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Erica Komisar, LCSW, is a clinical social worker, psychoanalyst, parent guidance expert who has been in private family practice in New York City for more 25 years, and author of Being There: Why Prioritizing Motherhood in The First Three Years Matters

In this episode of the Bottom Line Advocator Podcast, Erica joins Bottom Line President Sarah Hiner to discuss and expand on her recently published op-ed for The Wall Street Journal titled “We’re Overmedicating Our Children.” Erica wrote the piece after witnessing the dramatic increase in medicating children for emotional problems (stress response, family issues, trauma, or pressure to achieve). Instead of addressing the underlying issues, she believes that many parents, doctors and practitioners are taking the “easy” solution—silence the symptoms with dangerous medications.

How’d we get to this point? And what can we do about it? Listen in as Sarah and Erica get to the bottom of it.

Other topics explored…

  • Why Erica chose to write her Op Ed “We’re overmedicating our children” (2:22 – 3:12)
  • Why so many people are treated for ADHD when they don’t actually have it (3:14-5:30)
  • The important physical and emotional roles mothers must have during the first three years of a child’s life (and the influence it will have on the child’s emotional regulation going forward) (7:18 – 11:55)
  • How a parent’s guilt is a signal—and a good one (19:54 – 20:54)
  • The life-threatening dangers of stimulant medications used to treat ADHD (listen up parents)  (20:56 – 22:42)
  • The two critical age windows of brain development and why it’s never too late to save the relationship you have with your child (and 3 steps on how to do it) (31:10 –38:14)

The Bottom Line:  Our parenting strategies are negatively impacting the physical brain development and associated emotional development of our children. They need to be heard, not silenced with medication. A glimmer of hope—children’s brains continue to develop until age 25 and parents still are very important and influential in their emotional development.

Be sure to subscribe to the Bottom Line Advocator Podcast on Apple Podcasts!

Full podcast transcript:

Sarah Hiner:                  In all of our love for our children, we are treating their issues in absolutely the wrong way. We are giving them medications because we think they’re sick and because we think they have behavioral issues. What they have is a need for our love and our attention. Come learn about it. I’m Sarah Hiner, and this is the Bottom Line Advocator podcast.

Sarah Hiner:                  I’m Sarah Hiner, president of Bottom Line Inc, the number-one provider of expert-sourced, expert-vetted expert advice that empowers your life.

Sarah Hiner:                  I’m thrilled to be talking today to Erica Komisar, a clinical social worker, psychoanalyst, author and Wall Street Journal op-ed contributor. She works with people of all ages, especially kids, to overcome depression, anxiety and compulsive disorders with an empathic approach that helps patients to make better choices and take thoughtful action in their lives.

Sarah Hiner:                  Erica’s seen firsthand the vital importance of family support and interaction in the development of these disorders, and she’s also seen the damage that can be done by simply treating them in a traditional medical way. She’s the author of Being There: Why Prioritizing Motherhood in the First Three Years Matters [https://www.amazon.com/Being-There-Prioritizing-Motherhood-Matters-ebook/dp/B01IOHQ8MY/ref=sr_1_1?keywords=Being+there+Komisar&qid=1564512019&s=gateway&sr=8-1]. Her recent op-ed in The Wall Street Journal “We’re Overmedicating Our Children,” paints a frightening picture of the dangers of the current treatment practices for children with depression, ADHD and other psychosocial issues. You can learn more about Erica and her work at Komisar.com.

Sarah Hiner:                  Welcome, Erica. Thank you so much for being here.

Erica Komisar:               Thank you for having me.

Sarah Hiner:                  I read your op-ed, I have a passion and just a frustration and fear with the entire pharmacologic overmedicating our entire society and children, in particular. I read your op-ed, and it just struck a raw cord, and I said I have to talk to you because I can’t think of anything more important than making people aware of the dangerous practice that it is, but also you get underneath to a different place. While everybody’s talking about too many drugs and switching drugs and the cost of drugs, you actually are looking at the underlying root of it? That, to me, is such a critical thing. Can you paint the picture of what was in that op-ed? Give the high level of what’s going on, and then we’ll go from there.

Erica Komisar:               Well, I wrote the piece because in my practice, over the past 25, 30 years, I’ve seen this increase in medicating children at younger and younger ages for things that aren’t necessarily about physiological problems. Meaning these are emotional issues—they’re children’s response to stress and psychosocial stressors such as family issues or trauma or neglect or the pressure to achieve. I was seeing this increase in just wanting to silence symptoms rather than really looking at the underlying issues, which are that of emotional regulation. We have a whole many generations now of both children and adults who don’t know how to regulate their own emotions and aren’t resilient to stress.

Sarah Hiner:                  There was a story, I think, and this paints a really important picture because a lot of people say, “Not here…not in my house,” and there was a story of an eight-year-old that had ADHD, and his parents had divorced when he was three. Can you tell that story because I think that is a perfect example of what’s going on?

