The Nurtured Heart Approach

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The following excerpts are from Transforming the Difficult Child, by Howard Glasser and Jennifer Easley.

Chapter 1

How quickly things can change

  • Matthew, age 7, pushed his sister to the ground after she told him to leave her alone. He had been taunting her. His mother, angry and frustrated, lectured him on right and wrong, sent him to his room and promised that if he did it again he would have no TV for the next two days. Did it work? It would have worked on an average child. It didn't work on Matthew. He was back at it at the first opportunity. His mother feels betrayed and exhausted. She'd run out of tricks. She'd tried everything she had read in books and magazines. She worried about what her son would be like in six months and in six years if his seeming addiction to pushing the limits didn't stop. Mother and child both deeply feel the pain of what had been happening at home and at school. She was a very well-intentioned mom with a bright and well-intentioned child who just couldn't seem to control himself.
  • Brandon, age 4, will not take "no" for an answer. He tantrums at the least bit of disappointment, whether in the form of a "no" to his demand for more sweets, or a "stop that, please!" to his efforts to explore the family stereo system. Everyone had been saying that he'd outgrow it, but the tantrums were getting worse...and everyone didn't have to live with him! The tantrums were embarrassing in public and scary at home because he had started to break things and to be mean to pets. Nothing his parents tried or read about seemed to work for more than a short while. His parents had even had a few consultations with a psychologist a year earlier. They were beginning to feel as if people are staring at them... as if they were parents from hell. They were terrified of how Brandon would fit in at school. As things were going, the situation appeared destined for disaster.
  • Monique, age 13, has habitually under-functioned for as long as her parents remember. She was a smart child who was failing most of her classes and who would rather argue about homework or chores than ever just do them, no matter how simple they were. Her parents had divorced two years previously. They were tense all the time, largely over their distinctly differing opinions on how to deal with Monique. Her dad felt that she got away with murder with her mom, and her mom felt that Monique's father was much too strict. Besides, neither style seemed to work. Monique's defiance had brought her to the edge of growing up too fast. She wanted to pile on the make-up and hang out with older kids with questionable lifestyles. Her mom was positive Monique would find a way to get pregnant before too long. Monique knew exactly how to push her mom's buttons. The arguments, warnings and lectures that followed her defiance had become a way of life.

All three children had several things in common. They had become stuck in patterns of negativity from which they could not extricate themselves, no matter how much individual advice they received. All three children had the impression that they got more interesting reactions and larger responses from the adults in their lives as a result of their negativity than for positive behaviors. And, all three children were very smart young people who were seriously under-functioning, primarily because they expended the greater part of their wits and intelligence in the unproductive endeavor of trying to get strong reactions to their problem behaviors.

All the parents of these children also had several things in common. They were trying extremely hard to be good parents. In fact, they were trying every trick that they could mobilize. They had sought advice, read books and magazines, watched videos and observed the world around them for solutions. They basically had tried every reasonable traditional parenting possibility they could get their hands on. Not only that, but they tried things over and over, with as much conviction as they could muster. Despite their excellent intentions, nothing was working.

They might eventually have become looked upon as bad parents, but in actuality, just about everything they tried would have worked just fine with easier children. They had already reached their own conclusions that normal methods did not work with their child. They were also beginning to suspect that something was dreadfully wrong with their child. To say the least, they were not enjoying parenting and they were half-crazed with the thoughts of where this all was leading.

What these parents wound up doing, in each case, turned things completely around in only a month. They applied a wonderful combination of techniques designed specifically for the intense and challenging child. These simple but unusual methods created the changes that quickly and surely drew the child into a completely new focus on being successful.

Here's a glimpse of what these families wound up doing:

In all three families, the parents took a four-part class that explained how intense and difficult children really operate. Each class gave them theories and techniques to carry them along the way toward reversing the pattern of problems and toward shifting the child to a new pattern of successes.

