How to treat misbehaving child: Bad, Sick, or Uneducated?
I have to say, it really has surprised me (and even has disturbed me a little) that folks thought my previous suggestion to use Chloraseptic or Listerine on a young child as a form of discipline was “cruel.” Yet such assessments of my views make me sit back and look to make sure the criticisms are not correct. Was I really cruel in my discipline of my children? Am I giving parents the license to be cruel when I suggest this type of discipline? I certainly don’t want to later discover that I have unwittingly caused cruelty to be perpetuated on children.
Today in his blog, Dr. Charles brought to my attention a tragic story of a 4-year old child who died after being over-medicated for a presumed diagnosis of Bipolar disorder. The child was diagnosed at age 2, and was on multiple medications that were quite strong to treat this problem. There is a good op-ed from a psychiatrist that rightly addresses the wrong-thinking that can lead a child to be treated as such.
Combine these two things with my constant pressure as a pediatrician to treat children for ADD because of their academic performance and/or behavior, and it makes me stop and ask: what are we treating in children? Are children who are not behaving in the desired way just “bad,” as the traditional teaching goes? Perhaps children (and adults) who misbehave are instead “sick” - smitten with a disease such as bipolar disorder or ADD. Or maybe they are just “normal” kids that should not be punished or treated, but instead educated as to the proper way to behave.
Which is right?
Misbehavior is a Morality issue
Certainly the schools of thought on this depend greatly on a person’s overall view of human behavior. If you come from the traditional moralistic view where “right and wrong” are taught, then it is not hard to believe that children are sometimes neither sick nor uneducated when they misbehave. It this instance, the goal of discipline is to punish the child for their behavior. Punishment is a term often substituted for discipline, but the term belies a moral center. The dictionary definition for punishment is: penalty for wrongdoing, especially for crime.
So is childhood behavior to be equated with criminal behavior? Again, the answer will depend on your view of human behavior. Some feel prisons are places of punishment, some feel they are places to reform people, others feel that criminals are mentally ill and should simply receive treatment. Sounds familiar?
Misbehavior is an Education issue
Yet even the moralist will use the expression: teach the difference between right and wrong. This suggests that children (and adults) are sometimes not willfully disobeying, but are simply not aware of the proper behavior. Those who believe that children simply need education would say that teaching is the main goal of discipline. The suggestion is that all bad behavior comes out of ignorance and not out of a moral defect. Certainly when the idea of morality is rejected altogether (or simply made to be a “value” or personal preference), rejecting the idea of a moral defect will quickly follow. The premium of education has come forward strongly with the industrial revolution, and even more so with the modernist movement of the 20th century. The idea comes out of an optimism about the nature of humans - that they are basically good and that all bad behavior stems out of ignorance or illness.
Misbehavior is a Disease
So what about the “innocent on account of insanity” defense? There are certainly people in this world who do not lack education and yet act in ways that are irrational. Anyone who has dealt with mental illness can understand that there are some for whom neither discipline nor teaching will have any chance of changing very harmful behaviors. These people are mentally ill and need treatment. Attention deficit disorder has become a very hot item in this arena, where use of medication has replaced moral teaching or education on proper behavior. We simply can give medication and the behavior will get better.
Conclusion?
So what is the answer? I believe that the answer is a combination of all three. There are clearly cases where the goal of discipline is to give enough negative consequence that the behavior stops. The younger the child, the less effective education will be. I stand by my advice on Chloraseptic and reject the label of cruelty in this area because I am not advocating this be the sole form of discipline. If the child is amenable to lesser forms of discipline, such as time-out, then I suggest this be used first. Yet it seems to me the criticisms of this discipline come from parents who have not had children for whom time-out simply does not work. There is a great spectrum of child temperaments and some will respond to minimal discipline, while others will only respond to repeated and relatively strong forms of discipline. When choosing a discipline, you need to ask yourself:
- Does the discipline harm the child physically? The goal of discipline is never to harm a child. That is the major difference between discipline and abuse. The goal of abuse is to cause harm, while the goal of discipline is to help the child.
- Does the discipline have enough negative that it will change behavior? Some parents seem to believe that if they warn a child enough times, the child will start obeying. All this does, by my observation, is teach the child contempt for the parent. Discipline has to be a negative in the eyes of the child.
