Preventing Adolescence --Well, Sort Of

Our oldest is just in fifth grade, but we're already worried about middle school and the "terrible teens." Some of his friends already have earrings, and he kids us (sometimes I'm not sure he's joking) about getting green hair. We're scared about drugs and alcohol, who his friends will be, and whether he will stay on track with school and his life. Right now we can still talk together, but how long will that last?

Teenagers!

That word alone can send shivers up a parent's spine. It makes you think of loud arguments, sullen silences, hormones amok, and risky behavior. Parents wonder: "What happened to that nice kid who used to sit in my lap?"

Some ups and downs are inevitable during the teens. But adolescence is also a time when psychological difficulties can settle in as stable aspects of the personality, behavior can be annoying at best and dangerous at worst, and poor choices can have lifetime consequences.

Being a skillful parent while your kids are teenagers is obviously important. But the best approach is preventing problems during the elementary and middle school years. That time is a special opportunity to lay a foundation -- before the sap really begins to rise! -- for family harmony and reasonable behavior.

The key problems of adolescence are isolation, conflict, and mediocrity. Their best solution is loving intimacy, effective problem-solving, and developing internal motivation. Adolescence today is an extraordinary challenge. Prohibiting its pitfalls is not enough. Teenagers need to be attracted to positive alternatives.

In this series of columns in the Family News, we will explore how to do just that. This first column describes the nature of adolescence and a teenager's underlying positive wants and needs. In following columns I will describe specific ways that parents can promote intimacy, problem-solving, and meaningful interests, especially before their kids hit the "terrible teens."

Teenagers are from Pluto
Sometimes teenagers can almost seem like a separate species, mysterious and a bit frightening. Understanding the normal process of teenage development is the first step is preventing the problems of adolescence.

Numerous important and healthy developments occur during adolescence. They include emerging: Abstract thinking, personal values, sexuality, important relationships with peers, gender identity, physical stature and abilities, sense of personal identity distinct from parents, and scrutiny of and skepticism toward familiar authority. Adolescence can combine the best of childhood and adulthood.

Adolescence also normally contains a significant amount of intense reactions, inexplicable or eccentric behavior, wild emotions, and confusion. Teenagers are supposed to go through the kinds of things that drive their parents crazy. That's how they separate from parents, discover who they are, and learn some hard and enduring lessons in preparation for adulthood.

It's hard to be "teen"
Unfortunately, the negative aspects of adolescence have been worsened by a variety of social developments. In two generations, we have created a discrete social class -- teenagers -- that is generally isolated from adults yet supposed to respect them, flooded with frightening information yet expected to remain optimistic, and tempted every day at school with captivating pleasures yet supposed to just say no.

Adolescents today rarely have much access to an enlivening and inspiring adult world of intimacy, large-heartedness, and wisdom. They are shunted off to reservations, enclaves of hired help and other teenagers, such as schools and malls. They have little access to meaningful contact with adults beside their parents or the world of work. They are generally not drawn into healthy gender culture (in contrast to more "primitive" cultures that usually put young men and women in close contact with adults of their gender).

Teenagers have a negative status in our society: If you want to insult someone, you tell them "Don't be so adolescent about it!" Adolescents have few opportunities for productive work for pay, and chances for other kinds of contribution are scarce.

While the doors to positive experiences and relationships for teenagers are mainly closed or barely ajar, they are wide open to dangerous escapes and consolations such as drugs and alcohol, premature sexuality, and a cynical and tawdry youth culture.

Adolescence is a transition from childhood. But what is it a transition to? What can we offer our kids to compete with the very real pleasures of mall culture, punk attitude, goofing off, sex, drugs, and rock and roll??

Practicing what we preach
This is the tough part: The best way parents can help their kids prevent the common problems of adolescence is by living themselves a life that attracts their children toward intimacy, effective living, and productive self-expression.

How are you a model of intimacy for your children? How are you not? When your kids look at your marriage, what do they see?

How are you a model of good-hearted and effective approaches to conflict for your children? How are you not? When your kids watch you and your spouse trying to solve problems together, what do they see?

How are you a model of pursuing meaningful interests for your children? How are you not? We ask teens to exercise their will every day to persevere in the face of frustration, bear discomfort gracefully, and turn away from temptation -- so when they reflect on your drive, determination, self-control, and willpower, what do they see?

In sum, are your child's parents living a life that would be attractive, in broad outline, to a teenager? As a teenager, would you have been attracted to your life today?

Facing these questions openly honors our children and ourselves. Kids peer right through the fatuous rationalizations and sermons of adults to what's actually true behind the veil. We ask them to renounce so much in immediate gratification in order to attain the "goodies" available in adulthood. Well, our kids ask, where's the beef? And if there's not much between the bread in the lives of the adults they know best, then it's a tough sell.

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Optimizing a Child's Health

In our last column, we discussed how to teach several fundamental psychological skills to children, including letting go of upsetting experiences and taking in positive ones. These skills will help anyone, but they're especially useful for spirited or cautious/rigid children. In this column, we'll explore how to optimize a child's health - certainly worth doing in its own right, but also a real aid to any child with a challenging temperament. We'll also discuss getting support.

