YOU'RE A young mother at the playground with your 3-year-old son. The other mothers are engaged in relaxed conversation, but you're on edge. You know your son is "inflexible," and at any moment could go from happily playing to a tantrum.
Sure enough, as you try to join in the group, you see him getting upset because his toy car is stuck. You rush over to calm him, but his crying escalates. As the other children and mothers turn to look, you go from embarrassment to rage. You yell at your son to cut it out. This only makes him scream more. Finally, you grab him, your bag, and his toys and run to your car, where you collapse in tears of helplessness.
These days it would seem doctors are all to keen to fill our children full of mind-altering drugs instead of getting to the bottom of the problem
Being a parent of such a child is a hard job. In our society, parents are often alone, without support from extended family or a spouse.
However, the latest research integrating developmental psychology, neuroscience, and behavioral genetics into an approach called contemporary attachment theory is showing that if we can help this mother to join her child, to accept his low frustration tolerance as part of him, not a reflection of her own failure as a parent, she can help him regulate his frustration. He will then learn to manage his feelings on his own. Most important, if she can do this, she may actually change the way his brain handles stress and strong emotions.
In my pediatric practice, I aim to support parents in just this way. My goal is to listen to this mother's experience of her child, her sense of shame and inadequacy. I have found that with this kind of support, parents are fortified in their efforts to accept their children for who they are. Once these difficult emotions have been addressed, parents are resourceful, and don't generally need me to tell them what to do. This simple intervention often results in significant improvement in the child's behavior.
The last decade has seen an explosion of psychiatric diagnoses in young children, and with them an exponential growth in the number of children on medications. This is due in large part to marketing by the pharmaceutical industry combined with our society's expectation of a quick fix.
Managed care has also resulted in limited access to mental health services. To earn a living and cover the cost of the staff required to administer a practice accepting many insurance plans, primary care doctors are forced to see more patients in less time. Prescribing psychoactive medication is a common endpoint of all of these trends. Our society is at risk of raising a significant proportion of the next generation on psychotropic medications. To change this, a paradigm shift is needed in how we think about children, behavior, and relationships. Contemporary attachment theory offers such a paradigm.
In my pediatric practice I have many children on medication for attention deficit/hyperactivity disorder. These medications can be highly beneficial. I also have patients, including those who have suffered abuse and neglect, who are under the care of child psychiatrists and need several psychotropic medications. What is worrisome, however, is the increase in psychiatric diagnoses in very young children who might be only difficult, not disturbed - and the subsequent prescribing of medication. Parents of children like the one at the playground often ask me at the first visit if their child might have bipolar disorder.
A paradigm shift allows us to see the same story in a different way. If we can listen differently to parents of young children who have "behavior problems," we can intervene early, before there is even a question of medication, and may be able to change these developing brains.
Studies have shown that a parent's capacity to think about and understand a child's experience from the child's perspective is associated with a child's increased cognitive resourcefulness, greater social skills, and better capacity to regulate emotions. Healthcare policy, and the education of pediatricians and mental health professionals, must move toward giving our full support to parents of young children in this way. Only then can we hope to improve the mental health of the next generation.
Prescription Drugs 
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