Month: November 2015

Behavior & Diagnosis

On By Dr Craig ChildressIn DiagnosisLeave a comment

Behavior is a symptom.  The brain is the cause.

Simply putting the word “Disorder” after a set of symptoms is not a diagnosis.

Imagine if you had an infection that caused a fever, and you went to the doctor and received a diagnosis of a “Fever Disorder.” That’s not a diagnosis. That’s just putting the word “Disorder” after the set of symptoms.

Do we have medications to treat a “Fever Disorder”?  Absolutely.  There’s Tylenol, and Advil, and aspirin. But since we’re only treating the symptom we continually have to medicate to suppress the symptom. The moment we stop the medication the fever returns because we have not resolved the underlying cause of the fever. And our treatment of the “Fever Disorder” is only partially effective. It brings the fever down from 103 to 100, but it doesn’t get rid of the symptom, it just suppresses the symptom somewhat.  Yet our “treatment” for a Fever Disorder is empirically validated in clinical trials to reduce the symptoms of a Fever Disorder

If, on the other hand, we use the symptom of the fever to diagnose the cause, the underlying infection, then we instead treat with antibiotics, we cure the infection and the symptom, the fever, goes away – often without even having to address the symptom directly. Diagnosis is using the symptom to identify the underlying cause. We then treat and resolve the cause and the symptom goes away.

Behavior is a symptom.  The brain is the cause.

Inattention is a symptom, hyperactivity is a symptom, oppositional behavior and defiance are symptoms. Simply putting the word “Disorder” at the end of a set of symptoms (Attention Deficit Hyperactivity Disorder; Oppositional Defiant Disorder) is not a diagnosis, it’s simply a “Fever Disorder.”

A diagnosis involves using the symptom of the child’s behavior to identify the underlying cause in the integrated or non-integrated functioning of the underlying brain systems. Once we understand what is causing the particularly symptom display by the child, we then intervene specifically to resolve the cause and restore the integrated functioning of the various brain systems, and the symptoms go away – often without having to even address the symptoms directly.

An organized and well-regulated integration of brain systems produces organized and well-regulated behavior. Disorganized and dysregulated brain systems produce disorganized and dysregulated behavior.

When the underlying brain systems are disorganized and dysregulated, the child emits behavior that is too rigid, overly demanding and inflexible, too emotional, that is defiant and oppositional, impulsive, over-active, the child tantrums, is aggressive, etc.

When the underlying brain systems are organized and well-regulated, the child emits behavior that is relaxed, pleasant, and cooperative. The child is pleasant to be around. The child is relaxed and smiles.  The child is cooperative with the directives of parents and teachers. The child understands the social context of his or her behavior and gets along well with peers. Organized and well-regulated brain systems produce organized and well-regulated behavior.

There are six Primary Brain Systems underlying behavior:

1. Sensory-Motor Systems
2. Emotional Systems
3. Language and Communication Systems
4. Relationship Systems
5. Executive Function Systems
6. Three Motivational Systems

The functioning of each of these Primary Brain Systems will be described in separate essays.

We all live in a brain, so we all have direct personal experience with each of these brain systems, so they are actually pretty easy to understand once their functioning is explained.

Once we understand the functioning of the underlying brain systems, we can then use the child’s symptoms – the child’s behavior – to diagnose the underlying cause. We then address and resolve the cause of the child’s behavior and the symptom goes away, and we achieve a pleasant and cooperative child who grows into a mature, cooperative, and responsible young adult.

Craig Childress, Psy.D.
Clinical Psychologist, PSY 18857

Handout: Communicating with Children

On By Dr Craig ChildressIn Communication, Handouts, IntentionLeave a comment

This handout on communicating with children is posted on my webpage.

Communicating with Children

It is designed for younger age children (ages 3-5 years old) but the principles can be adapted for older children, particularly the communication strategies of reflective listening, using open-ended “what” and “how” questions, and encouraging the child into independent problem solving.

The relationship systems of attachment and psychological connection are designed to register the intention of other people through a set of brain cells called mirror neurons (see the online PBS Nova program on Mirror Neurons).  The relationship systems of the child’s brain are registering the parent’s intention, what’s motivating the parent to respond in that way.

One of the most powerful relationship intentions is the “intent to be-with.”  This is a wonderfully positive intention to just be-with the other person because that person is inherently valuable to us, because we love that person.  This wonderfully positive intention to simply be-with with the other person is communicated in the strategies described in the Communicating with Children handout.

In the gentle strategies of SOUL (silence, observation, understanding, listening) we communicate the child’s inherent value to us through our desire to simply be-with the child.

Self-talk and parallel talk are ways of being with the child without the pressure to do something, or accomplish something (an intent to task), but just simply to be together sharing in the same activity.

Repeating back what the child says (reflective listening) communicates that what the child said was valuable and that we listened to and heard the child.  This is an “intent to understand” the child’s world from the child’s perspective.

These two motivating intentions are the two most valuable and deeply wonderful relationship-building intentions:

The intent to be-with the child because the child is inherently wonderful and valuable, and

The intent to understand the child’s world from the child’s perspective because the child is inherently wonderful and valuable.

These motivating intentions are in contrast to the two maturation-building intentions:

The intent to task because accomplishing the task is more important than what the child may feel at the moment, and

The intent to change which is that the child must alter his or her behavior in order to coordinate the child’s behavior with the social needs of others.

Both of these maturation building intentions require that the child suppress his or her own feelings and motivations to the broader social requirements needed to accomplish a task or coordinate with other people’s motivations and needs.  The maturation building intentions of a parental intent to task and intent to change support the child’s developing maturation (the ability of the child to suppress his or her own needs of the moment to achieve an overarching goal or cooperate socially with others).

When parents communicate to children from the maturation-building intentions of an intent to task and intent to change they tend to offer advice, direction, and criticism of the child’s actions from a desire to help the child do better.

When parents communicate to children from the relationship-building intentions of an intent to be-with and intent to understand they provide their children with communications that the child is inherently wonderful, valuable, and deeply loved.

Sometimes in the day-to-day stresses of life it is easy for parents to get caught up in communicating an intent to task and intent to change, and it’s easy to slip away from the relationship-building intentions of simply being with the child and seeking to understand the child’s world from the child’s point of view.

The gentle communication strategies of silence, observation, understanding, and listening; of self-talk and parallel talk; of reflective listening, open-ended questions, and encouraging the child, all build important self-worth and inner self-esteem networks that are vital to healthy emotional and psychological development.

What we’re seeking is balance – a balance between healthy social maturation and the development of inherent self-worth and self-esteem; a alternating blend of intent to task and change in some situations with an intent to be-with and intent to understand the child’s world from the child’s perspective in other situations.

The outward communication strategies are born from our inner intentions.  Communication with children is born from an intent to be-with the child and from an intent to understand the child’s world from the child’s perspective.  Our intention then informs our response to the child using the strategies of silence, observation, understanding, listening, self-talk and parallel talk, reflective listening, open-ended questions, and encouraging the child.

The key is our intention.

Craig Childress, Psy.D.
Clinical Psychologist, PSY 18867