The Mind/Body Connection

Sometimes a temperamental issue that seems purely psychological will turn out to have, in part, a physical cause. For example, when he was about five years old, our son became grumpy and blue, a change from his normally sunny disposition (although he continued to appear perfectly healthy). At night, when Rick put our son to bed, he often heard forrest say that his throat was "tight." Some kids in Forrest's school had gotten strep throat recently, so Jan and Rick suggested that Forrest have a throat culture done at his upcoming, annual pediatric appointment. The doctor (a wonderful, caring pediatrician) did not see any symptoms, but he was happy to order the test anyway, and indeed Forrest had strep throat. Within days after treatment began, he was back to being his old, cheerful self.

Careful Assessment

This story also points out the importance of getting good assessment. With the development of modern medicine, many fabulous tests are available that will give you detailed information about your child's health: why not use them? They will give you the facts that will reduce your uncertainty about what's going on, and enable you and your child's health care providers to make better decisions. The sooner you have that information, the sooner everyone can benefit from it. Other than the prick of a needle for a blood draw, assessment can't hurt a child - unlike the wrong treatment, or no treatment at all (if there is in fact a problem, or an opportunity to improve his or her health). The worst case result is that assessment rules out a problem, but that means you've got one less thing to worry about: not a bad result, after all!

Whenever a child has a challenging temperament, we think it's a good idea to look into nutritional deficits, allergies and food sensitivities, and gastrointestinal (GI) problems. Why? Spirited children seem especially vulnerable to allergies (perhaps because they are one more form of dysregulation), and any child is more able to control himself and learn from his experience - and the efforts of his parents! - when he's not distracted internally by an overly reactive immune system. Stress - which is generally experienced more frequently by spirited and cautious children than by easygoing ones - disturbs the gastrointestinal system, and the results can include tummy aches, constipation, and less ability to absorb nutrients. We've consistently seen sensible efforts to bring an optimal balance to a child's physiology lead to mild to moderate improvements in her mood and temperament - and once in awhile, a dramatic benefit.

As a starting point, tell your pediatrician about your child's temperamental or psychological issues, and see if the doctor thinks there might be some physical basis for them. You could also consult with a licensed professional who has specialized experience with nutritional deficits, allergies, or gastrointestinal problems in children.

Sensible Care

If assessment reveals any condition that is wearing on your child - and perhaps exacerbating temperamental issues - you'll want to care for it in sensible ways. Here are some options for using nutrition, or the skillful management of allergies or GI disturbance, to help your child's temperament.

• Nutrition - Besides leading to weight gain and tooth decay, sugar can really crank up spirited kids - so we definitely recommend limiting it to 20 grams a day. One of the easiest ways to accomplish this is to cut down on sweet drinks; for example, there are about 45 grams of sugar in a can of coke.

A different sort of problem occurs when there's too little of a nutrient. In particular:

§ Research on children with attention deficit/hyperactivity disorder (ADHD) - an extreme version of spiritedness - has found that those who ate a high protein breakfast were much calmer and more focused at school.

§ Essential fatty acids have been useful in the treatment of ADHD for some children, as well as for dyslexia and dyspraxia (poor motor skills or balance), and we've seen rigidly cautious children become more flexible after giving them essential fatty acids.

§ Deficits in all of the B-vitamins have been shown to lower mood; one of the most important of these is B-6, which the body must have in order to make serotonin. Now here's the tricky part: B-6 may be low because a child is not eating enough (in foods or supplements), or because his body cannot convert the B-6 he does get into its active form, which has a mouth-bending name, pyridoxal-5-phosphate (P-5-P). You can get P-5-P in a health food store, and research has shown it to be quite effective in lifting a person's mood, particularly when his or her serotonin levels are known to be low. (P-5-P should be taken in the morning before eating breakfast or any supplements with minerals, since P-5-P and minerals block the absorption of each other.)

§ Minerals in general are important for mood and self-control, but they are low in many children. Magnesium is especially calming, and it has been shown to be helpful for children with ADHD. The Recommended Daily Allowance (RDA) of magnesium for adults is 320 mg; a reasonable aim would be to give a child the fraction of that dose that is proportionate to his body weight. Since it is hard to get that much magnesium from the diet most kids eat, we suggest using a supplement of magnesium citrate, aspertate, or glysinate. Besides helping the immune system, zinc has been shown to be low in children with ADHD, so supplementation may be worth trying with a particularly spirited child. The adult RDA is12 mg, and you can adjust that amount in proportion to your child's weight.

• Allergies, food sensitivities, and food intolerances - Allergies, etc. are becoming so widespread that they are probably the most common chronic illnesses in modern, industrialized societies, affecting 15% to 30% of the population. If you minimize or eliminate a child's exposure to the substances to which she reacts, in our experience there is often an improvement in temperamental problems. Sometimes this is fairly easy - don't acquire a cat if she's allergic to its hair, or get an air filter/ozone machine in her bedroom if she is affected by molds or pollen - but often it's a major pain. For example, if a child is allergic to gluten (in wheat, oats, rye, and barley), tasty, alternative foods are available in the cookbooks listed in the box, but it's still hard to keep a child away from bread, pizza, or cookies (we've dealt with this first-hand, since our son is allergic to gluten). Work with a good allergist, read up on allergies, and take the long view: an occasional splurge (birthday cake!) is alright for most kids, but it's the daily exposure to allergens that adds up over time.

