By Rita Brhel, APIâs publications coordinator, managing editor of Attached Family magazine and an API Leader (Hastings, Nebraska, USA). Originally published in the 2013 “Loving Uniquely” issue of Attached Family magazine (available free of charge to API members–and membership in API is free).
We often hear the importance of treating children fairly, but at Attachment Parenting International (API), we advocate rather to love each of our children uniquely. Because every childâjust like every adultâis one of a kind, each individual parent-child relationship forms to the distinctive shape of each otherâs differences in temperament, interests, opinions, aversions, conversions and other subtle nuances of what makes each person and their interactions unique.
API celebrates every personâs unique traits, but some childrenâs differences set them apart from societal expectations enough that daily interactionsâwhether at home, childcare or schoolâcan be challenging. Rather than viewing our children through the lens of understanding, however, our societyâs response is often to see these differences as âsymptomsâ of a disorder and to follow up with treatments that may not resolve the problem.
I am excited to share a discussion with Barbara Probst, PhD, LCSW, author of When the Labels Donât Fit, on her approach to facilitate understanding among parents and teachers in order to discover a new relationship with sometimes-challenging children based on appreciation and respect instead of illness.
RITA: What inspired your alternative approach to âtreatingâ children whose differences often lead them to being diagnosed with disorder?
DR. PROBST: I feel quite strongly about the way our culture seems to be viewing every difference, difficulty, struggle and quirkâevery extreme or unusual behaviorâas a disorder, especially when it comes to kids!
The idea for When the Labels Donât Fit really grew out of my experience as a clinical social worker. So many parents were coming to me with kids who were intense, complex, confusing, rigid, provocative, volatile, inconsistentâchallenging children who had either been given multiple diagnoses and treatments, none of which really helped, or whom no diagnosis seemed to fit.
These parents were understandably looking for some kind of explanation, some way to make sense of their childâs behavior. Yet the only thing they were offered was a negative framework, a way to categorize their child by what was supposedly wrong or missing.
There was no framework that also took into account a childâs strengths, talents, affinities, needs, style, temperamentâthe things a child loves and gravitates towardâas tools for understanding how that child responds to the world and who he or she really is. There seemed to be an assumption that ânaming the disorderâ was the key to assessing what was going on and making it betterâas in the medical way, âfixing the problemâ by diagnosis and cureâbut it was obvious that this narrow approach wasnât really helping anyone, neither kids nor their parents.
I got curious and started to investigate the whole âdiagnosis explosionââmore and more kids receiving psychiatric labels, at younger and younger ages, for fewer and milder symptoms. The statistics are pretty staggering! For instance, one in every five American children meets current criteria for a psychological disorder, with three times as many kids now being diagnosed with emotional or behavioral disorders than were diagnosed 15 years ago. It makes you wonder if thereâs really something wrong with 20% of our kids or something wrong with our definition of ânormal.â
As a culture, weâve pathologized a whole range of traits and ways of interacting with the world that used to be part of the variety of human experience. Some of the difficulties come from a poor fit with the environment, some from the struggles that are just part of living and growing up, and some are from unrealistic expectations and intolerance for kids who push the envelope or make us uncomfortable.
Itâs not that a childâs struggles arenât real or that some kids arenât truly hard to raise. Certainly, there are kids who do things that seem odd or excessive at various points in their development, and of course itâs painful for parents when they canât seem to reach or handle a child they love. And itâs not that âanything goesâ or that kids donât need to understand limits and develop empathy. But finding a disease-based category for the childâs problems isnât the answer either! Just because a child has difficulty managing stimulation or frustration, hates change or needs to ground herself through touch, it doesnât necessarily mean that those difficulties are indicators of an underlying pathology.
RITA: This is what many parents refer to as âspiritednessâ or âhigh needs.â
DR. PROBST: I knew there had to be a better, more direct way to understand and help these challenging kids and their parents. I began focusing on the specific issue or trait, rather than the label that âexplainedâ the trait as a symptom of one or another disease, zooming in to the feature, like perfectionism or impatience, that lay behind the problematic behavior. I wanted to understand who a child is, not what disorder he or she hasâto be truly solution-focused and figure out why the roof was leaking instead of how to reward the child for mopping the wet floor.
