Posted tagged ‘Behavior’

What can be learn from vending machines and casinos to stop childhood whining?

December 19, 2016

The Pediatric Insider

© 2016 Roy Benaroch, MD

Megan, like all parents, hates the whining and nagging:

It’s driving me crazy. My children whine and complain until they get what they want. I try not to give in, but sometimes it’s just impossible. What can I do?

(That’s an excerpt from a much longer message. You get the idea.)

Let’s look at whining from a classic behavioral approach. Stay with me, here – behavioral theory is a big part of why we do the things we do, children and adults alike. It’s worth understanding.

What we’re talking about here is called “operant conditioning.” Basically, whether people continue to do something depends on the consequences. If complimenting your spouse gets you a friendly smile or peck on the cheek, you’ll keep doing it (assuming you like smiles and kisses.) If your child’s whining means she gets what she wants, she’ll keep doing that, too. A related term is “positive reinforcement” – that’s a reward or benefit that comes after a behavior. Positive reinforcements (giving a child exactly what she wants) make it more likely that the behavior (whining) will happen again.

So: step one of dealing with whining (or many other undesirable behaviors) is to remove the positive reinforcement. But there’s a twist, here – it turns out that the schedule of the positive reinforcers can change how well it works. This might not be intuitive, but it turns out that regular, always-given, predictable positive reinforcements are not as lasting or powerful as irregular, unpredictable, changing positive reinforcers.

Think about vending machines and casinos. With a vending machine, you always get exactly what you ordered (assuming the stupid thing isn’t broken – there’s an interesting behavioral lesson about that situation, too, but we’ll save that for another time.) People who get things from vending machines are positively reinforced, but they don’t typically crave vending machines. And: when the positive reinforcement ends (say, for 1 or 2 times you don’t get your bag of Funyuns), you’ll quickly stop using the vending machine.

But at a casino, you don’t know what your reward will be, or even if you’ll get one. In fact, most of the time, you get nothing at all. But that kind of reinforcement, the “sometimes-surprise” schedule, reinforces the behavior even more effectively. Think about people pumping money into slot machines, only to get occasional, unpredictable rewards.

Let’s come back to whining. If you reinforce the whining sometimes, or in an unpredictable way (“Here! Just have the whole bag of lollopops!”), you’ll unintentionally be encouraging the behavior even more than if you always said “yes.” If Megan is serious about stopping the whining, she has to stop reinforcing it, and shouldn’t give in. Ever.

What about punishment to stop whining? A punishment is an action you take after the behavior, a consequence that’s designed to stop the behavior. It turns out that behavioral studies in animals, children, and adults show that punishment is typically only temporarily effective. Yelling at your child for whining, or restricting privileges, or some other punishment – none of these will work well. That’s like the vending machine giving you a bag of stale chips. You’ll be mad, and might avoid the vending machine for a few days, but you’ll be back. Or, imagine, if a casino sometimes just took your money away from you. That’s a valid punishment, but it doesn’t really change a behavior as well as completely stopping the positive reinforcements (in a casino, the occasional big payouts.) If the punishment of losing money at casinos actually worked, they’d all be out of business.

Sometimes, there’s more to whining than just behavior and consequences. I’d consider the child’s development and communication skills, and overall parenting style, expectations, mental health, resource scarcity — lots of things beyond behavioral theory. But a straight-up behavioral approach is sometimes the simplest, best way to get children to stop with the whining. And if it works, Megan owes me a trip to Vegas. Or at least a bag of Funyuns.

Red wine pouring into wine glass, close-up

Red wine pouring into wine glass, close-up

Whining and negativity in a nine-year-old girl

June 29, 2015

The Pediatric Insider

© 2015 Roy Benaroch, MD

Anna wrote in:

My daughter is now 9, and I’ve noticed a steady increase in negativity in the past several months.  She has become whinier, she has an attitude (more “entitled”), etc.  The latest is whenever I don’t let her have her way she says “you’re mean”. We try to enforce manners, for example, saying thank you when we give her something, but even the thank-yous seem grudging. I have a feeling most of this is normal (I hope), but do you have any suggestions to help me modify her behavior?

