Saying Yes to Mess

December 21, 2006, NEW YORK TIMES
Saying Yes to Mess
By PENELOPE GREEN
IT is a truism of American life that we’re too darn messy, or we think we are, and we feel really bad about it. Our desks and dining room tables are awash with paper; our closets are bursting with clothes and sports equipment and old files; our laundry areas boil; our basements and garages seethe. And so do our partners — or our parents, if we happen to be teenagers.
This is why sales of home-organizing products, like accordion files and labelmakers and plastic tubs, keep going up and up, from $5.9 billion last year to a projected $7.6 billion by 2009, as do the revenues of companies that make closet organizing systems, an industry that is pulling in $3 billion a year, according to Closets magazine.
This is why January is now Get Organized Month, thanks also to the efforts of the National Association of Professional Organizers, whose 4,000 clutter-busting members will be poised, clipboards and trash bags at the ready, to minister to the 10,000 clutter victims the association estimates will be calling for its members’ services just after the new year.
But contrarian voices can be heard in the wilderness. An anti-anticlutter movement is afoot, one that says yes to mess and urges you to embrace your disorder. Studies are piling up that show that messy desks are the vivid signatures of people with creative, limber minds (who reap higher salaries than those with neat “office landscapes”) and that messy closet owners are probably better parents and nicer and cooler than their tidier counterparts. It’s a movement that confirms what you have known, deep down, all along: really neat people are not avatars of the good life; they are humorless and inflexible prigs, and have way too much time on their hands.
“It’s chasing an illusion to think that any organization — be it a family unit or a corporation — can be completely rid of disorder on any consistent basis,” said Jerrold Pollak, a neuropsychologist at Seacoast Mental Health Center in Portsmouth, N.H., whose work involves helping people tolerate the inherent disorder in their lives. “And if it could, should it be? Total organization is a futile attempt to deny and control the unpredictability of life. I live in a world of total clutter, advising on cases where you’d think from all the paper it’s the F.B.I. files on the Unabomber,” when, in fact, he said, it’s only “a person with a stiff neck.”
“My wife has threatened divorce over all the piles,” continued Dr. Pollack, who has an office at home, too. “If we had kids the health department would have to be alerted. But what can I do?”
Stop feeling bad, say the mess apologists. There are more urgent things to worry about. Irwin Kula is a rabbi based in Manhattan and author of “Yearnings: Embracing the Sacred Messiness of Life,” which was published by Hyperion in September. “Order can be profane and life-diminishing,” he said the other day. “It’s a flippant remark, but if you’ve never had a messy kitchen, you’ve probably never had a home-cooked meal. Real life is very messy, but we need to have models about how that messiness works.”
His favorite example? His 15-year-old daughter Talia’s bedroom, a picture of utter disorder — and individuality, he said.
“One day I’m standing in front of the door,” he said, “and it’s out of control and my wife, Dana, is freaking out, and suddenly I see in all the piles the dress she wore to her first dance and an earring she wore to her bat mitzvah. She’s so trusting her journal is wide open on the floor, and there are photo-booth pictures of her friends strewn everywhere. I said, ‘Omigod, her cup overflows!’ And we started to laugh.”
The room was an invitation, he said, to search for a deeper meaning under the scurf.
Last week David H. Freedman, another amiable mess analyst (and science journalist), stood bemused in front of the heathery tweed collapsible storage boxes with clear panels ($29.99) at the Container Store in Natick, Mass., and suggested that the main thing most people’s closets are brimming with is unused organizing equipment. “This is another wonderful trend,” Mr. Freedman said dryly, referring to the clear panels. “We’re going to lose the ability to put clutter away. Inside your storage box, you’d better be organized.”
Mr. Freedman is co-author, with Eric Abrahamson, of “A Perfect Mess: The Hidden Benefits of Disorder,” out in two weeks from Little, Brown & Company. The book is a meandering, engaging tour of beneficial mess and the systems and individuals reaping those benefits, like Gov. Arnold Schwarzenegger, whose mess-for-success tips include never making a daily schedule.
