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.

Saturday, April 23, 2011

Why is this Post Different From All Other Posts?

My son's bar mitzvah is this September (yes-two weeks after my book comes out!!) and so despite the fact that we are not a particularly observant family, we found ourselves at Shabbat services on Saturday morning of Passover. The Rabbi has members of the congregation take turns reading parts of the service. By total random chance, it was my turn to read when we got to the translation of the day's Torah portion. And this is what I read:
A God, compassionate and gracious, slow to anger, abounding in kindness and faithfulness, extending kindness to the thousandth generation, forgiving iniquity, transgression, and sins. Yet He does not remit all punishment, but visits the iniquity of parents upon children and children's children, upon the third and fourth generations.
So there it is in the Torah, what in the world of child development is referred to as "intergenerational transmission of trauma," or "intergenerational transmission of attachment." This can take many forms. Parents who have been abused are more likely, without adequate help, to abuse their own children. Most parents I see in my office who are struggling with their child’s challenging behavior tell me some variation of the statement "Í don’t want to do to Charlie what my parents did to me.” Yet they are horrified to find that they are in fact behaving in exactly the same way as their parents. They find themselves distracted and emotionally unavailable, or explosive and full of rage. In the book History Beyond Trauma two French psychoanalysts describe how psychiatric symptoms can represent trauma of war that has not been expressed, sometimes for generations.

"So why is this in the Torah?" the Rabbi asked. One member of the congregation said that it was about taking responsibility for your behavior as a parent. I thought this was a good answer. When this question of how parents behavior affects their children comes up, it is often heard as blaming parents for their children's problems. In the first chapter of my book I have a section entitled "Guilt, Blame and Responsibility" (also a previous blog post of the same title) because I think is is important to address this problem up front. When people feel blamed, they may become defensive and shut down. Here's an excerpt
Guilt and blame are negative words, and responsibility is a positive one. People generally feel good about themselves when they take responsibility for their lives. They feel empowered. But taking on the responsibility for raising a child in a meaningful and effective way is not an easy task. In the setting of
fragmented families, financial stress or a parental history of abuse or neglect, it is especially difficult. Add to this a child with a challenging temperament, and the responsibility can easily feel overwhelming.
As I've said many times before, supporting parents in this essential task of raising the next generation is critical. The flip side of recognizing our society's responsibility to support parents is for parents to recognize their responsibility for facilitating their child's healthy development. For what its worth, the Torah seems to support this point of view.

Monday, April 18, 2011

A Beautiful Parenting Moment at the Local Coffee Shop

It was a peaceful Saturday morning at Fuel, a local coffee shop in Great Barrington. People sat quietly murmuring with friends over coffee and muffins, or intently working at their laptops. I was doing the final edits for my forthcoming book Keeping Your Child in Mind, when I looked up to see a small boy of about two years tottering down the narrow aisle holding a plate with an enormous cinnamon bun almost the size of his head. His father followed close behind and they sat down at a table right next to me. The boy was proudly surveying his prize when his father innocently reached over and asked "May I share?" Instantaneously the peace was shattered."NO!!! MINE!!! NO SHARE!!!" His father made a hasty retreat but it was too late. The boy quickly descended into an all out tantrum despite his father's attempts to soothe him.

His mother, who had been at the cash register, rushed back to try to help. While she joined the efforts to quiet his screams, now transformed into sobs of “no share!”, she and the boy’s father looked to be deciding whether to abandon their outing or try to repair the situation. Fuel is a friendly place, and the other customers, including myself, smiled at them knowingly. This, together with a gradual decline in the intensity of their son's crying, seemed to lead to a decision to stay. His mother sat with him while his father went to finish the transaction at the register. He returned with breakfast for the grown-ups and after a bit more time, the boy's crying slowed to a quiet whimper. Calm once again descended, and the three of them were quietly eating their breakfast when the boy took a piece of his cinnamon roll, reached across the table to his father and said, “Share?”

Mine is a favorite word of most toddlers. This word doesn’t represent greed, but rather the toddler’s great joy in his newly emerging sense of self. Certainly limits must be set, and a toddler must learn over time that everything is not in fact, "mine." Just how to impart this sense of limits while at the same time facilitating a healthy sense of self is one of the great challenges of being a parent of a toddler. Sometimes a child might feel particularly vulnerable, such as when he is hungry or tired, and can collapse in the face of a parent who shatters the illusion of his omnipotence. I imagine this was the case with this little boy and his cinnamon bun.

His parents, clearly attuned to the emotional state of their child despite the pressure of a public scene, sensed that this was not a moment to set a limit. He had his two-year-old reason for feeling that sole possession of this prize was essential. They were all rewarded by a happy repair of the disrupted morning. And with their respect for his autonomy, he was able to take in the idea of sharing, though for the time being, he needed to share at his own initiative.

This was a tiny moment, yet full of such richness and complexity. Strung together, such moments, when parents respond to the meaning of a child's behavior rather than simply the behavior itself, serve to set a child on a path of healthy emotional development.