Welcome to my blog, which speaks to parents, professionals who work with children, and policy makers. Through stories from my behavioral pediatrics practice (with details changed to protect privacy) I will show how contemporary research in child development can be applied to support parents in their efforts to facilitate their children’s healthy emotional development. I will address factors that converge to obstruct such support. These include limited access to quality mental health care, influences of a powerful health insurance industry and intensive marketing efforts by the pharmaceutical industry.

Tuesday, July 13, 2010

Neither Bad Parents nor Bad Seeds

As a pediatrician I have listened to many parents speak of their child in very negative terms. Dr. Richard Friedman, in his NY times article entitled Accepting That Good Parents May Plant Bad Seeds shares his patient's description of her "rude and defiant" teenage son. Like the parents in his piece, the parents of my patients have other children with whom they have had no such difficulty. The conclusion Dr. Friedman draws from this and other similar stories, is that perhaps these are simply "toxic" children.

I find this conclusion horrifying. Dr. Friedman's piece brought to mind two children from my pediatric practice who were described in similarly negative terms. These negative characterizations were openly discussed in front of them. Both were teenagers when I first saw them and for years had been identified as the "difficult child" in the family.

Rather than focus on whether or not these children had something "wrong" with them , I spent a visit with each mother alone(the fathers were welcome but didn't come) exploring what her experience of the child had been starting in infancy.

Both described very fussy infants who cried easily and did not like to be held. As they became toddlers these children were alternatively clingy and explosive. In addition they had many sensitivities to touch , taste and sound. These mothers recalled intense feelings of inadequacy. One mother remembered that she had similar sensory difficulties as a young child. She had suffered terribly as her own parents were drawn to her older and younger siblings who were much more easy going than she.

Yet when their children were young, these mothers did not have an opportunity to reflect on what was happening. Instead, a negative pattern of interaction was set in place. These mothers described becoming enraged with their children whose behavior in turn became more difficult. Marriages were strained and there were high levels of conflict and tension, all of which were increasingly blamed on this "problem child."

For both of these children the world did not feel like a safe, comfortable place from day one . But that does not mean there was something "wrong" with them. They needed more help than other children who did not have these biological vulnerabilities, to make sense of the world and manage their feelings. Research has shown that children learn to manage difficult feelings when their parents can reflect on and contain their experience.

The mother in Dr.Friedman's story describes her son as being "unsympathetic." It is in toddlerhood that children learn, by having their parents understand and contain their feelings, to think about not only their own feelings, but other people's feelings.

Rather than drawing the conclusion that this child was a "bad seed" I wonder, what were this child's particular biological vulnerabilities? What kind of stresses did his parents experience when he was very young? How did these stresses affect his parents ability to help him to learn to think about and manage his feelings? Only with this knowledge would I venture to understand how he has become the person he is today.

My two patients are both in therapy of their own. By the time a teenager has lived all those years being identified as a difficult child, and has not learned to think about his own and other people's feelings, he needs intensive help.

My patients are not "bad" children and their parents are not "bad" parents. Rather, they are children with biological vulnerabilities whose parents needed to work alot harder to help them learn to regulate their feelings.

In retrospect, these parents recognized that they needed someone to help them contain and manage their own experiences raising these challenging children. But they didn't have such help.

The difficulties these families faced were neither in the child nor in the parent, but in the relationship. When parents have support in their efforts to be fully present with their young child, their children feel understood. This understanding in turn helps them to manage difficult feelings. Behavior improves. Parents' sense of competence increases. A positive cycle of interaction is set in place. Development moves in a healthy direction.

7 comments:

  1. Once again, excellent post, amazing blog.

    That op-ed was a ceaselessly shallow piece of vomit distilled from our toxic culture and the trainwreck that is psychopharmacology centered psychiatry.

    Psychiatrists like Richard Friedman need to spend less time on the speaking circuit and golf courses, and perhaps more time engaged in self-reflection, which I'm sure is in reality a task on the scale of finding a firm genetic basis for depression.

    I wish your approach was the standard of care in medicine and psychiatry.

    No one in this country gives a crap about relationships. It is a pervasive orientation towards life in our country and a destructive one too.

    One negative function of psychopharmacology, whether intentional or not, is to maintain that status quo.

    Children are not dynamic, they can come broken just like computers, without any inherent ability to adapt. Children can be manipulated to a parents, immediate, short-sighted desires if need be, via Dr. Friedman's prescriptions.

    If it comes to it, they can be all but disposed of, as Dr. Friedman does to this woman's son in the NYT in front of the whole nation.

    Impressive.

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  2. What a great post! I totally agree with everything you wrote. (I had two people send me the NY Times article you're talking about).

    The key sentence in the original article may be "it was clear that her teenage son had been front and center for many years."

    Maybe too front and center?

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  3. JC - the son in the NY Times article was obviously born with heavy genetic loading for rudeness :)

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  4. Thank you for this post. I teach Redirecting Children's Behavior (www.WholeHeartedParenting.com) and one of the first experiences for participants in the course is to examine beliefs on why children "misbehave". Parents discover that a child misbehaves not because he is “bad” or because they themselves are “bad parents” but because the child is discouraged. When his needs are met, there is less need to act out or "misbehave." Parents, too, become discouraged when the parenting tools they possess are not effective. When parents gain the skills for challenging issues, they become encouraged, their family life becomes more peaceful and their children have the guidance they need.


    A link to this post will be included in the July 27th issue of Parenting News You Can Use, our free weekly e-zine for parents and teachers.

    Thanks again for all of your excellent posts!

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  5. Another thing to look at early on with toddlers who have these problems in the early stage is food sensitivities. Taking my daughter off of dairy, eggs, wheat, and soy made all the difference in her being able to interact with others.

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  6. Would you devote some future posts to understanding the mind of the teenager? Further advice on this age group would be helpful.

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  7. Thanks for your comment, Anne. I will keep your request in mind. I do have one previous post about teenagers: "Toddlers Teenagers and Winnicott's Wisdom" from July 2010

    My forthcoming book for parents, to be published by DaCapo Press in Sept 2011, has a whole chapter devoted to adolescence.

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