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Using the 12-Steps as a Parenting Intervention With ADHD

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DOI: 10.1080/01926187.2015.1051904

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Using the 12-Steps as a Parenting

Intervention With ADHD Adolescents
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Michael Grogan & Jack Weitzman
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Janette Prandi Children's Center, Corte Madera, California, USA
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Kaiser Permanente, San Jose, California, USA
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 The American Journal of Family Therapy, 43:364–377, 2015
Copyright © Taylor & Francis Group, LLC
ISSN: 0192-6187 print / 1521-0383 online
DOI: 10.1080/01926187.2015.1051904

Using the 12-Steps as a Parenting Intervention

With ADHD Adolescents

MICHAEL GROGAN
Janette Prandi Children’s Center, Corte Madera, California, USA
JACK WEITZMAN
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Kaiser Permanente, San Jose, California, USA

This article describes a self-help model for adolescents with ADHD

that draws on the 12-Steps. The model uses a modified form of the
12-Steps that incorporates parents into the process with the goal of
inculcating some of the executive functioning that is absent in their
adolescent by consistently using some of the 12-Steps as part of their
daily routine. The model proposes that parents assume a coaching
role with their adolescent to teach increased self-awareness, organi-
zation, accountability, and behavioral inhibition that, hopefully,
will have a reparative effect on their child’s immature neurological
functioning.

INTRODUCTION

An extensive clinical and research-based body of literature supports the ef-

fectiveness of 12-Step and other self-help groups in the treatment of a wide
variety of human problems, from eating disorders to sexual addictions, with
most studies focused on alcoholism and substance abuse. Yet, there are no
controlled studies or research reports on the application of the 12-Steps to
the ADHD population, though Hallowell (2005) has discussed the use of the
12-Steps with adults who have ADHD, and Friends of Recovery has pub-
lished a manual focused on adult ADHD (Friends of Recovery, 1996). The
dearth of information is particularly evident with regard to ADHD adoles-
cents. There is no research or even anecdotal reports of 12-Step programs
for ADHD adolescents. Still, adolescents for decades have been involved in
Alateen, Alanon, and NA, thus supporting the premise that the 12-Step model

Address correspondence to Jack Weitzman, Kaiser Permanente, 6620 Via Del Oro, San
Jose, CA 95119. E-mail: [email protected]

364
 The 12-Steps and ADHD Adolescents 365

can be used effectively for young people (Spicer, 1993; Kelly et al., 2002;
Kelly & Myers, 2007). This article makes a case that the 12-Step model for use
with ADHD adolescents may add a valuable treatment intervention for this
population, particularly because the model offers a structured program that
can be implemented by parents at minimal cost with relatively simple train-
ing. An important undercurrent of the approach is that the brain’s plasticity
through the lifespan might allow for greater opportunities of some repair
of the ADHD adolescent’s neurologically-based immaturities by reducing
impulsivity, improving attentional capacities, self-regulation, and behavioral
inhibition.
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CHARACTERISTICS OF THE ADHD ADOLESCENT

ADHD affects a considerable number of children and adolescents. Estimates

are that 3% to 6% of young people in the United States (approximately
2 million) are affected—and that number is rising (Rowland et al., 2002).
More boys are affected than girls (Kluger et al., 2004; Hinshaw et al, 2006).
ADHD has been variously referred to as a disability, a gift, a disorder, and
an affliction. Fundamental causes are generally traced to neurobiology and
genetics (Siegle, 1999; Goldstein & Naglieri, 2005), and strong arguments
have been made for an interpersonal etiology and attachment deficits, as
well as family factors that exacerbate the child’s problems (Markrova et al.,
2010; Chronis et al., 2004).
Clinical and research evidence suggests that the neurological integrity
of the ADHD child’s brain has been compromised from birth (e.g., Krain &
Castellanos, 2006; Goldstein & Naglieri, 2005). Brain scan mental imaging
technologies provide graphic images of the anomalies of the ADHD-afflicted
brain (ACAP, 2000; Giedd et al., 1999), though there is controversy relating to
the use of this technology. According to Amen, “ADHD affects the brain, pri-
marily the prefrontal cortex, the brain’s controller of concentration, attention
span, judgment, organization, planning and impulse control” (Amen, 2004,
p.17). These functions comprise the child’s executive skills and capacities,
with impairment in these areas leading to the significant social, emotional,
and behavior problems that are symptomatic of ADHD.
Whatever the underlying pathogenesis of the disorder, whether it
is principally neurological and biological, as opposed to social and
psychological—or some combination of both—the adolescent with ADHD
struggles with a wide range of problems that include: poor behavioral inhibi-
tion and self-regulation; egocentricity and insensitivity to others, distractibil-
ity and inattention, disorganization, and poor task completion; cognitive
gaps and absence of forethought about consequences; insufficient ability to
 366 M. Grogan and J. Weitzman

