Dr. Sarah (00:02):

Ever wonder what psychologists moms talk about when we get together, whether we’re consulting one another about a challenging case or one of our own kids, or just leaning on each other when parenting feels hard, because trust me, even when we do this for a living, it’s still hard. Joining me each week in these special Thursday shows are two of my closest friends, both moms, both psychologists, they’re the people I call when I need a sounding board. These are our unfiltered answers to your parenting questions. We’re letting you in on the conversations the three of us usually have behind closed doors. This is Securely Attached: Beyond the Sessions..

(00:41):

Welcome back. I’ve got Dr. Rebecca Hershberg and Dr. Emily Upshur here. We’re going to answer a listener question on this beyond the sessions segment of the securely attached podcast. How are you guys? You ready?

Dr. Emily (00:56):

Hey.

Dr. Rebecca (00:56):

Let’s do it.

Dr. Sarah (00:57):

Okay, so this parent writes in. I have a question I’d appreciate you addressing on your podcast. My wife and I have been going back and forth lately about how to handle our 10-year-old recent ADHD diagnosis. She’s all in on making a bunch of changes at home, diet routines, therapy, you name it. I’m not against it, but I guess I’m just not totally sure it’s necessary to go full steam ahead. Yet part of me wonders if he’s just being a typical energetic kid, we’re not really on the same page and it’s causing some tension between us. How do you know when it’s time to really lean in and how can we get more aligned as parents when we’re not seeing things the same way I just want to do right by my kid without going overboard and making this into such a big thing in his life?

(01:39):

It’s a very thoughtful question.

Dr. Rebecca (01:42):

I was about to say such a good question.

Dr. Emily (01:45):

I also think it’s so great when you get a new diagnosis that you’re sort of thinking about, okay, now how do we implement things related to this? It’s a really thoughtful way to approach it.

Dr. Sarah (01:56):

And I think he brings up a very common challenge that I think parents have, whether they’re on polar ends of the spectrum in terms of how to respond to a new diagnosis or honestly, I see parents ping pong between these two ends just in and of themselves sometimes where it’s like I am managing my own kind of anxiety about this diagnosis by either really wanting to not avoid, but really being a bit cautious about proceeding and wanting to get every single box checked and every duck in the row before I make changes. Almost stuck in preparation mode because feeling anxious or the other end of that is let’s throw everything at this problem and let’s just go full steam ahead. And I think there’s utility in looking at both of those poles and kind of finding that middle space.

Dr. Rebecca (02:49):

Goldilocks.

Dr. Sarah (02:50):

Yeah.

Dr. Emily (02:51):

Well, this reminds me of if you do all the things at once, you don’t know what works and then you’re exhausted. So that was my first reaction was like, well, don’t do it all at once, then you won’t know what’s your most bang for your buck and then what to focus on. And so you’re not exhausting all your resources.

Dr. Sarah (03:08):

It’s like an elimination diet.

Dr. Rebecca (03:10):

I think what I heard, and I may be reading into it, I definitely have clients that resemble this question, but I heard a little bit of skepticism about the diagnosis. And I don’t know if that’s this episode or another episode, but this whole idea of is my kid’s ADHD diagnosis real or do I have an active 10-year-old kid is interested here? It sounds like they’ve received the diagnosis, right. I’ve also met with parents where it’s like, do we get ’em evaluated, do we not? Oh, you’re making too much of it. Oh, you’re not seeing the real picture. It sounds like they have a diagnosis. I don’t know if they have a diagnosis from a pediatrician or a full neuropsych workup per se, but I think this parent’s concern is sort of twofold. It’s one, is this diagnosis “real”?

Dr. Emily (04:06):

Or, how seriously do I need to take it?

Dr. Rebecca (04:07):

Yeah, how seriously do I need to take it? Exactly. And then if I am acknowledging it’s real because they do get the sense they’re sort of trying to get on board, then to what extent do we turn it into the centerpiece of our family versus perhaps go a little bit more slowly? And I think those are two different and both important questions. I don’t know if we want to…

Dr. Sarah (04:30):

And they’re also somewhat chronological, so maybe we tackle that first one first and then the second. Because unless you are going to make the decision of accepting that this diagnosis is really going to be informing your next steps, then the next steps are somewhat irrelevant until you have stepped into this reality. So if you are, and I guess Rebecca, you made an important distinction, which is if you aren’t sure, I think there’s also, if you have this diagnosis and you’re not sure you are in agreement with it, where did the diagnosis come from? Like your point, Rebecca, that there’s a difference between a pediatrician offering this, and again, pediatricians may do very comprehensive evaluations and some may sort of see a couple of symptoms and say, this meets criteria. I ran through the symptom checklist and they checked the boxes. So we’re dealing with that versus a comprehensive neuropsychological evaluation that’s looking at such a global thing. So I guess I’m saying if you’re not a hundred percent sure that you are in alignment with the diagnosis and you haven’t yet done a neuropsych, then maybe that’s the next step to just get some clarity on how much trust can you put into this diagnosis and how much data are you going to be able to see and have presented to you to feel comfortable that this really is what’s going on or maybe may not be.

