016: Listening, Growth, and Lifelong Resilience

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Transcript Jen: [00:30] Hello and welcome to the Your Parenting Mojo podcast. In today’s episode, we’re going to learn a lot about the science of what’s going on behind a child’s difficult behavior, including the behavior that is often described as a symptom of ADHD. I’d like to extend a warm welcome to my guest, Dr. Claudia Gold MD. Dr. Gold is a pediatrician and writer with a longstanding interest in addressing children’s mental health care in a preventive model. She’s practiced general and behavioral pediatrics for 25 years and currently specializes in early childhood mental health. Dr Gold’s latest book is The Silenced Child: From Labels, Medications, and Quick Fix Solutions to Listening, Growth, and Life-Long Resilience. Welcome Dr. Gold. Thank you so much for joining us. Dr. Gold:   [01:11] Thank you for having me. Jen:  [01:12] So you spent a while running an ADHD practice earlier in your career, right? Dr. Gold: [01:17] Well, as part of a general pediatrics practice, yes. Jen: [01:20] Okay. I wonder if you could tell us a little bit about that experience and how it contributed to your feeling the need to write this book? Dr. Gold: [01:27] Well, um, I think it was because there were the visits allotted were generally 30 minutes long. Kids came in not with a plan to just listen to them but rather for what was termed in ADHD evaluation. So it was almost like we had decided what was the problem before we even spoke to them and it was, I found that it was really not sufficient time to understand what was going on in the family and then the kind of standard of care for treatment of ADHD is to see kids every three months and to just have them have their medication refilled. And again, it was not nearly enough time to really understand all the complexities in their lives. So then when I practiced behavioral pediatrics so that I was able to have appointments that were longer and I would sit with these families and, and listen in more depth, I would really come to appreciate all of the factors that were impacting on the child’s behavior and able to have a much broader view than the opportunities given me by the kind of standard of care in pediatrics. Jen: [02:39] And what might some of those factors be that could influence behavior that’s like ADHD? Dr. Gold: [02:44] Oh, well there are, for example, um, I had one family where, uh, there was significant amount of a substance abuse in the family that was untreated and unaddressed, one child who actually had experienced the death of a parent and was being raised by a step parent with things that had never been addressed or acknowledged stresses on kids, that people just felt didn’t really impact on kids that were young. Which of course we know is not the case. So I think so there were, you know, dramatic things like that. Other things that I began that I, in the course of my practice, I began to have a great respect for, um, challenges of sensory processing, not to say that kids have a sensory processing disorder per se because I don’t really like to think in terms of disorder, but I really have gained an appreciation of how a kid’s sensory experience of the world is very intimately intertwined with the way their emotional experience and a lot of kids who have the ADHD label based on just sort of a basic checklist have for much of their lives, had challenges in this area that have not been addressed. So those are a couple of the things that I was able to uncover. Jen: [04:12] It seems as though the traditional approach to ADHD like a lot of other childhood behavioral problems is really to just focus on the behavior and if you fix the behavior, you’ve fixed the problem. Can you tell us how you think differently from that; what do you think difficult behavior really is? Dr. Gold:  [04:28] Well, I think again, what the science shows us is that behavior is a form of communication and babies actually, even from birth have the ability to communicate with us through their behavior. So and when we look at the meaning of their behavior, again, in my first book, I talk a lot about the decades of research showing us that when, when the people who care for children are curious about the meaning of behavior, then we help them to develop the ability to think about their own feelings, to have better capacity for emotional regulation, to have better social skills, to have better thinking skills and really develop the capacity for resilience. So to kind of be concrete about it. I would have a family come in and say, well, we can’t get our child ready to go out the door. And so he’s very disorganized and loses things and all those very typical ADHD symptoms so that, uh, if we. Yeah, and you know, it’s true that the medications for ADHD are very effective at getting, eliminating me symptoms at least in the short term. but then when you dig a little deeper, you find, for example, a kid is very disorganized, is extremely anxious and so they are so focused on, let’s say, whether or not their parent is going to pick them up because a lot of kids who experienced a lot of anxiety or have separation anxiety. So let’s say that kid is worried the entire day and spending all of their energy worrying about whether or not their parent is going to pick them up so they don’t have the ability to spend the time to put the right piece of paper in the right folder so that underlying their disorganization is some significant issue in relationships. And so when we just treat the symptom, that’s just one of a gazillion examples I could give you. We just treat the symptom. We don’t get to hear what the child’s behavior is communicating and it’s when we hear that, what it’s communicating that we know what to do about it. Jen:  06:42 And it seems to me as the central thesis of the book, is that our healthcare system is really geared towards this treating of the symptoms. And if you’ll indulge me, I just want to read a paragraph from the book you say, “I recently had the opportunity to teach a seminar and infant mental health to the child psychiatry fellows at a major teaching hospital of just spending an hour giving an overview of contemporary research on infant mental health. I presented a case of a seven year old boy with a very complex family and developmental history. I then turned to the group and the how they would make sense of his behavior. A fellow responded without pause, ‘I would see if he met the DSM, the diagnostic and statistical manual I think it is, criteria for a mood disorder, and