I am Worried About My Child. Where do I Begin?

There is no need to be embarrassed about asking questions or reaching out for help. It is okay to be concerned about your child and it is your job as a parent to make sure that you are doing everything you can to get them the support they need. You know your child better than anyone, and your instincts are there for a reason. If your instinct tells you that something is wrong and this is not “just a phase” then you should listen.

Sometimes our embarrassment comes from not knowing where to turn. The mental health system can be confusing for people who are reaching out to get help and the goal of this article is to assist you in better knowing what resources are available and how to access them.

The first thing you need to do is get some clarity about what is worrying you. One of the best ways to try to pinpoint the specific behaviors or feelings that have you concerned is to think about the ways in which these behaviors are ‘changes’ from the way your child normally acts. Are things different just at home or also at school? How about with friends? Siblings? Listing examples of the behaviors that have fueled your concerns is a concrete and objective place to start.


Your Pediatrician or Family Doctor

A good place to start looking for help for your child is through your Pediatrician or family doctor. The American Academy of Pediatricians says, “Pediatricians are, and will continue to be an important first source for parents who are worried about their child’s behavioral problems.”


Outpatient Therapists

The outpatient therapist is someone who can treat mild to moderate symptoms of depression, anxiety, some experimentation with drugs or alcohol, attentional issues, acting out behaviors and family conflict. Just as portrayed in movies or on television, the therapist usually sits across from an individual patient or client, and asks questions or makes comments. These sessions typically last from 45-60 minutes and take place about once a week. The frequency can vary, though, from 2-3 times per week to once every other week depending on the therapists’ availability and the severity of the symptoms.

Therapists can have any number of different degrees and credentials, which can be confusing when you are trying to figure out which professional to see. A licensed social worker (LSW or LCSW), licensed mental health counselor (LMHC), licensed family counselor (LMFT), licensed associate or professional counselor (LAC, LPC) all have Masters Degrees in the mental health field. From a practical viewpoint, it does not matter which degree or letters therapists have after their names; they are all trained to provide clinical care in the community. What matters is how comfortable you and your family member feel with them.


Nurses with Advanced Mental Health Training

Nurses with specialized training (CRN) provide mental health care in a variety of settings. They also function as case managers and patient advocates. They can provide group and individual therapy, can assess and diagnose mental health problems and in some states can prescribe medications.



Psychologists also can provide outpatient therapy. A psychologist (PhD, PsyD or EdD) has advanced training and a doctorate in the mental health field. Psychologists are the only mental health professionals qualified to administer and interpret psychological tests that can be helpful in diagnosing and understanding complex cases.


Group Therapy

Outpatient therapists also may provide group therapy that is designed to allow individuals of similar ages and problems to be treated within a group setting. Many of these groups occur for 1-1.5 hours a week and generally deal with specific topics. Some of the most common groups for adolescents include social skills groups, and groups to assist teenagers with attentional difficulties. For example, if you are concerned that your child is struggling socially, group therapy can be a great resource to assist with development of these skills in an appropriate and therapeutic setting.



These are medical doctors (MDs or DOs) with advanced training in dealing with serious mental illness. Most psychiatrists primarily prescribe and monitor medications. Often the psychiatrist will see individuals for an initial evaluation, and then follow up monthly for medication management sessions. Some psychiatrists will see patients weekly while others will provide both individual talk therapy sessions and medication management sessions. However, this varies from doctor to doctor.

Many people who are seeking help for the first time will try to make their initial appointment with a psychiatrist. Some psychiatrists do not take insurance and some have longer waiting-lists for appointments than other kinds of therapists. So if you are concerned about a family member, it can be easier and quicker to get them in to see an outpatient therapist first. They can begin talk therapy and if the clinician believes that medication is necessary or should be considered, they can assist with making a referral to a psychiatrist.


Intensive Outpatient Programs (IOP)

These programs, which meet for multiple hours, multiple days per week have higher levels of care and are designed to treat individuals who are experiencing moderate to severe symptoms. Most IOP’s are scheduled from 3 – 5 times per week and typically run for about 3-4 hours per treatment day for approximately 2-3 months. However, all IOPs are designed with a strong emphasis on group work to assist clients in developing specific skills to improve their level of functioning. There are usually a variety of groups that address particular problems like substance abuse, eating disorder or psychiatric disorders (such as mood, anxiety and psychotic disorders). If your child is using drugs or alcohol on a semi-regular to regular basis, then this is most likely the appropriate level of care for them. Similarly, many individuals who are struggling with eating disorder symptoms are often referred to this level of care.

If you have a child who has been in therapy with an outpatient clinician and has not made the progress you were hoping for, then an IOP may be the next step. Conversely, if your family member has not been in treatment before, but their symptoms are raising safety concerns (for example, you have recently discovered that they are harming themselves through cutting or burning) or if they are struggling with suicidal thoughts, then an IOP may be a more appropriate level of care for them than just outpatient therapy.


