Read an Excerpt

ARE YOU CONCERNED ABOUT YOUR CHILD?

Eight-year-old Joshua looks unhappy most of the time. He is easily disappointed and reduced to tears. Playmates don't call as much, and Joshua says sadly that no one likes him. He has become whiny, and he shadows his mother around the apartment.

Joshua's parents argue about the best way to deal with him. Joshua's father believes that his son would make friends and feel better if he participated in sports. He has enrolled Joshua in a soccer league and insists that the boy join him for a daily workout.

Joshua's mother thinks her husband's approach is too simplistic. She urges her son to talk about his feelings. To boost his self-esteem, she compliments him lavishly and tells him often how much she loves him. But sometimes even she becomes exasperated by Joshua's behavior: She angrily tells him to stop pestering her and to go out and do something instead of just feeling sorry for himself Afterward, she is overwhelmed by remorse and doubles her efforts to be caring and understanding.

* * *

Joanna is four, and the director of her preschool has asked her parents to make another child-care arrangement by the end of the month. Joanna's teacher complains that she disrupts the class: She protests loudly when an activity is over and refuses to clean up; she won't lie down at nap time or sit still for a story. On the playground, she's too impatient to wait her turn for the riding toys and pushes other children out of line. The school director has suggested testing her for ADD.

Joanna's parents are devastated by their daughter's expulsion from preschool. At the same time, they're exasperated with her, since she's defiant at home as well. Daily life--from getting Joanna dressed in the morning to putting her to bed at night--is a series of power struggles. Her mother feels humiliated and confused. She's bombarded by conflicting advice from friends, relatives, and even strangers who witness Joanna's public misbehavior. Her father, who occasionally explodes at his daughter's disobedience and swats her on the behind, guiltily wonders if his bad example is behind her aggressive behavior.

* * *

Rosemary's mother doesn't recognize her twelve-year-old daughter. Rosemary, an only child, had always been loving and well-behaved. Now she's increasingly angry and defiant. In school, her usual A's have slid to B's and C's, and her provocative behavior recently prompted a call from the guidance counselor.

Five years ago, when Rosemary was seven, her father left the family; she has had little contact with him since. When her mom began dating again, Rosemary seemed enthusiastic. But her attitude changed when her mother became involved in a serious relationship. Last year her mother remarried, and things went from bad to worse.

Rosemary greets her mother's concerned overtures with a wall of impenetrable silence, punctuated by explosions: "Just leave me alone! All you care about is him!" Though Rosemary's stepfather tries to be understanding, the mother feels torn between her daughter and her new husband. The stepfather downplays the girl's behavior as normal adolescent rebellion. But her mother wonders if Rosemary has suffered emotional damage because she once again feels abandoned by a parent.

* * *

Myra and Ellen, sisters ages six and nine, bicker constantly. They argue over whose turn it is to pick the TV show; who gets to eat the last cookie; who sits behind the driver in the car--and who is to blame for their quarreling. Though their parents bend over backward to be evenhanded, both youngsters seize upon their slightest inconsistency and accuse them of playing favorites.

The girls' mother, an only child who always longed for a sister, is baffled by the conflict between her daughters. Their father, whose own sisters became estranged as adults after a bitter quarrel, struggles to make peace between his girls. He lectures them about the importance of the family, and tries to referee their arguments. But no matter what he says or does, the fighting continues.

* * *

Three months ago Tim's parents divorced, and he moved across the state with his mother and sister. Since then, Tim, who is seven, has been unable to sleep through the night. Sometimes he awakens crying from frightening nightmares. Or he comes into his mother's room with anxious questions: How would they know if a fire started in the middle of the night? Could burglars break into the house through the roof? Lately, he has insisted on touching each toy in his room exactly twice before he goes to bed. If he forgets so much as a single Matchbox car, he insists on starting over.

