S1: Eps 5. Let's Talk Kids' Mental Health (feat. Dr. Shmuel Mandelman, PhD)

How do I know when to be worried about my child? How do I know when it's just, "Yeah, he doesn't want to go to school. She doesn't want to go to school because she doesn't like school." >> How does one assess if their educational leader that's giving them advice with regard to mental health issues knows what they're talking about or not? Welcome to the Learning Curve podcast brought to you by Mishbaha Magazine. We're raising children in a changing and challenging world. >> So, let's tackle the important issues facing from families today. >> I'm Rabbi Rafel Garfield, Manal of Yeshiva Taurus MS in Houston and I love talking about >> I'm Rabbi Ari Shonfeld, man of Manhattan, director of camp. I also love talking and sometimes fishing. >> Join us as we answer your questions and discuss the topics that matter to parents the most. >> Welcome back to another episode of the learning curve. Onward we move. Rabbi Garfield, as we started, >> yeah, we're going through so many fascinating issues. It's amazing. And today we're going to continue on a topic that we began last week, which was the role of therapy, the growing role of therapy, the very sensitive role of therapy that it plays and shouldn't play in the roles of our children. We have a very special guest today to continue on that theme. As always, we begin with the fireball emails. So, here we go. Rabbi Garfield, let's get right to it. Question number one goes from me to you. And just of course as a disclaimer, these emails were not written by us about our own children. They were sent in by our listeners. Some of them have names attached, some of them don't, but we'll keep them anonymous to protect the mothers and fathers. Dear TLC, my daughter has a real problem with honesty, and she really works on convincing herself that her fabricated version of the reality is the truth. My husband and I have such a hard time approaching it. We have tried a lot lots of different approaches and nothing seems to be working. Any advice? Doesn't say the age of the daughter. So, I'll allow you to pick that lane. >> Problem with honesty and she doesn't seem to ever see the truth. >> So, I have a funny take on honesty. It doesn't really fully apply to this case per se, but I'll say it and then I'll work it to this question, which is sometimes I love when students lie to me. You're right. You don't hear that. >> Yeah. Please don't make that the quote on the >> Yeah. on the mishbuck ad. Sometimes I love when students lie to me. As long as the bubble is by your like coming out. >> Exactly. Wow. >> Exactly. But I'll tell you why. Because I learned this early on. It's it's the child saying I know what I did was wrong essentially. >> Oh, I've heard from you. You had you told us in the first episode of remember? >> Did I? Okay. >> Yes. For our ad. going to tell me the shickle of so you mean of course you wouldn't talk okay in class because if you're going to do that >> I wasn't going to go down that exact route but yeah that's the idea basically a student saying >> unpack it >> yeah it's basically a student or child saying I know it was wrong of me to do x y and z and I'm so embarrassed that I did it that I've made up this lie and as I probably mentioned the first episode because it's what I think about when I think about lying we don't have to go far in Hashem's Torah to find people who are in denial or trying to avoid responsib ibility for acts they did that were wrong. So when you see a child being dishonest, you don't have to go far to look at some of the great personalities of our Torah to see that's a common reaction to being caught or being put in a position that you're in trouble. So I just want to put that out there that being dishonest even though of course em is theu and bracious parlo Kim spells MS and I'm not trying to minimize it. I just I think it's important to recognize that it's a human sort of natural reaction to shame and let's focus on the what's really going on and not on the end of the line is a lie, but what's underlying it? What caused it? What are the real reasons that child is acting out that way? >> What's your advice for this parent? >> Yeah. So, I just what I was going to say is for this parent is that if the children are young, seven, eight and younger, they do have this imaginary reality. And I didn't review the developmental literature to give like an exact analysis. Maybe we could ask our guests later on. >> Yes. For that, >> but there is an appropriate stage where children live in a more fantasy world. They play in fantasy. They live in fantasy. The whole idea of a child playing peekaboo, right? They think you're gone. They have this alternative reality of truth sometimes. And so helping a child grow out of that is important. But I just mean to say that if a child is living in that and they're younger, it's not the end of the world. Now, how do you help a child move past that? I don't think it's on forcing them to admit that they're YOU'RE LYING AND I KNOW IT. I would think that there are softer ways to go about it. Say, okay, maybe that's true, but what are we going to do? There are no cookies left in the cookie jar or however we could avoid a non-confrontational focus. I don't think youth >> she's in seventh grade. >> So, that's already a bigger problem. Meaning, if you have a seventh grader who definitely developmentally knows what lying is, that is concerning. And I imagine there are a lot of other things going on that need to be addressed. So, that kid needs to perhaps be in therapy or be talking to someone or has other problems in their life. I guarantee you the only thing going on is not lying. And I would say to that parent, let's address some of those bigger issues and the lying will follow it. >> You remind me of a story. It's not about lying, but it's similar. I had someone that I was close with and his son stole his wallet and this boy was a high school kid. Stole his father's wallet and he says to his father, "I want a computer and I'm not giving you a wallet back until you buy me a computer." So the father calls me and said, "What should I do?" I knew the father. I was close to him. So I said to him, my initial reaction is call the cops. Don't let you know this is a while. This happened a