Additionally, it seems like a wise, general principle to allow as few artificial or toxic chemicals to enter any child's body as possible. Some kids - particularly ones who are anxious or spirited - seem especially sensitive to their environment, such as to new carpets or a fresh coat of paint. Certain food additives may seem to have a marked effect on your child's temperament, like food dyes, artificial sweeteners, or monosodium glutamate. You can try eliminating a suspected culprit from his diet for a few weeks, and see if that makes a difference.

§ Starve the pathogens by eating much less sugar and white flour

§ Kill them with prescription drugs or herbal products

§ Compete with them by adding beneficial microorganisms (e.g., lactobacillus or other "probiotics")

§ Repair the damage to the GI tract, typically by taking supplements such as deglycyrrhizinated licorice or L-glutamine

Get Support

Since kids with demanding temperaments are bound to take more work, their parents need to make a special effort to share the load fairly, and to get support. In general, it may make sense to increase the amount of care your child receives from others, and it always makes sense for you to increase your own self-nurturance! In particular, you and your partner should have periodic summit-meetings about your plan for your child; a challenging temperament is not going to go away or be entirely "fixed" by any intervention, no matter how skillful. Perhaps read a book together - such as the excellent, Raising Your Spirited Child- and use it to come to a common view, or go together to see a parent educator, therapist, or a behavioral pediatrician.

Counseling or a social skills group could be an effective way to teach a child, even a young one, important skills - as well as offer ongoing guidance to his or her parents. This is also an effective way to identify and deal with psychological factors that may be affecting a child and intensifying her temperament, such as stress on the family or tensions in the parents' relationship. These resources are highly confidential, and young children usually like going to a therapist, since they get to play for an hour with a nice grown-up who gives them her undivided attention; before a first visit, you can describe the therapist as a kind of coach or teacher. Your pediatrician or preschool director can probably give you referrals to local therapists or social skills groups, or you can call the referral line in the local county association of different kinds of therapists that is listed in the yellow pages of the phone book. Many therapists will work on a sliding scale basis, and most counties also have non-profit agencies that offer professional services at a very low fee - such as A.P.P.L.E. FamilyWorks! Additionally, the office of education - or the school districts, in many counties - will assess, at no charge, preschool and school-aged children with perceptual, motor, or other psychological difficulties, and often provide helpful interventions as well; contact these organizations to see what services they might offer your family.

Sometimes, what looks like an ordinary matter of temperament is, in fact, a deeper psychological issue. For example, some children who are particularly rigid have a developmental disorder on the autistic spectrum, and some highly spirited kids actually have ADHD; for example, at least five percent of the first-grade boys in a typical school will have ADHD. In such cases, you definitely need professional help - and you can find it using the referral sources described in the paragraph above.


(Rick Hanson is a clinical psychologist, Jan Hanson is an acupuncturist/nutritionist, and they are raising a daughter and son, ages 12 and 14. With Ricki Pollycove, M.D., they are the authors of Mother Nurture: A Mother's Guide to Health in Body, Mind, and Intimate Relationships, published by Penguin.)

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Teaching Kids Psychological Skills

In our last column, we discussed how to create a nurturing and structured environment for spirited or cautious/rigid children. In this column, we're broadening our focus to explore how to teach basic, essential psychological skills that all children need, like being able to let go of upsetting experiences or take in positive ones.

Relaxation

Especially in early childhood, a child's reactions to things are more a matter of the body than the mind. When the body is more settled, the reactions usually becomes less extreme, and it is easier for him to think clearly and control himself - and remember what his momma said! That's why knowing how to settle his body down is vitally useful to a child.

One of the best ways to teach this skill is at night, when a child is already more relaxed and open, and more willing to try (or put up with) some new things just to keep his mom or dad in the room. We suggest leading your child through some of these techniques and finding the ones that work for him:

• Draw letters or shapes on his back and see if he can figure them out

• Tense his muscles for about five seconds and then relax completely

• Systematically put his attention on each major part of his body, starting with his feet and working up to his head

• Take big breaths; one trick is to get a child to exhale fully and then hold the exhalation for a couple of seconds - when he inhales, he'll naturally take a big breath

• Imagine that he is very heavy, sinking more and more deeply into his bed

• Imagine that his hands are very warm

• Recall or imagine a very relaxing scene, like snuggling in bed with you

You would normally spend five to fifteen minutes a night on these methods. As he gains more experience, you can ask your child to relax his body increasingly on his own. And during the day, you can gently encourage him to recall those feelings of relaxation or to use the techniques he has learned.

Letting Go of Upsetting Feelings

Over time, upsetting experiences form a kind of residue in a child's emotional memory banks. The next time a similar situation occurs, that residue gets activated and intensifies her reactions, like a pre-amp blasting music out of the loudspeakers. Besides being more uncomfortable for the child and stressful for you, her BIG reactions trigger more intense responses from other kids or adults - making her feel more picked on than ever, more unfairly dealt with, more besieged and anxious and angry, and worse about herself.

So teaching her how to filter out painful feelings at the end of the day, or as the day goes along, can be very helpful. Again at night, when you've got a captive audience, you can follow the relaxation by asking your child to recall anything that was bothersome or upsetting during the day, and then imagine that those feelings are being released through one or more of these methods:

• Let her vent for a few minutes. During that time, try not to dampen her feelings (e.g., It's not as bad as all that).