Erica Komisar:               Well, again, many children are diagnosed with ADHD who don’t necessarily have ADHD. ADHD there is an organic condition but, for the most part, the symptoms we’re seeing that are being so quickly diagnosed—or I should say misdiagnosed—are not often ADHD. They are a response of the brain to stress. That boy was diagnosed with ADHD, but he didn’t necessarily have ADHD. What he had was this response in the brain to stress, which causes the symptoms that seem like ADHD-

Sarah Hiner:                  Again, this was a kid who was eight years old…his parents had divorced when he was three. As I recall from the story, there was a lot of pressure on him to perform?

Erica Komisar:               Yeah, that’s right, because stress actually…and if you think about what the fight-or-flight response in the brain is…that the brain responds to stress in various ways. One of the ways it responds to stress is to become aggressive, meaning the behaviors that are associated with a child whose brain has too much stress is to become aggressive. The other is to flee, which we see in symptoms of, basically, being hypervigilant or very active. You could say it’s the flight part of fight or flight.

Erica Komisar:               So these are children who are under stress, and rather than looking at the stress that’s causing these symptoms and these behaviors, we’re just wanting to silence them. Parents want to silence them…educators want to silence them, so they can do better on tests and do better in school. Even, I hate to say it, but practitioners who are not that well-versed in this issue also just say, “Take a pill, silence the symptom,” rather than really wanting to understand where the symptoms come from. Where they come from is stress, so we really need to uncover what kind of psychosocial stress that child is under and then address that issue.

Sarah Hiner:                  So, paint the picture because you’re in private practice, and you’ve got these families that are coming in there, and they’re coming in and saying, “Doctor, fix my kid,” and then you look. What are the stories that these parents are telling, and how do you help them see their role in it?

Erica Komisar:               Well, parents are coming to their practitioners or to the schools and saying, “Look, my child is exhibiting symptoms of ADHD like being extremely active, being very distractable, maybe being more aggressive, having trouble focusing,” and the schools and practitioners and pediatricians are cooperating and saying, “Take medication…just silence these symptoms.”

Erica Komisar:               What we know now, from a recent study, is that most children are not getting the kind of proper diagnosis and treatment that they need. They’re just being silenced, and that can be a problem.

Sarah Hiner:                  Let’s back up, I want to go back to what’s going on that drove them there. So, I want to paint this picture of what’s happening in that family? Your book talks about mothers needing to be home for the first three years of life, so that they can bond with their kids. Then, even beyond that, are homes that are…how are the parents putting stress on it? How do we paint this picture for people who are listening of what’s going on in these houses? What’s the parental interaction with each other instead of saying, “Great job,” they’re saying, “How can we miss this?” What are these kids hearing? What are the messages they’re getting that’s creating this stress on them?

Erica Komisar:               Well, go back to the very beginning. So, the ability to regulate one’s emotions—meaning the ability to not go too high or too low with your emotions— and the ability to be resilient to stress in the future—meaning we’re all exposed to stressful things, but the ability to cope with those stressful things is called resilience—and also other things like the ability to be empathic or to read social cues, these are all developed in a part of the brain called the prefrontal cortex, the right side of the brain, which is connected to the limbic system, which is also the stress-regulating part of the brain. This is all developed in the first three years.

Erica Komisar:               So you’d say in the first three years of a child’s life, it’s that moment-to-moment comforting and soothing and reflecting of their emotions—what we call, sensitive empathic nurturing—from their mothers or primary caregivers that basically builds into that child the ability to regulate his emotions or, what we call, self-regulate going forward. It also builds into them…meaning mother’s buffer children from stress moment to moment. Soothing a baby is really buffering a child from stress, and that buffering in the first three years is then internalized—what we say, at 1000 days, at three years, as the ability to be able to be resilient to stress in the future.

Erica Komisar:               When a child doesn’t get enough of that moment-to-moment soothing and nurturing, and we know that many mothers and primary caregivers, if they’re fathers, are stressed themselves, very anxious, have to work to make a living, or are not home with their babies in the first three years. What we’re finding is really the consequences of that and, again, a lot of mothers say to me, “This makes me feel so guilty,” and it’s really not meant to make people guilty, but at the same time, we have to understand where stress regulation and emotional regulation come from. The idea that children should just be resilient to everything we throw them into is just not realistic. It is a biological function that mothers serve in the first three years.

Sarah Hiner:                  So, in those first three years…

Erica Komisar:               That doesn’t mean that after that three-year period, if you miss that, all is lost because mothers and primary care givers can serve the same function for children going forward. If you miss those first three years, you can still, as I say in my book—and there’s so much in my book that mothers can do to repair and fathers, what they missed in the beginning—but that is where things like stress resilience and emotional regulation come from.

Sarah Hiner:                  I want to talk, actually, later on about the now—like what do people do about it once they’ve the missed the three years because a lot of people have. You and I were joking before that, when you and I first talked, I was a working mother as well, and I was not home with my kids those first three years, and now I’ve got great relationships with my kids, but I’m one of those wracked-with-guilt people.

Sarah Hiner:                  To paint the picture, so we’ve got children that did not—if the parents weren’t there, if the mother wasn’t there, if they weren’t given, what I’ll call, a safe environment—they didn’t develop their emotional security and safety, and they just, I’ll call it, feel don’t safe, quite safe, in the world.