Partial Care Programs/Partial Hospitalization Programs (PCP/PHP)

This level of care is the step between an IOP and an inpatient hospitalization program. This program is designed for individuals who are not at immediate risk of harming themselves but are experiencing significant symptoms which make it difficult for them to function in their daily lives. PCPs usually run 5 days a week for 5-6 hours. Like IOP’s, they are group-based programs but also provide family work, individual work as well as medication management with a psychiatrist. Patients usually attend these programs from 2- 4 weeks, with the specific goals of getting their medications adjusted, improving the level of functioning, addressing any safety concerns and creating an appropriate aftercare plan. Many Partial Care patients will go directly to an IOP once they are more stable. If your child is not attending school, not functioning well, having severe depressive symptoms, self-injuring, or expressing suicidal thoughts with regularity, then this may be the appropriate level of care for them.


Inpatient Hospitalization

Just like you’d do if your child broke an arm or leg, when you are worried that your child is in immediate danger the best thing to do is take them to the emergency room for an evaluation. Any suicidal behavior or attempt should be taken seriously, so if your child is telling you or someone else that they want to die or have a plan to harm themselves, this is the level of care you may need. When you take your child to the emergency room, they will be provided a quick medical exam by the emergency room physician, after this, a psychiatrist, nurse or social worker will provide an assessment to determine the next step.

Many times children who are suicidal will be recommended for admission to the hospital for a week or so. Although this recommendation may sound scary, it really may be the best course of action for a child who is in crisis. As an inpatient, your child will attend groups, family sessions and be seen regularly by the psychiatrist for medication management. Once your child is more stable and no longer at high risk for self-harm, there will be an assessment by a social worker to assist you with determining what level of care is appropriate for follow up.

How to Talk to My Child About Suicide

Every parent would like to believe that suicide is not relevant to them or their family or friends. Unfortunately, it’s all too relevant for all of us. It’s the 2nd leading cause of death for youth age 10-24. Even more disturbing are national surveys that tell us that 17% of high school students admit to thinking about suicide and almost 8% acknowledge actually making an attempt. The unfortunate truth is that suicide can happen to ANY kid in ANY family at ANY time!

So how do you deal with this reality? Once you acknowledge that suicide is as much risk for your child as not wearing a seat belt while driving, or using alcohol or drugs, or engaging in risky sexual behavior, you’ve taken the first step in prevention. You talk to your children about these other behaviors which can put them at personal risk, and suicide is no different. It’s something you CAN and SHOULD talk about with your children!

Contrary to myth, talking about suicide CANNOT plant the idea in someone’s head! It actually can open up communication about a topic that is often kept a secret. And secrets that are exposed to the rational light of day often become less powerful and scary. You also give your child permission to bring up the subject again in the future.

If it isn’t prompted by something your kid is saying or doing that worries you, approach this topic in the same way as other subjects that are important to you, but may or may not be important to your child:

Timing is everything! Pick a time when you have the best chance of getting your child’s attention. Sometimes a car ride, for example, assures you of a captive, attentive audience. Or a suicide that has received media attention can provide the perfect opportunity to bring up the topic.

Think about what you want to say ahead of time and rehearse a script if necessary It always helps to have a reference point: (”I was reading in the paper that youth suicide has been increasing…” or “I saw that your school is having a program for teachers on suicide prevention.”)

Be It this is a hard subject for you to talk about, admit it! (”You know, I never thought this was something I’d be talking with you about, but I think it’s really important”). By acknowledging your discomfort, you give your child permission to acknowledge his/her discomfort too.

Ask for your child’s response. Be direct! (”What do you think about suicide?”; “Is it something that any of your friends talk about?”, “Have you ever thought about it? What about your friends?”)

Listen to what your child has to You’ve asked the questions, so simply consider your child’s answers. If you hear something that worries you, be honest about that too. “What you’re telling me has really gotten my attention and I need to think about it some more. Let’s talk about this again, okay?”

Don’t overreact or under Overreaction will close off any future communication on the subject. Under reacting, especially in relation to suicide, is often just a way to make ourselves feel better. ANY thoughts or talk of suicide (”I felt that way a while ago but don’t any more”) should ALWAYS be revisited. Remember that suicide is an attempt to solve a problem that seems impossible to solve in any other way. Ask about the problem that created the suicidal thoughts. This can make it easier to bring up again in the future (”I wanted to ask you again about the situation you were telling me about…”)

Here are some possible warning signs that can be organized around the word “FACTS”:

