Wild Gift

Is medication the only way to deal with a difficult child? The nurtured heart offers an empowering alternative.

Your 7-year-old is driving you nuts. She refuses to follow the simplest direction – no matter how much you threaten or yell. Getting her ready for school is a nightmare, and judging from the notes you’re getting from her teachers, other people can’t control her either. The school has encouraged you to think about medical intervention. The idea of drugging your kid gives you the willies – but you’re equally frightened by your child’s destructive energy. Is there another way to help her?

Tuscon family therapist Howard Glasser thinks so, and many people consider his Nurtured Heart Approach (NHA) a revolutionary new model for helping difficult children. In 1999, Glasser and Jennifer Easley co-authored Transforming the Difficult Child: The Nurtured Heart Approach. The book is now a best-selling title in the areas of Attention Deficit-Hyperactivity, and Oppositional Defiant Disorder.

A champion of ADD, ADHD, and ODD children (he was once one of them, he says), Glasser insists that it’s high time our culture ditched what he calls “our dreadful diagnostic epidemic” and focus on what these children have in common: intensity.

In Glasser’s eyes, this intensity is actually a very valuable gift, one replete with energy, creativity and other special capacities. Often, Glasser points out, so-called “difficult” kids are of higher-than-average intelligence. They also frequently possess exceptional creative skills and, interestingly, many of them also possess a special ability to focus. Not on what you are telling them to do, of course, but on other things, like video games (more on that in a moment).

Unfortunately, neither the child nor the parents usually know exactly how to handle the “blessing” of intensity, which frequently expresses itself as rule breaking, disruption, tantrums and other destructive outbursts. Many parents wind up feeling that constant punishment or regular medication seem like the only alternatives. And that is not their fault, Glasser stresses. The traditional methods of child rearing simply don’t work with these kids.

Why? In Glasser’s view, it’s because they crave attention and emotional energy more acutely than other kids, and they need their internal emotional intensity to be “matched” by their parents. But since parents tend to react most intensely to bad behavior, the child eventually figures this out and responds by acting up more and more, forever seeking an energy eruption. Following their own natural impulse, meanwhile, frustrated parents meet increased misbehavior with amplified voices, threats and punishments. And so the cycle continues.

Meanwhile, as a rule, responsible or neutral behavior gets little or no reaction – parents are just relieved to be experiencing a moment of quiet. A fulfilled chore or completed task gets maybe a ho-hum smile and a “thank you” or a pat on the head and a “good job.” These modes of feedback barely register with intense kids, notes Glasser, and more importantly, he stresses, “they just don’t mean anything.” The net result is that eventually these kids figure out that unless they are setting the curtains on fire or sassing the soccer coach, they just aren’t going to get enough intensity or attention to keep them satisfied.

New Game

Glasser’s simple yet startling idea is that the difficult child’s intensity should be met with parental intensity and attention – but only in positive ways. Instead of giving energy to negative reactions (e.g., yelling and fuming when the child acts out), the parent or teacher expends intense emotional energy (and rewards privileges) only when responding to nondestructive, responsible or positive behavior. And they must strive to issue such positive responses at every possible opportunity.

How does this work? In Glasser’s approach, the parent’s task is to regularly notice and enthusiastically comment on the absence of trouble – not just exemplary behavior (as in the old idea of “catching your child being good”) but rather, the moments when the child is not activelymisbehaving. In other words, you program yourself to notice and then call attention and heartfelt appreciation to even those moments when your kid is simply “doing okay.”

Glasser developed his unique approach after noticing that many ADD/ADHD kids love video games. Despite their supposed “attention deficit,” many are terrifically successful at playing them for hours on end. After some close examination, Glasser discovered a few key elements of play that he felt were important in making the games both rewarding and addictive: The rules are clear, but there are still choices to be made. There is a sense of constant movement and progress. The results of a good choice deliver lots of excitement (flashing lights and sound effects) and allow the player to rack up points. The effects of a bad choice, meanwhile, are immediate, predictable and over relatively quickly: You hear a crash or a buzzer and immediately lose some points, but you get to keep playing. Or the game is over, but then it immediately starts up again so you can go right back to racking up points.

