An Expert Explains How Parents Can Ease the Growing Pains of Children Who Are Hard to Manage
During the early years of his practice as a child psychiatrist, Dr. Stanley Turecki's approach—like that of most of his colleagues—was to find out "what has the family done to the child?" That began to change in 1974 when Turecki's wife, Lucille, gave birth to Jillian, their third offspring. Unlike her sisters, Jillian was restless and raucous as a baby. As a toddler her sense of humor and imagination emerged, but so did erratic eating and sleeping patterns and tantrums. Despite his training, Turecki, 47, admits, "I reacted like a parent," turning anxious and irritable. Bewildered, he began talking to other professionals and delving into the latest research on temperament. "I clearly started to see that many child-parent problems were not caused by the parents alone," he says. Armed with the fruit of his study and his personal experience, Turecki, in 1983, launched the Difficult Child Program at New York's Beth Israel Medical Center and, in 1985, the private Difficult Child Center. Last year he distilled the program's techniques and insights into a book for parents, The Difficult Child (Bantam, $15.95), co-authored by Leslie Tonner. Child development expert Dr. T. Berry Brazelton hailed the book as "just what we all need to understand...difficult children." Turecki met with Assistant Editor Bonnie Johnson to discuss his findings and assure parents that life with a difficult child need not be so difficult.
How can parents tell if their child is difficult?
I start by dividing temperament into nine traits, which are evident from an early age. These are each assessed on a scale from easy to handle to difficult to handle. In general if a child has four traits in the difficult end of the spectrum, he's a difficult child.
What are these traits?
The first is activity level. The more active a child, the more difficult he becomes to manage. Next is attention span. The shorter the span the more difficult the child. Then there is persistence. In a positive sense it means a child is goal oriented. Negatively it means he is stubborn. Poor adaptability is next. He has difficulty switching from one activity to another. Fifth is response to a new person or situation. Is his instinct to go forward or to cling?
Mood. Obviously a sunny child will be much easier to raise than a cranky kid who rarely smiles. The seventh trait is intensity—a child who, whether he's laughing or crying, is always at high volume. Regularity is next. How predictable is the child in patterns of eating and sleeping? Last is threshold, which has to do with how sensitive the child is physically to fabric texture, bright lights and colors, loud noises, smells and tastes. About 15 percent of all children in America under the age of 6 or 7 can be classified as difficult. We know that temperament is inborn, and genetics seem to play a role. Parental mismanagement does not cause a difficult temperament.
Can we say that these children are emotionally troubled?
No. That involves other signs: a child who says "I'm bad," who always cheats at games, can't stand to lose or is afraid of too many things. Difficult children are normal, but because they are so hard to raise, parents get caught up in repeated power struggles. They yell, threaten and hit a lot—to no avail. One purpose of my book is to teach parents to manage these normal traits early on to prevent emotional problems from developing later.
When do these traits begin to show up?
A child can be difficult from infancy. The typical things you see are the irregularities in sleeping and eating and the "colicky" baby who screams for no apparent reason. These babies lack an inner clock, so parents must begin to set up a schedule as best they can. As for the screaming, I tell these parents they should get earplugs. I help them understand it's the nature of the baby and not a sign of something dreadful.
How should parents begin to deal with a difficult toddler or older child?
The first step is to draw up a list of the kinds of behavior that cause problems in their family. An active, impulsive girl may be a handful for a quiet, serious couple, but in a rough-and-tumble home where she's the youngest child with three older brothers, she'll fit in beautifully. The next step is to look at that list and see how many of these behaviors can be linked to a difficult temperamental trait.
What does this accomplish?
It enables the parents to distinguish between naughty behavior and temperament-related behavior. If a behavior stems from temperament, the child in a sense "can't help himself." This calls for sympathetic management rather than punishment. Instead of calling the child "bad," the parent should take the attitude, "This is your nature, and I'm going to help you with it—not criticize you." Don't take the behavior personally. Don't say, "You're driving me crazy." Say, "You are getting overexcited." When labeling in this way, be specific, be neutral and don't use emotional or technical words. Don't say, "I know you have a low sensory threshold," but rather, "You're very sensitive to the tags on clothes." This is one way of showing your child that you understand him. Children over the age of 3 can be taught to understand their own behavior. Once the child can recognize some of his temperamental features, he will gain more self-control.
What management techniques do you suggest for the other difficult traits?
For the highly active child, parents need to spot when the child is becoming overexcited, to neutrally identify the behavior and then intervene by distracting him or switching to an activity like reading or watching TV that calms him down.
What about the child who adapts poorly to new situations?
Always explain in brief what the day's sequence of events will be. They'll be calmer if they know what's coming—they hate surprises. Another technique is to use what I call a "changing clock," a small digital clock that is used only for this purpose. If, say, your daughter hates to stop play ing and come inside for lunch, you go out with the changing clock in hand and say, "It's 12:10. When the last number becomes a 5, you must come in for lunch." This gives them a chance to prepare within a time frame set by something neutral—the clock.
How can erratic sleeping and eating schedules be handled?
The key is to separate bedtime from sleeptime, and mealtime from eating time. Parents have the right to enforce a bedtime and a mealtime, but they can't force their child to fall asleep or to eat. Thus when bedtime arrives, the child must get into bed and stay there, perhaps with a book or a record playing softly. He will fall asleep when he is tired. At mealtime the parents may insist the child sit down with them but not force him to eat. If he gets hungry between meals, the mother shouldn't become a short-order cook. She can keep a goody plate of nutritious things like vegetables, cheese, crackers, nuts and raisins in the refrigerator for the child to choose from.
When is punishment appropriate?
When the child does something that he has been told is not permitted and when that behavior is manipulative or mean, rather than an outgrowth of his temperament. Deciding which type it is can be hard because sometimes they overlap. But when you decide punishment is deserved, it should be done right away. Warn only once, then act with authority and use a menacing tone of voice.
What punishments are acceptable?
Most parents of difficult children punish frequently but ineffectively, often yelling, threatening or sinking to the level of the child. I advise parents to replace this so-called discipline with a few simple but consistent punishments. I tell them to select three ways in which they feel comfortable punishing their child and to use only these three means for all situations. Parents could send the child to his room, withdraw a privilege such as a favorite TV program or give a swat on the behind for emphasis. The child should be told in advance what misbehavior will lead to punishment. If he misbehaves, don't negotiate. When you discipline your child, think of yourself as a benevolent dictator. The child gets no vote in deciding what his punishment should be.
Is there any way to correct behavior without resorting to punishment?
A reward system for acceptable behavior can be set up. By and large, difficult children do better with this than with punishment. For example, if the child dresses himself five mornings in a row, he will receive a present. He can participate in choosing the present, within reason. Or a chart-and-star system can be initiated to reward the child for mastering a routine, such as getting ready for bed. After a while the routine becomes part of everyday life.
Does that mean you believe there is hope for difficult children?
Absolutely. Over the years a difficult child will learn to manage the negative qualities himself, and some of these traits will actually become assets. A highly active child might become an athlete. A child with an upside-down sleep schedule might become a disc jockey. Or a child with a high sensitivity to taste could become a master chef. Most difficult children are creative, interesting and individualistic. Winston Churchill was a classically difficult child: Active and stubborn, he did terribly at school, yet look what he became. In a way, he's my shining beacon for these kids.
How is your daughter Jillian now?
She's still very intense and has occasional difficulties with the unfamiliar, but she's learned to verbalize her feelings instead of always overreacting. She's a charming, exuberant, outgoing and happy 12-year-old now, and she is very proud of the role she's played in my career.
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