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.