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Archive for September 2015


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.

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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.


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