I can no longer take this. Over the years, I wondered what might be helpful in such situations—restaurants, grocery stores, airports, and on and on. Ultimately, the idea I term “mini-therapy” emerged. I figured I had about 90 seconds within which to work. Over time I created a three-step process: form an alliance with the parent(s); provide some practical help for the moment; and, finally, chat about what has happened and offer some tools for the future.

So I walked up the aisle, introduced myself, and said something like: “What a handsome, lively young lad you have here!” (I had learned over the years that a punitive, limit-setting approach seemed only to increase the rage and was not too effective!) “Thank you,” she said, and then introduced herself and her son, noting, “But it is tough traveling like this… He gets so fidgety!” I tried to be empathic and validate her feelings: “Travel can be very distressing and difficult, and small children can get bored so quickly.”

Having tried to form a bit of an alliance, I now moved to step two: “I wonder if Leo would like to draw a picture? I have some paper and a couple markers back at my seat. Would that be okay?” I asked mother. “Sure, thank you,” she nodded. I went and got the materials, and Leo took them eagerly. “Draw or write or do whatever you like—we could even make some paper airplanes,” I suggested. Leo plunged in and began scribbling.

I moved on to step three. I said to the mom, “Leo seems like a bright, engaging little boy. I think he’s just bored. He is not a bad kid. His brain is just doing what it is supposed to do—exploring and learning. When he peeks out, or roams around, or can’t sit still, his good brain is looking for stimulation, something to do, something to play with, just like you and I want to read or write or do puzzles or whatever on a trip like this.” We chatted a bit more, and our conversation included a little about feelings and behaviors and infant and child development, and I went back to my seat.

I found myself thinking about a similar incident in a family-style restaurant years ago: I had gone in for breakfast and found it was a nice, quiet place to get a little work done as well. A little girl was playing with some straws while she tried to wait patiently for her breakfast. As the play became more animated, her grandmother slapped her across the face. I had intervened much as described in the incident on the train. When I went to pay my bill, the cashier said two women had already paid it and left me a note. The note read: “Thank you for doing something about that slap—it’s so nice to see that someone cares.” I framed that note, and it hangs in my home office to this day.

So as the train moved on through the darkness, I wondered, Did my interaction with Leo and his mom do any good? Were there any short-term or long-term benefits? I do not know. Things seemed fairly calm and quiet between them over the next few hours before they got off. At times I heard them conversing and laughing a bit. Several times Leo came back to show me what he had drawn or written. Later he gave me two of his pictures. I still have them.

Conference on Human Emotions

For those interested, there is a terrific conference coming this fall dealing with the emotional life of human beings. Hosted by The Tomkins Institute, it will be held October 14-17, 2010 in Fort Worth, Texas.

For information, go to www.Tomkins.org, click on 2010 Conference and then click on Maximizing Brochure.

Author of the renowned book The Scientist in the Crib, Dr. Gopnik engagingly presents a number of studies she and her colleagues have conducted over the years to show what goes on in the minds of infants and small children. For instance, they found that: 18-month-olds can understand preferences in other people which differ from their own (“I might want one thing, whereas you want another” ― the beginnings of empathy!); babies understand the relation between a statistical sample and a population; and young children use statistical evidence and experiments to determine cause and effect. You might enjoy reading the article to see how Alison and her colleagues conducted these studies.

Alison summarized the studies as follows: “when children play spontaneously (‘getting into everything’) they are also exploring cause and effect and doing experiments ― the most effective way to discover how the world works.”

As parents and educators, we are often so eager to “teach” our children, to help them not make the mistakes we made, that we tend to impose rather than listen. Or, as Cat Stevens said in one of his early songs: “As soon as I could talk, I was ordered to listen.” The idea here is to turn all this on its head, listen to the child, and ask: what is the child interested in?

One organization which is quite tuned in to this work is the Ounce of Prevention (www.ounceofprevention.org). As Board Member Susan Baird notes: “The Ounce was founded in 1982 by Irving Harris and has various programs which focus on early learning opportunities for children.” It now has several preschools (termed Educare Schools―www.educarecenters.org) around the country.

In a sense, one can divide development into two overlapping parts, the cognitive and the emotional. The work described above highlights the exciting advances in our understanding how children think and learn, i.e., the cognitive area. We are indebted to Dr. Gopnik and her colleagues for these insights.

Conference on Human Emotions

For those interested, there is a terrific conference coming this fall dealing with the emotional life of human beings. Hosted by The Tomkins Institute, it will be held October 14-17, 2010 in Fort Worth, Texas.