Erica Komisar:               In the part of the brain called the limbic system, there’s a little almond-shaped part of the brain called the amygdala, which is part of the limbic system, which is the stress-regulating part of the brain. Really, it’s not meant to come online for the first year. Meaning babies and other parts of the world are literally worn on their mother’s body, so there’s very little stress that they’re exposed to in the outside world, and so that little part of the brain doesn’t actually even come online for a year.

Erica Komisar:               We know that we are leaving babies much earlier…babies are exposed to stress much earlier…we even sleep separately from our babies, which is not done in the rest of the world and which is literally separating a baby from its source of comfort. Think about all these things as turning this part of the brain on too early…this little almond-shaped part of the brain starts to inflate and get more active and enlarges essentially. When it enlarges too early, it actually, at some point, burns out because it just ceases to function for that child, and it ceases to be able to regulate stress. Then you have these symptoms that we’re seeing like ADHD and early signs of aggression in children. We’re seeing more and more of that.

Sarah Hiner:                  Let me challenge one thing, and then we’re going to come back to talking about, I’ll call it, the co-conspirators in the medical community and the teachers and all that. So 100 years ago, the mothers—and even when I was young 55 years ago, my mother was around, but she wasn’t hanging with me…she wasn’t playing games with me. So what’s different now from 50 years, 100 years ago. There were a gaggle of kids…mom wasn’t cooing into the baby’s eyes…they weren’t necessarily having those soft romantic moments either…and yet those kids were not displaying the same behaviors of ADHD, can’t focus, aggression, all of this cascade of symptoms and behaviors that are going on now.

Erica Komisar:               Well, that’s a very interesting question. So the answer is that it’s better to be there both physically and emotionally. We know that we’re always better off, and children are always better off when they have the physical and emotional presence of their mothers—not every single moment…it’s not possible. You have to go to the bathroom, you have to take a shower, you have to cook dinner.

Sarah Hiner:                  I didn’t do that alone for the first year. My kids were always with me.

Erica Komisar:               I don’t know if I’m allowed to say that on radio, but you have to go take a pee and you’re not always there every second.

Sarah Hiner:                  No, they were with me. The shower and the bathroom sometimes—they weren’t alone. It was the time I went to work.

Erica Komisar:               Well, the idea is…but being there, and that’s what my book says, being there physically and emotionally for moment to moment in the first three years as much as possible is what really creates that emotional security and that foundation for stress resilience and emotional regulation. Now what happened years ago is that mothers weren’t necessarily, I mean all of them, that emotionally attuned. We’ve certainly become more sensitive, but mothers acted on a more instinctual empathic sensitive level that’s tied to something called oxytocin. So they didn’t necessarily know the right words to say, but they understood the idea that touch and physical presence were a very important part of stress buffering and emotional regulation. That child who was playing in the other room but had the mother in the other room with another child or cooking, that child could go in to do what Margaret Mahler called emotional refueling. Which is that as children get older and become toddlers, they don’t necessarily need their mothers hovering over them. We have another issue when we have mothers hovering over children.

Sarah Hiner:                  Yeah, that’s another conversation for another day.

Erica Komisar:               Yeah so I’ll talk to you about that in another conversation.

Sarah Hiner:                  The copter, snowplow mother.

Erica Komisar:               That child still needs to, what we call, touch base. It’s called rapprochement, which is they go back and forth…they go get a snuggle from their mother or whoever their primary caregiver is…and then they can go off and explore the world again, and go play a game by themselves. It’s the concept that the mother is available enough to them that they can go back and feel safe. It’s that kind of back-and forth that emotional refueling that actually builds security in the idea of separating in an organic way.

Erica Komisar:               Attachment is incredibly important for emotional security, but so is separation, healthy separation. So, in a way, by forcing our children to separate from us before they’re actually emotionally ready forces them to develop, which we called, defensive independence. These defenses that make them seem very self-sufficient but underneath, they’re very emotionally secure. So, to answer your question, that child whose mother had a lot of children and was still home, that child could still go back and forth and do emotional refueling.

Sarah Hiner:                  Got it. So, the world was different then—the moms were around, and they instinctively touched and all that.

Sarah Hiner:                  Now let’s come back to today. So, now, these kids are stressed and they’re displaying these behaviors. They’re symptoms of the stress…they’re disruptive…they can’t focus…they’re depressed—all these things. Again, the numbers, I just want to say some of these numbers, if I read these numbers correctly, 7 million children below age 17 are on some kind of drugs including kids zero to one year old, over half a million kids are on psychotic drugs, antidepressants, antipsychotics. Infants are on this…kids less than five years old. So these kids are running around.

Sarah Hiner:                  In whose right mind are they diagnosing these kids with these stress disorders that should be medicated? So the parents come in and go, “I have a problem. My kid’s not behaving.” How can the doctors and the medical practitioners think that this is an OK treatment versus asking, “What’s going on in the family? What’s going on for you? How do you interact? Here’s a prescription—go color with your kid tonight for 20 minutes.”