The Nurtured Heart Approach (NHA) works in similar ways. The child gets constant energy and regular, positive parental feedback whenever he is doing okay. He gets especially excited praise and rewards when he is doing well. To this end, the NHA incorporates a point system for responsible behavior (accumulated points translate to privileges like TV time and outings), and also emphasizes the child’s participation in rule setting.

The emphasis is always on teaching the child that she has a choice in how she behaves. And it’s an informed choice, because the consequences of both positive and negative behavior are always well defined: When the child breaks a rule, the parent or teacher calmly sends the child to a time-out and/or suspends points or privileges until the consequence is complete. Game over. No flashing lights. No bells and whistles. Just a consequence. Once it’s been fulfilled, the kid can get back in the game and start winning again.

In time, the child realizes that only positive behavior attracts the intense emotional reaction and connection she craves. Acting out only works against her: The consequences are both predictable and unappealing, devoid of parental outbursts and other forms of emotional excitement.

The kid figures out that if she wants to be recognized and emotionally engaged, she’ll need to seek out ways to please her parent or teacher, not to drive them bonkers.

All this proactive attention creates successes for both parent and child, asserts Tina Feigal, an NHA coach/instructor who founded The Minnesota Center for the Difficult Child (www.mbspirit.net). Instead of scanning for bad behavior, the parent is constantly seeking out opportunities to express pride and confidence: “It’s changing the parent’s role from behavior police to success mentor.”

Success Stories

Amid rising concerns about the widespread use of prescription drugs like Ritalin, the interest in alternative approaches like NHA is growing. But does NHA really work? Practiced properly, the answer appears to be “yes” – even in extreme cases where the child has been in and out of hospitals.

After Tucson’s Head Start program tested the approach last year in their most difficult classrooms, the results led them to adopt it districtwide. This year, Glasser notes, for all 80 classrooms representing 2,000 children, “they have had no referrals to the mental health system, as compared to a disproportional number of referrals in past years.” During a 10-month period in 1998, CDC worked with 211 children. Of these, 51 were already on medications prior to referral to CDC. Of the 160 children who were not already on medications, only eight were subsequently referred for psychiatric evaluations and only four were actually prescribed medications subsequent to the evaluation. This represents less than a 3 percent rate of utilization of medications. Perhaps just as interesting is that nine of the 51 on medications were successfully transitioned off medications during this time frame.

Plenty of parental testimony supports these statistics. A year and a half ago, a fourth-grade boy in Brooklyn Park, Minn., was mouthing off to teachers and landing in the principal’s office regularly. He was uncooperative and stubborn at home. His mother, Joan, heard about Glasser on the radio, picked up his book and attended a seminar he was holding in the Twin Cities. She also received phone coaching from Feigal. “Things started to turn around in about four months,” she remembers. “Around mid-school-year, I got notes from teachers saying, ‘This is a significantly different child than the one who started the school year.’ I ran into the principal at a school event recently, and he complimented me: He said he hadn’t seen my son at all this year.”

Which is not to say that the family’s journey was easy. First Joan had to overcome her own doubts. “I have to say that when I read the part in the book about time-outs I thought, ‘This is a bunch of baloney.’ I’d tried time-outs before with my son, and they never worked.” This time, though, Joan didn’t let her son’s obstinancy lead her into yelling or threatening. She didn’t re-explain rules or discuss the situation. She told him neutrally that he had a choice: to take the time-out and go back to using his privileges – or refuse and enjoy no privileges.

“The book says, ‘At first, expect a tornado.’ And that’s exactly what happened,” Joan recalls. “Initially it was, ‘Nope, I’m not gonna do it’ and he’d throw a chair across the floor. But I just kept working on it, and gradually, things got better.”

Joan also began praising her son’s good behavior daily, energetically, repetitively. “At first, he kind of looked at me like I was strange,” she says. “One time he came right out and said, ‘Why are you saying this to me?’ ”

Practicing NHA was, Joan admits, “a very extensive commitment,” particularly because no one she knew understood what she was trying to do. “Most parents are in the same boat,” she says. “You’re busy, you’re frustrated, you don’t have time.” There were days when it was all Joan could do to reassure her son, and herself, that they were strong enough to keep going. But her messages finally sank in. “Eventually, I would tell him, ‘You broke a rule: That was a disrespectful tone of voice. Take a time-out.’ And he would actually go get a chair, put it down, and sit! Then at the end of the time-out, I’d thank him for doing his time-out so calmly. I’d say, ‘I really appreciate that there’s so much more peace in our house.’ I told him that repeatedly, and he really picked up on it.”

