Chapter Six

An Adaptive Approach

Many years of clinical practice led me to identify a group of children who had, among other qualities, a striking desire to be the boss in all situations; who felt that they should have not only the same rights as adults; and who believed they are of equal competence despite their young age. While these children were not omnipotent, they seemed to believe they were. I labeled their characteristics “the Omnipotent Child Syndrome.”

Here are the four components of the Omnipotent Child Syndrome:

·               retained omnipotence illusion

·               infantile egocentricity

·               intolerance for normal unpleasure

·               poor self esteem

Let me describe these components briefly.

These children believe themselves omnipotent, and they say so. “You’re not the boss of me, I don’t have to do what you say,” is the theme song they sing every day.

They are as self centered as the two year old who thinks the sun gets up when he does, follows him around all day, and goes to bed when he does. This makes these children a pain for other kids to play with and hard work for their family to live with.

They have very limited tolerance for life’s unpleasures. Disappointed, they cry. Frustrated, they scream. They cannot wait for satisfactions and cannot persist with tasks, so nothing gets done unless mother or teacher stands over them. Finally, despite their arrogance and braggadocio, self esteem is sorely lacking.

After many years I came to comprehend how they remained so infantile. What they lacked in their rearing was not love; it was effective training. Out of this understanding I devised methods to re-parent them. My book The Omnipotent Child describes these troubled children in detail. It explains how they got that way and provides programs of management by parents designed to get them back on the track to normal growth.

About the time I wrote my book, along came ADHD with its implied etiology, to wit that all these qualities in children were caused by some mysterious defect in the child’s capacity to sustain attention. Nobody wants to think they are responsible for their child’s problems and a check list ADD/ADHD diagnosis says exactly that. ADHD says it’s not your fault, there’s something awry in your child’s brain. As a dissolver of parental guilt, the ADD/ADHD diagnosis has been truly effective. In every other way it has been desperately harmful.

But as I have argued in this book, ADHD is not a proper diagnosis. There are much better explanations for the check list behaviors, explanations that lead to better parenting, not to drugs. Let me offer a few of those explanations.

An Adaptive Approach to the ADHD Check List

The adaptive approach is based upon a particular view of humanity that needs to be made clear at the outset. The mature human is a person able to cope with himself or herself and the world. This means that within that human being, instinct, emotion, and reason are functioning in harmony. Such a person does not deny instincts, drives for food, sex, and security, but nor does that person indulge those to excess. This person is in touch with his or her emotions – love, anger, sadness and joy – but is not overwhelmed by them. This person is, in the end, governed by reason but not enchained by it.

The newborn baby is pure instinct. The toddler adds emotion to the mix, By the time the child begins kindergarten reason is making its presence felt. The early portion of this psychological growth is automatic, but increasingly adaptive growth comes to depend upon parental input. This parental input involves two things: loving the child and training the child. Both are essential, but it is the training part which is the main generator of adaptive growth.

The effect of nurturance is primarily upon satisfaction or contentment, while the effect of training is upon developing adaptive skill. A child may be well nurtured but poorly trained, or poorly nurtured and well trained. Or poorly both, or properly both. Each of these combinations generates a different result. Here is a chart I have constructed to illustrate how those inputs generally interact with one another.

Children with behavioral problems generally fall in the first two of these categories. One of these, the sunny non-coper, is a good candidate for adaptive retraining through parental guidance. A child who has been emotionally neglected is a more difficult proposition. The longer the nurturance has been deferred, the more difficult it is to make up the loss.

Children who have been neither nurtured nor trained have found the world an ungiving place, and they are not motivated to learn to cope. The worst of these children are concerned with getting even. From this group come the destructive antisocial types, and also some of those people who seek pleasure in the only way that seems to work for them: substance abuse.

The sullen copers are a special case. They are not, in my experience, as common as they used to be. Harsh, ungiving parenting used to be common, I’m told. It is not common in North America today. Sullen copers cope with life, indeed they sometime achieve reasonable success, but they rarely find happiness. That die has probably been cast.