Erica Komisar:               Well, to be fair to many of the clinicians around the country, there aren’t enough mental health services in some parts of the country for all of these children and these families that are under stress, but there is also now a system in place where pediatricians can themselves give out this medication without that child being properly diagnosed by someone in the mental health field who is an expert on this. Also, many of these children are being given—and their parents are being given—a questionnaire that is a few pages and, as a result of this questionnaire, they’re being medicated.

Erica Komisar:               So, people who are very serious about this take it very seriously, and they do not give out this medication easily, and it is the last line of defense, not the first line of defense. So, the American Pediatric Association said that the first line of defense should always be talk therapy or play therapy with children. That’s the first line of defense. Sometimes that is also connected to medication, if the talk therapy alone doesn’t work, but the first line of defense is always therapy. The problem is in this country is that our first line of defense has become silencing symptoms and medication, and we have to turn that around.

Sarah Hiner:                  Well and also, it sounds like, there should be a piece of it that’s an education for the parents that these kids, again, they’re blaming these behaviors as though there’s something wrong, and there is something wrong, but not with the kid. These are simply ways that these kids are trying to get attention of their parents because they need them.

Erica Komisar:               It’s why I do parent guidance. Meaning, for the most part, my parent guidance practice is me speaking to parents about their children, about their children as young as two years of age, and about their children’s behavior. It’s by helping the parents to change the way they interact and the way they think abou, and the way they are empathic toward their children. Meaning the way they understand what’s causing the children’s behavior so that the children’s behavior changes. So, it’s through changing parents that the children change.

Sarah Hiner:                  The parents have to be willing to listen and to make those changes versus to hear it in some other way or deny it because, oh by the way, they have to get to their whatever, golf game.

Erica Komisar:               Right. It’s much easier to say to your pediatrician or to a teacher, “There’s something wrong with my child. It’s not me,” and also, as you said earlier, what about guilt? How does guilt play into all of this? I think when parents do feel guilty, it often means that they avoid their contribution to things.

Erica Komisar:               For me, guilt is a very useful tool. I do not see guilt as a bad thing. I actually see guilt as a helpful thing. It’s what we call a signal feeling like physical pain. So if you break your ankle running or playing basketball, no one in their right mind would tell you that you should keep running on that ankle because it’s broken and you’re in physical pain. So the physical pain is a sign that you should go get help.

Erica Komisar:               For some reason, when we feel guilty, it’s a sign that our conscience is working…that maybe we’re making a decision that may not feel right to us. Instead of society saying, “This is a signal feeling…go get help with this feeling,” you might make a different decision or you might come to peace with the decisions you’ve made. We tell parents to avoid their feelings. We tell them, “Don’t worry.” We say to women, “Don’t worry…your kids will be fine.” That’s not the point, the guilt is a signal feeling, so parents will then avoid looking at themselves or being self-reflective about their behavior or their contribution to their children’s behavior.

Sarah Hiner:                  So, let’s talk for a second about…and I presume I know the answer to this, but I just want to get it on the record. So, now these parents, they’d much rather have their kid diagnosed with ADHD because then their kid has a diagnosis. It couldn’t be them being wrong, right?

Erica Komisar:               Right.

Sarah Hiner:                  So now they’re socially acceptable, and they’ve got the medications for the kids. I presume that these things (a) don’t heal anything and (b) there are risky side effects. So, now we’ve got kids and it’s making it worse for them in some way? What’s happening to these kids who are on these medications?

Erica Komisar:               That’s also a very good question given, I don’t know if you saw the Harvard study that just came out, that these stimulants that are used to treat ADHD are now connected to the development of psychosis in children. There’s another study that just came out that connects these medications, like Vyvanse and Adderall and Ritalin, to becoming addicted to these medications. So, not only is addiction one of the side effects, but possibly psychosis, things like suicidal ideation increase, irritability, anxiety, sleeplessness. You’re basically giving your child a stimulant.

Erica Komisar:               Think of the amphetamines that people used to take in the ’80s for weight control and how we found that they were terribly unhealthy. That’s essentially…you’re giving your children a stimulant, and so those kinds of stimulants can have very, very negative effects including things like increased anxiety, suicidal ideation, psychosis. Yeah, really bad side effects, and you’re not getting to the root of the problem. You’re not really helping your child to become more emotionally mature or resilient to stress in the future. You’re, basically, just relegating your child to becoming addicted to these medicines.

Sarah Hiner:                  Exactly. I was going to say also, so it sends them into this cycle. Everybody wants to be up in arms about the growing suicide rates, which are horrifying and tragic, and they just can’t say enough sad things about it. So kids are killing themselves…kids are killing each other…kids are displaying aggressive behavior toward each other. They want to worry about mass shooters and go after the guns, but nobody says, “Look in the prescription, look in the medicine cabinets of what’s going on.” I’m sure the vast majority of these kids are on some kind of medication, and they’re in denial. Or is it politics?

Erica Komisar:               Well, again, I also want to add to what you just said that the world has become a much more stressful place. So, that means that because the world is a more pressured place for us and for our children, because there are more dangers and risks than there were before including things that our children have to think about that we didn’t have to think about. The climate change, and the world ending, and just terrible things that they actually talk about and think about and are exposed to, and how achievement-oriented our kids have to be just to get into college, and get jobs. So they’re in a much more stressful world, which actually makes it even more important that they have that kind of proper foundation, and that they’re emotionally secure as a start to help them deal with the increased stress.