After the first class, the parents were clear that they no longer wanted to accidentally fall into the trap of feeding a pattern of negativity by having a response that was not a true consequence. They were beginning to realize that some of the conventional tactics for parenting a child with problem behaviors--tactics such as reprimands, words of concern, lectures, redirections, threats, discussions, yelling and other ways of making a big deal about negativity-- were actually rewards rather than consequences, however unintended that result. They also left the class conscious of different ways they could make a big deal over several different kinds of successes that had been going unnoticed. They were ready to apply some magic and "trick" their child into a world of successes.

All three parents began by briefly visiting their child several times a day "before" the predictable behavior glitches occurred and applying three techniques. They did a form of recognition in which they verbally described what they saw the child doing. They also gave their child increased acknowledgement for skills, values and attributes that they wanted to see more often, and they consciously gave recognition for qualities like showing a good attitude, using self-control, being respectful, getting along with others, being cooperative and so forth. The parents needed to be very diligent and creative to ensure that this appreciation occurred whenever possible, at the slightest glimpse of the desired trait.

They also left the class ready and willing to give their child compliments throughout the day for instances when rules were not being broken. In this way they were teaching the rules by actually creating positive experiences through pointing out when their child was not fighting, not whining, not arguing or not being disrespectful. They were realizing that, inadvertently, they had always made it more interesting for their child to break rules by reacting more strongly when the rules were broken and, in effect, rewarding disrespect and bad attitude by giving more energy to the problem than the solution.

Now they were having more animated responses when things were going right, and they were using new techniques and creativity to make it happen. All this added up to five minutes of intervention a day. A far cry from the hours it typically took to discuss and solve problems.

By the end of the second week, these parents had devised and implemented a way to give their children credit when rules were not being broken, credit for performing chores and responsibilities, as well as credit and recognition for a host of other desirable behaviors. They had linked this with a clever way to exchange these credits for privileges, and they were quickly seeing how the children were buying in, despite their initial reluctance.

Each child was making considerably more effort to follow the rules, to be cooperative and helpful, and to meet his or her responsibilities. Each child seemed pleased to have acquired a newfound ability to get back old privileges and some new ones in a predictable and straightforward way.

By the third week, the stage was set to have consequences really work. The children now really knew what the rules were and really knew what happened when the rules weren't broken. They were beginning to trust that they would be noticed for not breaking rules, and this both felt good and benefited their new economy of credits.

Since the parent was no longer inadvertently feeding the negative behavior, they could now deliver a simple but effective consequence each and every time a rule was broken. After initial testing, each child quickly reassessed his or her new circumstances and realized that all the interesting reactions happened when things were going well and when rules were not being broken. And they also realized that all that happened when a rule was broken was a consequence, without the reward of a reaction. The children began to deepen their investment in successes.

By the fourth week, the parents were able to extend these beneficial strategies to school. They were now able to have their child succeed, regardless of whether the teacher was skillful or not, and without having to actually spend time there themselves. This made an enormous difference in their ability to go through the workday without fear of being called or remanded to the principal's office for a conference.

Miracles happen. What's more, miracles such as these are driven by tactics that add up to a fraction of the time it ordinarily takes to handle problems. Such tactics ultimately gave these parents the satisfaction of feeling like they had turned things around and that they were indeed gifted and talented parents.

The parents of these children, like many others who have come across The Nurtured Heart Approach, have simply realized that it's all about how and when we choose to give our energy and that the parenting and education of intense children simply requires a slightly different spin.

As for Matthew, Brandon and Monique, they are all doing great, living out new scripts of success. And as for their parents, they are savoring both their own accomplishments and that of each of their children.

Chapter 2

A New Primer: Understanding the Difficult Child

In order to best teach you the techniques, we'd like to introduce you to a few of our basic premises that explain the thinking behind the techniques. It will greatly increase your therapeutic impact and help you understand what you are doing and why you are doing it.

