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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  • Alice

    You write in such caring manner….not a rant, but a search for and willingness to help. It is one of those topics we cannot sum up easily, although we often search for ways to label it knowing one-size clearly does not fit all. I am the mom of six who used to have all the answers…now hmm….more questions than answers most days. :). I grew up in a highly abusive home, and came out quirky….although literally scarred.

    Biological vulnerabilities is an interesting term. Does it imply a type of victimhood to our DNA? Label bad parents as victims?

    One wonders where the good examples of parenthood will come from? TV? Daycare? The school system where money is brought in if kids are labeled and filled with drugs because they do not fit into the normal behavioral pattern, or test out?

    Is normal relative depending on the counselor or teacher (knowing the best teachers see beyond and reach into the heart knowing a true education includes this). I am a bit of a biography reader and find the most interesting people were not normal….the system or Facebook would have crushed them (still thinking of the local teen who was heavy, and was dying at the Cleveland
    Clinic. While doctors did everything possible to save her life her family received so many Facebook messages wishing the girl would die already they had to delete her account when she did die).

    Why is bullying up? The breakdown of the family unit? Narcissism? I heard once that a study of death row inmates showed extremely high self-esteem.

    I would agree that some people are born with neurological problems. But I also think some are created and not at the fate of biology as much as they are circumstance and poor decisions from people who make poor choices (knowing many people find help and change which means the biological label may be a bit misplaced?)

    Some are just, Lookin’ for Love in all the Wrong Places……

  • Mike

    An interesting article and the author could be right. Yet, it is still possible, in my opinion, for some children to just be difficult despite the best efforts of parent and any number of therapist.

  • JRB

    Children are innocent. Being labeled as difficult makes me sad for the kids because it will affect their development and will be an obstacle to their potential in every aspect of their life, including their ability to parent. Kids with the label of difficult are so as a reflection of their parents.

  • AnnR

    I had a difficult child. He was an easy baby, a natural student, but encountered a rough spot during his teen years.

    My mother-in-law pointed out to me that he was a lot like his father. It didn’t make the rough spot any easier but it put it in perspective. I think it’s always good to have support with children and Grandparents have a unique perspective.

  • MIS Prof

    Great article. It might well be very difficult for an infant with a sensitive nervous system and a mother who reaches her wit’s end in figuring out how to cope with the fussy infant. For an easy read on what might be going on, try Daniel Goleman’s book Social Intelligence (he summarizes neurological and behavioral research on the early mother/infant interactions and the possible consequences on later relationships).

    We often cast blame on the child or parent when we don’t really know what is going on in the child’s physiology (or the parent’s). Recent research on the brain and CNS, brain plasticity and response to environmental stimulus and internal pain signals, and epigenetics may offer some hope of understanding what is going wrong and what treatments may offer relief.

  • Alice

    While all you say is true, we are in the age of victimhood. I think AnnR makes a simple and valid point…..grandparents are a wonderful asset in a child’s life (instead of a label, drugs, or counseling, her mil recognized the human nature of the human where patience and love can conquer). I believe every child needs at least one person who thinks that child is beautiful just the way they are. When that doesn’t happen we often see problems, and although the medical community needs to label and diagnose, they are often over-treating (via drugs, counseling, etc.), and over-diagnosing.

    My point is few humans are born with the type of damage to cause this type of a huge problem. The real over-riding problem is, most likely, in the human nature, not physical. And it’s much easier to treat a physical problem, than an intangible one that needs responsible human behavior. So treat it with drugs, or diagnose it, because that’s much easier than giving the kid the time and love they need. Eye contact, hugs, and time are much more productive at times, but more labor intensive.

  • Molly Ciliberti, RN

    Thanks for the very caring post. How unbelievable to be discussed in such a disparaging way in front of you! If you felt bad about yourself before you must really feel bad after. We don’t get to pick our parents or our kids, but we can provide love, understanding and a safe place to grow in your own way.

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