As a corollary, the book’s authors examine the high cost of neatness — measured in shame, mostly, and family fights, as well as wasted dollars — and generally have a fine time tipping over orthodoxies and poking fun at clutter busters and their ilk, and at the self-help tips they live or die by. They wonder: Why is it better to pack more activities into one day? By whose standards are procrastinators less effective than their well-scheduled peers? Why should children have to do chores to earn back their possessions if they leave them on the floor, as many professional organizers suggest?
In their book Mr. Freedman and Mr. Abrahamson describe the properties of mess in loving terms. Mess has resonance, they write, which means it can vibrate beyond its own confines and connect to the larger world. It was the overall scumminess of Alexander Fleming’s laboratory that led to his discovery of penicillin, from a moldy bloom in a petri dish he had forgotten on his desk.
Mess is robust and adaptable, like Mr. Schwarzenegger’s open calendar, as opposed to brittle, like a parent’s rigid schedule that doesn’t allow for a small child’s wool-gathering or balkiness. Mess is complete, in that it embraces all sorts of random elements. Mess tells a story: you can learn a lot about people from their detritus, whereas neat — well, neat is a closed book. Neat has no narrative and no personality (as any cover of Real Simple magazine will demonstrate). Mess is also natural, as Mr. Freedman and Mr. Abrahamson point out, and a real time-saver. “It takes extra effort to neaten up a system,” they write. “Things don’t generally neaten themselves.”
Indeed, the most valuable dividend of living with mess may be time. Mr. Freedman, who has three children and a hard-working spouse, Laurie Tobey-Freedman, a preschool special-needs coordinator, is studying Mandarin in his precious spare moments. Perusing a four-door stainless steel shoe cabinet ($149) at the Container Store, and imagining gussying up a shoe collection, he shook his head and said, “I don’t get the appeal of this, which may be a huge defect on my part in terms of higher forms of entertainment.”
The success of the Container Store notwithstanding, there is indeed something messy — and not in a good way — about so many organizing options. “When I think about this urge to organize, it reminds me of how it was when Americans began to take more and more control of their weight: they got fatter,” said Marian Salzman, chief marketing officer of J. Walter Thompson and co-author, with Ira Matathia, of “Next Now: Trends for the Future,” which is about to be published by Palgrave Macmillan. “I never gained weight until I went on a diet,” she said, adding that she has a room in which she hides a treadmill and, now, two bags of organizing supplies.
“I got sick of looking at them so I bought plastic tubs and stuffed the bags in the tubs and put the tubs in the room.” Right now, she said, “we are emotionally overloaded, and so what this is about is that we are getting better and better at living superficially.”
“Superficial is the new intimate,” Ms. Salzman said, gaining steam, “and these boxes, these organizing supplies, are the containers for all our superficial selves. ‘I will be a neater mom, a hipper mom, a mom that gets more done.’ Do I sound cynical?”
Nah.
In the semiotics of mess, desks may be the richest texts. Messy-desk research borrows from cognitive ergonomics, a field of study dealing with how a work environment supports productivity. Consider that desks, our work landscapes, are stand-ins for our brains, and so the piles we array on them are “cognitive artifacts,” or data cues, of our thoughts as we work.
To a professional organizer brandishing colored files and stackable trays, cluttered horizontal surfaces are a horror; to cognitive psychologists like Jay Brand, who works in the Ideation Group of Haworth Inc., the huge office furniture company, their peaks and valleys glow with intellectual intent and showcase a mind whirring away: sorting, linking, producing. (By extension, a clean desk can be seen as a dormant area, an indication that no thought or work is being undertaken.)
His studies and others, like a survey conducted last year by Ajilon Professional Staffing, in Saddle Brook, N.J., which linked messy desks to higher salaries (and neat ones to salaries under $35,000), answer Einstein’s oft-quoted remark, “If a cluttered desk is a sign of a cluttered mind, of what, then, is an empty desk?”
Don Springer, 61, is an information technology project manager and the winner of the Type O-No! contest sponsored by Dymo, the labelmaker manufacturer, in October. The contest offered $5,000 worth of clutter management — for the tools (the boxes, the bins and the systems, as well as a labelmaker) and the services of a professional organizer — to the best example of a “clutter nightmare,” as expressed by contestants in a photograph and a 100-word essay. “Type O-Nos,” reads a definition on the Dymo Web site, are “outlaws on the tidy trail, clutter criminals twice over.”