  • FEELINGS that, again, seem different from the past, like hopelessness; fear of losing control; helplessness; worthlessness; feeling anxious, worried or angry often
  • ACTIONS that are different from the way your child acted in the past, especially things like talking about death or suicide, taking dangerous risks, withdrawing from activities or sports or using alcohol or drugs
  • CHANGES in personality, behavior, sleeping patterns, eating habits; loss of interest in friends or activities or sudden improvement after a period of being down or withdrawn
  • THREATS that convey a sense of hopelessness, worthlessness, or preoccupation with death (”Life doesn’t seem worth it sometimes”; “I wish I were dead”; “Heaven’s got to be better than this”); plans like giving away favorite things, studying ways to die, obtaining a weapon or stash of pills; suicide attempts like overdosing or cutting
  • SITUATIONS that can serve as “trigger points” for suicidal behaviors. These include things like loss or death; humiliations, rejections, or failures, getting in trouble at home, in school or with the law; a break-up; or impending changes for which your child feels scared or unprepared

When a Child's Friend Dies By Suicide

First deal with your own feelings

When your child’s life is touched by the suicide of a peer or a friend, you may find yourself experiencing a lot of different things about the same time. Initially, you will most likely be stunned by the death. Suicide is, in fact, a rare occurrence that is difficult for most of us to understand. When a young person makes the devastating choice, our personal sense of shock and confusion can be overwhelming. The questions of how and why did this happen are often fodder for neighborhood gossip and speculation. This is when it’s so important to remember that suicide is a complex act that is always related to a variety of causes.

We may never know all the reasons for any suicide, and within this vacuum of complete and accurate information, we are often presented with half-facts and speculation. Especially after the suicide of a young person, we want to ferret out the causes so we can protect ourselves, and our children, from a similar fate. And while it’s true that understanding the risk factors and warning signs of suicide can be very helpful, we don’t want to make judgments or assumptions about this particular death. So don’t give in to random conversations about the reasons for death. The most important thing any of us can say is that this young person was not thinking clearly and made a terrible choice, and the cost was his or her life.

If you knew the deceased personally, you may feel a jumble of emotions yourself. Give yourself some time to let the news settle. Expect shock to mix with sadness and helplessness. Ultimately, the fact that this youngster died by suicide will be less central to your emotions than the fact that he or she is dead and will be missed by you.

It is critical for you to take time to deal with your own feelings before you approach your child. Remember the directives from air travel about the use of oxygen masks – you must put on your own mask before you can help anyone else with theirs!


NEXT help your child

This initial response of shock may be followed quickly by concern for your own children. If your child had a personal relationship with the deceased, your child’s grief should be your first priority. Grief in childhood looks differently than it does in those that accompany a significant loss, in short bursts. Such feelings normally pass quickly, which is why it’s important to seize those “teachable moments” when the door to conversation about the death may be open.

Start by expressing your own sadness and confusion about the death, and then ask your child to share his or her reactions. Validate whatever you hear. I can appreciate your sadness, confusion, anger, lack of understanding. Be prepared for the classic response of “I don’t know” and validate that too! I understand when something like this happens, it can be hard to know how you feel.

If you’ve been hearing rumors about the death, chances are your child has heard them also. Address the rumors with your child. There are a lot of rumors floating around about what happened. Have you heard anything? Explain that although some of the rumors may be true, they are only part of the story and we have to be careful not to make judgments based on limited information. Emphasize that the most important piece of the story is the fact that the deceased felt so terrible or was thinking so unclearly that he or she did not realize in the consequences of what he or she was doing. This is especially important to discuss if drugs or alcohol are implicated in the death. Remind your child, without preaching or lecturing, about the effects of drugs on impulse control and judgment.

Because children normally imitate or copy the behavior of peers, you may want to underscore the dangerous consequences of the deceased’s behavior. Sometimes children are intrigued by the circumstances of a suicide death or attempt, so it’s essential to state emphatically that there can be a fine line between dangerous and deadly behavior – and their friend’s death is a reflection of this. If they hear any of their friends talking about copying the behavior of the deceased, they need to tell an adult immediately!

This leads into the final part of the conversation: a discussion about help-seeking. Emphasize that nothing in life is ever so terrible or devastating that suicide is the way to handle it. Ask your child to whom she or he would turn to for help with a serious problem.

Hopefully, your name will be on the top of the list, but don’t be upset if it isn’t. Depending on your child’s age, his or her allegiance may have shifted to peers. Agree that friends are a great resource but that when a problem is so big that suicide is being considered as its solution, it’s essential to get help from an adult too.

Ask which adults your child views as helpful, especially with difficult problems. If the list is short or nonexistent, make some suggestions. Good choices can include other adult family members, school staff such as teachers, counselors, coaches or the school nurse, clergy or youth ministers, a friend’s parent and older siblings or even neighbors. The identity of the person is less important than the fact that your child recognizes the importance of sharing problems with a trusted adult.

A time may come when your child is concerned about the well-being of a friend or classmate. You may want to help them recognize that these same adults are a great resource in those situations too. It’s never good to keep worries about a friend to one’s self, especially if the worries are about something as serious as suicide.

