From “Problem Child” to Child Behavioral Therapist:
James Lehman’s Personal Transformation

by Elisabeth Wilkins, EP Editor

Next week: Read the Excerpt from James’ new book, Transform Your Problem Child.

This week, James Lehman, MSW sits down with EP Editor Elisabeth Wilkins to talk about his life, his new book, and the hard-won lessons he discovered growing up as a defiant, acting-out child. From being abandoned in a basement as an infant to a life of crime and drug addiction in his teens and young adulthood, learn how James transformed his life—and how he’s teaching parents across North America to do the same thing with their own children.

Q: James, you had a difficult childhood and adolescence, and were headed down a dangerous path. Today you’re a nationally renowned child behavioral therapist who’s helped hundreds of thousands of families turn their kids’ behavior around. Did you ever imagine this role would be in your future when you were growing up?

James: It’s funny, I never saw myself becoming a therapist when I was a kid—far from it. I expected very little out of life. I had a very chaotic and painful childhood. I was abandoned in the basement of a building at around the age of 18 months, and then adopted by the man who found me, Ted Lehman. I wound up having some really serious behavior problems, both at home and in school. I was 13 years old the first time I ran away. And the truth was that I liked living out on the streets better than living with my family, because I felt like a loser and a failure at home; I hated myself. In contrast, there were no responsibilities when I lived on the streets, and since I had a hard time meeting the expectations my parents had for me—such as homework and appropriate behavior at home and at school—it was actually much easier for me to live as a runaway.

Looking back, I realize there were a lot of social problems that I couldn’t solve—I simply didn’t know how. My parents tried their best, but because I had conditions which weren’t very well understood at the time, such as Oppositional Defiant Disorder and Attachment Disorder, I was incapable of learning. And so I solved my problems through the most basic, instinctual problem-solving mechanism: fight or flight. I was defiant, which was “fight”—up until I became old enough to start running away from home, and that was “flight.” Those were my only coping skills.

I dropped out of high school at a young age and got into trouble with alcohol, drugs and the police. I wound up doing a significant amount of time in prisons and institutions during my teen and young adult years. I didn’t know how to deal with the obstacles life presented, so I turned to drugs and alcohol. Crime gave me access to and the means to buy both. From the age of 17 to 20 I was in prison, and that’s where I got my high school diploma. In my early adulthood, I hitchhiked across the country twice; I was trying to leave behind the life I’d created for myself. But no matter where I went, I couldn’t get away from drugs and alcohol, which always brought me back to criminal behavior—which in turn, brought me back to jail. It was a dangerous, negative cycle I couldn’t seem to escape from on my own.

Q: Sadly, many people aren’t able to escape from this cycle—they are never able to change the course of their lives after making those choices early on. What changed all that for you?

James: In 1973, a judge sent me to a responsibility and accountability-based treatment program, where I was really forced to confront many of the errors in thinking I’d made to justify being a drug addict and a criminal. Before I went into that program, I expected very little out of life; I thought I was just doing the best I could every day. (For me, that meant getting enough money for drugs and alcohol.) But in that program, I was forced to look at myself and my faulty thinking. After about 14 months, I had really learned to be responsible for my behavior. I learned to stop making excuses, blaming others, and thinking I was a victim of someone or something. And I learned how to accept accountability for the result of my actions.

A key part of that program included helping the other addicts who were in there with me. If I didn’t, my group leader would say, “Why aren’t you helping Tommy out with his problem? You know, he’s going to die if he doesn’t change, man. And it’s your responsibility to challenge him and help him in the same way other people helped you.” They pointed out your thinking errors to you, but they were also there to support you. They kicked your butt in that program—not physically—but both emotionally and mentally, they didn’t let you off the hook. They didn’t let you make excuses or lash out at others without being held accountable for your behavior.

I ended up graduating and staying on as a staff counselor. One of the things I learned about myself there was that I really liked the idea of talking to people and solving problems. I volunteered to be trained to work with others; I was one of the lucky few who got picked. That decision literally changed the course of my life.

Q: Was that when you decided to focus on working with acting-out kids? Or did that come later?

James: I actually started working with teens while I was still in the program. First, I did it voluntarily, because they seemed to gravitate towards me. I think they felt comfortable talking to me because I was able to recall how painful my own adolescence was. I combined that understanding with what I had learned about getting people to take responsibility for their actions, and I helped them learn how to be accountable. I found I really enjoyed working with the adolescents who were there—they were more open than the adults, and I had a knack for helping them. So when I left, I applied for jobs where I’d be counseling kids.

