Shirah Vollmer MD

The Musings of Dr. Vollmer

Parents Worried About Their Six Year Old: Who Is The Patient?

Posted by Dr. Vollmer on July 19, 2012

“The fact that the parents bring in their child, that does not mean the child is the patient,” a trainee tells me with the wisdom of a more seasoned clinician. “Yes,” I enthusiastically agree. The patient’s opinion of the problem and the clinician’s opinion do not always agree, particularly in the field of child psychiatry where the “identified patient” may not be the one with psychological issues, but rather the target of family dysfunction. Herein lies the job of child psychiatrists, to discern the stated problem from the underlying problem. Johnnny, the fictional six-year old, may have behavior problems, but at the risk of offending my loyal reader Shelly, those behavior problems may not lie within Johnny, but rather they could stem from the discord between his parents. I reference Shelly here, as she is frequently concerned that I have a “blame the parents” approach to childhood assessment. Certainly, one size does not fit all, and sensitive parents can have children with severe behavior issues, yet, at the same time, there are times when severe aggression is a result of an environment which is chaotic and frustrating for the child. Johnny’s parents may be taken aback at the notion that his behavior is a result of insensitive parenting, and yet, this may be the message that the clinician needs to convey. What I am calling “insensitive parents” may then be so angry that their child is “misunderstood” that they will seek a professional who shares their point of view about their child. This inherent issue, that parents can only tolerate so much information about their parenting style, is the challenge of all child psychiatrists. Telling parents what they don’t want to hear is never easy, even if it means telling them that their child is normal and healthy. And one wonders why there is a shortage of child psychiatrists? Not.

8 Responses to “Parents Worried About Their Six Year Old: Who Is The Patient?”

  1. Jon said

    Sadly, bur necessarily, the first question a parent must ask in dealing with a child’s behavior problem is, “What have I done wrong?”

    Nature and nurture both loom large in determining a child’s behavior. The biological parents have already done what they will about the nature. The parents who raise the child are the main source of the nurture of the child.

    Hopefully a wise parent will be aware of this; however, as the song writer and poet Steve Gillette will tell us, “Age doesn’t always bring wisdom. Sometimes she comes alone.”

    • Nice quote, Jon. The issue is how to help parents see that they might be contributing to their child’s issues, when narcissistic defenses make it almost impossible for parents to process that information. Since the parents are not consenting to their own treatment, then how does a child psychiatrist point them in a direction they are resistant to go in? Sadly, as you imply, some parents won’t engage in the discussion of parenting styles and as such, the child psychiatrist is rendered helpless.

  2. Shelly said

    Hmmm. How flattering to be in a post of yours, Shirah. Even I know the difference between nature and nurture, though. I have two children–my oldest and my youngest, who have behavioral issues. The oldest, an Aspie, has had these problems practically since birth. The youngest was born a calm and relaxed child into a household of chaos and disorganization. No doubt he was unduly influenced by his environment. Ergo his behavioral problems. And his parents (at least one of them) are very well aware of the environment’s influence on the child(ren).

    • Yes, but I have listened to your frustration over being “blamed” for issues in your children and that is also a tragedy in that it is hard enough to struggle with trying to figure out how to help your child, that to feel “blamed” just makes things worse. At the same time, understanding the various factors which enter into a child’s behavior, or misbehavior, is a complex task which hopefully involves a sensitive clinician who can guide the family through potentially shameful realizations, and then hopefully, helpful solutions. When this process strays, then the pain can be very deep, for all involved. Thanks.

  3. jo said

    How about childhood anxiety? Is that often affected by parenting style as well? I had severe childhood anxiety issues despite a very stable and loving home life.

    • Yes, absolutely. Some childhood anxieties stem predominantly from a genetic predisposition, but at the same time, an inconsistent parenting styles can certainly contribute to anxiety in children. It sounds like your situation is the former, and so I could imagine that you might have been a good candidate for medication.

      • jo said

        Yes, I believe a genetic predisposition and trauma outside of the home contributed heavily to my anxiety levels as a child. 30 years later, I’m probably still a good candidate for medication … I haven’t had much patience with side effects!

        • You raise a good point about outside trauma, outside of the home, that is, can also be a large factor in creating internal instability. As for side effects, starting low and going slow, is a good way to ease into medication.

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