Welcome to Your Child's Brain: How the Mind Grows From Conception to College (44 page)

A popular chain of clinics is operated by Daniel Amen, a cheerful celebrity doctor and bestselling author. At his Amen Clinics, expensive SPECT brain imaging scans are claimed to identify patterns of activity to design custom treatment for ADHD, anxiety, obesity, the prevention of Alzheimer’s disease—and even marital problems. Amen’s books are filled with vignettes in which the treatments are consistent with what most psychiatrists would do on hearing the patient’s symptoms, without any brain imaging at all.

Scientists have offered to test the Amen Clinics’ diagnostic tools under controlled conditions in which the evaluator makes a diagnosis without knowing the patient’s problem in advance. Amen has declined this opportunity. Although neuroimaging may someday be useful in diagnosing brain ailments, no one yet has the ability to do it.

The caudate receives powerful projections from the ventral tegmental area and the substantia nigra. The structural findings suggest that Ritalin may work by increasing the strength of dopamine signals coming into the caudate (and perhaps other brain areas as well). Think of the mechanism for staying on task as an unresponsive appliance switch, and Ritalin as a means for pushing the button a little harder.

Although ADHD is sometimes useful for identifying children who might need additional help, it is not a permanent designation. The signs of ADHD can change over time—mostly for the better. For example, though small children are generally not big on attention, in only the most extreme cases would it make sense to say that they have ADHD. Activity levels that may be quite
typical in a four-year-old might be considered abnormal in a seven-year-old. In one estimate that is typical of the ADHD scientific literature, by age eighteen, ADHD symptoms have subsided in about 60 percent of boys who received the diagnosis earlier in life.

Most adults who once had childhood ADHD do not experience emotional or behavioral problems. In the long term, Ritalin does not improve academic outcomes—nor does it increase the risk for substance abuse, as you might fear for an amphetamine-like drug. In fact, the risk of later substance abuse may be lowered by Ritalin treatment. In general, ADHD kids are at higher risk for criminality and substance abuse, but the largest known predictor of this outcome is whether antisocial tendencies and conduct problems arise during adolescence (see
chapter 9
).

All in all, the boundary between ADHD and normal function is a blurry one that is determined by both biology and cultural expectations. To some extent, differences between ADHD and typical brains simply reflect a delay in development. In both groups of children, neocortical gray matter reaches a peak at or before the onset of puberty, but the peak occurs about three years later in ADHD children. Furthermore, the difference in the caudate essentially disappears by midadolescence.

These lags, as well as the resolution of behavioral problems in the majority of ADHD children, suggest that ADHD is at its core a matter of slightly slower brain maturation and that brains catch up by adulthood. In this respect, ADHD appears to be part of the natural range in attentiveness that results from generation-to-generation shuffling of the gene pool. Evolutionarily speaking, most of this range has generated functional people for most of the history of our species. Stimulants such as Ritalin should probably be reserved for those who are failing despite all other interventions. For other kids the right prescription may be, to paraphrase the old physician’s advice: wait two years and call us in the morning.

Chapter 29
CATCH YOUR CHILD BEING GOOD: BEHAVIOR MODIFICATION

AGES: ONE YEAR TO TWELVE YEARS

When it comes to getting your kids to pick up their toys, we have good news and bad news. The good news is that children’s behavior is strongly influenced by the positive or negative consequences that immediately follow from certain actions. If you can set appropriate expectations for behavior and get the consequences right (more on that later), your children will follow your household rules—most of the time, anyway.

The bad news … well, it’s the same news. If whining or throwing tantrums gets your kids something they want, that’s what they’ll do. You may not think of nagging as a way of rewarding your child for misbehaving, but even yelling can actually encourage the behavior you’re trying to stop, especially if that’s the best way for your child to get your attention. Completely ignoring the problem behavior is usually the most effective way to get it to stop—if you can stick with it long enough.

It’s common for parents to turn to yelling or spanking as their first response to problem behaviors, but a large body of research shows that this negative approach to behavior modification is not very effective in the long run. The effects of punishment are fleeting and tend not to generalize to other situations. Punishment also leads to fear and anxiety, which may cause emotional difficulties for your kids down the line. Besides, you probably don’t want to teach your kids that violence is an appropriate way to solve their conflicts with other people.

Many parents put extra pressure on themselves and their kids by believing that learning to obey family rules shapes children’s eventual adult character. This belief may sound reasonable, but in fact, it’s rarely true. No matter how you handle toilet training, your child is probably not going to be wetting the bed at twenty-five. As we discussed in
chapter 17
, parents do not sculpt children’s personalities nearly as much as our culture leads us to believe. Understanding that your child’s future is not at stake in routine parent-child conflicts, no matter how they turn out, should allow you to relax a bit.

