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.

Overview of Physical Punishment

It turns out that 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 still 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 physical punishment is associated with 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 (see Readings, 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 will “identify with the aggressor,” and they 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.

What Is Physical Punishment?  What is Physical Abuse?

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” (see Readings, 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” (see Readings, 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 should stop.  Alternatives exist which are more effective in enhancing the healthy development of children.

International Considerations

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 (see Readings, 1).

Effective Alternatives to Physical Punishment

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” (see Readings, 2, p. 723).

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.  These alternatives will be the subject of the next article. 

As Martin Luther King, Jr., stated: “I’m sick and tired of violence… I’m tired of war and conflict in the world.  I’m tired of shooting.  I’m tired of hatred.  I’m tired of selfishness.  I’m tired of evil.  I’m not going to use violence no matter who says it!”  (As quoted in At Canaan’s Edge by Brandon Taylor).

If we truly want a less violent society, not hitting our children is a good place to start. 

 Readings

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 (2^nd 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?

Additional Research

Gershoff 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 (Readings, 1, 4).

Gershoff 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 (Readings, 1, 4).

It has become fashionable of late to trash the “parenting market” — that is, the books and magazines and TV shows which deal with parenting.  Yet, much of this “parenting market” is a response to well-intentioned parents who are trying their best with their children to prevent problems and enhance potential.  And, in fact, much progress has been made, with sophisticated explorations of the inner world of children and adults beginning in the early 1900’s via psychoanalysis and child psychoanalysis.  The pioneers writing for the lay public back then had their hands full: they were struggling just to get parents to stop threatening their children with castration and to understand that masturbation did not cause serious mental illness!

So, progress is being made, and part of the purpose of the last few articles has been to show how much better we understand feelings (motivations) and the actions (behaviors) which result.  Many people have contributed to these advances; a few of them are noted here, with some names being more familiar than others: Sigmund Freud, Anna Freud, Klein, Piaget, Spitz, Winnicott, Mahler, Fraiberg, Tomkins, and Stern.

But, of course, there is still progress to be made, and this ushers in the discussion of physical (corporal) punishment.  Physical punishment is a major public health problem in the United States, and it is still underemphasized and largely unaddressed.

Physical punishment will be discussed in detail in the next article, but a few introductory comments might be made here.  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 behaviors; 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 (see the Readings below).  Internationally, there is increasing consensus that physical punishment of children violates international human rights law.

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.”  A marvelous recent report summarizing the research in this area has been written by Elizabeth Gershoff, Ph.D., and is titled Report on Physical Punishment in the United States: What Research Tells Us About Its Effects on Children (see Readings below).  It can be accessed through the Center for Effective Discipline (www.StopHitting.org).

Readings

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

Fraiberg S, Adelson E, and Shapiro V (1975).  Ghosts in the nursery: A psychoanalytic approach to the problems of impaired infant-mother relationships.  Journal of the American Academy of Child Psychiatry 14 (1975): 387-421.

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.

 Now, how do these feelings work? Try putting aside everything you have ever learned about feelings before!

 Surprise, fear, and interest depend on the speed of the in-coming stimulus. Any stimulus (noise, light, etc.) which comes in very fast will cause the baby to be surprised (and to show that facial expression). If the stimulus comes in a bit slower, the baby will register fear. And if the stimulus comes in still more slowly, interest is seen in the baby’s face. Previous posts show these expressions. Think about it in terms of the baby’s brain needing time to process the incoming information, and showing these various expressions as it does so. This model also takes into account individual differences between babies, because different babies will process different information at different rates.

Example: Several young children are walking to a auditorium somewhat near an airport. Suddenly, there is a loud noise, and the children jump, their faces showing a surprise reaction; moments later, their faces show the fear expression; and then, as they look up and realize the noise was caused by an airplane flying low over the rooftops, they manifest the interest expression. These feelings, or “affects”, can occur very quickly—milliseconds.

Distress and anger do not depend on the speed of the in-coming stimulus, but rather on the amount, or quantity, of the stimulus. Any stimulus (again, light or noise or pain or whatever) which is too much for the baby will cause the distress reaction. If this stimulus becomes greater or is sustained too long, the anger reaction occurs. This is very important for parents to understand…the anger of a baby (and adult!) is simply excessive distress, a “too muchness”! Think of adults: too much stress leads to distress; even more stress leads to irritability and anger.

