Parents as victims of rebellious children, and children who suffer from Tourette Syndrome

Abused parents are the forgotten victims o f family violence. This paper re­ ports on the victimisation o f 50 parents who are members o f a lay support group, "Parents o f Rebellious Children" (PORCH). Although it was not the aim o f this study to investigate the role that TS could possibly play, it was a serendipity finding that TS may be a contributing factor in the rebel­ liousness exhibited by some children. These parents d id not only expe­ rience severe verbal and physical abuse but also suffered serious damage to property at the hands o f their violent children. They were often blamed if they spoke o f their plight and received little moral support. Abused parents need to be recognized and treated as victims o f violence. Eleven rebellious children who were treated fo r TS with psychotropic drugs, showed dramatic behavioural changes and the implications o f such treatment are also in­ dicated.


Introduction
Wife and child abuse have received much attention over the past years (Colvin, 1982;Eekelaar & Katz, 1978;Garbarino & Garbarino, 1982;Pagelow, 1981;Straus e t al., 1980).However, another category o f victimisation, namely the emotional and/or physical abuse o f parents by their children, has been largely neglected or ignored.A possible reason for this can be ascribed to the Judeo-Christian viewpoint that requires children to respect their parents and prohibits them from cursing, provoking, or physically assaulting them.Parents whose children break this rule may find it difficult to talk about their experiences.They may remain silent because they are ashamed o f what is happening or fear that they will be regarded as poor disciplinarians, lacking the ability to rear their children according to the required norms (Pretorius, 1992:9).They may also feel that the disclosure o f the fact that their children are victimising them will be re garded as a disgrace.
Koers 59 (1) 1994:133-142 Whereas rebellious children, and the problems caused by delinquency receive adequate attention from psychologists, social w orkers and criminologists, the parents, as victims o f abuse, are ignored (Borland, 1976).These parents usually suffer in silence.Academics and researchers working with children who have behavioural problems do not always realise that the parents experience anxiety, guilt feelings, suffer emotionally, feel hopeless and pow erless, and have a need for empathy.
The only type o f parent victimisation that has received attention from researchers, is granny bashing (Finkelhor, 1983).Regarding the lack o f research on parent bashing, Straus et al .(1980:119) say "perhaps one does not hear about it (and re searchers do not study it) because o f the need to preserve the myth that all children love and respect their parents".In addition as W alklate (1989:69) points out, the notion o f "childhood innocence" is very strong in m odem society.Sears and his associates (in Straus et a l., 1980:119) was possibly the first researcher who briefly referred to parental battering by teenagers in their 1959 publication, P a ttern s o f C h ild R earing.These researchers found that one o f the reasons pa rents put forward for beating a child w as that the child had assaulted them.In a national survey on family violence conducted in the USA Straus e t al. (1980) found that approximately 18% o f the children in the sample assaulted their pa rents during the year the survey was conducted.Furthermore it appeared that the frequency with which parents assaulted their children w as directly related to the frequency with which the children assaulted their parents.
In a new spaper article "Testy kids drive parents to drink" (W eeken d Post, 1990-09-01) it becam e evident that the excessive drinking o f some parents could be attributed to the disruptive behaviour o f their children.In this regard the jo u r nalist states that "while we usually think o f parents as influencers o f children, children can affect parents as well.And the outcome is not always favourable".
Since a dearth o f information regarding parental abuse by their rebellious children apparently exists, a study w as undertaken to determine parents' experience o f verbal and physical abuse.Although it w as not the aim o f this study to inves tigate the role that TS could possibly play, it was a serendipity finding that TS may be a contributing factor in the rebelliousness exhibited by some children.
When medication is administered it may result in a dramatic improvement in the behaviour o f rebellious children suffering from TS. PORCH is a selfhelp, support group (Borman, 1982) for parents w hose children exhibit severe behavioural problems.The aims o f PORCH is to offer a forum to parents w here they can discuss the problems they experience in coping with their rebellious children, and to give moral support to each other.

