Is Ritalin the solution?

Millions of parents have had the experience of their child’s teacher saying that he ‘has ADHD’ and the pediatrician should prescribe a stimulant like Ritalin or Adderall to address the problem. Sometimes parents feel they are seen as falling down on the job if they don’t do this right away.

It’s very hard to have someone describe your child negatively, and even worse to worry whether your child’s struggles are your fault. Over the past 30 years ADHD seems to have become an epidemic in our society, with 1 in 10 of all ten-year-old boys being medicated for these symptoms. Teachers are often at the forefront of dealing with classroom difficulties, so it’s not surprising that they sometimes turn with relief to the idea that a pill can change a child’s school behavior.

The complication is that medications like Ritalin, Adderall and other stimulants can change everyone’s behavior. They increase concentration and ability to focus for anyone who takes them, at any age, whether they show ‘ADHD symptoms’ or not.

So it’s a big challenge to assess what’s right for your child, when you know he is a whole complex person, with all sorts of strengths, as well as the vulnerable areas he is still grappling with. Any child is a work in progress and we don’t expect their behavior always to proceed smoothly. But it’s unlikely that one solution can fix multiple issues or be the best for every child.

In addition, sophisticated research is increasingly showing that these drugs may not do all that parents and teachers hope they will, and there are serious potential long-term disadvantages. Last week an eminent developmental researcher, L. Alan Sroufe, wrote in the NY Times about his growing doubts about the impact and usefulness of drugs to address these problems. You can read his article at

Unfortunately he didn’t go on to address the important next step. If your child is struggling, you want to do everything you can to help him. If the drugs don’t really work over time or are bad for children long-term, what can a parent do? This is the sentiment expressed on many parenting sites since Dr. Sroufe’s article. You can see one example at

Most of us make parenting decisions based on what we think is the top priority. Sometimes that’s an immediate crisis, in which case we reach for a short-term solution. You know then that you will have to deal both with the current fallout and eventually find longer-term answers. Since medication does have an effect right away, it might tide you and your child over the current upset and concern, with the idea that it’s temporary.

In the meantime you would work with his teacher, the school psychologist, and maybe other professionals to create a team to support lasting growth in his capacity for self-control, concentration, persistence and managing his feelings – some of the emotional muscles parents and children work on together throughout development.

One problem with the short-term medication idea is the impact it can have on your child’s self-image. Many doctors, with good intentions, explain to children that their brain chemistry isn’t working right and the pills will correct it. First, that isn’t true – there is no research evidence to support that idea. Second, children are sensitive to the idea that there is something wrong with them; their self-image and self-esteem start to include the idea of being defective in some mysterious way. Thirdly, kids then feel discouraged from taking responsibility – why try to change if it’s hopeless?

But it isn’t hopeless. With effort, love and goodwill, parents can be strong enough to make the demand that their child learn to regulate himself better. Together you can devise coping mechanisms that spring from his own personality and makeup. Building on his strengths not only equips him with the emotional muscles he needs for life: it gives him a powerful message of your love and respect.

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Fighting back against fears

Everybody gets worried sometimes. All our lives there are things that scare us. Psychoanalysts and psychologists, as well as neurobiologists, describe a normal sequence of threats to our good feelings about ourselves in the world.

Infants worry about abandonment, aloneness, and separation from the people they need to keep them safe. Toddlers worry that their feelings will overwhelm them and blast the universe. Kids fear that their parents won’t love them any more if they are naughty. Teens dread humiliation from their peers. Adults worry about security of relationships and practical life. Seniors worry about death. Everyone worries about their bodies being intact and free from debilitating or painful illness. Underlying all these worries that unfold through the life cycle is a profound fear of helplessness.

What can we do to feel sturdier? How can we fight back against the inevitable fears so that we can live our lives with more confidence and joy? How well are we doing at that task?

It doesn’t look like we are succeeding very well. There were 46 million prescriptions for Xanax in the United States last year, according to an article in the New York Times the other day. That works out to 1 in every 7 people, including children! Xanax is a strong (and addictive) anti-anxiety drug. Apparently our society’s current response to life’s difficult challenges is to sedate ourselves.

We will never eradicate worries and we shouldn’t be trying to. Emotions, including anxiety, are crucial signals -- they alert us that something is going on that merits our attention. A good feeling signals us “This is nice, I like it, how can I make this continue or happen again?” Anger tells us “I don’t like this. What can I do to change it?” Worry or fear tells us “This feels dangerous. What do I need to do to feel safe?”