I’d look at this two ways: First, is there a reason for the change, especially a reason you could address? And second, forgetting about any possible reason or whatever, what can you do about whining and negativity to change a child’s behavior?

Why do kids act like this? Sometimes, there really is specific reason. A new sibling, marital discord, medical problems, bullying in school, a friend moving away, not getting enough sleep, over-scheduling, boredom, attention-seeking… all sorts of things. I’m not sure it’s always obvious, or that it’s always possible to know *for sure* what led to a behavior change, but sometimes there really is a reason staring you in the face. Perhaps that’s worth talking about, or at least thinking about.

One of the most common reasons for negativity and whining is attention-seeking. If a child doesn’t feel like she’s getting your attention—maybe you’ve been preoccupied with work—she may develop, let’s say, “maladaptive” ways to forcing you to pay attention to her. In other words, she may become a pain in the ass not because she’s a pain in the ass, but because she’s figured out that the behavior gets what she craves: more attention. One way to “fix” this is by giving more attention, but not at times that reward the whiney and negative behavior (see this prior post, under “love,” for a method called “magic time.”)

But sometimes there really doesn’t seem to be a specific reason, or at least not one that you can easily figure out. Maybe it’s just a phase, or a “normal thing.” Even without worrying about the specific “why”, there are ways to help a child change this behavior:

#1: Don’t reward it. She’s looking for a reaction. Don’t ignore her, but don’t get into it, either. Be bland and boring and non-reactive to negativity, and it tends to go away.

#2: At the same time, do reward times when she’s not negative, or at least when she’s less negative. Make sure to not only tell her that it makes you happy to hear her say something positive, but (more importantly) do what it is she’s asking for, if she’s asking for it in a reasonably nice way. Now, sometimes you just can’t do this (“Mom, can I please have a bazooka? No.”), but other times you might be saying “No” a little too reflexively, because, I know, they never stop asking for things. Surprise them with a yes, or even better, with some happy silliness:


Good: Child: “I want a bubble bath!”

Mom: “No.” (Looks away, bored. Not a lot more talking and explaining and attention.)

Better: Child says “Can I have a bubble bath?”

You: “Good idea!”

Best:    Child says “Can I please have a bubble bath?”

You: “That’s a great idea! I know—why not take some shaving cream and spray it on the wall of the tub, too?”


You’ll also want to set a good example. Kids only sometimes, barely, pay attention to what we say. But what they really pay attention to is what we’re doing and how we act. If you’re whining and negative and complaining, don’t be surprised if your kids do that too. Your kids learn far more by watching and modeling what you’re doing than by listening to your explanations. Be gracious with your partner and all of your children, say your own thank-yous (like you mean it!), and maybe even try to work in other expressions of gratitude. Kids notice these things.

Don’t stay mad. This is a tough one—but children, they don’t think like we do. You might still be steaming over those dirty looks at dinner (It’s tortellini for God’s sake! Eat it!), but 20 minutes later your child is over that and thinking about other things. Giving her grief, then, isn’t going to help.

Use humor, too. I know it can be hard, but next time your child tells you you’re mean, make a bear face and say “I’m going to eat you!” and chase her around the house. Mmm, tasty child!

Another idea: talk with a child about what would work best. Not when she’s all upset and whiney, but at another time, bring it up. “Sweetie, you seem to get so mad sometimes, is there something I can do to help keep you happy?” You might just learn something.

Every age brings its challenges—it’s not just terrible twos, but terrible threes and nines and (OMG!) sixteens. Though chasing your teenager around pretending to eat her might not be the best specific idea for that age, the basic principles are the same. Look for causes, reward what you want to encourage, and ignore what you want to discourage. Use humor, and try to solve problems as a family. Meanwhile, remember to forgive. You have bad days too. You’ll make it through, together.

