In the history, psychiatry has been pretty harsh to mothers. Early (and mostly incorrect) thoughts about what led to’ emotional/behavioral challenges and psychiatric disorders made it simple for clinicians to blame parents for all childhood diseases. Autism is a classic example. In the 1940s Leo Kanner, one of the most influential child psychiatrists of the time, said that children with autism were kept in “refrigerators that did not defrost.” By refrigerators, he was referring to mothers, who he thought were emotionally and interpersonally distant. As most of you likely know by now, Kanner made a mistake.
Since that time, the attack on parents seems to be relentless. Our media outlets are full of misinterpretations (and sometimes correct interpretations) of research results and statements by clinicians that directly or indirectly blame parental behaviors for their kids’ issues.
You cuddle your kids too much
You don’t love them enough
You are too strict
You are too permissive
You are too emotional
You are not emotional enough
You give too much freedom
You hover over them
You don’t praise them enough
You praise them too much
The list never finishes.
The consequences of this parental blaming are devastating: parents full of either guilt and shame or anger and defensiveness, and worse, children who don’t get the treatment they actually need.
So I often find myself doing damage control with parents and explaining their new role in aiding their children in improvement. So today I wanted to share with you what I often tell parents who are either reluctant about therapy or are struggling with making decisions regarding their kids treatment.
Does your kid require help? Observe your child's academic, social, family, and emotional functioning to determine whether he needs help. If your kid’s behavioral or emotional challenges are such that his functioning at home, school, or with peers is impaired, he may need help. You may ask, what is impaired functioning? There is no standard definition, but we usually become worried when a child is unable to fulfill many of the basic tasks of being a child: going to school, getting at least Cs in his courses, developing and keeping friends, controlling his emotions, keeping himself out of trouble with the law, understanding and following basic rules, etc.
Getting help does not necessarily mean medication or years of therapy! Getting help may just involve an evaluation to find out what intervention, if any, may be good for your child. So it is often less scary if parents think that the first step is just to seek an evaluation or consultation, without any commitment to go beyond this initial consult. The process should not be any different than when taking your child to the pediatrician for an evaluation if your child is having some physical symptoms. If your child needs help, most of our current interventions are relatively short (20-30 sessions) and the times of keeping kids in never-ending years of therapy are gone (at least mostly). If you are concerned about your child’s functioning don’t accept a “he is just fine” answer from your pediatrician, especially if the pediatrician only asked you a couple of questions.
I am always reluctant to say anything negative about other professionals, but the reality is that many pediatricians have not enough training in child psychology and psychiatry and especially in the right evaluation of child psychological conditions. This is not just my perception. A comprehensive national survey of pediatricians revealed that about 70% of pediatricians feel that they lack appropriate training in diagnosing and treating mental health conditions and over 60% felt that they were not competent in proper diagnostic practices . So if you don't agree with your pediatricians opinion that your kid is just fine, request a referral for a consultation with a child mental health provider, such as a psychologist, psychiatrist, or clinical social worker. In many, many, many, situations, what led to your child’s condition does not really matter. This is likely a controversial statement, especially with some traditional therapists, but I say it because parents are often overly worried about finding out what resulted in their kids having OCD or ADHD. Often parents feel guilty and want to know if they caused the problem somehow or they are seeking answers that help them understand and accept why things turned out this way. The reality is that in most situations the “cause” will never be known. Although good clinicians will have a deep understanding of the historical and current context (family dynamics, peer group, thinking style, etc.) that may contribute to some of the difficulties, what matters right now is what we do from this day forward to help your child improve.
Remember, we can’t change the past but we can improve your child’s future. We can’t help your child without your help. There is very little we can do in one hour of weekly therapy without getting parents, and often teachers, involved in the treatment process. This is because the most effective interventions usually require that we make alterations at home and sometimes at school.
On that note: When we suggest a different parenting or discipline tactic we are not saying that what you were doing was wrong or that you led to the issue. There are many, many parenting styles that are effective for most children. In fact, some scientists even use the term “good enough parenting” to refer to the phenomenon that most children will be alright regardless of what you do as a parent. But we also have extensive research suggesting that in some cases, such as when a child has a specific disorder, some parenting behaviors are more helpful than others. In addition, the most effective treatments for some conditions require that parents implement specific discipline plans that may be very different from what comes naturally to some parents. So we may ask you to change how things functions at home, but not because we are judging your practices or skills, but because we need you to help us implement a treatment that may involve doing things differently. It is really not any different than if your child had a food allergy and the pediatrician recommended that you change your cooking. You were not doing it wrong. You did not cause the problem. But you can help your child by making the changes that need to be made.
In sum, I want parents to know that clinicians want first and foremost to help your child, not to find someone to blame for your child’s issues. We ask you to be involved because that is the most effective way to help your kid improve. We need you to be our allies because without your help and support there is often little we can do.