Sean’s ADHD, Part 4: Sticks and Stones

In my many posts about ADHD, and many other kinds of behavior issues as well, I have described cases in which a lot of the things a kid did looked just like the kind of things that a kid with ADHD would do. (It is for this reason, I suspect, that so many kids get diagnosed with ADHD and get prescribed medication.) Sometimes another doctor will send the child to me because they have ‘failed’ treatment with standard ADHD medication. Careful, patient, and thorough investigation often shows me that the child’s attention problem is actually caused by unappreciated anxiety, unseen depression, itchy skin or itchy eyes, a vision or hearing problem, or a bully.

Some aspects of attention are driven from within us. In order to accomplish any task, we have to shut out sensory inputs from the world. There are many medical studies that show fairly conclusively that multitasking is a simple delusion. We don’t really focus on driving and talking on the phone and sipping our coffee all at the same time. We actually do them in sequence, one after another. Because we’re not spending a visible amount of time on one before moving on to another, the sequence is invisible and it gives the illusion of simultaneous action. In every waking moment, we multitask in the same way. We walk and talk, we look where we’re going, we keep our pants from falling down. (When people get impaired in some way, they stumble.)

In Sean’s case, I thought he clearly had some attention and hyperactivity issues. He will have to learn to restrain some of his impulses in certain situations--such as a classroom. He also needs to be respectful of teachers, even if they aren’t the best. But when I asked him about bullies, he denied this problem. Now I realize that I hadn’t considered the possibility that the bully could be his teacher.

His mom asked him if what the other parent wrote in the email was true. He confirmed all of it.

Even without physical violence, this is abuse. Sean didn’t know or understand that a teacher could be wrong, or could do something wrong. So when Mr. Dickson called him a ‘rotten child,’ he didn’t take it as an insult. He understood it to be a professional assessment, like a B+ grade, or advice that he needed to practice his arithmetic. Since he now understood himself to be a rotten child, he realized that this new identity afforded him a freedom from behavior boundaries that he had not had before.

The rhyme about sticks and stones is simply a lie. It is irresponsible to teach it to your child as a defense. It is curious to me that parents will teach this to their children as if they believed it to be true. Given, part of being an adult is knowing when not to respond to hostility or an insult, when to simply keep your feelings to yourself, when to appear noncommittal when you really do have strong feelings. Most people, maybe everyone, has lost friends, relationships, jobs and many other important things because of words. Believe as we do in freedom of speech, there is no freedom from feeling hurt by speech. If your son struggles in school, and a sibling called him stupid, what would you do? Would you teach him about sticks and stones? Is that doing your job? I’ll come back to this.

When a teacher, and especially a parent, gives a negative assessment of the way a child is, a scar is made.

There are 2 important points here. If your kid messes up, you don’t have to go through some self-effacing nonsense--just tell them how it is. It’s OK to tell them they are wrong, that they must never play with daddy’s drafting equipment, that they are not allowed into the street without holding a grown-up’s hand. You must never tell them that they are stupid, unattractive, incompetent, or that they speak funny. Never tell them that they are rotten kids—save this one for your toast at their weddings. Never even hint that you wish they weren’t born, or wish they were more like one of their siblings or cousins.

In a work environment, there’s a big difference between hearing an assessment that you need to improve the way you organize the files and hearing that you are disorganized. One is a skill you need to improve, and can try to improve. The other is a label that is permanently attached to you.

The second point is how you deal with the bullies in your child’s life.

In the movies, the caring father teaches the child boxing or martial arts, so that when threatened, the on-screen David can beat up a schoolyard Goliath, humiliating him or her and inducing a catharsis in the ticket-buyer powerful enough to provoke tears. While I have often admired the positive impact on a child when they study martial arts, for example, real life never, ever has worked like this even once. If there’s a child threatening your kid, physically or emotionally, are you going to sign the kid up for lessons? How many years will that take? And then when the bully gets the desired reaction, and your kid finally explodes with the righteous justice of any number of action movies, who will be suspended from school? What will the lesson be about fairness and right and wrong? When the bully is an authority figure, who does the child have who could compete with that? Who is more powerful than a teacher or a school principal who tells your kid that he is some kind of delinquent? Only you can fill this role.