The trouble arises when feelings swamp us. That is actually the definition of “trauma,” when something is so intense that it overwhelms our internal capacity to cope. Often people describe trauma in terms of outside events like natural disasters, violence or misfortune, but it is inner helplessness that is the actual trauma. The scale of the feelings and the vulnerability of our responses make something traumatic. An anxiety attack or a temper tantrum can leave a person of any age shaken and afraid.

Anybody can be overwhelmed by a massive experience that truly renders us helpless. All too often, though, it’s not the outside scale that does it – it’s the inner meaning of the experience that gets to us. For instance, most 4-year-olds have quite a lot of worries, especially at night. They may be afraid of the dark, or monsters, or robbers. Some kids are anxious about wolves, or cows, or clowns. Each child seems to choose her own.

Let's look at 4-year-olds as an example. 4-year-olds are dealing with a lot of strong feelings in their lives. They are working to get a handle on their wishes and emotions. Their beginning conscience development tells them that their angry wishes in particular are not good. It’s uncomfortable to want to hit your brother or push your daddy away from your mommy, so you can have her all to yourself, when you know you’ll get a bad feeling about it. One solution that most little kids try is to dump the feelings outside, hooking them on something, like robbers. But then they boomerang right back! Instead of the danger coming from inside, it feels like it’s coming from outside.

We can handle physical illness or danger better if we are physically fit. The same holds true of psychological threats. Building strong emotional muscles equips us to face psychological challenges. Just as we begin to build our bodily strength from birth on, by kicking, stretching, crawling, running, playing, dancing, exercise, and good nutrition and sleep, parents can help babies, children and teens build emotional strength by exercising their own emotional muscles and teaching their children to do the same.

Grownups can be more understanding of fears in children while simultaneously gently helping kids take the feelings back inside and take responsibility for their own wishes. After all, feelings and wishes are just that – they don’t make anything happen. It’s part of the important emotional muscle of distinguishing between thought and action that children build throughout their development.

And if the main grownups in children’s lives, their parents, teachers, grandparents, find that the fears are too big and won’t go away, a consultation with a professional, like a child psychoanalyst, can help in finding a growth-promoting solution to the problem. Rather than sedate troubles away, adults can offer children strength, emotional muscles that they can use for the rest of their lives to master anxiety and fight back against fears.

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For the sake of the children

How often have we heard people explain big life decisions by saying that they are “doing it for the children?” Parents do large and small things every day for their children; in a sense that is what parenthood is about. When we can think and feel beyond ourselves it is one of the signs of psychological readiness to be a parent, whether we have actual children or not.

But good reasons can also be turned into rationalizations. Parents may face terrible dilemmas, where they don’t know what will be best for themselves and their kids. Here’s a link to a poignant article about a situation that may in itself be unusual, but illustrates the challenge of deciding what to do and why.

Jane Isay’s story points us to thinking through how to differentiate parents’ constructive altruism from destructive family secrets. Family secrets are usually toxic. Children pick up the vibes – they are good observers and they have amazing emotional sensitivity to blank spots, silences, and avoidance. They fill the vacuum with imagined possibilities that are usually worse than any truth. Then they shape themselves to fit that constructed reality. Our clinical practices abound with people who have to painstakingly reconstruct an accurate family history to counteract the lies they were brought up with.

Every family has hard things in their history; scandals, failures and betrayals are part of life. But grownups with strong emotional muscles know that reality is always better than living in an artificial world. Those are the parents who find a way to share hard things with their children, confident that they will be able to find ways to help them understand and master the feelings surrounding the issue.

Explaining the world, in its wonderful and more difficult aspects, respecting your children’s capacity to master and integrate truth, is the way to truly do something for the sake of the children.

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Why hugging matters

We all crave hugs, at moments of celebration and moments of distress. Do we know why they matter so much and make us feel so comforted, safe and refueled? Recent research describes the roots of our dependence on hugs in terms of early attachment behaviors between babies and their mothers and fathers.

Babies who are securely attached are babies whose parents have been able to be available consistently enough to give their babies confidence that they will be there when needed. One of the ways that message gets transmitted is through hugs that come at the needed moment, and last long enough to allow the baby to relax safely into a happy, satisfied state of contentment.

We have talked about the importance of the emotional muscle of holding on to positive feelings, even in the face of difficulties or stress. Given that our brains reproduce the original feelings when we summon up a memory, it’s important to reinforce the good feelings from good memories. Whether it’s a caregiver handing over to a parent at the end of the day, or the caretaking parent greeting a partner, the first thing to talk about is the funny, or good, or pleasurable incidents during the day. Only then it is useful to you both to move on to the not-so-easy moments.

