V. Sierpina
Please Don't Label My Child. Shannon & Heckman. Rodale Inc. 2007.
One of the most pressing questions of parents to physicians these days is, “Are there alternatives to drug therapy for my child with ADHD?” Given the highly pervasive nature of this condition (3-10% of American children) and the documented effectiveness of stimulant medications, we immediately enter onto a challenging territory. Children with conditions such as attention deficit disorder, with or without hyperactivity, often respond dramatically to psychostimulants such as methylphenidate. Both school grades and social behaviors improve quickly. Teachers, classmates, and family members are relieved. Yet there remains unease about a large cohort of our children requiring long-term drug therapy that has potential for side effects such as growth, appetite, and sleep disturbance and potential cardiac, endocrine, or sympathetic nervous system effects.
What are we to do? Are there effective, reliable, and safe alternatives to these widely prescribed medications? What is the evidence for their long-term use? Indeed, what is the evidence for long-term effectiveness and safety of the pharmacological treatments for ADD and ADHD?
. At a recent nutritional supplements conference in San Diego sponsored by the Scripps Integrative Medicine Center, I reconnected with a long-time colleague of mine, Dr. Scott Shannon. Dr. Shannon is a child psychiatrist in private practice in northern Colorado who has started the first holistic and integrative child psychiatry program at a major teaching hospital in Denver. He is past president of the American Holistic Medical Association and has written an excellent academic textbook for professionals on complementary and alternative approaches in mental health (1) and a more recent popular one called Please Don’t Label My Child. (2)
I’d like to review his latest book here with the hope that those with a serious interest in the area of children’s mental health would consider reading it and perhaps his earlier, more detailed work. While written for a lay public audience, Please Don’t Label My Child is informed by a compassionate, experienced child psychiatrist who takes a pragmatic approach to conditions such as ADD/ADHD.
He advocates an approach of moderation and restraint, believing children are designed to function at a high level of well-being without a lot of medical intervention. Further, he holds that consistent, loving, focused attention are a constant need of children that may alleviate many of the so-called diagnoses and labels under which they suffer.
The first chapter describes the “high cost of labeling” our children with conditions such as ADHD, anxiety disorders, bipolar disorder, conduct disorder, and depression which result in a cycle of diagnosis and medication. Our children may suffer not only from these conditions but the subsequent stigma attached to the disease labels, the problems with drugs and their side effects, and often the narrowing of their life around a single diagnostic label. Shannon pleads for us to listen more closely (even non-verbally) to our children, to the distress signals they are giving, to try to understand what these mean, and to prevent, if we can premature or inappropriate labeling.
In Chapter 2, he briefs us on the plasticity and growth of the young brain and the effects of this on the emotional climate and even volatility of children and adolescents. Basics for optimal brain development include a safe and secure home life; love and touch; proper nutrition; a clean environment, stimulation’ and strong, stable relationships. Chapter 3 delves further into the power of relationship, particularly the mother-child bond in creating attunement and attachment and the long-term social and emotional consequences of these going awry. Father-child bonds are also highly essential to health child development. Indeed, citing the Harvard Mastery of Stress Study, Shannon points out that “nothing is more important to our emotional and mental health and overall well-being than experiencing a close, loving, supportive relationship with our parents during childhood.” The temperament of children and the match of these temperaments with their parents may support or strain this relationship. Parents are in the best position to overcome such strains by maintaining a degree of non-judgmentalism and unconditional love while acknowledging their own temperaments and level of consciousness.
Chapter 4 gives a highly detailed and evidence-based review of healthy nutrition in children, something often ignored in children’s mental health. Macronutrients, micronutrients, essential fatty acids, needs for minerals, vitamins, and so on vary enormously over the lifespan of an infant, child, and adolescent and can have major impacts on behavior. So too can environmental factors be detrimental or supportive to behavioral health. Chapter 5 describes how toxins in water, air, and food pollution, poor sleep patterns, inadequate sunlight, excess TV watching, particularly of violent programs all affect children’s emotions and behaviors.
Chapters 6 and 7 review how the family system, its relationships and stress levels, divorce, resilience, school, different earning styles, and social context all are highly critical to the optimal development of the brain and the child’s behavior as a whole organism. Kids who manage stress well tend to have high self-esteem, a sense of control over their lives, a safe, consistent family system, and a supportive social network. Further they have open communication with family members, living supportive relationships with parents or caregivers, recognition and support of their resilience, a sense of humor and optimism and faith in the future.
Chapter 8 on trauma and post-traumatic stress disorder provides an insight into behavioral difficulties rooted in the neurology of the traumatized brain. This can result in a wide variety of acting out behaviors from bullying to avoidant behavior, anxiety, depression, anger, sexual acting out, and learning difficulties. Special approaches and therapies are needed for children suffering with traumatic stress and inappropriate labeling and misdiagnosis only aggravates their condition and delays effective therapy.
Chapter 9, “Parenting for Emotional and Mental Health” is a summative guide to raising children with a strong sense of self-identify, the ability to self-regulate, and with an inner core of resilience. Practical tips on parenting are given that are direct and clear, though implementation may be a challenge in many families.
I want to emphasize that parents are not made to feel “to blame” for their children’s problems at any point in this last chapter nor throughout the book. In fact, they are empowered, encouraged, and enabled to break out of the “doctor-diagnosis-drug cycle” to a healthier way of life for them and their families. Medications may be necessary for some children, but ought be considered a downstream option rather than the first choice of intervention.
Appendix chapters cover psychiatric labels commonly given to children with a description of each, glossaries of mental health terms and nutritional supplements, and some self-test questionnaires for family stress and trauma. There are also supplemental readings in this area and information on how to find appropriate integrative and holistic practitioners.
When I attended Scott’s lecture on this topic in San Diego, I observed that many of the professional audience, many parents themselves, seemed to want a “magic bullet”(myself included!). This might be a nutritional supplement, a special diet, a certain dosage and type of fish oil, neurobiofeedback, or something else to replace medication. All of these can certainly be helpful to children with behavioral problems. However, I respect Dr. Shannon’s not only including such lifestyle and nutritional approaches, but combining them with a more integrative mind-body-spirit approach to parenting, to family, to social and school dynamics. His approach honors the individuality and personality of each child and each parent and family. By stepping back from labeling, we may be in a better place to love and care for our children better, to respect their differences, and to optimize their physical and mental health.
1. Shannon S (ed).Handbook of Complementary and Alternative Therapies in Mental Health. San Diego: Academic Press, 2002.
2. Shannon SM, Heckman E. Please Don’t Label My Child. New York: Rodale, 2007. ISBN 1-57954-682-X
Victor S. Sierpina, MD
Associate Editor, Explore, Professor, University of Texas Medical Branch