A new Approach for Understanding and Parenting Easily Frustrated

Does the CPS model ever fail to work? What then? 
There’s good reason to be optimistic that, with your 
help, your explosive child will be able to respond to frustra-
tion more adaptively. These are resilient kids—they do re-
spond to being understood and to good treatment. 
Most of the time. There are, unfortunately, children who 
do not have access to, refuse to participate in, or do not re-
spond as favorably to treatment and who continue to be-
have in an unsafe manner at home, at school, and/or in the 
community. Many started a downward spiral early, became 
increasingly alienated, began exhibiting more serious forms 

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Family Matters 
227 
of inappropriate behavior, and began to hang out with 
other children who have come down a similar path. 
Unfortunately, society isn’t yet well prepared to help 
these children. Many school personnel don’t have the expe-
rience or expertise to handle the difficulties of students 
whose learning disability is in the domains of flexibility and 
frustration tolerance. Many alternative day-school place-
ments still use traditional reward and punishment pro-
grams as their primary therapeutic modality. The police 
and courts often aren’t equipped to provide the type of in-
tervention needed by many families. Often, the best the ju-
dicial system can do is hold the threat of a significant 
consequence over a child’s head. Many social service agen-
cies are overwhelmed; the problems of an explosive child 
and his family may pale in comparison to the problems of 
other children and families that are referred to and fol-
lowed by these agencies. Mental health professionals aren’t 
especially effective in working with individuals who won’t 
come in for treatment or whose needs require attention 
outside the boundaries of a fifty-minute session in a thera-
pist’s office. And managed care issues are sometimes a sig-
nificant obstacle. 
After all else has been tried—therapy, medication, per-
haps even alternative day-school placements—what many of 
these children ultimately need is a change of environment. 
A new start. A way to start working on a new identity. Once 
alienation and deviance become a child’s identity and a 
means of being a part of something, things are a lot harder 

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228 
The Explosive Child 
to turn around. Many such children ultimately need treat-
ment that is more intensive than the kind that can be pro-
vided on an outpatient basis or in a regular education setting. 
One way to give them this new start is by placing them in a 
therapeutic facility. As horrible as that may sound, there are 
some outstanding residential facilities in the United States 
that do an exceptional job of working with such children. 
The better residential facilities have excellent academic 
programs, so a child’s chance of being accepted to college 
isn’t sacrificed. Although many of these facilities have a be-
havior management component for maintaining order, the 
better ones also have a strong therapeutic component 
through which many of the thinking and communicating 
skills described in the preceding chapters can be developed. 
Many of them also have a family therapy component (re-
member, the goal is for the child to return to his own home 
and community). Residential programs whose primary 
agents of change are large human beings who make sure 
your child knows who’s boss should be avoided. 
The prospect of placing one’s child in a residential facility 
can feel like a nightmare to many parents, although parents 
who have been living a constant nightmare at home are often 
more open to the idea. Our instincts are to keep our families 
together, even when they’re being torn apart. Our instincts 
are to keep our children under our supervision, even when 
our supervision is no longer sufficient. We don’t like to feel 
that we’re throwing in the towel, even when all the evidence 

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Family Matters 
229 
suggests we cannot provide everything a child needs. We 
don’t like asking someone else to take care of our child, even 
when we think it may be for the best. So our every instinct is 
to hang on, tough it out, and try something else. A new drug. 
A new therapist. A new program. A new school. A new book. 
If a child is acting out in school, it is sometimes possible 
to convince or compel a school system to pay for a place-
ment outside the school system. Under the Individuals with 
Disabilities Act (a federal law, and it’s a good one, that ap-
plies to public schools), school systems are obliged to place 
their students in the least restrictive setting appropriate to 
their needs; residential placements are considered the most 
restrictive setting, so such placements are generally held 
out as a last resort. School systems vary widely in their re-
sources for children who need more than the mainstream 
can provide. If it becomes apparent, after adjustments and 
accommodations are made, that a general education pro-
gram is not sufficient for your child’s needs, the first consid-
eration in many school systems is a classroom aide. The 
next stop is often a special classroom for children with be-
havioral problems. A day-school placement outside the 
school system is frequently the next stop. If these alterna-
tives fail to achieve the desired effect, a residential program 
may become a more serious consideration. In some cases, if 
it’s clear that these intermediate placements are insufficient 
for a child’s needs, a residential program may be considered 
earlier in the process. 