Dr. Rebecca (06:14):

Well, I also think, and again, I can see this episode, I have a visual of paths going in different directions because they’re such important and such common questions. But I also, when I work with families, always come back to distress and impairment. So whether or not there is a diagnosis and whether or not you’re full steam ahead, one way to help get on the same page as partners or just to think about even just as a parent within yourself to think about your kid is what’s not going well? What led you to seek guidance on what’s going on with your kid in the first place? And if your kid is having a really hard time at home and there’s a ton of fighting, then certainly something like adding structures and routines is going to be very, very helpful whether there’s an official diagnosis of A DHD or anxiety or not. So I also wouldn’t want to get too caught. Again, there’s so many different questions at hand here, but I might say to parents who are in disagreement about how much to embrace a diagnosis, I might sort of say, well, let’s step away from that and look at what’s going really well for your kid and what’s not going well for your kid?

(07:38):

What’s getting in the way of day-to-day life pleasure slash functionality, and then what’s the best way to address that? And then you look at the choices that this person laid out. Is it routines, is it diet? Is it, I mean, that’s just sort of what occurs to me. There’s a lot of things that can be going on with a kid where some of those things can be helpful and you can get stuck in arguing about the diagnosis and you could get stuck with a kid who doesn’t have a diagnosis where things aren’t going well at home and one parent is like, let’s change everything. And one parent is like, whoa, whoa, whoa. Take it easy. So I wouldn’t want to get sidetracked by that conversation necessarily either. I also have no idea if any of this is helpful to this person who wrote the question and whether we’re giving any.

Dr. Sarah (08:28):

But it might be helpful to other listeners too though, right? Because this is, like you said, this is a pretty common issue that we see where among all of the things we’re talking about, having some ambivalence around how much you can feel comfortable accepting a diagnosis either because you don’t feel like you’ve exhausted all of the necessary data that needs to be collected or because you don’t want to look at this because it’s hard to look at. Those are different things, but also worth kind of checking in on. But I also think there’s this other piece of what’s your strategy once you have, okay, let’s say we have now moved into the acceptance of the diagnosis and now we’re debating what’s the best strategy for supporting this child at home, at school in other environments, which I think we’ve already said, but I think is very much I agree with, let’s be kind of thoughtful and strategic. And yes, you can have a big picture game plan that includes all those things, but I’d roll them out in phases so you can, to your point, Emily, track what’s working.

Dr. Emily (09:42):

Yeah, I would pick one that also…

Dr. Rebecca (09:43):

What’s working and not burn out, which are both points we made.

Dr. Emily (09:46):

Right. And I also think it’s important to pick one that you as parents feel like you can do to fidelity, because that’s not always an easy ask. I can never get diet down. It is hard enough for me to get the different color foods into my child, so that wouldn’t be where I would personally start. Some people are great at that, they’re great at meal planning and food and nutritious meals and all that stuff. So I think you have to also shine a light on what you as a parent can really maybe execute or maybe this couple, what is one thing they might agree on a regular bedtime, they might be able to get on the same page about a couple of these things and just start there.

Dr. Sarah (10:30):

And to your point, Rebecca, what you were saying before, how this family might have some intel into how their own specific child is showing up, that led to this whole process kind of unfolding, right? Each kid, especially with ADHD, you could look at put five kids in a room with an ADHD diagnosis and they’re all going to look very different because these are clusters of symptoms and they could combine in many different ways. But to that point, let’s individualize this. If you go on Google and say, what are all the things that are helpful when you get diagnosed with ADHD, it’s going to give you 50 things that could be helpful. But I think it’s always helpful to go back to the child. What are the things that they’re struggling with? Where is the distress where keep rubbing up against a lot of friction in the family dynamic.

(11:24):

And the family rhythm is, Emily, you were talking about diet. I’m like if your kid’s constantly getting super hangry because they’re a super fast metabolizer because they’re go, go, go, go, go, then actually shoring up their diet might have way more impact than if you have a kid who’s inattentive and they’re forgetting all their things and they’re just sort of off in space all the time. Diet may or may not be a core instigator for their what’s falling apart for them, they might need more of a visual schedule. So again, it’s like the interventions also need to match the symptoms your child’s experiencing sing.