long time ago, 10 years ago when I was much younger. And I said, "How you that can't let your son control you like that's crazy." I said, 'But before I tell you to call the cops, I didn't mean it literally, but I meant totally be tough on your son in that scenario, let me have an uncle, Abby Fishoff, who deals with teens at risk. Let me call him. So, I called my uncle and my uncle says to me, tell the father to go to Best Buy and buy him the most expensive computer in the store. So, I said, "Ai, Tazley, explain this to me." >> He said, "Such an amazing VA, exactly what you just said." He said, "This is not a kid that is struggling with computers. There are plenty of kids that want technology, that want a computer. They don't steal their father's wallet. This is a kid that has deep issues, who needs real, deep therapy, and needs to unpack whatever is really hurting him. And this father has to show the kid that I care about what you care about and has to become on this kid's team and help him through whatever he's helping through. This is not a computer fight. This is a He's struggling with something much bigger. It was such a mindopening moment for me. But I think when it comes to lying, it's similar. As you said, if the daughter is in the boy's seventh, 8th, ninth year, and he's pathological and he's lying and not seeing the honesty, there's something much deeper there that needs to be probed as opposed to just I know you're lying. Tell the truth. >> Agreed. All right, let me ask you a question now. You handle that very well. Here we go. Dear TLC, please walk me through an early stage vaping conversation with my son Barakashem. It's not an issue yet, but I hear it's prevalent in other classes and yeshivas, and I want to get ahead of the problem. Vaping conversation with my son. So, I have three teenage sons. I'll just share my wife and my approach. I think I hope my sons are the non. >> If they weren't listening to the podcast yet, they'll be listening to this one. Hey guys, >> two different yeshivas. So it's not just one type of yeshiva and all three of them are amazing. >> Who's the best fisher of the three? >> Is that even a thing? >> Azie. Yeah. No, it's Pasha. My ninth grade son. Yeah. >> Would anyone feel insighted by that question or? >> No, they they know. >> Okay. Azie, keep it up, man. >> Yes. >> That fish. >> Yeah. >> Okay. Go ahead. >> So anyways, you get me distracted. So I think of course this is cultural. There are certain cultures where this is a real battle. I know. Yes, nonhivish. Of course, in the Mohivish schools, vaping is more of an issue. Our approach we try at our home is I think when you try to convince kids not to vape because you tell them it's dangerous or you tell them this or tell them that 9th, 10th, 8th, 7th, 11th graders don't think most things are dangerous. I had a tom of mine who just broke his leg and the first question that the doctor asked in seventh two weeks ago, do you vape? And he said, why do you care? He doesn't. He said, because the recovery process will be twice as long because it slows your blood flow to your ankle. He hurt his ankle. the recovery process will be twice as long for for a 16-year-old kid. Interesting. But anyways, my point is that it's about we're above that. I think the conversation about vaping is kids that vape because they think it's cool. No one vapes because it tastes good. Everyone knows it's bad for you. The stud and you're not going to inundate them with studies. You could show them the horrible videos and st Yeshivas do about smoking and vaping what it does, but we're above that. We don't do that in our family. We don't need to do things that other people might do, might consider cool. Where in our line is we're shuffles don't vape. Passnished. It's a pnish conversation for you who such a good boy from such a good family. I think the peer pressure. The point is cuz vaping is a peer pressure conversation. So is drinking. So is vaping. And you have to give the self-confidence to your son that he doesn't need a vape to be cool. And the kids that vape, there's nothing less cool. I tell this to my tummy. Then I taught him sister for a bunch of years. There is nothing less cool than a kid trying to be cool. The kid that comes onto the basketball court matching his headband and his socks does not have the best three-point shot. And vaping is an attempt in certain circles to be cool. And we are bea cool in this family. It doesn't you don't have to have the coolest family. I think are pretty cool, but we're not the coolest, right? But we're proud of who we are and we don't need it. It's almost you have to take it away from who you are. That's been that's our approach. One of my children, I won't say which one, came home and let us know that someone in his yeshiva offered him a cigarette. I think was a whatever it was. And he turned it down and he was very proud and he was open with us and obviously having an open relationship and trusting is all important. >> Wow. >> And it's a hard >> it is. It's amazing how it's like slowly slipping further and younger. I was just somewhere and I saw 12 year olds or 11 year olds in the northeast like vaping and I was like shocked that it's become such a part of the system and it's so weird that it's like a f thing almost. >> Yeah, you could get very deep and maybe philosophical of how could it be that it seems the more right-wing you get the more prevalent it is. Is it because they believe they don't believe they don't trust the studies? Is it of course because they don't have so many outlets? There's a lot of I'm not here to I don't think we're discussing why is it that causes this challenge. This is a parent that doesn't want a kid to have that challenge. And obviously, by the way, part of the issue is going to be who he's with, who his friends are, what he goes to, what is your value system on certain. >> What's your camp policy on vaping for counselors and for students? >> No, vaping is vaping. Vaping, drinking, >> you're because is the coolest camp. You don't need to, >> right? We're cool. No. And that's I believe again 95% of camps have that >> and a kid who's thriving in camp doesn't need the external high cuz he he has it hopefully if he's happy in camp. >> I hear you. No, definitely. It always goes back to this idea of what