But perhaps the very first thing to do is not to talk at all, but greet your partner with a full hug that lasts until you feel each other relax. Here’s a link to a video that describes that process as part of what can make a couple’s partnership stronger.

Building parental emotional muscle is a crucial foundation for helping your child grow emotionally strong and resilient. When you know how to seek and give comfort and support, you will be able to teach your child important lessons for life. All too often children get the message that they are not supposed to have feelings, or be needy, or want comfort.

In fact people grow strong from knowing what they need and seeking it out. Emotional refueling gives us all the resources to offer empathy and help to others. Teaching your child that he or she can turn to you in need and then offer support freely to friends and family will foster a personality that others will appreciate throughout life.

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Deciding on more kids

Dear Readers,
Here's a letter I recently received from a mom wondering about having more kids - See what you think!

Dear Kerry,
My hubby and I are contemplating staying with just two children rather than going for a third. We have the finances and space for 3. What are the general differences (if one can speculate) in family dynamics for the children… having one sibling or two? And further division of parental time? (Dad works 60 hours/week, Mom works about
15 hrs/week). Thanks, KM, Ohio

Dear KM,
It’s nice that you and your husband have options to consider. It would be great to hear from readers what their experiences have been growing up in different-sized families, and also what has gone into thinking through their own family structure.

Here’s the deceptively simple question: Do you WANT another child? It’s hard to tell from your letter whether you are trying to be logical, to justify a strong wish to have a third child. Or if you are reluctant, but feel you should have another since you can afford it and are available for caretaking.

A wish for a child is never a simple thing. It is bound up in deep biological imperatives to ensure the continuation of the species; our earliest ideas of being a woman or a man can be formed around having a baby, since it’s grownups who have children. Whether we actually have children or not, the adult phase of parenthood, where we care for and nurture someone or something beyond ourselves, is a central part of the personal development that continues throughout life. The majority of people enter and consolidate that phase of their adult development by bearing or rearing children.

We’ve all seen the financial projections that calculate the cost of raising a child, so we know that it’s a considerable burden to take on. And everyone knows that parenting is hard work that leaves parents vulnerable to worry and disappointment. Parents who have external struggles to find enough food for their families, or internal obstacles to safe and satisfying experiences, perhaps through their own hard life histories of deprivation or abuse, may have a difficult time enjoying the role.

Yet these issues are usually trumped by the enormous, irrational, satisfying experience of loving babies and children. Loving someone else expands the self. Even when attention is more divided with each additional child, love grows to fill the additional need. It’s sad when people think that love is like a pizza, with only so many slices to go around. Instead, the more you love, the more you have to give.

Whether you have another biological child or not, or think about adopting a needy child whose parents did not have enough options, there are always logical arguments for and against most decisions. When you are thinking about something important, don’t forget to include your feelings in the process of choosing your course of action.

I wish you well as your family develops!

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When parents feel helpless

Every parent is challenged by moments of helplessness. Babies and toddlers growing up constantly present us with new situations that we don’t yet know how to handle. We all recognize that overwhelmed feeling, when nothing you do seems to work. And it feels embarrassing to be unable to control someone who only weighs 25 pounds!

Since there is no way to avoid those moments, the issue is how to respond. How can you equip yourself to feel capable at moments of stress, to be able to reach for comfortable techniques in the heat of the moment?

One tool is to understand where your little one is coming from. With a toddler, his drive to explore is much stronger than his beginning sense of what is safe and right or dangerous and wrong. Curiosity is a good thing to nurture for his whole life, so it’s important to make his environment as safe for that as you can. Putting plasticware and light pots in a bottom kitchen cupboard, for instance, so he can safely open and close the door himself, pull them out, nest them, bang on them with a wooden spoon, put them all back in (probably over and over) – this gives him an acceptable way to learn about his world. If you secure the other cupboard doors with childproof latches, then you won’t have to say no all the time; you’ll be less likely to get into control battles.

Helplessness is one of our most basic fears and most of us are geared to respond to that awful feeling with a deep danger reaction of ‘fight or flight.’ Part of what makes parenting so hard is that we can’t just run away from our babies to regroup, since our impulse to keep them safe and love them is also so strong. They need us to stay there and take care of them.

And we can’t fight someone so little and defenseless. Except that is just what many parents find themselves doing, because they don’t have alternatives available. Hundreds of studies document that physical punishment in childhood is associated with later verbal and physical aggression; delinquent, antisocial, and criminal behavior; poorer quality of parent-child relationships; impaired mental health; and later abuse of one’s own spouse and children. Despite all the evidence of bad effects, some people elevate spanking, paddling, and whipping into a child-rearing method, for instance the report in the Nov. 6 issue of the New York Times of a systematic program of beating babies, toddlers and children with plastic pipes, belts, straps and willow switches, sanctioned by a so-called religious authority.