RITA: Thatâs a great analogy. How did this approach work in the field?
DR. PROBST: I began to apply this new approach in my work, looking for a âdifficultâ childâs core features as the key to what made that child tick. Again and again, this new approach brought practical and positive results where nothing had helped beforeâin an amazingly short time!
I began to give presentations and workshops to parents, educators and mental health professionals, showing them how to use the temperamental map Iâd developed to figure out how unusual or extreme traits interact with elements of the environment, and then how to target strategiesâconcretely and proactivelyâto a childâs specific features. It was so empowering! It gave parents real hope.
They began to see their challenging child as someone intriguing instead of someone to control or fear. What a great experience!
RITA: What temperamental differences do you find create the most friction? How would you define a âchallenging childâ?
DR. PROBST: Let me start by saying a word about temperament. Temperament is your essential nature, your innate way of being in the world. The early view of temperament, however, like the model Chess and Thomas developed in the mid-1970s, tended to present temperament as a series of good/bad polarities: attentive or distractible, adaptable or inflexible, and so on. I find that quite biased and value-laden, to be honest, like another set of pejorative labels.
Itâs really about the fit between traits and context, not about some traits being intrinsically better than others. After all, a highly tenacious child who wonât cede her turn at the kindergarten easel until sheâs satisfied with her painting is seen as resistant and antisocial, but sheâs seen as admirably persistent in the science lab.
More broadly, if we lived in a culture that valued curiosity and responsiveness instead of order and self-restraint, weâd think that a child who could sit still for an hour, ignoring all the interesting people and impressions around him, as having âattention surplus disorderâ!
So it varies, and traits that seem to be problematic in one situation or at one age can be an asset in another, the seeds of a childâs authenticity and fulfillment.
In addition, temperamental traits exist on a continuum, like a high need for stimulation or a low tolerance for change. Although traits in the middle may make you more mellow and adaptable to a wider range of contexts, no trait is inherently âbetterâ or âworseâ than another.
Think of it descriptively, rather than judgmentally: Some kids go off on tangents, some canât bear to leave something unfinished, some find comfort in order and repetition or, on the contrary, always want change. Some like to plunge right in while others take time to warm up and then need to disengage slowly. Within each dimension, thereâs a range, with a child tending toward the high or low end when heâs stressed.
Friction is more likely to arise, then, when a trait or its manifestation is at one of the extreme ends of the continuum, especially when the environment has a narrow zone of tolerance. A fixed time scheduleââItâs 10:00, put away your journals and get ready for recessââcan cause a shrieking tantrum in a child who has to âcomplete his missionâ or needs to stop incrementally. A classroom full of stimulating choices can make a perfectionistic child, overwhelmed by all the roads not taken no matter what she chooses, highly anxious or irritable.
RITA: What about temperamental difference between a child and an adult?
DR. PROBST: By âenvironment,â I also mean the people in the childâs world. If youâre a parent who thinks spontaneity is fun, for example, and you have a child for whom thatâs distressing and who really needs to know ahead of time exactly what to expect in order to feel safe, or vice versa, youâre more likely to encounter misunderstanding and conflict. For example, does your child prefer to know what sheâs getting for her birthday, or does she want to be surprised?
So itâs often the mismatch, rather than the trait itself, especially when a child hasnât matured enough to develop a repertoire of coping strategies or is blamed by adults who expect him to be the one to do all the adapting, rather than being curious and open to small changes in the environment that might create âwiggle roomâ or a âmargin of tolerance.â
Itâs also important to remember that different traits can lie behind the same challenging behavior, so you need to step back and figure out why your angry child wonât go to bed. Is it because of an irregular inner rhythm or pajamas that âdonât feel rightâ? Does he need to disengage a bit at a time because of high intensity and focus? Does she need to finish her game because sheâs a perfectionist who canât bear to leave something incomplete? Does he need a set of tactile markers to anchor the verbal instructions?
