среда, 4 июня 2008 г.

Living with children

One of the consequences of postponing toilet training until well past the second birthday (per the bad advice of most post-1960s parenting "experts") is a well-documented problem known as "stool refusal" _ children three and older who will use the toilet for urinating but stubbornly refuse to use it for a bowel movement. Fifty years ago, when most children were expected (and expected they were!) to use the toilet successfully before they turned 2, this problem was rare; today, it is almost commonplace. As one might imagine, it is one of the most frustrating of all parenting problems.

And so it recently was for the parents of a 3-{-year-old stool refusing boy. The parents had talked and rewarded and punished and talked some more, all to no avail. In the meantime, they were beginning to suffer self-induced baldness. Several Web-based experts weighed in, saying that stool refusal almost certainly indicates deep-seated psychological issues, implying that the road to solution would be long and longer still.

Over the past several years, a colleague and I have developed a program that has been very successful at persuading these kids that it is in their best interests to _ using contemporary vernacular _ "give it up" for the potty. This child was the perfect candidate. I recommended that immediately after breakfast on the morning of P-Day, the parents take this recalcitrant child to the bathroom, remove his clothes, and say, "We spoke to your doctor, and he said you have to stay in the bathroom, without any clothes on, until you have a poopy. When you have a poopy, call us to see, and then you can put on your clothes and play. Call us!" I told the parents to keep it short and simple and then cheerfully turn and walk away. If their son refused to stay in the bathroom, they were to gate him in, again explaining that such were the doctor's orders. When he produced a bowel movement, they were not to make a big fuss or reward him, but simply acknowledge his success in a low-key manner.

To the parents' amazement, their son had a bowel movement after five minutes in the bathroom on B-Day. They asked, "Now what?" to which I told them to stay the course. He took three minutes on day two. His mother wrote: "No crying, screaming, nothing. My husband and I have battled this issue for many months now, cried, and lost sleep over it. I'm sitting here absolutely astounded at how simple it has been. Unless told otherwise, we'll continue to use this method until we see him initiate the trip to the bathroom himself."

One week later, she gave me a second update: "As we bring tonight to a close, it marks a full week since we put into action your plan. We have had ZERO accidents this week. ... He is going to the potty on his own. He has been an absolute joy to be around since not having to fight the potty battle."

There was no trick to this at all. The solution involved nothing more than clearly stated expectations and a clearly defined boundary. In short, the parents stopped wishing (in the form of pleading, explaining, rewarding, and exploding) their son would poop in the potty and told him he was going to.

Conjuring the doctor's authority simply reduced any possibility of rebellion. Before closing this column, I would be remiss not to note that on occasion, stool refusal is actually constipation or the result of some other physical problem. Before coming to me for advice, the parents checked this possibility out with a physician. Any parent thinking of trying this should first do the same.

Responsible parenting key to safe campuses

The report states that at best school safety and security in America's schools in inconsistent, and they place much of the blame on " emotionally immature parenting."

These parents are detached from their children academically and developmentally, the report states.

"Early discipline failures are a primary casual factor in the development of conduct problems. Harsh discipline, low supervision, lack of parental involvement all add to the development of aggressive children," researchers stated.

Local educators agree, saying that irresponsible parenting is a common thread they find within the majority of their problem students.

"Many parents have simply stopped parenting. Their maturity level is about the same as their teens. Another problem comes from single parents who suffer from guilt," Hanson said.

By defending poor behavior and not being responsible parents, they are doing their children a disservice, Hanson said.

"Nine times out of 10 when there's a child with a major discipline issue, I have the parents coming to tell me it's the school's fault," said teacher Kelly Hanson. "They accept no responsibility and their children are the ones that give us the most problems."

She said the problems don't go away and oftentimes escalate.

Six out of 10 parents exhibit the immature behavior patterns, according to the report. And only 38 percent of parents admitted to teaching their children critical life skills and morality.

There are other factors as well.