The main effect of parents’ rules and their consequences is to determine how your children behave while they’re living with your family—and when they return home for holiday dinners as adults. Researchers find surprisingly little similarity between an adult’s personality as evaluated by his friends or colleagues and his personality as evaluated by parents and siblings (see
Myth: Birth order influences personality
).

Explaining exactly what you’d like your child to do is the first step in behavior change—not the last, as many lecture-happy parents seem to believe.

If you’re not building your child’s character, why bother to enforce rules? There are several good reasons. Learning to abide by sensible restrictions does help children to develop self-control ability (see
chapter 13
). On the flip side, growing up in a chaotic household full of conflict is a common source of stress that can interfere with the development of resilience (see
chapter 26
). The most important reason, though, is simply that it’s very difficult to build a good relationship with your children if you’re trapped in a constant struggle over their behavior. Effective discipline allows everyone to put their energy into more important aspects of family life.

A good foundation for a smoothly functioning household is warm parent-child relationships (see
Practical tip: Promoting conscience
). Enjoying fun times together with your child is good for its own sake, of course, but it also helps to keep everyone on the same side, wanting what’s best for each other. The easiest children to discipline are the ones who want to please their parents. Research shows that spouses who have fewer than five positive interactions for every negative interaction are at high risk of divorce. Despite the occasional temptation, parents and children cannot divorce one another, but a similar rule probably applies to distinguishing happy families from unhappy families. If you spend much of your time with your child nagging and correcting, it’s worth giving some thought to how you can both get more enjoyment out of the relationship. That should improve both the quality of your home life and your child’s behavior.

Broadly speaking, when parents talk about discipline, they want children
either to do something or to stop doing something. One of the most effective methods of reducing the frequency of an unwanted behavior goes by the scary-sounding technical name of
extinction
, which is nothing more than ignoring the behavior. Your child whines; you act as if you didn’t hear her say anything. Once you start that approach, though, you’ve got to hang tough until the child stops whining. The very last thing you want to teach your child is that you’ll give in after many hours of persistent whining—which is what a lot of kids end up learning, once their parents’ resistance is worn down.

For that reason, it’s easier to stop difficult behavior before it’s become entrenched. You should be very skeptical of the phrase “just this once” when it pops into your head in moments of parenting stress. Frankly, whatever you’re thinking of doing, you’re unlikely to do it only once. So unless you’re prepared to spend hundreds of hours in the car with your baby, don’t use a car ride to put her to sleep. Similarly, putting your toddler to sleep by crawling into bed with him is setting yourself up for a lot of nights of human teddy bear duty.

Along the same lines, learning to anticipate and head off approaching problems before they become serious can save a lot of wear and tear on everyone. It’s usually easier to intervene early by changing situations that lead your child to bad behavior—whether that means choosing the candy-free checkout line at the grocery store or suggesting that your child run around for a while before getting in the car for a long ride—than it is to deal with the resulting problems after they’ve occurred.

The practice of giving your child a time-out derives from studies of extinction in lab animals, where it is called
time-out from reinforcement
. As the name suggests, its purpose is to prevent children from getting any form of attention for bad behavior. Even negative attention is still attention. Like rewards, the time-out should immediately follow the behavior, or it will not be effective. Lecturing or touching your child during a time-out defeats its purpose and will probably act as an attentional reward. Brief time-outs of a minute or two are sufficient to change behavior. If at the end you briefly praise your child for cooperating with a timeout, she will be more likely to do so again the next time. If your child refuses to take a time-out when asked, it is time for her to learn the act of time-out itself. Use positive reinforcement on “dry run” time-outs while you are both calm (see
Practical tip: Getting to good
).

In brain terms, extinction is not a form of forgetting but an additional form of learning. Laboratory studies show that extinction does not directly modify the synapses involved in the original behavior, but instead strengthens the frontal cortex’s ability to suppress the existing activity of those synapses. As a result, the undesired behavior may suddenly pop up again at moments when frontal cortex function is weak—such as when your child is tired or has spent a long time focusing on something, like homework or chores. This outcome is expected and does not mean that the approach has failed, but it might mean that the kid needs a rest. As long as you don’t reward the problem behavior, it will go away again.

PRACTICAL TIP: GETTING TO GOOD

It’s more effective to reward your child for being good than to punish him for being bad. But how can you reward him if he won’t do what you want him to do? There are two options, and you can use both of them together.

The first option is to reward him for being a little bit good. Imagine that you want him to pick up all his toys before dinnertime, but you can’t reward him for that because he never does it. Instead of turning the interaction negative by nagging or giving up on the whole idea because it’s too much hassle, set the bar lower at first. The first day, if he picks up a single toy, praise him immediately and enthusiastically, telling him exactly what part of his behavior made you so happy.