Revisit these messages about finding adult helpers in other conversations. Unanswered questions and complicated feelings about a suicide linger, even if they are unspoken, and ignoring them does not make them go away. Talking about suicide can’t plant the idea in your child’s head. On the contrary, creating an open forum for discussion of difficult subjects like suicide can give your child the opportunity to recognize you as one of his trusted adults and will offer the chance to practice help seeking skills.


  • Deal with your own reactions
  • Avoid gossip about the causes
  • Remain nonjudgmental about the deceased
  • Share your reactions with your child
  • Ask for his/her response and validate it
  • Acknowledge rumors and put into context
  • Underscore the dangerous behavior of the deceased
  • Introduce topic of help seeking
  • Keep channels of communication open!

After an Attempt:
The Next Steps

“Not My Child”. Not until it becomes part of your life. Most parents have or will say “Not My Child”. But what if it happens to your child? What now?

"Having a child released from the hospital after a suicide attempt can be an unsettling experience for parents and guardians. Although many parents report being shocked that their child needed to be hospitalized at all, there is often a momentary sense of relief during the hospital stay that at least their child is safe and in good hands. As planning for discharge from the hospital begins, parents may be unprepared for their mounting anxiety about how to maintain a safe environment for their child once he or she returns home."

Treatment options after hospital discharge often include something called “Intensive Outpatient Treatment” or IOP. This usually includes a prescribed number of hours in an outpatient treatment facility like a mental health clinic where individual and group counseling focuses on helping the child develop healthier coping strategies. If the child was prescribed medication during his or her hospital stay, the IOP staff also monitors the drugs for evidence of effectiveness, side effects, etc. At the conclusion of the IOP treatment, the child is usually referred to a mental health provider in the community. This person continues to work with your child to address the issues that led to his or her suicidality.

In other instances, the hospital may decide to skip the IOP and directly refer your child to an outpatient therapist. Sometimes this happens when a child was in treatment with a mental health professional prior to his or her attempt, and then he or she is simply referred back to that original person to continue counseling after hospital discharge. In some parts of the country, an appropriate IOP may not be accessible so intensive outpatient treatment with a private practitioner may be suggested as a substitute.

It is really important for you to be involved in your child’s treatment after hospital discharge. What is essential is a conversation with the counselor about what is called a safety plan for your child. Since your child is designated by insurance as the “identified patient” there may be confidentiality issues. The therapist may be reluctant to share details of the treatment but should be able to talk with you, as a key member of your child’s support system, about specific ways you can help maintain his or her safety. Unfortunately, because the clinical picture for each child is unique, there is really no one set of prescribed guidelines to help you in this process. The safety plan would include helping him or her identify situations that may trigger thoughts of suicide and coming up with alternative responses. You should also get clear instructions about what to do and whom to call in a mental health emergency.

Remember, you are a critical member of your child’s support system and need to understand the goals of counseling, what measures the counselor will use to assess progress and the specific ways in which you can work with your child to increase his or her feelings of safety. SPTS has produced a video which models how to address questions to mental health providers and how to keep asking questions until you understand and are comfortable with the answers.

Bullying & Cyber Bullying

Are you concerned that your child might be bullied?

Potential Signs to look for:

  • Does s/he return home from school with torn, damaged, or missing articles of clothing, books or belongings?
  • Does s/he have unexplained cuts, bruises or scratches?
  • Does s/he have few, if any, friends?
  • Does s/he seem afraid of going to school?
  • Has s/he lost interest in school work?
  • Does s/he have physical complaints, trouble sleeping or frequent nightmares?
  • Does s/he appear sad, moody or depressed?
  • Does s/he appear anxious, worried, or have poor self-esteem?
  • Has s/he become quiet, sensitive or passive?

If you notice any of these things, talk with your child and keep your eyes open. Don’t get frustrated if your initial attempts at a conversation about bullying go nowhere. It can take time for kids to open up about what may feel like an embarrassing experience. Be patient and persistent. It can also help to express your concerns to your child’s teachers and ask them to observe his/her social interactions more closely. Always stay supportive of your child! If you continue to feel uneasy despite reassurances from both your child and his/her teachers, consult with a mental health professional.

One of the biggest stories making headlines today is the news about the pervasiveness of bullying behaviors in youth. As most of us probably remember from our own childhood, bullying has been around for a long time. It has always been mean-spirited, primarily about intimidation and power, and pitted a child (or adult) who seems different against other peer group members. It’s never a once in a lifetime occurrence – it happens repeatedly, and there are often bystanders who witness the behaviors but do not intervene.

What may make today’s bullying behaviors different is that they now can occur online, which has earned the name ‘cyberbullying’. Years ago, kids who were victims of bullies could retreat to the safety of their homes after an abusive experience at school. Now, however, the barrage of insults often continues via texts, emails, and Facebook messages. Because of the anonymity of the internet, cyberbullies may be even more coarse and abusive. It can seem as if there is no way to escape.

So what’s a parent to do?

