A Practical Guide to the Kind of Communication Between Doctors, Parents, Therapists and Educators that Helps Children Succeed
Every day for the past 22 years, we’ve been working with parents and professionals. We’ve seen firsthand, countless times, that the goal of raising emotionally and developmentally healthy children is largely dependent on productive communication between parents and the professionals they’re working with in the medical and educational fields.
Even 22 years ago, and all the more so in the decades prior, good communication was simpler.
A pediatrician often knew a child from the time they were born through young adulthood. Because of the close relationship, and also due to the lack of information from other sources, the pediatrician was the trusted go-to for any medical or developmental questions.
At the same time, a good pediatrician knew his limits and would refer to a specialist for any issues that were beyond his training and expertise.
The world has changed.
Technological advancements have made a wealth of information available to anyone and everyone, for better and for worse. The insurance industry and technology has (not always, but often) made the relationship with a physician more perfunctory and technical, and less of an organic, long-term relationship.
And what are the results?
Parents have less trust in professionals. Professionals have less patience for parents. Both parents and professionals build and get stuck in firmly held convictions that leave little room for discussion. One side doesn’t hear the other; the second doesn’t hear the first.
And the children slip through the cracks. Although these slips are usually the exception and not the rule, when it comes to a precious child, any slip that could have been prevented is one too many.
So what can we do about it?
Take the Time to Understand
When you’re faced with two contradicting opinions, the first order of business is figuring out the rationale behind each one. In other words, I can only address someone else’s opinion if I have fully understood it first.
We were present at a heated discussion between an eighth-grade teacher and a guidance counselor. The subject was whether to put 13-year-old Shaun on medication for his anxiety and ADHD. The teacher insisted it would be the best way to give Shaun a chance at academic and social success. The guidance counselor thought other treatments should be tried first. The volume was rising, but the conversation wasn’t going anywhere.
Then the guidance counselor paused. “Why are you so insistent about moving to medication before trying other treatments?” he asked.
“Shaun’s already in eighth grade,” replied the teacher. “Next year he’s entering high school, and being in high school with severely underdeveloped social skills can spell disaster. When I taught in high school, I saw it happen several times, and I don’t want that happening to Shaun. Other treatments might help, but they usually take longer, and he needs the help before it’s too late.”
“I hear your point,” said the guidance counselor. “My concern is that the medication won’t help him. From my experience with children who have Shaun’s presenting issues, psychiatrists end up prescribing one medicine for anxiety, another for ADHD, another to cancel out the effects of the ADHD medicine on the anxiety prescription, and these children end up on a cocktail of drugs that doesn’t get them anywhere.”
“I see,” said the teacher.
There was silence, both of them thinking.
In the end, they decided to refer Shaun to a psychiatrist who would get to know Shaun and become familiar with his involved history and his current manifesting issues before prescribing any medication or referring to a particular treatment.
What was the turning point that helped them move past the impasse?
It was the guidance counselor’s question: “Why do you feel this way?” He had a sincere desire to understand the teacher’s position. Once there was an attempt to understand, the door of cooperation sprung open. Shaun will be much better off for it.
We’re living in exciting times. Neurodevelopment is a frontier of research. Every day we learn more about neurochemicals, their impact on brain development and functionality, and new ways of releasing and affecting them. Just as importantly, we’re also learning about their — and our own — limitations.
Anyone working with children, be it in the field of medicine or education, or even a parent, can gain so much by learning more about this topic. Just being aware of the advances and discoveries in this field helps generate new ideas for helping, directing — and possibly saving — our children.
A short while ago, we met a nurse practitioner who was on a quest to help a 16-year-old patient cope with ADD, depression and mood disorders. “After a year and a half of prescribing different medications with no significant gains, we both wanted to give up,” the nurse practitioner told us. “And then I thought, ‘Maybe I’m missing something here. Maybe there are tools and approaches that could be effective that I don’t have any awareness of.’ That’s when I decided to explore alternative ways of helping this girl.”
We were impressed by this professional’s humility, admitting that she doesn’t have all the answers. And we were doubly impressed with her dedication, putting in the effort to learn new things and find answers.
Look for Evidence
Just because attention and focus issues have always been addressed a certain way doesn’t mean that needs to continue if another way might work better. And, at the same time, just because one person had success with an alternative treatment or some other method doesn’t mean it will help every child, or even that it’s worthwhile trying.
Not infrequently, a parent will come to us asking if we can do craniosacral therapy, vision therapy, the Tomatis method, and so on. When we ask what makes them think this therapy would be a good idea for their child, the answer is often something along the lines of “I don’t know; my neighbor is doing it for her daughter and she says it’s helping.”