is the underlying cause, right? Like why is he vaping? It's not because he has money to burn or the love >> vaping because he thinks it's cool. At a seventh, ninth grader, he's vaping or smoking or drinking alcohol. Doesn't taste no kid likes that beer or the schnaps. He's vaping because he thinks it's cool and you have to show them that it's not. Chunfeld I'm curious like as a manal or even in camp but let's say go back to school scenario if you find that like some older boys who are more exposed to it are bringing it into school and even exposing younger kids to it like selling it or sharing it with younger kids how would you handle that >> I've actually have dealt with that in the past in one of my experiences and that is a red line the general rule in >> any of you will kill the child is that what you're saying >> I know I have to explain what that word means The general rule is that if a child is a mai, if you're causing others to sin and if you're exposing children to cigarettes, to alcohol, to inappropriate material, that's where a yeshiva a camp has zero tolerance. Zero. I was involved in a scenario once as an educator and there was zero tolerance and that was that for literally this exact case. That's where you have to show the kids that your is not to be masic others. I think of Jakob Kameki said he's not Michael the person who gave him his first cigarette. >> Wow. Yeah, you might want to get that quote straight. That's a pretty serious quote. >> Yeah, I think so. I know. I think so. I'm pretty confident. But yeah, these are tough suggest. >> Wonderful. Now, we have a great honor to have one of the real leading lights in the mental health space to talk to us about these issues. I'll just briefly tell you all who the few people who don't know about Dr. Mandleman. Dr. Mandelman has degrees from Colombia, Yale. He did work at Cornell close to of Greenblat as well as rebella and he does a lot of consultation for eer and other organizations including tomasura's acclaim diverse learners initiative and mash and training program and it's great to have you run the clinic which is a mental health I don't know exactly what it is maybe you'll tell us about the clinic which is a place in Brooklyn where's the clinic located >> Brick, New Jersey, right outside of Lakewood. >> And that's what you do now, right? That's your primary focus? >> I don't know if I have a primary focus, but it is where I spend a lot of my time. >> Got it. So, what does the clinic do? And then I have a question for you. >> It is a multi-pety center where we have neurosych, psychology, social work, speech, language, pharmarmacology all under one roof. >> Amazing. Amazing. Sounds great. And do you work primarily with the firm community? >> At this point, the vast majority of my patients are from the Orthodox community. >> All right. So, you'll be that's a great resource for us to discuss. Here's my question for you, Dr. Mandleman. I'm looking at your resume. I see Colombia. I see Yale. I see Cornell. Besides your proclivity to be involved in anti-semitic institutions, why did you choose to go down the route of academic study, why did you just get some therapy degree, become some kind of therapist, one of these specialized type of amigootherapy counselor and put out a shingle and help for me in Lakewood? Why did you take this route that's so full of more complexity? Why don't you just go the simple yeshiva way? Despite my appearance, I do not believe clinical and yeshiva should go in the same sentence. I am a firm believer in the need for there to be a level of excellence in clinical care and I therefore pursued degrees and training in the institutions in this country outside of whatever political stances they may have, >> right? that offer the highest level of excellence where excellence in whatever it is that one is doing is of paramount importance. And >> do you find that the people around who are all over our community who have much less training do damage and are a problem for the community? So I spent 12 years in graduate school and again at institutions that you previously have mentioned without appropriate education, training, supervision. When one is dealing with things as delicate as other humans lives, by definition they're going to be damage done. Not that everyone is maliciously intentioned. However, when it is that you don't know what you are doing and you don't know your boundaries and you don't know the scope of your work and you are in a community which unfortunately is not as informed and educated within mental health as it should be. And as long as you are a co-religionist with something on your wall, people feel comfortable and people are desperate and therefore they make decisions in terms of which clinicians they are going to use not necessarily based on their background and expertise, but rather because of religious affinity as well as their availability. And a lot of them will espouse areas of expertise and specialty which in reality is quite limited. That isn't to speak to all clinicians that happen to be orthodox and practice within the orthodox community but there are many of them that do that I would claim to be outright dangerous. >> Wow. Part of my motivation of opening the clinic is in order for the Orthodox community to understand that being orthodox and expecting clinical excellence is not contradictory in any way, shape or form. And in the same way that the Orthodox community when it comes to medical care will only pursue those with the greatest reputations and those who are the hardest to get into and they will use whatever level of protection necessary because they believe when it comes to something such as physical health that's of paramount importance. Part of what the clinic does is being able to demonstrate we can have clinical excellence in mental health within the orthodox community by and for the orthodox community. And I end up as part of my work given that my focus is on diagnostics and consultation unfortunately cleaning up many cases of clinicians who were not appropriately trained or supervised or educated and therefore have misdiagnosed, mistreated, misguided. Again talking about their intent and talking about the outcome for patients experience. How would you respond to one who says that there's a big difference