Sarah Hiner:                  Yeah, actually I want to talk about emotional regulation and resilience, but before I do that I’m going to challenge you on that. I think that actually it’s the lack of emotional regulation and resilience that is really taking root here because, yes, it’s stressful…yes, we’ve got all this pressure…yes, these parents are crazy town about getting their kids into colleges that they don’t belong going to. But I do not subscribe to the opinion that today is more stressful than it was during the Great Depression, when people couldn’t rub two nickels together to feed their family. That went on for 10 years. Or during World War II, when your husband and your father were across the ocean. Tere was no FaceTime…there was no cell phone…there was no texting…you had no idea where they were…you had no idea what food you were going to get…if you were going to get bombed tomorrow. Today is not more stressful than what they went through in London in the blitzkrieg.

Erica Komisar:               Again, you have all of those external or, what we call, environmental stressors, and you had more of your mother and more of your family, and you just had more in the beginning, so you’re more prepared to deal with the stress. So we have different stressors than World War II. We have things like social media, easy access to drugs—things that kids didn’t have in the Great Depression or in times of World War II. Again I’m going back to where does emotional regulation and resilience to stress come from originally? What forms the foundation?

Erica Komisar:               I always use the three little pigs analogy. If you build a house of bricks, that house can rest withstand any storm. If you build a house of wood or hay, that house will blow down when the first storm comes. So our storms are different than the storms of earlier times and, in some ways, they’re worse but, as you say, there were terrible things happening then, but the foundation was there. Families were still intact…families still lived together…mothers still raised children at least in the beginning. So it’s really become a very different world than 100 years ago.

Sarah Hiner:                  Right, exactly, and that’s where I wanted to go. We didn’t even rehearse this. Exactly, so that then they had built in because the parents were there. Let’s walk through the emotional resilience and the emotional regulation that…because they had that basic foundation whereas now it’s lacking.

Sarah Hiner:                  Again, we referred to it. You talked about it a little bit before. Let’s go into that a little bit in more detail. Let’s redefine emotional regulation—what it is, why it’s important, where that develops—and then we’ll talk about the resilience aspect of it because these are what’s so lacking.

Erica Komisar:               Emotional regulation, again, is what keeps us from getting depressed or anxious…or when we’re angry, keeps us from getting enraged. So what is the balance in our emotions…and it keeps us from going too high or too low. When we feel disappointment, we don’t necessarily go into depression…when we feel anger, we don’t go into rage…when we feel sadness, we don’t go into despair. It is a metronome in all of us. It keeps us ticking, it keeps us steady, keeps the ballast in the boat.

Erica Komisar:               For the most part, that actually is not something children are born with. We are born with something called either sensitivity or less sensitivity, aggression or less aggression—that is constitutional. So all babies are born with a constitution, and what the research shows is that some babies are born more sensitive than others biologically—genetically with something called the short allele on the serotonin receptor. There are some babies who are just constitutionally born more susceptible to things like depression and the anxiety. And for those babies it’s even more important to have a mother or primary caregiver there to soothe you from moment to moment to keep the ballast in the boat.

Erica Komisar:               There was a researcher…there’s a lot of research in my book if people really enjoy reading about the research behind this because these aren’t my ideas. This is based on thousands of pages of research, different research. Basically, the researcher that I interviewed in Holland, a woman named Judi Mesman said, “Well, you know, in other parts of the world newborn babies don’t cry nearly as much as they do in the Western world,” and she said, “The reason is because mothers actually carry their babies on their bodies for the first year. They breast-feed for the most part, and they sleep with their babies. They don’t separate their babies, and they don’t leave their babies in the care of others or in daycare. They’re not separating from their babies prematurely, so the babies actually kind of live in a safe zone.” You used the word safety—they live in a safe zone the first year of their lives and up to the first three years of their lives. That safety gives them the foundation to build the emotional security.

Erica Komisar:               The father of attachment, a man named John Bowlby, called it the scaffolding. Meaning every child has a scaffolding that’s built, and that scaffolding is either a scaffolding that teaches you that the world and the people that care for you are reliable and that when you’re in distress you will be comforted, and that scaffolding then is the foundation for emotional security. So going forward, you internalize that, so even when your mother’s not there after the age of three, you feel she’s with you. That is what emotional regulation is. It’s based on that moment-to-moment soothing that keeps the baby’s ballast in the boat.

Sarah Hiner:                  The stronger the emotional regulation the more resilient they are, so that they can handle?

Erica Komisar:               That’s right, because in addition to regulating their emotions mothers, by doing that, are also protecting. Remember, they’re creating a safe zone…they’re protecting the baby from stress. That protection is then internalized by the baby at three years as safety and security. So no matter what they do, no matter where they go, the exploration that they have, they feel safe.