For information, go to www.Tomkins.org, click on 2010 Conference and then click on Maximizing Brochure.

This issue affects human beings around the world. The Position Statement of the American Psychoanalytic Association is quite complete. It highlights the recent research, the national and international issues involved, and the alternatives and solutions. This Position Statement is presented below.

http://apsa.org/About_APsaA/Position_Statements/Physical_Punishment.aspx

American Psychoanalytic Association Position Statement:  Physical Punishment

The American Psychoanalytic Association condemns the use of physical punishment (corporal punishment) in the discipline of children and recommends alternative methods which enhance children’s capacities to develop healthy emotional lives, tolerate frustration, regulate tensions, and behave in socially acceptable ways.

A Social Problem

Physical punishment is a serious public health problem in the United States, and it profoundly affects the mental health of children and the society in which we live. Studies show that over 60% of families use physical punishment to discipline children. Yet, the research shows that physical punishment is associated with an increase in delinquency, antisocial behavior, and aggression in children, and a decrease in the quality of the parent-child relationship, mental health, and the child’s capacity to internalize socially acceptable behavior. Adults who have been subject to physical punishment as children are more likely to abuse their own child or spouse and to manifest criminal behavior (1).

Spanking is a euphemism for hitting. One is not permitted to hit one’s spouse or a stranger; these actions are considered domestic violence and/or assault. Nor should one be permitted to hit a smaller and even more vulnerable child. Hitting a child elicits precisely the feelings one does not want to generate in a child: distress, anger, fear, shame, and disgust. Studies show that children who are hit identify with the aggressor and are more likely to become hitters themselves, i.e., bullies and future abusers of their children and spouses. They tend to learn to use violent behavior as a way to deal with disputes.

Internationally, there is increasing consensus that physical punishment of children violates international human rights law. Significantly, 24 countries have prohibited physical punishment in all settings, including the home. Among these countries are Sweden, Germany, Spain, Greece, and Venezuela. More than 100 countries have banned physical punishment in the schools. The United States has not banned physical punishment, but approval of physical punishment in the United States has declined gradually and steadily over the past 40 years. The United States has signed, but not ratified, the United Nations Convention on the Rights of the Child (CRC), an international treaty which expressly prohibits all forms of physical or mental violence(1).

Effective alternatives to physical punishment exist to help children tolerate frustrations, regulate tension, behave in socially-acceptable ways, develop appropriate ethical and moral standards, and improve self-esteem.

The American Psychoanalytic Association joins other mental health and medical organizations in strongly condemning the use of physical punishment with children. The American Academy of Pediatrics concludes: “Corporal punishment is of limited effectiveness and has potentially deleterious side effects. The American Academy of Pediatrics recommends that parents be encouraged and assisted in the development of methods other than spanking for managing undesired behavior” (2, p. 723).

Defining Physical Punishment

Physical punishment has been defined as “the use of physical force with the intention of causing a child to experience bodily pain or discomfort so as to correct or punish the child’s behavior” (1, p. 9). This includes: spanking, hitting, pinching, squeezing, paddling, whipping/whupping, swatting, smacking, slapping, washing a child’s mouth with soap, making a child kneel on painful objects, and forcing a child to stand or sit in painful positions for long periods of time. Physical abuse can be characterized by “the infliction of physical injury as a result of punching, beating, kicking, biting, burning, shaking, or otherwise harming a child” (5, as cited in 4, p 540). Behaviors which cause pain but not physical injury are considered physical punishment, whereas behaviors which risk physical injury are termed physical abuse. Both physical punishment and physical abuse must be condemned. Alternatives exist which are more effective in enhancing the healthy development of children.

Effective Alternatives

These suggested alternatives provide parents with greater understanding of their children’s development, present strategies which can lead to less violent behavior in children and adults, and decrease the frustration and helplessness in parents which often lead to physical punishment (see also Reference 2).

1. One of the most useful ways to achieve healthy child development is to promote words instead of actions.* Increasing the child’s capacity to put words to feelings and actions results in increased tension regulation, self-awareness, and thoughtful decision-making. This process is accomplished by:

a. Talking and using words instead of actions – talk rather than hit. Talk with the child about what behaviors are acceptable or not, what is safe or dangerous, and why.

b. Listening to the child – find out why he/she did or did not do something.

c. Explaining your reasons – this will enhance the child’s decision – making capacities.

2. The word “discipline” comes from the Latin word for “teaching” or “learning.” Children’s behaviors have meaning, and behaviors are directly connected to inner feelings. Thus, discipline is a process which addresses behaviors and the feelings which cause them.