between medical issues and the nama of a human being? Psychology touches on the understanding of the basic psyche, the basic humanity of a person. And to go to the gym, to understand that is inconsistent with our messiah that represents a human being aid and an ashama at a different place in humanity. First of all, there is no such mess. First, let's start with that. Second has a different mitas >> that what >> that has a different mitas in the >> we all know the we all know how he gives Madreish. We can go into who adds Madr on top of it. We're familiar. >> We can deal with all that. But when we're talking and I think a lot of what people's misconceptions are is that when somebody has a psychiatric illness or the by definition there is interplay with something religious and then if you go to anyone again even from clinicians there's a great danger that you are going to be negatively influenced and your soul is going to be damaged because of the vulnerability that's involved in the process >> and Freud's perception of humanity which was >> so Freud is dead has evolved very significantly since then and we are preoccupied with making sure that our practices are evidence-based and I have the opportunity to collaborate on a constant basis with daily And whenever there is a point of concern, I'm able to reach out to any of them and discuss whatever possible area of concern there is. And I can tell you that the just based on my patient load has come to that understanding as well that there is something called a psychiatric illness which is in the domain of a mental health professional and then there areistic and that are within the domains of our great rebbitic leadership. >> I just want to share a story. It happened a few months ago. I was sitting at a kadesh on a shabas and there was a fellow a very orthodox fellow who was saying this idea regardful that therapy is a trafe and then like mamish therapy is tra would never let anyone go to therapy and he said to me at the kdish I went to falls and he said to me at the kdish $10,000 bear is against all therapists so I was like wow okay I said I think you're crazy I left the kdish I went shabas I was eating shabas by at his family I said the story the guy looks at me and he says to me who I was eating at. He says, "I'm a Zik Sheni my second marriage. I went to Revel before my second marriage and bear said to me, get a therapist and I said, "No, a good one." So, I went back. It's a good thing. You'd owe me a lot of money. I can tell you that I learned son for two years bear as a daughter-in-law who's a mental health professional here in Lake of New Jersey and that I am in regular contact with Rebellar about mental health cases that he refers and guides to appropriate mental health professionals. Yeah, I think we're all on the same page. Regardful for those trying to poke the bear a little bit. >> Exactly where he was going. >> Yes. You know him well enough to know where he goes. Here's my sh Dr. Mandleman as we're both menal. So we have parents that call us and say, "How do I know when to be worried about my child? How do I know when it's just, yeah, he doesn't want to go to school, she doesn't want to go to school because she doesn't like school or she's a little anxious and it's the normal anxiety. And then when is there a barometer where a parent can of course we're stereotyping and I understand I picked anxiety it could be OCD it could be ADHD where we as manalin should direct a parent to go get professional help. Is there a simply explainable mahalak to understanding the difference between normalbah and normal jumpiness and normal anxiety for the first of yeshiva of test taking and when it turns into the area of that's concerning I think you should go for professional help >> so the paradigm that we generally use is and again even diagnostically is really looking at the level of impact on functionality that it has and the level of pervasiveness that exists, all kids are going to be somewhat anxious before a test. But if a kid is not able to get out of bed that morning and for days before they haven't slept and they will do anything under the sun to avoid it and we are seeing negative behaviors as a result of it that would be suggestive that this is not just garden variety test anxiety which is a normative human response to it having to be able to perform at a specific level that has some stakes attached to it. But it really comes down to pervasiveness and level of impact on function. And this is a question that obviously we deal with on a constant basis. And but the interesting thing is if you tell a parent that your child is normal and they're developing and you need to give them time and space to do they want a refund because they want letters attached to their name because therefore it gives them a >> an ability to identify this is the issue. This is what's wrong. No, no, no. Your kid is a kid. They're developing. This takes time. Give them the time and space. Support them appropriately. And if you don't slap a diagnosis and a label on it, and if you tell them that this is normative developmental variation and that they just need to be able to go into themselves or really if the presentation is secondary to something else, if they would address the primary, the secondary would be less prominent. They don't know what to do with themselves. What percentage of parents come in and that's your response? Do you find parents are being overly cautious? >> I tell you the truth, the nature of my practice, the >> You're the last stop, not the first stop. >> Exactly. The vast majority of people who are walking in my door have seen multiple mental health professionals, have had extensive testing. There's been previous treatment. Not all, but the vast majority. and they're coming because they've not been able to arrive at the level of clarity or care that they've been looking for until this point. >> When it comes to a child like this struggling in a classroom, what could we expect from a Moora or a Rebby in order to be supportive or to make it worse? generally do you find that teachers are trustworthy partners in addressing mental health issues or but do we have to approach them with more concern >> I don't think it's a question of trustworthy it's a question of how informed they are and like Garfield