(Condensation of chapter by the same name in Mind the Children: How to Think about the Youth Mental Health Collapse (AEI Press, 2025)
“Max bit another child today,” was the report over the telephone. I am not a veterinarian, and Max is not a dog. I’m a behavioral/developmental pediatrician with over four decades of experience practicing in an affluent suburb of San Francisco. Max is a three-and-a-half-year-old referred to my practice by his general pediatrician. The caller was Max’s mother.
A new survey of parents with children under six years old found that the majority are adopting a greater emphasis on the emotional life of their children compared to the way their parents raised them. Max is one of eight three- to five-year-olds that I’m currently seeing -- all referred in the last two months. This wave of younger children is unprecedented to me. I generally would see children five and older (once they had gotten to kindergarten). There’d be an occasional preschooler, but nothing more.
Let me offer a theory. Feelings, especially bad feelings of sadness and anger, have become more important to the parents of the children I am seeing. Beginning in the 1960s, the cultural importance attached to feelings began to increase. It’s very hard to pinpoint the reasons for the ascendancy of feelings, but without question the importance of children being happy—and avoiding unhappiness—has become a tyranny over parents, teachers and mental health professionals dealing with kids.
No one wants a child to be unhappy but learning to tolerate distress and unhappiness is one of the key coping skills that must be learned by children to manage a world that is filled with frustrations and stressors. The constant demand to pursue happiness for children and help them avoid any unhappiness, has altered, over the decades the way adults address and handle the feelings and needs of children, especially discipline.
A large group of pre-school age children struggle with self-regulation or coping, especially when other children are present. They act aggressively by grabbing, hitting, shouting, crying and yes, biting, when feeling thwarted or threatened. They are not coming from especially troubled households. The parents are of diverse ethnic backgrounds, loving and well off. Some of them may be working too hard – the Bay Area is an expensive place that generally requires two significant incomes. But these children are not suffering from a lack of attention or care.
This particular group of children actually do worse when their parents commit to avoid conflicts and persist with “positive parenting.” Studies show that those children whose temperaments are characterized by intensity, persistence and sensitivity (qualities not necessarily “bad”) become more aggressive and angrier between the ages of three and six when the parents continue with positive parenting strategies. Undoubtedly many of them by six will meet someone’s criteria for psychiatric disorders like ADHD, ASD or ODD. But these outcomes could have been avoided.
These children’s preschool environments are well maintained and stimulating. There is a good staff to child ratio. The intensity of the problems can vary from child to child and household to household. Sometimes the problems are worse at home, sometimes worse at the preschool. Many preschools now promote their environment to parents by offering alternatives to the strategy of time-out (removal from the group or activity) for an emotionally out-of-control child. Any number of multiple alternative choices/activities are offered that may soothe instead. Time-out has developed such a negative connotation that the programs that continue the strategy euphemistically call this removal “break time” instead. Nonetheless, there’s an underlying growing feeling that any adverse response to a child’s behavior undermines their feelings and self-image (another tyranny).
Fears of damaging a child’s self-esteem (along with potential angry-parents’ lawsuits) have led to school situations where the entire class leaves a room instead of the out-of-control child—actually, in my opinion, a much worse experience for the kid than being escorted to the hallway or principal’s office. A whole industry of mental health professionals and learning specialists has grown to address the needs of the child. These groups, while well-intentioned, promote accommodating to the children’s problems rather than finding a balance between helping a child learn to cope with the environment versus the environment adapting to the child.
I’m surprised by the number of children I’m currently seeing with these problems, but not shocked. I think it was only a matter of time. Being on the front lines of children’s mental health, I’m often several years ahead of the media and general public’s awareness of a change. I encountered the great rise in the diagnosis of ADHD in children and adults beginning in the mid-1990s. I noticed the first of many transgender teens coming into my office six years ago. I’m the canary in the mind shaft of children’s mental health problems.
I’m not suggesting or advocating a return to spare the rod, spoil the child. To be clear, I think children’s feelings should still be acknowledged and validated. But children, parents, and professionals need to relearn how to sit with and tolerate their children’s distress and their own—and see that it is often short term—and they all can get through it. Without such practice at an early age, these children grown up, will have to learn how to manage unhappiness when the stakes are much higher—in the school of hard knocks. There’s just no getting around it.
Lawrence Diller, M.D. practices in Walnut Creek, CA and is on the clinical faculty of the University of California, San Francisco. This piece was adapted from his chapter in Mind the Children: How to Think About the Youth Mental Health Collapse (AEI Press, June 2025)