available to my spouse. Counseling and support networks have been a tremendous help.
10:49am
Arlington, VA
Good advice, doc, but if you have a stubborn mate who can't or won't learn how to help then the child comes first.