• Exhale the feelings with each breath; perhaps imagine that the breath is like a broom that sweeps dusty, schmuggy feelings away: Good riddance!

• Let them drain out of the body, perhaps as if there were tiny valves at the tips of each finger and toe

• Imagine the feelings being swept away by standing in a cool and refreshing stream on a beautiful, sunny day

• Imagine putting the feelings into a jar and tossing it into a river to be carried off to the sea, or placing them on a rocket ship blasting off to be burned up in the sun

• Imagine that a cord of some kind connects her to the things that are bothering her, and then she takes a pair of golden, super-powerful scissors and cuts the cord

• Say to herself phrases such as, Let it go, it's alright, I can feel better now.

As with relaxation, you would ask your child to use these methods increasingly on her own, both at night and during the day.Taking In Good Experiences

A child will have lots of positive experiences in a day, but many of them may flow through his awareness without really sticking. On the other hand, if the good moments sink in, they become a crucial resource inside, a source of soothing and encouragement he can draw on the next time things get rough. They contradict the negative, self-fulfilling beliefs he might have, such as I'll never do it right, or No one likes me, so why bother trying to be nice? They are a counter-weight in emotional memory to the painful moments of life. For example, paying special attention to taking in good experiences gives an anxious child the internal sense of being loved and safe that he of all people really needs, and it enables a spirited child - zooming around so much that new experiences are constantly crowding out old ones before they have a chance to register deeply in memory - to integrate positive experiences at all.

You can teach your child how to make good moments a part of himself at night as well, typically after you have already helped him relax and let go of upsetting feelings. As with those skills, you can encourage him to use what he's learning on his own, both in the evening with you in the room, and during the day by himself. Here's a powerful, step-by-step method:

• Review the day and talk about or visualize the nice moments within it, such as sweet times with you, accomplishing something, learning a new skill, or an acknowledgement from others. Especially look for events that are the opposite of how a child might characteristically feel, like reminding a cautious kid who was nervous about petting a dog that it was really fun when the animal licked his hand.

• As he recalls these, help him sense the positive feelings that come with them[, either by recalling how he felt earlier in the day or by evoking how he's entitled to feel right now]. It's important that he not just recall a nice event, but that he have a nice feeling.

• Encourage him to let the positive feeling sink in to his body, like water into a sponge. (If you haven't already, show him how water soaks into a dry sponge.) He could also imagine that there's a treasure chest in his heart, into which he places a picture of your smiling face, a great time with his father, a success riding his tricycle, and so on. Remind him that he is taking you and his dad with him wherever he goes, and that he can draw on the memory of these good feelings whenever he wants. While he is having this good experience, he could touch a part of his body, such as his wrist or heart, so that he can "cue up" the nice feelings again, in the future, just by touching that same part of his body.

• As an optional bonus, (especially for older children) you could finish up by having your child visualize a difficult situation - while remaining completely relaxed, with a strong sense of feeling good inside - and see himself acting effectively. Start with relatively easy situations, and work up to more challenging ones as the days go by. For example, you could ask a cautious child to imagine being accidentally bumped while standing in line at preschool, and see himself staying relaxed and calm, not worried about being hurt. Or you could ask a spirited child to imagine another child beating him in a board game, and then see himself shrugging it off, staying relaxed and calm, not getting mad or knocking the board over, and telling himself he'll probably win next time. Then, have the child imagine the positive outcomes that would result and the good feelings he'd have.

You can also use this technique as the basis of a powerful, three-step exercise. First, the child imagines the situation (while staying relaxed), sees himself acting in an effective, positive way, and imagines how good that will feel. Then he imagines the same situation, but this time he sees himself acting in the old, not-so-great ways, and he imagines the bad results and crummy feelings that would occur. Third, he makes a conscious choice about which way he wants to act (hopefully, the positive approach!), and then he visualizes that and the results. Taking Charge of His or Her Mind

Even young children can be taught how to gain more control over their thoughts, feelings, and wants. Adjusting their approach to the age of the child, there are lots of ways that parents can teach three useful skills:

• Self-observation - It's crucial for a child to be able to notice when she is slipping into, or already in, a state of being that could be a problem, such as getting rigid or revved up. Just noticing it puts her back in the driver's seat - like the rider of a horse who suddenly realizes her mount is heading the wrong way. You can help by being like a mirror, reflecting the child back to herself so she can see herself more clearly; it's simple to do this by saying - in a gentle, non-judgmental way - what you think might be going on, like: You gotta have the red cup, right? Or: Are you feeling kind of zoomy? You can also ask a child to step back from herself and tell you what's happening inside: How excited are you right now - a little, medium, or a lot?