These first chapters will keep you briefly on hold while we explain the pieces of the puzzle that we think are crucial. This chapter is not about techniques, so even if you can't stand the suspense and want to jump ahead, hang in there for the next 30 pages. The techniques will follow.

Keep one more thing in mind as you start reading. When we were bright young therapists fresh out of school, like many other bright young therapists our theories were complex and complicated. Now that we are older and much more direct, our theories are much simpler in nature. Fortunately, "simpler" turns out to be far more powerful. What follows are a few of our core ideas:

Playthings `R' Us

Take a second and think about your child's favorite toys. How many features do they have? Do they have five, 10 or even 100? Even if they had 1000 features, they wouldn't come close to approaching the number of amazing features we parents have.

Simply translated: we are by far our child's favorite "toy."

We not only have many more features than any other "toy," but we are much more animated, reactive and interactive, as well as having the best remote control ever made.

We can walk and talk and do virtually anything under the sun. In addition to an endless array of actions, we can display a multitude of interesting emotions and moods in an infinite number of combinations, subtleties and gradations.

It isn't even close to a level playing field. The other "toys" can't compete. We are the closest things to a personal entertainment center imaginable.

We can also combine our actions and feelings into seemingly limitless interactive pairings. We can wash the dishes in a flourishing blend of glory, song and dance on one day, and the very next day we can be doing the dishes in an utterly foul mood.

The volume buttons on these "toys" are readily and handsomely displayed, as are all the other buttons that, when pushed, really get the show going.

These "buttons" are certainly fascinating to the sensibilities of a child in the throes of forming opinions of how the world works along with opinions of his or her effect on the world.

Here's an illustration. When a child is slow to get ready for school, especially when his parent is in a rush to leave the house, what occurs? The parent, with the best of intentions and simply using mainstream methods of parenting, might express some annoyance or frustration. The parent might then give a few warnings or issue a few mild threats in attempts to move the situation along. If the situation continues, the parent could easily show some anger, give a stern lecture or fire off a reprimand or two. This would all be quite within the norm and might well have the desired effect on the average child.

In any case, the child gets a first-hand glimpse of one of many ways to get the "toy" to have a more animated reaction. The "toy" is simply more reactive and more energized under these adverse circumstances.

With this in mind, consider how easy it is for a child who is a bit more needy, or a bit more sensitive or intense, to reach a simple conclusion that can come to govern his life, albeit in a most unfortunate way.

The conclusion is that we are by far their most fascinating "toy" and that this "toy" operates in much more interesting ways when things are going wrong.

Unfortunately, given the traditional methods of parenting at our disposal, an intense child can have this perception despite our very best intentions.

The Flatliners

The energy, reactivity and animation that we radiate when we are pleased is relatively flat compared to our verbal and nonverbal responses to behaviors that cause us displeasure, frustration or anger.

Get out your Geiger counters.

Our cultural ways of saying "Thank you" and "Good job" pale in comparison to the sharper tones we display even in simple redirections such as "Leave your brother alone" or stronger reminders such as "Get your shoes on, the bus will be here in two minutes."

As a culture, we seem to amp up the "nos" in contrast to the "yeses."

Traditional parenting approaches do not lend themselves to showing much excitement for positive behaviors or smaller successes. Our normal tendency is to deliver a relatively neutral level of acknowledgement.

However, as a culture, we jump all over every level of failure. Non-success captivates us and draws our focused attention and our bigger reactions.

Children certainly have what amounts to built-in energy detectors. They can easily sense when we become more animated. And their impressions stay on file. If you need an image to help hone in on just how judicious children can be in weighing when and how "more can be had," just watch the next time your child splits hairs over which serving of dessert is bigger.

As an illustration, if a child perceives that mom or dad gives a bigger reaction to poor grades or annoying behavior, the child absorbs and measures this experience, and other like experiences, as part of her impression of the world and of how we operate.