Hey! Some of the best—heck, probably all of the best—ideas I give parents come from you guys. What other advice do you have for Anna? What did I say that was stupid and off-base? Add a comment! You’ll be glad you did! Probably!

A parenting lesson from The Potato King

January 22, 2015

The Pediatric Insider

© 2015 Roy Benaroch, MD

It’s easier to get kids to do what they want to do rather than what you want them to do.

King Frederick the Great (1712-1786) of Prussia had a problem. He had plenty of cheap, nutritious potatoes—but no one wanted to eat them. They didn’t smell good, they grew in the ground, and even dogs turned up their noses. No one was even willing to try them. (Does this remind you of mealtimes at your house?)

So he planted a big field of potatoes near one of his castles. And he had his guards surround it, and march around, and make sure to keep everyone away.

Naturally, people became curious.

After a while, the King quietly ordered the guards to be a little less vigilant at night. And sure enough, a few brave souls snuck onto the field and stole some potatoes. After a while more people were stealing more potato plants, and soon enough everyone was planting potatoes. And eating them.

Sometimes the best trick to get kids to do what you want them to do is to get them to want to do it. I’m not even sure that’s a trick. But it’s good parenting.

As far as I know, the potato story is true. Or, at least, I want it to be.

Regular bedtimes improve behavior in kids

October 28, 2013

The Pediatric Insider

© 2013 Roy Benaroch, MD

A British study published this month in Pediatrics confirmed what Grandmas have been saying: regular bedtimes can help children behave.

Researchers followed a cohort of 10,230 children born in 2000-2002, performing structured interviews at home visits by study nurses every few years through age 7. They asked about bedtime routines—what time the children went to bed, and whether that was a fairly regular time, or whether the time varied on different days. Validated questionnaires were also administered to help determine if behavioral problems were present, including questions about conduct problems, emotional difficulties, and trouble with peer relationships.

It turns out that the exact bedtime, itself, didn’t matter very much. Earlier bedtimes had a very mild and inconsistent effect of overall behavior. However, what did matter was how consistent the bedtimes were. More consistency across the years of the interviews was correlated with better behavior, and there was even a dose effect. The more years of irregular bedtimes, the worse the behavior seemed to be.

Now, there may be some reverse causality here—perhaps the ill-behaved children ended up with irregular bedtimes because their parents couldn’t get them to bed, instead of the other way around. But another observation from this study strengthens the case for a causal relationship: over time, if bedtimes become more regular, behavior does improve.

Early to bed, early to rise makes a man healthy wealthy and wise. But if you want a well-behaved child, it may be more important to have a regular bedtime than an early bedtime.

Score another one for Grandma!

Are sweets at bedtime a bad idea?

April 18, 2013

The Pediatric Insider

© 2013 Roy Benaroch, MD

Jack wrote, “What is the deal with not allowing kids to eat dessert before bed? That’s how I was brought up, and how my kids have been brought up. My fiancée doesn’t allow her kids to have sweets after about 7:30 because she fears it will interfere with their sleep. Any truth to that theory? Or is it an old wives tale like not swimming after eating?”

That’d be one of those handy “little white lies.” Medically speaking, there’s no particular reason not to have sweets before bed, or (gasp!) not to eat prior to swimming.

I suppose if Junior does have a big bowl of ice cream, he’d better be sure to brush his teeth at bedtime. And a full belly at bedtime might just increase the chance of a nightmare. But I don’t think it really matters what the bedtime snack is.

There is a persistent feeling among many parents (and grandparents) that sugary, junky food gets kids hyper. I think that’s because these kinds of foods are often eaten at birthdays and happy occasions, when kids do get worked up. But when it’s been studied, simple carb meals don’t seem to change behavior in children, at least not when the kids and the observers are blinded. One study even looked at a small number of children with attention-deficit disorder, and found that sugar didn’t worsen their behavior. Those authors suggested that the perception of worse behavior may be related to those kids’ difficulty in adjusting back to classroom behavior after a snack.