Dr. John Buckley, superintendent of Lucerne Valley Unified School District, said he has seen first hand the behavior issues caused by students who don't read well, if at all.

He said that 99.99 percent of the children were illiterate in a Utah youth detention facility he oversaw.

Because of this they had low self-esteem. They were teased so much ... those kids get very angry. And they tend to come from homes where education is not valued," he said.

He also said kids that are different are easy marks for being teased.

"Kids that are different from other kids, they have disabilities, they're overweight and so on, they can only take so much abuse and they break," Buckley said. "That's not about the home so much as kids are just unmerciful."

About my daughter

My daughter, 10, has always had a very strong will and she can be very argumentative. I am concerned that she is not finding it easy to cope with not getting her way and that with puberty looming this might become more problematic.

So I took her to see a psychiatrist who diagnosed oppositional defiance disorder (ODD), which we then looked up on the internet. Most of the criteria seem to apply, but it sounds like a new term to describe children who are rebellious and stubborn, and to give parents a label for children who pose more than the usual parenting problems. The doctor also said that she indicated autistic traits, while not having classic autistic syndrome. My child became very upset with him, and said that she was no different from her friends, who also argue with their parents. When we left she told me that she was normal and it was the doctor who wasn't normal. I reassured her that we were only concerned to help her to find ways of accepting things that don't go according to her wishes. The doctor said that while he realised that medication would not be our first choice he felt it would be helpful to her. He talked about other options, namely CBT, play therapy and group therapy. All this upset my daughter, but I reminded her that her sister had had art therapy to help her through a difficult period and how helpful it had been. I cannot deny that my daughter's behaviour does give me cause for concern, and there are times I have been frustrated with it. But part of me thinks I am making a mountain out of a molehill. I don't want a diagnosis to become a self-fulfilling prophecy.


ODD is usually diagnosed in childhood or adolescence. The diagnostic criteria for ODD in a young person are the following, but need to occur more often than is typically observed in individuals of comparable age and development: losing temper; arguing with adults; actively defying or refusing to comply with adult requests; deliberately annoying people; blaming others for their mistakes or misbehaviour; easily annoyed by others; angry and resentful; spiteful or vindictive. Four or more of these problems must be present with a "clinically significant impairment in social, academic or occupational functioning".

For many, having "symptoms", or behaviour, similar to ODD, is a transient state during puberty and adolescence. So, should we rush our children to a psychiatric clinic in case there are any other psychiatric diagnoses? Certainly some would also be described as having "autistic traits" -being withdrawn, finding difficulty in being close to others, wanting to be alone and so on.

Because psychiatry is underpinned by a medical model, psychiatrists use diagnostic criteria when dealing with mental ill health in the same way that a GP would for someone who is physically ill -thus leading to the notion of prescribing medication within the medical "diagnose-treat-cure" model. However, with mental health there is huge evidence that such a model can be limited and limiting: at times, neither adequately describes a person's difficulties nor treats them successfully. A psychiatric diagnosis of a condition can be dehumanising -your child now has ODD plus autistic traits, which tells us nothing about her, how she is experiencing her world and how you, as her family, experience and react to her.

These are the most essential considerations for successful assessment and treatment. In this case, a diagnosis places responsibility for the difficulties with the person experiencing them, with no idea of sharing understanding and responsibility for the problems. I agree with your disquiet at the diagnosis and your daughter's rejection of how she is hearing herself being described.

Your daughter is 10 and already could have a psychiatric evaluation. This makes me angry. It reminds me of parents who wave the latest newspaper article in my (and colleagues') faces telling us, for example, that their child has ADHD and could it please be diagnosed. When it is suggested that the child may be responding to family atmosphere, the parents behave erratically, some moving on until they get the diagnosis they want. It negates their need to take responsibility for their child's difficulties. And when I say "take responsibility" I do not mean "be blamed for". I mean enter into an honest dialogue that looks at the problems.

