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Boy's crushing disappointment in himself
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Q A 3 1/2-year-old boy cries so hard when he makes a mistake that he becomes short of breath. He is developmentally normal otherwise. Should the parents be concerned? How can they help him?
A It is unusual for a child this age to be so sensitive about his performance that he becomes greatly distressed at his imperfections. First, carefully determine if he has been abused physically or emotionally. Then find out if either parent has threatened the child with loss of love or with abandonment if he does not meet their expectations. Also: What are the parents' expectatioms for themselves? Their aspirations for the child?
Your evaluation should include learning about the child's relationship with each of his parents, where the child's strengths lie, and what each parent considers especially appealing about him. A projective interview would be useful if this 3 1/2-year-old is sufficiently bright and verbal enough to have some insight into his own behavior. If he has siblings, include them in the evaluation. They may offer special insights into this boy's distress.
Intervene immediately with a support plan while the evaluation gets underway (see below). A possibility, once sexual abuse has been ruled out, is to have each parent spend a 20-minute period, three days a week, doing something enjoyable with the child: reading, talking, playing a game, going for a walk. This period can be given a name, such as "special time" or "alone time."
The parents should also watch for some activity that the child is particularly good at, and should then find (or make) opportunities several times a day to comment on his successes. The parents, with help from the child, could also make a chart that lists his achievements and could encourage him to put stickers on it to flag successes.
If this child has siblings, the parents should avoid making comparisons among them. They should be careful not to point out either his superiority or inferiority to another sibling.
Last, if the child does not respond to any of these interventions, refer him to a mental health colleague skilled in evaluating and treating very young children.
Participation involves only one parent and one child
No interruptions (no telephone or television)
The parent offers the child a choice of activity from three or four options
The scheduled period comes at a predictable time so that the child has something to look forward to
The duration of the period is controlled with a timer or alarm clock so that, first, the child will learn to make transitions from one activity to another and, second, the parent will not be viewed as the reason that an enjoyable activity has come to an end
Behavior: Ask the experts. Contemporary Pediatrics 2001;11:39.