symbolize feelings and thoughts in words; and impaired ability to work

toward future goals requiring deferred gratification.

ADHD TREATMENT RESEARCH

The prevailing treatment research indicates that, with appropriate psychoso-

cial and behavioral intervention, it is possible to improve the brain-related
effects of ADHD. Behavior modification and behavior parent training, in par-
ticular, are associated with improvements in the overall functioning of the
ADHD child. Meta-analyses of social skills training (Pelham & Fabiano, 2008;
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Chronis, 2004) and psychosocial treatments, particularly behavior manage-

ment training for parents, are associated with improvements in the areas of
increased behavioral inhibition, less distractibility, improved working mem-
ory, and improved attention (Comer et al., 2012; Van den Hootdakker, et al.,
2010; Ellis & Nigg, 2009). Controlled studies have shown evidence that work-
ing memory can be improved with training (Beck et al., 2010). Other reports
have indicated that it is possible to instill better behavior controls, reduce
impulsivity, and enhance cognitive controls through training programs (Du-
Paul & Ekert, 1997). Barkley extolls behavior management interventions for
children with ADHD, though he pointed out that generalizability of the ef-
ficacy of behavioral treatments is somewhat limited to the context of the
research setting (Barkley, 2012b). The conclusion of this research is that
behavior management and social skills training that uses systematically ap-
plied rewards, consequences, and reinforcements can have a significant and
positive effect on the disruptive and impulsive problems of the ADHD child.
Another factor that has empirical support is parental involvement in
treatment (Webster-Stratton et al., 2010; Deault, 2010). Involving parents in
a constructive way in their child’s treatment is associated with reduced im-
pulsivity, improved task completion, and better organizational skills. Barkley
made the point that it is the adults (parents and teachers) who must become
the therapists for these children, with the clinician in the role of consultant
and trainer because children with ADHD do not have the internal structures
to organize themselves and follow through on tasks (Barkley, 2012a). The
caveat, however, is that disturbed or highly distressed parents can make
matters even worse if their parenting style is overly critical (Ellis et al., 2009;
Makrova et al., 2010). Parents, therefore, exert a powerful influence on the
course of the disorder and should be engaged in the treatment process
whether as patients who themselves require treatment or as lay treatment
providers. In short, if parents are not part of the solution, they are part of
the problem.
Pharmacological treatment is another empirically validated intervention
for ADHD (Connor, 2006; MTA, 2004). The studies just cited demonstrate
that there is an important role for medication management, though best
 The 12-Steps and ADHD Adolescents 367

practices approaches are holistic, eschewing single-modality interventions

such as medications only. The MTA studies of the efficacy of multimodal
treatment for ADHD indicate that medication alone is superior to no treat-
ment or behavioral treatment alone, but treatment that combines behav-
ioral and pharmacological interventions is most effective. The conclusion of
these research reports on the clinical management of ADHD is that effec-
tive treatment depends on positive parental involvement, a focus on behav-
ioral change that uses systematically applied rewards and consequences,
multimodal intervention, and a long-term commitment to the treatment
process.
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RESEARCH SUPPORT FOR THE 12-STEPS