I was hired by an agency to work in one of their group homes for acting-out kids and teens. From there I went on to work in a series of residential and outpatient adolescent treatment centers, where I continued to take on more and more responsibilities. My work with adolescents and families progressed for the next 13 years. During that time I had supervisors who urged me to go to school and get the credentials necessary to complement my skills and life experience. In the end, I took their advice, studying and working full-time until I acquired my Masters in Social Work from Boston University.

At that time I was a treatment supervisor at a residential treatment center for adolescents and children. Eventually I was responsible for many different programs, which meant I developed a treatment plan, supervised staff regarding its implementation, and was responsible for the treatment of around 40 children at a time. Later, I sat for an exam in Clinical Social Work and began a part-time private practice. This was very fulfilling for me because it allowed me to really train parents how to be more effective with their kids. Both the parents and I began to see real change occur in the behavior of their children, both at home and in school. In fact, I structured my book, Transform Your Problem Child, in such a way as to give people an idea of what it was like to “sit in” on my meetings with parents and kids. I believe this allows the reader to see how I helped families deal with their various emotional issues. Although the characters in the book are fictitious, the situations are very real; I’ve worked with hundreds of parents who had the very same problems you’ll read about in this book.

Q: Transform Your Problem Child certainly puts the reader in the room with you and those parents! It also lets people see how you helped acting-out kids. Besides your ability to remember the conflict of adolescence, what else made you such an effective therapist when it came to children and teens?

James: I believe part of the reason is because I focused on actions, not feelings. Many counselors are taught to deal with kids by asking, “How did it feel when that happened?” I was taught, “What can you do differently the next time that happens?”

And I would lay it on the line with kids right away by asking, “Where would you like to be in ten years? What would you like to have?” The answer was usually what everybody wants: a car, a job, an apartment, a nice girlfriend or boyfriend. And then I showed these kids how their current behavior wasn’t taking them in that direction; I told them that if they wanted these things out of life, they had to learn how to act differently. One of the reasons that kids responded well to my approach was because I was working in terms that were realistic to them. I also didn’t get into arguments with them about their feelings.

So instead of saying, “How did you feel when you punched the wall?” I’d say, “Let’s look at what you do when you get angry.” This is a very different sentence, although the goal is the same. And if that child replied, “Well, I wasn’t angry,” I’d say, “Well you know, you punched a hole in the wall—usually happy people don’t do that. But if you were happy, let’s talk about what you’re going to do differently next time you get that happy. Because you can’t punch holes in the wall, no matter how you feel.” It was—and still is—a very different way of coming at the problem of inappropriate behavior.

You know, kids—and teens especially—often don’t know how they feel or why they feel that way. They might acknowledge they were angry when they punched that wall, but they can’t see that they’re angry all the time. And why are they angry? In The Total Transformation framework, my approach is that it’s because they’re confronted with social situations and problems which they don’t have the skills to solve. In fact, their best coping mechanism is to punch a hole in the wall, threaten you or throw a chair to make you stop. When they get a little older, they learn to run away or use drugs and alcohol. Then that becomes their highest coping skill. So you’ll see defiant, acting-out kids verbally abusing or threatening others, breaking things or running away.

I also think talking about emotions makes kids feel vulnerable. They don’t want to let go of that feeling, because holding onto their anger gives them a sense of power. They certainly don’t want to answer the question, “Why did you get angry?” Believe me, by the time they’re adolescents, kids have learned that if adults ask why, it means they’ve done something wrong. Adults very rarely say, “Why did you get an ‘A’ on your test?”

So, instead I focused on identifying the feeling and moving on to, “Let’s look at what you do when you get angry. Because the problem is not that you get angry—the problem is what you do when you get angry.”

Q: In The Total Transformation, your articles in Empowering Parents, and your new book, you talk a lot about problem-solving. Why is this such an important concept, in your opinion, for kids and parents to grasp?

James: Fairly early on, I recognized that one of the common characteristics of the kids I dealt with, regardless of their age, was their inability to solve both simple and complex social problems. These are the kids who are defiant at age three and don’t grow out of it. These are the kids who won’t sit down in kindergarten. These are the kids who turn everything into an argument, starting at a very young age. And in fact, in case after case, their acting-out behavior forced other people to solve their problems for them; they never had to deal with the stress and frustration of working through a problem on their own. As I thought about this more, I realized that these acting-out kids came from a wide range of backgrounds. In fact, a lot of them came from intact families—the kind of family where people would say “Gee, I wonder why that kid is acting out? He has his whole family behind him.”