- Is the discipline excessive for the “bad behavior?” “The punishment should match the crime.” There certainly is a spectrum of behavior, some is worse than others. Parents should have more than one penalty in their arsenal to be able to match the penalty to the behavior.
- Am I disciplining, or am I angry? My mother told me to never discipline a child if you are angry at them. The goal is to help the child, not vent your frustration. Either delay the discipline until you are less angry, or simply let the behavior go. The teacher needs to get their story straight before the student can be taught.
Clearly there is a wide range of beliefs in this arena. I think that we should show tolerance in the gray areas and save our condemnation for the extreme cases (like the 2 year old bipolar). I don’t think that discipline can ever be “one size fits all.” I think we can have guiding principles and intelligent discussions. Clearly discipline is an important issue and a lack of good parenting is often sited in both conservative and liberal circles. Our goal is to bring up individuals who can contribute positively to our society. As long as we can agree on the goal, maybe we can show some tolerance regarding our means.
February 19th, 2007 at 12:15 pm
Perhaps I have an overly sensitive mouth but I considered listerine mouthwash to be quite painful and thus never used it a second time. I would rather have stankbreath than go through that. I don’t know what the sprays are like but my concern would be that it might be no different on a pain scale as a light slap or pinch. I don’t accept that physical punishment is ever necessary so I wouldn’t be comfortable with the spray. Also, I have a little trouble with using a behavior modification technique such as that which doesn’t insruct the child and is no different than how I might coach a dog to not eat my shoes. Peter Singer would probably argue that you are morally wrong for such actions, even if done on an animal, but he lives in another dimension in my opinion. I don’t think it is morally wrong, I just wouldn’t be comfortable doing or recommending it.
February 19th, 2007 at 1:29 pm
So are you saying that it is categorically wrong to inflict pain on a child, or just that it is something you cannot advise as a Pediatrician?
February 20th, 2007 at 11:00 pm
Displine is always a difficult topic to discuss. As a parent i think it is probably one of the hardest areas to work out. the question is when you have a child who is hurting another one and time out dosn’t work does physical displine help or hinder? I tend to think it hinders but when you have a young child who dosn’t understand much, how do you teach them that what they are doing is really bad?
February 20th, 2007 at 11:08 pm
I am a conservative dad who believes very strongly in self-reliance. As a result, I wrongly diagnosed my son as a lazy liberal even after a pediatrician concluded that my son had ADD (without testing). I always thought that ADD was over diagnosed - still do. We resisted medicating our son and went with teaching and consequences. Despite our best efforts, my son continued to struggle. Another expert thought ear infections, which led to speech delay, was the main problem. Tubes went in. Ear infections subsided. Experts concluded after IQ type testing my son would catch up. Second grade discipline problems surfaced again. The experts said oh that just the boy in him no worries. My son stumbled through school, but was moving ahead until he hit a wall in 7th grade. The experts said, oh he is just a teen he will be fine. I was not convinced so I finally pushed for tests. He was diagnosed with ADD at the end of the school year. In eighth grade, we were on his teachers like white on rice to adhere to our son’s special needs. All of the sudden, his grades were great. But I had my suspicions that something was not quite right because he was still not applying himself. He graduated middle school and we were hopeful even though we remained skeptical. In HS (9th), my son failed 4 of 7 classes the first semester and 5 of 7 with 2 D(s) the next semester. What I realized too late was his teachers in middle school gave him a free pass. He was not prepared for the rigors of HS. These teachers did not want to be bothered by a kid with special needs and two persistent parents.
So my advice to all who will listen, if your kid is misbehaving and underperforming and basic parenting discipline and teaching is not working - make sure you get the right diagnosis as quickly as possible.
February 21st, 2007 at 10:24 am
Wolfbaby: Yes, this is the tough side of things. Some kids respond well while others do not. I think there are some children who are far more defiant and this is not an issue necessarily of parenting. This is why I advocate the mouth spray because it is not something that is at all harmful, or even has the chance of becoming harmful. These things are meant to go in the mouth. I don’t advocate vinegar or Tabasco, as I have heard some do. Yet they are unpleasant enough to make a child think twice about getting up out of time-out. Once they know you will use it, I find that you need to use it very infrequently.