3. Help the child label his or her feelings with words as early as possible. The nine inborn feelings (interest, enjoyment, surprise, distress, anger, fear, shame, disgust, and dissmell [reaction to noxious odors]) should be labeled with words. This will facilitate tension regulation and aid the transition to more mature ways of handling emotion.

4. Positive reinforcement – rewards and praise – will enhance the child’s self-esteem when appropriate standards are met. Positive reinforcement is more effective in obtaining long-term behavioral compliance than frightening and shaming punishments.

5. Set a good example for the child. The child wants to be like the parents. Children identify with their parents, and they will put feelings and actions into words when they see their parents doing this. Who the parents are, and how they behave, will have a profound impact on the development of their children. Your child will follow your lead.

References

1. Gershoff ET (2008). Report on Physical Punishment in the United States: What Research Tells Us About Its Effects on Children. Columbus OH: Center for Effective Discipline.

2. American Academy of Pediatrics – Committee on Psychosocial Aspects of Child and Family Health (1998). Guidance for Effective Discipline. Pediatrics 101: 723-728.

3. Strauss MA (2001). Beating the Devil Out of Them: Physical Punishment in American Families (2nd Edition). Piscataway NJ: Transaction Publishers.

4. Gershoff ET (2002). Physical punishment by parents and associated child behaviors and experiences: A meta-analytic and theoretical review. Psychological Bulletin 128: 539-579.

5. National Clearinghouse on Child Abuse and Neglect Information (2000). What Is Child Maltreatment?

6. Katan A (1961). Some thoughts about the role of verbalization in early childhood. Psychoanalytic Study of the Child 16: 184-188.

Supporting Research

Gershoff (1,4) examined hundreds of studies and presented the results of meta-analyses of the association between parental physical punishment and child and adult outcomes. She found that in childhood physical punishment was positively associated with aggression, delinquent and antisocial behavior, and being the victim of physical abuse; it was negatively associated with the quality of the parent-child relationship, mental health, and moral internalization (child’s internalizing of socially acceptable behavior); and associations with immediate compliance were mixed. When measured in adulthood, physical punishment was positively associated with aggression, criminal and antisocial behavior, and adult abuse of one’s own child or spouse; physical punishment was negatively associated with mental health.

Gershoff (1,4) also summarized the various demographic and risk factors which are more likely to be associated with use of physical punishment: being single, separated, or divorced; excessive stress from negative life events; maternal depression; lower income, education, and job status; southern part of the United States; and conservative religious beliefs and affiliation.

Conference on Human Emotions

For those interested, there is a terrific conference coming this fall dealing with the emotional life of human beings. Hosted by The Tomkins Institute, it will be held October 14-17, 2010 in Fort Worth, Texas.

For information, go to www.Tomkins.org, click on 2010 Conference and then click on Maximizing Brochure.

This bill would prohibit corporal punishment in public and private schools throughout the United States.  Though there is no evidence that corporal punishment has any beneficial effect on children’s behavior ― and much evidence of deleterious effects ― 20 states still allow it.

A congressional committee recently held a hearing about the subject and found that as many as 10,000-20,000 children sought medical treatment as a result of being physically disciplined in schools.

Many medical and psychological organizations, including the American Academy of Pediatrics, the American Psychoanalytic Association, and the National Association of Social Workers, have position statements condemning physical punishment.

For further information about this congressional bill (HR 5628), go to www.socialworkers.org, click on Advocacy, then Legislative Alerts and Updates, then Support Legislation to Ban Corporal Punishment in Schools.

This post describes the profound impact Silvan Tomkins had on our understanding of human emotions.  It was written in collaboration with Donald Nathanson, MD. 

 
“We do not possess a systematic statement of the psychoanalytic theory of affects” (Rappaport, 1953, p. 476).

“Tomkins began a limited revolution – a paradigm shift, in Kuhnian terms” (Knapp, 1987, p 221).

Freud “had no satisfactory hypothesis to account for affectivity in general… Adequate explanations were finally proposed by Tomkins” (Gedo, 2005, p. 90).

 
Working within the traditions of both Darwin and Freud, Silvan S. Tomkins fused evolutionary and psychodynamic concepts to describe the specific kinds of affects, their mechanism of action, and their development. Tomkins detailed the nature of affect itself and the triggers for each of the nine affects, demonstrating 1) the nature, development, and transformations of the affect system; 2) its virtually unlimited ideo-affective structure; 3) the importance of affect as the source of all motivation; 4) its functional relation to both cognition and the drives; and 5) the clinical implications of these concepts. Psychoanalytic theorist Michael Franz Basch called Tomkins the “founder of modern affect theory” (1991, p. 296).

