Dr. Stanley Goldstein - Author and Psychologist

While it is best for a distressed child to receive mental health treatment as soon as possible this is not always done. Babies are not born with instructions and parent guilt is often a factor, they not wanting to accept their role in their child's problems. While parents don't blame themselves for a child's physical illness they often do so with their child's emotional problems. Feeling responsible, and with justification since early life experiences are the bedrock of adequate functioning. But parenting mistakes derive from their own imperfect life experiences so, after gaining treatment for their child, parental guilty feelings are undeserved and counter-productive in helping their child. And though children will readily forgive parental mistakes they never forget having been ignored.

Some child interaction guidelines, which have long been followed by both parents and teachers, derive from the popular notion that reward and punishment effect behavior. Thus if a child is punished for misbehaving they are less likely to do so in the future. A belief which sounds reasonable but is not.

As psychologists have long known, behavior modification work with dogs but not cats, with those of severely limited intellect (since it simplifies their environment) but not those of near normal and above intelligence, and for inhabitants of tightly controlled environments such as prisons. It does not work with others since humans are a thinking species.

Moreover, children are reasonable and want to develop into adults. Thus if asked to do something by their parent or teacher they usually will though being less likely to do so if they are hungry or tired or ill or troubled, or unable to do what is asked for a reason which may make sense to their immature mind but not to others.

Thus, apart from emergency situations involving harm or danger, explaining why a child should do something will usually gain their cooperation. If not it will be for one of the above reasons in which case they will be behaving like similarly afflicted adults.

A January 7, 2022 letter in The Wall Street Journal, "The Tragedy of 'Special Ed,'" insisting that these programs consign students "to a treadmill of failure," aroused my long-past memory. While doing psychological research in a Mid-West school, I sensed the similarity between a school and a factory.

Both operate on a rigid timetable where products (widgets or students) must move smoothly along the production line. With students this involves flowing without interruption from classroom to lunchroom to dismissal, with interference being removed. Thus defective widgets, or slowly moving/uncooperative students, are removed, with the latter being sent to Special Education to begin their struggle along the "treadmill of failure." The reason for this is simple: while academic failure can result from several reasons, it usually reflects psychological causation which schools, lacking sophisticated child development knowledge, are ill-equipped to remedy.

This past weekend, an article in The Wall Street Journal ("Harry Potter and the Children Whose Parents Named Them After Wizards" - The Wall Street Journal Article) jogged a personal memory.
In my grade school class were two children with my first name. Being the one with a middle name, I was long addressed as that, later hating it when a laughable TV teenage character was given this name. There were also a famed actor and a government official with this name but I didn't know it and children don't always think logically.

Years later, while walking a beach, I met a grade school friend cavorting with a bikini clad woman. He immediately jumped up, ran toward me, and warmly exclaimed my hated middle name to which I impulsively responded, "Shut up!" Don't ask me the name since I still hate it though I once told it to a young child who vowed to keep it secret.

Though scary dreams frighten and can greatly upset, "they are our friends" I tell my young patients. Stories that our mind creates to tell what is bothering us and, like the mystery movies we love, that we must try to figure out.

A scary dream could mean that we are nervous about school the next day or learning a new task like swimming. Or even of growing up and leaving home, which is a common worry as one grows older.
Explaining nightmares in this manner reassures a child and reduces their fear. And, if scary dreams don't frighten their parents, perhaps they are not to be feared at all. Once, having spoken this way to a five-year-old girl and repeating myself a month later, she dismissively said, "Oh I know that!"

Parents have varying levels of success in coping with their child's lingering medical illness. This derives from whether "poorer" or "better" interactions are used by their doctors and medical establishments. Some are vague regarded diagnosis and prognosis when communicating with parents while others describe the illness realistically but also focus on possible research breakthroughs and the parents' hopes during remissions when the child lives comfortably at home. Yet family mourning is inevitable since, until the child's diagnosis, they were considered normal and happy rather than chronically ill and suffering.