When you really want to help a child, you need to be a bit of a Sherlock Holmes. If you’re a parent interested in a treatment, investigate it. If you’re an educator wondering how to best develop social skills in your students with Asperger’s, take a hard look at all the programs available. Put together all the scientific evidence, anecdotal evidence, and experiential evidence, giving each piece the appropriate weight, and apply it to the particular case of the child before you.
Be Leery of Black and White
Warning: bad joke ahead.
What’s black and white and red all over?
A parent of an ADHD child who is pro-medication and a professional who is anti-medication (or vice versa) having a heated argument.
Every individual — parent or professional — is entitled to have an opinion. The problem is when opinions turn into black-and-white, unshakeable convictions. “Yes, for sure put them on medication!” Or, “No, never use medication!”
When you have a one-size-fits-all approach to treatment of developmental, behavioral, or emotional issues, someone is going to get shortchanged.
Maybe it would be a shame to push 8-year-old Matt onto ADD medications and their inevitable side effects when he might get along fine with occupational therapy and alternative treatments. Maybe 10-year-old Anna is suffering socially and academically to an extent that waiting to track down an effective alternative treatment could have negative repercussions into young adulthood and beyond, and she should be given the opportunity to take medication.
We do a service to our children when we are open to exploring what approach would truly be the best for each individual case.
(A note to professionals: If you do have a no-budge policy on something, share that with parents before you decide to start treatment. Otherwise, it’s not fair to either of you.)
When you show others respect, aside from developing your own character, you also achieve a very practical outcome: They tend to listen to you more.
A mother recently told us about her daughter, who had a temporary (and foreseen) regression as a result of her treatment regimen with us. The girl’s school-based therapists, who were told in advance about the possible changes they would see in the child, were overwhelmed and complained to the principal. The principal called the mother and said, “Your child is deteriorating. Whatever you’re doing isn’t working. There’s no hope for her in our school system if you continue this way.” The mother shared how she felt frightened and intimidated — and she was a therapist herself, who understood what was going on with her child.
As a professional, appreciate the power of the white coat (or black suit, or whatever symbolizes your position of authority). If you don’t take time to ask and understand with an attitude of respect toward the parent, you’ll shut down the lines of communication, and the child will be the worse for it.
As a parent, give respect to the professionals you work with. First, show the therapist, or doctor or educator that you appreciate her approach. Then, and only then, explain your concerns with that approach or express your desire to explore other options.
Don’t Wait Too Long
When an individual is struggling, there are three possible outcomes:
- He develops adaptive, positive coping mechanisms.
- He develops maladaptive coping mechanisms.
- He sinks.
Children with sensory integration and other developmental issues that aren’t addressed are more likely to develop maladaptive coping mechanisms. They are at a higher risk for mental health issues later in life. This means that finding effective treatments should be a priority. This does not mean that the parent should panic. It does mean that the parent should make sure to put in the appropriate effort and shouldn’t be negligent.
Obviously, most treatments don’t deliver instant or even close to instant results. A competent professional should know — and let the parent know — how long it should reasonably take to see results, and the maximum amount of time it could take to finally see results.
If the maximum time has elapsed and the issue is still unresolved in a way that is affecting the child’s and her family’s functionality, it’s time to try something else — and possibly a different direction entirely. Don’t just let it go.
We once evaluated a girl who had been on and off different mental-health medications for years. Her parents had taken her from doctor to doctor to find some treatment that would address her self-harming behaviors and alarming statements like “I wish a wall would just fall down on me.” When we brought up the idea of an underactive proprioceptive system, and how the body can crave intense physical stimuli and pressure, the girl’s eyes simultaneously lit up with delight and burned with anger. “How come these women can understand me,” she turned to her parents, “and you and all those dozens of doctors can’t?”
It’s never too late to receive treatment. That said, the more layers of frustration, maladaptive coping mechanisms and anger a child builds up, the more difficult the treatment process is going to be.
There’s a fine balance here, and one that needs to be shared by the child’s parents and the involved professionals. On the one hand, don’t rush; don’t panic; have patience. At the same time, don’t neglect or wave away an issue. And don’t beat a dead horse. If you’ve given it the requisite time and patience, it’s time for a parent to look elsewhere and for a professional to refer elsewhere.
The Power of Together
We are not raising our children in a vacuum. Each child has a team — parents, family members, educators, medical professionals, therapists and more — contributing to their growth and development.
Just because you are a team, however, doesn’t mean you automatically work as a team. That takes patience, respect, efforts at good communication, and the desire to learn and improve. When you’re on a team with people who each have their own unique characters, opinions and approaches, that can be challenging work. But, for the sake of our children, it’s well worth it.
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