Shirah Vollmer MD

The Musings of Dr. Vollmer

Nature or Nurture: Will The Debate Ever End?

Posted by Dr. Vollmer on February 8, 2012

   Daniel http://shirahvollmermd.wordpress.com/2012/02/07/the-aggressive-child/ is out of control in that he throws chairs when he gets frustrated with his video games. He punches his mother when she asks him to do homework. Is the problem a parenting issue or a mental health problem or both? Although seemingly complex, the issues become straightforward. All children, especially aggressive children, need to have very clear limits: a “holding environment” as Winnicott has taught us. By clear limits, I mean that Daniel has to be told that hitting is not acceptable. He needs help to use his words when he gets frustrated. He needs to be exposed to video games which are age-appropriate. He needs to have guidance with self-regulation when it comes to eating and sleeping. The parents need to make sure that he eats well and has a regular bedtime. They also need to make sure that the school is attending to his academic and emotional needs. Finally, they need to make sure that Daniel is exposed to playdates so that he has the opportunity to learn social behaviors from his peers. When all of this is in place, and Daniel still has problems with frustration and aggression, then the discussion about diagnosis and medication management needs to begin. It is not that Daniel’s parents are responsible for Daniel’s aggression, it is that Daniel’s parents can provide the basic nurturing environment such that we can see that even with a clear “holding environment” whether Daniel can control his impulses. It is hard to know if Daniel can control his impulses when the environment is chaotic and unpredictable. In this latter circumstance, many kids, with or without a mental illness, become anxious and physical. I think I am stating the obvious, and yet controversy ensues. What am I missing?

6 Responses to “Nature or Nurture: Will The Debate Ever End?”

  1. Jon said

    What are you missing? Nothing. Nature defines the rules of the game. Nurture is what can be done within those rules.

    Daniel’s nature is part of what makes him aggressive. However, is he necessarily with a mental health problem? The situation is unclear. Good nurturing by creating a clear “holding environment” would be what might help.

    Like

    • Shirah said

      Yes, but those who tilt towards thinking that parents can fix all of their kid’s problems are rivalrous with those parents who believe that medicating their children are the only option. Clearly, both are important. My issue is why do these two group of parents get so hostile with each other. To put it another way, parenting styles seem to generate tremendous conflict and judgment. I find that very interesting. I also think it suggests insecurities all around. Thanks,as always.

      Like

  2. i am a parent of a child diagnosed with ADHD and anxiety, who also has problems with agression. Iit is not clear how much his anxiety and ADHD contribute to his behaviourial problems, although there is probably a link. I am not particularly concerned about why my son behaves the way he does. I am much more concerned with helping him manage his behaviour so he doesn’t become frustrated and/or angry.

    I agree with you that it is important for parents to clearly identify what sorts of behaviours are unacceptable (e.g., hitting) and to create a “basic nurturing environment.” However, in my experience, maintaining a “nuturing environment” for children who are easily frustrated and/or agressive is not “straight forward.” When he was younger, my son did not deal well with any sort of transition from one activity to the next. While we did our best to give him advance notice of events, etc, it was impossible to plan for every contingency. As well, when your child behaves agressively towards other children, finding any playmate can be challenging because other parents rarely want their child to interact with a child whose behaviour is unpredictable. And if you know of a school that can adequately attend to a child with behaviourial problems “academinc and emotional needs,” I am sure many parents would like to know the name. My son is in a very good public school, but we have to fight every year to ensure he gets the support he needs.

    I am not surprised that the child does well in your office, as it is highly unlikely that his ususal triggers are present in such a controlled environment. We have had the most success in terms of managing our sons behaviour by identifying common triggers (tired, hungry, anxious) and related situations and taking mitigating steps. Perhaps this is what you mean by “a basic nuturing environment.” Even highly enlightened parents can find this challenging – it is anything but “straight forward.”

    Like

    • Shirah said

      Hi SJMCLELLAND,
      Thank you for sharing your story. I fear that my post was not clear. I do not mean that it is straightforward to help aggressive, violent and/or easily frustrated children. I meant to say that the steps to begin helping these children are straightforward. The environment needs to be “holding” meaning there needs to be clear rules and expectations, and then if that does not calm the child down, then other means of intervention are necessary. These other interventions often includes psychopharmacologiy. Some kids respond quickly to one or two interventions, whereas others require a longer, more involved course of interventions. These latter children are by no means straightforward, and indeed, I am often involved in such treatment plans. Thank you again for your comments.

      Like

  3. Shelly said

    Daniel’s parents surely tell him that hitting is not allowed, but he does not listen. His parents probably encourage him to express himself verbally instead of hitting, biting, pushing, or slamming things. To give themselves some respite, they probably allow him to play video games or watch some tv. The may have good intentions and begin the bedtime ritual early, but until he winds down and finally ends up in bed, it’s late. The school he attends probably is tired of his aggressive behavior and has threatened to expel him unless his poor parents either medicate him or straighten Daniel out. Daniel may have playmates, but he hits, doesn’t wait his turn, or grabs all the toys. Are the parents still to blame for not providing a “holding environment”?

    Like

    • There are certainly kids and families like you are describing, but Daniel and his family are not one of them. Yes, some kids, in the most “holding” of environments still act up in unspeakably destructive and out of control ways. For some of these kids, there is very little that can be done to help them, sadly speaking. These parents are sometimes stuck with few decent options which can help control their child’s behavior. However, in other situations, parents can do more to help their children calm down. Again, the first step is to see if changing the environment, by helping the parents makes a difference. If the environment is more orderly and the child still acts up, then other interventions need to be tried. Like anything else in life, there are no guarantees, and certain kids are not helped by the tools which we have available today. Perhaps in the future we will have more tools to help kids, but it is certainly true, that some unfortunate kids, do not calm down, no matter how much “holding” is provided. This post, though, is designed to make the point that each child is different, and yet, each deserve a “holding” environment to see if this would help them. Thank you again for your comments.

      Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

 
%d bloggers like this: