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When sibling rivalry goes too far

Little sibling boy fighting on sofaA mom contacted me wondering why her two very young sons – only about a year and a half apart – are suddenly showing intense sibling rivalry. Prior, they wanted to be together all the time and played without friction. Turns out, the older one is starting kindergarten. He’s developmentally pulling ahead of his younger brother. I suspect their sibling rivalry will wax and wane over the years as they grow and move forward at different rates. The older boy will want to establish himself as older, biggest, smartest, and best at everything… while the younger will be right there on his brother’s heels competing. It’s all quite normal and healthy.

But whenever sibling rivalry goes too far, do what this mom did.

As soon as she saw negative behavior in either son that had been designated as unacceptable, a swift time-away was given. Those time-aways would be lengthened or made more frequent if the behaviors didn’t stop. That’s the best way to handle these type normal sibling issues. As a parent, you’re making a clear statement that in our family we don’t disrespect parents or tease siblings (beyond playful teasing), and hitting is never acceptable. By separating from the family, a child gets to first calm himself down and work through whatever anger or conflicted feelings they have (and do it on their own). They also think about how to improve their behavior so they can rejoin the family, It’s important that upon leaving a time-away, children always promise parents that their behavior will improve and specifically reference what got them in trouble to begin with. That increases accountability.

Please contact Dr. Rao about reproducing any material found on these pages.

A Warning about “Screenings”

A mom on the west coast recently told me her 2.5 year old son was “informally” assessed for ASD (Autism Spectrum Disorder) at a prestigious medical center. The boy was asked to do a puzzle, and showed good joint attention towards his parents, and toward the Intern who was observing, but not towards the neuropsychologist conducting the assessment. The boy then said he wanted to go home. The examiner told the parents that their son has social delays because he is supposed to show joint attention and interaction towards her, not only toward parents. When the examiner next tried to have the boy build a tower of five blocks, he refused, and tried to steal her tower.

Seems to me his joint attention was fine. He just didn’t like this stranger.

The good news is that this 2.5 year old doesn’t have any glaring cognitive or language delays. Still, the examiner told the parents that she couldn’t rule out ASD, and that he might have a mild case – saying her gut feeling was that the worst outcome would be that he’s an “engineer” in Silicon Valley.

That’s a lot to pick up (and predict) from a puzzle or block tower in a few minutes.

Not being there, I can’t speak for the quality of this informal clinical evaluation, but my general impression about “informal evaluations” is that they aren’t very accurate or highly predictive. I assume informal means “screening”…   and to my way of thinking, quick screenings (whether for anxiety, depression, ADHD, ASD, etc), have little value other than trying to educate folks about potential mental health risks. Think of cholesterol screening or blood pressure screenings… you don’t have heart disease based on one time elevated findings. And these are objective, real medical tests measuring real body changes. We have nothing like that in psychiatry. Most screenings are subjective and are generally designed to cast a very large net. That generates lots of false positives. They generate lots of parental anxiety too.

I told this mom to take this informal screening with a grain of diagnostic salt. I told her that what’s more important is not building a tower of blocks with a stranger one time, but how he relates to other kids in his real life day in and day out – over weeks and months – on the playground – in the sandbox – at day care, etc. Early behavior of boys is often not very “social” or too “hyper”, but with more and more experience playing and interacting with other kids, they start to build their social toolbox.

I also told this mom – as I tell all parents – don’t coach your son too much when he struggles socializing. Let him make mistakes and learn from the real-life consequences. The presence of well-intentioned adults often delays development, instead of facilitating it.

She’s going to investigate things further for her son, but wants to meet a professional who won’t rush to a label in ten minutes. She’ll keep an eye on his social development, and will follow through with lots of play time and opportunities to be social.


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Do genes matter in ADHD?

ADHD symbol design isolated on white backgroundA reader recently asked: How much do genes matter in ADHD? She’s getting conflicting opinions, and there’s a reason why… there’s no simple answer to that complex question.

Different techniques are used by experts to estimate genetic contributions to all sorts of human traits and problems. Also, it’s hard to determine genes of something that’s not easily or accurately measured, like ADHD – there is no blood test or x-ray or true biological markers. It’s a “clinical” diagnosis, which means, lots of guess work and weighing in and watching over time to see if a diagnosis fits or doesn’t, and ruling out lots of other reasons a child has trouble sitting still or focusing or behaving impulsively.

