Environment & the Expression of “Disorders”

An essential characteristic of ALL “disorders” is that they are defined within specific ENVIRONMENTS and lose their diagnostic platform in other environments. In the case of ADHD, symptoms are not volitional. This means discipline (dependent as it is on a child’s ability to anticipate consequences and choose appropriate antecedent behaviors) cannot abate the symptoms.

Faced with the symptoms of ADHD (and having eliminated other masquerading conditions like lead poisoning, thyroid abnormalities, bipolar disorder and a MYRIAD of others) parents have only 3 choices to make: 1) Accept and adjust to the behaviors 2) CHANGE THE ENVIRONMENT or 3) Change brain chemistry (with medication).

In the Australian outback, inability to detect the scent of water can be termed a “Water Indetection Disorder”. Untreated, it might lead to death (choice 1); a move to New York city eliminates the “disorder” component of the diagnosis (choice 2); equipping the person with a hydrometric device to “sniff” water vapor (analagous to a prescription) abates the symptoms of the disorder (choice 3).

Is ADHD a Hoax Foisted on the Public by Drug Companies?

Before we ascribe the definition and management of the entity(ies) most recently named ADHD to a pharma cartel, let’s review a bit of history and some basic principles.

A “Defect in Moral Control”, described at the turn of the last century, identified a number of children who couldn’t consistently follow rules or succesfully complete series of sequential academic tasks. Corporal punishment, the mainstay of discipline at that time, intensified these behaviors. Many such children clustering in families, suggested a genetic inheritance pattern. Many other such children had histories of central nervous system insults, like meningitis, head trauma or prolonged seizures, suggesting subtle forms of brain damage.

Mid-century, the chance observation some children with the “Defect” prescribed Benzadrine for headaches, and whose “Defect” abated on the medication, alerted scientists to the possibility brain chemistry could be favorably altered. The subsequent development of more effective medications with lessened side effects is, as they say, history,

The designation “Defect in Moral Control” was next replaced with “Minimal Brain Damage”, then with Attention Deficit Disorder (with or without Hyperactivity). The key word to note is “Disorder”. A behavioral disorder is defined by its consequences on a child’s performance – specifically on age-related skills within the areas of physical, social and intellectual abilities, the reactions of others in the child’s environment and the child’s ability to abide by reasonable rules. The norms for each of these criteria vary with a child’s age and with the specific environment. But when performance in ANY of these areas is deficient for age and environment, a “disorder” is defined. Disorders may be managed by changing the environment, changing the levels of expectation by the adult guardians/authorities, changing the child’s brain chemistry, or a combination of these approaches.

The diagnosis of ADHD begins with the recognition of the last “D” – disorder. The ADH part is then defined by any number of available measures, including characteristic behaviors (such as on Vanderbilt Scales), subtest patterns on tests of intelligence, or even on PET scans. At this stage, there is no influence by “pharma.”

Once a management approach has been chosen, progress can be judged by monitoring the presence or absence of the defining criteria of “disorder.” Cessation of treatment is appropriate when the criteria of a disorder are no longer met. Ignoring any accurately defined disorder eventually becomes life-endangering, since children who cannot express age-appropriate skills, relate meaningfully to others or follow reasonable rules become either depressed or angry with eventual risk suicidal or homicidal behaviors.

In summary, ADHD is real and not a figment of “pharma’s” imagination. Ignoring it is not an appropriate option. Effective treatment strategies include manipulating the environment, if possible, and adjusting expectations. Medication, prescribed by an experienced and knowledgeable practitioner, is usually a safe and effective component of treatment and offers the possibility for a child to successfully sequence complex tasks, focus on chosen tasks in distracting environments and choose rewarding behavioral options.

Holiday Discipline

Okay. The Holidays are here. Kids are hyped up and they expect to receive goodies. Discipline for the near future will be more challenging than usual. Let’s learn 4 tricks you can use to keep control:

  • The Hansel & Gretel trick. Leave a trail of enticing bread crumbs, guiding a kid in your chosen direction:

Example: You’re in the mall and Sally sees a doll she wants. She insists on getting the doll. Here’s how this trick works:

You- “Do you really like that doll?”

Sally- “Yes. Her hair is the same as mine and she’s cuddly.”

You- “Do you think she’d like a doll house to live in when you’re not holding her?”

