Client Feedback: Daughter with Substance Abuse

We came to Fonthill Counseling after our seventeen year old daughter spun out of control.  They helped get her into treatment when her behavior became unmanageable.  They saved her life. They coordinated all of the services that her care came to involve –therapists, doctors, attorneys, police, schools, hospitals and treatment centers.  They helped us put our family back together.  They continue to help us manage her transition into independent living.

– Anonymous NC Parent

When to Seek Treatment for Your Teen

There is no perfect time to place a family member in treatment, especially when they deny having problems. This, of course, does not apply to medical emergencies, but you already knew that. Below is a quick guide to help you be aware of some of the things we often hear from parents led to calling us or treatment providers directly.

Emotional Changes 

  • Increased and persistant hopelessness
  • Cries suddenly and often
  • Extremely angry outbursts that seem like an overreaction
  • Phobias or fears that seem exaggerated
  • States that ‘no one understands’ them
  • Child states he or she feels “controlled” by bad thoughts
  • Excessive worry or anxiety
  • Bizarre behavior (temper tantrums; rambling speech; paranoid)

Behavioral Changes

  • Grades suddenly drop
  • No longer interested in activities they seemed to love just months ago
  • Isolates themselves; avoids people, even those they use to care about
  • Changes peer group and avoids introducing new friends to family
  • Threatening suicide, even seemingly insincere threats
  • Significant change in how they express themselves
  • Destructive toward self, others, or property
  • Dramatic changes in appearance (clothing, body piercing, tattoos)
  • Change in level of hygiene (no longer cares about appearance)

If you notice any of these changes call us for a complimentary conversation. You can also call your physician and/or therapist/counselor. Ultimately, it’s better to act and be described as overreacting rather than wind up losing your son or daughter to their internal demons.

Book Review: How Children Succeed: Grit, Curiosity and the Hidden Power of Character

Ok, this is less a review of Paul Tough‘s new book and more a post to start the conversation since none of us have read it yet. The write-up in the Wall Street Journal was intriguing enough to make us want to put our two cents in about this little gem before our little Amazon box showed up. He’s taking aim at the sacred cow of how we protect our children from adversity which, in the long run, undermines their ability to creatively overcome obstacles and find true success.

Here’s is a short synopsis from the author’s site:

Early adversity, scientists have come to understand, not only affects the conditions of children’s lives, it can also alter the physical development of their brains. But innovative thinkers around the country are now using this knowledge to help children overcome the constraints of poverty. With the right support, as Tough’s extraordinary reporting makes clear, children who grow up in the most painful circumstances can go on to achieve amazing things.

This provocative and profoundly hopeful book has the potential to change how we raise our children, how we run our schools, and how we construct our social safety net. It will not only inspire and engage readers, it will also change our understanding of childhood itself.

The thing that’s most interesting is the mounting evidence that pushes back against the hyper-aggressive nature of early childhood rearing these days. Kids are thrust into soccer, violin, Mandarin, basket weaving and calligraphy, not because they are curious or passionate about new subjects, but because parents have the delusion that this is the  price of admission to Harvard, Princeton or Yale. Our clinicians see it every day – over scheduled, over-indulged, over-stimulated kids stretched to the breaking point. They develop eating disorders, anxiety issues and substance abuse problems earlier and earlier. Just check out a pre-teens Facebook page in any upper-middle class neighborhood if you don’t believe it.

Thumbs up so far by Fonthill. Buy the book here.

Comparison: IEP vs. 504



The 504 plan offers all children with disabilities equal access to an education.  In some cases this may include special education services, but for a child in a wheelchair it may mean a ramp or elevator to access the classroom.
The 504 is documented in a written plan.
Specific timelines for the 504 do not exist.
There are no requirements stating who must attend the 504 plan meeting.
Reports of noncompliance and the request for a hearing are made to the Office for Civil Rights.
The 504 does not offer as many specific procedural safeguards as the IEP.



The IEP is only for children who require special education services. The individualized program must meet each child’s unique needs and it must provide educational benefit.
The IEP documents contain very specific language and parts such as goals and objectives that are not included in the 504.
Timelines for an IEP are very specific and important.
A minimum number of IEP participants and who they are, such as administrator, general education teacher, and special education teacher, are stipulated.
Reports of noncompliance and the request for due process are made to the State’s Department of Education.
IEP specific procedural safeguards include, but are not limited to: 1) The right to request an independent assessment at public expense and 2) the student may “stay put” until a dispute is resolved.