Similarly, if a child sees that doing the chores, or doing homework, or having a good attitude or not breaking the rules nets less response, that child begins forming an operational view of reality.

In light of experiences like these, the sensitive, needy or intense child can easily become convinced that the "payoff" for not doing what a parent wants is much greater than the "payoff" for complying or behaving nicely.

It's much more about reaction than attention.

"Payoff" is used here to refer to the level of energy or level of response that the child comes to believe is available in relation to each and every event that comprises his or her life. Many children will simply go for the bigger slice of life every time.

The question then becomes: "If we truly are in some fashion our child's interactive, virtual reality toy, then just what kind of toy are we going to choose to be?"

Can we regulate the flow of "payoff," or the way we choose to radiate energy, to the advantage of our child and our family?

Fortunately, there are some great choices that make a world of difference.

Video Game Therapy

Have you ever noticed how many intense and challenging children are drawn to video games?

For the time they are playing, they are captivated, content, focused and alive. The reason is that their lives make total sense while they are engaged in the game.

While they are avoiding dangers or attaining the goals, they are forever being acknowledged and recognized with landmarks of success. When they break a rule of the game, they get a clear and immediate consequence.

Children figure out in no time flat that the game is totally consistent and predictable. There's no getting around the program.

It's unflappable. It can't be bullied or manipulated. No amount of tantrums or pleading or nagging can change the format.

They not only come to accept the realities of the game very quickly, on their own, but they also figure out new games in the time it would take us to locate the manual. And once they size the game up and assess that there's plenty of excitement and recognition for their wise and skillful actions and only a consequence for crossing the line, they throw themselves into performing at their top level. They typically don't waste their time trying to manipulate or bully the game. They direct their intelligence exclusively into doing well.

They seem to love video games, and well they should. Children typically throw themselves into the game with great zeal, and that feels good. They get to experience what it feels like to use their intensity in a successful manner. They constantly try to attain new levels and outdo their personal best and the personal best of friends and family members. They can both sense and see their attainment: the game provides evidence of their attainment and the excitement that is associated with success, every time at every turn.

How many parents would give anything to see their children involve themselves in school life and home life in the same manner... investing and focusing their energies in increasingly successful ways?

The secret is amazingly simple. Video games have the structure that more and more children need and demand. Acknowledgement and consequences are reflected in completely straightforward ways. Frequent audible "bells and whistles" and discernable continuous scoring reward the child's positive accomplishments as well as steps in the right direction. Conversely, clear and immediate consequences mark actions that are unacceptable. When the consequence is over, it's right back to scoring.

Much like athletic events, the lines defining a consequence are perfectly clear alongside the clearly delineated ways that the goals are achieved. The cheering, encouragement, and scoring always happen in-bounds, while simultaneously the knowledge exists that there is always a result of a transgression, no matter how slight. The referee doesn't yell or scream at a player, but simply states the consequence neutrally while still holding the player fully accountable. There is no excitement or energy given to the broken rule, just a result.

This structure consistently brings out the best that athletes have to give. Even athletes who lack internal structure and who can barely conduct themselves off the playing field without creating havoc seem to thrive within the structured parameters of the game.

The basic translation is: energy, reaction and payoff for the good stuff and "Oops, broke a rule... here's your consequence... no energy, reaction and payoff for violations." The accountability is clean and then it's right back to the excitement of participation and success. The outcome is predictable and reliably consistent every time the game is played.

It's the same in the venue of the video game. The essential feature is that the excitement and fireworks occur when the child is on track, busily attaining the goals and avoiding the obstacles. "Scoring" equals recognition and emotional nutrition. When things go awry, the game's response is straightforward. The consequence occurs in a simple, unceremonious fashion, and when it's over, it's right back to successes.

The structure is brilliant and simple. It's a beautiful blend of recognition and limits and a beautiful outcome of mastery and accomplishment for the child.

