Welcome to Childhood Made Crazy, an interview series that takes a critical look at the current “mental disorders of childhood” model. This series is comprised of interviews with practitioners, parents, and other children’s advocates as well as pieces that investigate fundamental questions in the mental health field. Visit the following page to learn more about the series, to see which interviews are coming, and to learn about the topics under discussion: ericmaisel.com/interview-series/
Claudia Gold is a pediatrician and writer with a long-standing interest in addressing children’s mental health needs in a preventive model. She currently specializes in early childhood mental health. She is on the faculty of William James College, the Berkshire Psychoanalytic Institute, and the Austen Riggs Center. She is the author of Keeping Your Child in Mind: Overcoming Defiance, Tantrums and Other Everyday Behavior Problems by Seeing the World through Your Child’s Eyes (2011) and the forthcoming The Silenced Child: From Labels, Medication and Quick-Fix Solutions to Listening, Growth and Lifelong Resilience (May 2016).
EM: How would you suggest a parent think about being told that his or her child meets the criteria for a mental disorder or a mental illness diagnosis?
CG: It may be necessary in our current education and health care systems to name a child’s distress as a disorder in order to “get services” in the form of coverage by health insurance and support in the school system. I encourage parents to approach an evaluation of emotional distress and worrisome behavior in their child with courage and caution.
By courage I mean trusting that they know their child best. Even when a child is given a diagnosis it is important to recognize the complexity and uncertainty underlying the causes of emotional distress that are not reflected in the current DSM system used to name disorders.
By caution I mean not simply embracing these diagnoses as the whole story, but rather taking time to explore options and come to a full understanding of the situation. Mainstream mental health care tends to reify these disorders, when contemporary research in developmental psychology, genetics and neuroscience indicates that the conceptual framework offered by the DSM is outliving its usefulness.
Parents should be especially cautious accepting a diagnosis from a clinician who does not see both parents alone without the child at least once and who does not take a thorough developmental history. Both can be critical in understanding the current problem and deciding on an appropriate treatment plan.
When parents have an approach of caution, the word “denial” is often thrown about. Carefulness and caution are called for in our current system that may not protect the time necessary to fully understand the situation. I suggest parents use these more positive words to balance the negative language they may encounter as they take time to fully make sense of their child’s problems and find appropriate treatment.
EM: How would you suggest a parent think about being told that his or her child ought to go on one or more than one psychiatric medication for his or her diagnosed mental disorder or mental illness?
CG: Psychiatric medications can be a quick, and at least in the short term, effective way to control problems of regulation of attention, emotion and behavior.
Alternative ways of supporting self-regulation should always be explored and implemented even if psychopharmacology is the main treatment being offered. These interventions can be tailored to the child’s particular temperament and sensory profile. Some examples include meditation, parent-child martial arts, drumming and other forms of music, swimming or any other activities that a child finds calming and regulating. For parents, finding ways to feel calm in their own body can be a critical aspect of supporting a child who is struggling with behavioral and emotional regulation.
EM: What if a parent currently has a child in treatment for a mental disorder? How should he or she monitor the treatment regimen and/or communicate with mental health professionals involved?
CG: Parents must be careful to have a full assessment of the situation when there is a worsening of symptoms and/or a decline in school performance. Often clinicians will simply adjust the dose of medication without taking time to understand the developmental context and other factors that may be impacting on the child’s functioning.
For example when a child enters adolescence, oppositional behavior may be a typical manifestation of that developmental stage. Limits must be set and disruptive behaviors addressed. However, attributing the behavior to a worsening of ADHD symptoms with a subsequent adjustment of medication dose may help control behavior in the short term but possibly cause harm by interfering with the family’s successful navigation of this phase if the meaning of the behavior in developmental context is not addressed.
Or stress in the home and/or in school may lead to worsening of symptoms that doctors address only with an adjustment of medication. While a child may have a genetic predisposition to problems of emotional regulation, we now know that the environment can affect the expression of those genes. So taking time to address environmental stressors, while it can be difficult and take more time, offers a more long-term and long lasting solution.
EM: In what ways might a parent help his or her child who is experiencing emotional difficulties in addition to, or different from, seeking traditional psychotherapy and/or psychopharmacology?
CG: Having courage in the face of a child’s distress is not easy. Parents may feel tempted to relinquish their natural authority in the face of “expert” opinion. An approach of courage and caution calls for a kind of holding environment of support for parents as they go through the process. Trusted friends and/or family members may offer this kind of support. Therapy for individual parents and/or a couple may be useful.
This approach of supporting parents does not mean that a child’s behavior is the parents’ “fault.” Rather it acknowledges the stress of caring for a child who is struggling, and the need for parents themselves to be cared for and understood in order to be most available to help their child. (Also see question 2.)
EM: You’ve written The Silenced Child: From Labels, Medications, and Quick-Fix Solutions to Listening, Growth, and Lifelong Resilience. What might parents get from that book that might help them?
CG: The first two sections of my book put our current system of mental health care in social and cultural context, and present the explosion of new science that supports careful listening over a rush to label and medicate. My aim is to share this knowledge and perspective with both parents and professionals.
The most concrete help for parents from this book comes in the final section entitled “Ways of Listening.” First I discuss in depth ways of listening to the body that can support emotional regulation. Next I address the role of loss and trauma in emotional distress. I demonstrate the value of taking time to listen to the full story including early development and family history. I show how when parents have the opportunity to mourn loss that has been unacknowledged and unaddressed, there is often significant improvement in a child’s behavior. And last I explore in depth the role of courage and the value of tolerating uncertainty while taking time to let development unfold.