Tim's ten-year-old sister, who misses the friends she left behind when the family moved, resents all the attention he gets; she complains that nobody cares about her. Tim's mother is dealing with her own problems: She doesn't like being single, and she has trouble making ends meet because her ex-husband is behind on child support payments. She feels guilty about neglecting her daughter, but mostly she worries about Tim.


As a child and family psychiatrist, I see youngsters like these every day. They are not disturbed or mentally ill, and yet they have significant problems. I'm sure you can identify with their loving, concerned parents. We all want our children to be happy and to feel good about themselves. When they don't, we feel awful too. Underneath the frustration and worry there is often considerable guilt, and the lurking fear that something is seriously wrong.




THE PURPOSE OF THIS BOOK

This book is for mothers and fathers of children ages three to twelve, who are experiencing problems like the ones just described. If you're in this situation, you may have reached a point where you feel you've tried everything and don't know what to do next.

Discussions with your spouse and child may have become emotionally charged and unproductive. If your child seems unhappy, you may be tentative and overprotective; if the difficulty involves misbehavior, you may be criticizing and punishing too much. At the same time, you may dislike the parent you see yourself becoming.

I can assure you that you will see improvement once you've read this book and put its ideas into practice. But I want to emphasize at the outset that it isn't a "how to" encyclopedia, with specific solutions for particular problems, presented as if they apply to all children. The essence of my approach is to look at problems and devise solutions for the individual child and family.

Therefore, I offer you a collaboration with me, modeled on the way I work with parents and illustrated by many dialogs and case histories. (Of course, all individuals are renamed and identifying details are changed to protect privacy.) We will approach this joint effort as co-experts. My contribution is my professional knowledge, objectivity, therapeutic involvement with many children and families, and a philosophy based upon respect for the individual. You bring your deep love, practical experience with your son or daughter, and powerful motivation to take action.

You will learn how to tap yourself as a resource for your child--no one knows her as well as you do. I won't tell you what she should be like; after all, she's a unique individual. But I will help you think about the person she is, so that your expectations are reasonable. Nor am I going to tell you how to run your family. My goal is to provide principles that you can apply to your own situation.

Underlying my approach are two basic assumptions:
Normal children can have problems.

Parents can help them.
First, the fact that your child is having difficulties doesn't mean that he's disturbed or that there's something seriously wrong with him. Perhaps because of my personal background--I have lived in four countries and work in one of the most culturally diverse cities in the world--my view of normality is broad and encompasses a wide range of personal styles and preferences. Consequently I am very cautious about applying terms like "abnormal" or "disturbed" to youngsters with emotional problems.

Second, even if you are less than perfect and have problems of your own, you can do much to help your child. Competent parenting does not require detailed knowledge of child development; nor does it mean that you never make mistakes. Rather it is founded on a loving yet objective understanding of your son or daughter, and a sensible system of family discipline. You can't be your child's therapist, but you can offer meaningful support and make valuable changes in his or her environment.



DOES YOUR CHILD NEED PROFESSIONAL HELP?

This book is not intended as a substitute for professional treatment. Though I emphasize what you can do, sometimes your own best efforts aren't enough. In that case, the book will help you clarify the situation and work effectively with mental-health professionals. Self-help and professional help are not mutually exclusive--on the contrary, they complement each other.

Emotional problems are a matter of degree. If a boy feels depressed, that could mean he's experiencing fleeting sadness--or misery powerful enough to precipitate a suicide attempt. A girl may express fear of the dark by insisting on a night light--or she may tremble and sob inconsolably. Knowing where your child's difficulties lie on a range of severity will tell you a great deal about the role you can play in resolving them. As problems move further out along the spectrum, it becomes increasingly likely that your best efforts will need to be supplemented by professional assistance. (See Chapter 12 for information on when to seek help.)