Mr. Springer, who in a phone interview spoke softly, precisely and with great humor, professed deep shame over the contents of what he calls his oh-by-the-way room, a library/junk room that his wife would like cleaned to make a nursery for a new grandchild. With a full-time job and membership in various clubs and organizations, and a desire to spend his free time seeing a movie with his wife instead of “expending the emotional energy it would take to sort through all the stuff,” Mr. Springer said, he is unable to prune the piles to his wife’s satisfaction. “There are emotional treasures buried in there, and I don’t want to part with them,” he said.
So, why bother?
“Because I love my wife and I want to make her happy,” he said.
According to a small survey that Mr. Freedman and Mr. Abrahamson conducted for their book — 160 adults representing a cross section of genders, races and incomes, Mr. Freedman said — of those who had split up with a partner, one in 12 had done so over a struggle involving one partner’s idea of mess. Happy partnerships turn out not necessarily to be those in which products from Staples figure largely. Mr. Freedman and his wife, for example, have been married for over two decades, and live in an offhandedly messy house with a violently messy basement — the latter area, where their three children hang out, decorated (though that’s not quite the right word) in a pre-1990s Tompkins Square Park lean-to style.
The room’s chaos is an example of one of Mr. Freedman and Mr. Abrahamson’s mess strategies, which is to create a mess-free DMZ (in this case, the basement stairs) and acknowledge areas of complementary mess. Cherish your mess management strategies, suggested Mr. Freedman, speaking approvingly of the pile builders and the under-the-bed stuffers; of those who let their messes wax and wane — the cyclers, he called them; and those who create satellite messes (in storage units off-site). “Most people don’t realize their own efficiency or effectiveness,” he said with a grin.
It’s also nice to remember, as Mr. Freedman pointed out, that almost anything looks pretty neat if it’s shuffled into a pile.

Do You Believe in Surnits?

December 23, 2006
New York Times Op-Ed Contributor
Do You Believe in Surnits?
By JACQUELINE WOOLLEY
Austin, Tex.
WE delight in our children’s belief in reindeer that can fly and a fat man who fits through chimneys and travels the whole world in a single night. Many children believe fiercely not only in Santa Claus but also in other fantastical beings like the Easter Bunny and the Tooth Fairy from the time they are about 3 until they are 7 or 8.
Their eager belief contributes to the common view, shared by psychologists and other scientists, that young children are credulous (and conversely, that adults are not). Children believe everything they are told, we assume, with little regard for logic, a sense of the real world or any of the other criteria adults use to debunk such fictions as the Loch Ness monster or Sasquatch.
But are children really that different from us? A study that my colleagues and I conducted at the Children’s Research Laboratory at the University of Texas suggests not. We found that, in fact, children use many of the same cues adults use to distinguish fantasy from reality.
Our experiment was designed to investigate how a young child, upon encountering a fantastical being like a unicorn in a storybook, decides whether it is real or imaginary. Adults often make the call based on context. If, for example, we encounter a weird and unfamiliar insect at a science museum, we are more likely to think it is something real than if we find it in a joke store.
To see if children could also use context in this way, we described “surnits” and other made-up things to our study group. To some of the children, we put surnits in a fantastical context: “Ghosts try to catch surnits when they fly around at night.” To others, we characterized them in scientific terms: “Doctors use surnits to help them in the hospital.”
The 4- to 6-year-olds who heard the medical description were much more likely to think surnits were real than children who were told they had something to do with ghosts. The children demonstrated that they do not indiscriminately believe everything they’re told, but use some pretty high-level tools to distinguish between fantasy and reality.
If children are so smart, why do they believe in Santa Claus? My view is that they are exhibiting their very rational and scientific cognitive abilities. The adults they count on to provide reliable information about the world introduce them to Santa. Then his existence is affirmed by friends, books, TV and movies. It is also validated by hard evidence: the half-eaten cookies and empty milk glasses by the tree on Christmas morning.