(12:13):

And so I always have parents do a week of behavioral observations and really track it. I have a behavioral observation tracker that I give parents and I just literally say, write down every time there is some type of challenging moment or where you’re seeing some of these symptoms show up, what happened before, what happened in the moment, how you responded to it. Just notes. Do a little bit of field study, gather some data. And then after a week of that, we look over the whole chart and we say, okay, well what of these, first of all, what patterns do we see? Are there certain transitions that always seem to be difficult or are there certain times of day or is it always when they get home from school and they’re starving and they’re hangry? What is the problems that we’re seeing come up over and over and over again? And then of those, which ones do we feel like to what you were saying, Emily, before, which one could we target that we feel like we have the resources to actually touch consistently right now that feels like a safe place to start. And then it gives us some kind of structure to how we’re going to collect our kids’ data, create a plan that matches what they’re showing us is repeatedly coming up as a problem in our day-to-day life. And then you can kind of order them.

Dr. Rebecca (13:38):

Yeah, I do that and I say we can either start with a behavior that’s really sort of causing a really hard time or a time of day. And the other sort of cheat sheet that I offer to parents, and certainly I do this in my book and I do this when I give talks is just I always come back just as an initial assessment. Where are we with love and where are we with limits? How much is your child feeling or not even your child? How much is everyone in the family feeling seen and understood and cared about? And where are we with structures and routines? Because I would say eight out of 10 times if we tweak, if just have a general area and especially for families that even, it’s so funny hearing you say Sarah, that you do a behavioral tracker. I went to a place of like she’d lose me right there.

(14:32):

I would just be, it all just feels terrible all the time next. And so that’s not true. A behavioral tracker I think would be very helpful to families who feel that way. But again, it’s like let’s just take this big part of this mess and then hone in. And I just think love and limits is an incredibly easy in a world with kind of all these sort of details around parenting and do this, don’t do this and this script and that script. There are easy kind of guideposts that whether or not your child has a diagnosis, your whole family is going to kind of do better if you’re doing well in the love and limits categories. And so that can be also a way to get on the same page with going back to this question, there are very few parents, even if they disagree about a diagnosis or even what’s a hard time of day or it’s like, do you agree that we want our kid to feel loved and understood and do you agree that our family would benefit from some level of structure and routine and predictability? Most parents say yes, and that can provide an entry point.

Dr. Sarah (15:33):

Yes, I love that. Do you find that love and limits in the families that you work for when there’s something’s out of whack that they are two independent variables or are they connected? Do you find that it’s a seesaw where one is over index, the other feels like it’s going down? Or do they feel like completely independent variables that could be both too high or too low no matter what?

Dr. Rebecca (15:54):

Yeah, I mean we definitely talk about, which we’ve talked about in here that it’s quadrants and not an axis, but I think is there a correlation between something being off in both? I don’t know. Sometimes yes, but sometimes not always.

Dr. Sarah (16:15):

Yeah, I think sometimes parents might, I honestly asked that question without an answer in mind. I wasn’t leading you anywhere. But as I’m thinking about it more, I actually think, and maybe I asked it because from a parent standpoint, I think this, and I think maybe a lot of parents might, and I think it might be a misconception, which is that if something’s out of whack, if my limits need work, then I need to pull back on the love and connection piece versus I think they are maybe actually independent variables.

Dr. Rebecca (16:53):

That’s the four. I mean I talk about that all the time. There’s a misconception that it’s like if my kid doesn’t respect me and I need to show him whose boss, then how could I possibly be kind of warm and loving and affectionate or simultaneously, if I really want to connect and snuggle with my kid, how could I possibly come down hard about screen time? And the fact is we know, and I’m sure you can link to other episodes where either we or you with guests go in depth that for the most part with absolutely some cultural considerations as always, but that high love and high limits is what leads to the most sort of healthy and functional child outcomes and family dynamics and that you don’t have to impact one in order to impact the other.

Dr. Sarah (17:49):

And I’m curious, I tell this story a lot to families when I am working with parents who do not feel like they’re on the same page. And this is more about the love and limits piece than it is about how do we roll out a treatment for a diagnosis we’ve received. But chances are there’s, if there’s that, there’s the other too. So I always describe to parents, I’m like, usually I’ll be working with a family and one of the parents will be more comfortable and more entrenched in the role of disciplining limit setting. And the other parent is more on that side of high warmth, high validation, high emotion holding, but they end up being more permissive. And what I feel like always happens is the more polar the parents’ roles end up getting, the more they feel like they’re holding up their end of the house, and if I let go of this side of the house, it’s going to fall down because the other parent is not doing anything to create supports.

(18:57):

So the parent who’s disciplining all the time doesn’t feel like they can take one step away from holding up that end so they don’t feel comfortable doing the validating and the emotion holding because they’re stuck holding the discipline. And then the other parent equally feels stuck holding up their end of the house. If I don’t hold these emotions and don’t validate, the other parent’s not going to do it, so I have to do this. So I can’t move into the discipline space. When I explain that to parents and they really feel like that is exactly what is happening, and that can be enough just to break through to both of them. You both have to do both. You can’t, if you get stuck in these roles, the other person can’t move into the middle. And so you both have to be willing to move into the middle together and both do both things. That’s I think one of the best paths forward when you see parents not really on the same page with their strategies.