• Talking back to his or her thoughts - Your child can also argue with the wrong or overly negative thoughts in her mind. As usual, you start by doing it for the child, and then encourage her over time to do it more and more on her own. (A fun way to move in that direction is to take turns coming up with a reason why some negative thought is wrong.) For example, if she is worried about burglars, you could help her come up with this list of reasons why she's safe: The house is all locked; lights are on; no one has ever been burglarized in our neighborhood; three dogs live next door that bark at anything that moves, and burglars stay away from dogs like that; our house does not look rich. Or let's suppose that your spirited son was excluded from some group of boys in kindergarten, and he thinks no one likes him and school will be horrible. The rebuttals could include: It happened once but it may not happen again; it happened for a reason that you can change (i.e. don't grab the ball from one of the boys in the group); mom will talk with the teacher who will try to help out; kids are mean for lots of reasons (like their brother was picking on them) that have nothing to do with you, so it does not mean anything about you if they are mean; you played with other kids later that day and it was fun; there are other kids you could become friends with; you are a great and special person in such-and-such ways; you will make lots of new and better friends in the future; we love you a ton; your dog loves you; you are lovable; love and a sense of your own worth are deep in your heart and will never go away.

• Making good plans - It's so helpful for a child to be aware of the plan that's currently in place, the need sometimes to make a new plan, and the basic idea that it's not OK to change plans unless mom or dad agrees. You can tell a child what the current plan is: We're getting ready to leave, and you shouldn't be trying to do anything else. Or ask - neutrally, as a coach and teacher, not a scolding parent - what she thinks the plan is: What are you supposed to be doing right now? Or have her tell you what her plan is for something: How are you going to clean up the cereal on the counter? What are the steps? If she gets rigidly locked on to a plan in her mind - like she has to get into the car before her younger brother - that needs to change, you can talk with her about the need for a different plan: Yes, you thought you could get in the car first. But Bobby's sick, he's got the runny nose, so I didn't want him to stand in the wind while you got in the car. I'm sorry, but we had to make a new plan. That happens sometimes. Finally, suppose your spirited, rather impulsive daughter sometimes changes the rules in games in order to win, and that creates problems for her with other kids. You could say: Did we agree you could roll the dice twice? No, we didn't. The plan in this game is each person rolls once. You can't change the plan unless everyone agrees.

To recap, the psychological skills you give your child will not make a difference overnight. But if you stick with them for several months, in most cases you'll see a substantial improvement. If you don't, that would suggest a greater extreme of temperament, or perhaps other issues, that are worth discussing with a specialist in child temperament, your pediatrician, or a therapist who works with children.

(Rick Hanson is a clinical psychologist, Jan Hanson is an acupuncturist/nutritionist, and they are raising a daughter and son, ages 12 and 14. With Ricki Pollycove, M.D., they are the authors of Mother Nurture: A Mother's Guide to Health in Body, Mind, and Intimate Relationships, published by Penguin.)

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Working with Challenging Child Temperaments

Some kids are naturally easy-going, adaptable, and cheerful. Sure, they'll still cry if the ice cream falls off their cone, but in general, they have the sort of temperament that makes a parent's job considerably easier: they trot into preschool with no clinging to mom or dad at the door, and if their favorite sweatshirt is in the wash, it's no big deal to put on a different one. They can sit quietly for fairly long periods and settle down quickly if they get excited or mad, and if they can't build their block structure just right, they don't knock it over out of frustration.

On the other hand, probably at least a third of all children depart dramatically from this profile, and it's usually quite clear by the child's first or second birthday. Most of these kids fit one these patterns:

• Cautious/Rigid - Slow to warm to new situations, people, or activities. Obsessive attachment to objects (like favorite articles of clothing) or routines. Highly insecure about separating from parent or father. Often have intense fears (ie. dogs, loud noises, or the dark).

• Spirited - High activity level, and rev up quickly. Always looking for something new and exciting. Often seem to have short attention span or difficulty listening. Physically bold, risk-taking, even aggressive. Intense, dramatic, fill the room with their energy.

These children bring special gifts to their families, like helping their parents really pay attention to family routines (cautious kids), or livening up otherwise stuffy occasions (spirited ones). Nonetheless, they can't help but be considerably more stressful for you to raise, especially if their disposition tends toward the high end of either type - in which case his or her temperament could well be the biggest single stressor in your life.

A cautious or spirited temperament has consequences for the child as well, often leading to more difficulties with other children, problems in childcare or school, and angry conflicts with his or her parents. To help yourself, and your child, we've put together a package of approaches (on a foundation, of presumably, of loving nurturance and reasonable discipline) that we've seen work in numerous families - many of which are useful for more easygoing kids as well:

• Have extra compassion for your child and you

• Nurture more than ever

• Provide lots of structure

• Teach skills

• Optimize the child's physiology

• Get support

Box:

Twins and Triplets

There are more twins and triplets than ever before; for example, since 1980, there's been a 42% jump in twin births. Obviously, having twins or triplets is not a matter of a challenging temperament - unless each of them is cautious or spirited! But having several children all at once is definitely more work. Plus, they're often the result of fertility treatments for older women, so their parent is more easily worn out. Or they could have been born prematurely, another challenging complication.