The sunny coper is, of course, the kind of child most of us are striving to rear. All it takes is parenting that is nurturant and discipline that is effective. Why, then, it is so hard to do? I think it is because rearing children is the most complex task life has to offer, and one way or another most of us parents fall a little short of our goals. But if we get reasonably close, that will just have to be good enough.

With the omnipotent child it is the training that has been ineffective, either because the parent doesn’t know how to train, is too drained by complications of her or his own life, or has been given one of those high energy, intense kids whom any mother would have trouble rearing. This brings us to the most sorely neglected subject in child psychiatry. We cannot go on until we have paid some attention to the concept of temperament in humans.

What Is Temperament?

All people have different physical and temperamental qualities. The scientists who study this topic seem to be narrowing down the field to nine basic differences. In my work I have identified five common characteristics which seem most significant in the clinical setting of the child psychiatrist. When I take a history from a mother I am always trying, among other things, to get a picture of her child’s temperament. The five main characteristics I see, in different degrees, are:

·                 activity level, high, low

·                 intensity, placid, fierce

·                 rhythmicity, regular, irregular

·                 persistence butterfly, intent

·                 mood. sunny, moody

To illustrate this idea, let me give you an example of how temperament interacts with training as that has shown up in my practice.

There is a common stage of development that has, over time, acquired the name the “terrible twos.” Sometime, usually in the latter part of the second year of life, a hitherto sunny child suddenly becomes cranky and demanding. Mother says yes; the child says no. Mother offers Wheaties; the child wants Cheerios. Battles-of-will start over nothing. Some encounters escalate to temper tantrums. At the same time, the child frequently becomes clingy and, for example, wants mother to stay at bedtime until the child is asleep. Thus we see a “terrible twos’ triad”:

·         battles of will

·         temper tantrums

·         separation anxiety

In a series of twenty five children brought to me demonstrating this triad of behaviors in marked form, twenty-three were temperamentally energetic and intense children. Of the two children with milder temperamental characteristics, one mother was mentally ill and the other was a self-centered woman who could not find it in herself to train her child.

All children go through the psychological change these children were going through, a stage I call the omnipotence-devaluation phase of adaptive growth. In some children this phase passes almost unnoticed. In the temperamentally energetic and intense child it can hit like a tropical storm out of the Caribbean.

So, the first thing to understand is that some children are temperamentally difficult to steer through the normal phases of adaptive growth, and parents of these children are more likely to get into trouble. There is nothing wrong with the brains of these children.

Now we need to look at the phases of adaptive growth. In the first year, the child is getting his or her automatic equipment running reasonably well. In the second year, the child is first learning to feel his or her emotions and then to harness them. In the third year, the child becomes self aware and starts to bring reason into the equation, a process that continues until adulthood.

It is parental training that brings the child through this growth. Nurturance alone will not do the job. The notion that love is all it takes to grow children up is a pernicious and persistent misunderstanding that has produced a thousand books and misled a million parents. The authors of these books should be thrown into a vat of loving care and be allowed to soften to death.

The child with a behavior problem is stuck in the process of adaptive growth. Reason is having trouble assuming the chair in the board room of the mind. Before I examine the check list in adaptive terms, let me illustrate my point by contrasting the one of the major adaptive competencies – tolerance for the normal unpleasures of life – with its corresponding adaptive weakness. Examples of “normal unpleasures” for children include getting dressed, going to bed on time, doing their homework, helping with the dishes, and so on.

Babies have no tolerance for unpleasure, though some – the temperamentally energetic and intense ones – express their unhappiness more vigorously than others. Babies develop tolerance for unpleasure by repeatedly experiencing measured doses of the same, doses that are not so great as to overwhelm nor so minimal as to be invisible.

For example, an infant who has to wait for her bottle or who doesn’t get picked up the moment she cries practices a little waiting. The toddler who is denied a cookie until after supper learns that mild hunger is not forever. The two year old goes to his room for four minutes for blowing his stack learns not to escalate his battles-of-will past a certain point. The three-year-old learns to get his pajamas on, or he gets no story. The preschool child gets a chip in her rude jar if she talks back to her sister. On and on the training goes, and  step by step the child learns to tolerate greater doses of unpleasure.