then consider prescribing an SSRI. A similarly complex case was met by this question from the head of psychiatry: ‘Do the parents need parent training or does the child have ADHD and need medication?'” And it almost seems as though the medical professionals in the system that we’ve set up for ourselves don’t have any time or energy or something to understand these underlying symptoms. And instead, the treat that behavior is, is the first thing that that happens. Dr. Gold: [07:52] Right. I mean, I think time is certainly lacking. I also think that a basic understanding is lacking because, and a language to talk about this because in child psychiatry training, there’s really minimal to no discussion of development and relationships. I know that sounds shocking. It’s very much based on diagnosis, and treatment often with medication so that there’s no language, there’s no way to think about, well, how do we make sense of what happened to this person in their infancy and how that connects with who they are today at the age of seven, and that’s what we need in order to really understand what’s going on for a kid, how kids develop the ability to regulate their attention, to regulate their emotions, to regulate their behaviors. And then once we understand that, then we know again, what kinds of things to do to help. But the psychiatrists don’t even have a way to ask about that or to think it. And that’s why they ended up with a very limited toolbox, which is just to look at the behavior and then eliminate the behavior. Jen: [09:04] Yeah, I’ve been doing a lot of thinking lately about how we transition from childhood to adulthood and how we treat adults and how we treat child children and how those two are different than you and I tend to think we have something going on between our ears. We agree and acknowledge that we have feelings and that sometimes it’s nice to have someone listen to these feelings and acknowledge them and also that those feelings impact our behavior. But it seems as though a lot of people feel as though children don’t and that all that matters is their behavior. And I guess I’m curious as to your thoughts as to when we make that shift, to the child is a person who, who has feelings that really impact what their behavior is as they get older. And whereas in the beginning it was just the child has behavior. How does that shift occur, do you think? Dr. Gold:   [09:55] That’s a great question. I mean, it really should occur when the baby is born. Jen: [10:01] I agree. Dr. Gold: [10:03] Yeah. I mean, I, and that’s what, and in fact, the work I do is with something called a newborn behavioral observation system where we go in and work with parents and babies from birth because of baby, even a very young baby can communicate. For example, I was talking about the sensory issues. A baby who is born with a particular intense response to touch, let’s say for example, not that there’s anything wrong with them, but that baby may cry and cry and cry when they’re swaddled and then when you put them down, they stop crying. So that’s how they’re communicating through their behavior. And they have tremendous capacity to do that from very early on, but we just need to be paying attention to it and take the time to listen to what their behavior is communicating. And it takes what it means to listen to a child takes different forms at different ages. Dr. Gold: [10:58] So for example, with toddlers, a toddler with out of control behavior may may seem like he’s trying to make your life miserable, but what he actually made me communicating is that he feels out of control and he’s looking for you to help him to set limits to, to contain his big angry feelings. So depending on where the child is developmentally, the way they communicate is different. But the idea is the same that when we take the time to listen to what the behavior is communicating, then we help them to get through it in a way that’s much more effective than if we just put kids in time out, for example. Jen: [11:41] Yeah. I actually just yesterday interviewed Julie King, who is the coauthor of a new book, How to Talk so Little Kids Will Listen based on How to Talk so Kids Will Listen, and Listen so Kids Will Talk. They are producing a new edition for the two to seven crowd. Um, and so that, that interview will be on hold until the book is released in January and yours will probably go out before this. But I think that what you’re saying is very much in line with what she is saying, which is that that behavior isn’t just, what you said is it’s not just a way to annoy you or something, that children do to drive you crazy as a parent that it is designed to communicate something or maybe even not designed. It’s, it just does communicate something. Um, if we can pay attention to that, you know, may, maybe we can respond better in the moment, but even if we can’t, as a parent of a young child, I understand that sometimes it’s really hard to take that step back in the moment, but maybe after the fact, what could we do to, if we see something that’s gone wrong, what could we do to try and make it go better next time? Dr. Gold: [12:51] Right. And I think that’s an incredibly important point to highlight, which is that often we don’t know, can’t do the right thing. We don’t do the right thing. And that’s fine. In fact, kids develop in a healthy way when just that process is that things go wrong and we go back and say, wow, that didn’t work out well. So let’s say, you know, the sort of typical scenario of being in the grocery store where your kid is grabbing at, everything and you’re embarrassed and you know, and it’s just a totally impossible thing and you lose your cool because you feel kind of humiliated and you scream at your kid and finally you just leave. And then either you yourself reflect. And if it’s a child who’s old enough to have a conversation about it, you can say, well that didn’t Go well and you can reflect on the fact that maybe the child was overtired and, and you are overtired and perhaps it would have been better to recognize that ahead of time and not go to the store at that time. But you know, you got through it. It was a bad moment. You learn from it and you move on. Jen:  [13:53] Yeah. Yeah. And it seems as though I’ve heard from other sources that, that that acknowledgement process within yourself. But also with the child, if they’re old enough to understand is really a critical process, right? Dr. Gold: [14:06] Exactly. And it’s, you know, the inevitably life is full of disruptions like that, so you don’t want everything to always...