I am not criticising psychiatrists -many of my most valued colleagues practice within the profession. But we live in a world that is sanitised in a way that places the value of a label over the more ragged process of understanding the individual. A diagnostic label may provide a psychiatric shorthand for your child's difficulties, and may also allow a neater (though not necessarily more successful) treatment, but I agree with your concerns about it becoming a self-fulfilling prophecy

A friend of mine

A friend of mine was concerned about an aspect of his little girl's behaviour, so he asked his health visitor: "Should I be worried?" To which she replied: "Do you think you should be worried?"

Hopefully, the latest NHS pilot scheme in Fife will be a bit more forthcoming with solutions to parenting problems. The Community Mums service provides trained, experienced, volunteer mums to visit shell-shocked new mothers, chat to them and give them whatever friendly advice they need on issues from breastfeeding to healthy eating and general parenting problems.

Schemes such as this are particularly valuable to people like me, who had a baby without a traditional support network or, indeed, any previous experience of the creatures. It's important to have access to someone who's been there, done that and got the stains on their T-shirt. I've always been very open to advice because I've felt I don't know much, but after nearly two and a half years of hands-on kid-wrangling, I'm wondering whether I could be a volunteer expert mother.

Well, I had no problems breastfeeding, so I could talk about that (tickle its nose with your nipple -the baby, I mean -and its mouth will open wide so you can pop the breast in and away you go). Sleep whenever you can, even if you haven't vacuumed the house since the second trimester. If you mix baby rice into yoghurt, it makes mousse. Oh, and when the going gets really tough, this mantra helps: "Less than two decades to go ... less than two decades to go."

Do we really need that?

Public service announcements admonish us to eat dinner with our families, to remember that it takes a real man to be a dad, that losing weight makes you feel better about yourself.

We do not need commercials to tell us that eating dinner with your kids and talking to them is better than parking them in front of the television with a plate of microwaved chicken nuggets while you sit in front of the computer. That kind of parenting problem won't be solved with a 30-second TV spot.

The cable channel Nickelodeon sponsors what it calls the Worldwide Day of Play. It's a day where kids are told to turn off the television and go -- shockingly -- play and use their imaginations. What a concept.

The sad thing is, if these issues weren't problems, we probably wouldn't be seeing these kind of announcements. And maybe these kind of public education campaigns reach people and help them. But they do beg the question.

So, because we've evidently lost the collective ability to function as thinking people, we are being encouraged by singing and dancing medical personnel to ask our doctors questions to help prevent medical mistakes; we're being told cyberbullying is bad, we're reminded to put kids in safe car booster seats.

What's next, public service announcements reminding us to take out the trash?

So in the spirit of what should be decisions requiring common sense instead of an ad campaign, we're offering a few of our own public service announcement suggestions.

--Wear underpants. The reason? Two words: Britney Spears.

Turn on the television and you can't avoid seeing coverage -- sorry, we mean footage -- of the sad pop princess flashing the world. It's unfortunate all the way around. And if you just can't bring yourself to don skivvies, do the rest of us a favor and wear pants. Please.

--Floss. There may be an official service announcement out there about this somewhere, but take a minute and remember that you need your teeth, just like they need you.

--Take the sun shield out of the front car windshield before you start driving.

--Hang up the phone when you're driving, biking or walking. This applies to talking, text messaging or listening to music. Take a lesson from a California man who was killed in November after stepping in front of an oncoming Amtrak train. He evidently didn't notice the train because he was so absorbed in his cell phone conversation.

--Talk to the live person in front of you. This includes dates, children, parents, friends.

We've noticed a plethora of people sitting or walking together who are all on the phone to someone else more interesting. We've also seen what looks to be two people on a date in restaurants, except one person is on the phone nattering to someone else while the other party is left fiddling with the bread basket. Good times.

--Don't eat food past the expiration date.

The list could go on.

We would like to think that we're a society of people smart enough to figure these things out. But we're waiting for the public service announcement to tell us if we're right.