Sally- “Yes!”

You- “Okay. Here’s how you can get the doll and her doll house. When you go back to school next week, you have to get dressed in the morning without arguing about the clothes I pick out. If you can do that for a week, you get the doll. If you do that another week, you get the doll house.”

Using this trick: Present a series of enticing rewards to lead your kid to good behavior.

  • The Distraction trick. Offer alternative, but acceptable (to you) actions:

Example: Your son, Dante, wants you to buy him an expensive Star Wars outfit. Here how to use Distraction:

Dante- “I want that Star Wars outfit.”

You- “Why do you want it?”

Dante- “My friend has one.”

You- “I know some things you’d like better. How about you go fishing with Dad this weekend? If we save the money from the Star Wars outfit, we can get bait for fishing. Or, if you prefer, you and I will see that Disney movie you wanted to see.”

Using this trick: Bury your kid’s unacceptable demand with attractive alternatives.

  • The Sibling Rivalry trick. Pit kids’ good behaviors against each other:

Example: While visiting with your family, your kids Billy and Donna are teasing each other to tears. First one, then the other runs to you complaining, “He said….she said.”

You- “I’m hanging this chart on the wall. Every time one of you teases the other I will stick a black star in a box. Every star you get means you go to bed 15 minutes earlier tonight. Either of you who gets no black stars can stay up late tonight, have ice cream and watch a movie.”

Using this trick: Having siblings strive for a common goal is a powerful, but potentially risky technique, since it can anger or depress the “loser.” To avoid that, it’s best to find a way to reward both kids for their efforts, though not equally.

  • The Billiard trick. Deflect misbehavior with a proposed punishment while redirecting it with a reward:

Example: Kristina just turned 16. Last week, some beer was found hidden in her bedroom. You’ll be visiting family for the Holidays and you know alcohol will be served to the adults.

You- “Remember that beer we found in your room? You know we can’t let you drive if we think you’re sneaking alcohol.

“If we have reason to think you’re using alcohol, we’ll hold off on Drivers Ed for at least a year. Otherwise, after the Holidays, we’ll sign you up for Drivers Ed.”

Using this trick: The Billiard trick deflects bad behavior with a punishment and guides kids toward better behavior with seductive rewards.

You may have noticed these tricks rely as little as possible on punishment as a means of discipline. That’s because punishment risks creating anger or depression, both of which reduce kids’ compliance. Carefully chosen rewards encourage better behavior, build self-esteem and ensure Happy Holidays for the whole family.

Explaining Anxiety Disorders

Do you experience persistent over-concerns or fears relating to everyday activities like eating with others, meeting with others or even thinking about bodily functions? If your anxiety has lasted more than 6 months and interferes with getting things done or working with family, friends or co-workers, you may have an Anxiety Disorder.

Anxiety disorders often accompany other disorders. For example, Attention Deficit Disorder (ADHD), Obsessive Compulsive Disorder (OCD) and many Depressive Disorders, often complicate anxiety disorders. When anxiety becomes so intense as to cause physical symptoms, like knocking of the heart (palpitations) or the sensation of suffocation (hyperventilation), it has reached the level of a Panic Disorder.

Anxiety disorders can be fueled by stressful events or activities, like sexual molestation or rape, the death of a loved one or bullying. But seemingly trivial activities, like participation in a group or meeting new people, can also trigger an anxiety disorder for some vulnerable individuals. Inheritance often creates such vulnerabilities; that is, anxiety disorders can run in families.

Successful therapy for anxiety disorders often requires effective treatment of any associated conditions and may include psychotherapy, medication or both.

Psychotherapy aims to provide an individual with effective strategies to avoid known triggers and to manage stressful events or activities. Medications can directly change brain chemistry to create resistance to stress and resultant anxiety.

Psychologists and Psychiatrists are best equipped to treat anxiety disorders, but the latter group of professionals are licensed to prescribe medications.

Have You Heard of Asperger Disorder?

Asperger Disorder is a higher functioning form of Autism. This means, with the exception of social competence, thinking ability is usually average or above average.

What makes children with Asperger Disorder most recognizable are deficiencies in social and communication skills associated with repetitive and restrictive behaviors. Commonly included in communication disturbances are odd patterns of speech. Deficient social-adaptive skills make it hard for affected children to interpret other people’s body language. For example, they may not recognize a parent’s annoyance or anger and continue to engage in behaviors seemingly intended to provoke more annoyance or anger. Poor eye contact can be seen as early as toddlerhood, and often persists into adult life.