Parent Power

Intense kids need and crave intense structures to support them and keep them safe, notes Glasser, even if they don’t admit it. Showing your children that you have no control over them only robs them of emotional security, he suggests, making them anxious and out of control and even more likely to go in search of a reaction. Ultimately, he insists, all children want to know that their parents are capably in charge and available to them for help in times of need. The Nurtured Heart Approach supports parents in delivering that by giving them a new, high-quality structure of their own.

“With this approach,” says Glasser, “you become a mirror. Instead of reflecting your child’s most out-of-control behaviors, you start reflecting their best: ‘I like that you’re following the rules; I like that you’re being respectful and using good judgment.’ Over time you build a new mental and emotional portfolio for them – proof that they are a good and worthwhile kid who is loveable and in control.”

As Feigal explains it, it’s a little like a software upgrade. In the new program, instead of a child seeing himself as a terror on wheels, he now sees himself as a good kid. He completes chores, shares his feelings, and shows respect to his teachers because that’s the normal behavior of the person he now believes himself to be. Most importantly, his intensity has not been dampened or done away with (as it might have been with medication). Rather, it’s been controlled – by the child’s own will – and rechanneled.

“What people really want is a remedy that is transformative,” observes Glasser. “They want to be able to love their kids for who they are, but where intensity is no longer the enemy – it’s what makes that child remarkable.”

Taking On Intensity

For a system that relies on parents exercising their power to withhold and express affectionate energy, NHA is remarkably democratic. In practice and theory, it seeks to make parents – not prescription-writing doctors – the experts. The end goal of Glasser’s method is to strengthen the child so that she doesn’t require so much policing.

In the last two years, Glasser has opened up his licensing practice and now schools teachers and therapists on NHA in one intensive week. Feigal notes that families usually meet her only four times to complete their training.

But just because the method is quickly communicated does not mean using it is effortless. First of all, banishing negativity is a many-leveled endeavor, as subtle as the widening of a parent’s eyes when a child disobeys. (“Stay calm and neutral” can be trickier than it sounds.) So, if you’re interested in NHA, pick up Glasser’s book and/or attend a seminar to prepare yourself for the complexity of its practice (see www.difficultchild.com for more details).

Second, as Feigal explains, parents must fit this struggle around their own personal challenges. Tracking and “matching” an intense kid is serious work. It requires a great deal of emotional and physical energy, and those are resources that a great many American adults are currently lacking. In fact, the growing incidence of adult lethargy, inactivity, emotional repression and mental stress – as evidenced by the rise in obesity and antidepressant prescriptions – may be a large part of the problem. So, according to Feigal, are overpacked schedules.

“A lot of the time,” she says, “I think overwhelmed parents inadvertently end up telling their kids: ‘You go and sit in front of the TV and grow up until I have time for you.’ Children need one-on-one attention, they need exercise and good food, and they need appropriate loving appreciation from adults.”

Obviously, these are truths for parents of not-so-difficult children too. “Given what’s going on in the world,” asserts Feigal, “I think we are living in a time when all kids need to be stronger inside,” he says.

Indeed, as Glasser sees it, “the anxiety blooming in the world right now” may be a real factor in the explosive rise in difficult children in the past 30 years. “It’s quite possible that the kids feel this anxiety,” he says, “and that it feeds their intensity.”

But Glasser also has a more positive spin on the new influx of children filled with this special energy and determination. Specifically, he entertains the possibility that they may play an important role in solving the world’s problems. Properly channeled, Glasser notes, that much intensity and drive could go a long way toward helping the world address its faults and rebuild its ailing structures. In short, he sees these kids as a sort of evolutionary force for good.

Glasser acknowledges that it may be a stretch for some parents to see their kids’ intensity as heaven-sent. But for parents facing decisions about medication, and for those who’ve sometimes wondered whether they were up to the task of raising such kids in a constructive way, the relief and loving direction provided by the Nurtured Heart Approach may seem like godsend enough.

Terri Sutton is a writer and a parent. She lives in Minneapolis.

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