R esearch procedure and background o f the study
The Department o f Human Genetics and Developmental Biology o f the Uni versity o f Pretoria is currently involved in research on TS as well as the behavioural problems associated with it.Prof. George Gericke, H ead o f the Department o f Human Genetics and Developmental Biology is also Head o f the TS Clinic o f the above-mentioned department.He is regularly confronted by parents with requests for assistance in the controlling o f the rebelliousness and behavioural problems shown by their children suffering from TS, and he invited the author to join their research team as from January 1991.After attending a number o f interviews conducted at the TS Clinic, it becam e apparent that the complaints o f some o f the parents o f children with TS corresponded to those of parents belonging to PORCH.This realisation lead to the inclusion o f a selected number o f parents who attended the PORCH group and whose children were diagnosed as TS patients.
A total o f 50 parents were included in the sample, eleven o f these parents' (22%) children were diagnosed as TS patients.They completed a questionnaire which is based on the Conflict Tactic Scale o f Straus et al. (1980:253-256).This ques tionnaire inter alia provides information on the following: The extent o f the children's aggression and violence as experienced by the parents.
How the rebellious behaviour o f children influences the parents' sleeping patterns, their health, and relationships with other family members.
The extent to which parents are blamed for their children's behaviour.
Feelings o f failure, self-blame and hopelessness experienced by parents.
W hether the parents require support and assistance for the problems they have with their children and how others respond to their need for support and assistance.These questionnaires were completed at a PORCH meeting under the supervision o f the researcher.W here necessary, further interviews w ere conducted by the author herself to get more information on aspects she rendered necessary.This information w as verified at the TS Clinic by studying the files o f the respondents.

The questionnaire completed by parents belonging to PORCH
An analysis o f the data shows that parents who become members o f PORCH regard themselves as victims o f their children's rebellious behaviour.They join this support group because all attempts to control their children's behaviour by means o f educational, psychological, psychiatric, social worker and even police intervention have failed to provide solutions.As members o f PORCH they hope to at least receive moral and emotional support from other group members who are equally distressed by the unruly behaviour o f their children.Muller (1987:36) states that "(selfhelp groups) are formed ... for mutual assistance in satisfying a common need, overcoming a common handicap or life-disrupting problem, and bringing about desired social and/or personal change".

Behavioural problems reported by parents
Behavioural problems reported by parents about their children take various forms, and the seriousness o f these are highlighted by the following: 40% o f these children had at one stage or another clashed with the police; 34% had been referred to an institution for treatment or rehabilitation; and 88% did not only achieve poorly at school but their parents were approached by teachers with complaints about behavioural problems.

Reasoning
The desperate position o f parents is clearly dem onstrated in the way in which these children reason.According to the data obtained from the respondents all of these rebellious children lack the ability to calmly discuss and reason about a problem.All the parents reported that a difference o f opinion is never settled in an acceptable manner, the general pattern being that any small problem develops into a heated argument.A further characteristic o f these children is their refusal to take no for an answer.A typical example is a child w ho used the family car on numerous occasions without permission and has been involved in an accident, but does not want to understand why he is not permitted to use the car whenever he so wishes.Reports o f vehicles being used once or more without permission oc curred in 48% o f the sample.
Arguments due to parents' refusal to continue to provide money, or allowing chil dren to go out or to stay out late, usually result in aggression and conflict.The outcome o f these conflicts is usually the child storming out o f the house and slamming the doors.Parents experience this behaviour as an unwillingness o f the child to listen to reason, an ignoring o f the problem or that the context within 136 Koers 59(1) 1994:133-142 which the discussion takes place is disregarded.This contributes to parents' feel ing that they are not getting through to the child, and this consequently leads to feelings o f frustration and desperation.

V erb al abuse
The verbal abuse o f parents is extensive; only nine (18%) respondents reported that they have never been sworn at by their children.In addition to using the most vile language, some o f the parents indicated that the cursing usually ends with the child making an obscene sign before storming out o f the room.
Parents indicated that they experience cursing by the child as being traumatic.They felt that they have failed as parents, and that the child's behaviour is a re flection o f a hopeless parent-child relationship.The swearing o f the child is feared because they are afraid that the other children in the family or even the neighbours may overhear.
Only one parent in the sample (2%) indicated that her child never purposely said anything to hurt her.The others, however, reported that their children constantly confronted them with the shortcomings and mistakes they had made, as well as with their inability to provide enough money and grant whatever the child wished for.The majority o f parents also indicated that they found it traumatic when the child tried to humiliate them in the presence o f other children or their spouses.

Aggression
Aggression displayed towards parents manifested in many forms: 54% o f the pa rents reported having been threatened more than once that they would be beaten up or that an object would be thrown at them; 24% experienced at least once that an object such as a shoe, cup, book or toy was thrown at them.One o f the mothers reported that her 16 year old son in one instance threw his plate o f food at her because she had served vegetables in addition to the meat and potatoes he preferred.
Various parents (44%) reported that they had been subjected to physical violence at least once.The assaultive behaviour involved being kicked at or physically shaken during an argument.Furthermore parents reported that they w ere injured (26%), or that furniture was broken during such encounters (20%).A number o f parents (20% ) indicated that this type o f violence followed an incident in which one o f the parents had attempted or threatened to slap the child and the child then retaliated by hitting back.Twenty four percent o f the parents indicated that they had been beaten more than once with the fist, 16% had been threatened with a knife or fire-arm, while three parents (6%) were stabbed with a knife or a pair of scissors.Although these assaults were traumatic, serious injury w as avoided.
Despite the trauma o f being assaulted by one's own child, only 14% o f the sub jects believed that the assaults were o f a serious nature.The seriousness o f the assaults was judged in terms o f the nature o f the injury, such as a bruise due to being beaten with the fist, a cracked lip on account o f a slap, or lesions sustained during a fall after having been pushed around.The three parents who were assaulted with sharp instruments described these incidents as serio u s because o f the possible injuries that could have been sustained in such attacks.