Let us take a look at Spitzer’s list in these terms. For openers, ask yourself: if a child has difficulty remaining seated, could it be he hasn’t been trained to tolerate life’s normal unpleasures, like sitting still for a while in the classroom? Is it still reasonable to say there must be something wrong in his brain?

Similarly, if a child is easily distracted by extraneous stimuli, do we need to postulate an that there is an attention center in the brain and that something has gone wrong with it? If a child has difficulty waiting his or her turn in games, would in not be more reasonable to look at how well that child has been trained in patience before jumping to the conclusion that his or her frontal lobes are to blame?

How do you train a child to be more patient and persistent? You set up a program to deal with one item of that child’s impatient impulsive agenda. One at a time is the best way to go.

Suppose your five year old is always getting down from the dinner table and having to be fetched. She isn’t being provocative. Something just catches her eye and away she goes. “Listen, Anna,” you tell her. “You know I expect you to come to the dinner table and stay there until excused. But you are always leaving and having to be fetched back. I am therefore starting a get down from the table program just for you.”

“Oh yeah,” says Anna. “Dad gets down too.”

“Rarely and with good reason.”

“I got good reasons.”

“Not good enough. Now here’s the deal. If I see your bottom getting restless or you start from you seat, I am going to say ‘Don’t get down Anna, and you better settle right back. If you don’t and I have to fetch you back , you are going to get a chip in a “get down from the table” jar.

“Cool,” responds Anna.

“When you get three chips in your jar you get a punishment.”

“What punishment?”

“No Lego for one day.”

“I'll play with something else.”

Okay, but it won’t be Lego.”

You follow this program, and at the first meal she will get three chips and a punishment, then she will be two chips toward the next punishment before she sticks in her seat for the rest of the meal. Next dinner time, just like penalties in hockey, she starts period two with two chips already in the jar. After about four days she only gets down once or twice, and after two weeks she lifts his bottom, changes her mind, and bitches about stupid jars.

What has happened here? A lot more than just getting Anna to stay at the table. She still gets the impulse to leave, but she controls it. Isn’t that what we were trying to do, increase impulse control?

Take a quick look at the rest of the items on the ADHD check list and see if you don’t see a large component of intolerance for tedium in most of them.

Egocentricity

What about the second cardinal characteristic of the Omnipotent Child Syndrome: retained egocentricity?

The newborn doesn’t know where his body ends and the world begins, so how can his view of things be anything but totally egocentric? The toddler plays hide and seek by standing in the corner and covering her eyes. She assumes that if she can't see you, you can’t see her. Many four-year-olds believe that when they go to bed, it’s night for the rest of the world. You can’t get much more egocentric than this, can you?

Once the child is on his feet and into his mother’s world, his mother begins to train him out of this egocentricity. By requiring that he sometimes accommodate to her, mother teaches the child he is not the center of the family but a member of it: that he is not the sun, merely one of the planets.

How does a mother teach such a thing as this? By loving him to pieces? No way! She does it by showing him she is a person with rights and on this occasion he better do some of the accommodating if he wants to ride his trike tomorrow.

This kind of input not only dispels egocentricity but also requires the child cope with the unpleasure of not getting to do his thing the moment he wants to. Adaptive development proceeds.

ADHD behavior number ten – often talks excessively – is a good example of egocentric behavior, isn’t it? There, sitting at the table with him, is his mother, mouth open, waiting to get her say, and his sister who has given up on ever getting her say.

The loving thing may be to let this child rattle on, smile, and try to look as if you cared. The training thing to do is set a limit on the oratory. If necessary, parents can use an egg timer to lay out for the child the two-way nature of interpersonal communication. If that doesn't work, maybe four minutes, judiciously applied, of conversing with the wall of his room will help. But guard your egg timer! Once the child figures out what’s going on, that device is liable to disappear.

Look over the ADHD check list again and see if you cannot detect bits and pieces of infantile egocentricity floating around a lot of those behaviors.

