Recently I had an "aha" moment of sorts. I was speaking to a group at the Pacella Parent Child Center in New York. I was explaining the path that had led me to write my book, Keeping Your Child in Mind. I was telling the group how in 2006, when my own kids were both school age, I stopped doing primary care and began doing exclusively behavioral pediatrics. I was still working within a general pediatrics practice. The major change was that I started scheduling all my patients for 50 minute visits. Where previously an "ADHD evaluation" had been, at most, one 50 minute visit, and many visits for behavior problems only 30 minutes in length, I began insisting on a minimum of two 50 minute visits for any behavior problem, preferably the first with parents alone.
Many practitioners might now dismiss what I am about to say, insisting that this is not a financially viable plan. But the fact is that I have been reimbursed for these visits on average $150. It is possible for a practice to have one or two clinicians devote several 50 minutes a week to addressing "behavior problems," especially given the potential gain. As I describe in my book, when parents are simply given advice about "what to do" both clinician and parent often experience failure. In contrast, giving a parent time and space to be heard often results in dramatic improvements in behavior.
With this change in my practice, I began to listen more carefully to my patients, specifically to parents. I heard stories of struggles with infertility, newborns who were difficult to soothe from day one, parents who struggled with depression when their children were infants, among many other things. But I also learned about what made things better. Once parents were given the time and space to tell their story, they came up with many resourceful solutions to address their children's difficulties.
Certainly the ideas I have developed over the years come in large part from studying contemporary research from leaders in the field of child development. I am a graduate of the Scholar's program of the Berkshire Psychoanalytic Institute and of the UMass Boston Infant-Parent Mental Health Post-Graduate Certificate Program. But perhaps my most important education has been in carefully listening to the experience of parents.
Last week I had the privilege to be on the Diane Rehm Show speaking about the new guidelines from the American Academy of Pediatrics extending age of diagnosis of ADHD down to age four. To sum up the position I presented on the hour- long show, I advised using caution before prescribing medications to kids under six. I advocated for early intervention, even in infancy when problems of self regulation can present. I argued for validating parent's experience without using a major psychiatric diagnosis, and for recognizing the meaning of behavior rather than focusing exclusively on symptoms.
A mother who had listened to the show emailed me, thanking me for being "the voice of reason." She shared in detail her experience with her now six-year-old child. She described terrible struggles for the first five years until she and her husband discovered Stanley Greenspan's book about ADHD (his ideas and approach are very similar to mine) and everything "clicked." They took matters into their own hands in advocating for their son, who is now thriving. There were many details in her story- both the obstacles to help and the elements of the path to success.
Recently I have seen myself referred to in the media as a "child mental health expert." I appreciate this description, as it affords an opportunity for recognition of this important perspective that my infant mental health colleagues and I bring to the conversation. But reading what this mother wrote reminded me again that parents are always the experts with their child, and that there is still much that I can learn.