By George Tucker, PhD
When we come into the world, no one expects us to be able to control our attention span or our moods. That is relegated to our caretaker, usually the mother, and it is expected that the caretaker will anticipate the needs of the child and respond accordingly. The child will begin to learn that the world is a predictable place, and that certain behaviors result in certain outcomes. If they cry when they are hungry, they will be fed. If they cry when they are tired, they will be rocked to sleep. The bases of learning to regulate our attention, concentration, and mood are developed during the early months of life. Lo and behold, after a few short months or years, predictable routines will result in the development of regular eating and sleeping cycles, and the child and parents will live happily ever after.
If that happened, your child then went on to develop elementary self-control. When they were not immediately fed when hungry, they either learned to ask for food, or they learned to tell themselves that dinner would be ready soon, and they could wait. This then morphed into learning to delay gratification in other areas, such as waiting until after eating a meal to eat the sweet stuff called dessert, learning to take turns in games, or learning that there are other people out there who also have needs, and that we can get along better if we learn to cooperate and soothe ourselves rather than pushing to have our needs met immediately.
If you are lucky enough to have a child who has developed the above skills in such a fashion, rejoice and be exceeding glad. However, if you are still reading this article, chances are something went wrong somewhere. What happens to children who have difficulty developing those routines, eating and sleeping at predictable times, learning to attend, concentrate, and moderate their moods in order to profit from those first days at preschool or Kindergarten? That is, what happens to children who have a learning disability in the areas of attention, concentration, or mood regulation?
Much was written in the years prior to 2000 regarding Attention Deficit/Hyperactivity Disorder, and there are numerous resources available for those problems. Excellent resources are The Parents’ Hyperactivity Handbook, by Dr. David Paltin, who is one of our staff writers. Russell Barkley’s work is also excellent. Numerous tools for diagnosing and treating attention, concentration, and hyperactivity issues abound. Please see the list at the end of this article for additional references and helpful resources.
Since the year 2000, much has also been written about the area now commonly referred to as Juvenile Bipolar Disorder. The work of Young and his colleagues has indicated that many youngsters who failed to respond to the usual interventions for AD/HD such as behavioral and social skills programs, neurofeedback, and medication may have been erroneously diagnosed as AD/HD when they actually suffered from a mood disorder. The mood disorder could have been depression, or it could have been Juvenile Bipolar Disorder. A scale was developed whereby children could be rated and given a probability of having Juvenile Bipolar Disorder. The scale, referred to as the Parent Young Mania Rating Scale (PYMRS), is still being developed and, to this writer’s knowledge, is not yet commercially available, but it can be used by a good clinician to help in diagnosis.
Young and his colleagues also report that some children can have a mood disorder and AD/HD, and this complicates treatment as well. However, knowing what you are dealing with can sometimes make the battle much easier to endure. Heredity can be a valuable source of information in making the final diagnosis here. A family history of depression, Bipolar Disorder (formerly called Manic-Depressive Disorder), or alcohol/substance abuse is often present in either the parents, aunts, uncles, or grandparents of the child. If the child is adopted, this can make diagnosis more difficult.
In brief, if the usual methods of dealing with attention and concentration issues have not proven successful, it may be time to consider the possibility of a mood disorder. Next month I will have more about cognitive and behavioral techniques, including developing more optimistic thinking, that can be used in a therapeutic attempt to increase a child’s regulation of their moods.