An alternative option is to develop your own emotional muscles to find the positive of curiosity when he “gets into everything;” remembering that you share his goal of being in charge of himself long-term so that you can support his learning how the world works; setting limits that mesh with his real capacities; putting words to feelings and actions to enlist the power of language to help you both; seeking help and support from a spouse, friend or professional. Along the way you will be helping him develop his own emotional muscles of a sense of agency and self-control as he learns what he can and can’t do.

Together you will both get a lot of fun out of finding new ways to play and be with each other. Enjoy these precious years!

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Fall is a great time outdoors

This is the time of the year when the weather turns in many parts of the country. Our thoughts turn to raking leaves, soup, boots, and mittens. It’s also a time when it gets harder to face outdoor activities with kids – it’s cold and damp or it’s raining and there are lots of extra clothes to get on.

There is something wonderful about snuggling in, finding fun things to do indoors, responding to the change in the seasons, and we will talk in a later posting about some of the ways to avoid cabin fever as the winter sets in. But here we want to think together about how to keep the outside world available, how to make sure that your child still gets fresh air every day, and how to enjoy that!

The autumn brings hayrides, pumpkin patches and apple picking, expeditions that children of all ages can enjoy and learn from. If you go to a corn maze, do make sure that you know how to find the exit – it’s scary for children if parents get lost. In another posting, we give our traditional Halloween message for parents of young children about how to make it fun for all.

Consider two of the main effects of having children – they learn from you and you learn from them. Getting out and doing things together gives you a chance to do both. Fall offers many opportunities for that kind of expansion of the self and building of emotional muscle.

When you take an autumn walk, you can collect leaves, acorns, sticks and more for home projects (leaf-rubbing, collages, mobiles, gifts to distant relatives, and so forth). It is also an ideal setting for comfortable conversations about the life cycle, which teach children about plants and animals, as well as about life, growth, death and change.

When you rake leaves or tidy the yard or put away the hose for the winter, you and your child are building memories of working together, lovely in themselves. In addition, your child is learning to be part of a team, accomplish a task, experience the satisfaction of finishing a job, and may even be of real help.

In our well-insulated and well-heated houses and apartments, fall and winter bring lots of coughs and colds. The more fresh air children have, the more likely they are to resist illness. With outdoor fun comes exercise, another necessary ingredient for health and well-being.

So put on those scarves and jackets and have a great time outside together this fall!

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Halloween fun for little ones

Halloween is coming, bringing thoughts of pumpkins, candy, and costumes.
It also evokes the excitement of being out in the dark and the scariness of ghosts, goblins and witches. Schoolchildren enjoy testing the limits of their bravery, confirming their newfound independence and knowledge by pretending to be monsters and so forth. For little children, however, Halloween can be very scary, unless we make sure that the celebration matches their level of understanding.
Preschoolers are just learning all about the world around them, anchoring themselves in what they are used to. Very young children do not understand masks, and find it hard to remember that it may be a familiar person behind the different face. To them it can be terrifying when the familiar child or adult disappears, to be replaced by a strange-looking, motionless mask.
Older children know that monsters and ghosts are imaginary, but little children don’t yet know the difference between real and pretend. They may be confused by the images they see in stores and on neighborhood lawns, and frightened when people dress up as witches or vampires.
Preschoolers turn to their parents, grandparents and trusted adults for reassurance. It helps them make sense of their experiences when grownups are consistent. Adults dressed up in costumes can be disorienting and confusing. We will have more fun at Halloween if we are available to ensure our little ones’ enjoyment.
Other people may not understand how preschoolers think and feel – if you go trick-or-treating, grownups may answer the door in scary costumes or startle children with sound effects or saying “boo”, so it is important to accompany your little one. Walk up to the door with your child and have an adult available to each child to explain what is going on and make sure that each part of the experience is fun. A walk in the dark to a few familiar houses is adventure enough for most preschoolers!
Making costumes out of readily available clothes and props at home can be a shared creative activity that makes the run-up to Halloween part of the pleasure. Imitating familiar real-life characters – firefighters, nurses, construction workers – or animals like cats, bears, or tigers is a way of learning about the world. It is also easier to make such costumes visible, safe and cosy for a cold, dark evening!
There is another aspect of Halloween that can be scary for young children -- overexcitement is scary in itself, as the feelings threaten to get out of control. Holidays are exciting times, but little ones are just beginning to master their feelings. Measured Halloween excitement can be a shared pleasure that helps your child grow. Have a Happy Halloween!