We are not enamored by the subject matter of most video games that we've seen on the market. The gratuitous violence and frequently inane content are unwelcome guests in our homes. However, the crucial question is: can we observe, learn and apply these principals to parenting our challenging children away from failures and toward new patterns of success?

We've never seen a child play these games to lose. That quality of attainment, carried over to important areas of functioning, can have delightful meaning in the life of a difficult child and family members.

The Big Bang Theory

Children are attracted to energy. They feel energy and they quickly perceive what it is that produces fireworks.

When July 4th comes around every year, if fireworks displays are available and in the plans, chances are we'd rather see a significant display than just a few firecrackers. Does a child want to see a few sparklers in the back yard or get to a real show? And does a child want to see the first few minutes of the show and leave or stick around for the grand finale?

Back to the video game analogy for a second. Players are quick to determine that flashing lights and high scores are more exciting. It is easy to see that the energy of success has the bigger payoff.

How does this affect a child's view of his or her parent as a personal entertainment center?

Unfortunately, when a child perceives that there is far more energy and animation available for negative behavior, it becomes fascinating to attempt to light up all the lights. Many very intense and intelligent children have fixated the greater part of their wits and intelligence on figuring out just how to make "Us" have the very strongest reactions. If it's the bigger fireworks that capture their interest, then the child might just discover a few circumstances under which the "toy" tends to have some pretty interesting reactions.

Of course, this represents a horrible waste for the child and hell for the parent. However, the child may well feel at some level as if he had hit the jackpot.

The risk of this phenomena increases when the child has a high level of energy and sensitivity, along with a heightened need for attention, and when the child perceives negativity as the best or only way to get the bells, lights and whistles really going. Under these conditions, the child quickly figures out the "video game" and realizes that not doing what the parent wants essentially gets far more reaction and emotion.

Many parents aptly describe this experience in terms of the child's "pushing their buttons." "He really knows how to push my buttons." Of course, we all have buttons. We all have particular behaviors that are especially frustrating or especially annoying to us. Some of us simply advertise where those buttons are and exactly what it takes to push them. Most of us do this to one extent or another without realizing what hit us and without realizing that there are indeed ways to create better buttons!

When our children are feeling especially needy or sensitive or energized, they can often dial into our reactions by manifesting particular behaviors that will draw us into the trap.

We are particularly vulnerable when we are stressed or distracted and our child takes note that we are otherwise unavailable. We might as well wear neon signs declaring that the only way our attention is available is to push a button and extract a reaction, albeit negative in nature. To a child who is feeling needy, certainly no crime in itself, any response is better than no response at all.

It is a trap... unless we can demonstrate, to our child's satisfaction, that the payoffs, or the ways in which we choose to give our energies, are substantially greater for the good stuff.

We must create a new perception... that we as "Toys" or as the "Entertainment Center" indeed radiate greater responses when the challenging behaviors are not happening and when successful behaviors are happening.

And we have to be convincing. We cannot just give lip service to this idea. We have to demonstrate that we truly radiate more excitement, animation and energy to everything that is not a problem.

Our challenging children are not out to get us. They are out to get our energy.


Chapter 14

More on ADHD Symptoms, Medication & Diagnosis

Parent after parent comes to our office to announce that their child has been diagnosed ADHD. Somewhere in the child's travels, a well-intentioned individual volunteered this diagnosis. Although some parents actively seek information about ADHD and are fairly well informed, most only pick up bits and pieces of information from the media or the neighborhood. Posing the question, what is ADHD, has often become a roundabout way of asking for help with some very frustrating habitual behaviors.

Many myths have been generated regarding ADHD. In many sectors of our cities, statistics and cries for help would have us believe that ADHD has reached epidemic proportions.

We have purposely saved this topic for the tail end of our work whereas almost every other parenting book places it front and center. We do so because we take a dramatically different view of the significance of this diagnosis and its relevance to the course of treatment.

