Children who are difficult may not be simply toxic

As a pediatrician I have listened to many parents speak of their child in very negative terms. Dr. Richard Friedman, in his New York Times article entitled Accepting That Good Parents May Plant Bad Seeds shares his patient’s description of her “rude and defiant” teenage son. Like the parents in his piece, the parents of my patients have other children with whom they have had no such difficulty. The conclusion Dr. Friedman draws from this and other similar stories, is that perhaps these are simply “toxic” children.

I find this conclusion horrifying. Dr. Friedman’s piece brought to mind two children from my pediatric practice who were described in similarly negative terms. These negative characterizations were openly discussed in front of them. Both were teenagers when I first saw them and for years had been identified as the “difficult child” in the family.

Rather than focus on whether or not these children had something “wrong” with them , I spent a visit with each mother alone (the fathers were welcome but didn’t come) exploring what her experience of the child had been starting in infancy.

Both described very fussy infants who cried easily and did not like to be held. As they became toddlers these children were alternatively clingy and explosive. In addition they had many sensitivities to touch , taste and sound. These mothers recalled intense feelings of inadequacy. One mother remembered that she had similar sensory difficulties as a young child. She had suffered terribly as her own parents were drawn to her older and younger siblings who were much more easy going than she.

Yet when their children were young, these mothers did not have an opportunity to reflect on what was happening. Instead, a negative pattern of interaction was set in place. These mothers described becoming enraged with their children whose behavior in turn became more difficult. Marriages were strained and there were high levels of conflict and tension, all of which were increasingly blamed on this “problem child.”

For both of these children the world did not feel like a safe, comfortable place from day one . But that does not mean there was something “wrong” with them. They needed more help than other children who did not have these biological vulnerabilities, to make sense of the world and manage their feelings. Research has shown that children learn to manage difficult feelings when their parents can reflect on and contain their experience.

The mother in Dr.Friedman’s story describes her son as being “unsympathetic.” It is in toddlerhood that children learn, by having their parents understand and contain their feelings, to think about not only their own feelings, but other people’s feelings.

Rather than drawing the conclusion that this child was a “bad seed” I wonder, what were this child’s particular biological vulnerabilities? What kind of stresses did his parents experience when he was very young? How did these stresses affect his parents ability to help him to learn to think about and manage his feelings? Only with this knowledge would I venture to understand how he has become the person he is today.

My two patients are both in therapy of their own. By the time a teenager has lived all those years being identified as a difficult child, and has not learned to think about his own and other people’s feelings, he needs intensive help.

My patients are not “bad” children and their parents are not “bad” parents. Rather, they are children with biological vulnerabilities whose parents needed to work a lot harder to help them learn to regulate their feelings.

In retrospect, these parents recognized that they needed someone to help them contain and manage their own experiences raising these challenging children. But they didn’t have such help.

The difficulties these families faced were neither in the child nor in the parent, but in the relationship. When parents have support in their efforts to be fully present with their young child, their children feel understood. This understanding in turn helps them to manage difficult feelings. Behavior improves. Parents’ sense of competence increases. A positive cycle of interaction is set in place. Development moves in a healthy direction.

Claudia M. Gold is a pediatrician who blogs at Child in Mind and is the author of Keeping Your Child in Mind.

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