 Also, too much of any negative feeling can lead to anger. Example: Your young child runs into the street. When you catch up to him, you are mad. Why? Because your fear and distress were triggered and  heightened, and then morphed into anger.

 Enjoyment is signaled by a decrease in tension. Think of how you feel when you are distressed or scared of something and the issue is resolved.

 Shame is a reaction to the interruption of interest and/or enjoyment. Example:  The baby is in her high chair with a cup of milk in front of her. The parent leaves the room, and the baby begins playing with the milk…it smells good, tastes good, and looks neat as it splashes out of the cup; she lifts the cup up and slowly begins pouring it out, making a wonderful white waterfall—and then the parent walks in again! “What in the world are you doing?” her parent may yelp, and with this interruption of the baby’s interest and exploratory activities, the baby’s eyes may drop, head avert, and shoulders slump, in the classic expression of shame.

 Disgust and dissmell are the body’s  defensive reactions to bad toxic tastes and odors, respectively. Later, they take on psychological meaning, such as “this situation leaves a bad taste in my mouth.”

 So try thinking about your and your baby’s feelings in this different way. Adults have these feelings too:  these nine feelings combine with each other and with experience to form our more complex adult emotional life. 

                                                             Readings

 The following readings give more examples and pictures, and, for those who are interested, convey some of the complexities of this model.

 Holinger, Paul C. (2003) . What Babies Say Before They Can Tal k: The Nine Signals Infants Use To Express Their Feelings. New York: Simon and Schuster.

 Holinger, Paul C. (2008). Further issues in the psychology of affect and motivation: A developmental perspective. Psychoanalytic Psychology 25:425-442.

There are six negative feelings.

Distress:          Distress is an “SOS” signal – the baby is saying “I need help!  Something is wrong!”  The eyebrows arch in the middle, the corners of the mouth turn down, and there may be tears and crying, or fussiness.

Anger:              Anger is really an “SOS” signal!  While most of us feel assaulted and hurt by someone’s anger, anger from the baby really means “I need help!”  Why?  Because anger is simply excessive distress.  There may be a clenched jaw, red face, slit eyes, distended nostrils; or you may see the “roar of rage,” with screaming, kicking, hitting, or biting.

Fear:                Fear occurs when something happens too quickly for the baby to control or understand.  Fear is quite toxic and may be expressed in several ways.  The baby’s eyes may be frozen open, skin pale, trembling, hair on end; she may be very still or cry out.

Shame:             A shame reaction occurs when your baby’s interest or enjoyment feeling is interrupted.  Shame is marked by slumped shoulders, downcast eyes, and sometimes head averted.

Disgust:           This is a reaction to bad tastes – it is built-in to protect your baby!  Disgust is shown by a protruding lower lip and tongue, sometimes with spitting things out or becoming nauseous and vomiting.  Later, this reaction is expressed psychologically, as in “this situation left a bad taste in my mouth.”

Dissmell:         This is also a protective device – it protects the baby from substances with bad odors.  The baby raises and averts his head, raises his upper lip and wrinkles his nose.  Later this reaction turns into the feeling that “this idea smells bad.” 

This, then, completes our list of nine built-in feelings.  Next time we talk about how these feelings work – and when you understand how they work, your life as a parent becomes much easier!

Over the next several months, we’ll be looking at infant and child development, parenting, and the role of feelings.  If you understand what your child is feeling, everything else falls into place.

Some of the topics I’ll take up include your baby’s earliest feelings, how they are expressed, what feelings are and how they work, and how understanding feelings can make sense of not only early childhood, but adolescence and adulthood as well.  We’ll take a look at pictures of babies, and we’ll explore specific issues such as self-esteem, corporal punishment, recent research, and the views of experts in a variety of fields.

For the moment, let’s just take a brief look at your baby’s earliest feelings.  You might ask “How do you know my baby even has feelings?”  Great question!  After all, the baby is not using words yet to tell you how he/she is feeling!  I’ll explore this question later when discussing how feelings work, but for now the answer lies primarily in the facial expressions of your baby.