It could indeed make the child’s school life more uncomfortable if you intervene on your child’s behalf. But that child will be with you long after this school term is a bad memory. Step up to the plate on the child’s side, and they will remember it for decades. If you don’t, they will remember just as long. Don’t measure your success by whether the child gets a new teacher, or is being sent to the principal’s office. Your success is in your relationship with your children, who have acquired the secure knowledge that you’re always there for them, you’re always going to stand by them against the bullies of the world.

My Child Hates Me

Hitting Mommy

"You will not be punished for your anger, you will be punished by your anger.” --Hindu Prince Gautama Siddhartha, the founder of Buddhism, 563-483 B.C.

A sensitive and intelligent mother started the visit by saying that her 3-year-old said, "I hate you." There had to be a lot more to the story, of course, so I said, "that must be very hard for you." Mom started to cry.

"She hits me," she said, very seriously as if confessing.

"How long has this been going on?" I asked. She said that her daughter has been hitting her and only her for about 6 months. Though she hasn't been hurting anyone else, she's been more difficult in preschool and quicker to fight over toys and play turns. She said that the child hits as hard as she can, with obvious intention to hurt.

It wasn't always like this, mom said as I started to examine her 6-month old baby. There used to be times of cuddling and laughing, and now it seems that the toddler is angry all the time. With gentle questioning, this mother admitted that her daughter still has happy times with dad, who is working long hours but is a big help when he's home. She admitted worrying about the future of her daughter, worrying if she will be violent as a teenager or adult. This made her very sad.

I felt sad for her, too. I told her the quote above, to help share my perspective--as on most child behavior issues--through an empathic view of the child. Siddhartha could easily have had preschoolers in mind. They don't want to be angry! It may seem like the child spent a lot of energy on her anger, but it wasn't a fun place to be for her. So I knew that she wasn't enjoying feeling or expressing this aggression, especially against her mother. And toddlers don't do things they don't enjoy for reasons of principle.

It should be obvious that the child's aggressive behavior towards mom started soon after the baby was born. When I pointed this out to the mother, however, she was surprised. She tried to retrace the calendar in her mind as a way of proving that it had nothing to do with the new baby. She failed, and realized it had everything to do with the baby.

This is not an unusual story, and many kids (as well as many dogs and cats) can get pretty resentful of the new baby.

Mom was surprised, however, because she said she had followed my advice from before the baby was born: make time to be one-on-one with the older child, so they know you are still interested in them and their priorities. She said she did this as much as possible. Depending on what time her husband came home, and the baby's nap schedule and feeding schedule (which varied every day), this could be a couple of hours or none. Sometimes the dad came home after bedtime, and he wouldn't see his daughter at all that day.

Now all the pieces fell into place. This 3-year-old had VPS, and a bad case of it. Vanishing Parent Syndrome, a problem that often arises as a complication of Concrete Thinking. (NB to the reader with OCD: Concrete Thinking is real, look it up. I just made up VPS.)

First, the problem arose because the parent has made a subtle but serious error in empathy. Mom was trying as hard as she could, and made as much time for the child as possible, but the kid is only 3 and cannot appreciate her mother’s sacrifice. It is perfectly understandable and natural for the loving parent to make the assumptions she did. But it's an error. Would you take your 3-year-old jogging? No, she wouldn't be able to keep up. Would you take her to a college lecture? No, because it wouldn't be reasonable to expect her to pay quiet attention for so long. Concrete thinking means that the child has a limited capacity to imagine herself in somebody else's shoes. Her ability to think abstractly in the future, which is to say imagine herself doing something tomorrow or next week, is absent.

So let me apply empathic analysis, a methodology I came up with to help work through challenging child behavior issues. Maybe she can't put herself in my place, but I can put myself in hers.

From the 3-year-old's point of view, these one-on-one sessions with mommy and daddy are great. But because she can't plan tomorrow or the next day, she is trapped into reacting to whatever is happening right now. She doesn't remember the hours spent with her yesterday--they might as well have been ancient history. Even if you remind her, she can't grasp the feeling it gave her yesterday when you were with her. Thus, it doesn't soothe her or relieve her need any more than the drink of water you had last week can relieve your thirst right now. In the same way, your promise of spending time with her tomorrow is of no value to her today. In this case, there wasn't even that promise. Maybe there would be time tomorrow, maybe not.