Ritualistic, repetitive behaviors, like reciting a sequence of numbers or moving arms or legs in a complex, but stereotyped fashion, may become intense and intrusive enough to qualify as Obsessive Compulsive Disorder (OCD). Indeed, it’s common to see children with Asperger Disorder exhibit several associated disorders. Among the most frequent accompaniments of Asperger Disorder are OCD, Attention Deficit Hyperactivity Disorder (ADHD) and Depressive and Anxiety Disorders.

Asperger Disorder is several times more common in males than in females. The disorder may affect several individuals within an extended family, suggesting inheritance may play an ill-defined role. Many theories have been proposed to explain the occurrence of Asperger Disorder, including poor bonding between parent and child, exposure to toxins during pregnancy and the accumulation of mercury from thimerosol-preserved vaccines. None of these proposed causes for Asperger Disorder has been scientifically established.

The treatment of Asperger Disorder aims to improve an affected child’s ability to understand and relate to other people. One well proven form of treatment is Applied Behavioral Analysis (ABA therapy). Through ABA therapy, a skilled therapist can improve an affected child’s performance of Activities of Daily Living (ADL’s), like personal hygiene, managing finances, employment routines as well as social mores.

A child’s intellectual level (IQ) and level of motivation are directly related to successful integration into society. Equally important is effective treatment of associated disorders.

How Parents Can Decide If a Child’s Misbehavior is Worth Their Attention

Misbehavior is best judged by its consequences. The consequences of a child’s misbehavior affect 3 areas of performance. We might call them Consequence Areas:

  •        Developmental (or age-appropriate) abilities – by which we mean physical skills (controlling one’s body) , social skills (benefitting from being with others) and intellectual skills (understanding things at an age-appropriate level).
  •        Rule-following – being able to abide by reasonable rules for one’s age.
  •        Relationships to others – avoiding a pattern of complaints from others.

When a child’s behavior fails to affect any of the Consequence Areas, it’s not worthy of a parent’s attention. Indeed, parents will quickly run out of energy if they attempt to manage all of a child’s annoying behaviors.

The greater the number of Consequence Areas threatened by misbehaviors or the more intense the disruption of performance in any Area, the more serious and potentially dangerous the misbehaviors become. Misbehaviors intensely affecting all 3 Consequence Areas are truly life-threatening and require the imposition of immediate steps to lessen danger. Lesser degrees of intensity, though requiring parents’ intervention, leave time to discover causes and develop management strategies.

To decide which professional(s) to consult and in what order, I suggest checking to see which developmental abilities are affected by the misbehavior (physical, social, intellectual).

  •        For lagging or deficient physical performance consult a medical doctor, such as a Pediatrician, Behavioral-Developmental Pediatrician or a Pediatric Neurologist.
  •        For lagging or deficient social performance consult a psychologist.
  •        For impaired intellectual performance consult a Psychologist or an Educator.

Since misbehavior often affects more than one area of development, the order in which professionals check for causes is important. Physical causes should be sought by medical doctors before social deficiencies are assessed by psychologists. Social deficiencies should be checked by a psychologist before intellectual deficiencies are assessed by educators.

STOP Bullying & Victimization

Children who bully intentionally and repeatedly humiliate or injure others. There’s always a reason for bullying. Some children suffer from mental health conditions which lead to bullying and over which they have no control. Other children choose to bully to defend against such conditions. In all cases, there are underlying causes fueling bullying. Take away the fuel and bullying stops.

As with bullies, children who are victims of bullying are targeted for a reason. Their vulnerabilities may be based on mental health conditions or circumstances over which they have no control, or their victimhood may rest on circumstances they can be taught to control. Remove the foundation upon which children’s vulnerability rests and their victimhood ends.