Current research shows that your baby is born with about 8 to 10 built-in feelings, as shown by the facial expressions.  Although there are some interesting controversies in this area, the best information available now suggests humans are born with 9 feelings:

Interest (curiosity)

Enjoyment

Surprise

Distress

Anger

Fear

Shame

Disgust (a reaction to noxious tastes)

Dissmell (a reaction to noxious odors)

Believe it or not, these are your baby’s earliest feelings!  Most of them are apparent within the first few days of your baby’s life.  Over time, they will combine with experience and with each other to form our more complex emotional life.  This is the embryology of feelings!

These feelings operate on a low-to-high scale, so that the range of feelings looks like this:

Interest – Excitement

Enjoyment – Joy

Surprise – Startle

Distress – Anguish

Anger – Rage

Fear – Terror

Shame – Humiliation

Disgust – lower to higher levels

Dissmell – lower to higher levels

“But,” you might say, “What do all these look like?   How does my baby communicate these feelings?  And, most importantly, what do I do with them?!”

Again, great questions!  And if you use these feelings to understand your baby, parenting – and your life – becomes a lot easier… so, that’s where we’ll start next time! 

Suggested Readings

1. Ekman, Paul.  Emotions Revealed: Recognizing Faces and Feelings to Improve Communication and Emotional Life.  New York: Henry Holt, 2003.
2. Stern, Daniel.  The Interpersonal World of the Infant.  New York: Basic Books, 1985.
3. Tomkins, Silvan S.  Affect Imagery Consciousness (Volume III): The Negative Affects: Anger and Fear.  New York: Springer, 1991.

 What Do Feelings Look Like?

 Last time the discussion involved your baby’s earliest feelings.  The idea was introduced that human beings are born with about 8-10 reactions, or feelings, which turn into the more complex adult emotional life.  Today the exploration involves what these feelings look like – that is, how your baby expresses her feelings.  In a future discussion, we will examine how feelings work.

The human face is made up of many small muscles.  These muscles help give the face its expressiveness.  The face is a wonderful area for communication.  The infant cannot talk.  “Infant” means “incapable of speech.”  So the infant uses its face, along with vocalizations and bodily movements, to express what’s going on.

Studies show that babies prefer to look at human faces more than anything else.  They especially focus on the eyes and the mouth.  The eyes and mouth have the most muscles in the face and can send the most overt and subtle messages.  Thus, the baby and the adult communicate largely through their faces.  The adult will also use words, which the baby will gradually learn and hook up with feelings.  As future articles will explore, things can get complicated and confused because the words of the adult may not accurately label the feelings of the baby; in addition, adults are able, to some extent, to mask and distort their basic innate feelings. 

One way to understand feelings is to divide them up into positive and negative feelings.  There are two positive feelings: interest and enjoyment.  There is one transitional or “re-setting” feeling, surprise: surprise seems to clear or rest the nervous system to prepare it for the next stimulus.  There are six negative feelings: distress, anger, fear, shame, disgust, and dissmell.

You might wonder: why are there more negative than positive feelings?  Great question!  It may be because it is more important for your baby to let you know when there are problems than when things are going well.   Negative feelings are really “SOS” signals.  Negative feelings are your baby’s way of saying “Please help! I am in trouble – something is wrong here!”

Today, the positive and transitional feelings will be presented.  Each feeling will be described and shown how it is expressed. 

Positive Feelings

Interest (curiosity): The feeling of interest or curiosity is seen in your baby’s exploring.  Interest is the root of our learning and creativity.  The facial expression includes the baby being focused, looking and listening, engrossed.  The eyebrows may be slightly lifted or slightly lowered; the mouth may be a bit open.

Enjoyment:       Your baby smiles, her lips widens up and out, she laughs, and her eyes brighten.  She may make some high-pitched sounds and gleeful noises.  If your baby is smiling and laughing, all is well.

Transitional Feelings

Surprise:          The baby’s eyebrows are up, and the mouth forms an “O” shape.  Her head may turn, and she may make an effort to turn the body if the surprise came from the side or in back of her.

So these, then, are the earliest positive and transitional feelings.  The next time the negative feelings will be examined.

Suggested Readings

Ekman P (2003).  Emotions Revealed: Recognizing Faces and Feelings to Improve Communication and Emotional Life.  New York: Henry Holt.