This morning while driving my son and two friends to practice for their high school singing group, we listened, as part of an NPR report on his death at age 94, to Pete Seeger tell the story of his song Where Have All the Flowers Gone. His voice, his message and his music together had a profound calming effect on me, and I suspect on my passengers as well. There was quiet, and perhaps even a tear shed by others besides me.
In my behavioral pediatrics practice I make a point of asking about a child's interest in music. Whether the presenting problem is one of anxiety, frequent meltdowns, inattention, hyperactivity, or a range of other concerns, I have found that music often has a calming effect. One little girl, whose mother was under considerable pressure to have her diagnosed with ADHD and put on medication, stopped her scattered and frenetic play to sing me a song. Another, struggling with social anxiety, who for much of the visit refused to speak, at first with his back to me and then with increasing boldness, did the same. When parents see this effect of music on their child, they are moved to incorporate music in to our efforts to support development of emotional regulation. Problems with emotional regulation are central to all of these behavioral symptoms.
I was in need of emotional regulation myself this morning after spending the weekend embroiled in a difficult discussion about the subject of "ADHD." In a conversation on a list serve made up primarily of child psychiatrists, I pointed to a recent study about ADHD that showed very poor long-term outcome. I wondered if there might be an alternative explanation to that offered by the authors of the study, namely that ADHD is a chronic illness that requires lifelong treatment. Could it be, I asked, that the poor long-term outcome is because we are not properly treating the problem in the first place? That when we diagnose based on symptoms alone, and treat with behavior management and medication, we fail to address the full complexity of symptoms of dysregulation of attention, behavior, and emotion? I wondered how we would separate this issue from the possible long-term effects of stimulant medication itself.
I got a huge amount of push back, with a number of people implying that I was "unscientific," and that I might be affiliated with the church of Scientology. Given that there is extensive scientific evidence supporting an alternative paradigm for understanding symptoms of dysregulation of attention, behavior and emotion, this suggestion particularly got under my skin.
Not only music, but dance, martial arts, yoga and other activities have an important role to play in self-regulation. This is particularly true for children who have biological vulnerability to dysregulation, including those with problems of sensory processing. All of these activities occur in the context of important relationships, relationships that themselves are essential to development of emotional regulation. My little patients perform their songs in the context of a growing relationship with me.
But if we employ a purely medical model, diagnose ADHD, anxiety or any range of problems using the DSM ( Diagnostic and Statistical Manuel of Mental Disorders), we miss the relational and historical context of these symptoms. We need to offer room to hear the individual story of a child and his family in order to make sense of his symptoms. This story is itself can be a kind of music. Dar Williams incredible song "After All" offers a beautiful example.
When children present with a range of behavioral symptoms, if we simply "manage behavior" and treat with medication, where is there room for the music?
Arlo Guthrie, who frequently performed with Seeger, in his song Alice's Restaurant, proposed that everyone being evaluated for the draft walk in singing the chorus of his song, and in doing so create an anti-war movement.
Borrowing the idea, espoused by both Arlo and Pete, of changing the world with music, what if every new evaluation of a child with a behavior problem included singing and/or listening to one of Pete's songs? It might help calm everyone down-parent, clinician, and child alike. If, in turn, the next generation were helped to develop in a healthy way, with an ability to think creatively and engage effectively in a complex social environment, it might change the world.
Welcome to my blog, which speaks to parents, professionals who work with children, and policy makers. Through stories from my behavioral pediatrics practice (with details changed to protect privacy) I will show how contemporary developmental science can be applied to support parents in their efforts to facilitate their children’s healthy emotional development. I will address factors that converge to obstruct such support. These include limited access to quality mental health care, influences of a powerful health insurance industry and intensive marketing efforts by the pharmaceutical industry.