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230 
The Explosive Child 
If you end up seriously considering placing your child in 
a residential facility, try to visit some of the places where 
you’re thinking of sending him. Make sure you feel com-
fortable with the staff, the philosophy of the program, and 
the other children at the facility. Make sure the staff have 
lots of experience working with children whose profiles are 
similar to your child’s. Make sure they are open to your 
ideas about your child. 
Placement won’t be forever. With luck, only a year or 
two. That gives you some time to get your own house in or-
der, while your child is in a controlled, safe environment 
where he can learn how to think more flexibly and handle 
frustration more adaptively, where he can get his medica-
tion straight, and where he can be helped to come home. 
It’s not the end of the world. It can be a new beginning. 

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Better Living Through Chemicals 
A
s noted in Chapter 7, there 
are some children who will not benefit substantially 
from the approach described in this book until they’ve 
been satisfactorily medicated. No one wants to see a 
child medicated unnecessarily, so a conservative ap-
proach to medication is recommended. However, some 
characteristics are well addressed by medication; namely, 
hyperactivity and poor impulse control, inattention and 
distractibility, irritability and obsessiveness, and having 
an exceedingly short fuse. Medication does not teach a 
child thinking skills, but when it’s effective, it can open 
231 

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232 
The Explosive Child 
the door to such teaching. The goal of this chapter is to 
provide a brief overview of (rather than a comprehensive 
guide to) the medical options. 
Deciding whether to medicate one’s child should be 
difficult; you’ll need a lot of information, much more 
than is provided in this chapter. Ultimately, what you’ll 
need most of all is an outstanding child psychiatrist. 
You’ll want one who 
• takes the time to get to know you and your child, lis-
tens to you, and is familiar with treatment options 
that have nothing to do with a prescription pad 
• knows that a diagnosis provides little useful informa-
tion about your child 
• understands that there are many things medication 
doesn’t treat well at all 
• has a good working knowledge of the potential side 
effects of medication and their management 
• makes sure that you—and your child, if it’s 
appropriate—understand each medication and its 
anticipated benefits and potential side effects and in-
teractions with other medications 

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Better Living Through Chemicals 
233 
• is willing to devote sufficient time to monitoring your 
child’s progress carefully and continually over time 
• continually evaluates when it’s time to consider tak-
ing your child off his medication 
When children have a poor response to medication, it 
is often because one of the foregoing elements was miss-
ing from their treatment. 
All medications—aspirin included—have side effects. 
Your doctor should help you weigh the anticipated bene-
fits of medication against the potential risks so that you 
can make educated decisions. Although it’s important to 
have faith in the doctor’s expertise, it’s equally important 
that you feel comfortable with the treatment plan he or 
she proposes, or at least that you’re comfortable with the 
balance between benefits and risks. If you are not com-
fortable with or confident in the information you’ve been 
given, you need more information. If your doctor doesn’t 
have the time or expertise to provide you with more in-
formation, you need a new doctor. Medical treatment is 
not something to fear, but it needs to be implemented 
and monitored competently and compassionately. 
Not all the medications described here have been offi-
cially approved for use with kids, and many have not been 
studied extensively in use with children and adolescents, 
especially with regard to their long-term side effects. 

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234 
The Explosive Child 
INATTENTION AND DISTRACTIBILITY 
If inattention and distractibility are significantly interfer-
ing with your child’s academic progress or with his abil-
ity to participate in Plan B discussions, medication may 
offer some promise. The mainstays of medical treatment 
for inattention and cognitive inefficiency are the stimulant 
medications, some of which have been in use for more 
than sixty years. This category of medicines include well 
known, well studied agents such as methylphenidate (Ri-
talin) and dextroamphetamine sulfate (Dexedrine). Stim-
ulants come in short- and long-acting preparations. In 
most cases, the side effects associated with stimulants 
tend to be mild, but they are worth mentioning. Two of 
the more common side effects are insomnia (especially 
if a full dose is administered after the mid- to late-
afternoon hours) and loss of appetite, which can, over 
the long term, result in weight loss. In some children, 
stimulants may unmask or exacerbate existing vocal or 
motor tics (this circumstance may require adding a sec-
ond medication to reduce the tics or discontinuing the 
stimulant medication). Stimulants may increase anxiety 
and irritability in some children, an undesirable circum-
stance for any child but perhaps especially an explosive 
one. The behavior of some children can deteriorate when 
stimulant medication wears off (a phenomenon called 
rebound), and this side effect is sometimes addressed by 

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Better Living Through Chemicals 
235 
administering a half dose late in the afternoon to ease 
the child off the medication. Finally, particularly in ado-
lescents, parents need to be aware of the potential for 
abusing stimulants. 
HYPERACTIVITY AND POOR IMPULSE CONTROL 
If hyperactivity and poor impulse control are signifi-
cantly interfering with your child’s behavior at home or 
at school or his academic progress, or with his ability to