Affluenza: Are Your Kids at Risk?

What is Affluenza?


A social condition arising from the desire to be more wealthy, successful or to keep pace with family, friends and neighbors. Affluenza is symptomatic of a culture that holds up financial success as one of the highest achievements. People said to be affected by affluenza typically find that the very economic success for which they have been striving ends up leaving them feeling unfulfilled and lacking identity. The cycle starts again since acquiring more wealth and belongings can, for a short time, dull the malaise.

Impact on Children and Teens


The incessant pressure to acquire material goods can result in the following:

Inability to delay gratification or tolerate frustration, Trouble maintaining interest in anything requiring effort, False sense of entitlement, Expectation of material goods without responsibility, Loss of future motivation, Life activities don’t seem very real and nothing matters much, Low self esteem, self worth, and loss of self confidence, Approval dependent on possessions and status rather than on personal values, Preoccupation with externals and habituation for more material goods, Difficulty believing people like them for themselves rather than for possessions and status, Inability to trust prevents true friendships, Emotional energy becomes invested in material gains and sensitivity toward others declines. Sound familiar?

Here are The 5 Things Parents Can Do


1. Role Model Boundaries

Let’s start with the basics. If kids and teens see parents Respecting for boundaries, they are more likely to adopt those same perspectives and skills. Our staff encourage parents to talk about things they have to do at work, at home or in the community which they don’t necessarily like but contribute to a bigger picture.

2. Set Boundaries

It’s important to set boundaries with kids and teens early and often. Boundaries are the limits that teach us where we end and others begin. Boundaries teach kids that the center of the universe is not them and that if they want or need something, there are rules we all need to respect. This is the place where kids learn to play nicely with others, develop admiration among teachers and, most importantly, learn to say ‘no‘ to others that may attempt to take advantage of them.

3. Discuss the Value of Money

Parents are weirded-out talking about sex, money, drugs and death yet, if we don’t talk about all of these, the kids are at higher risk for not having a healthy understanding of sexuality, not respecting money, experimenting a bit too much with drugs and being, well, deathly afraid of death. Fonthill staff role model, facilitate and ultimately encourage parents to run regular family meetings (once per month is great) where the family discusses upcoming travel plans, scheduling and financial issues that are appropriate to share with the kids. Not all details are necessary – just general updates like “Hey Kids, give your mother a big hug since she was just promoted. We also are going to cut back a little on how much we spend on iTunes purchases so we can save some money for our next vacation.” It’s also ok to help kids plan upcoming purchases important to them and require they contribute to it. Even if you have gazillions of dollars, having them pitch in helps them feel a part of the family in a way just buying them stuff can’t.

4. Volunteer and Give Back

This takes a bit of time but setting an expectation that the family will volunteer and give back to the community is just another way to have them contribute to something bigger than them. It also exposes them to people and economic struggles which they may not otherwise interact. Some examples of things you can do: Buy groceries and drop off at local food pantry, join litter-pick up group at local park, or volunteer to read to young kids at the library or school.

5. Reward for Behavior

Parents buy lots of stuff for kids and think that as soon as you leave the store, the item belongs to them. Oh, no, no, no. Try this: If your kid accomplishes a task over extended time (ie. Earns a 4.0 over first report card period) your buy something (like a video game). But here is where the power comes in. Rather than giving them the game, they earn time to use the game each weekend (1 hour if they complete all their homework during the week). Here’s what we just did: Exposed them to delayed gratification, rewarded them for behavior rather than just being alive, and reinforced that parents own the home and rewards, not the kids.

Eating Disorders: Impact on Teens and their Families

It’s a sad irony that in a country with such significant obesity, we have an emerging, but very hidden, epidemic of eating disorders among teens and young adults. When we combine wealth, entitlement, and super high expectations of perfectionism teens become at high risk for controlling their eating and food related behavior in ways that put them at risk for long-lasting medical and mental health issues. Eating disorders eventually impact the whole family – leaving parents and siblings feeling disempowered and unable to make change.

According to the National Eating Disorders Association, cases of eating disorders such as anorexia nervosa, bulimia nervosa, and binge eating have been on the rise. School-aged young women and men often exhibit the following:

  • 10 million women have an eating disorder
  • 1 million men have an eating disorder
  • 80% of Americans say they are unhappy with their appearance.
  • More than half of all teenage girls and almost one-third of teenage boys skip meals, refuse to eat, smoke cigarettes, vomit, and take laxatives in an effort to control their weight and appearance
  • 40% of new cases of anorexia involve female patients 15 – 19 years old.