Erica Komisar:               Even after the age of three you can watch three-year-olds, even three- to five-year-olds doing this—what Mahler called, Margaret Mahler called rapprochement. This is back and forth with their mothers…going to touch base. Toddlers do this all day long. They go and they touch their mothers, and then they go off and play in the playground, and they’ll even look back to make sure their mother’s still there. So it’s this emotional refueling that actually further reinforces this idea that they’re safe and secure, and that is the foundation for being resilient to bad things that happen in life, what we call, stress resilience.

Sarah Hiner:                  Got it. All right. So, now we have a generation of young people who are lacking in emotional regulation, lacking in emotional resilience, and we have a whole bunch of people listening that are going, “Oh man, it’s too late. My kids are older.” So, now what? You said that it’s never too late and that there are things that parents and families can do to help their children to develop it even if they’re beyond the three years old.

Erica Komisar:               It is never too late. There is a point at which it becomes harder and, I would say, that the point at which it becomes harder is after the first critical window of brain development for emotional regulation and stress resilience, which is is 0 to 3. There is a second window of critical brain development, and it’s adolescence, which is what I’m writing now. I’m writing a book about the second critical window of brain development, which is nine to 25.

Sarah Hiner:                  That’s so funny, I never think of adolescence as that long.

Erica Komisar:               Oh, it’s even longer.

Sarah Hiner:                  I think of adolescence as like preteens.

Erica Komisar:               Now we can actually see when the brain stops really developing to the same degree, and it’s about 25. Meaning when the synapses stop—there’s a period between nine to 25 when the synapses are growing and pruning, and so that is what we call the second critical window of brain development. There’s kind of a reorganization of those structures of the brain that are responsible for emotional regulation and stress resilience. So, if you’ve had a good foundation, zero to three, it makes adolescence much easier for you. If you didn’t, then it makes adolescence harder and oftentimes adolescence is the period where, if you don’t see a breakdown earlier in a child, you’ll often see them break down in adolescence. So, now that makes sense to a lot of people because they’ll say, “Well, my child is 21 and in college, and that’s not adolescence, is it?” Yes, it is adolescence, and so that’s when many children do breakdown if they didn’t have what they needed earlier on.

Erica Komisar:               Having said that, it also means that you, as a parent, still have influence over that child’s brain development between nine to 25.

Sarah Hiner:                  Yeah, I always thought I was done the minute after they hit kindergarten that it was all about the kids and they were done listening to me.

Erica Komisar:               Well, people think that about adolescence, too, because their teenagers push them away, and they say, “Oh, they don’t need me anymore. Now, I can go get a full-time job, or I can travel, or I can leave them home alone,” and the point is no. They may seem like they don’t need you, but they need you as much as they did in a different way.

Sarah Hiner:                  So, what are the three things parents should be doing from ages nine to 25? So how do they help? How do they overcome? What do they need to do?

Erica Komisar:               It’s actually similar to what they do earlier on. Interestingly, I’m not saying buy my second book because there’s a lot in there that is specific to the issues of adolescence. But one of the things that parents need to remember is that they need to be as present as possible for their teenagers both physically and emotionally in a different way than when they’re little. When they’re little, they literally are doing rapprochement and they’re needing soothing from moment to moment. So, in the first three years, it’s a moment-to-moment process.

Erica Komisar:               It isn’t a moment-to-moment process, but the problem is—and this is the way I think about it— teenagers will let you in on their timing. Meaning that they’ll let you in when their door opens. If no one is there when their door opens—and that’s both a real thing and a metaphorical thing, meaning when they’re open to talking to you and you are not there. Let’s say they come home from school, and it’s 4 o’clock and they’ve come home really in distress. It’s not any different than it is for a zero to three-year-old child. They are needing tending in that moment. Once the door closes, you can’t come in and knock on their door and say, “I’m here now…talk to me,” because it’s on their time, not yours.

Erica Komisar:               I’m going to say it’s a little like gambling. The more present you are physically and emotionally for your teenager, the greater the chance that you’ll be there when the door opens.

Sarah Hiner:                  Are there things that you can do… So let’s say I wasn’t home when my kids came home from school, but I would talk to them every day and then I would say, “When I get home, we’ll spend time together, we’ll go through this.” So I would touch them a little bit because not everybody’s able to be there…or your kids run off to practice or whatever it is. So, are there tactics that you can try and stay connected, be available, let them know that you’re there, and then create environments?

Erica Komisar:               Well, other than the first, be there as much as possible—so what I say in both of my books is more is more. The more emotionally and physically available you are, the better. OK, but if you come home and the door is closed, most parents will ask me, “What do I do if the door is closed both in a real way and metaphorically. What do I do?” The idea is that you can knock on the door and absolutely you should knock on the door. If your child sends you packing because, again, it’s not now, not on their time, you can say, “I’m here now. I’m here, and my door is open to you, and I want to listen to you and hear what your day was like.”