Silvan Solomon Tomkins was born June 4, 1911, in Philadelphia and died June 10, 1991, at the nearby New Jersey shore he loved so deeply. He entered the University of Pennsylvania with the intent to become a playwright, earned an MA in psychology, and left in 1934 with a doctorate in philosophy. The topics of his dissertation – logic and value theory – remained central throughout his career. In 1936 he began postdoctoral study in philosophy at Harvard University, where he became fascinated by the pioneering work on personality emerging from the Harvard Psychological Clinic under the leadership of Henry A. Murray and Robert W. White. In 1947 he began an 18-year tenure in Princeton University’s Department of Psychology, where his interest in the relation between emotion (which he came to call “affect”) and personality formation became the defining theme of his career.

Tomkins’s life work saw print as the four volumes of Affect Imagery Consciousness (1962, 1963, 1991, 1992). Central was the question: How do such varied internal and external stimuli as biological drives, external events, memory, imagination, thinking, words, and other affects, all trigger the relatively small number of discrete responses he defined as the nine innate affects? Collected as his Affect Theory, Tomkins’s answer involves his definition of the affect system as a set of physiological responses to the increase, decrease, or level (quantity) of any stimulus, and it takes into account both the environment (stimuli) and individual variation (temperament).

Most of the basic inborn affects he described were given a range name to indicate the scope of their variations: interest-excitement, enjoyment-joy, surprise-startle, distress-anguish, anger-rage, fear-terror, shame-humiliation, disgust (reaction to noxious tastes) and dissmell (reaction to noxious odors). These affects combine with each other and with any form of experience to become our complex emotional life. His Script Theory organizes a sophisticated understanding of character structure and draws together a wide range of clinical observations and treatment implications.

Tomkins was mentor to and colleague with Virginia Demos, Paul Ekman, Carroll Izard, and Donald Nathanson, among many others. In the latter half of the 20th century this group was instrumental in advancing the understanding of affect by more specifically describing these universal inherited emotional processes and how they develop and function. As nicely described by Ekman (1998), this work provided compelling evidence to help reject the cultural relativism of Margaret Mead and Gregory Bateson; current scientific data overwhelmingly support the evolutionary and inherited roles of expressions of emotion (Ekman, 1998; Mayr, 2001; Panksepp, 1998).

Tomkins’s theoretical, experimental, and clinical work has been extended by a number of former students, many now working under the banner of The Silvan Tomkins Institute. His ideas have taken root in several fields, and the subject of innate affect now intrigues a new generation of scholars and clinicians. Undoubtedly, time will increasingly enhance our understanding of human feelings and motivation, but perhaps Demos says it best: “Tomkins’ theory represents the state of the art at this time” (1998, p. 102).

(For those interested, the website for the Tomkins Institute is www.tomkins.org. It also contains information about the October 2010 conference.)
References

Basch, M. F. (1976). The concept of affect: A re-examination. Journal of American Psychoanalytic Association, 24, 759-777.

Basch, M. F. (1991). The significance of a theory of affect for psychoanalytic technique. Journal of American Psychoanalytic Association, 39, 291-304.

Demos, E. V. (1998). Differentiating the repetition compulsion from trauma through the lens of Tomkins’ script theory: A response to Russell. In J. G. Teicholz & D. Kriegman (Eds.), Trauma, repetition, and affect regulation: The work of Paul Russell (pp. 67-104). New York: Other Press.

Ekman, P. (Ed.). (1998). The expression of the emotions in man and animals (C. Darwin, 3rd ed.). New York: Oxford University Press. (Original work published 1872)

Gedo, J. E. (2005). Psychoanalysis as biological science: A comprehensive theory. Baltimore: Johns Hopkins University Press.

Knapp, P. H. (1987). Some contemporary contributions to the study of emotions. Journal of American Psychoanalytic Association,35, 205-248.

Mayr, E. (2001). What evolution is. New York: Basic Books.

Nathanson, D.L. (1991) Shame and Pride: Affect, sex, and the birth of the self. New York: WW Norton.

Panksepp, J. (1998). Affective neuroscience: The foundations of human and animal emotions. New York: Oxford University Press.

Rapaport, D. (1967). On the psychoanalytic theory of affects. International Journal of Psychoanalysis, 34, 177-198. In M. M. Gill (Ed.), Collected papers (pp. 476-512). New York: Basic Books. (Original work published 1953)

Tomkins, S. S. (1962). Affect imagery consciousness: Vol. I. The positive affects. New York: Springer.