Many of the people making the diagnosis are unqualified to do so: school nurses, teachers and other school personnel, as well as neighbors, relatives and family members who do not hold a license in a related subject. Unfortunately, as we see it, some qualified professionals also may be limited by their perspective to properly arrive at such conclusions.

ADD or ADHD (Attention Deficit Disorder, with or without hyperactivity), as currently diagnosed, is not much more than a laundry list of 14 descriptive symptoms, which to differing degrees describe virtually every person who ever walked the planet. Everyone is distractible sometimes. Everyone seeks attention sometimes. The formal diagnosis of ADD or ADHD is proffered when a child shows significant manifestations of any six of the 14 descriptions on a consistent basis over a six-month period.

The symptoms thus become the disorder and another illusion of conventional medicine that encourages many parents to think something terrible is happening to their child and they must get rid of it in order to fit the illusive and betraying picture of normal.

Instead of labeling a child as disordered and her parent as dysfunctional, isn't it possible that both manifestations are a function of how we choose to view the things we see? Take a trip to your local museum of natural history and look at a slice of life from the past. Look at the tools of 50, 100, and 150 years ago and then imagine the tools that will be in use that far into the future. We are going to change entirely how we look at energy-challenged children and the way in which we work with them. And as we move from the parenting tools of the past to the ones of the future, we will see that the malfunctions of the intense child were more a result of the tools available than a result of a disordered child or a dysfunctional adult. Given the right tools, children with ADHD-like symptoms are by far the easiest to transform.

Treatment through Medication

If you go to a golf instructor, the parameters of what you are offered are going to be fairly limited to ideas and interventions related to golf. If you show up with a tennis racket, the instructor might respectfully point out that, although there are some similarities in the weight shift, he is not in the business of teaching tennis. You'll be directed elsewhere or invited to drop the racket and to try using a golf club.

In the conventional scheme of things, families faced with the thought of dealing with ADHD are frequently directed into the narrow perspective of conventional medicine for the initial official assessment and treatment. Child psychiatrists, pediatricians and family medicine practitioners, although extremely well-intentioned and very much wanting to help, are sometimes bound to a menu as limited as that of the golf pro when it comes to possible interventions.

If a child's intensity is viewed as a disorder and disorders are 'bad' and need to be fixed, then if you are a medical professional, you are possibly going to try to alter the disorder by looking within the current medical bag of tricks to see what can best alleviate the intensity of the problem. This frequently translates to one medication or another. Granted, everyone wants to help and if a parent comes to a physician frantically pleading for a solution, who wouldn't want to provide a solution to the best of their abilities?

The holistic point of view, however, sees intensity as inherently a good thing. Of course it's annoying at times and of great concern when it escalates into a pattern of problem behaviors, but let's look for a way to redirect it into a new pattern of success.

Unfortunately, the current wisdom in the field is to recommend a "multi-modal approach" in relation to treatment. This is an allopathic concept. It almost always means that medication is front and center in the regime. If the holistic view-- that the intensity and energy are positive-- were in effect, doctors would be extremely cautious about prescribing medications. Why would they want to tamper with the energy system as a first-line intervention, especially if energy is viewed as a gift?

Informal Study

And don't let anyone tell you that medication isn't still a first-line intervention. About four years ago, a referral system change brought a change in the kids who came our way. Up until then, we were getting only the most difficult children, those who had been in the public mental health system for years and in most cases were already on medications. Then suddenly, many children were referred to us who had the very same kinds and degrees of presenting problems, but who had not yet been sent to a child psychiatrist for an evaluation.

There is no doubt whatsoever that a high proportion of these new referrals would have been given medications as a first-line intervention had they seen a psychiatrist first. The national statistics concur that 75% of the children initially evaluated for ADHD are given medications.