said before I'm involved in terms diverse learners initiative program and what is so important about that program is that we're able to allow ow people to gain the knowledge and understanding of what it is that they're actually looking at and what it is that's going on. So instead of it being a knee-jerk reaction as to this kid isn't behaving, therefore I'm going to do this, they already can give pause and think about what are the possible contributing factors that may be leading to this behavior or fueling this behavior or furthering this behavior. So it's not a question of trust as much it is a question of how informed they are of whatever it is that's going on in the front. >> Have you found that that our moros and reb again we're being so stereotypical but that's what we're doing that's all we can do are informed enough to help the struggling I know it's the HVH but is that a huge challenge or is that something that there's been a lot of growth in? There's been a huge shift of late where there is more understanding and a greater level of awareness as opposed to them just thinking that there's something bad about the child. Is there still an enormous amount of room for improvement? Yes. But I think a tremendous amount of credit goes to the mistas that even mistas that we would not necessarily think of as being progressive in any way are very much the flagships and institutions of have really stretched themselves beyond what they would normally be thought of to really understand and appreciate what it is. And a lot of that is an artifact of the reality of things not working. And I'll tell you I'm nice. I got a call two weeks ago from a Rebi. I happened to know the manal didn't know he was reaching out. Nobody knew. He reached out and totally no information shared about who, what, when, where, and said I, it's the end of the school year. I been struggling with this kid. I've done everyone's given me. Throw me a lifeline. What am I want this kid to be able to finish with a positive end of his year and can't manage him in the classroom entirely. What can I do? And here's a Rebi who is seasoned, accomplished, extremely wellliked. But when he saw that none of the traditional methodology impressive the kid, he took the initiative to reach out and say, "Give me something. What am I missing? How does this make any sense?" So again there is no question more and more of that is happening and again when traditional methodologies and approaches are not being effective it obviously is a significant motivating factor for them to be looking elsewhere. A few years ago, I was bothered by something, but I think it's even changing now, which is I was so impressed that elementary schools had become places of more sophisticated training, mental health, special ed. And I felt like the yeshiva system, the high schools didn't have that same level of sophistication. Like, how many high school yeshivas have resource rooms with properly trained professionals or have mashki or mental health professionals who come and work with the kids? And I wonder if you see that changing even into the high school level. >> I I know that there's a movement now with elephant budney. Maybe you're part of that Dr. Melman to train manal. I got a phone call from sisters to try to I think you're part of that aren't you? There is certainly a push now that there needs to be at all levels. >> There's a buy in from the topas >> and there is buy in and I can tell you I am positioned in a way that I get to interact with all of the most competitive mistas in Bali. with rash that have me on speed dial and institutions again that no one would think this is a sheet. But no, there is more and more understanding and more and more push for them to get appropriate help and not allowing it to sit until it's gone to a level where crisis but identifying and there are mist again that are would never be thought of as progressive where there are conversations that are going on about mental health and people making sure they're getting appropriate interventions. >> That's great. Dr. Melment as something that was always considered a red line for yeshiva. You're never allowed to tell a parent that your kid needs medication, right? And we're not doctors, but we both I'll speak of half myself. I've seen enough kids. I run a camp. We we spent one summer together think I was in Heler. And there are kids that you just I just know this kid needs to be medicated. I know his brother maybe or I know him. I see it. He's ADHD. He's anx what the titles don't matter. And is that an appropriate a measal to have a frank conversation with a parent? You have the parents that are anti- meds. I don't mean the parents that they're the organic homeopathic. That's a much harder conversation. The taboo of medication. I don't like the way my son feels on medication. And me as the experienced manal, I know time after time that your son's life will change once he's medicated for whatever ADHD, anxiety, OCD, whatever it is. You're the professional. You're the doctor. Is that me overstepping my boundaries by trying to be almost overtly aggressive with parents in a loving I'm not talking about parents that I'm that I'm close with. >> I'll tell you where we get into trouble. We get into trouble when believe that the beginning and end of everything is you take a pill and everything will be fine. Beyond that, parents very much feel when there is a mandate coming from the top, they feel very uncomfortable about it. And I think it all comes down to presentation and when they're hearing it from the whose expertise is in and they've seen many children benefit from it. if it's presented that I think this is an area that's worthwhile exploring and this is something that I think it needs further diagnostics and an evaluation instead of it being the minalis telling me my kid needs meds >> right >> both telling me that my child is struggling and there's possibly something that if done through appropriate channels would be helpful to leading my child to success. The muscle that I like to use and it's not my own is the eyeglasses muscle of the kid who's struggling to read and you move his desk and you give and then you realize he can't see. So the glasses is turning him back to what he is or she is and you're alleviating an unnecessary pain