Tomkins, S. S. (1963). Affect imagery consciousness: Vol. II. The negative affects. New York: Springer.

Tomkins, S. S. (1991). Affect imagery consciousness: Vol. III. The negative affects: Anger and fear. New York: Springer.

Tomkins, S. S. (1992). Affect imagery consciousness: Vol. IV. Cognition: Duplication and transformation of information. New York: Springer.

Roy R. Grinker, Sr., M.D.  (1900 – 1993)

 Roy Grinker’s life spanned nearly the entire 20^th century, and his influence on the development of psychiatry during that century was profound.  A clinician, teacher, researcher, and administrator, he wrote over 25 books, more than 350 papers, was Chief Editor of the Archives of Neurology and Psychiatry from 1956 – 1976, and founded one of the finest inpatient and outpatient psychiatric facilities in the country. 

Grinker was born in 1900 in Chicago, attended the University of Chicago, Rush Medical School, became a neurologist and then psychiatrist, did post-graduate training in Zurich, London, and Hamburg, and at 27 years old became Professor of Neurology and Psychiatry at the new University of Chicago Hospital.  He sought further training in the new field of psychoanalysis, going to Vienna in 1933 where he was one of Freud’s last patients.  Returning to Chicago, he built the Institute for Psychosomatic and Psychiatric Research and Training at Michael Reese Hospital (P&PI) which became renowned for psychiatric treatment, training, and research.  He became Professor of Psychiatry at the University of Chicago, University of Illinois, and Northwestern University, was on the faculty of the Chicago Institute for Psychoanalysis, and served on several editorial boards.

One of Grinker’s first major publications was his neurology textbook (Grinker’s Neurology) (1).  This was followed by two books based on his work with the military in North Africa and Florida during World War II: War Neuroses in North Africa (2) and Men Under Stress (3).  This research involved war trauma and treatment and remains important today.  Grinker was committed to an integrated biopsychosocial view of understanding human functioning, as reflected in his 1956 book Toward a Unified Theory of Human Behavior (4).  Over the next 35 years, he pioneered work in three major clinical areas: depression, borderline psychopathology and character structure, and schizophrenia.  These studies were published in 1961 (The Phenomena of Depressions) (5), 1968 (The Borderline Syndrome) (6), and 1987 (Clinical Research in Schizophrenia) (7); of all his work, he may be best known for his research on the borderline dilemma.

In the midst of this productive professional life, he also had an active social life.  He married and had two children, a daughter who became a lawyer and a son who became a psychoanalyst.  He enjoyed bridge, gin rummy, golf, and horseshoes.  Unfortunately, later in life he developed herpes zoster and suffered intractable pain until his death at age 93.

Roy Grinker was especially proud of his teaching and training, and many of his students went on to become chairs of departments across the country.  He used to tell his residents who were anxious about graduating and going out into the world: “Well, you can always start the program over!”  During his career, Grinker’s interests ranged over neurology, psychiatry, psychosomatic medicine, clinical research, and psychoanalysis.  Ultimately, he was a mentor and role-model for several generations of teachers and leaders in all these various fields.

1. Grinker RR: Grinker’s Neurology.  Springfield, IL: Charles C. Thomas, 1933.
2. Grinker RR, Spiegel J: War Neuroses in North Africa. New York: Macy Foundation, 1943.
3. Grinker RR, Spiegel J: Men Under Stress.  Philadelphia: Blakiston, 1945.
4. Grinker RR: Toward a Unified Theory of Human Behavior. New York: Basic Books, 1956.
5. Grinker RR et al: The Phenomena of Depressions.  New York: Hoeber, 1961.
6. Grinker RR et al: The Borderline Syndrome.  New York: Basic Books, 1968.
7. Grinker RR, Harrow M: Clinical Research in Schizophrenia.  Springfield, IL: Charles C. Thomas, 1987.

What Is ADHD — And Why Are So Many Major League

Baseball Players Getting This Diagnosis? 

How Do You Spell D-R-U-G-S?
Baseball Is Asking For Trouble Again

In December, 2009, the New York Times reported that the number of major league baseball players permitted to take otherwise-banned stimulants rose for the third year in a row, to 108 players (Michael S. Schmidt, New York Times, 12/1/09).  The report was released by the testing administrator, Dr. Bryan Smith.  Players can use these stimulants by virtue of having been diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD) (Attention Deficit Disorder – or ADD – is an older term and is now subsumed under ADHD).  In 2008, 106 players were granted therapeutic use exemptions, representing 7.86% of all major league baseball players.  In 2007, 103 players were exempted, and, in 2006, 28 players. 

