A NUMBER of years ago the children who presented themselves to the child psychiatrist were anxious, striving, depressed, or neurotic. They were enjoyable to treat because they usually got better. The children who lied, stole, or refused to work were handled routinely-by priests, a switch at school, or parents who were not loath to make their feelings an important influence in the life of the child. Those parents sometimes felt helpless and guilty, too, but somehow the child shared in their culpability so that they were miserable together.

We still see neurotic children, albeit in lesser numbers. But there are different children in the waiting room now, stomping Play-Doh in the rug. These are the "enfants terribles." They are crafty and well aware of their parents' weaknesses and their therapist's limitations. Reared with copious love and minimal responsibility, they expect everything and are furious when denied anything. Parental ulcers, high blood pressure, and depression are met with disdain. These self-indulgent autocrats control the family and insist on being the center of attention. Well-stuffed, protected, and regularly immunized, they claim eternal nurturance. Life is an umbilical cord attached to an endless reservoir of vanilla pudding. When faced with adversity they push, plead, whine, and screech; or they tearfully complain, "You never told me." Undisciplined, with scant social skills, they are disliked by peers and neighbors.When angered they attack a smaller sibling, twist the cat's tail, or accuse their mother of lack of love.

Seen as immature in kindergarten, they are labeled "hyperactive" in second grade and are eventually referred to the psychiatrist simply because the teacher can't stand them. Unfortunately, standard therapy techniques make them worse. The permissive approach, which provides a plethora of toys and encourages infantile behavior, is a recapitulation of their lives. The newest approach is the "positively based behavior modification program." Parents avoid noticing horrid behavior and reward the good. This yields excellent results with anxious, guilty children but scarcely touches these young despots. The psychiatrist can only help the parents develop firmness and common sense. Responsibility is best learned in the home.

The parents are an uncomfortable lot, who endure their progeny as if they were a crown of thorns on the cross of parenthood. They try so hard they make a mess of things. They ask me if children may be affected by food additives, hypoglycemia, or separation anxiety. Their offspring are seeds in the desert which, with love, will sprout and flower. I am the expensive gardener who will magically transform the monsters into marigolds. In fact, children, like flowers, can wilt from too much care.

The first of these children I clearly recall was a small sturdy eighteen-month-old name Angel. He had the knack of turning blue by holding his breath. His mother hovered over him and attempted to divert his attention as he pulled over wastebaskets and skillfully emptied drawers. When she placed him on the couch for a nap, he kicked at her face, twisted, screamed, and clawed at her dress. Finally, like a chameleon, he changed from pink to purple. Mother quickly picked him up.

Another "enfant terrible" was a pert self-possessed young lady of four. She was piloted to my pediatric waiting room by an exhausted father. He soon lost himself in Field and Stream, while she systematically demolished books, toys, and less aggressive children. After several such encounters, I removed crayons, scissors, and all breakable objects from the waiting area. On her next visit she circulated aimlessly about looking for any sharp or gooey object. There was none. She spent a few minutes perusing the large lighted tank of tropical fish. She methodically collected every ash tray in the room, dumped them together,and,standing on a table, unloaded her collection on the fish. Father glanced up from his magazine, groaned, and took her to wash her hands. On their return, she glanced about to see if the toys had reappeared, then settled against Daddy, sucking her fist with legs widespread and her free hand massaging beneath her panties.

© 2008