or struggle. And if we would view therapy medicine as glasses to the apprehensive parent that's my approach is the same way if if I took off my glasses I wouldn't be able to see the board. And that's the stigma that we try to erase that we've made tremendous strides in. But right, it's about the presentation and they're not feeling that you're >> even even within my clinical work. I will tell them my clinical recommendation is that pharmarmacology is something that would likely be very helpful here. And parents are again for a multitude of reasons, some far more legitimate than others, are apprehensive, even hearing it from a clinician. But I make it very clear, I can only tell you what my clinical recommendation is based 2,000 cases a year that I deal with when you're not going to. Sometimes they need to wait and sometimes they need to start another process to see and often times if let's say for example a child presents with both an attentional deficit and a language disorder I will tell the parents clinically there's a clear indication for ADHD here we have another issue we can go start language therapy and I'm just telling you that what we want is your child to be able to maximally benefit from whatever interventions are being offered you can start that process but in that process if it becomes evident that they're not able to maximally benefit given the fact that their attention is getting in the way then it's an incumbent and again there are some parents that I have to plea and tell them that your child without medication you're doing an out of law and it all depends on the severity of the case and severity of what else is going on and the level of impact we parents and again any responsible parent would be reticent and hesitant to go jump and do it. But when they're shephered through that process and there's a level of transparency in terms of side effects, every single person believes that a kid on ADHD medicine is the same thing as having somebody on thorazine where they're going to be entirely sedated and drooling on themselves as opposed to it being something that will aid in their ability to focus and benefit them within the classroom. And again, lots of misinformation. Again, the vast majority of our population's information is coming from this school bus stop in the morning with other parents who share similar levels of concern. And even diagnostically I will get all the time in part of our intake process we ask who suggested this diagnosis and it will literally be from a friend, a neighbor, a family member that heard something of a similar nature and therefore decided this is the direction that it should be going in. But again, there's a lot of misinformation about medication, including what side effects are and how it will impact. And I and I tell parents all the time, the objective with medication is to position your child to succeed. It is not to rob them of their personality. And if we're seeing drastic changes in who they are as human beings, it's a question of them being on the wrong medication or the wrong dosage. And it is an art more than it is a perfected science. But the benefits when it is in fact called for are enormous. Rabbi Elephant was here from the mirror before Pesak and he got up in front of a huge crowd of parents and he said the one piece of advice that I have for you is if your school or someone is suggesting medication do it because he said kids are coming to him in the mirror third fourth year based medish and they are missing this piece and it like really starts to impact them significantly which makes me think of people often say my child starts with drugs in sixth grade and what's going to It's like what do you think are the risk factors for drugs if you don't help him succeed in sixth grade >> out you know? >> Yeah. What do you think is a bigger chance of someone ending up in drugs at 23 years old or 18? Is it a kid who was successful in school through medication and was really much and goes on and is academically a success or a kid who can't pay attention, can't do well and is constantly feeling bad about himself? Which is a bigger risk factor for medication? And again and I are very close and constantly are in consultation with each other. But I see it play out not only in I'll see it play out of bias. and I'll see it play out. Now again DSM the latest guide in terms of diagnostics is now much more permissive of adult diagnosis of ADHD which is a recent change but and I'll get it all the time and I'll get it in terms of parents bringing in their child obviously ask for a family history and the wife invariably points to the husband and the ADHD, anxiety, language deficit, depression is all attributable to that and often times there'll be a question of and then the father will ask is there something at this point in my life that I would still be able to benefit from >> me and Garfield have a hard time relating to such people are both docile tame no ADHD here >> and I I tell everybody that I have done thousands and thousands of evaluations I've yet to meet a person that has a shorter attention span than myself I I was once evalu valuating a child of a prominent mental health person and the end of the evaluation and that evaluation was pushed by one of the most premiered Russia yeshiva because he was concerned that there was some component going on in a very competitive and at the end of the valuation the child tells his mother whether or not I have ADHD you'll find out soon that mandelman has ADHD. I can tell you now. >> I love it. I love it. >> Yeah. Heard from someone that if you take ADHD away, if you cure ADHD, who will be the rebame of our children? >> Yeah. >> Let me ask you this. Assuming that someone's manal, a parent listening to this has a manal that was not yet trained by DI, the few that are still not trained by you and to Misora through DI or the Mamco training program. How does one assess if their educational leader that's giving them advice with regard to mental health issues knows what they're talking about or not? Maybe the person is ill advised and giving them bad advice. Like how does a parent assess their own educators? >> So again, I'm not here to bash educators tonight. We could do that on a different night. >> Are you available? >> I think is also able to take that