Adolescence Interrupted: The unregulated, abusive war on troubled teens

Much has been written about the troubled teen industry by former clients, advocates and journalists. On a daily basis the "still-traumatized" post their experiences on social media platforms. They bear witness to friends who died during or after abuse at facilities that were supposed to help create lives of meaning and purpose. The community of survivors publish online to help make sense of their struggles. They also want to raise awareness about punitive and damaging treatments doled out by certain institutions.

The industry that has arisen around troubled teens is a profitable one, estimated at over two billion dollars a year. A wide range of behavioral and psychological issues affect adolescents who are remanded to residential facilities. They include substance abuse, ADHD, oppositional defiance, conduct disorder, and many other diagnoses. A common thread runs through family narratives; they can no longer manage the behavior of their children. Parents are fearful, bewildered, overwhelmed and often angry about their children's actions. Teens, on the other hand, may see their parents' responses as hand-wringing overkill. When these conflicts come to a head, an adolescent can find himself awoken in the middle of the night by strangers with restraints, and forcibly taken to a residential boarding school far from home.

The teen years are a roller coaster of emotional intensity for adolescents and their families. As independence from parents is developing, emotional autonomy can manifest itself as conflict. Social problems become more complex, and teens often prefer the counsel of peers to provide context for their emotions. Family struggles over levels of autonomy, academic performance and romantic interactions can detonate regularly. In the midst of tumult, the lines between acceptable behavior and that which requires intervention can blur. The choice between seeking therapy or sending teens to a lockdown can be strongly influenced by third parties brought in to assist families in crisis.

When the behavior of an underage family member becomes problematic there are a variety of paths the family can take to get help. There are psychologists, counselors and specialized public schools to which a student can be referred to better meet their needs.

Dr. Nicholas Smith is Principal of the Ivy Creek School. It's a public institution in Virginia that provides education and related services to students identified with a disability. He has worked with kids and families for the past 35 years in day school settings. The goal is to create optimal outcomes for students during and after their academic careers.

Every public school system is required to identify kids who are having trouble. When students act out or are under-performing academically, the school evaluates them to determine whether there is a learning disability, intellectual disability, emotional disability or a combination of all three. If a student's needs cannot be met in a standard pubic school, there are specialized programs they can be referred to, which happen to be tuition-free.

There is a difference between the emotional response of a child who has a disability and one who is temporarily acting out. A student who has an emotional disability is not in control of these responses. Smith notes that some parents presume all behavior is volitional but for kids with emotional disabilities this is not the case. A child who is emotionally disabled escalates into crisis, their emotions totally overwhelm them. They may react defensively by kicking, throwing things or running away to keep people from them. Parents may yell at or punish a child, which escalates the incident further. A bootcamp-style facility is not the appropriate therapy for kids with emotional disabilities. The problem is that kids are often misdiagnosed or not diagnosed by a professional when being sent to "therapeutic" boarding schools. Punitive treatments such as isolation can worsen emotional disabilities and prove traumatic for the child.

Smith said, "In many situations parents have been inconsistent in setting boundaries for behavior. Kids need structure, safety and an understanding that there are consequences to every action." Parents often do not want to see their part in a child's issues and prefer to see a kid's behavior as completely isolated from other things going on in the home.

Diagnosis can be another difficulty when evaluating the still-developing child's brain. Smith noted, "Many of them have been diagnosed with a number of different things, it's tough, but a responsible psychiatrist who treats a child should probably give a provisional diagnosis rather than a definitive one. Lately, I've been seeing a lot of kids who are diagnosed as ADHD when in fact they have anxiety that is not helped by ADHD medications. Part of the whole thing is working closely with psychiatrists and general practitioners to get good information to parents so they can make informed decisions. Sometimes parents are only seeing surface level behaviors, they aren't seeing the context, or what is driving it. They don't understand that a tense, unpredictable home is a contributor to the problem." Surprisingly, fads in diagnoses exist among professionals. For a period of several years the predominant diagnosis Smith saw was autism, then it was bipolar disorder. Diligence in re-evaluating an original diagnosis is crucial to creating an appropriate treatment plan.

One of the many vexing issues at hand is that dangerous programs may be advertised side-by-side with principled ones. It presents an extreme case of caveat emptor for parents and guardians. Unfortunately, overwhelmed parents doing a midnight Internet search for help are not operating with clear minds or accurate information. It's interesting to note that in the regulated public school system there is a legal imperative to provide the least restrictive placement (LRP) for students. The discussions involve administrators, teachers, counselors and parents in any decision to escalate treatment. They ask themselves the question, "Have we done everything possible to provide a continuum of services that support the student?" If a student needs residential treatment for educational or safety issues, the state and locality provide and pay for treatment. Because public schools have so much oversight, the choice of a residential program is carefully considered, and utilized short-term to stabilize a crisis situation. The student ultimately is returned to the day school environment.