Thus, the data look like this:

2006 = 28 players given therapeutic exemptions

2007 = 103 players given therapeutic exemptions

2008 = 106 players given therapeutic exemptions

2009 = 108 players given therapeutic exemptions

Baseball says that this represents a leveling off and that few new exemptions are being given.  That sounds good, but can we still be a bit skeptical?

Data from epidemiologic studies indicate that the prevalence of ADHD in children worldwide may be as high as 8-12%; however, existing data show that in adulthood the prevalence of ADHD decreases to 3-5% (1-3).  So how can it be that major leagues baseball players have approximately twice the usual rate of ADHD?  How do you spell D-R-U-G-S?

What Is ADHD?
ADHD is a neuropsychiatric condition characterized by problems with organization, sustaining attention, procrastination, daydreaming, hyperactivity, restlessness, and impulsivity (4).  The causation of this symptom complex is not clear.  It is most likely multi-faceted, involving a combination of biological and psychological factors.  There are probably subgroups, within which either the biological or the psychological is more dominant.

This is a very complex and controversial problem (5-8).  Are people born with brains which develop or are vulnerable to developing ADHD?  Do early parenting problems and trauma cause or contribute to biological changes and susceptibility to developing ADHD?  The jury is still out on these questions – the answers are simply not there yet.

What is the Treatment for ADHD?
The treatment for ADHD includes medications, psychotherapy (e.g., talking therapy, psychodynamic psychotherapy, cognitive behavioral therapy, etc.) and educational assistance (studying and organizational skills, tutoring, and the like).  Medications tend to be the predominant form of treatment, but this is where things get complicated: those who work intensely with children report that talking therapy can be very effective with some children who have been diagnosed with ADHD.

So what medications are used for ADHD?  Some of the commonest are Ritalin (methylphenidate), Concerta (methylphenidate), Focalin (methylphenidate), Dexedrine (dextroamphetamine), Adderall (dextroamphetamine plus amphetamine), Strattera (atomoxetine), and Provigil (modafinil).

And what are these medications?  They are amphetamines or amphetamine-like drugs!  They are performance enhancers!  They are among the most abused drugs in the world.  Perhaps most importantly, these medications are routinely sold and bought by children and adolescents in school.  They are addictive.  Some recent studies have shown them to be associated with sudden death (9, 10).  And we do not yet know the long-term effects of sustained use of these medications.

Baseball and ADHD
Now – back to baseball.  No doubt some major league ballplayers are legitimately diagnosed with and treated for ADHD… but 2-3 times the usual adult rate of ADHD?

In response to the steroid scandal, baseball instituted an increasingly effective drug-testing program.  However, it is hard not to be skeptical about the high incidence of ADHD diagnoses among major league baseball players.  It is hard to escape the conclusion that many players are being diagnosed ADHD as a way to obtain amphetamines and amphetamine-like drugs.

The following questions emerge:  What professionals are diagnosing these players?  What kind of physicians are treating and prescribing medication for them?  Are Board-Certified psychiatrists with experience in ADHD involved in any part of the process?  How much are the professionals involved in the diagnostic and prescribing process being paid?

Summary
It would appear baseball once again is asking for trouble in the drug arena.  The solution is readily available: oversight by the appropriate physicians.  But first things first: baseball must acknowledge and investigate yet another problem of potential drug abuse.

References

1. Faraone SV, Sergeant J, Gillberg C, Biederman J (2003). The worldwide prevalence of ADHD: Is it an American condition?  World Psychiatry 2:104-113.
2. Kessler RC, Adler L, Barkley R, et al (2006).  The prevalence and correlates of adult ADHD in the United States: Results from the National Comorbidity Survey Replication.  Am J Psychiatry 163:716-723.
3. Faraone SV, Biederman J (2005).  What is the prevalence of adult ADHD?  Results of a population screen of 966 adults.  J Atten Disord 9:384-391.
4. American Psychiatric Association (2000).  Diagnostic and Statistical Manual of Mental Disorders: DSM IV-TR. 4^th ed.  Washington, DC: American Psychiatric Association.
5. Faraone SV, Biederman J (2009).  Attention-deficit/hyperactivity disorder research: Current status and future directions.  J ADHD Relat Disord 1:7-13.
6. Sugarman A (2006).  Attention deficit hyperactivity disorder and trauma.  Int J Psychonal 87:237-241.
7. Salomonsson B (2004).  Some psychoanalytic viewpoints on neuropsychiatric disorders in children.  Int J Psychoanal 85:117-136.
8. Salomonsson B (2006).  The impact of words on children with ADHD and DAMP.  Int J Psychoanal 87:1029-1047.
9. Vitiello B, Towbin K (2009).  Stimulant treatment of ADHD and risk of sudden death in children.  Am J Psychiatry 166: 955-957.
10. Gould MS et al (2009).  Sudden death and use of stimulant medications in youths.  Am J Psychiatry 166: 992-1001.