Effect on the parents
An important question that arises is how this rebellious behaviour o f a child affects the parents.In this regard 82% o f the respondents stated that they lay awake at night worrying about their child.They were especially concerned about the child's future, whether he will be able to pass his grades at school and his abi lity to prepare him self for an occupation.Seventy percent attributed a poor appe tite to the child's behaviour while 48% believed that their ability to concentrate at work was seriously impaired.Some parents (40%) believed that this impairment was so serious that their productivity was affected.Twenty nine o f the respon dents (58%) indicated that the behaviour o f the rebellious child had a negative effect on their relationship with their spouse, while 70% believed that it had a detrimental effect on their relationship with the other children in the family.The negative effect that the rebellious child has on the family is further demonstrated by the fact that 82% o f the parents reported that the total household is disrupted in some way or another and that they were powerless to do anything about it.

Blaming of the parents
According to the respondents they are more frequently blamed for their children's behaviour by relatives than by non-family members.Being blamed by their own parents as well as brothers and sisters w as reported by 70% o f the respondents.Friends (46% ) were the next largest group that blamed them for either being too strict or being too slack in disciplining the child.
In addition to family and friends some o f the parents (46% ) blamed one another for the child's unruly behaviour.This was based on perceptions that one o f the parents either favoured the child by ignoring his unacceptable behaviour or by nagging so much that it contributed towards the problem.
Thirty six percent o f the respondents reported that teachers blamed them in a subtle way for the child's bad behaviour at school, as well as for his poor acade mic achievement.A further 10% indicated that neighbours gave them advice re garding child rearing and made them feel responsible for the behaviour o f the child.
138 Koers 59 (1) 1994:133-142 From the above it appears that various groups o f people blame the parents direct ly or indirectly for their children's behaviour.In the questionnaires all the parents em phasized that being blamed for their children's behaviour frequently made them feel that they have failed as parents.These subtle accusations hurted and insulted them because they felt that it is based on misconceptions and deductions that cannot be substantiated.These misconceptions contribute tow ards them be coming victims o f the child's behaviour over which they have little or no control.

Need for support
All the parents at one time or another have approached a professional person for help.Fifty eight percent o f the respondents consulted teachers, while 74% con sulted social workers, psychologists and psychiatrists.Although 64% indicated that the professionals they approached w ere helpful, it needs to be stressed that the focus w as on the child and not on the p ro b le m s the p a re n ts h a d to cope with.As a rule consultations focused on the child's behavioural problem s and not on the pain and suffering these caused the parents.
In addition to consulting professional people, 64% o f the parents discussed their problem s with friends, while 72% turned to relatives for help.Although the m a jority o f parents found it easier to talk to friends and relatives about their fears, pain and general emotional state, these individuals w ere unable to assist.Usually they gave advice which w as o f little help, or they advised parents to change their methods o f child rearing.This, as well as subtle references to the parents' shortcomings, made them feel that they were, if not fully, then at least partially, to blame for the dilemma.In this regard 88% reported that they felt that they had failed as parents, and 58% believed that they w ere somehow responsible for their child's behaviour.This indicates that self-blame is a feeling that is regularly ex perienced by these parents.
Parents are o f the opinion that society offers very little support: 82% indicated that in reality there was no available help for parents such as them, and that the only people who could understand their dilemma, were those parents in a similar situation.Because o f this, 70% indicated that they often felt so desperate that they considered irrational behaviour such as leaving home or turning the rebel lious child out into the street.