Here’s how to stop bullying:

  • Don’t look for causes while anyone is in danger.
    • Physically remove bullies who threaten or seriously harm others.
    • Call 911 for bigger bullies.
    • Consider immediate psychiatric hospitalization.
  • Before attempting to discipline a bully, check for disorders over which the child has little or no control – like Mood Disorders & Personality Disorders.
    • Consult with an experienced child psychiatrist or child psychologist.
    • Some mental health conditions will require medication.
  • Once life-endangering threats are eliminated and underlying disorders blocking right choice-making have been identified and treated, you can discipline a bully.
    • Distinguish love (food, shelter and clothing – independent of behavior) from affection (all the perks you give your child – like toys, games, computer time, time spent with you, privileges). Love is a heritage, never withdrawn for misbehavior.
    • Use affection as a reward for your child’s right choices and withhold it when it’s unearned.

Here’s how to shield, then strengthen a victim:

  • Stop life-endangering victimhood immediately.
  • Physically remove your child from danger.
  • Call 911 to stop dangerous bullying by bigger children.
  • Discuss the bullying with the parent(s) of the bully & with responsible authorities.
  • Identify possible physical, environmental or mental health conditions (like short stature, racial issues and autism) creating your child’s vulnerability.
    • Consult with an experienced pediatrician, child psychiatrist or child psychologist.
    • Some mental health disorders will require medication and others psychotherapy.
  • Once underlying vulnerabilities are identified and treated, your child can learn strategies to avoid or fend off bullying.
    • Consult with a school counselor or psychotherapist to teach your child specific strategies.
    • Use affection to encourage your child to learn and use the strategies.

Make Discipline Fun

Disciplining Your Child

Can you imagine your child enjoying discipline? It can be done! As a Behavioral-Developmental Pediatrician currently practicing Child Psychiatry in Southwest Florida, I’ve taught many parents how to use discipline to guide their children away from misbehavior, motivate them to embrace right behavior and actually enjoy the process.

There’s a way to use discipline to instruct rather than punish your child. Punishments, especially spanking, slapping, restricting privileges and taking things away, inevitably lead your child to anger or depression – both of which make it more difficult to gain control. Anger provokes defiance and depression curbs motivation.

Here are the basic strategies:

  • STOP life-endangering misbehavior with whatever (legal) force is required. A 911 call or admission to a child psychiatric crisis unit to prevent harm to your child or others is mandatory for such behavior. Don’t waste efforts on disciplining such behavior.
  • Be sure misbehavior is worthy of your time. Don’t waste energy on merely annoying behavior.
  • Be sure misbehavior is the result of willful defiance rather than due to a physical or mental disorder.
    • Bad choice-making by your child, expressed as willful defiance, makes you angry when you observe it. Defiance targets certain people and occurs under predictable circumstances.
    • Physical or mental disorders causing misbehavior are not under your child’s control and make you anxious or confused when you observe them.
    • Physical and mental disorders need treatment to restore your child’s ability to make right choices before they will respond to discipline. You’ll need professional help.
    • Willful defiance, worthy of your attention and not threatening immediate harm to your child or others, will respond to discipline. You can handle this yourself.
  • Distinguish love (food, shelter and clothing – independent of behavior) from affection (all the perks you give your child – like toys, games, computer time, time spent with you, privileges). Love is a heritage, never withdrawn for misbehavior. Use affection as a reward for your child’s right choices and withhold when it’s unearned. Affection given in the presence of misbehavior defines bribery (a reward given before it’s earned) and bribery encourages misbehavior.

The secret to effective and enjoyable discipline for your child is to offer affection as a reward for right behavior. When affection is doled out carefully and thoughtfully, it becomes ever more valuable and attractive as an inducement to right behavior.

If you’d like to learn more about using these powerful strategies, visit my website: www.DrDavick.com.

Some Little Known Facts About AD(H)D

At the turn of the last century, what is now called ADHD was known as “A Defect in Moral Control,” because kids couldn’t avoid breaking rules.
When it was discovered some kids with the defect had suffered injury to the brain or nervous system, the name was changed to Minimal Brain Dysfunction (MBD).
As time went on, it became clear many kids with MBD inherited the disorder from previous generations. The name was again changed to ADHD.
Kids don’t choose to acquire the disorder and they can’t choose to make it go away. Its symptoms, including impulsivity, distractibility and difficulty sequencing thoughts make it difficult or impossible for kids to anticipate the consequences of their acts.
Since kids with ADHD have trouble anticipating consequences, failing to restore their ability to anticipate consequences by treating their ADHD inevitably blocks effective discipline.
Disciplining kids with untreated ADHD leads to frustration, then to depression or anger – both unwelcome visitors in any household.