Many parents come into my office already having a diagnosis for their child firmly planted in their heads. "My son has ADHD" is a refrain I hear all too frequently. Equally often, I hear a mother say: "I was reading an article in a magazine on childhood depression, and my daughter has all the signs. I think she's clinically depressed."
In our society, diagnosing mental disorders in children has become an acceptable, even fashionable, way of categorizing sad or angry or inattentive kids. If we pause for a moment and ask ourselves why parents so readily embrace these diagnoses for their youngsters, one answer immediately jumps to mind. A diagnosis of mental illness shifts responsibility for a child's troubling behavior away from parents. Parents cannot be blamed for their child's ADHD or clinical depression or oppositional defiant disorder any more than they can be blamed for their child's diabetes or asthma or any other medical condition. Biological psychiatry has banished all trace of Freudian parent-blaming.
Because we are a pill-taking society, it is socially acceptable to give a child a pill to ease her suffering: a pill for school problems, a pill for sadness or moodiness, even a pill for temper tantrums. In an effort not to blame parents, we see these difficulties as problems inside our children's biological make-ups, rather than the result of the child's social environment. It's nature at fault, not nurture. It's the wiring of the kid's brain gone askew or a "chemical imbalance" (although the exact chemicals involved in these maladies still remain a mystery). Even a child as young as three years old can be diagnosed with a serious mental illness.
This biological point of view, so prominent in the past three decades, now seems to be at odds with the latest advances in neuroscience; for neuroscientists are telling us that we must look to nurture as well as nature to understand a child's difficulties. The wiring of a child's brain, neuroscientists argue, is structured in large part by the child's nurturing environment. If a child's family environment is disrespectful or stressful, this factor actually impacts the neural wiring of the child's brain. In a fascinating article in the January 5, 2011 issue of the Huffington Post, neuroscientist Dr. Douglas Fields tells us that environmental stress is actually a "neurotoxin", especially during the development of the brain of a child. Our brains, argues Fields, are not fully formed at birth, but are actually products of "the environment in which we are nurtured during the first two decades of life." And research shows that harsh words in the parenting environment are as toxic to the brain of a child as harsh blows. If I understand Fields correctly, this means that the child's social environment can create a biological condition in the child's brain. Although the child's problem did not begin as biological, it can become biological.
But just as a stressful, toxic environment can etch the eminently plastic and shapeable brain of the child, so a positive change in the parenting environment can create healthy changes in the child. If parents change their behavior to become more respectful, their child's brain can change accordingly. This does not mean that we need to go back to blaming parents. It only means that we must educate and instruct parents as to how to create the nurturing environment that will produce a healthy brain in their child.
All of this neuroscience becomes especially relevant to the family therapist, who must strike a delicate balance between changing a stressful family situation without placing blame on parents. In practice, this is not as difficult as it sounds. Every family therapist is aware that in order to help a child, the therapist must have a good relationship with the parents, while at the same time changing parental behaviors that are toxic and cause the child to feel unhappy or misbehave.
A few weeks ago, I met for the first time with a twelve-year-old boy named Howie (not his real name) and his parents Belinda and Victor. Howie had been refusing to go to school for several months. He was recently diagnosed with ADHD--which has become a catch-all diagnosis for any kind of school problem--and was taking stimulant medication. After two months, the medication still was not helping. Howie still refused to go to school. A half hour conversation with Howie's parents revealed a significant problem in his family environment: Howie and his father had come to blows one day, after Howie refused to do his homework. In daily power struggles, Victor often yelled at Howie to get him to do his chores around the house or do his homework. The parents also argued about how to discipline Howie. These stressors in Howie's environment seemed to be a much more significant factor in his refusal to go to school than any purported biological condition. Healing the relationship with his father, I believed, would help Howie more than any bottle of pills.
Without heaping blame or shame on Victor, who already felt terrible about hitting and yelling at his son, I suggested some strategies to heal the relationship. I earnestly told Victor that every parent "loses it" occasionally, and the important thing was to apologize to Howie. Victor apologized right there in the session. In a session with the parents alone later in the week, I asked Victor to tell Howie two good things about himself every day, and to take Howie out for an enjoyable activity on the weekend. Victor readily agreed to this. I also told Belinda and Victor that together we could figure out an agreement about discipline that would work for both of them. After meeting with the parents for three sessions and having them make changes at home, Howie began going to school.
If children's brains are continuously developing in response to the parenting environment, labeling a child with a purportedly biological "mental disorder" and giving him pills doesn't make any sense. When the child's social environment changes to become more respectful and thus less toxic to his brain, the child's mental structure will change accordingly. The recent theories of brain plasticity mean that damage from the nurturing environment--as long as it has not been severe and chronic-can be reversed with the help of the correct family interventions. Family therapists have known this for years. Now neuroscientists are providing us with a scientific underpinning for just how this occurs.