Dr. Rebecca (20:01):

Absolutely. I’ll get parents to just play around, pick one time in the next week where you’re going to trade pick a half an hour on Sunday mornings and you are not allowed to say anything corrective to the kids and you are not allowed to say anything validating to them. And again, it obviously rarely plays out that way, but what it does do is bring to the surface a lot of very cool, it’s thought provoking and often kind of highlights some things that need to be highlighted.

Dr. Emily (20:36):

And it polarization. It’s like polarization relieving. It helps you get out of, I mean, I talked about…

Dr. Rebecca (20:43):

Even good cop, bad cop is another way to say it.

Dr. Sarah (20:45):

And away from resentment, right? Because a lot of the reasons why one person is doing all of one thing and not any of the other is because resentful of the amount of the other thing the other person’s doing. But I think if we can say, Hey, you guys are both responsible for doing both, it takes the onus off of one person to hold it all. And so then there’s less resentment too. It’s like I am acknowledging that you’re doing a lot of work, actually both of them, the heavy validator and the heavy limit holder and…

Dr. Rebecca (21:21):

Being clear, sorry to interrupt, but I just, because I just am remembering particular families, but the validator is often afraid. But if I stop, what if I lose all of my ability to validate? Or the limit head is like, well, what if I, it’s I don’t worry about that for you. You know what I mean? Worry if it comes naturally to you in such a way that you’ve landed in this dynamic where you are the person. I don’t worry that you’re going to slide so far in the other direction. It’s almost like recognizing what you’re always going to have naturally and then what’s a muscle you actually have to build.

Dr. Sarah (21:55):

Well, I find that it’s less that fear for parents and it’s more the fear that if I stop doing this, will the other person do it?

Dr. Emily (22:02):

Yeah, I was going to say it’s a trust. I think that usually it’s a parent being like, but they’re not going to do it. Right. They’re not going to validate right, or they’re not going to discipline either one of them.

Dr. Rebecca (22:13):

Letting go of the perfectionism. Right? Exactly. It’s like I have to wash the dishes because the other person doesn’t know how to wash them the way that I like.

Dr. Sarah (22:19):

Right? You got to let ’em wash the dishes.

Dr. Rebecca (22:20):

You got to let ’em wash the dishes.

Dr. Emily (22:22):

Whatever way they turn out.

Dr. Sarah (22:24):

And to bring it back to this ADHD question because we sort of diverted, but I’m going to go ahead and wager that this family has the same issue because most family, everyone does, everyone does. I think you guys are both kind of holding up two ends of the house, right? One is saying, I’m not sure I want to go all in on pigeonholing my child or labeling my child as this one thing and putting all of our attention and this one thing which is valid. And the other parent is like, I want to treat what’s going on and give my kid everything to solve this problem. And both parents are holding up each end of the house. And so I think what we ideally want to do is say, can you both do both? Can you both be willing to give this child and the family system and the environment, the kind of sort of care and strategy to address improving the environment’s ability to scaffold this child and help them build skills in a sustainable way for everybody?

(23:35):

So let’s do one thing at a time. We also can’t overwhelm the kid with all these things either, but then they’re both agreeing to also both not make it the center of our family’s life and we don’t need to orbit my child’s A DHD diagnosis that is not the son that we need to orbit. We’re still going to be a family centered family and not a child centered family or worse a child diagnosis centered family. Let’s make sure we’re both agreeing to do both. And then if we can both trust that we’re both going to show up kind of holding both ends of the house, we don’t get as stuck and we don’t feel as afraid to come into the middle.

Dr. Rebecca (24:20):

I think that’s spot on guidance for where this family is right now, honestly.

Dr. Sarah (24:26):

Middle path guys. You got this. All right, well, we will see you all Talk to you all very soon and keep sending in your questions.

Dr. Rebecca (24:35):

Bye everyone.

Dr. Sarah (24:36):

Bye

Dr. Emily (24:36):

Bye.

Dr. Sarah (24:39):

Thank you so much for listening. As you can hear, parenting is not one size fits all. It’s nuanced and it’s complicated. So I really hope that this series where we’re answering your questions really helps you to cut through some of the noise and find out what works best for you and your unique child. If you have a burning parenting question, something you’re struggling to navigate or a topic you really want us to shed light on or share research about, we want to know, go to drsarahbren.com/question to send in anything that you want, Rebecca, Emily, and me to answer in Securely Attached: Beyond the Sessions. That’s drsarahbren.com/question. And check back for a brand new securely attached next Tuesday. And until then, don’t be a stranger.