In other words, children do a great job of scientifically evaluating Santa. And adults do a great job of duping them. As we gradually withdraw our support for the myth, and children piece together the truth, their view of Santa aligns with ours. Perhaps it is this kinship with the adult world that prevents children from feeling anger over having been misled.
So maybe this holiday season, when the children come rushing in to see what Santa brought, we should revel not in their wide-eyed wonder, but in how sophisticated and clever their young minds really are.
Jacqueline Woolley is a professor of psychology at the University of Texas at Austin.

Questions Couples Should Ask (Or Wish They Had) Before Marrying

Relationship experts report that too many couples fail to ask each other critical questions before marrying. Here are a few key ones that couples should consider asking:
1) Have we discussed whether or not to have children, and if the answer is yes, who is going to be the primary care giver?
2) Do we have a clear idea of each other’s financial obligations and goals, and do our ideas about spending and saving mesh?
3) Have we discussed our expectations for how the household will be maintained, and are we in agreement on who will manage the chores?
4) Have we fully disclosed our health histories, both physical and mental?
5) Is my partner affectionate to the degree that I expect?
6) Can we comfortably and openly discuss our sexual needs, preferences and fears?
7) Will there be a television in the bedroom?
8) Do we truly listen to each other and fairly consider one another’s ideas and complaints?
9) Have we reached a clear understanding of each other’s spiritual beliefs and needs, and have we discussed when and how our children will be exposed to religious/moral education?
10) Do we like and respect each other’s friends?
11) Do we value and respect each other’s parents, and is either of us concerned about whether the parents will interfere with the relationship?
12) What does my family do that annoys you?
13) Are there some things that you and I are NOT prepared to give up in the marriage?
14) If one of us were to be offered a career opportunity in a location far from the other’s family, are we prepared to move?
15) Does each of us feel fully confident in the other’s commitment to the marriage and believe that the bond can survive whatever challenges we may face?

Parenting as Therapy for Child’s Mental Disorders

By BENEDICT CAREY , NEW YORK TIMES
Correction Appended
BUFFALO — In school he was as floppy and good-natured as a puppy, a boy who bear-hugged his friends, who was always in motion, who could fall off his chair repeatedly, as if he had no idea how to use one.
But at home, after run-ins with his parents, his exuberance could turn feral. From the exile of his room, Peter Popczynski would throw anything that could be launched — books, pencils, lamps, clothes, toys — scarring the walls of the family’s brick bungalow, and leaving some items to rattle down the hallway, like flotsam from a storm.
The Popczynskis soon received a diagnosis for their son, attention-deficit hyperactivity disorder, or A.D.H.D., and were told that they could turn to a stimulant medication like Ritalin. Doctors have ample evidence that stimulants not only calm children physically but may also improve their school performance, at least for as long as they are on medication.
But like most other parents, the couple preferred to avoid drug treatment, if possible. Instead, with the guidance of psychologists at the University at Buffalo, they altered the way they interacted with Peter and his younger brother, Scott. And over the course of a difficult year, they brought about a transformation in their son. He still has days when he gets into trouble, like any other 10-year-old, but he no longer exhibits the level of restless distractibility that earned him a psychiatric diagnosis.
“People are so stressed out, and it’s so much easier to say, ‘Here, take this pill and go to your room; leave me alone,’ ” Lisa Popczynski said on a recent Monday after work. Peter sat on the couch, hunched over his homework, while her husband, Roman, occupied Scott, 8.
“But what I would say is that if you are willing to take on the responsibility of extra parenting, you can make a big difference,” said Ms. Popczynski, an interior designer. “I compare parenting to driving. We all learn pretty quickly how to drive a car. But if you have to drive a Mack truck, you’re going to need some training.”
In recent decades, psychiatry has come to understand mental disorders as a matter of biology, of brain abnormalities rooted in genetic variation. This consensus helped discredit theories from the 1960s that blamed the parents — usually the mother — for problems like neurosis, schizophrenia and autism.
By defining mental disorders as primarily problems of brain chemicals, the emphasis on biology also led to an increasing dependence on psychiatric drugs, especially those that entered the market in the 1980s and 1990s.