Threats, logic, cajoling, even offers of kindness and generosityââhow about an extra story?ââmay have nothing to do with the reason your child refuses to go to bed. Itâs like throwing solution darts at a situation in the hope that one will somehow stick! Itâs not a matter of changing the exterior resultâgetting the child to âbehaveâ and go to bedâbut of understanding the interior cause and the childâs interaction with elements of the environment, including space, timing, tempo and sensory factors.
So a âchallenging childâ is one whose unusual, extreme or erratic traits have been misunderstood and mishandled, often due to a poor contextual fit. Your childâs need for movement or silence or control still must be met proactively, but a need thatâs been respected and met, even partially, tends to lead to far less âchallenging behaviorâ than a need thatâs been ignored, denied or shamed.
RITA: What steps would you suggest for a parent seeking to learn a different way to look at and act toward their child?
DR. PROBST: One of the most powerful things parents can do is to change their language. Describe your child, to yourself and to her, as organized rather than obsessive, curious about life rather than distractible. Instead of calling her picky, tell her: âYou sure do know what you like!â Instead of stubborn: âYouâre not a quitter!â That helps her feel sheâs not fundamentally defective and helps you feel more open and positive, which results in a less tense relationship that benefits everyone.
You can also use language to put borders around troublesome behavior. âYouâre the kind of person who has a tough time with disappointment (or waiting, feeling rushed or feeling there are too many rules for how to do something).â That gives a precise, bounded and concrete place to begin, rather than making a child feel globally wrong or defective.
When a trait like low adaptability, for instance, is likely to pose a problem, talk about it in advance. Name it, predict and use respectful curiosity to help your child make a plan: âIt really bothers you when kids change the rules for Capture the Flag. Variations arenât fun to you; it just feels like theyâre ruining the game. So whatâs your plan if that happens today? Any ideas about what you can do?â
If your child has had a successful experience of managing a similar situation in the past, remind him of his past success and let him be the expert: âRemember how well you handled things that time the pizza place turned out to be closed? What was the secret of your success?â
If heâs not yet been able to handle it well, offer a suggestion in the spirit of experimentation. Collaborate with your child as detectives or scientists on a quest for data: âWell, I know something that tends to help people who like things to stay the same. Are you game to try and let me know if it helps?â
Tell your child: âI see that you really like to make your own decisions.â Include that feature in advance, rather than punishing your child afterward for asserting her desire to be in control. Give her a way to be involved in the decision about how to clean up, for example, before itâs time to clean up.
This kind of practical, respectful approach is so much more effective than trying to maintain complicated systems of points and penalties! Remember that your child is doing the best he can under the circumstances, given his limited resources. Itâs not about reward and punishment, but about the power of self-knowledge. Your goal, in the end, is to help your child be happy and successful because of who he is.
RITA: Some parents still struggle to set limits with their children. Itâs as if they and their child arenât talking the same language.
DR. PROBST: A few core principles lie behind the more than 60 practical strategies in When the Labels Donât Fit. One principle is to proactively and concretely match the strategy to the feature. For instance, a child who has difficulty feeling time needs a way to organize externally what she canât organize internally. Tell her: âTwo more times going down the slide,â (a unit of action), rather than, âFive more minutes till we have to leave the playground.â
A child who canât bear disappointment needs a backup plan thatâs already in place right from the beginning. For example: âMy Plan B is chocolate chip cookie dough ice cream if they donât have rocky road.â Your child can figure out his backup plan before getting in the car to go out for ice cream, then write it on an index card and put it in his pocket. Unexpected let-downs are harder, but the Plan B approach will be more likely to be accepted if your child has already practiced it in other situations.
A child with a ten-minute attention span needs a planned break after eight minutes.
A child who needs to control and becomes angry at not being in control needs a safe avenue to express power with temporal and spatial boundaries. What can she control? Can you give her a Magic Coin that she can âspendâ each day on something where she can be the âbossâ? That helps her learn to make and live with choices. Remember: If the only power you give a strong-willed child is the power to refuse, she will surely use it.
And so on. Once you get the idea that it all stems from âthe kind of kid this is,â it becomes so much easier to be effective.