Recognizing that bullying behaviors can occur in any peer group setting is an important place to start. Too many parents feel that their child is protected because s/he goes to a ‘good’ school or because the parents ‘know’ all of their child’s friends. Don’t fool yourself into thinking that you know everything that happens in your child’s life. Even young children keep certain things to themselves; the targets of bullying behaviors are often too intimidated or embarrassed to talk to anyone about what’s going on.

Here are some specific action steps to remember:

  • Recognize that bullying does happen, even as early as elementary school. If you notice worrisome changes in your child’s behavior, try to remain open-minded and consider bullying as a possible cause. Ask questions about your child’s social interactions to see if s/he is having problems with particular peers. You don’t need to use the word “bullied”- you can ask if kids seem mean, or bossy, or if your child feels left-out at lunch or recess. Kids face all kinds of social challenges and do not have to meet the technical definition of bullying to be having a difficult time with peers.
  • Even though your child’s school may include curricula that deal with bullying behaviors or host assemblies on the topic, don’t rely on the school to be the primary monitor of bullying behaviors. Most bullying happens in places where there is no adult supervision: in halls, the lunchroom, playground or in bathrooms. School officials may be unaware that it’s even taking place.
  • Have an open conversation about bullying with your child long before it becomes a problem. It’s a whole lot easier to have a conversation about prevention before there is a problem to prevent! Periodically revisit the topic. This isn’t a ‘one time only’ conversation, but a subject that should be regularly integrated into your discussions about what’s going on in your child’s life.
  • Make use of opportunities presented by media coverage of bullying to get your child’s opinion on the subject. It may be easier to start a conversation about bullying that’s initiated by reactions to an impersonal news story than it is to talk about something personally affecting your child’ life. It can open the door to a discussion about bullying in a non-threatening way.
  • Remind your child about the importance of telling a trusted adult if s/he is worried about being bullied or for a peer. Unfortunately, studies have shown that almost 25% of youth who have been bullied didn’t tell anyone about the experience.
  • Pay attention to what happens in your own home. It’s a whole lot easier for kids to use abusive and foul language in the hallways of their schools if it’s what they’re used to hearing in the hallways of their homes.
  • Recognize that your goal is to help your child learn to be bully-resistant, not bully free. There will always be bullies who scapegoat those they perceive to be different or weaker. Your job is to reinforce skills that will help your child respond if and when bullying occurs. What are some skills you can encourage in your children?
  • Deciding on a plan of action before bullying occurs. Help your children understand how to identify intimidating, bullying behaviors and work with them to develop strategies to address them.
  • While telling a trusted adult is the recommended strategy, especially for younger children, be sensitive to the perception that kids who ‘tell’ on their peers may be seen as tattletales or snitches. Help your child develop a plan to share this information with an adult in private.
  • Avoid telling your child to ‘fight back’ and respond with similar intimidating behaviors. When bullying behaviors escalate, everyone loses! What you can encourage, is for your child to ‘fight back’ in a positive way by:
    • Avoiding places where the bullying takes place.
    • Staying off internet sites that contain intimidating or hostile messages.
    • Identifying trusted adults with whom s/he can discretely talk about what’s been going on.
    • Telling you!
  • Encourage your child to be an ‘up-stander’ rather than a ‘bystander’. If they see someone else being bullied or harassed, urge them to intervene by getting an adult involved. Remind them that their job is not to stand up to the bully, but to find an adult to take on that responsibility.
  • Finally, it is importance that you maintain access to the websites frequented by your children, especially your younger ones. Even though most of them will argue that their privacy is being violated, children need to understand that privacy is not an absolute. While you can certainly respect some of the ways in which they are developing independence, because of the real dangers posed by the internet, you need to remain vigilant about that aspect of their lives.

You may have also seen stories in the press that link being bullied and suicide. While bullying behaviors are one of the risk factors for youth suicide, they are only one of many. It’s important to remember that there is more than one reason for every suicide. It’s equally important to learn what you can about not only youth suicide risk factors and warning signs but also about the factors that insulate or protect your child from suicide risk

We know that bullies come in all sizes and can be found in many places – playgrounds, cafeterias, sports teams, college dorms, even workplaces. In the last ten years of advanced technology there is a new hiding place for a destructive and often lethal bully – cyber space.

What is Cyberbullying?

Cyberbullying is the use of internet or other digital devices as E-mail, instant messaging, text messages, social networking sites, web pages, blogs, chat rooms or interactive game sites to send negative and harmful messages and images. While the term “Cyberbullying” is technically used when the victim or bully in a minor, it is also applied to the cyber harassment of college students.

Cyberbullying Takes Many Forms

According to Nancy Willard of the Center for Safe and Responsible Use of the Internet, cyberbullying can take the form of:

  • flaming or online fighting with vulgar language
  • harassment or repeated sending of mean and insulting messages
  • denigration or demeaning gossip
  • impersonation or pretending to be someone else and posting damaging messages
  • outing or sharing someone’s personal information or embarrassing secrets
  • trickery or covertly drawing out and then exposing personal information
  • exclusion or intentionally excluding someone from an inner on-line group or site
  • Cyber stalking or repeated frightening threats

Cyberbullying like any form of bullying is relational aggression. It is intended to make the victim feel frightened, humiliated, helpless and too often – hopeless. What makes cyber bullying particularly harmful and in the case of at least five young people who have committed suicide, so deadly, is the nature and virulent reach of electronic medium.