In any case, I’ve found that it’s just about impossible to dispel the sugar-misbehavior contention, and I suspect it will be just as hard to convince parents that desserts before bed are no worse than desserts with dinner. It’s never bothered me or my kids, but if you’ve found it’s better to not have sweets later, that’s fine with me. It will at least make your dentist happy too.

Help your child learn to listen

December 11, 2012

The Pediatric Insider

© 2012 Roy Benaroch, MD

We pay a lot of attention to hearing. Newborns get their hearing tested in most states, and periodic hearing screening is part of regular checkups. We know which children cannot hear. So why is it that so many kids don’t listen?

When we’re raising little kids, we know that we’re supposed to talk all the time. We yammer on in the grocery store – “Look! An apple! And that guy has a brown hat!” – because it is true that children exposed to more words from their caretakers get better word skills, quicker. Even if they’re not paying complete attention, talking to your children when they’re young is how they learn to communicate. But then something happens. We keep talking, and they stop listening.

This can be fixed.  It’s time for an action plan: How to re-train your child to listen. It will take some work, but in the long run they’ll be far less yelling and teeth gnashing. Do yourself a favor and tackle this before all of your hair falls out.

What I suggest is a period of “listening training,” during which both you and your kids learn new habits. Be consistent and strong, and use all of the steps below. As your child gets better at listening, you’ll be able to back off of some of these, gradually. But at first, it’s best to take big steps to make progress. You need to kick yourself and your kids out of the “not listening” rut, and it might take a bit of a push.

Stop talking so much. Your children are used to the fact that a lot of what you say isn’t really important, and doesn’t require them to respond or do anything. So they’re used to not really paying attention. Cut back on the chatter—or at least start to develop a different voice to use when you really need your kids to listen.

Get your child’s attention before you tell them something important. It’s takes a few extra seconds, but it saves a whole lot of misunderstanding later on. Walk over, touch Pepe’s chin, make him look at you. “Sweetie, I need to tell you something. Stop playing and get your shoes on.”

Avoid vague adult phrases. You want your son to go kiss grandma? Tell him to. Don’t say “I’ll bet grandma would like a kiss” to a 14 month old and expect him to connect the dots. “It’s time to clean your room,” “Why don’t you stop punching your friend?”, and “I wish someone would help me clean the kitchen” are all vague and indirect and kind of, well, weenie-ish. During “listening training”, get more direct.

Avoid instructions you can’t enforce. During listening training, it’s best to avoid giving commands that you really can’t follow through. “Stop fidgeting” is tough to make happen—if your child don’t stop, how are you going to enforce it? “Don’t make faces,” “Be more respectful,” “Just hold still” are all reasonable things for advanced listeners, but at least at first you’re not going to be able to enforce these kinds of commands. During initial listening training, stick with specific, simple commands that you can make happen if your child doesn’t. “Turn off the TV,” “Pick up your socks,” “Stop pulling the dog’s tail” are good, simple instructions that parents can enforce.

Say it once, like you mean it—then make it happen. If he doesn’t turn off the TV, you do it. If he doesn’t pick up his socks, take him by the hands and make it happen. If he keeps pulling the dog’s tail, shut the dog up in another room.Say it once, and mean it, and if it doesn’t happen immediately make it happen. The idea here is that mom’s word is final. You say it. It happens. Always. (That’s why you need to avoid saying things you can’t actually enforce, at first. After a while, once your child gets in the habit of listening, you’ll be able to bend that rule. But first you need good listening habits!)

Don’t count. I know, I know. A lot of people like the “1-2-3” business, and they’ve sold a lot of books (far, far more than me. I’m not bitter.) I don’t like it. You count 1,2… and what you’re really saying is “OK, you don’t need to listen now… or now… but by golly soon enough I’m going to mean it!” I really prefer “say it once and mean it once”, and I think in the long run it works better.