Bob Dylan’s line from his song “Tangled Up In Blue” sums up beautifully much of infant and child development, particularly the problems some parents experience as their infant transitions into toddlerhood and begins to talk. Babies and their parents do have the same feelings, but a very different point of view – parents have language, and this changes everything!

All human beings are born with the same built-in feelings. The best model we have currently suggests about nine such feelings (previous posts describe this in detail). These are interest, enjoyment, surprise, distress, anger, fear, shame, disgust (a reaction to toxic tastes) and dissmell (a reaction to toxic odors). The parents have words and language for the feelings… but the infant does not! How does she express and communicate her feelings? Through her facial expressions and gestures and the noises she makes! So how do the parents know what her baby is feeling? The parents translate – they translate from the facial expressions, gestures, and noises to the feelings! The key is translation.

So what happens when language appears between about 1 and 3 years of age? Daniel Stern calls language a double-edged sword: it can distort as well as aid communication, especially in the world of feelings. The toddler’s early language tends to be quite limited and primitive, and it is this transition to language which can cause things to go awry.

Say a 1-year-old girl drops her toy car from her highchair – she points, makes noises, and, with too much delay, begins to whimper or get red in the face and squalls. The feelings? Increasing distress and anger. Most parents will understand these feelings, be reassuring, and pick up the car.

Now, let’s fast-forward a year or two – the same girl, highchair, and car. The car falls. The girl is patient, but then begins to get upset… “Car, car!” she calls out. With too much delay, the voice gets more strident: “Car down!” And, finally, she cries out to the too-slowing-moving parent: “I no like you! I hate you!” The parent may feel assaulted and lash back: “Don’t talk like that… we don’t use those words here!”

What has happened? The feelings at one year and three years are the same: the little girl is feeling distress and anger when her car falls and she can’t get it back. But the same parent who could understand the feelings of the younger girl now is thrown off by the words of the older girl – even though the feelings are the same. The answer? Again, translation – but this time into the feelings from the words!

It’s the feelings which are most important. Why? Because it is feelings which lead to actions. Understand your child’s feelings and you will understand your child. Translate your child’s expressions – or words – back into the feelings. Label these feelings with your child: interest, enjoyment, distress, fear, and so on. Use the language of feelings.

Dylan got it right. We do feel the same – we may just be starting from a different point of view. The solution is easy – just translate into feelings!

 Teenagers cause parents such angst!  So let’s address three questions: What are some of the issues with which parents and teens struggle?  How can we understand teenagers?  And what one key might be most helpful in your relationship with your teen and his or her development?

Teen and Parent Issues

Teenagers are remarkable – the volatility!  The passion!  The chaos, self-absorption, mood shifts, love and anger, separation and closeness. 

What are teenagers dealing with?  Physical changes, puberty, sexuality; the formation of their own identity, as they grapple with their identifications with their mother and father and try to figure out their own interests.  Increased pressure around school, work, and friendships abound.

And what do parents struggle with?  How to give their teens both roots and wings — how to enhance healthy maturation and independence while providing necessary structure and boundaries.  And the arguments and distortions the teens inflict upon their parents — all this can leave parents gasping, remembering their own adolescence, and asking themselves why their teenagers have to separate in such a noisy, messy (in every sense of the word!), and provocative fashion.

Understanding Your Teenager: Focus on the Feelings

The best way to understand your teenager is by focusing on his or her feelings.  Feelings are the foundation.  Behaviors are caused by feelings.

Human beings appear to be born with the capacity for approximately nine feelings: interest (curiosity), enjoyment, surprise, distress, anger, fear, shame, disgust (reaction to toxic tastes) and dissmell (reaction to toxic odors).  These feelings combine with each other and with experience to form our complex emotional life.  Remember the issues with which teenagers struggle as noted above?  These issues all stir up feelings: distress, joy, anger, embarrassment, and on and on.

 So, how can we make teenagers understandable?  Focus on — and talk about — their feelings!