Most outcome studies and meta-analyses of the effectiveness of the 12-Steps

have focused on alcoholism treatment with positive findings (Klaw & Luong,
2010; Humphreys & Moors, 2007), though rigorous studies are few and a
minority of studies are ambiguous or show no effects (The Cochrane Group,
2006). In perhaps the most well-known study, Project Match, the 12-Step
approach was found to be at least as effective in sustaining sobriety as
cognitive-behavior therapy and motivational enhancement therapy (Project
Match Research Group, 1998). In short, 12-Step groups held their own de-
spite the fact that they are organized and operated by non-professionals and
do not require highly specialized training. In a comprehensive review of
research findings from 2002-2007, Straussner and Byrne (2009) found that
Alcoholics Anonymous (AA) is efficacious in achieving abstinence, a conclu-
sion supported by Kaskutas (2009) who reviewed the contradictory evidence
and found that the large majority of studies confirm the effectiveness of the
12-Steps (Kaskutas, 2009). Moors and Timko (2008) also found that self-help
groups are effective in sustaining sobriety. They attributed improvement to
different facets of the 12-step model such as social support, clear goals,
and teaching new coping skills. They emphasized that factors such as ac-
countability for sobriety and monitoring of progress by other AA members,
acceptance of his or her powerlessness over alcohol, and relinquishing con-
trol to a spiritual (external) power were instrumental to success (Galanter,
2007; Dupont & Humphreys, 2011).

THE 12-STEPS AND THE TRADITIONAL CLINICAL MANAGEMENT

OF ADHD

12-Step interventions and the clinical management of ADHD have overlap-

ping characteristics, and their respective effectiveness converges on a variety
 368 M. Grogan and J. Weitzman

of points. First, each places a premium on behavioral change. For the

12-Steps, this means maintaining a vigilant focus on abstinence and alle-
giance to the tenants of the program. Participants in most self-help programs
are intensively involved in the recovery process, often attending many meet-
ings each week, involved with sponsors and a community of members. For
ADHD, effective treatment means close scrutiny of the ADHD child’s prob-
lems with impulsivity, distractibility, and other executive functions that are
managed with systematically applied behavioral rewards and consequences,
as well as social skills training. When properly implemented, it is an in-
tensive approach that involves close monitoring and measurement. Second,
each requires the involvement of supportive parents and teachers or spon-
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sors: sponsors in the 12 -Steps and parents and teachers in the traditional
clinical management of ADHD. Neither approach works well if supportive
others are absent and unavailable to encourage and enforce the implementa-
tion of the program. Third, both require a long-term treatment commitment
to a disease and a disorder that are potentially life-long. Both addictions
and ADHD are refractory to short-term programs and require long-term in-
vestment from all parties involved. For those in self-help groups, relapse
is more likely without long-term support. The same applies to ADHD ado-
lescents who are highly vulnerable to poor outcomes in adulthood without
long-term support (Barbaresi et al; 2012; Molina, 2009). Fourth, there is a
commonality of curative factors such as the adoption of new coping skills,
clear goals, accountability, and monitoring of progress that each approach
incorporates into the treatment process. It is largely these factors that help
to explain why change occurs.

A Unique Role for Parents

Although adolescents may be somewhat more capable than younger children
in managing their disorder, most still require extensive external structuring
and support. A purely independent self-help approach operated only by
ADHD adolescents isn’t feasible with such impulse-disordered teens who re-
quire the closer supervision, direction, care, and control of parents, though
a subset of more mildly afflicted teens may be capable of benefiting from
a purely independent self-help approach. Adults essentially subsidize the
ADHD teen’s missing executive functions without which he or she will floun-
der. On this point, Barkley says,
“Children with ADHD have limitations in internally represented informa-
tion and motivation that instructs, guides and supports behavior and there-
fore require more externally represented information and artificially arranged
consequences to compensate for these executive deficits. Consequently, par-
ents are going to need to use more explicit, systematic, externalized and
compelling forms of presenting rules and instructions to ADHD children and
 The 12-Steps and ADHD Adolescents 369