Cyberbullying is anonymous. Perpetrators can torture and harass without detection. Cyberbullying is relentless. It can be conducted 24/7 appearing constantly on the phone and computer that a young person uses on a daily basis for school and social connections. Cyberbullying assaults privacy boundaries in a way that magnifies the horror as it makes damaging material public to an infinite audience that can instantly download, save or forward to others.

Reported in Cyber Bully: Bullying in a Digital Age, David Knight, a high school student who found that a web page of negative, sexual accusations and negative descriptions about him had reached as far as Thailand, painfully describes, “Anyone with a computer can see it…It doesn’t go away when you come home from school. It makes me feel even more trapped.”

Statistics on Cyberbullying

Statistics reveals an increasing problem. Four in ten teens have experienced online bullying; girls are twice as likely to be victims and perpetrators, usually engaging in social sabotage of others; boys are more likely to target girls and less aggressive males; sexual and homophobic harassment is emerging as a prevalent aspect of cyberbullying; cyberbullying is most prevalent among 15 and 16 year olds; and the more that young people share their identities and thoughts on social networking sites as MySpace and Facebook, the more likely they are to be targets than those who do not use the sites.

Why Teens Don’t Tell

Electronic harassment is as real as and often more frightening than face to face bullying. Much like stalking or other types of assault the victim can often feel helpless, frozen, isolated, ashamed and not likely to reveal what is going on to parents or sometimes even to friends. According to surveys, only 35% of cyberbullied teens and 51% of preteens told parents. The reasons given by teens in Focus Groups were fear of restriction from electronic use, fear of being blamed or expectation of parents’ overreactions.

Feeling Safer in Cyber-Space

The answer for parents is not to ban a child or teen from their technological connections or to read every E-mail. Cyberspace is as much a viable social world as the playground, candy store or Mall was to earlier generations.

  • For parents, talking with children and teens about the forms of cyberbullying and strategies for dealing with it can be a valuable trusted collaboration. Supervision is different from invasion of privacy.
  • For pre- teens and teens living at home or college students living with friends the answer in the face of harassing material or cyber terror is not to isolate and hide. You have done nothing wrong. You are entitled to the support of those around you. Work together and draw upon the guidelines listed below to respond to cyberbullying.

Guidelines for Responding to Cyberbullying

  • Stop- Don’t respond to the bully- even to the first offense -it only escalates the problem.
  • Save the evidence- print copies and save the messages.  Young children can be instructed to shut off the monitor if something upsetting appears (not the computer) and/or CALL YOU.
  • Block the sender or point out how you can click the warning button on an instant message (IM) screen or chat screen that alerts the Internet Service Provider of objectionable material.
  • As a parent if you and your child find that the perpetrator is another student, share evidence with the guidance counselor – even though 70% of the cyberbullying happens when a youngster is home, if often involves other students in the school.
  • If the cyberbullying continues – contact the parents of the perpetrator.  If you are comfortable with that, it can be very effective in helping everyone. Given that you have saved evidence, you can invite the need for steps to correct a dangerous situation for all.
  • If needed contact an attorney to help you deal with the parents of the perpetrator.
  • If the cyberbullying contains threats, intimidation, obscene material or sexual exploitation report it to the police or cyber crime unit it your area.
  • Seek support and professional help for yourself and or your child if there is emotional stress reflected in depression, desperation, anxiety or thoughts of self-harm.

The Bystanders

As reflected in the title of Barbara Coloroso’s book on bullying, the cycle of this type of violence includes the bully, the bullied and the bystanders. In all types of bullying the role of the bystander is crucial – perhaps even more so in cyber bullying.

If we overlook the ease with which we or our children can unwittingly add to the horror of damaging someone’s life by passing on the secrets, privacy or exposure of another with a simple click, we make cyberspace a dangerous place. If we talk about and participate in steps with friends and family to stop, delete, tell, block and report cyber assault, if we show compassion, we change from bystanders to protectors.

The Crisis Is Over - What Now?

One of the biggest challenges for teens following a suicide attempt, hospitalization or an intensive treatment program is figuring out how to get their lives back. As parents, though, you have your own set of worries. A lot of anxiety can come from the fact that your child is no longer receiving intensive mental health services. There can be lots of confusing and worrisome questions. How protective do you need to be? How much should you push your child? When do you give them space? An equally pressing concern can be what to say about these recent events.

As you can imagine, this is usually a concern for your child as well and it’s really important for you AND your child to try to have a conversation about this with your mental health provider before the return to school is planned. Because one of the things that gets pretty damaged after a suicide attempt or episode of self-harm is trust, it helps to talk about this with everyone in the room at the same time so the communication is clear.