Be positive. Children will not learn new behaviors if they’re always in the doghouse. If there is a lot of criticism going on, and you’re giving your child the impression that you’re mad a lot, this new listening training thing isn’t going to work. You need to make your relationship more positive, loving, and supportive first. The Greenies is one good method of bringing more positives into the lives of preschoolers. Once you’ve started listening training, make sure that every time your child does actually listen—the first time—there’s positive and specific and immediate feedback. “Thanks for taking care of the TV, buddy!”

But don’t turn your feedback into another opportunity to get a negative dig it. “Thanks for picking up your socks. Why don’t you do that all the time when I ask you to?” Just pushes him back to the doghouse. Stay away from negative comments after positive feedback.

Listening is a skill, like riding a bike or peeling an orange all in one stripe. It takes practice, and sometimes it starts with stopping some bad habits. Once you’ve started listening training, every success will help develop and reinforce a new habit. Kids can listen—if you help them learn to do it, and if you help them practice.

Time-out can work

November 8, 2012

The Pediatric Insider

© 2012 Roy Benaroch, MD

“I tried time out and it never works!”

Time-out is a great discipline tool for parents of toddlers to young-school-age kids—if it’s done right. Done incorrectly, time-out may make problematic behavior even worse.

First: time-outs are only one discipline strategy. If you use them too often, they won’t work at all. You can’t rely on time-outs alone to solve every problem. Also, time-outs only work if your child is usually in “time-in”. That is, if your child is always “in the doghouse,” being criticized and punished, then he probably doesn’t even know what “time-in” is like. For your child to learn lessons from time-out, he should be living in a world that’s full of love and smiles at support at least 90% of the time. That way, those periods of time-out are really shocking and powerful. If you’re feeling like your child is being bad a lot and needs to be punished a lot, it’s better to work on positive techniques than intensify your punishments.

Rules for good time-outs:

Never warn that at time-out is coming, and never threaten. If you’re warning Junior about a time-out, you’re not doing a time-out. As soon as your child earns one—say, for hitting—immediately start the time-out. Don’t talk about it, don’t warn, don’t give dirty looks, don’t threaten “next time, one is coming.” Just do it. In fact, if you can’t do an effective time-out, it’s better to ignore the behavior than to make a half-hearted warning that is going to be ignored.

Start your time-out with a two-word statement of the rule, saying something like “NO HITTING.” Say this strongly, with emotion, and even a little anger. You’re supposed to look mean and unloving at that moment. But do not keep talking and explaining! You’ve said everything you need to say. Now do the time out.

Physically place the child where he or she cannot see you. Alone in a room is best, in a corner is probably OK—but sitting in a special chair facing you is not going to help. The idea of a time-out is that your child has lost her place in the family, is not welcome, and is excluded from your love and your presence (temporarily!). If your child can see you and watch you, that is not a time-out.

Leave your child in time-out for about 1 minute per year of life. Do not check on him. Do not talk to him. Ignore him for this period of time. If you have to lean on the door or hold the knob silently to keep him in his room, do it. Do not talk!

When the time is over, your facial expression should completely change. You are no longer angry. Hug him and say you love him, and repeat the broken rule once, in a loving voice. “No hitting.” Do NOT keep talking or explaining or discussing the rule. Do not stay angry—even if you are angry, pretend you’re not. Remember: time-out only works if the child then returns to time-in afterwards.

When parents start using time-outs correctly, many children will have a temporary increase in negative behavior. They’re testing you. Don’t escalate the punishments, don’t make time-out longer. Just keep doing them exactly this way.

Time-outs are one very effective tool to help younger children learn to behave. They work best in a loving, supportive house where lessons are also being taught with positive reinforcement, modeling, and very clear rules that are always enforced. I know, it’s a lot of work to teach children to behave. Being a parent is a tough job. You owe it to your kids to do your best.

Adapted from a post that first appeared on WebMD’s Your Children’s Health blog.

The runaway toddler

November 21, 2011

The Pediatric Insider

© 2011 Roy Benaroch, MD

For November, I’m concentrating my writing chops on National Novel Writing Month. Fun! So I’m re-running revised versions of some classic posts. And by classic, I mean “old.” This one was originally from August, 2008. Enjoy!