Erica Komisar:               A lot of the same things that you do with very young children, you do with older children to regulate them. You use touch to regulate. There’s two kinds of regulation—there’s primary regulation, and there’s secondary regulation. Primary regulation is eye contact, touch, using your voice in a calm and reflective way. These are what we call nonverbal things that we can do with our children, and some children are not that comfortable with touch. So then you go to secondary regulation. Secondary regulation is using your imagination as a parent to interpret what happened to your child that day. You always say the best word that a parent can have in their toolbox is I wonder. “I wonder if you’re feeling sad because of the test that you took today,” so the one thing that I can say to parents of either very young children or adolescents is know your child. Spend the time knowing your child’s schedule, knowing down to what tests they’re taking that day.

Erica Komisar:               That is not intrusive—that’s being a knowing parent. Meaning when you ask them, “How was your day?” the answer you’re going to get is, “Fine.” When you ask them very specifically, “I know you took a math test today. How did it go? Did you do as well as you thought you would? I’m wondering if you’re sad because the math test was harder than you thought,” that’s a very different question, and that child is going to respond to you and your knowing them. They’re not going to respond to the first question which is, “How was your day?”

Erica Komisar:               Know your child. And when you do come home, be a knowing parent, and ask very pointed and specific questions, and reflect. Use your imagination to imagine what they’re feeling and put it into words.

Sarah Hiner:                  So, in your book, you talk about in the zero to three, and I don’t know about later on, but the oxytocin that women produce… that there’s something unique in the mother-child relationship, and the mother’s ability to soothe the child. It’s physiological and chemical and biological.

Sarah Hiner:                  So what role can fathers play in this as well? Do they have a role in this? Obviously, they’re fathers, and they’ve got relationships with the kids, but talk about the fathers in this for a minute.

Erica Komisar:               By the way, oxytocin is something from the very beginning, but it also is something for parents of teenagers. We produce oxytocin as women—it’s connected to our hormones. We say women produce more…mothers produce more oxytocin…and it comes from a different part of the brain than when men produce oxytocin because fathers can produce oxytocin, too, but it comes from a different part of the brain. For the most part, the behavior associated with this hormone—what we call the love hormone—when we touch our babies, when we look at our babies, when we breast-feed, it is something…and it’s also in giving birth—oxytocin is produced, and it helps us to bond with our babies, but it’s specifically to sensitive empathic behaviors in mothers. Meaning mothers are very innately naturally biologically good at tuning into a baby’s pain, and soothing the baby with their pain.

Erica Komisar:               An example of that might be a baby falls down. A flood of oxytocin in a mother might make that mother lean into the baby and empathically ask the baby if he is OK, and give the baby a hug and soothe the baby’s distress. When fathers produce oxytocin, it makes them more, what we call, playfully tactically stimulating. It makes them throw the baby up in the air or tickle the baby or want to play or even distract the baby away from pain. So, it’s not that fathers can’t produce oxytocin—it behaves differently in their bodies and in their nurturing than in a mother.

Erica Komisar:               Fathers produce a different hormone…more of a different hormone called vasopressin, which makes them protectively aggressive, and that’s also critical, and that’s a critical part of separation. So fathers are very important to help babies to separate from their mothers at the right time and play and explore the world and become more resilient over time. But in the first three years, we know that sensitive empathic nurturing is more critical to that right brain development.

Erica Komisar:               Fathers can become more like mothers—we know this. We can teach fathers to become more like mothers—that means, with very young children and even with teenagers, not to dismiss feelings…not to push self-sufficiency and resilience on them…but to actually tune into the pain and listen to the pain and reflect that child’s feelings.

Sarah Hiner:                  So they can play a role then? Sometimes I found, when my kids were in their teens, it wasn’t necessarily good cop/bad cop. It was like good cop/good cop—whose turn was it today? There’s also something uniquely tense about the mother-daughter relationship. You get the best of them in the worst of them. So if they had a bad day, sometimes they’d take it out on me uniquely as well, so sometimes my husband would be better at stepping into situations. So there, to me, it’s a tag-team thing in terms of this emotional regulation and helping the adolescents to develop.

Erica Komisar:               Well, it is. You’d say even in zero to three. So if a father is playing with a baby to encourage exploration, the mother is there to be the touchstone for security. So even if you have, let’s say, a gay couple—and I treat gay couples—and they come and they say, “What we do because we’re two men or two women?” and I say, “Well, one of you has to be the mother and one of you has to be the father metaphorically.” Meaning that one of you has to take on the role of being that primary caregiver who provides that baby with that emotional security. The other has to take on the role of encouraging separation and exploration and playful tactful stimulation. So we know we can learn some of these things, but that doesn’t eliminate the biological hormonal influences. Yes, we’re very complementary to one another in terms of nurturing, and so it does make it critical that we have more than one influence in a child’s life.

Sarah Hiner:                  Let’s talk about one other thing—I’m going to call it door openers. So, again, you come home, the door’s closed, whatever, but there were certain situations that parents can kind of set up where the kids might be more open to talking. I loved driving with the kids—somehow you never knew what came out on long car rides. Walking the dog. Are there other suggestions that you have of things that parents can try to create places where their kids will talk? Like cooking together—”Do you want to come help me stir, make the soup?” whatever? Are there other suggestions that you have about that?