Therefore, if you've got twins or triplets, you need more nurturing than ever. Look into local organizations for the parents of "multiple" births; you can also get information, referrals, and support from:

• The National Organization of Mothers of Twins Clubs, Inc. (NOMOTC). Box 438, thompson Station, TN 37179-0438. 615-595-0936. www.nomotc.org/index.html

• TWINS Magazine: www.twinsmagazine.com

• www.potatonet.org

• www.tripletconnection.com

• Winnipeg Parents of Twins & Triplets Organization: www.umanitoba.ca/womens_health/twins.htm

• Tamba: Twins and Multiple Births Associations: www.tamba.org.uk/

If there isn't a group near you that specifializes in twins and triplets, join one of the regular mothers' clubs in your area: you'll get plenty of sympathy and practical help. Dads can also make a big difference: they tend to pitch in more when babies make four (or more) and they just have to, since it is simply impossible for one caregiver to take care of two young children at once, especially infants. Try to get extra support, too, from your family and his, friends and neighbors, and paid childcare. Give yourself permission to let the housework go, and maybe get an occasional housekeeper. Long after you've forgotten about the grime on the counter, you'll have twice as many reasons - or even three! - to celebrate being a parent.

Have Extra Compassion for Your Child and Yourself

There's a saying that parents of one child think that their child's disposition is all about "nurture," while parents of two or more kids think it's much more about "nature" - because they see how different two children can be who are raised in much the same environment. A child's temperament - those stable tendencies in how he feels, reacts to situations, or sees the world - is biologically determined, and it's often obvious within a few months - or hours! - after his birth. For example, our first child, Forrest, stayed awake for several hours after he was delivered, looking around with interest, eager to interact, as if he were saying, Where's the party?! Our second child, Laurel, came out, blinked, closed her eyes, and went back to sleep; her attitude seemed more like, This is OK, but I'm more interested in other things, and please don't bother me. These fundamental approaches to life have persisted to this day: Forrest is more spirited, sociable, extroverted, and responsive to others while Laurel is more introverted, interested in projects she pursues on her own, and independent-minded. Both are happy and thriving. But they're doing it in very different ways.

It's natural for you to view your child's temperament as a reflection on you, as if it were a project that needs fixing, or a sign of willful disobedience - or perhaps a deliberate effort to drive you mad! It's also natural to feel disappointed in a child that hasn't turned out to be what you thought you had bargained for. These feelings are often painful to acknowledge - yet if we shove them down, they don't go away, and they inevitably leak out and the child always sense them. Like any difficult feeling, they're best admitted to oneself and perhaps another, and then (if possible) released and replaced with a more accepting, philosophical, and humorous attitude.

But in fact, a child is as much the victim of her temperament as you are, like the hapless rider of a runaway horse. You can sometimes see that a child really wishes she could act differently, but she just can't help it. One time Rick was trying to give Laurel (then age three) breakfast, and she had to have a certain kind of cereal - which wasn't in the house. In spite of being offered lots of other good foods, she threw a major fit. Midway through it, Rick had the sense, looking in her eyes, that she was in fact horrified at where her blind insistence on getting her way was leading, and frightened at being out of control, but she simply could not stop.

Certainly, a child needs discipline regardless of her temperament, and her parents need to offer guidance and skills and sensible boundaries. Yet the foundation of all this has to be compassion from her parents, or she'll feel in a deep place that there is something wrong with her essential nature. Besides being good for her, compassion calms you down and draws you into a less stressful place inside. It helps you feel more peaceful to see the strengths in her nature, particularly if it is different from your own.

When the friction between you is at its worst, or other people are giving you The Look, it's easy to think that her temperament is a kind of aberration from the ideal of the shiny happy child. But it's important to keep in mind that there is a wide range of temperaments for very good reason: until recently, humans lived - and mated - mainly in tribal groups, and those that contained a diversity of temperaments were generally more able to survive the diversity of problems that nature threw at them.. Every group - whether a Stone Age tribe or the board of a Fortune 500 corporation - needs people who are cautious, and others who are eager to take risks.

Finally, you deserve compassion, too, since no matter how much you cherish your child, her temperament still brings more stress and demands upon you. And, of course, try not to be hard on yourself because your child is cautious or spirited, nor rattled by the judgments or rolled eyes of others. If anything, you deserve extra kudos!

[ Pull out

Our mothers teach us the power and value of compasion right from our birth.

The Dalai Lama ]

Nurturing as Prevention

A cautious or spirited child is bound to receive more correction, criticism, and scolding than one who is more easy-going. So he needs more nurturing from his parents, and other caregivers, in order to compensate.

Additionally, the degree of a child's cautiousness or spiritedness is often intensified by a drop in nurturance, perhaps due to the arrival of a new baby, a change in sleeping arrangements, an entry into childcare or a new preschool, mom returning to work, or dad getting a new job with a longer commute. By finding it within yourself to surge greater nurturance into your child, there will often be a pleasant easing of some of the extremes of temperament: less clinging, anxiety, and rigidity - or less jumpiness, distractibility, and intensity. Reasonably enough, you might fear that if you give your child more nurturance (sometimes framed as "giving in to his demands"), then he will just want more than ever. But in fact, your loving attention will help settle down his neediness, particularly if you also teach him how to take in good experiences and make them a permanent part of himself (which we'll discuss further, in our next column); he'll be happier, and easier for your to raise. In essence, extra nurturance for the challenging child is the ounce of prevention that heads off a pound of trouble.

Provide Lots of Structure

Of course, being super-nurturing doesn't mean letting a child walk all over you, or anyone else, simply because he's being "temperamental." Cautious and spirited children need even more consistency and limits than most kids do. Structure is reassuring, soothing the fears of both cautious and spirited children (while a cautious child looks more conspicuously fearful, a spirited child is often quite anxious behind his bravado, and one of the main motives behind any aggressiveness is that it is a way to dispel fear).

