Welcome to DocDiller.com
I'm a behavioral/developmental pediatrician who has been on the front-lines of clinical practice with ADHD, ODD, OCD, ASD, learning problems for over forty years. I've written some books and numerous articles for professionals and the public. My opinions have been expressed not only on television and radio, but also in front of Congress and the President's Council on Bioethics.
Whether you're looking for an sensible expert to help you make decisions about your child locally or are interested in the opinions of a doctor who prescribes medications to children but takes a broader look at the issues involved, you've come to the right place. Take a look at the opeds. Get some answers to questions on ADHD and psychiatric drugs for children.
- Category: Opinions & Editorials Opinions & Editorials
- Published: 15 February 2021 15 February 2021
Parenting Eleven Months into the Pandemic: Ten Steps to Help Children Cope
No one has to remind parents that we’re living through a dangerous pandemic and that they have to keep their families safe. But as a behavioral/developmental pediatrician with more than 40 years’ experience, I’m concerned parents may be worrying more about their children’s physical health than on the toll the pandemic is taking on their mental health and school performance.
The news is grim. Truancy, school failure, mental health problems, even suicide rates are all on the rise. I'm seeing first-hand the extraordinary stressors on children and their families posed by COVID 19 and the concomitant lockdowns. I’ve watched in dismay as families struggle who, before the pandemic, were doing a decent job of parenting. Others, who were having trouble prior to the lockdown have declined into severely distressing situations.
Here are some steps parents can take to help their children and teens — and themselves — better cope.
We cannot wait for definitive academic studies to tell us what works and what does not, given the declines I’ve seen. I am not advocating a wholesale abandonment of social distancing. Each family has to weigh the benefits and risks of what to do. I’m offering ten suggestions parents can try to address problems of loneliness, sadness, depression and non-compliance with virtual learning.
Parenting is never easy — now it’s harder
Many of my suggestions imply a degree of parental control that may have been weak or absent before the pandemic struck. Parents often fear further “disturbing” their already unhappy/uncooperative child or teen, which only empowers the factors that caused them to not do their school work or fall into depression.
All of this is complicated because many parents, themselves, struggle with the effects of the virus/lockdown on their jobs, activities, and general health, not to mention their own mental health. I advise following what the airlines tell us in case of emergency — you must first apply oxygen to yourself before putting the mask on your children’s faces. But once some oxygen is flowing, try the following:
- Get your children and teens out of the house. While still practicing appropriate social distancing, go for a hike, take a bike ride, stroll around the neighborhood.
- Sign children and teens up for organized activities. Many sports, martial arts, and art classes are still in operation. Make it clear participation is not voluntary. Have children try the activity three times before they can quit. Reward them for trying without complaining.
3. Limit online time unrelated to school. I suggest 2-3 hours on weekdays; 4-6 hours weekends (these higher limits reflect stay-at-home realities). Consider limiting internet activity to public areas, like the kitchen or family room, rather than behind closed doors in their rooms.
- Remove all devices from the child/teen at bedtime. Dedicated devices that play music are okay. Your teens will complain. Remind them, “Nothing good happens online after 10 pm.”
- Use timers rather than parents’ voices to set time limits. It’s uncanny how kids “listen” better to a machine than their parents’ voices. Allow 5 to 10 minutes to transition/close-down time at the first alarm. After the second warning, pull the plug.
- Post a written daily schedule for each child, teen, and parent.Structured time helps everyone know what to expect and can make school/study time seem more manageable.
- Develop a parental hour-on, hour-off routine. For example, between 10-11 am, the children are only allowed to approach dad; between 11- 12 noon, they can only speak to mom. This gives parents some guilt-free time to unwind or pursue other tasks.
- Register for hybrid schooling or form a learning pod. Children and teens are social animals. They do better in a group. Push to the front of the line for hybrid school participation. Have your pediatrician or family doctor write a letter on the child’s behalf.If hybrid schooling is not offered, form a learning pod with other families. Your child will do more when there are other students around and will work harder for anyone else (even another parent) than for you.
- Pick and choose your battle: Virtual learning poses particular challenges, especially if your child has a pre-existing learning or behavioral problem. Try to let go of some of your concerns if they are underperforming. You are unlikely to be successful and the emotional cost to you and your child isn’t worth it. Find an area of performance to work on where you have a chance for success (for a younger child, like picking up her toys or for a teen, coming to the table to join the family for dinner)
- Consider outside help. Hire a high school senior or college student to supervise classwork and homework, 90-minutes a day, Monday-Thursday. Bringing in someone new is more effective and will cut down on parent-child/teen tension.