I reached out to a Harvard Medical School geneticist I know and asked him. He said, “The actual risk to a first degree relative has variously been reported in the 15-60% risk range, with boys, purportedly, at higher risk than girls.” What I take from this is the following. (1) No one really knows exactly how much genes play a role, hence the wide range of 15-60%, and (2) genes are only a piece, perhaps a small piece, of the ADHD puzzle.

My advice is not to think about genetics, but focus on the many environmental factors in our control that are tied to making an ADHD diagnoses:

  • Crowded classrooms
  • Pushing standardized tests
  • Sitting all day, having little movement in schools
  • No recess or breaks
  • Too much screen time
  • Food preservatives
  • Not enough sleep
  • Vision problems
  • Hearing problems
  • Not recognizing gender learning differences – which leads to mostly boys being diagnosed

The list goes on and on…

So let’s think of all the environmental changes and improvements we can make that will help ADHD not become a problem in the first place.

Please contact Dr. Rao about reproducing any material found on these pages.

Q&A – Help with Time-Aways

Question and Answers on speech bubbles

A fan asked a question after the recent post on Sibling Rivarly and using Time-Aways as a tool: What do you suggest when you march a child to their room when they are not clearly upset (ie, name-calling, being overly rude, hurting a sibling for no clear reason other than to be annoying), and they tell you they “won’t do it again” as you put them in their room? How long do they take time-away in a situation such as this, when there is no clear “waiting for the storm to calm”?

Time-aways should be as long as needed. They help lower the negative behaviors you’re trying to change. If a child says “sorry”, over and over, but keeps doing basically same negative behaviors, it means you have to lengthen the time-away. Before letting them out of their room make certain they tell you why they went in and what they will do differently. Some kids need a lengthier time-away (like a mini-grounding that can last a half hour or more). Try that, and keep calm. No lectures. Tell them they’ve made choices that got them in their rooms. Tell them you know they are smart and will figure out a way to hold back those urges. If this doesn’t work, add a consequence too. Perhaps they’ve lost a special treat that night for dessert or can’t join watching a favorite TV show or they have to go to bed 15 minutes earlier that night.

Please contact Dr. Rao about reproducing any material found on these pages.

Stopping Sib Rivalry… First, Do No Harm

Truth is, you can’t fix sib rivalry. It’s part of growing up. Surprisingly, the best thing to do when sibs fight is nothing. Don’t ever comment on the fighting and never jump in to save one child from another. As soon as parents get pulled into these perpetual mini-battles and complaints, sibs play up their victimhood. The tears start flowing. The accusations of hurt feelings and ouches skyrocket. It’s a classic parent trap you need to avoid.

Then why so much fighting? Here’s what’s really going on beneath the surface. Both sibs want your attention and want to win (that means you side with them over their brother or sister). Haven’t you realized that sib rivalry sparks as soon as you step into a room… and haven’t you noticed it’s really bad in confined spaces (like cars) where you’re stuck in the front seat like a judge listening to passionate legal arguments. So, keep in mind, your presence is a catalyst for these epoch battles. Don’t join in or try to fix them – it makes things worse.

But there are times you can’t ignore, for example, if one sib smacks the other for no justified reason or an over-the-top insult is lobbed. When this happens, march the offender immediately to their room without warning or a second chance. No lecturing… they already know what they’ve done is wrong. Remove them from family interaction for a bit (I call this a time-away in my book). And if both kids are fighting or getting under your nerves with yelling and nasty behavior, don’t try to negotiate or settle the fight or figure out who did what. You’d have run a DNA analysis like a CSI investigator to get at the bottom of it. Instead, immediately separate them, give no second chances. Give equal time-aways in separate, quiet space. And tell them this:

“I don’t know why you keep fighting and making so much unpleasantness. We don’t do that in our home. You both will have to stay separate until you figure out how to work out your differences and your disagreements better.”

Then do something nice for yourself… pat yourself on the back… knowing you avoided a classic parent trap. Then enjoy the ensuing, temporary quiet!

Please contact Dr. Rao about reproducing any material found on these pages.