I started to think, “Well, maybe this child has some type of learning disability which prevents him from learning problem-solving skills. So he falls into the same pattern of behavior as children who don’t learn those skills because their home life is so chaotic. Perhaps for some reason their parents have been unable to teach them those skills.”

I put some research and thought into ways I could teach kids to solve social problems. As soon as I started using these new techniques with them in my office, I started seeing changes in their behavior. I found that once kids had other ways of solving a problem that didn’t depend on processing things emotionally, they were much better able to engage in constructive conversations about their behavior and what triggered it.

Q: How did The Total Transformation Program come about? And why did you decide to write your book?

James: In my private practice, I was working with a lot of sincere, caring parents who were doing their best to raise kids with mild to severe behavior problems. In fact, often the family dysfunction emanated from the parents simply not having the skills and the training to deal with children who had behavior problems. I realized that parents needed help in managing their kids—they needed a different type of intervention than the ones they’d already gotten, because by the time I saw their kids, they’d usually been to two or three other therapists.

My vision and motivation as I wrote the Total Transformation was the realization that there were a lot of families across the country living in little prisons—and they were being held prisoner by their kid’s behavior. I began to see that these parents were often the victims of their kids’ acting-out issues, not the cause of them. And I believed that these parents needed to learn effective ways of dealing with their kids; I reasoned that if they learned the skills, their kids’ behavior would turn around.

Transform Your Problem Child came about because parents kept asking to hear more about the techniques I used in the office when I dealt with various behaviors, from lying, to defiance, to anger and verbal abuse from their kids. In the book, I try to empower parents by showing them that with commitment and the right parenting skills, there is hope to turn their child’s behavior around.

One way of looking at a parent’s job is to see it as a responsibility to empower kids with the skills they’ll need to make a good start when they reach adulthood. Here’s the bottom line: unempowered parents cannot empower their children. So, parents need to be empowered with the right skills and techniques so they can turn around and empower their children to start making better choices. I know how important this is, both because I lived it, and because of all the families I’ve helped over the years who’ve been able to implement these changes—and take the bars off their own little prisons and step outside.

Next week: Read an excerpt from James’ new book, Transform Your Problem Child. EP will feature the story of Caleb, an acting out, defiant teen whose parents had almost given up. Read how James helps this family get their son’s behavior under control, and how he gives them real hope for their son’s future.

Elisabeth Wilkins is the editor of Empowering Parents and the mother of a 6 year old son. Her work has appeared in national and international publications, including Mothering, Motherhood, Hausfrau, The Bad Mother Chronicles, and The Japan Times. Elisabeth holds a Masters in Fine Arts in Creative Writing from the University of Southern Maine.

Ever since I have been counseling children and families, I have tried to combine my entertaining talents with my therapy skills in order to make my treatments more powerful.  I even conducted workshops for mental health professionals on how to use unique toys to improve counseling skills.  I also conducted workshops for ventriloquists on puppet therapy.  In fact, I am an honorary member of the Japanese Puppet Therapy Association.

For a long time I have wanted to use my skills to provide group family treatment for ADHD families.  However, living in a small town, it is difficult to start this type of group.  Also most people accept the fact that it is tricky to run groups for children with ADHD since they tend to set each other off.

That is why I have finally decided to run these groups online.  I am actively preparing them and hope that some of you will be interested in participating.  We can have fun while simultaneously improving the quality of family life.  More information will follow.

Today was the first day of school. I always worry that the other kids will tease me and call me a dummy. Dr. C told me that puppets like me are called dummies. I told him that I preferred puppet or vent figure, and he told me that he would just call me Elwood.

The first day of school is always hard for me. I worry whether or not I will like my teacher. I worry whether I will know the children in my class, and if they will be nice. I also worry about bullies.

Dr. C. made a shirt with me on it. I say no, no, no, no, no, no, no to a bully who wants my money. The shirt is in Japanese, so all I can read are the no’s. I told Dr. C that if I said no, no, no, no, no, no, no to a bully, the bully might hurt me. Next he told me that I could tell the teacher or the counselor, or the principal. I told him that then the other children might not like me. Finally he agreed that bullies can be a big problem.

The writing on the shirt is in Japanese because Dr. C. wore it when he spoke about bullying at the Japanese Puppet Therapy meeting. I got to be there too because I am the puppet. Dr. C. said that bullies are even a bigger problem in Japan than in here in the USA. I am sure glad I don’t live in Japan because I don’t like bullies.

Anyway, probably it will be ok for me this year. Usually I have friends and nobody bullies me. Also my friends can help me if there is a bully. That’s good to know.

That’s all for now from me. Elwood, signing off.