Long-term private residential treatment centers are populated both by kids from upper middle class backgrounds and those who are mandated by courts and paid for by Medicaid. Problems affecting teens are equal opportunity concerns. The consequences of sending an adolescent to the wrong program runs deep. Some clients come back with severe PTSD, making it difficult to resume lives interrupted before they had barely begun. The most damaged teens find going to college or working impossible. They tend to spend a lot of their time online, documenting personal stories or researching the intricate web of former employees at one program who move on to another and another.

There are programs available that are informed by transparency and ethics. Clients in these settings are making positive changes where other approaches failed to achieve results. The road to wellness is as unique as the individuals who navigate it. There is no single solution for those who suffer from the same problem.

The term "oppositional defiance" is used generously on the websites of residential academies as if it is the determining factor of an adolescent being placed in their care.

"You could have a kid with a psychiatric disorder or one who is self-medicating or one who just says, 'Screw you, Mom and Dad.' I think everybody has a little bit of oppositional defiance; it's like everyone wants to be independent, they don't want everyone telling them what to do. It's actually part of growing up and individuating yourself. All kids push the limits to see what the boundaries are. We all have to do some of this while growing up, but when it's taken to the extreme, a teen might respond to discipline by leaving home altogether, and putting themselves and others at risk. How you deal with this behavior is what can make all the difference." says Smith.

Setting boundaries in an even-handed way and using power in appropriate ways is what his program aims to teach. "The ideal outcome for an adolescent at Ivy Creek is that when they leave they become self-advocates in appropriate ways; that they are able to be flexible and work with other people, pick and choose their battles. We can all fight over a million different things every day. Is it worth it in terms of how it affects your relationships? Ivy Creek conducts job training and mock interviews with kids to prepare them with people skills in the real world. If they know how to talk with people they will have many more opportunities by developing these social skills."

I've read hundreds of stories from survivors of abusive programs. I've talked with therapists and practitioners to understand how this largely unregulated business has evolved. It's clear that it is a complex and broken system whose stakes are the highest - the lives and emotional health of young minds. The stories from clients are alternately inspirational and gut wrenching. The amount of information available is overwhelming and difficult to wade through objectively. A topic this controversial requires more than the usual measure of neutrality in reporting.

Understanding the present state of the business requires examining the roots of the business, and what need these institutions fill in society. The genesis of troubled teen programs came in the 1980s along with the Reagan administration's "War on Drugs." The Reagans were proponents of one of the first programs, called Straight Inc. Straight, Incorporated was a non-profit drug rehab program in business from 1976 to 1993. Its focus was on clients aged 13 to 20. More than 10,000 teens went through Straight's programs, which spanned from California to Florida and New Jersey.

Straight Inc. was given public props by former President George H. W. Bush, but was dogged by investigations and lawsuits claiming abusive practices. In every state that Straight operated, allegations of abuse were brought by District Attorneys and in a litany of civil suits. Ultimately, the company ceased operations. Former associates created a new entity called, "The Drug Free America Foundation." This organization entered the less litigious business of consulting employee assistance programs and working on federal and international drug policies.

Some former staff members from Straight Inc. created offshoots of the program. Other operations opened utilizing similar practices. They went by many names. There are common threads to programs profiting on the dark side of the troubled teen industry. All of them take generous helpings from the Synanon playbook. The concept of "tough love" is taken to punishing excesses, including tactics like food/sleep deprivation, humiliation, beatings and hard labor. All of these methods are embraced to break and remake behavior patterns. Residents of many programs are not permitted to speak to their families for months on end. The centers urge parents not to believe anything their children say about their treatment.

One problem with implementing radical practices is that there is no evidence that they are effective. While programs may claim extraordinary success rates, there is no way to validate the information due to the lack of regulatory oversight. It's counter-intuitive to believe that curricula based on confrontation, shaming, peer pressure and corporal punishment will help adolescents already experiencing deep psychic pain. Acting out with hostility, drug use, eating disorders and self-mutilation calls for empathy, not further emotional scarring.

Involuntary commitment of an adult requires the participation of legal, mental health and medical professionals. At each step in the process, adults have the right to question, appeal and have the situation reassessed. The architecture of the legal system has checks and balances built in to protect the constitutional and legal right to due process. In stark contrast is the lack of rights afforded minors. A kid doesn't have to break any law or indicate he is a danger to himself or others to be put under lock and key until he is 18 years of age.

If problems arise with a child and a consultant is engaged to evaluate the situation, it is essential that party is neutral. Objectivity can be established by evaluating the spate of solutions the consultant has brought to the table. If that individual indicates a bias towards certain kinds of treatment or specific treatment facilities, it's time to re-evaluate. This statement reads with deceptive simplicity. When parents are in the throes of a crisis, they are often highly emotional and vulnerable to manipulation.