There are actually some common questions and concerns that treatment providers are frequently asked regarding ‘reintegration’, which is what we call the process of returning back to regular life after being gone for a while. Here are some of these questions along with suggested answers.

What do you tell people about where your child has been?

This is the most common question. The best answer is “whatever makes you comfortable.” There is no reason for you or your child to feel embarrassed about getting help; however, that being said, it’s important to recognize that there still is a lot of misinformation about mental health treatment. While it’s not necessary to advertise where your child has been, there’s also no need to lie. So, how do you strike that balance?

  • First of all, most treatment providers recommend that someone in the school, club or activity have some basic information about your child and his/her recent struggle. No one needs to know all the details, but it will be extraordinarily helpful for your child to have an identified adult whom they can trust to be a resource if they are stru As one wise teen put it: “You may not want anyone to know, but make sure that someone knows just enough to have your back. You’ll be thankful when you need it.”
  • Secondly, make sure you have your child’s back. Academic pressure is often a stress trigger for adolescents, and teens who are struggling with mood shifts, anxiety or adjusting to medication find that these symptoms affect their school performance. Poor focus, concentration, and memory, difficulty with sleep – all of these are common symptoms which can have a really negative effect on academic performance.
  • For students who have missed some school due to symptoms or treatment, it gets even more challenging. There’s the pressure of both catching up and moving ahead at the same time. Although it is your son/daughter’s responsibility to complete missing school work, they may need your help in advocating with the school to create a reasonable academic plan. Meet with the appropriate staff at the school to find out what work needs to be completed and what kind of flexibility exists. Schools can frequently adjust deadlines or reduce the number of missed assignments in order to assist with reintegration into school.
  • Sometimes it may be necessary to make schedule or class changes to reduce pressure. Is there an elective that can be put off until next year to allow for a study hall? Would a subject-matter tutor make catching up easier? Can the school provide or suggest one? What before and after school assistance is available to help your child complete schoolwork and catch up with classes? You may even want to suggest to your child’s mental health care provider, that they initiate a conference with the school prior to discharge so that some of this can be ironed out before your child even reenters a class  It will make your child’s return to school easier and can reduce some potential stressors for them.

How can I help my child come up with an explanation for peers about where he’s been?

Dealing with other students or peers is a bit trickier than dealing with adults. Some kids tell peers that they have been in treatment, but don’t explain the reason why. If your child is the type to get away with it, answering follow up questions with “it’s none of your business” or “I only talk with personal things with close friends” are certainly acceptable answers.  Other kids have used the explanation that they have been “dealing with family problems.” It’s a way to acknowledge the question, without giving specific information. It also has the advantage of ending the conversation quickly since most people won’t pry about the type of family problems.

Some adolescents can use their sense of humor. If your child tends to be humorous or sarcastic, then this skill can come in handy when answering these questions. An adolescent can tell peers almost anything that comes to mind. Kids have reported that they have used explanations like “trying out a new school on Mars, running a secret government program, catching fish in Alaska.” and gotten away with it.   Without follow-up questions!

Another common answer is for kids to say they have been out sick dealing with a medical problem. This can work especially well if your child is going to be missing some additional school for follow up appointments – it’s a built in excuse for continuing absences. Again, the privacy shield is usually your best option. “I really don’t want to talk about it.  Thank you for asking.” is usually a conversation stopper. Be careful, however, with using specific medical excuses like mono or the flu, as it can be easy to be caught in a lie, which can make things even more difficult for your child.

Another thing to consider is that if your child has been out of school for a while, there are almost certainly rumors circulating about them and where they have been. It’s important to recognize that this may happen; don’t put your head in the sand and think no one has noticed the absence. If your child has siblings or friends in the school, ask them what the rumors are. What you hear might not be nice – rumors and gossip rarely are – but at least your child can be realistically prepared for what they’ll face. And you can help them create a plan to cope with it! If your child will allow it, make sure that the guidance counselor or trusted adult is involved as well. The good thing about rumor mills is that they tend to move fast, and your child will only be the topic of conversation until the next interesting event. Reassure your son or daughter that they can deal with it and that they won’t have to deal with rumors alone.

How much freedom do we give our child?

Phone, Computer, Friends – What do we let them do? These questions are challenging for parents of all adolescents, but they become even more significant when you’re worried about your child’s safety and the possibility of self-harm. The best strategy addresses the issue of ‘trust’ we’ve talked about before and the importance of communication. You know your child and the pitfalls he/she may encounter so set realistic expectations and be open with your teenager about what they are.  It is okay to monitor your kids closely and stay on top of their behavior and interactions with peers as long as they know that it’s happening and is part of what they need to do to earn back trust.