The Attention Deficit Hyperactivity Disorder (ADHD) diagnosis persists despite it possibly being the most unsophisticated notion in mental health for the past two-hundred years. In the late 1700s an English physician described the symptoms as "mental restlessness." In early 20th century America it was described as Minimal Brain Dysfunction (MBD) of which a Harvard psychiatrist remarked that any doctor who uses this diagnosis has a minimal brain dysfunction (a cute remark, I think). ADHD is merely its latest incarnation and makes no sense with more diagnoses on the East Coast than the West Coast and more boys than girls, apart from its symptoms being identical to anxiety and depression.

In both children and adults, when these symptoms are present and not related to real worry or unconscious conflict, they reflect Elements of a Borderline Psychotic Psychostructural Organization. Which does not mean Psychotic or Borderline Psychotic but rather a weakness of basic ego capacities because of faulty early developmental experience which occur during the first three years of life and affect the development of reality testing, mood regulation, sense of self, and control of behavior and thinking.

The ADHD diagnosis has persisted, I believe, for a number of reasons:
1. Large, profitable mental health and pharmaceutical industries have grown up around it.
2. Ego psychology has grown out of favor with a consequent dearth of education of clinicians on sophisticated early life ego and child development. My (long deceased but still mourned) doctoral advisor once said that to understand human behavior one must go to psychoanalytic concepts, that there is simply no where else to go, and I agree.
3. Sixty years ago most psychiatrists provided therapy but today few do, apart from those who have had psychoanalytic training and these are not many. Thus, apart from reasons 1 and 2, they prescribe drugs. Which, alas, some parents demand and doctors comply. As a mother once said to me, she would rather that her child had a brain tumor than an emotional problem since a tumor could be cut out. Most new patients don't know what therapy is and must be educated.

My experience with treating mothers has long impressed me with their strength. Despite their continuing daily tasks of tending to wandering-about youngsters, seemingly incomprehensible teenagers, difficult husbands, and an occasional sickly rabbit or other pet, they cook, clean, negotiatate with school officials, provide transportation to appointments, and cope with such intermittent crises as helping with children's homework and arranging for home repairs. All while trying, and often failing, to care for themselves.

Part of this is inevitable since, in most families, the mother is the emotional center of the family, which also makes her the major recipient of children's complaints. If a child is unhappy, it's HER fault. Is this fair? Of course not but that's how it is.

Which is not to say that the father's role is unimportant since, though the mother (or mothering figure who can be a male) is the most important figure during the first two years of a child's life, the father becomes equally important during their third year, serving to pull the child from the symbiotic relationship with their mother into the larger world and, ultimately, independent adult functioning.

While all children are sometimes irritating, occasionally they're completely impossible. I've joked with parents that the business office next to mine has a Saturday swap meet where children are exchanged.

But troublesome behavior has meaning since when a child is unhappy they don't spontaneously speak of their distress but instead act difficult. This is why Oppositional Defiant Behavior is the most common mental health diagnosis of children.

When asked to do something by their parent a child will usually comply since they want to grow up, to be an adult. Resistance thus indicates their inability to do what is asked because of illness, exhaustion, emotional upset, or an unspoken reason making sense to them but isn't logical. Then, speaking with the child is more productive than yelling, which should only be done when confronting a potentially dangerous or harmful situation. Otherwise, frequent yelling by a parent will cause warnings that a child should respect to be ignored.

While a child's birth is joyously anticipated, their parents' initial reaction is stress. This, even with a child who is generally considered easy to parent since this pain is both universal and unavoidable.

Beginning at birth, a newborn makes unceasing demands of their parents to become a more effective caretaker. Demands that are critical since a child is dependent on their parents for survival. But the adult mind is conservative and resists the rapid personality change that is needed. This clashing of demands and wills creates parental stress but, slowly, a melding of the needs of both.

An added stress is that a newborn is inserted into an ongoing (family) social system that has developed over time, and must now transform itself to incorporate this unselected newcomer.