Structure consists both of what you make sure is present in a child's life as well as what is deliberately absent. In terms of what's present, a consistent daily routine will help keep both spirited and cautious kids "inside the lines." Your expectations for behavior should be very clear, and kindly and relentlessly enforced. Try to be creative in your family's structures, tailoring them to the unique needs of your child. For example, since a spirited child is particularly prone to forgetfulness and disorganization - How many times do I have to tell you to get your lunchbox in the morning?! What, you've left your jacket at school again?! - try to provide forms of structure that simplify things and provide reminders. For example, you could put a basket in his bedroom for dirty clothes rather than hope he'll put them in the hamper - and he'll probably turn it into a chance to shoot some hoops. Or take a snapshot of each of the basic steps in the morning routine - wash face, put away pajamas, put on clothes, eat breakfast, get jacket for trip to childcare, etc. - and glue them to a piece of poster board for a daily, visual checklist.

As to what you intentionally keep out of your child's world, at the top of the list should be those things that exacerbate his or her temperamental tendencies. For example, highly intense or novel experiences can be so frightening that they heighten the rigidities of a cautious child. Exposing a spirited child to thrill-a-minute or violent stimuli - like many TV shows or video games - or to angry quarrrels between his parents, often evokes more aggression in him. Consider your child's friends: do they bring out the best in your child, or those qualities that are most challenging for him - and you?

* * *

In our next column, we'll cover how to teach kids the skills they need to manage their own temperaments - like relaxing, lightening up, soothing oneself, letting go of upsetting experiences, shifting gears and making new plans, and taking in positive experiences so they become a permanent part of oneself (which helps balance negative experiences and also helps develop inner resources).

(Rick Hanson is a clinical psychologist, Jan Hanson is an acupuncturist/nutritionist, and they are raising a daughter and son, ages 12 and 14. With Ricki Pollycove, M.D., they are the authors of Mother Nurture: A Mother's Guide to Health in Body, Mind, and Intimate Relationships, published by Penguin.)

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Caring for Inattention, Restlessness, and Impulsive Behavior

Our third-grader"s teacher has been hinting that he might be "hyperactive." She says it's hard for him to sit still, he talks a lot without raising his hand, and he's distracted by any little thing. At home, I have to constantly remind him to do things; he says he just forgets. He can play Nintendo for hours, but if he is supposed to write something for school, it seems like it is torture for him to sit in the chair.

In last month's column, we described "attention deficit/hyperactivity disorder" (ADHD), which may possibly apply in the case of this third-grader. In this column we will discuss things that parents and teachers can do to help children who are inattentive, restless, and impulsive.

Assessment

All children are distractible, fidgety, and act without thinking some of the time. ADHD refers to a cluster of related symptoms that are biologically based in the constitution of the child. The key diagnostic questions are degree of severity and consistency of symptoms across settings and times.

Other biological conditions, or purely psychological factors, may present a picture of behavior similar to ADHD. And ADHD may coexist with other biological conditions (such as sensori-motor delays) or psychological factors (such as anxiety due to family discord). Every parent knows that children are complicated!

People who discount the reality of ADHD because they believe children are over-medicated (occasionally true) or parents are too preoccupied or busy with other matters (sometimes true) are taking an overly simplified stance that misses an important constitutional factor that disrupts the lives of many children, families, and classrooms.

As discussed in the previous column, your first step is a thorough assessment by a psychotherapist or physician. The suggestions below will also be helpful for many children, especially those who are spirited but do not have ADHD.

Summary of Care for ADHD

In sum, w recommend four key elements in the care of ADHD

• Education and understanding

• Community and support

• Sensible physiological interventions

• Psychological interventions both "inside" the child and "outside" at home and school environments

Generally do these four elements first. If those do not produce a sufficient result after at least several months of real effort, consult a child psychiatrist or pediatrician for possible medication (e.g., Ritalin). On the other hand, if you just know that the "full-court press" approach of the four bullets above is not going to happen, or a child's behavior has gotten rather serious and needs rapid improvement, you may want to consider medication early on.

Understanding and Education

Sometimes when we look into dense forest, we suddenly put together a pattern of "brown here, long line there" and see . . . a deer.

Identifying ADHD is like seeing the deer. What had been seemingly unrelated details come together into a coherent whole. Once we see the whole "deer," the unifying and underlying pattern of ADHD, we can also track it as it moves through different environments such as classrooms, birthday parties, going to bed, or forgetting chores.

Through understanding, we can be more compassionate with our child, knowing that he or she is does not deliberately "doing it to us." We can help our child with "deerness" in various settings, and not get distracted by the details of different situations. And as we said in our last column, we regard ADHD as a normal variation on human temperament that has persisted during millions of years of human evolution because it was useful in the hunter-gatherer groups that everyone lived in until agriculture began to spread 10,000 years ago. The problem is not with hyperactivity, impulsivity, and distractibility per se, but with the fit between those characteristics and the tightly scheduled, controlled, sit-down-for-six-hours-a-day environments in which most children spend their days.

Study ADHD. Since there is a genetic basis for ADHD, you may find aspects of yourself, your spouse, or your relatives in the pages of the books recommended in "Resources" below.

