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A growing body of research shows that many seriously troubled children and adolescents are reacting to adverse life experiences. Yet traditional diagnostic labels are based on checklists of surface symptoms. Distracted by disruptive behavior, the common response is to medicate, punish, or exclude rather than respond to needs of youth who have experienced relational trauma. Among the most traumatized youth are those removed from family, school, and community and placed in residential settings. Whether in treatment or juvenile justice programs, the focus is more on managing disruptive behavior rather than fostering healing and growth. As trauma expert Sandra Bloom (1997) suggests, the question should not be "What is wrong with you?" but rather "What has happened to you?" This article describes findings from the Adolescent Subjective Experience of Treatment (ASET) study of youth in residential treatment settings. Their exposure to Adverse Childhood Experiences was surveyed. While a majority of youth had experienced serious trauma, the diagnoses they were given usually failed to acknowledge these experiences.

Emphasis on neuropsychiatric frameworks of conceptualizing troubled youth is increasing. This focus leads to more biologically-based interventions. As such, the use of psychotropic medications is skyrocketing, while the utilization of psychosocial strategies is diminishing. Yet overall outcomes seem to be faltering. Admissions to outpatient, partial-hospitalization, and residential care have all increased dramatically between 1986 and 2004. In this article, the author stresses the need to re-establish the importance of relationships in care, and incorporate ecological interventions and skill development into treatment strategies. These are aptly represented by the Re-Education principles and evident in all Re-ED practice settings. Even when integrating the exciting science that is available, any additional strategies should be developed on the platform of the strength-based models of Re-ED and the Circle of Courage (Brendtro, Brokenleg, & Van Bockern, 2001).

Children who have experienced relational trauma present a host of problems and are often diagnosed with psychiatric disorders and then medicated. But there is evidence that commonly used drugs interfere with oxytocin or vasopressin, the human trust and bonding hormones. Thus, psychotropic drugs may impair interpersonal relationships and impede forming a therapeutic alliance. One prominent characteristic of trauma is that the safety within interpersonal connectedness is disrupted. These breaches of trust, respect, safety, and collaboration with adults further impair children's ability to recover from traumatic experiences. They become dysregulated, impulsive, moody, aggressive, untrusting, and withdrawn. These troubled youth become wary of adults. They receive wide-ranging diagnoses. A youth who becomes too impaired (or symptomatic) is often swept up into the realms of psychiatric and psychological treatment. Moreover, it is often believed that the combination of these disciplines can result in optimal outcomes for these children. This article provides a brief overview of the different classes of medications that troubled youth are typically prescribed. The use of medications in youth is not well researched and becomes particularly complex when considering developmental aspects of children, their histories, the use of multiple, concurrent medicines (polypharmacy), and the supportive networks in their lives. Nonetheless, research does provide some insight as to how these medications may affect the ability of a child to connect when in treatment.

Everyone experiences stress and needs extra help at times. Often this involves informal support, but in certain circumstances, help comes in the form of therapy. Sometimes there is a negative impression about "needing" therapy. But when the going gets tough, sometimes the tough go to therapy. With a wide range of factors working against them, youth in residential care have endured tremendous stress. The likelihood that they have faced trauma is significantly increased; however, many have fewer resources to assist in coping with stress. Typically, a multidisciplinary team provides treatment experiences for troubled youth. But what do teens think of this treatment? Specifically, what do those placed in residential care think of being in therapy? Surprisingly, teens in residential care are rarely seen as important sources of data on treatment. Yet professionals can learn valuable lessons from them, in particular what they think works and what they think does not. Young people in residential treatment participated in the Adolescent Subjective Experience of Treatment (ASET) study. This article presents the findings of the ASET survey. Most responses indicated a high value on involvement in individual therapy. (Contains 1 graph and 1 table.)

A parent's goal is to be sure each teen stays safe, makes responsible decisions, and respects others. But the influence of peers, the temptation of freedom, access to alcohol and other drugs, and unsupervised activities cause parents to fear that their teen may be ill-equipped to negotiate the complicated world. The transition from dependence to independence poses new challenges to both teens and parents. Adolescence brings greater access to the world and its risks. But being overly protective does little to teach responsibility. Technology is providing more ways for parents to keep tabs on their kids. Does this surveillance foster positive behavior or fuel distrust? The author contends that there is no easy answer for how much to monitor a teen. Some parents make decisions based on unfounded concerns about peers, memories of their own turbulent teen years, or day-to-day family stress. Whatever the level of monitoring, this has impact on teens, their independence, and the relationship with their parents.