Holly asked, “Do you have behavior modification suggestions for children who think it is funny to run away when you call them?”

The key here is to practice success—get her used to the fact that when you call her, she will come to you. At the same time, stop practicing failure—don’t instigate or encourage a situation where she can run away from you. In time, she’ll be so used to doing this correctly that you’ll no longer have to be strict about these steps. But for now, this is what you should do:

  • Don’t play any “tag” or chasing games, or any other game that encourages her to run away. I know these games are fun, but it’s practicing what you don’t want her to do. For the time being, play something else.
  • If you’re in a situation where she can run away from you, don’t call her name. First, move closer to her, or move yourself so she’s cornered. Do what it takes so that when you do call her name, she can’t get away. Avoid setting up a situation where she gets to practice running away.
  • As soon as you call her, grab her so she comes close to you. Then thank her for doing it (I know this sounds weird, but make it as if she chose to do the right thing, not that you forced her to.) Say, “thanks for coming quickly when I asked you to!”
  • Only ask her to come to you once. Do not repeat yourself.
  • Try to make it fun for her when she does come when you call. Say “come here sweetie” with love and affection, and if it seems like she really was heading your way, give her extra noogies and affection. Help her realize that it’s more fun to come when you’re called than to run away by stopping the run-away games completely.
  • If by some chance she does “get away,” grab her if possible without saying a single word. Don’t chase her unless you have to (if she’s somewhere unsafe.) Rather, walk towards her without really meeting her gaze or engaging her. You should seem bored and uninterested. Hold her away from you in an unloving way, and put her in her room, alone, for about 3 minutes. Afterwards, open her door, give her a hug, and say with love “don’t run away.” Don’t stay mad at her.

It will probably take about 2 weeks for her to get used to the new expectation of what a “come here” means. There will probably be setbacks, but stick with the plan! Let me know how it works out.

Let kids play

July 8, 2010

The Pediatric Insider

© 2010 Roy Benaroch, MD

School has become far more intense since I was a kid. Kindergarteners are expected to read; first graders bubble in standardized tests; third graders are doing book reports, frantically re-reading The Old Man and the Sea by candlelight with a Vente Mocha. Are we working them too hard?

Researchers at the Albert Einstein College of Medicine examined data from about 12,000 children aged 8-9, collected across many different schools in  the USA in 2001. Their study correlated classroom behavior with the availability of routine recess time—time to get outside and play. No one ought to be surprised at the results: the children with no or little recess had far-worse classroom behavior than the kids who had time to run and play. In fact, more playtime equaled better behavior. If playtime were a medicine, higher doses (as expected) worked even better than low doses. The improved behavior was seen even after correcting for factors like overall classroom achievement, the income of the families, proportion of minority and disadvantaged students, and the proportion of boys in the class. Among all groups, more playtime led to better functioning in the classroom.

Is your child tough to handle, restless, jumpy, a noodge? Get him or her outside, playing. Playtime one “drug” that everyone needs. It helps kids focus and do well in school. And it’s cheaper than a trip to Starbucks!

Behavior and diagnostics

April 22, 2010

The Pediatric Insider

© 2010 Roy Benaroch, MD

Children have always been challenging. Jacob took advantage of his hairy and slightly-older twin brother Esau by purchasing his birthright for some lentil stew; he also tricked his father into blessing the arrangement by hiding under a wig. But children like Jacob weren’t diagnosed with Oppositional Defiant Disorder, or even Expensive Soup Selling Disorder. They were just … children, each with their own skills, shortcomings, and challenges.

Now, there seems to be a quiet change taking place among those who care for children, towards more labeling and identifying of specific “problems.” I’m not so sure that’s always a good idea.