So, we started an informal tracking system and devised an informal study to monitor the outcomes of 50 consecutive cases of this nature. In the families that entered into and completed the 4 to 6 hour course of The Nurtured Heart Approach, 95% of the children were able to leave treatment essentially symptom free, without the need for any medications. The primary exception was a relatively small percent of children who had improved but were still hyperactive to a detrimental level. It was decided that these children could absolutely benefit from medication and they were referred to a physician.

For this reason, although we are very glad that medications exist, we must re-examine their wholesale use in situations where children do not need them.

Beyond the many physical risks and side-effects of medications, the psychological side-effect is that a child who is medicated comes to feel that his intensity is a bad thing that must be made to go away because it scares people and causes problems. He also may infer that he cannot possibly be in charge of his strong feelings and energy-- that he needs a pill to gain self-control. This is not a message that will help the majority of children in the long run. With the right tools and plan, children can easily learn to handle their intensity well.

It is not an uncommon psychiatric position to believe that most behavioral disorders are indeed brain disorders and that simply treating these conditions through medications is comparable to treating diabetes through the use of insulin. There is an internal logic here, but we are not convinced of its validity, especially after having treated as many children as we have and coming to realize that what appeared to be brain-related when treatment began no longer seems so as treatment evolves.

Of course there is an interrelationship between the brain and behaviors. It works both ways though. As the behaviors move to a new realm of success, the concurrent brain functions move to a healthy place. Doctors are only beginning to believe in the miraculous.

People who are proponents of "brain disorder" theories may not be considering that a child faced with living with this label may feel a lifetime of shame, as well as a lifetime of issues related to responsibility.

If a child comes to feel that there is something wrong with his brain, it stands to reason that our courts will be clogged with people who have acted out and who argue that they lacked the control to act responsibly. Some paid professional witness will argue on their behalf that a brain disorder was responsible, not the person. It is time to get off that train. It only goes downhill.

Juvenile correction facilities are full of children who are and have been on medications and are still out of control. Medications inherently do not solve the control problem. On the contrary, they inadvertently teach kids that we've given up on our ability to control them and their ability to control themselves.

Yes, it is a wonderful fix in some cases. However, considering the plethora of side effects, it is an intervention that frequently can be avoided.

Fortunately, many child psychiatrists, pediatricians and primary care physicians here in Tucson have reversed the old procedure by deferring prescriptions until parents have tried interventions like ours first. By taking this tact, even if they ultimately need to medicate, they have a truer clinical picture of the situation.

We believe that our informal study has held up over the years in that at least three-fourths of those who work with our model are able to avoid the need for medications completely. Four years later, in 1998, The Tucson Center for the Difficult Child had 212 referrals. Sixty-one were already on medications and 15 were able to be taken off. Of the 151 children not on medications, we only needed to refer eight for evaluations and only four of these ultimately needed medications.

It should also be said that pioneers in holistic health such as Dr. Andrew Weil have demonstrated a strong impact of nutrition and other alternative interventions on the outcome of children with behavioral problems, disputing the beliefs of conventional medicine that foods and food allergies have no proven effects on behavior. Our non-medical experiences confirm this and also confirm that, in addition to innovative ways of providing emotional, physical and spiritual nutrition, issues of intake, exercise and lifestyle have an enormous overall effect on us all. This is particularly relevant to intense, energy-challenged children who are prone to finding less substantial ways of self-regulating their energy level. Left to their own devices, they may make poor nutritional choices.

Just as adults can so easily form patterns around ways of self-regulating their energy level, such as by drinking coffee, smoking cigarettes or drinking alcohol, children begin self-regulating patterns through the intake of substances that affect their energy level. We are referring to a range of influences from the subduing/stimulating effects of sweets to the subduing/stimulating effects of television. Many of these things are not inherently a problem, though there are healthier ways for children to affect their energy level without becoming a slave to an outside influence. They can find stimulation in their excitement for sports or involvement in art, music or other focused endeavors, and they can achieve quiet control over their intensity through the peace found in calming activities such as reading, walking, meditating, yoga and other soothing endeavors.