A high percentage of children with ADHD , particularly boys, also have Oppositional Defiant Disorder (ODD). ADHD alone can create friction within the family. ADHD, when combined with ODD, can make family life much more challenging. I have known parents who did not want to go home after work and face the frequent conflicts. Some were also concerned that if they did not go home, the problems might escalate even more. Family life with ADHD and ODD can become quite unhealthy for children and parents alike.

It is better to act than to react. In order to improve the situation it is a good idea to have a plan in place to improve family communication and cooperation. Consequences need to be clearly stated, and parents must follow through. I also want families to have fun together and accomplish goals as a team. I want people in families to treat each other with respect.

I have created a program specifically designed to encourage more peaceful families. The program takes into account the special needs of children with ADHD. I will be presenting the program in the near future in a series of teleconferences. I hope you will be able to attend.

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When medication helps, the effects can often be remarkable. It is easy to fall into the trap of putting all of the responsibility for the improvements on the medication and forgetting that the child is responsible for her/his own behavior.

Obviously the medication is an important part of the treatment. However you have to remember that children improve because they try to change. The medication does not make them act appropriately. It just makes it easier for them to improve if they try.

When we put all of the emphasis on the medication, the child can stop taking responsibility. Remember to emphasize that your child is doing better because he or she is trying rather than just focusing on the importance of the medication.

A child does not have to have all of the symptoms of ADHD in order to be diagnosed. Only 6 hyperactive/impulsive symptoms are needed to diagnose ADHD primarily hyperactive/impulsive.  The child needs 6 of the inattentive symptoms to be diagnosed with ADHD primarily inattentive.

If the child has six in each category, the combined ADHD can be diagnosed.  However, 3 year olds probably need to have 7 or 8 of the symptoms since more of the symptoms are normal at that age.  It is also important that the child be compared with his/her peers when deciding whether the symptoms are present.  Finally a child must also meet the impairment requirements in DSM IV in order to be diagnosed.  If the child is not significantly impaired, the diagnosis should not be given.

If you have concerns, I recommend that you take your child to be evaluated by a child psychologist or by his/her pediatrician.

~Dr. C

Today I am going to discuss some of the advantages of joining a support group. Support groups can help you in several ways. To begin with they offer you a group of peers with whom you can swap frustrations, successes, and strategies. Frequently talking to peers is less threatening than talking to professionals. Sometimes peers have practical insights which we professionals might overlook.

Next, peer groups offer you a place where you can learn which local professionals work well with ADHD. Other parents know which professionals have been able to help them. They also know which school teachers and counselors are sensitive to ADHD.

Peer groups are able to recommend or even provide advocates and help you to better understand your rights. They are also able to set up professional presentations so that you can learn more about ADHD. There are regional and national conventions at which you can learn from many different experts. ChADD, http://www.chadd.org, for example, will be having their national convention this November in Anaheim. I will be there with Elwood and lots of other fun surprises. I hope that I will be able to meet those of you who attend.

Finally, sometimes you can meet parents at support groups who are willing to swap baby sitting with you. As you all know, it is not always easy to find people you trust who are willing to stay with your children while you have a well needed, relaxing night away from responsibilities.

Peer support groups can be a very worthwhile investment in time, energy, and money.

We are building a Support Group of our own! It’s Dr. C & Elwood’s ADHD Club. Sign up for our newsletter to receive helpful tips to help your child and your family!

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When you put your hand up, you can block out the sun. One little hand can stop you from seeing the biggest object in our solar system. This phenomenon is truly amazing.

ADHD, just like your hand, can block out your ability to see and enjoy your child. There is a tendency to find ones self focusing entirely on ADHD related problems and losing sight of the child as a whole. It is easy to fall into this trap when every night you spend four hours helping your child do homework, when every time the phone rings during a school day you begin to feel anxious that your child is again in trouble, when you feel unable to take your child into stores or to other children’s homes to visit, and when you spend considerable time in counseling sessions because of the ADHD.

DON’T LET ADHD STOP YOU FROM ENJOYING AND APPRECIATING YOUR CHILD!

Find fun activities which you can enjoy doing with your child on a regular basis.
Limit the amount of nightly homework time.
Reduce the amount of energy you spend on ADHD related problems.
Appreciate your child’s assets instead of only focusing on the deficits.
Don’t take the problems personally or too seriously.
Create an ADHD friendly home environment to increase success to reduce the stress.

Remember that your children will only be children for a short time period. If you spend all of your time on the problems, you will miss out on all the fun. Don’t let ADHD block out your son or daughter. If you don’t start enjoying them now, they’ll be grown up before you know it.