providing consequences for their compliance with them than are likely to be
needed with normal children.” (Barkley, 2012b, p. 32)
In a 12-Step program for ADHD teens, parents can occupy a unique po-
sition as sponsors who play a crucial role in coaching their adolescent to use
the 12-Step process. Coaching has many similarities to sponsoring and has
some empirical validation. For example, Green et al. (2007) used coaching
to help high school seniors determine future goals and stay focused on tasks.
Oden and Asher (2007) used coaching to help facilitate children’s friendship-
building skills. In a related study, Vilardo (2007) used coaching techniques
to enhance social skills among children with ADHD. Still other researchers
successfully applied coaching techniques to adolescents and college students
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with ADHD, to help them remain on task and complete assignments (Field
et al., 2010; Rietman et al., 2005). Rietman’s study used parents as coaches
with their ADHD adolescents to enhance their commitment to participation
in sports and pro-social behavior.
Just like the 12-steps and the clinical management of ADHD, the effec-
tiveness of coaching is based on the supportive role of the coach, an em-
phasis on behavioral change, accountability, and a significant commitment
of time and effort to the treatment process. Thus, instead of professionals act-
ing as coaches and behavioral specialists, parents can act as coaches, using
the 12-Steps to provide structure and support to induce behavioral change
in their ADHD teen. At the very least, parents can provide adjunct treat-
ment to the professionals who might be involved in their child’s treatment.
Parents can be trained to use the 12-Steps through a combination of attend-
ing 12-Step meetings, absorbing the 12-Step literature and getting involved
in workshops conducted by professionals and non-professionals who work
with ADHD teens.
The 12-Steps approach can help parents have a clearer understanding
of how to manage the child. It can give the parents a straight-forward way to
understand their own roles in the treatment process. Ideally, the relationship
between parent and child emulates a teamwork approach that is common in
athletics, where there is a commitment to learning new skills, together with
daily practice and execution. Some parts of the program can and should be
used daily, at least to start, while other parts may be used only as the need
arises, such as the step on crisis debriefing. Most of the time, the work will
involve only the steps that address present and daily issues such as the daily
prayer and personal inventory. Parents can be guided in communicating
effectively and avoiding attempts to coerce the adolescent into a coaching
encounter. Forced coaching encounters will likely have poor results. If there
is too much resistance on any given day, it is better to wait until the resistance
subsides. If a parent is unable to act as the child’s coach because of some
psychological impairment or resistance, another person such as a committed
relative may provide a good alternative. The approach presented below
is a modified version of the 12-Steps and endorses the use of stimulant
 370 M. Grogan and J. Weitzman

medications as an integral part of treatment based on the known research

relating to efficacious treatment of ADHD.

Step 1: Acceptance
The first step of a modified 12-Step program is, as in the adult model, accep-
tance of the disorder. One can’t change something without first acknowledg-
ing it. Many ADHD adolescents know that they can’t sit, focus, collaborate
with others, inhibit impulsivity, or complete tasks. They may arouse negative
reactions in others, but many don’t really take ownership of the disorder or
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even connect their ADHD to the social and emotional problems they incur
(Hallberg et al., 2010). Just as parents have to accept their need for the
program in order to better manage their adolescent’s disorder, adolescents
also have to accept the unmanageability of their lives as a result of having
ADHD, as Friedman, an ADHD afflicted teen, recently published in her own
account about her struggle to accept her disorder (Friedman, 2014).
This step requires that parents have a conference with the adolescent,
often with the help of a therapist or other important people in the ado-
lescent’s life, in order to come to a meeting of the minds about why the
child is struggling, and to confront any resistance or denial. This involves
helping the adolescent accept the reality of being distractible, impulsive, and
having trouble with decision-making and commitments. If the adolescent
can admit to the disability, openly and explicitly acknowledging it in words,
the chances of developing a productive collaborative coaching relationship
are significantly enhanced. On this point, Dawson and Guare (2009) stated
that coaching is most successful with adolescents who are willing and active
participants in the change process.

Step 2: Surrender to a Higher Power

Acceptance of the disorder is not the same as surrendering control. Accep-
tance means acknowledging that something exists. A person may accept
that he is an alcoholic, but that doesn’t mean that he is willing to turn over
control of his life to another entity. He may continue to insist that he can
cope effectively with his disease and refuse to change any of his behavior.
Similarly, an adolescent may accept that he has a disorder, but deny that he
needs help from anyone to manage it. He may insist that he does not need
anyone’s help, not from a parent, coach or a higher power. Acceptance with-
out surrender only leads to false beliefs about ability to control self-defeating
behavior.
Turning over control of one’s life to another entity means follow-
ing someone else’s rules, whether that person is a parent, coach, God or
 The 12-Steps and ADHD Adolescents 371

spiritual power. It requires that the ADHD adolescent recognize that his
way is not working, and that he recognizes his limitations. Only then can
he fully accept the idea that there is a better way to live, namely, with
structure, planning, rules, responsibility, consistency, commitment, follow
through, and organization—in short, with executive functions. Acceptance
and surrender to the wisdom of others is, for the ADHD teen, the anti-
dote to a life of disorganization and dysfunction, most especially if liv-
ing with external structure and direction leads to the internalization of
controls.
It is asking a lot of the pseudo-independent ADHD teen to surren-
der control to another, but that is what the coaching process requires.
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Resistance to surrender is substantially rooted in early life attachment