With young children, avoid labels; talk about aspects of ADHD in everyday language such as "focusing," "jumping around," "daydreaming," "organization," etc. Depending on the age of the child, the severity of the condition, and the conspicuousness of classroom interventions, more explicit descriptions may be called for.

Be positive and hopeful. Focus on pieces of behavior and not the whole person. You are addressing small aspects of an overall wonderful child.

Community and Support

Connecting with other parents with children who have ADHD can be extremely helpful. The main support association for ADHD is CHADD (Children and Adults with Attention Deficit Disorder). In Marin, CHADD can be reached through Matrix at 499-3877.

Caregivers need care too, especially when dealing with a child who may sometimes be exasperating and stressful. ADHD is a long-term project, so parents need to think about the ongoing support for themselves that will enable them to sustain their efforts for many years.

Sensible Physiological Interventions

Always assess a child for physical conditions (such as allergies or chronic low-grade infections) which may be exacerbating ADHD. Sensori-motor delays often accompany ADHD and should be cared for in their own right, often through a program of exercises conducted by a sensori-motor specialist; schools or therapists can offer referrals.

A balanced, healthy diet with low sugar or junk food, and frequent small meals, can reduce ADHD symptoms. Physical exercise can be calming. Homeopathy can also provide a beneficial effect. Biofeedback may sometimes be helpful.

Watch out for dogmatism and quackery in the biological treatment of ADHD. Sound research has not discovered any magic bullets. What usually works is the accumulation of moderate benefits (through many treatment modalities) that together amount to a large change.

Psychological Interventions

At school and home, psychological interventions include:

• modifications in the environment (e.g., removing distractions, placing a child with quieter classmates, or a bulletin board with reminders in a child's bedroom)

• teaching self-awareness (e.g., noticing the feeling of one's mind wandering)

• creating ways a child can self-calm (through time-outs or special places he or she can go to settle down and re-group)

• rewarding positive behaviors and the absence of negative behaviors (e.g.,"smiling faces," extra privileges, or other small rewards for completing an assignment in a reasonable period of time, catching oneself before grabbing a classmate's pencil)

• penalizing problematic behaviors or the absence of appropriate behaviors (through withdrawing privileges, charging a child a nickel, requiring a child to make amends, etc.)

• developing social, physical, emotional, and cognitive skills (such as social skills groups, practice in guided relaxation, using words and not hands, making plans, applying "the brakes," etc.);

• parental guidance

• counseling to help develop skills and to deal with the psychological effects on the child of having ADHD

The books below will give you many, many detailed suggestions about how to implement the interventions noted above. But as broad, general principles:

• The key elements in all these interventions are structure and coaching.

• Support self-esteem, the most common casualty of ADHD.

• Have clear expectations.

• Communicate expectations clearly. Emphasize brief and visual or kinesthetic communications. Show, don't say. Keep instructions simple, broken into many steps.

• Teach self-monitoring: Help children become aware themselves of what they are feeling, thinking, and doing.

• Emphasize self-awareness, cognitive skills, and rewards over penalizing negative behaviors. Caregivers can get locked into attacking problematic behaviors.

• In general, the more potent the rewards and the penalties, the more quickly you will see change.

• Keep information flowing between school and home. Work as a team with teachers.

Medication

ADHD does not equate to medication! Parents may be illogically unwilling to contemplate ADHD in their child's case because they don't want their child on drugs.

Medication is typically a stimulant (such as Ritalin or Benzedrine) which paradoxically slows a person down; antidepressants have also been used to good effect in some cases. Fears about medication leading to drug abuse, growth suppression, or low self-confidence have generally not been supported by research. Medication works for roughly two-thirds of those treated. There can be side effects which should be monitored. The response to medication is often very individualized so that one must try two or more medicines before finding the one that works best.

Done properly by an child psychiatrist or pediatrician, with sensitive and sensible communication with the child, medication can transform a child's experience and performance at home and school. Done casually, or without the other four categories of care discussed above, medication can make a child feel drugged and like "damaged goods." Without other interventions (see the four categories of care above), when medication is stopped children usually revert to previous (problematic) academic and social behavior.

Resources

Based on the Americans with Disabilities Act of 1990, ADHD is considered a disability that is protected under law. School districts are obligated to provide resources in order not to discriminate against children with ADD.

CHADD can direct interested parents to the many legal, medical, academic, and psychological resources available to help with ADHD.

Good books: Driven to Distraction (Hallowell), How to Reach and Teach ADD/ADHD Children (Rief), Keeping a Head in School (Levine), Your Hyperactive Child (Ingersoll), ADD: A Different Perception (Hartmann).

Perspectives

Unlike a degenerative condition such as multiple sclerosis, ADHD usually gets better over time. Nature is on your side!

Also, what really matters is the whole child. It can be easy to get "ADHD-fixated and lose sight of the being who is experiencing - and sometimes suffering - ADHD. At the end of the day, or at the end of childhood, what will matter most is a child who feels well-loved, respected, and confident.

(Rick Hanson is a clinical psychologist, Jan Hanson is an acupuncturist/nutritionist, and they are raising a daughter and son, ages 12 and 14. With Ricki Pollycove, M.D., they are the authors of Mother Nurture: A Mother's Guide to Health in Body, Mind, and Intimate Relationships, published by Penguin.)

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