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Measure your pleasure

I received the following query from a mom this week -
Dear Kerry,
When I recently mentioned something I read on a parenting site, my father-in-law got impatient. He said I was “overthinking” and “being a worrywart.” Parenting doesn’t just “come naturally” to me. I find it helpful to get ideas and advice from books and websites, and it’s great to know that I’m not alone. But it feels lonely when people look at me funny in the supermarket if I take the time to explain something to my toddler. How can I counter this kind of criticism?
JL, Maryland

Dear JL,
You’re putting your finger on a sore spot for many parents. The idea that people should know “instinctively” what to do as parents makes most of us feel inadequate, since we all worry, especially when we face parenting for the first time. Just the other day, a very capable, confident TV producer contemplating her new pregnancy said to me, “Motherhood is just plain terrifying.”

We don’t expect anyone to jump into a car and know instinctively how to drive. They have to learn the component skills (and some will come more easily than others); practice how to integrate and apply them; gain practical experience before they can feel they are truly good drivers. The fact that most of us have deeper and more intense feelings about parenting than about learning to drive only complicates the picture. Those strong feelings don’t necessarily make it easier. But they can be harnessed to fuel the effort to master the skills of parenting.

One way you can assess your own level of involvement and attention to your parenting job is to measure your pleasure – are you having fun? Do you generally feel satisfied, no matter how tired you are at the end of the day? The good fatigue that comes from working hard and feeling it’s a job well done – whether it’s the tired muscles from painting the family room, the finished report at work, the apple crumble for supper – that’s what we are all aiming for. Your toddler’s face when she understands your explanation and moderates her behavior is an important piece of positive feedback and reinforcement that you are doing something right. And you deserve to feel pride and satisfaction in achieving that step in building her emotional muscles of regulating her feelings with the knowledge you give her.

If, on the other hand, you are feeling constantly stressed and uncertain, then it’s worth examining your goals – are you pitching your standards for yourself too high? Are your expectations of your child beyond her capacity? Then your father-in-law may be accurately picking up that you are worrying unnecessarily.

Parenting, like everything else, is a work in progress. Over time, we are likely to get better at it if we think and work, exercising our emotional muscles and moving forward past hard times. When they are grown up, we can hope that our children will be able to see that we have done the best we could at the time, made the best decisions we could with the information available, and, most of all, worked from a place of love and caring. You are not alone in your efforts to be the best parent you can be and you deserve support and respect for that effort. Enjoy and keep it up!

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Check in before you check out

Adolescence is a time when young people are pressured from inside and outside to try new things -- this makes sense since they are emerging from the protective world of the family to the larger world of opportunities, risks, mastery, excitement and dangers. Teenagers seek out novelty and heightened sources of stimulation, some as benign as roller coasters and scary horror movies, some as dangerous as substance abuse, reckless driving, unsafe sex, or delinquency.

Teenagers need the courage to try new things, but the wisdom to keep themselves safe. Significant changes in brain structure and functioning mean they may do things with less judgment, caution or rational thinking even than when they were a bit younger. So the action side is legislated for by neurological and biological shifts. But what about safety?

How can we help teenagers be brave but not stupid, take chances but include safeguards, be adventurous, creative and innovative but still retain a connection with past and current reality, plus future consequences?

Anglo-American attitudes have always stressed the need for adolescents to physically separate and reject parents and other adults. This leaves a vacuum that is quickly filled by peers, advertising, and social media, which all can emphasize immediate gratification without reflection of judgment. Studies show, however, that bad things are more likely to happen when teenagers use only peers for reference when they do risky things. There are more accidents when cars are driven with other kids there; parties with only teenagers present are more likely to include alcohol, drugs and unprotected or forced sex, and so on. American parents and other significant adults are often reluctant to help young people balance their biological push toward action and novelty with the wisdom, judgment and forethought that comes from adult experience.

The remedy is pretty simple - staying involved with your teenager's life will protect her, teach her needed skills, and will offer you unexpected benefits in learning and growth for yourself. Behind every successful teenager there is usually a wise adult, a parent, coach, teacher, big brother, or mentor. But this reality is seldom mentioned when the tale of success is told, which perpetuates the American myth of solitary and singular achievement.

When we talk about building emotional muscle in parents and children, we describe a lifelong process of transforming the parent-child relationship rather than separating from your child. It is never too late to start developing the parental emotional muscles needed to start and maintain a rich conversation with your teenager. Teenagers, too, can learn how much they gain by "checking in before you check out."

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