Creating a Crisis Management Plan

We knew we needed a crisis plan the day our son angrily grabbed his lacrosse stick and proceeded to completely destroy his room. I don't remember what triggered that particular episode, but I do know it was the first time that he was strong enough to do some serious damage. I vividly recall watching helplessly as he shattered his light fixture, put holes in his walls, and smashed his bedroom door. I was 5 months pregnant at the time, and when our sweet boy turned and raised that lacrosse stick toward me, I ran from his room in terror.

He was 9 years old at the time.

Now, he may have stopped himself before he hit me. Or he may not have intended to hit me at all. But at that moment, I had no idea what he would or wouldn't do.

I panicked.

I paged his psychiatrist and hysterically explained what was happening. Her response shocked me. She told me to call 911 and let the police help keep everyone safe.

Could You Call 911?

I couldn't do it.

I just couldn't imagine having to call the police to help me control my child. What would that mean? Would they take him away in handcuffs? Was that really the right thing to do? How could that be the right thing to do?

You see, this wasn't the first time our son had become violent when upset. Previously, he had pulled down his curtains, ripped pictures off the walls, and thrown books and other items around his room.

When he reached that tipping point of violence, it was as if someone else took over his little body. He could not hear us or see us; he had lost control over his actions and had no connection to reality.

When the rage ended, he would often collapse on his bed and sleep for hours – exhausted in the aftermath. More often than not, he would look around his room in horror – stunned by the destruction.

Doing All the “Right” Things

We did not stand by and watch the violence escalate. I feel confident we did all the right things in the years leading up to the “lacrosse stick” incident.

• We had a family meeting and created house rules

House Rule #1: we respect ourselves (we don't hurt ourselves)
House Rule #2: we respect other people (we don't hurt other people)
House Rule #3: we respect our things (we don't hurt/break our things)

• We worked with a therapist to better identify what triggered him and then created routines and structures to minimize those triggers.

• He worked hard, too. By adding new anger management tools to his ever-growing toolbox, he learned how to recognize what anger felt like in his body. He got better at identifying when the rage was getting out of hand, and he was able to create his own crisis management response plan. It had one step: Remove myself from the situation. Go to my room, to the backyard or to a safe place and burn the anger off there.

This worked great for a long time. We were okay with him punching a pillow or his bed in frustration if that would help. We were also okay with smashing cardboard boxes in the backyard, jumping on the trampoline, or running circles around the house until he calmed down.

But the day he grabbed the lacrosse stick and turned toward me, we knew we needed more.

Crises Can Occur without a Warning

Carla C. Allan, Ph.D., Director of Psychological Services for the Children's Mercy ADHD Specialty Clinic in Kansas City says incidents like this can be common for kids with ADHD. She says it's normal for parents to feel a great deal of shame when their child becomes violent because the family is in shock.

More importantly, she points out that ‘Even when parents are following their child's treatment plan perfectly (i.e., using the behavioral procedures taught and modeled in clinic), behavioral crises can seemingly occur without warning. Parents are not to blame for their child's explosive behavior, but they are the ones that have the most power to reduce the likelihood of future outbursts.'

Creating a Crisis Plan

Knowing that other families struggled with this same challenge went a long way toward helping us move forward with creating a stronger crisis plan. It was also a relief to know that even though we were doing all the ‘right' things, our son could still escalate to violence quickly.

So, what should parents be doing to protect themselves, their child, and their families when a crisis like this occurs? Dr. Allan suggests this:

Meet the Police: I'm not kidding here. Plan ahead. If your child has the potential to become violent, consider requesting an in-home visit with law enforcement. This visit serves a few purposes:

• It will give you a potential contact in the future, should the situation arise again
• It defuses everyone's fear of what might happen if you have to call the authorities for assistance
• It will help your child better understand future consequences for exhibiting dangerous behaviors. We know that children with ADHD, relative to children without ADHD, require more salient consequences in order to learn (regardless of whether the consequences are positive or negative).

What to Do IN Crisis

If your child is currently having a violent meltdown, follow these steps (again, courtesy of Dr. Allan):

1) Assess the situation: is the child in immediate danger of harming themselves or others? If so, call 9-1-1, and tell the dispatcher that your child is in the midst of a mental health crisis. Take steps to ensure safety for everyone until help arrives. You may have to back off to keep yourself out of harm's way.

2) If everyone in the home is safe, call your child's behavioral health provider's on-call line for guidance. Pediatricians, psychologists, psychiatrists, therapists, and social workers are there to help assess safety risks and provide recommendations for de-escalating the situation.

3) Monitor the situation as best you can until you can be seen for an urgent appointment with your child's mental health provider. If things escalate and become dangerous, call 9-1-1 and follow the recommendations from step 1.

Thankfully we haven't needed to call 9-1-1 because our son was out of control. Just having a plan has helped us de-escalate crisis situations before they get to that point. But our son now knows that we will make that call if we have to. And we know what will happen if we do.

For more information about crisis management in your area, please visit your state's NAMI or mental health crisis website.