The Main Key

And, yes, in the midst of all this complexity, there really is one major key which can enhance your relationship with your teenager and help his or her development.  Focus like a laser beam on the feeling of interest (or curiosity).  The feeling of interest is the root of all our exploratory, learning, and creative activities.  Do your best with your teenager to figure out what his/her major interest(s) is, and then help pursue it.  Does she like horses and riding?  Find her a stable and opportunity to ride and take care of horses.  Does he love baseball?  Take him to games, get him a coach, and help him participate in whatever teams and leagues he wants.  Does she like acting and singing?  Get her to drama classes, stage opportunities, and a voice instructor.  Is he passionate about firefighting and paramedic work?  Hook him up with fire department programs, ride-along opportunities, and CPR and paramedic classes.  Think it won’t work?  Try it!

By understanding and focusing on what your teenager is interested in, you set them up to put 110% into their life.  You give them great teen years, and you also give them the best tools for the rest of life’s major decisions — their work and relationships.

The last several articles focused on setting up a foundation for understanding feelings. The best current model suggests human beings are born with nine feelings: interest, enjoyment, surprise, distress, anger, fear, shame, disgust (a reaction to toxic tastes) and dissmell (a reaction to toxic odors). These feelings combine with each other and with experience to form our more complex adult emotions.

The problem with physical punishment is twofold. First, physical punishment elicits precisely the negative feelings one does not want to generate in children, namely, distress, anger, fear, shame, and disgust. Second, physical punishment squashes precisely the feelings one wants to encourage in children, specifically interest and enjoyment.

For instance, what about the little boy or girl who is consistently hit for “getting into everything”? In such a case, distress, anger, fear, and shame become associated with the feeling of interest, which is exactly what one does not want because interest drives our learning and exploratory activities. Or how about so-called “bad words”? Try reaching for the dictionary, not the soap. The dictionary triggers interest (learning), the soap triggers anger, fear, and disgust (inhibiting learning).

Effective Alternatives to Physical Punishment

These alternatives provide parents and other caregivers with a focus on child development. They present strategies which can lead to less violent behavior in children and adults, and they can help decrease the frustration and helplessness in parents which often lead to physical punishment.

1. One of the most useful ways to achieve healthy child development is to promote words instead of actions. As Anny Katan eloquently summarized: “If a child would verbalize his feelings, he would learn to delay action.” Increasing the child’s capacity to put words to feelings and actions results in increased tension regulation, self-awareness, and thoughtful decision-making. This process is accomplished by:

a. Talking and using words instead of actions – talk rather than hit. Talk with the child about what behaviors are acceptable or not, what is safe or dangerous, and why.

b. Listening to the child – find out why he/she did or did not do something.

c. Explaining your reasons – this will enhance the child’s decision-making capacities.

2. The word “discipline” comes from the Latin word for “teaching” or “learning.” Children’s behaviors have meaning, and behaviors are directly connected to inner feelings. Thus, discipline is a process which addresses behaviors and the feelings which cause them.

3. Help the child label his or her feelings with words as early as possible. The nine inborn feelings (interest, enjoyment, surprise, distress, anger, fear, shame, disgust, and dissmell) should be labeled with words. This will facilitate tension regulation and aid the transition to more mature ways of handling emotion.

4. Positive reinforcement – rewards and praise – will enhance the child’s self-esteem when appropriate standards are met. Positive reinforcement is more effective in obtaining long-term behavioral compliance than frightening and shaming punishments.

5. Set a good example for the child. The child wants to be like the parents. Children identify with their parents, and they will put feelings and actions into words when they see their parents doing this. Who the parents are, and how they behave, will have a profound impact on the development of their children. Your child will follow your lead.

Suggested Readings

American Academy of Pediatrics – Committee on Psychosocial Aspects of Child and Family Health (1998). Guidance for Effective Discipline. Pediatrics 101: 723-728.

Darwin C (1872). The Expression of the Emotions in Man and Animals. (Third Edition, P. Ekman, Editor). Oxford University Press, 1998.

Gershoff ET (2008). Report on Physical Punishment in the United States: What Research Tells Us About Its Effects on Children. Columbus OH: Center for Effective Discipline.

Gershoff ET (2002). Physical punishment by parents and associated child behaviors and experiences: A meta-analytic and theoretical review. Psychological Bulletin 128: 539-579.

Holinger PC (2003). What Babies Say Before They Can Talk: The Nine Signals Infants Use to Express Their Feelings. New York: Simon and Schuster.

Katan A (1961). Some thoughts about the role of verbalization in early childhood. Psychoanalytic Study of the Child 16: 184-188.

Strauss MA (2001). Beating the Devil Out of Them: Physical Punishment in American Families (2nd Edition). Piscataway NJ: Transaction Publishers.