Parents who struggle with a child’s public tantrums or frequent defiance may feel powerless and unsure how to deal with the behavior problems. Many are reluctant to discuss these oppositional behaviors because they fear being judged by others. But the best course of action is to talk about it with your child’s doctor.
An analysis presented at the 2009 annual US Psychiatric and Mental Health Congress showed that there is often a communication gap between physicians and parents of children with ADHD who display oppositional symptoms. Michael Manos, PhD, study investigator and head of the Center for Pediatric Behavioral Health at Cleveland Clinic Children’s Hospital, agrees that one of the most common reasons for this gap in communication is often a parent’s past experiences with being unfairly judged by others. He gives an example:
“A mother goes to the grocery store where her child runs around and doesn’t listen to admonitions to stop. The mom feels almost helpless to manage the child effectively. What do you think other people are standing there thinking? They are not thinking: ‘Oh, that child’s got ADHD and that is exactly why they are behaving the way they are. I have compassion for the mom.’ Instead they are thinking: ‘Why, that parent ought to discipline that child better. That parent ought to be a better parent.’”
Having your parenting skills scrutinized and dealing with inaccurate assumptions from others can be very draining and may make a parent feel less inclined to openly share. No parent wants to feel this loss of control or this uncertainty about managing a child’s behavior. However, if the physician is not aware of such issues, treatment is less effective and at times less monitored.
Dr. Manos describes what frequently occurs in the doctor’s office:
“The parent comes into the office to inform the physician about the characteristics and behavioral symptoms of the child. What we found was that parents tended not to bring up oppositionality right off the bat. So there is a disconnect between what the physician knows about the child and how the child is actually behaving. This is pervasive with children with ADHD and their families. So what we noted was that many times physicians don’t know about the oppositional symptoms so they weren’t able to treat them. It didn’t occur to them to refer a parent to a psychologist or perhaps use a different strategy of medication management and the like.”
Good communication between a physician and a parent is going to accurately represent what is occurring with the child. Use these steps to ensure that you and your child’s doctor maintain open lines of communication:
1. Chose a Doctor Who Can See Things From Your Perspective
Your pediatrician should understand the frustration parents may experience when raising a defiant child. According to Dr. Manos, this means “physician communication with parents [should] take the burden and the ownership of responsibility off of the parent and put it on the whole situation, which includes the child who is actually behaving atypically.”
2. Prepare for Appointments
It is very helpful to prepare for your child’s appointment by writing down your specific list of concerns and questions ahead of time and bringing that list to the doctor. This way you are more likely to cover and discuss issues more effectively and directly and less likely to miss or forget things. In addition, be prepared to share with the doctor information about your child’s developmental, medical, and family history and any other factors you feel may be contributing to the problematic behaviors. Write down any medications, including any over the counter medication, your child is currently taking and share this information with the doctor, as well.
3. Partner With the Doctor
Establishing a positive partnership with your child’s doctor is paramount. You should feel comfortable sharing, asking questions, and engaging in ongoing discussions with the doctor in order to sort out the best ways to help your child. Sometimes parents may not realize that certain types of behaviors, such as defiance, are worth sharing. This is why your doctor should inquire more specifically and ask open ended questions that help to clarify issues. Such questioning probes can let the doctor know how often defiance occurs and how intense it is, both bits of information are useful in determining treatment plans.
Michael Manos, PhD. Phone interview/email correspondence. December 8, 2009 and January 18, 2010