This vulnerability can lead parents down a dangerous path. The soothing tones of admissions staff and reassuring success rates boasted by a facility have to be carefully vetted before investing time, money and the still-forming adolescent brain.

Regulation

State regulation and oversight of private residential treatment programs for adolescents varies wildly. Those with scant oversight are prime locations for human rights violations and/or 
abuse to occur. Some offending facilities are called "emotional recovery boarding schools" or "wilderness intervention programs." Others fall into the larger category of residential treatment programs. All programs require intense scrutiny prior to committing to them. If any institution does not have a transparent grievance policy in place, or barrages parents with tales of adolescent manipulations, it's the facility itself which must come under question.

While there are reams of evidence that extreme behavior modification does not work for kids with substance abuse or mental health challenges, the business model continues to grow. Some parents have regrets about sending their children off to programs once they find the results have caused more damage than they prevented.

The lack of federal standards to evaluate practices and outcomes of private residential treatment programs is an inherent problem. Programs typically have 24 hour supervision, but that supervision is not regulated like a psychiatric hospital. This can lead to employment of professionals whose only credential is having "graduated" from the facility in question. Actions that can change the course of this crisis include requirements for state licensing and accreditation by independent national organizations. Bureaucracy is also part of the problem. Even in states where parameters are in place, gaps in communication and understaffing of regulatory bodies leave room for grave outcomes.

The fact that treatment facilities based on the failed protocols of Synanon are still popping up and gaining momentum points to a larger societal question. Why are boot camp programs appealing to parents? The fact is that when people are gripped by fear of losing control they are the most vulnerable to questionable promises to make their world whole again. There are some common themes that come up in families experiencing behavior problems with their kids. The parents are frustrated. They may fear for the safety of everyone in the home. There may be a sense of disdain for school psychologists and programs attempted thus far. The strongest influencers are the triad of self-doubt, exhaustion, and the desire to return to happier days. Months or years of drama can wear down the most dedicated souls. Everyone may need a break, but the answer does not have to be a dubious course of treatment.

Suburban life has been upended. The "American Dream" seems to be falling apart or edging towards irrelevance. Assumptions on the value of a traditional college education and the career that might follow are evolving faster than parents are able to follow. They're on the 
front lines being faced with questions that lack ready answers. The typical American family has two working spouses. The demands on their time and emotional bandwidth can be overwhelming. When a teen acts out, using drugs or otherwise pushing boundaries, the cracks in a family system can threaten to destroy it. Fear and emotional exhaustion create a crisis point that causes otherwise mindful parents to make ill-considered decisions.

Some psychologists posit that Boomer and Post Baby-Boomer parents have child rearing styles, which are part of the problem. Acting as friends and confidants rather than authority figures
 are hallmarks of their ethos. Is this truly a root cause? The factors contributing to emotional or substance issues are too complex to sum up in a neat sound bite. The question of what's going wrong needs to be addressed in the face of some inescapable facts. More than 30,000 minors were forcibly placed in treatment centers in 2013. When nothing makes sense to parents, almost anything can be made to sound sensible.

The arc of adolescence is difficult for everyone in a family unit to navigate. It's concerning that parents in increasing numbers are turning to ideas and programs that have been proven ineffective.

Facilities using these techniques pull a dangerous bait and switch game. "Educational Consultants," who get kickbacks from the centers, take advantage of the worst fears of parents. They have more in common with used car salesmen than credentialed behavior modification consultants. Without oversight and the promise of fat commissions some educational consultants scare six figure fees out of parents to place teens in a Gulag.

The organization ASTART (Alliance for Safe Therapeutic and Appropriate use of Residential Treatment) has published an enlightening and practical guide for parents who may be considering sending a teen to a specialized program. If a child is exhibiting new and frightening behavior parents can be driven by desperation. In this state of mind, a quick Internet search will produce hundreds of wilderness programs and therapeutic boarding schools. The websites have carefully written copy that creates a sense of both urgency and impending doom. If parents could first read the ASTART guidelines, manipulative practices might fall flat on more educated ears.

One of the frustrating facts about this industry is that even after a major scandal (see The Gatehouse Academy) the players regroup, pick a new moniker and begin again. It's hard to keep track of all of the thieves in the temple. Forums like HEAL may inconvenience, but cannot entirely halt the cycle of reinvention.

Teens can be locked up until they are 18. After that, they are free. But then what? The PTSD symptoms exhibited by many former clients create a rough passage to achieve emotional health. The original issues of addiction and mental illness tend to rear their heads again. It's hard to imagine a deeper sorrow for parents than the realization that their chosen treatment created more problems than it has solved.

About the author

Dawn Roberts is a writer and media consultant. She lives in the Catskill Mountains with two dogs, a cat and a recording engineer. She last wrote about options to quit Suboxone and interviewed Bob Forrest.

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