R elationship betw een rebellious behaviour and T ourette
Syndrom e

Tourette Syndrome
TS is a genetic disorder which manifests as a chemical imbalance in the synapse or space between neurons or nerve cells in the brain.This hereditary disorder is characterised by suppressible motor and vocal tics that occur almost daily.The Diagnostic and Statistical Manual o f M ental Disorders (DSM-I1I-R) defines a tic as "an involuntary, sudden, rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalization.It is experienced as irresistible, but can be suppressed for various lengths o f time" (quoted in Comings, 1990:12).Compulsive swearing (coprolalia) is probably the most dramatic and publicised symptom o f TS, but just as important are very common motor tics like eyeblinking, licking o f lips, facial grimacing and the shrugging or jerking contractions o f any muscle, such as that o f the neck and shoulder.
However, what is o f importance for this paper is that a wide range o f behavioural problems in children have been found to be associated with TS.Comings (1990) reports extensively on this phenomenon in his book Tourette S yndrom e an d Human B ehavior.Research done by Chase, Friedhoff and Cohen (1992) as well as by Kurlan (1993) convinces the author that TS may, at least to some extent, play a role in violent behaviour.

Tourette Syndrome and rebellious children
The parents o f eleven children with TS who were interviewed for this study, complained o f behavioural problems which included defiance o f authority, aggressiveness and violence, lying, stealing, destructiveness, disobedience and poor interpersonal relationships.These corresponded exactly with the beha vioural problems that parents o f rebellious children complained about.
The eleven children diagnosed as suffering from TS were treated with psycho tropic drugs for their motor and vocal tics.In addition to an improvement o f the tics it also became evident that a dramatic change in these children's behaviour had occurred within three w eeks after starting to take these daigs (Clonidine or Pimozide).Feedback from the parents indicated that the children w ere no longer as impatient as before, impulsiveness and excitability had declined and in general their behaviour had become socially more acceptable.The following case illu strates this point: One o f the patients with an 18 year old boy, had before being given a psycho tropic drug (Pimozide) for TS, licked his lips compulsively to such an extent that 140 Koers 59(1) 1994:133-142 he had developed chronic ulcers around his mouth.Furthermore he had a history o f alcohol abuse, promiscuity, stealing and selling his parents' property, violent assaults on his mother and behavioural problems at school.After approximately three w eeks o f taking Pimozide he stopped licking his lips, and his mother reported that he had calmed down and behaved in a more acceptable manner.In addition to this his interest in school work becam e evident.He also became willing to co-operate in a psychotherapy programme.Indications w ere that he would be able to adjust to a normal and acceptable lifestyle, and that interaction with his parents as well as with other individuals were improving.

C onclusions
Parental victimisation by children is a phenomenon that should not be dis regarded.It is a reality that parents are being blamed for their children's mis behaviour while they are at their w its' end in handling these children.Although these parents desperately need help they feel that they had no one to relate their feelings o f pain and powerlessness to.If their desperation for emotional and moral support is considered, it has become essential that all psychologists and other professionals dealing with rebellious children should becom e more aware of the fact that the mental health o f these parents should be an integral part o f any therapeutic programme or intervention.
Although it cannot be denied that a host o f social and psychological factors may be responsible for rebellious behaviour in children, it is also essential that these children should be evaluated for TS.If a positive diagnosis is made, their behavioural problems can effectively be treated with psychotropic drugs in com bination with other therapeutic techniques, such as psychotherapy and behaviour therapy.Therapists should always bear in mind that although children with TS have a good prognosis, if they receive pharmacotherapy they, as well as their parents, may have developed certain behavioural patterns due to poor communi cation.With the unlearning o f these behavioural patterns it is necessary to sup port the children, as well as their parents, in developing better communication and interpersonal skills.
Finally it is imperative that cognisance should be taken o f the misconception that sufferers from TS will always outgrow related behavioural problems.If these problems are not treated, the possibility exists that these children, when they becom e adults, will exhibit the same, or other behavioural patterns although these may manifest themselves in different ways, such as physical, sexual, and emo tional battering or abusing o f their spouses and children.In support o f this it can be pointed out that Eldridge et al. (1977:163) in their study o f 21 families w here a family member suffered from TS, found that sexual abuse occurred in 12 cases.Comings (1990:263) also describes six cases in which a relationship between TS and child battering could be found.These findings raise questions about genetic influences on family violence, and, as Lystad (1986:63) points out, these also need to be explored.
In cases where incidents o f child battering occur, it is advisable to have the pa rents evaluated for TS.Should such an evaluation prove positive for TS (or as is common in adults, a TS variant) it is essential that the batterer should receive psychopharmacotherapy in combination with psychoterapy and behaviour thera py.This also applies in the case o f other forms o f family violence.Since TS is a genetically inheritable condition that can be treated effectively, early diagnosis and treatment is essential for the prevention, rehabilitation and possibly the breaking o f a vicious circle o f violence that occurs in many families.
The data for this study w as obtained through a lay support group, Parents o f Rebellious Children (PORCH) and the Department o f Human G enetics and Developmental Biology o f the Faculty o f Medicine at the University o f Pretoria.134 Koers 59(1) 1994:133-142