For the child living in the moment, as would be developmentally normal for a child this age, these times with her parents seem arbitrary and unpredictable. Though nice when they happen, they start and end for inconceivable reasons. The child has no confidence that these times will ever happen again.

When did this start? It's a mistake to think that the child has formed a conspiracy theory to explain it, with the newborn baby as the evil leader. Earlier, I said that I helped mom see that the problems started about the time when the baby arrived. But the baby didn’t do anything—it was the behavior of the parents that changed. The baby is an incidental artifact to the situation from the child’s point of view. It's the parents that this child depends upon, and it is their actions alone that she reacts to. So it's perfectly reasonable that a developmentally normal child will try one thing or another to regain the attention that she has inexplicably lost. Maybe it's refusing to go to sleep or eat. Maybe it's giving up the potty and going back to diapers. Maybe it's hitting mommy. She's creative, inventive, and needy. She has now learned that the hitting thing works, in a big way. Mom puts down the baby and talks directly to her--maybe not in the tone she hoped for, but at least, like a desperate salesman, she's got her foot in the door. The attention of her parents is the single most valuable thing in her world, yet her parents dole it out like worthless crumbs.

This mismatch between the priorities of the child and the priorities of the parent is a set up for relationship friction. Each party doesn’t understand why the other can’t see reality in the clear bright light of truth.

This sweet preschooler couldn’t jump up to her mother’s perspective, but maybe I could get mom to kneel down to hers. What I had to do was come up with a system that the child could rely upon, that the parents could live with, and that would still include the baby. I needed to work with the tools I had.

The child didn’t know numbers and couldn’t read, but did know colors. So I told the mother to get a big desk calendar at an office supply store. Every day had a plan. On weekends, daddy would go for a walk to the park and leave mom at home with the baby. Every weekend morning, even in a cold, drenching rain. This is crucial—the child thinks concretely, so she can’t abstractly imagine her own wet discomfort trying to play in the rain (and she might, in fact, enjoy it). So get over your petty adult comfort preferences and take her to the park, at the same time every weekend morning. If you go and she says she wants to go home, that’s OK, but that still means isolating dad and her from mom and baby and giving her one-on-one time with dad. These are orange days, and every weekend day must be colored orange. On green days, mom would do laundry when the baby was sleeping in the afternoon. And laundry was their special time to be alone together. The child was given special helping tasks and made to feel important and useful to mom. She knows a baby couldn’t do these things! By the time dad came home, mom would have specific things she could tell him about all the helpful things she did. On blue days mommy would go to the store with her and the baby. But before going to the store, she helped mommy make a list of things to buy. She helped take things off the shelves and put them in the cart. A baby couldn’t do that!

Every day, at bedtime, the child would put a dinosaur sticker in that day on the calendar. That was the end of that day. Goodnight, dinosaur!

Though the child had limited ability to picture the next day, this became a bedtime ritual. When the next day was green, she was reminded of the important job she had helping to sort light from dark wash, or adding the dryer sheets.

I can’t emphasize enough that for this plan to work, it needs to be cast in steel. It isn’t the tasks that change the toddler’s behavior, it’s the dependability. When she feels confident that she can count on the plan happening, she won’t feel the need to experiment with new and inventive attention-getting techniques. The plan is designed to build confidence, so it doesn’t matter if it’s only an hour a day of parent time. It matters a lot if the parent doesn’t follow through. That will erode the child’s confidence in the parents even more, with predictable increases in problems. So the key success factor here is the commitment of the parents to do what they contract to do.

Her parents told me that she’d sometimes ask to start the laundry first thing in the morning. When reminded that they have to wait for the baby to be asleep, she’d talk very quietly and sometimes sing softly to the baby to help initiate this process.

She stopped hitting mommy.

I need to add this caveat. There are kids this age who are aggressive, even hurtful. Not just with mom and dad, but with peers, strangers, grandparents. I’d guess that in the last 10 years, I’ve seen 1 child like this for sure, maybe a couple of other, less clear cases. This aggression and oppositionality can sometimes be perceived at a very early age. It’s not normal, and it obviously is going to have an impact on this child’s life. It seems to be caused by brain chemistry, not some external influence. The child should be carefully evaluated.