Conservative Dad: Thanks for stopping by. I think advocacy is extremely important and you should always push until you feel comfortable with the diagnosis. Obviously the first diagnosis of ADD was either poorly made or just not explained well. The first pediatrician may have been right, but did the messenger get in the way of the message? It is hard to tell - you would probably know best. ADD treatment is a whole other big topic, but your main point of understanding a child’s behavior is important. Equally important (and I suspect you would agree with this) is that discipline should not dwell on motives as much as the action itself. Some parents of ADD children (correctly diagnosed) use it as an excuse for the child’s bad behavior and so don’t discipline like they should. This is a huge mistake. Discipline is all about behavior. We teach motives and morals more through example and direct teaching than we do through discipline - this is why some strict parents fail to raise good kids - they don’t teach the reason for the behavior. That is not to say that circumstances have no influence on choice of punishment, but they are taken far too much into account by many parents.
Rob
February 22nd, 2007 at 11:13 pm
Sorry for the delayed response Rob. I can’t, especially as a pediatrician, say it is categorically wrong to inflict pain on a child. I do it on an almost daily basis and sometimes with questionable evidence that it is necessary(you know what I’m talking about I’m sure).
As far as discipline goes, I do not support physical punishment like spanking because there I think that there are other options that are just as or more effective. I worry how young children interpret being hit by their parents and the potential for terror. I worry that many instances of abuse start out as “I was just trying to get him to stop crying and things got out of hand…..” kind of events. I don’t think that you are a bad parent, or that parents that spank are bad. I was spanked and I turned out fine. I can be done safely and effectively however I don’t feel comfortable supporting it as a pediatrician giving parenting advice.
February 24th, 2007 at 2:51 am
I dont know. When we were kids we got spankings. We all turned out OK. No, serial killers among the bunch of us. This was what I hated worse than a spanking though. My mother would squirt dish soap in our mouths. Now, dish soap does not belong in ones mouth so what was the point of this? I never did this with my own children.
Also is the discipline of standing a child into the corner. This was a big used form of discipline when I was a kid. it was used at school alot. Tell me what it is supposed to teach a child to stand into a corner? Not only do I think it is useless I think it is mentally damaging. Into the corner enough and I think you can cause some serious mental issues.
My husband was a cop and our boys knew what would and would not be tolerated. But, we had one who was a hard child. Always pushing the envelop to see what he could get away with. My husband just smacked their butts when they misbehaved, and that was it. I was a pushover but he was not.
I also dont see anything wrong with using cloraseptic..But dish soap= NO!
February 24th, 2007 at 10:08 pm
I am with you, Clark. I had the realization after using spanking some on our kids that it could easily be done out of anger. That scared me. That does not mean that I think parents who do spank are bad parents - it is just something I can’t really recommend, and when parents say they do it (which is common in the South) I tell them to be VERY careful. That is truthfully why I so like the Chloraseptic or Listerine approach (or even weak vinegar). We used it predominantly when the child spoke or used their voice in a way that was negative. In a child who bites other children, it helps to respond quickly. I don’t think other disciplines are as effective.
Cathy’s point of the time-out approach being more humiliation is well taken. To have to stand in a corner - especially in front of other children - is meant to hurt in a totally different way.
All discipline is about causing pain. It is about using pain for bringing about good instead of bad. It is about using pain as a means for positive things. As a pediatrician we give immunizations and the surgeon causes pain doing surgery. I think people who say they “don’t want to teach a child it is OK to inflict pain on someone” are ignorant. It IS OK to inflict pain; it is only OK, however, if you are in a position of authority and if you are doing it truly for the other’s best interest. Coaches inflict pain on their players by pushing them hard. I inflict pain on myself when I exercise. Pain is a part of life - neither good nor bad - that is a sure thing to happen. How pain is used, however, will determine if it is “good” or “bad” pain.
Rob
August 17th, 2007 at 1:00 pm
Our discipline type thing over here is just empty threats to give beloved toys away? Surprisingly, not at the recommendation of our pediatrician. Also, only moderately effective.