Retained Infantile Omnipotence

The third area of adaptive incompetence, the retention of the omnipotent illusion, is revealed more as an attitude which affects behavior than as a specific incompetence for interpersonal function. However the characteristic is just as crippling.

Where does this omnipotent attitude come from? It is a normal part of infancy. When the baby hollers and the bottle comes, the baby puts two and two together and concludes yelling is what makes bottles come. In time this generalizes to “things happen because I will them to happen.” Mothers go along with until their child is on his or her feet and into things. Then mothers begin to say a few “no’s”. Toddlers do not take kindly to these “no’s” and, if they have an intense and energetic temperament, they fight back. These no/yes exchanges escalate to battles-of-will and temper tantrums. Now the terrible twos are off the launching pad.

It is essential that the terrible twos are worked though, and it is training, not love, which works them through. I describe how this is accomplished, in clinical detail , in my professional paper “An Adaptive Approach to Primary Prevention in Child Psychiatry,” (Perspectives in Biology and Medicine 38, 2 (Winter 1995) and for parents in The Omnipotent Child and Rearing the Preschool Child.

When this phase is not successfully worked through, the child continues to try to impose his will upon those around him. He says things like “You're not the boss of me. I don’t have to do what you say” or, “It's my room I'll keep it dirty if I want.” He believes he should enjoy all the prerogatives adults enjoy. “Why should I go to bed you're not going to bed?”

The omnipotent child truly thinks he is as competent as any grown up. One nine-year-old child I met in my practice once gave me a list of all the adult things he was capable of doing, including driving a car. “I can steer. I know where the gas is. I know to brake.” He ended his long winded declaration by saying “I can do anything adults can do.”

He paused. “Except adultery.”

I asked him what adultery was.

“You know,” he replied. “Filling out income tax forms and all that junk.”

Clearly his omnipotence is illusory.

Consider again, if you will, the fourteen behaviors inscribed on the DSM III tablets. Mature children may want to indulge themselves in some of these behaviors – after all, they are still children – but they don’t indulge themselves. Because they know it is not allowed. “Not allowed by whom?” the literate omnipotent child asks. “The teacher?! She’s not the boss of me.”

Implicit in all the behaviors on the list is a lack of respect for authority, the respect that normal children hold and which makes them try to come up to what the world expects of them.

What to do about omnipotence? When you set up a program such as stay in your seat, or don’t interrupt, the child either obeys or disobeys. When the child obeys, he or she is accepting your right to make rules, which means surrendering the illusion of omnipotence a mite. When the child disobeys he or she gets a punishment. This says, “I’m the mother, you’re the child. Get used to it.” That reality also does wonders to disillusion omnipotence.

Adaptive growth is all of a piece. Training addressed to one cardinal characteristic affects them all.

Of course Ritalin does too. Except when you stop dispensing the Ritalin, you’re back at square one.

Self Esteem

Self esteem is not an adaptive competence. It is a result of the development of well developed adaptive competence.

Whenever a parent sets a limit or communicates an expectation to her child she is training him. When the child copes with the expectation, he masters a little piece of living in the world. We call this coping. An accumulation of coping becomes mastery. Mastery is accompanied by a good feeling, which accumulates over time. The feeling combines confidence and a feeling of worth. Together these feelings help to build the child’s self esteem.

The omnipotent child has poor self esteem because he or she rarely copes. This child’s has not learned to cope and so has never constructed a sense of self esteem. The child has not developed this sense either because his or her parents lacked parenting skills or the child was temperamentally hard to rear. Both of these issues can be dealt with and techniques are described in The Omnipotent Child and Rearing the Preschool Child.

I hope that I have demonstrated my principal intention in writing this book: to show parents that it is necessary to think long and hard before allowing anybody to label their child ADHD and put him or her on Ritalin. All that is left to do is point the way, in the hope that it is not too late to change course, to where we seem to be going with this ADHD nonsense, as I do in Chapter Seven. And maybe to puncture some medical egos with a little satirical humor, as I try to do in Chapter Eight.