This will be a quick post on a topic that deserves much more attention.  Last Sunday the New York Times published an opinion by Dr. Alan Sroufe on the treatment, origins, and mechanisms of childhood problems with attention and emotion regulation. It is an excellent article that briefly summarizes the lifetimes of research by Alan Sroufe, Byron England, Marti Erickson, Glen Elder and others. It is worth your time and thought.

The treatment for children with challenging behaviors and emotion dysregulation is both complicated and not complicated. Initially, psychologists, pediatricians, and neurologists looked extensively into the ways in disruptions in brain biology caused attention problems. And, it turns out, brain injuries and developmental anomalies do cause problems with attention and concentration as well as learning, social behavior, motor behavior, communication, . . . The list goes on. Drugs can change some of this for some time.

Now, we also know from all kinds of amazing studies that experience changes the expression of genetics. We know that physical and psychological experiences change the structure of the brain. Cool! Scary! Exciting! Little can be determined from only looking at experiences, environments, or biology.

When we try to understand a problem and more importantly try to change it! We have to look at all the contributing factors. If you generate a solution from only one variable, you will get the wrong answer. For example, suppose you go to the store to buy your child a pair of jeans in size 7 because he is a size 7 and, that is all that matters. OOPS! He may not have wanted rhinestone flowers on the back pocket. If you buy your daughter the latest greatest pair of kids cleats for soccer but she plays tennis and doesn’t wear that size, you have a problem. Anyway, if you had it all right for today, it might not work at all. It is Feburary. Where we live, kids won’t be playing outdoor sports for another 6 months. Her size may change with time!

The more time that someone spends engaged in pathological behavior, the bigger the problem and the poorer the outcome. I think that the most important and unemphasized point in Dr. Sroufe’s paper is that prevention is important. Interventions do work. Treatment works — both drug and behavioral treatment. The problem seems to be that there is no one shot cure. There are lots of examples of improvements. Treatments need to be flexible and data driven. If you are are coping with a child with a lot of challenging behaviors you need to know that there is something that can be done. If you are struggling yourself, there is something that can be done to reduce the risks to your children. We have really sophisticated and limited tools for making changes and preventing problems. There will not be a magic trick that makes everything something you want. There will be good days and tough days. See if you find a path to better days and do not give up.

The article is posted here: http://www.nytimes.com/2012/01/29/opinion/sunday/childrens-add-drugs-dont-work-long-term.html