difficulties—specifically, many ADHD adolescents are insecurely attached or
even counter-dependent. An encouraging parent or coach who can help the
adolescent recognize his or her struggles with trust and dependency, espe-
cially when he or she is backsliding into pseudo-independence and putting
up walls against feedback from others, can go a long way toward breaking
the destructive cycle of counter-dependency and pseudo-independence. If
the coach can arrive at a word or phrase that tells the adolescent that he
is resisting the 2nd step such as, “You’re going solo again” or, “The lone
wolf is back,” some levity can be brought into the situation to soften the
adolescent’s resistance.

Step 3: Inventory: Daily Review

This step of the adult AA program advises the participant to engage in a
searching and fearless self-inventory, in order to become fully aware of the
person’s past and current problems. This step is more focused on devel-
oping awareness of how ADHD impacts relationships each day. It means
doing a daily inventory to review the actions that may have given rise to so-
cial and personal problems. This step is especially important because many
adolescents with ADHD cannot recount the events of the day, can’t place
themselves in time, and have little sense of how the day’s events affect
him, her or others. This lack of ability to reflect is a serious impairment of
executive functioning.
Reviewing misbehavior is a way of raising awareness in the adolescent
with regard to impulsiveness and the absence of interposing thought before
action. It is the “think before you act” step that builds self-reflection. That can
instill in the child an awareness of his or her motives, feelings and intentions
as the source of actions. So long as the ADHD teen fails to look inward
for the sources of internal motivation, he or she is hopelessly focused on
blaming others, with no internal locus of control. This step can be easily
accomplished over dinner or as part of an agreement between parent and
 372 M. Grogan and J. Weitzman

child to inventory the day, so that important events are not forgotten or lost,
or building up to a more major problem.

Step 4: Crisis De-Briefing

While de-briefing is not a part of the traditional 12-step model, it is in-
cluded here as an important part of a modified 12-Step program because
crises happen frequently in the lives of ADHD teens, as any parent of an
ADHD teen will attest. The lives of ADHD adolescents are often filled with
altercations, crises, and intense conflict. When a serious problem occurs, de-
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briefing about the incident is crucial to learning about the crisis. It should
be viewed as an opportunity to teach better conflict resolution skills, insight,
and self-control. It does involve taking a personal inventory, but is more
strictly focused on crisis intervention and getting through the crisis without
escalations and exacerbations.
Allowing the aggrieved adolescent to vent his or her frustrations and
verbalize the individual’s perspective about the incident should be the
starting point of a coaching encounter. Even if his or her initial views
of the problem are distorted, validation of their frustrations is essential.
Only then can the typical ADHD adolescent be more open to accept-
ing his or her own role in the conflict. This requires that the parent as
coach is able to temporarily set aside the parent’s own angry or anxious
reactions to the situation and assume a teaching role with the struggling
teenager.
Debriefing is pivotal for several reasons. First, many ADHD adolescents
who find themselves in a high-conflict situation are entranced by the drama
and excitement of the situation, unable to achieve any emotional distance
or objectivity about what happened, or they are habituated to lying and ma-
nipulating the facts, trying to avoid punishment or criticism. They can rarely
see their own contribution to the conflict, and they don’t, therefore, think
about reparations and repair. They typically feel victimized, or entitled to act
on their impulses. Debriefing can help them reconstruct the events of the
crises and reappraise their role in them. By doing so, ADHD adolescents can
develop greater awareness of their own actions, underlying motivations and
more constructive ways to deal with conflicts. Such crises take precedence
over more routine issues, and a de-briefing step should substituted for the
daily inventory.