guidance and direction. Parents also very much feel like if they're given guidance and direction, they're stuck, they're mandated, sit with that information, there are enough from mental health professionals that they can bounce an idea off of. And again, anyone who's willing to make a diagnostic conclusion, who isn't willing to be challenged and isn't willing for somebody else to look over their shoulder and say, "Does this make sense or not?" is problematic. And I encourage every one of my clients that come in here to argue with me about the formulation. I want them to walk away with a level of clarity and a level of understanding as to why I arrived with what I arrived to. And again with Manalim Morris Manales, whoever it is, if they're saying something and you then can go to somebody who you can trust that is more knowledgeable and better versed in mental health and bounce that off of them. And again, often times parents are untrusting of their own gut. And because they're untrusting of their own gut, either they take whatever is said as gospel or they have to question everything, >> right? >> As opposed to being able, and I do this multiple times a day at mom, does this sit well with you? Does this make sense to you? How is it that you view this? again making them stakeholders within the process and making sure and again when we're in positions that we can make determinations whether that be a be a clinician we have to understand that there's a huge power dynamic at play and people are coming to you they're vulnerable by definition >> and the fact that we hold the positions and the titles that we do introduces a very significant empowered dynamic and people don't want to disappoint. They don't want to make you feel like they're not trusting of you and therefore they're put in a very difficult position as to if it doesn't resonate, what do I do then? And and I even challenge the kids when I explain to them what I think is going on. I want it to sit well with them. I want them to be able to understand the process and where it manifests and why. So people also have to still know that despite there being a power differential, they shouldn't lose their common sense or their parental intuition, >> right? >> That's assuming that they're healthy, which is not always the case. But again, the more we can bring them into that process and the more we can educate them and empower them, the better our outcomes are. >> Dr. Lemon, I have one more question. I'm gonna leave the micro and turn macro maybe a little bit big picture then hand it over to Rabbi Garfield maybe to finish it off but I'm not asking you to be a ni only and that is is there a trend in the mental health the ch let's discuss the children is there a trend in terms of the biggest issue facing cli from orthodox community today and do you see it do you see a pattern do you see a trend is anything that you are concerned about anything that you see changing if someone says Dr. commandment you get to speak at I don't know what the next event and you get to speak for five minutes about the number one challenge facing the mental health of the of our children today what's your answer >> parent child relationship >> just to be clear there's more listeners here than the adira event but as if the ad tora is like a crowd see podcast is where it's at anyway continue the parent child relationship >> I think it all comes down to parent child relationship and I am a developmental psychologist by training and case after case when it is that we see that there is a healthy relationship between the parent and the child our outcomes irregardless of diagnosis are exponentially better. >> Wow. >> From eating disorders to learning deficits, it all comes down to the basics. And we often times get lost in all of the rest of the pieces given lots of conflicting values and lots of things competing for our attention. At the end of the day, the single most important factor and outcomes of a child with or without the diagnosis is the relationship between parent and child. >> Which part of the relationship? >> The level of attachment, the level of understanding, that feeling of security. And again, irregardless of diagnosis, because if I don't have and I could just take you through my dayto-day eating disorder to a bipolar to a child with a reading deficit to a child with significant anxiety. And part of why in my process it's so important that we sit with the parents is we get to see those dynamics. I had a kid here who is struggling enormously academically and I I was asking him are there any parts of school that you like don't like and immediately the kid fall apart and watching how is it that parent goes ahead and tries to soo that child? How is it connecting? How is it the parent is understanding that what it is that the child is going through >> is and again it's a gamecher and it is frightening the opposite and how much of our children's anxiety is secondary to parental anxiety and one of my associates is now doing their dissertation really looking at the impact that parental anxiety has on their children in terms of their academic performance. and their overall ability because think about with all of the expectations and demands that exist. When parents are highly anxious and they're not able to regulate themselves and they're not able to therefore give what they need to give, the children suffer and then we end up projecting our own issues and shortcomings onto our children which has very significant long-term negative impact. I assume you've seen Rabbi Schlommo Halman's countress called Kamayam upon him. >> Yeah. >> It's a masterpiece that talks about this and really like you said he focuses on the relationship between parent and child as the key to all the other aspects. Really beautiful >> again irregardless of diagnosis. >> Yeah. He even says even if the parent is not in the presence of the child that they get those messages which is almost cabalistic. It's pretty wild. That's what attachment means. It means that I know and I have that sense of safety and security that there is somebody who is able to understand, appreciate, care, hold that which I'm experiencing. It's not about physical proximity. And that's really again what is in terms of we look at risk and protective factors within developmental