WHY COUNSELING

SAMUEL R. CARON, Ph.D.

We all know that the treatment of choice for children with ADHD is a combination of medication and counseling. The medication increases brain activity and thus improves functioning. What I am going to discuss today are the purposes for the counseling component.

My first goal when I counsel ADHD families is to educate children and parents about ADHD. I use my 10 video lessons (http://www.adhd1.net/adhd-dvd.htm) to help me accomplish this. Understanding the disorder helps parents make informed decisions. It also aids them in better differentiating between misbehavior and ADHD related problems. It allows them to feel more comfortable with the medication when they understand the disorder and the purpose of the medication. It gives them the information they need to explain what is going on to skeptical relatives and friends.

Understanding ADHD

The children also need to understand the disorder. Understanding ADHD allows them to blame ADHD for historical inadequacies. This is probably better than their previous conclusions since so many children with ADHD decide that they are bad, stupid, crazy, lazy, uncontrollable, unlovable, etc. This education helps achieve a second counseling goal of improving the child’s self-esteem, which is so frequently damaged.

While encouraging the child to blame previous problem behaviors on ADHD, I simultaneously discourage them from continuing to use ADHD as an excuse. It is important that children take responsibility for their behaviors. On the other hand, we simultaneously want to make their environment more ADHD friendly so that they have a better chance of succeeding. Helping families develop ADHD friendly environments is a third goal of counseling.

Reward Programs

Setting up reward programs; improving family communication; constructing external reminders such as signs around the house; developing consistent family structures; reducing family arguing; practicing personal problem solving strategies; developing reasonable expectations; if necessary, reducing the amount of time spent daily on homework; having more family fun; helping parents to stop taking the problems personally; etc. are all ways to help make the environment more ADHD friendly.

Another counseling goal is to educate the children and parents about medication. It is easy to fall into the trap of thinking of the medication as a good pill or a smart pill. We discuss the fact that there is no medication that will make them smarter or keep them out of trouble. Although the medication does help improve concentration and reduce impulsivity, the children must try in order to improve. I want children to take responsibility for any improvements since this can also help improve self-esteem.

I think that some children resist the effects of the medication if they believe that we are trying to control them. That is why it is essential not to tap into their oppositionality with regards to medication.

Educate the Family

Another goal of the counseling is to educate siblings about ADHD. This can help them better understand the problems. We want the siblings to be our allies in treatment, and we do this by involving them in the treatment process.

A major counseling goal is to repair what is broken. ADHD can impair the relationships the child has with his parents, siblings, teachers, and peers. It is important to try to repair these. ADHD can also strain the relationship between the parents. It is essential that the parents are able to work together as a cooperative team in order to cope better with the problems.

Another goal of counseling is to determine whether other family members also need treatment. Every full sibling has a 40% chance of having the disorder. It is not unusual for the primary care taker to be depressed, and so this also needs to be explored. Parents might need marital therapy if the problems are affecting their marriage.

This article is not all-inclusive, but it does provide information about the importance of the counseling component.

Samuel R. Caron, Ph.D.
Dr. C & Elwood

I was thinking about the problems that parents have in public places managing children who have ADHD. The children easily can become overly stimulated and wild. They have a difficult time sitting still. They talk too loudly. The become bored easily. Many also have Oppositional Defiant Disorder in addition to ADHD. Before going out in public, it is important to :

1. Anticipate the problems so that you can develop a plan of action. It is always better to act rather than react.

2. Tell your child the ground rules in advance. Let your child know what the consequences will be both for compliance and non-compliance. Having a reward system in place is frequently helpful. Immediate consequences are very important.

3. When you arrive in the public place, identify a private place to which you can take your child, if needed, to deal with any problems. It can be embarrassing to discipline your child in front of lots of other people. A private place could be your car, the bathroom, or a corner away from everyone.

4. Plan a structure which will reduce the possibility that the problems will occur. For example, if you know that your children will fight with each other, keep them physically apart. At the Seder I recommended separating some siblings, and we even sat some of them with other families.

5. In a church or synagogue event, you should feel free enlisting the help of other adults. Don’t feel as if you are alone. Religious groups should function as extended families.

6. Don’t let one child’s problems interfere with everybody else’s enjoyment. If necessary, you can have a sitter on call, and entirely remove the child from the event without significantly interfering with your involvement.

7. Many problems recur. If you don’t figure out how to manage the problem properly the first time around, go “back to the drawing board” and come up with a better plan for any recurrence.

8. If your child takes medication, remember that medication is not just for school. It can also make it easier for your child to succeed in public places.

I hope these suggestions are helpful.