Step 5: Daily Prayer of Staying Focused on Goals

Adolescents who have some religious or spiritual orientation will be more
amenable to the idea of a daily prayer, but even adolescents who are not
 The 12-Steps and ADHD Adolescents 373

spiritual or religious can benefit from the idea of starting out the day with
affirmations or a personally-styled statement of good intentions and clear
goals for the day. This is a way of teaching the adolescent to go beyond
himself, to keep the bigger picture in mind and to refrain from getting
caught up in momentary distractions and impulse. It is a way of reaching
for higher goals or having faith in the coaching process and in help from
others—in something greater than himself and his often short-sighted and
dysfunctional ways of coping with tasks, obstacles and the expectations of
others.
Orienting the adolescent with a simple plan or goal at the beginning
of the day is a helpful way to teach planning and forethought. While some
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adolescents will feel comfortable asking for help from the creator or God,
adolescents who are not religious might feel more comfortable with a simple
affirmation such as, “Please let me be more mindful today. Let me be slow to
react and to think before I act.” As organization represents a major problem
for most ADHD teens, a daily prayer that sanctifies the idea of focusing on
daily goals is essential for inculcating good planning skills. Focus on a single
target behavior such as bringing homework home or inhibiting disruptive
talking in class can be very useful in getting the adolescent to attend to a
goal and to experience small successes that can grow over time. Obviously,
when a parent in the capacity of coach engages with his or her ADHD
teenager in a prayer or mindful moment, the process can be very powerful
for both, as they strive toward a mutual goal.

Step 6: Admit to Others the Exact Nature of Our Wrongs

This step is about helping the ADHD adolescent to be accountable. Account-
ability is so central to learning how to be more conscious of oneself, to be
self-reflective, and to becoming a responsible person. When the ADHD ado-
lescent has to admit to another that he acted badly and then apologizes, he
cements the process of becoming more sensitive to others and responsible
for himself.
This is not an easy step for the adolescent, as it is a humbling experience
to admit one’s faults, especially as many ADHD teens already feel so hapless
and inferior. In the coaching process, it means helping the adolescent to
take ownership of his or her behavior and to validate the individual’s efforts
to take responsibility for his or her actions. Admitting to wrong doing—
seeing one’s role in a problem—is the antidote to preventing the ADHD
adolescent tendency toward victimization, blaming others, and ignoring the
person’s own contributions to conflicts. It can increase the adolescent’s locus
of control and decrease the sense of powerlessness that is often at the root of
negative acting out. It is about training the ADHD adolescent to stop making
 374 M. Grogan and J. Weitzman

excuses about his own circumstances and to be honest with himself and
others when mistakes are made and corrections are required.

Step 7: Making Restitution for Infractions: Awareness

of Injury to Others
When the ADHD adolescent takes responsibility for his or her actions, mak-
ing amends, admitting wrongs and taking action to fix things is tantamount
to building authenticity and honesty. It is one thing to admit one’s mistakes.
It is another to take action and correct a wrong because the act of making
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restitution reinforces the authenticity of the ADHD adolescent’s intentions

to be honest. It is analogous to making a child return the candy bar that
was stolen from the store, facing up to others and to self, accepting conse-
quences. It helps to create a person with stronger convictions about being
truthful and repairing damages. It also enhances the ADHD adolescent’s ten-
dency to reverse roles, and to develop more empathy for those who are
injured by his behavior. Needless to say, when the adolescent humbles him-
self and repairs the damage that was done, he should be praised for the
maturity of his actions.

SUMMARY AND CONCLUSIONS

ADHD is a disorder characterized by impulsivity, disorganization, impulsiv-

ity, risk-taking, and difficulty with self-regulation and behavioral inhibition.
In short, it is a vacuum of executive functioning. While there are a variety
of treatment approaches that can help, the modified 12-Step approach as
described above can make another contribution to helping such adolescents
build stronger executive functions into their lives. The ADHD adolescent’s
problems with organization, planning, and structure can be offset by adher-
ence to the highly structured nature of 12-Step programs. The model relies
heavily on parents acting as sponsors or coaches, in executing the treatment
process, This, although the model prescribes a judicious use of the steps as
well as an emphasis on keeping things short and simple—even if it is heavily
front loaded and daily sessions may initially be required to get on track. A
long term commitment to the 12-Step model is essential to more successful
outcomes. Obviously, the model may work better for some families than
others, and an adult other than a parent may assume the role of coach.
However, when parents are motivated by and interested in the approach,
the adolescent is more likely to engage as well. The 12-Step approach can
augment parenting skills and provide a simple, organized way of managing
and teaching the ADHD teen. It gives a clear structure for the parent and
 The 12-Steps and ADHD Adolescents 375

adolescent to follow and it can, hopefully, lead to the internalization of ex-

ecutive functions, as well as a more satisfactory life for both the afflicted
teenager and the teen’s family.

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