April 22, 2016

We all want the best for our children, in health, happiness, family life, friendships, work satisfaction, prosperity, financial security and many other variables that impact their sense of well being. I think of the combination of all these factors as the desire that each of us has for our children to be able to be their best selves.\r\n \r\nFor so many children, behavioral illness blocks the path toward achieving their full potential, and imposes problems that complicate their lives. Think of the child with ADHD who is unable to pay attention well enough to learn in school, or the anxious child who is too much on edge to be able to tolerate even small transitions, or the depressed adolescent who feels too badly to maintain basic routines. We all know children and teenagers with problems not unlike these.\r\n \r\nOur health systems do a reasonable job at providing care for children with most chronic illnesses, allowing children with asthma to breathe comfortably and children with diabetes to control their blood sugar, for example. Too many children with behavioral illnesses do not receive effective care, or even any care, much more often than we should tolerate. The reasons are complex, relating to the ways our doctors are trained, the ways they are paid, and basic societal concepts about what is health and what is illness.\r\n \r\nMy goal is to help close the gap, to help make it more routine for the quality and availability of care of behavioral illness to be on par with the care of other medical problems, and in doing so to help more of our children have the chance to be their best selves.\r\n



May 17, 2016

So many times I hear a young child who is having trouble learning in elementary school described as lazy. I also hear the words stubborn, or difficult, used to describe young children with certain behavior problems. Whenever a parent uses these or similar words to describe their children, either based on their own observations or what they have been told by teachers, it prompts me to start a conversation about how to interpret children's behavior in light of what is developmentally appropriate for children of elementary school age.\r\n\r\nChildren in this age group are wired to want to please to adults in their lives, so if they are not doing so, our first thought should be that they can't, not that they won't. If we approach the problem with the premise that, for example, our third grader does not seem like she is trying to learn to read because she cannot pay attention well enough, or cannot grasp the basic skills, we are more likely to offer help rather than express disappointment. Similarly, if we understand that our kindergartener's tantrums in transition are due to anxiety, we are more likely to go out of our way to help prepare him for upcoming change rather than punish him when the difficult behavior surfaces.\r\n\r\nIn contrast, adolescent development creates behaviors that increase their sense of autonomy, often by creating distance from their parents and other adults, but that is its own topic for another day. When young children's behavior is consistently a problem we need to look for a possible underlying disorder as opposed to dealing with the behavior at face value. In doing so we will help these children be their best selves.\r\n