Daily or even weekly check in meetings (they don’t need to be long -they can be as short as five minutes,) can be helpful in terms of clarifying rules for the week and also giving back privileges as they are earned. Make it clear to your child that you expect them to communicate with you.  Explain that the more information you have about how they are doing and what they are feeling, the more helpful you can be as a parent.

If your child feels misunderstood, give them the opportunity to help you understand their side of things. And be open to their perceptions! You don’t have to agree with them to understand their point of view. Communication is a two-way street and has often been disrupted in families dealing with serious mental health issues. If you work on listening and not simply talking, you’ll get a much better understanding of what’s happening in your child’s life.

An often contentious subject of conversation in any family relates to the use of the phone and computer. Here’s your starting point: If your child is struggling with mental health issues and is in treatment, it is good to have the therapist involved in these discussions as they often raise a lot of conflicts. The bottom line, of course, is that it is your right as a parent to set limits and boundaries when it comes to the phone and computer use.

Monitoring your child’s interactions may be necessary until they are more stable and able to make better choices. Many suicide attempts have been precipitated by negative interactions on Facebook, Instagram, or text messages so knowing what your child is being exposed to may be necessary to help keep them safe.   Let your child know that you may look at their phone and if they have a Facebook account, you require having access to it. Yes, they can create another account and erase phone texts, but you are still sending a clear message of expectations that your child needs to hear.  As they get healthier, as they communicate more with you and as the trust grows, the amount of supervision and monitoring can decrease.

Hanging out with friends is another area of your child’s life that is important to consider. Friendships are vitally important to adolescent development, but when your child is struggling, conflict with peers is also a potential stress trigger. The best advice is to reintegrate friendships slowly. Allow your child to have friends come to the house. Be sure to check in after these interactions to get a sense of how it went. Is your child feeling less stressed and supported? Or more stressed and tearful?  These responses will be clues as to which friends are the healthiest for them to be around. The best ways to interact with peers is usually in more structured situations like groups at school or church, clubs, activities, sports. They provide the opportunity for peer interaction but with adult supervision and with an identified area of focus.

The more challenging question, of course, is what about the peers who may have supported your child’s unhealthy behaviors, like drinking or drugging or self-injury.   How do you handle those relationships? Hopefully, during the period of intensive treatment, the peers who were involved in your child’s poor choices will have been identified and some type of plan developed to address these relationships. If that didn’t happen, you will need to make your concerns about these friendships clear to your child, and keep your eyes open for behaviors that worry you. Also, remember that changing circles of friends doesn’t happen overnight and you need to be patient with the process.

What do I tell my friends and family about where my child has been?

Telling family and friends is another area where the best answer is “do what makes you most comfortable.” You know the people in your life who will be understanding and supportive listeners.   You also know the people who will be less than kind in their responses. Pick and choose. Everyone doesn’t need to get the whole story but just as it’s important for your child to have a trusted adult as a confidant, you also need someone you trust to support you. You can’t feel like you have to hide what you are thinking and feeling from everyone, and having that outlet of support is important for your own self-care.

For your other children, especially those that live in the home, including them in a conversation about what’s going on is important. Siblings know and understand more than we think, and not giving them information tends to confuse them. Just like most adults, children tend to jump to conclusions when given limited information, and those conclusions usually include the worst possible scenarios. Giving siblings an opportunity to ask questions and share their fears is helpful. Again, make educated choices about just how much information to give based on the ages of the siblings and discuss it with professionals

When it comes to extended family, giving some broad information is usually helpful but not everyone needs to know what you and your child are going through. Make your choices wisely and make sure everyone in the family understands what information will be shared with whom.  When it comes to family events, craft a plan ahead of time.   Help your child anticipate what part of the event might be overwhelming and then problem-solve some strategies to deal with the potential stressors. Can they go for a walk? Can they bring some books or video games to distract them? Even with a plan, recognize that groups of people may be tough for your child to handle right now and some additional support- or abrupt change in plans- might be necessary.

Where do I get support for myself?

Parenting is a tough job, even when things are going well. When you’re confronted with serious concerns about a child, however, there’s no way you can bear that burden alone! But just as you found help and support for your child, you can find it for yourself. First of all, you can get your own individual therapist if needed. Having someone to talk to about your feelings can be one of the best ways to take care of yourself.

There are also wonderful resources available to assist parents who are dealing with mental health issues in their children. The Federation of Families for Children’s Mental Health is a National organization with state and local chapters. They provide a broad array of services including parent advocates and advisors, support groups and some chapters provide respite services and teen support groups. is a great website that provides education and support for a variety of mental health issues that families can face. They also provide educational support groups for families dealing with serious mental illness.

What’s the take–away?

The most important thing to remember is that what happened with your child isn’t simply an ‘event’ but an ongoing process that will require you to continue to make decisions about your child’s welfare. If you are struggling with making good choices for your child due to concerns about their safety and their mood, then get a professional to help you. A therapist is going to be able to assist you in making the best decisions and can be a sounding board for your concerns.

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