Let me illustrate the spectrum of problems and solutions by describing four nine-year-old boys who devote a great deal of time to playing with Legos:


THE NORMAL CHILD

The first boy is happy and does well in school, but his parents feel that he spends too much time playing with his Legos. He has constructed an elaborate space station populated with tiny Lego warriors, all of whom have names and detailed military responsibilities. If someone were to ask him if the warriors are real, he would respond, "What! Do you think I'm crazy?"

This is a highly imaginative, but normal child who requires no treatment. His parents should respect their son's preference, though they certainly could place some limit on Lego play and encourage his involvement in other activities.


THE NORMAL CHILD UNDER STRESS

The second boy became involved in intense Lego play after being hospitalized for epiglottitis, a frightening life-threatening infection in which the epiglottis--the fleshy flap that hangs over the back of the tongue--suddenly swells and obstructs breathing. His play has a medical theme and is openly hostile: Patients hit their doctors; ambulances run over people. The boy knows his Lego world is imaginary, but it comes to life in vivid nightmares. At school he's preoccupied, and his grades are slipping. His parents think he's dwelling too long on his hospital experience and have urged him to stop playing with the Lego set.

This is a normal child who is experiencing a temporary problem. Since he was well-adjusted before he was hospitalized, it's clear that he's reacting to a specific stressful experience. His parents can help by allowing him to express his feelings, instead of insisting that he forget his illness. They can ask his doctor to talk to him, to make sure he understands what happened and that he's now cured. They could also arrange for him to get extra assistance with his schoolwork until he catches up. These measures should help a great deal. But if there's still concern a few weeks later, consultation with a mental-health professional might lead to a brief intervention.


THE TROUBLED CHILD

The third boy has been unhappy and withdrawn for more than a year; he has also been sullen and irritable at home and at school. Much of his free time is spent alone, playing with his Legos. He has set up a rural community with a farmhouse and animals. If he were asked if his Lego farm is real, he might reply, "No, but I wish it was."

This is a child with an unhappy family background, who has experienced other problems in the past. When he was three, his parents separated, only to reunite a year later. Two years ago his father lost his job, and the family split up again. The boy and his mother moved in with her parents, while the father joined a construction crew in another state. His parents' marriage suffered during their separation, and his mother began drinking.

Things are looking up now. The father recently obtained a local job, and the family moved to their own apartment. The mother has stopped drinking and the marriage is improving. The parents are very puzzled that their son continues to have difficulties despite all the positive changes at home.

This is a troubled child, whose symptoms are severe and longstanding. His parents could talk to him about the past family problems, so that he understands what has happened and can express his feelings. They might arrange special father-son and all-family activities to rebuild relationships weakened by the earlier separation. Though these measures should help, they probably won't be sufficient: The boy's difficulties may have originated in outside stresses, but they now seem to be generated as much from within him as from the outside world. A therapist could help him resolve his unhappy feelings, and could also guide his parents.


THE DISTURBED CHILD

The fourth boy has always seemed detached and odd. Unlike the other three boys, he cannot tell that his Lego world is unreal. He refers to the Lego pieces as his army, and says he's a military commander from the planet Yklopki. He explains that he cannot go to school because his classmates are dangerous.

This is a disturbed child, the rare youngster who has trouble distinguishing fantasy from reality, and whose functioning is significantly impaired. He has a serious psychiatric disorder and will need long-term intervention. Such a diagnosis is a terrible blow to parents. A professional can help them to accept the diagnosis without losing hope, and to adjust their expectations. Certainly, they can be encouraged by their child's strengths: Though disturbed, he is bright and creative.

* * *

Where does your child fit on the spectrum of problems? You may not know the answer now, but it will become clearer by the time you finish this book. In the meantime, there's usually no harm in trying new measures and waiting to decide about seeking professional evaluation or therapy. But I urge you to seek expert advice right away if your child exhibits any of the following symptoms: a sudden and very worrisome change in mood or behavior; bizarre or frightening behavior; conduct or statements that represent a serious threat to the child or to others. (See Chapter 12 for further information about emergencies.) Always err on the side of caution if you're uncertain.