But the science behind nondrug treatments is getting stronger. And now, some researchers and doctors are looking again at how inconsistent, overly permissive or uncertain child-rearing styles might worsen children’s problems, and how certain therapies might help resolve those problems, in combination with drug therapy or without drugs.
The psychotherapy techniques intended for the improvement of interactions between parents and children have been used mostly for children who suffer from attention disorders or who exhibit aggressive or defiant behavior. But recently, mental health professionals have been studying their use for families whose children suffer from depression or other mood problems.
In a comprehensive review, the American Psychological Association urged in August that for childhood mental disorders, “in most cases,” nondrug treatment “be considered first,” including techniques that focus on parents’ skills, as well as enlisting teachers’ help.
And in its just-completed guidelines, even the American Academy of Child and Adolescent Psychiatry, an organization whose members strongly favor drug treatment, recommends that children receive some form of talk therapy before being given drugs for moderate depression, a very common complaint.
“We are at a point where families who bring in a child ought to get a Chinese menu of treatments that are backed by some evidence, including not only medication but psychosocial or family interventions,” said Dr. John March, a child psychiatrist at Duke University. “Not to do so when we know some of these therapies work is, in my opinion, simply unethical. Then let the family choose which one they want.”
The argument over which is better, medication or psychotherapy intended to change the behavior of parents and children, is irrelevant in many cases. A child paralyzed by feelings of severe despair or anxiety, for example, often cannot begin to engage in any type of therapy without a period on medication to break the disabling mood. And many studies suggest that the combination of medication and talk therapy is significantly more effective, and safer, than either alone.
Drugs, Therapy or Both?
“It’s obvious that medication has been more effective than behavioral modification in treating the core symptoms of A.D.H.D., but behavioral treatments can produce real improvement, and for certain kids the combination of the two treatment appears to be best,” said Dr. Oscar Bukstein, a child psychiatrist at the University of Pittsburgh School of Medicine who is helping the American Academy of Child and Adolescent Psychiatry write treatment guidelines. “Children with other behavior problems in addition to A.D.H.D., for instance, seem to do best with both treatments.”
The Popczynskis found that a brand of family therapy by itself was sufficient to put Peter on track at school and at home. Their experience helps illustrate how a family can, in effect, treat a child’s psychiatric disorder — and for whom such an approach can be practical.
One thing the family had going for it was location. When Peter’s mother began scouring the Internet for resources in the spring of 2003, she quickly learned that they lived only a few miles from the University of Buffalo, which runs one of the country’s most comprehensive behavioral modification programs.
In a study involving 128 families, psychologists at the university had found that about a third of parents who completed the program saw enough improvement in their children that they had decided that medication was unnecessary. The other two-thirds put their children on stimulant medication at school but at doses significantly lower those typically prescribed, said William Pelham, a psychologist who is director of the Center for Children and Families at Buffalo and the senior author of the study. Eighty percent of the families who participated in the program, with follow-up parent training, decided that their children did not need medication at home.
“Most parents seeking help for a child with a psychiatric disorder never hear about programs like this,” Dr. Pelham said. “The only option they’re given is medication. Now, it may be that the best treatment for that child is medication. But how do you know if you never try anything else?”
Behavior modification for A.D.H.D. and for related problems, like habitually disruptive or defiant behavior, is based on a straightforward system of rewards and consequences. Parents reward every good or cooperative act they see: small things, like simply paying attention for a few moments, earn an “attaboy.” Completing homework without complaint might earn time on a Gameboy. Parents remove privileges, like television and playtime, or impose a “time out,” in response to defiance and other misbehavior.
And they learn to ignore annoying but harmless attempts to win attention, like making weird noises, tapping or acting like a baby.
Tracking Behavior
These skills are hardly unknown to seasoned parents. But most also know that stress or anger, even when dealing with a child who has no serious problems, can sour the best instincts. That is why family-based programs insist that parents try to maintain a clear, neutral tone when instructing their children, or penalizing them.
Bluntness, for example, is a virtue. Saying to a child, “Would you put your toys back in the box, please?” turns a command into a question. Saying, “Let’s put your toys back in the box,” implies collaboration. An unadorned “Put your toys back in the box” is clearer for everyone, psychologists say, especially so for a child who is highly distractible.