I’ve been thinking about this while trying to answer a question submitted a few months ago, by MKM:

“Would you please explain sensory integration and a ’spirted’ child? Is there a ‘checklist’ of signs/symptoms to look for? My 3 1/2 year old daughter is a very high energy child and not shy at all child who seems to be progressing as she should be. My concern is her ‘heightened’ anxiety (not sure if right word) in situations–completely clams up in new/somewhat familiar situations to the point of clinging to me and not participating, cries if startled, does not like being around men, can be somewhat sensitive. Many situations ‘change’ her personality. Is sensory integration similar to a ’spirited child’? Thanks for any information to help.”

It does sound like this girl can be a challenge. She’s clingy at times, can be sensitive, and doesn’t like men. But does that mean that she has a specific diagnosis that can be labeled, like “Sensory Integration Disorder,” or is she a “Spirited Child”?

The idea that problems should be diagnosed goes back to Hippocrates, or maybe further. In medical tradition, the patient presents with a symptom– “Why did you come to the doctor?”. The physician examines the patient, and then determines the “diagnosis.” From knowledge of the diagnosis comes the therapy. You’ve got pneumonia? Here’s the antibiotics. Your appendix is about to burst? Off to surgery you go. Know the diagnosis, then you know the therapy.

That way of thinking works quite well for medical problems. But I’m not so sure it’s a good fit for children with everyday behavioral challenges. After all, once you’ve settled on a diagnosis– let’s say, Attention Deficit Disorder– then therapy is going to be one of a few choices that work best for ADD. But children and their behaviors are far more complex than this one-to-one system of diagnosis and therapy. Different children even with the same “diagnosis”, like ADD, may have different challenges, strengths, and weaknesses. Worse, once you diagnose something like “ADD” it tends to mold the way you think about the child: all of the behavior problems are considered part of that one diagnosis, and if therapy doesn’t help, well, you’re stuck. In other words, specific diagnoses oversimplify children and their issues, and work against reformulating and refining treatment strategies. It’s like thinking along a “rut” in the road– the more times you diagnose the same problem and use the same therapy, the more “stuck” you’ll be in that rut, and pretty soon that’s the way you’re going to diagnose and treat all sorts of problems.

MKM mentioned two “diagnoses” that I don’t think are very useful for most families. “Sensory Integration Disorder” is a vague, poorly-defined entity that seems to encompass all sorts of behavior issues, and is treated with open-ended occupational therapy. Children who are to me completely normal– those that don’t like the sound of toilets flushing, or don’t like the feel of tags in their clothes– are labeled with this “illness,” whether or not the “symptoms” are actually causing any harm at all. Now, some kids do have intense tactile defensiveness, and have a hard time doing ordinary things. These kids do need OT, as well as family therapy to work through what can be debilitating symptoms. But simply crying when startled doesn’t make a child in any way abnormal.

Several books have been written about raising “spirited” or “high energy” children, and often do contain useful tidbits of advice. But no book could possibly identify the specific problem areas of any one specific child any more than one diagnosis could encompass all of the behavior issues that a family faces. Kids are just too complex to label in a meaningful way.

So for MKM’s daughter, I recommend staying away from the specific behavioral labels like “spirited child” and “Sensory Integration Disorder”. A more useful approach would be to make a list of specific behavioral challenges that prevent her and her family from doing normal things. The list might look like this:

1. Clingy in new situations

2. Cries if startled

3. Doesn’t like being around men

Now, put that list in order, putting the most problematic item first– let’s say in this case the clinginess. Then come up with a behavioral solution for the top problem, and continue to address issues one by one.

1. For clinginess- practice new situations more gradually, with warnings and “dry runs.” As these improve, back off on the extra support. Can also bring lovies or family photos to some of the most challenging new occasions to help them go easier.

Anticipate new challenges and problems– they will occur, and “The List” will need to be revised and reordered. Some therapies will work, and some won’t, so be prepared to learn and adapt.

In contrast to the one-diagnosis, one-therapy system implied by the medical model, my system is more individualized. It’s designed to identify unique characteristics and challenges for each child, rather than to pigeon-hole children into preexisting categories of problems and fixed solutions. I think it’s better, and I think Hippocrates and Isaac would agree.