Another important principle is to show your child that you âget it.â Donât try to make your child feel better by telling him that âitâs not a big dealââto him it isâor that he doesnât really feel what he feels. A child whoâs hurt or angry at being rejected needs you to respect his reality and his temperament. If you deny or dismiss his experience, heâll think youâre lying or donât care or both. Itâs better to say, âI get that it really hurts.â
Then think about his temperament. Is he the kind of person who feels better when he plunges into a new activity or when he has a quiet space to be alone? Does he tend to ruminate and thus need diversion to interrupt the cycle, or does he lock his feelings away and need help bringing them to the surface?
Too often, unfortunately, we end up rewarding a child for not being himself. A child who needs to touch or move, for instance, gets praised for not touching or not moving, rather than being given a safe way to meet his temperamental need for touch or movement. Then weâre surprised when that child becomes depressed or anxious or hostile.
Begin at the level where success is possible and build from there. Lowering the necessary dose gradually can be an empowering way to help a child manage her need for movement, praise, control and so on.
RITA: How do parents know when they may need more help, when a child should be evaluated for ADHD, bipolar disorder, obsessive-compulsive disorder, et cetera?
DR. PROBST: Certainly there are children whose difficulties go beyond an unusual temperament or poor temperament-environment fit. It would be just as wrong to dismiss a serious condition as it would be to over-diagnose a minor one. When we call every moody adolescent âbipolarâ or every fidgety preschooler âADHD,â we trivialize the very real suffering of those who truly do merit the label.
Deciding if a child may have an enduring problem beyond a quirky temperament is a complex process. Itâs important to remember, however, that thereâs no objective test for any of these diagnoses like there are for medical conditions like asthma or diabetes; the determination is always a subjective one. The criteria rely heavily on words like âfrequentlyâ and âoftenâ and on checklists completed by adults rather than on a childâs self-report.
But if difficulties persist despite strategies to reduce stress and maximize adaptation, are present under a wide range of circumstances and cause significant impairment, then it may be wise to seek an outside evaluation.
Itâs also important to remember that a child may still need help, even if she doesnât necessarily meet the criteria for an official mental health diagnosis. The way our insurance reimbursement system is set up requires some diagnosis in order to justify the need for treatment under the principle of âmedical necessity.â So the mental health clinician may select the label that seems the closest match, the least stigmatizing or the most likely to get the child the services he needs.
Yet in working with the child, whatâs often more significant than the formal label are the specific impairing traits, which may or may not correspond to items on the official symptom list. For instance, âdoesnât feel timeâ and âis a perfectionistâ arenât on the list for any of the educational or mental health categories, even though theyâre common problems.
RITA: Thank you so much, Dr. Probst, for your time and insights! Can you share any final thoughts on this topic?
DR. PROBST: Itâs vitally important for us to keep questioning the idea that âdifficultâ or âdifferentâ means disordered! We need to reject the idea that every child whoâs hard to handle or doesnât fit in has a psychiatric disorder.
Many children go through tough times or seem extreme, eccentric, provocative or immature at various points in their development. But that doesnât mean they have a disease that needs to be cured, medicated or taken as the most important aspect of who they are.
We need to ask the right questions. Instead of trying to figure out if a child has ADHD, Asperger syndrome or bipolar disorder, we need to take the labels apart, zoom in to understand each feature and find specific places where change is possible.
We need to identify the source of a problemâusually in unmet needs, discord and imbalance, not from something inherently wrong or missing in the childâs makeupâbefore trying to solve it by generic approaches. We need to tailor every strategy to fit a childâs specific traits and needs, and to take responsibility for how we, too, need to adapt. We canât ask our kids to do all the work.
You can read more in the “Loving Uniquely” issue of Attached Family magazine, in which we delve into temperament and how it intersects with parenting and the development of attachment style, and we challenge the notion that every hard-to-handle child needs a diagnosis. The magazine is free to API members–and membership in API is free! Click the link above to access your free issue or join API.
A mother on a mission can do amazing things, especially when working with an equally passionate parent support advocate.