However it is dressed up, family therapy like this teaches parents to provide what many critics say children these days are missing — discipline. But therapists make a careful distinction between corrective action and cruelty, between firmness and frostiness. Overly punitive parents increase the likelihood that a child will develop mood problems, some studies suggest. So parents learn not to become scolds, but to bring their children into line without demeaning them.
In some programs, parents play-act situations in front of their peers, who critique the performance for emotional tone and the clarity of parents’ statements. As a result, the parents say, they become immediately more deliberate at home. “You end up constantly saying things like, ‘That’s not an appropriate behavior,’ using this unnatural language,” said Ms. Popczynski. “But the point is you don’t get into it with them. The first thing I noticed was that I wasn’t yelling all the time. The house got a lot quieter right away.”
Their instructions to Peter and Scott became more precise, as well. Saying “Clean your room” is too vague and covers a half-dozen tasks, Roman Popczynski, the boys’ father, said. Peter might wonder where to start, or just decide it was too much to worry about, and give up, his father said. “Put your laundry in the hamper” is much more likely to get results, he said, and lead to the next clear step, like “Put your toys where they belong.”
Multiple commands are also confounding: “Put away your crayons, clear away the table, and organize your homework, please” leaves a child wondering which to do first, and whether it is too much work to finish. “It overloads a kid, and then he feels like he’s failing, which only makes it worse,” said Mr. Popczynski, who is a UPS driver.
Starting Slowly
Like most who try to use behavior modification techniques, the Popczynskis relied on a daily report card to keep a running tally of Peter’s specific problem behaviors, like wandering attention, ignoring commands or defiance, and his efforts to correct them.
For instance, at the beginning, Peter, then 7, would get a check mark every time he ignored more than two commands to do his homework, put away his toys or brush his teeth, but he would earn immediate praise if he got started. He received check marks when he slid off his chair at dinner, and earned approval if he stayed seated.
At bedtime he accumulated marks if hepulled delay tactics. A tantrum resulted in instant punishment: a timeout of 5 to 10 minutes, shortened for good behavior. The report card was posted on the refrigerator.
The Popczynskis started slowly. They measured how many marks Peter recorded in a normal day, and at first rewarded him if he reduced the number by even one: with an extra 15 minutes on Game Cube, for example. If he had more good days than bad ones over the course of a week, he got to choose from a bag of toys from the $1 store.
Mr. and Ms. Popczynski continued to raise the standard, one checkmark at a time, until Peter hit zero consistently.
“You want them to be able to succeed,” Mr. Popczynski said. “If you make it too hard, they’ll just give up, and so will you.”
The Buffalo program is more comprehensive than most: psychologists run a summer camp here, employing the same principles, and, during the school year, regularly visit the teachers of every child in the program. Those teachers who agree to cooperate — most do — keep daily behavior report cards for the child too, in effect providing full coverage for a child’s every waking hour.
Even then, the therapy is far from a silver bullet or an automatic replacement for treatment with Ritalin or other drugs that are routinely prescribed for attention disorder based on many studies showing their effectiveness. The constant tallying and reminding is too exhausting for some parents, especially those raising children on their own and juggling outside jobs. The Popczynskis did well in part because Peter’s difficulties were not severe, he was a capable student and his most disruptive behavior came out at home, Mr. Popczynski said. And the couple were able to share the many duties.
Yet most parents in the program have found that their children do best with a combination of the medication and family treatment, albeit with significantly lower doses of the drugs than typically prescribed.
Dawn Van de Wal, a single mother of three in Buffalo, said that over the last six months she has learned to contain and redirect the behavior of her exuberant 9-year-old, TJ, who has received a diagnosis of attention-deficit disorder. TJ can still become extremely frustrated when required to sit for long periods and concentrate on schoolwork, in the absence of his mother.
“I still give him medication for school, because the fact is that right now he needs it to get through the day, but it’s a low dose,” Ms. Van de Wal said while TJ practiced headstands on the couch. “He doesn’t take it at home, though, and I plan to reduce the dosage in time as much as I can.”