Finally, take heart. We’ve only got a couple more months to go before life returns to normal. And your child and you will be better prepared to take it on.
- Category: Opinions & Editorials Opinions & Editorials
- Published: 01 February 2021 01 February 2021
As I climbed up the step ladder to retrieve the alligator leather doctor’s bag on the top shelf in the closet, I thought of my father doing house calls when he was a general practitioner in Queens, New York. When he retired in the 1980s he gave me his doctor’s bag. There, it sat on the top shelf until three weeks ago when I began seeing children and their families in their backyards because of Covid19.
I’m a behavioral/developmental pediatrician/family therapist, a mouthful to describe my MD specialty. I’ve practiced in a Bay Area suburb for the last forty years. I see children and their families who are struggling at school or at home. I can prescribe medication but unlike many of my MD colleagues, I remain committed to using non-drug interventions like parenting strategies and special education support at school.
Because of Covid19 I stopped seeing any patients in my office in the middle of March. I was lucky in that I already had a HIPAA compliant Zoom platform in place because I used telepsychiatry once or twice a week out of a thirty-hour case load. I was a relative pioneer in the use of telepsychiatry in children and family therapy. I lived and worked in Melbourne, Australia for a year in 2015-2016 and during that time managed to maintain seventy California families that had been in my practice. I even wrote a Huffington Post piece when I came back entitled, “I Shrunk the Shrink and They Liked It.” (https://www.huffpost.com/entry/i-shrunk-the-shrink-and-t_b_10544710).
I want to alert you to an article that appeared on the front page of the Sunday New York Times today (1/17/21) highlighting the problems of families with boys who are spending too much time gaming on line during the extended Covid19 lockdown. https://www.nytimes.com/2021/01/16/health/covid-kids-tech-use.html?searchResultPosition=2. Most of the experts cited in the article are quite concerned. The family highlighted at the start of the article, decide at the end to completely cut off the gaming for their son for a period of time. This is difficult to do but often necessary. I am interested to hear your reactions.
The most recent issue (July 2020) of the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) has an article entitled, "Grasping Gaming: Parent Management Training for Excessive Videogame Use in Children." Videogame use in boys along with excessive use of social media (Snapchat, Instagram, etc.) in girls have been particularly worrisome phenomenons since the lock downs preventing the spread of Covid 19 have been instituted. I regularly receive reports of children spending up to eight hours or more daily on screens online. Usual diurnal patterns of wake/sleep have also been disrupted (e.g. up until 4 am playing games and now waking up until 2 PM in the afternoon as a result). These patterns have always existed but have become much more prevalent in the last four months. I reprint below the recommendations to parents from this article:
- 1. Screen time limits set by the parent and shared with the child. The American Academy of Pediatrics offers a Family Media Plan that is customizable for each family. Screen time limits should be specific to the child’s age, developmental level, emotional maturity, and behavioral responsibility.
- Parents should set limits as to when new games can be started, usually about 20 to 30 minutes before the child’s attendance is required
- The authors again caution about the extinction burst phenomenon and warn parents that behaviors will usually worsen before they get better when parents enforce new limits. Parents should consider consulting their pediatrician or behavioral specialist if negative behavior becomes difficult to manage.
- If a child’s behavior becomes dangerous or violent, we encourage parents to seek out a more formal gaming treatment program, such as those described in the article, as well as a psychiatric consultation to evaluate for any associated or confounding psychiatric conditions and required treatment (eg, ADHD, ASD, etc)
- 2. Using video games as a reward in a behavior plan. A tantrum should not be rewarded with extra game time.
- 3. Communicating with the child about appropriate versus inappropriate language and discussions.
- 4. Removing payment options from the game if the child is not allowed to make purchases, and learning about refund policies and procedures for unauthorized or unsupervised gaming purchases placed by minors.
I would add that keeping any device in a child's room (TV, phone, gaming system) is a terrible idea because most children lack the ability to self-regulate use (particularly at night).
I bolded the most difficult part of these recommendations because parents' have repeatedly told me they want to avoid this level of conflict with their child. I understand parental unease and anxiety about taking such actions but can only add that this "extinction burst phenomen" will be time limited and last no more than a couple of days.
I am not aware of any "formal gaming treatment program" in the Bay Area and would like to be informed if you know of one.
Please feel free to otherwise send your comments or questions to me about this problem of excessive gaming and social media in children.