psychopathology that early attachment is the cavea and now we have a lot of coups who are doing all sorts of repairative therapies for that attachment right >> and again a lot of what people are calling trauma and complex PTSD is really a manifestation of that lack of appropriate attachment and forensic relationship early on. And parents also believe that if they can't actually just be real and own their own stuff and acknowledge their own shortcomings, they think >> you mean to their children or just in general? >> No, in general as humans. But again, there's this sense that our ability to be there for our children is because we are the paragonss of perfection. And if you share something with your child feels like you're patronizing them in some way. I was here a few weeks ago with a colleague of mine who brought his child in and the child was having a hard time in school again was thought to be ADHD was not ADHD and the parent immediately connected with the child and said listen I had my experience like but you saw that bond and messaged the parent afterwards and I said your ability to be fully present and connect with your child in the way that you were was all inspiring. Just that piece of being connected, being real, and the child having that sense that I am understood and appreciated for who and what I am, and that there's somebody who's not looking at my test score and not looking at my performance, but rather can understand and appreciate me as a human is what sets people up long term for their ability to succeed in life and be able to contend with real challenges which are inevitable. So, I imagine our parents with this are listening to this. Some are probably feeling good about their relationships, but others are either wondering, "Oh, no. How do I do that?" Or, "Oh, no, I haven't done that." So, what advice would you give to an aspiring parent who really wants to work on that relationship? Is there a protocol or a training or a safer? What would you give that advice so we could end off giving parents something that they could do to develop that key relationship with their children? We are all aspiring parents. There is nobody who has perfected that craft. But it's really trying to be present despite all of the distractions that exist and despite any of the other things that we're contending with. When a kid knows that they are your top priority irregardless of anything else without any fancy techniques, without having to do any is to be able to accomplish that. When a child can understand and feel, my mom or my father are able to be there for me in the moment and be present, which is enormously difficult. Being present is something that is a matas. But when they feel that they are priority and my parent is able to do that for me and recognize me and it doesn't have to be these prolonged periods of time and it doesn't have to be these over-the-top experiences which are largely compensatory for the parents to be able to justify everything that they've done wrong till that point. And instead of just saying I'm human and sometimes I am not necessarily successful in the way that I want to be as a parent or as a human being in general, but just being present and that presence alone allows them to really feel and once they can start building on that connectivity and again people say you missed the critical developmental period it's game over. No, there is a concept of repair. There is a concept of even later in life being able to give people what it is that they need to be able to move forward. >> Dr. Lamb, that was not only riveting but inspiring and really we can't thank you enough for joining and we know your schedule is busy being and the health and the strength to continue helping. >> Thank you. There's a lot of takeaways regarding from Dr. Mandleman. To me, the most powerful was the ending with all his I don't want to use the words because I probably don't know it. You know, all his clinical expertise and all his shimish and what he does the whole day at the end end of the day, it's about relationships. It's like that for our parents and our children. It's like that for our to our It's like that was right. It's relationships are the bedrock of any healthy human being ability to function in this world. It was inspiring. Sounds I know sounds [ __ ] but >> it's like encouraging. It's empowering. >> Empowering. >> We have the tools that we need. >> We have it to be able to whatever our kids a natural mats or he or she has whatever the whatever the condition comes with it. If we're present, which is such a powerfully important word for them, that will be the number one indicator of well, they'll be able to navigate their journey of life, >> right? I wonder. I'm sure it's based on research if he was so confident in it. And I'm sure there are some reports about it, but it would be a fascinating thing to to look into and understand how that works, right? >> Well, there is a therapy LMFT. I have a family member who's a licensed marriage family therapist that her entire therapy is through the parent child relationship. So there is an entire field in therapy that focuses on that relationship and it's >> I know Dr. David Pelowitz, he's been quoting this for 20 years, this study, almost every speech, >> that the more times a week that a parents eat together as a family is directly correlated to the lack of drug use as teenagers. >> It's the same. It's the same part. >> Yeah, he's been quoting that for years, right? >> Very powerful. >> Just being present and just being a important figure in the child's life. So, what a wonderful episode. I hope our listeners enjoyed it as much as we did >> and we keep the TLC conversation going. We'd love to hear from you. We've heard from so many of you and it really gives us and is very insightful. You have wonderful things to say. We could hear from you either through a call-in. The number to call in and leave a message is 4436869339. Again, the call-in number is 443686-9339 or you can send an email to the learning [email protected]. Just spell it all out. The learning [email protected] Garfield once again it's a pleasure. Always is. Mashem, always will be. Take care. >> All the best. >> Thank you for joining us on the Learning Curve podcast. Find more on this and other topics at mishbah.com.