A pediatrician in shining armor?

There are no flawless parenting gurus, says Dr. Lawrence Diller, but as a behavioral pediatrician with 25 years in practice, he can guarantee thoughtful advice and plenty of moral support.


Dr. Lawrence Diller
September 17, 2002 11:17PM (UTC)

Editor's note: Readers of the Life site are active consumers of content: They write often to give praise, criticism or eloquent accounts of their own experiences. They also ask questions, most often about the frequently overwhelming or infuriating experience of being the parent of a teenager or a young child with confounding emotional quirks.

Starting next week, we hope to have some answers in a new column called "Second Opinions." In it Dr. Lawrence Diller and Dr. Lynn Ponton will take turns addressing reader queries about childhood behavioral issues and adolescence. Today, they introduce themselves, laying the groundwork, we hope, for an enlightening and enduring relationship with our readers.

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By Dr. Lawrence Diller

Sept. 17, 2002  |  You're sitting in the pediatrician's waiting room. Parenting magazines are everywhere. (The doctor gets them free -- paid for, more of less, by companies that make infant formula, baby products and pharmaceuticals.) One headline catches your eye. Something like: "Three Absolutely Effortless Secret Ways to Raise Perfect Children in Seven Days!"

It is a tantalizing lure, duplicated on nearly every glossy cover in the room. Failsafe answers while you wait -- and then on to the doctor, yet another font of perfect wisdom.

I happen to be one of those doctors, an alleged guru of all things pediatric. I've been practicing behavioral-developmental pediatrics for nearly 25 years, and have been writing articles and books on the subject for more than a decade. And I am the father of two teenage sons. But as I set out to write this column for Salon, I will be the first to admit that neither I, nor the magazines, have access to perfect wisdom. I'm no ingenue to the dilemmas and pitfalls of answering parents' questions and offering advice -- I can dish it out, and I can take it, but not without an intimate understanding of the fine print.

My training as a medical doctor specializing in children, several additional years of training in child development and behavior, more years learning family therapy, all supposedly make me an "expert" in knowing what is right and wrong for children. Our culture really believes in "experts," and "science" has replaced religion as the ultimate authority and guide to living life. (I should make it clear: I don't whole heartedly agree with the last statement.)

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But I know from my experience that helpful advice proferred by experts can have a curious reverse effect. It can belittle the seeker of advice. It happens in at least two ways. First, you think you have a problem with raising your child. You try to resolve it yourself without success. You think you don't have the answer, so you seek help from someone else, in this case an expert like me. I give you a suggestion or direction. You feel it makes sense and decide to try it out. Either the advice works or doesn't work.

If the advice helps, that should be a good thing. However, a subtle process has occurred to potentially undermine your sense of self-confidence. You didn't know the answer and I did. That makes me better (or at least smarter) than you. Also, since you didn't know the answer, maybe next time there's a problem you won't know the answer again, and you'll have to rely on me. This certainly isn't helpful in building up your sense of independence and self-reliance.

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It's even worse if my advice doesn't work for you and your child. Since I'm the expert, if my advice doesn't help, it must be that you did something wrong or something is wrong with you. You may return, saying "Doctor, it didn't work. Now what do I do?" and I may suggest another approach, and you think to yourself, "The doctor thinks I'm such a failure. His advice didn't work for me." This scenario is repeated millions of times each day, in experts' offices across the land, and it is not doing much to build the confidence of American parents.

Sigmund Freud (and even more so, his interpreters) was quite aware of this dilemma, believing that a doctor shouldn't give direct advice, but let the patient come up with the solution. The concept is still current among the few who still practice strict psychoanalysis. Even in the world of parenting guides, there are authors who stress "instinctive parenting" in the belief that the best strategies for child rearing will come from your own good judgment.

But really, if it were that simple, why would you be reading the piles of books on parenting -- or this column, for that matter? The whole point is that you've probably examined the problem in every which way, tried a myriad of solutions and looked deep into your soul, and still feel stuck with this problem involving your kid. And when it's your kid, you feel this awesome responsibility that just wont go away. So you ask others. You talk to your doctor and maybe read this column.

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Freud had a good point, but as a pediatrician on the front lines of parental (and child) struggles, I know that giving information or a direction can be immensely helpful. And offered sensitively and respectfully, good advice doesn't automatically demean the parents. In fact, the parents' success can generalize to other areas of parenting or just get them through a rough time -- increasing parents' self-confidence and belief in their own judgment all the while.

It is especially tough for parents these days because we've come to believe there are right and wrong ways of raising kids. This assumption places enormous pressure on parents (and their kids) and makes a life that is dramatic enough even more dramatic. The fact is that the vast majority of kids turn out fine -- just like you. But wait: If you're not particularly happy with yourself and how you were raised and want better for your kids, isn't that OK? Yes, but watch out. Life has a funny way of yielding problems where we look for them -- and this goes for raising kids too. But don't feel too bad, these extra dramatic moments happen to all of us.

I'm ready to help you and your kids get through those bad or worrisome situations that keep repeating themselves, that won't go away. But remember, if my advice isn't helping, it's not necessarily that you're a bad parent. It may be that my advice was bad for you! Or that it wasn't the right time, or your spouse or partner didn't agree. I'm not letting you off the hook entirely: You are the person most likely to make differences in your children's lives. That doesn't mean you caused their problems, but you are the person in the position to help them the most.

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When I started 25 years ago, Mommy was blamed for all of a child's problems. The current fashion is to blame no one at all. Now it's the child's brain and "chemical imbalance" at fault. I don't buy any of these extremes, and I don't like the notion of blame in the first place. I've seen many trends come and go: underwater birth, infant bonding mania, the Feingold diet, child sex abuse hysteria and the sudden onset of recovered memory. Some concepts have survived scrutiny and the test of time -- no more baby aspirin because of Reye's Syndrome, infants sleeping on their backs to prevent SIDS, day care, early learning, and increased use of psychiatric medication for kids.

I make no secret of my strong feelings about that last concept. Those of you who know my writing about Ritalin know that I prescribe the drug, but feel we use it way too often and too quickly in our society today. I see children's brains and heredity (their "chemical balance," if you will) as being important factors in their development and life. But these brains don't operate in isolation. The expectations and responses of parents, family, school and society are also critical to the healthy development of children.

Within my office practice, I actually address family problems of all ages and see couples with marital problems as well because of my background in family therapy. In this column, I will focus on the issues raised in the parenting of infants, on up to kids on the cusp of adolescence. I'm ready to take up issues of normal behavior and development: attachment, discipline, peer relations, normal milestones, academic learning, as well as specific problems like attention-deficit/hyperactivity disorder, language delays, oppositional behavior, anxiety, autism, dyslexia, bullying and teasing. Your questions and comments, directed to drdiller@salon.com, will drive the direction of the column.

Editor's note: This story has been corrected since its original publication.

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