Eating disorders are often caused or triggered by a number of events and experiences. Some students starve themselves in response to stresses or traumatic events. Others binge and purge because they believe it will help them improve their appearance. Some teens end up with eating disorders as a result of trying to enhance their athletic ability. Ultimately, it’s about control. Controlling themselves.

Here are some examples of stressors and triggers for teens:

    • Teasing & Taunting: Being ridiculed can have quietly devastating effects on teens. Struggling teens may, instead of acting-out may act-in and restrict their eating as a way to change their body to fit in or as a means of punishing themselves for not being good enough (in their eyes).
    • School and Academic Stress: Schools that emphasize competition and discipline can inadvertently be encouraging disordered eating by students. Competition is healthy, but obsession on grades and perfection lead to overcompensation in teens. This can influence teens to restrict eating as well as take what they think of as performance enhancing drugs (legal and illegal). This is a super bad combination.
    • Competition: Highly competitive athletes in sports such as gymnastics, diving, and bodybuilding may be driven into eating disorders by compulsions to achieve athletic and appearance perfection. Another bad combination of high intensity training, food restriction and increased demands on the body.

The 7 Signs to Watch For

Parents can support their teen’s wellness by watching behavior, having regular communication, and getting help early on when they suspect there’s an issue.The following signs could indicate that a teen is struggling with an eating disorder:

  1. Skipping Meals: Constantly makes excuses to skip meals. When he does sit down at the table, he eats very little.
  2. Strict Dieting: She follows a highly regimented and restricted diet, allowing herself small portions of limited types of food according to a strict meal schedule.
  3. Focus on Weight: He demonstrates an unhealthy focus on how much he weighs.
  4. Exercise Obsessed: He becomes obsessed with exercise, and becomes hostile, defensive, or withdrawn when questioned about his eating or exercise habits.
  5. Baggy Clothing: She starts wearing oversized, baggy clothes to hide her body, and becomes withdrawn and secretive about how she spends her time.
  6. Dry Skin: Skin becomes super dry; the hair on his head becomes thin and brittle; and soft, downy hairs begin to grow on his torso, arms, and legs.
  7. Stressed and Tired: She seems unusually fatigued or lethargic, and complains of being cold even in warm rooms and seems always on edge.

Some students who develop eating disorders are able to be treated on an outpatient basis, while others require hospitalization or a stay in a residential treatment facility. Prior to any treatment, Fonthill always recommends contacting a professional case manager to help determine the best course of treatment based on a family’s resources like time, money, and location. Eating disorder treatment requires multiple professionals working in concert with each other to ensure the most effective interventions are used and that after-care planning is established. Parents concerned about their teen should consult with their family physician, contact a school counselor, or seek assistance from a mental health professional.

How to Find a Treatment Program for a Struggling Teen

We put together a short but thorough list of what we have found most effective when helping parents find a residential treatment program for their struggling teens.

1. Find outside Help: This is not just a pitch to get you to use our services or someone else’s. This really is essential unless you are retired and have lots of time, knowledge of residential treatment programs, and consider yourself to be very objective. An outside professional like us can help formulate more than just a list of options. We help identify the goals, limitations and timeframe for when things need to happen. We also make sure that step-down and after-care are built into the plan.

2. Financial: What is your insurance willing to pay for? What can you afford?Most parents do not know that their are several billing codes that can be used throughout treatment that can be submitted to insurance for reimbursement. Treatment centers can range from $1000 per month up to $30,000 or more per month but expense does not always mean quality.

3. Timeframe: What is the timeframe you all need this to happen within? Is your teen preparing to go to college in the Fall and really needs a more aggressive, short-term solution? What about family vacations coming up or important events? Identifying all of these with your professional support will expedite the process and improve the outcome.

4. Goals and Objectives: This seems like easy-cheesy but more often than not professionals and education consultants do not build out a comprehensive treatment plan that includes what to do prior to treatment, what parents need to do while teen is in treatment, and what the plan is once the teen is completed treatment. We have found that comprehensive treatment planning is vital.

5. Communication: Part of every good plan is good professionals and family members. What we need with good people is a good way of communicating progress and obstacles. We highly encourage use of monthly team meetings via Skype, conference call or in person. These meetings should include anyone supporting the family in implementation of the treatment plan.

Finding a residential treatment program for a struggling teen is challenging but with the right plan and the right people supporting you, you will see safety, security, progress and hope clearly defined.