She added, “I don’t want him to look back and think the successes he’s had are all due to a drug.”
In surveys and in dozens of interviews, most parents of children with psychiatric diagnoses say that they prefer to avoid using medications, if possible. It is not so easy to do. Insurers as a rule do not fully cover behavior modification therapies because they cost substantially more than drugs.
The therapies require an enormous commitment from already overloaded parents, and some children are too severely troubled to respond. Many clinics do not even offer the programs.
Psychiatrists, pediatricians and family doctors also tend to be more comfortable writing prescriptions for psychological reasons.
Shifting Perceptions
“It’s a tremendous relief for the physician to prescribe something, because these kids are very tough, and it feels horrible to sit there and not be able to help,” said Dr. Jennifer Mary Harris, a child psychiatrist practicing in Arlington, Mass., who has argued for more caution in using medication. At every level, she said, the mental health system strongly favors drug treatment.
Yet the increasing number of studies that support family-based behavioral treatment is shifting perceptions. The largest study comparing medication with behavioral modification therapy for attention deficit problems, released in 1999, found that drugs were more effective in improving children’s ability to focus and keep still. But more than three-fourths of those treated without medication did well enough that their parents were able to keep them off drugs. And behavior therapy significantly improved children’s reading performance and their relations with parents and teachers when combined with medication, the study found.
Researchers have also studied a different approach to behavior treatment, called cognitive behavior therapy. This approach engages children directly, and signs up parents as helpers. The children meet in groups to speak with a therapist, and learn elementary ways to identify and manage their anger, frustration and hopelessness. The parents learn in sessions how to reinforce those lessons at home.
Studies find that up to three quarters of children who suffer from depression, anxiety or obsessive-compulsive disorder find relief of their symptoms with the help of this kind of therapy, which usually involves once-a-week sessions for a few months or so.
Alicia Brzycki, a freelance editor who lives in Lawrenceville, N.J., said she noticed several years ago that her son was struggling more than usual with Tourette’s syndrome, a neurological disorder that causes involuntary facial tics and limb movements.
The condition did not stop him from making friends or doing well in school, Ms. Brzycki said, “but I think it was first grade, I realized that he was stifling the tics at school, and it created this boomerang effect, and they came out like mad at home.”
At the urging of a doctor, she took the boy, by then 9, to a program at Temple University in Philadelphia that specializes in treating childhood anxiety, which can exacerbate Tourette’s. Therapists teach children to identify the thoughts that amplify their worries, and then defuse or moderate them. Ms. Brzycki and her husband attended sessions, too, and Ms. Brzycki learned she was unwittingly contributing to her son’s anxiety. “The main thing that came out for me was that I was being overprotective,” she said.
She added: “As a parent you want to protect a child from stressful situations, but by doing that you’re creating an avoidance mechanism that can turn a minuscule anxiety into the big, bad wolf. I had to loosen my grip” and let him face his fears.
Now in fourth grade, her son has helped make a DVD about Tourette’s syndrome that he has shown to classmates. He has a close circle of friends, his mother said, and his tics seem to have diminished lately. But he sometimes still feels self-conscious and will talk himself through it, with his parents’ help if needed.
Family-based therapy for a difficult childhood disorder is in almost all cases a way of life, not a weeks-long or months-long cure. If parents are serious about finding alternatives to drug treatments, experts say, they have to be willing to make difficult, and long lasting, changes to their behavior and the home environment, and to allow the child to progress at his or her own pace.
“You can’t let your foot off the accelerator with something like behavioral modification for A.D.H.D., for example,” said Dr. Gabrielle Carlson, director of child and adolescent psychiatry at Stony Brook University School of Medicine, who used the treatment for her own son. “It’s like making changes in diet and exercise to lose weight: you don’t lose 20 pounds and then you’re home free and can eat ice cream and cake again. No, it’s a complete lifestyle change, and when you have a child with any of these psychiatric difficulties you have to stay on the program, for as long as it takes.”
Correction: December 23, 2006
A front-page article yesterday about parents’ influence in helping their children overcome psychiatric disorders misstated the age of TJ Van de Wal, whose attention problems have improved in response to parental techniques. He is 7, not 9.