Erica Komisar:               That’s also a good point. Shoulder-to-shoulder activities—meaning just doing things together. Again, everything you just said requires just spending time together. So the more time you spend, and the more of a good listener you are…I don’t know…there was an old expression I remember. We have one mouth and two ears—that means we’re supposed to listen twice as much as we’re supposed to talk. So the concept that being there as much as possible also means walking the dog, cooking together. When you come home, as a parent, put your technology away, and this is the same for very young children. Leave your computers, and your phones, and the TV, and leave all the technology off. It leaves the space to really communicate with your children. Again, being present means that you’re doing more things together. You’re walking to the dog, you’re sitting on the couch, you’re cooking dinner.

Erica Komisar:               I’m going to say spending individual time with your children. One of the things that we have in our cultural—sort of the way we think about our culture in this country—is eating meals together all as a family, and that sounds like a great thing. Sounds great, but remember…you bring family dynamics into a dinner table where you’re all eating together, so sometimes the idea is to spend individual time with each child. They’re more likely to open up to you if they’re not in, what we call, the family cluster fuck…if they’re not all together and dealing with sibling rivalry issues and rivalry for parents’ attention and old issues.

Erica Komisar:               Really, even though it’s lovely—the idea of a family dinner table—don’t force that on teenage children. Have individual time with them…take them out for dinner yourself once a week. It doesn’t have to be a fancy dinner. Go out for fast food or a picnic, but individual time with each child.

Sarah Hiner:                  Do you see when families take this on and parents spend the time with their children that they’re able to get their children—just to cycle back to the start of this and the over medication—that they’re able to get their children off of these dangerous and wrongly prescribed medications?

Erica Komisar:               Yes. The answer is yes, but generally not alone. Meaning by the time that your child has gotten to a point that they’re being medicated, you often need help. Again, I’m realistic. I understand that there’s not nearly as much help in this country. There are articles that are coming out about how kids who go to college don’t have nearly as much help as they need in the college situation. Meaning there’s not enough mental health–care workers and services for all of the kids who need help right now.

Erica Komisar:               Having said that, seek it out because by the time your child is on some kind of medication that’s been prescribed too early on or by a pediatrician rather than a mental health–care worker you’re going to need help from a therapist. So I’m going to say seek out help, but, yeah, there are real changes that I see in my practice when families who have medicated their children really work hard to understand the dynamics underneath the child’s behavior. That empathy for their child is critical in changing that child’s behavior.

Sarah Hiner:                  You just made the comment about the increasing number of kids going into college that have mental or emotional issues, but the whole premise of this is that we wouldn’t have as many kids with those issues if we were spending the time and paying the attention to the children early on.

Erica Komisar:               And having empathy. I think of my book as just increasing…most parents would say they love their children. I would say that in treating adolescents and in treating adults, the biggest complaint is not that their parents don’t love them or that their parents didn’t love them. The biggest complaint is that their parents didn’t understand them. That nuance is what causes most forms of depression, anxiety and mental illness. So the idea that we as parents have to take more time to understand our children, not just love them—we can love them, we always want to love them—but we also need to understand them. By understanding their feelings, by understanding what causes the behavior on a very deep level, we’re understanding them.

Sarah Hiner:                  That’s great. All right, Erica Komisar, we could talk forever. Your book, Being There: Why Prioritizing Motherhood in the First Three Years Matters [https://www.amazon.com/Being-There-Prioritizing-Motherhood-Matters-ebook/dp/B01IOHQ8MY/ref=sr_1_1?keywords=Being+there+Komisar&qid=1564512019&s=gateway&sr=8-1]. I look forward to the new book. Send it along when it’s ready because we’ll write articles about it.

Erica Komisar:               Parenting in the Age of Anxiety—yeah, I will, I’ll send it along.

Sarah Hiner:                  Great. All right, and Komisar.com is your website. Thank you so much, Erica. I really appreciate it.

Erica Komisar:               Thank you. Thank you for having me.

Sarah Hiner:                  I’m talking to Erica Komisar, psychoanalyst and author of the book Being There: Why Prioritizing Motherhood in the First Three Years of Life Matters [https://www.amazon.com/Being-There-Prioritizing-Motherhood-Matters-ebook/dp/B01IOHQ8MY/ref=sr_1_1?keywords=Being+there+Komisar&qid=1564512019&s=gateway&sr=8-1]. Erica has worked with children and families to overcome the growing epidemic of overmedicated children in a world that treats their psychosocial challenges with prescription pads instead of emotional support and behavioral training. Erica understands that creating balanced physical and emotional health is about creating a healthy environment in which to grow and not simply about dialing chemicals up or down.

Sarah Hiner:                  Her message is just one from the thousands of experts featured in our twice -monthly newsletter, Bottom Line Personal. These experts provide their advice to guide readers into action in their own lives. In addition to Erica’s wisdom regarding depression and other psychosocial issues, Bottom Line Personal is filled with actionable advice on all aspects of your life including traveling safer and cheaper, finding the best insurance, retirement planning, smart tax strategies, secrets for getting and staying fit, and even travel to little-known destinations. Bottom Line Personal has been helping our readers lead more informed and vibrant lives for more than 40 years with our actionable and double-fact-checked advice.