My nurse warned me.  The patient in room 2.  The parents don’t want the child to know he is being examined by a doctor.  They think he will have a melt-down.  He thinks that you’re a scientist and he is here to join a research project for smart kids.  It wasn’t the most unusual warning I ever got.  That might belong to the fellow who brought a monkey to his disability examination.  He said it was his emotional support pet.  Another time a woman asked me to pretend to be her mother’s dead husband.  The old lady had Alzheimer’s disease and hated doctors but she had comforting nocturnal conversations with her husband.  She was a black lady and so was her husband, but I did my best and we got along fine.  Our clinic has had other interesting visitors but Esbryt was the boy in room 2, and he was a good example of the kind of child I want to tell you about.  He was a controlling child, one of many who have come to the clinic.  He was one of many who are widely misunderstood and usually misdiagnosed.

Esbryt was half-sitting in his mother’s lap when I walked in, and he greeted me with a look of deep suspicion.  He was 8 years old, a well formed, handsome young man with shaggy brown hair that he hated to have cut because he couldn’t stand the sound of scissors.  He spoke well, but his answers were terse and delivered as if he were doing me a favor.  He wasn’t afraid, just cautious.  ‘Guarded’ is the technical term.

Esbryt had had evaluations before and he had been in therapy more than once and I could understand why he was wary.  Controlling children don’t like to be scrutinized.  I wasn’t about to scrutinize him, though.  I knew what the problem was, right off.  His parents wrote on the admission form, He gets angry at the smallest thing and when he’s angry he flies into a rage.  

Esbryt was correct with strangers if he had to interact with them at all, and he behaved himself at school.  He was bossy with other children and didn’t care to play with them if they wouldn’t do what he wanted to do.  At home he was a tear.  He had a “meltdowns” or rage attacks at least once a day and usually around the most trivial matter.  His mother bought a new plastic container for the silverware drawer, and he noticed it that night before dinner.  He said, in his professorial voice, Why did you change it?  I liked the old one.  (His mother was, in fact, a professor at our University; his father was an IT guy.)   You wouldn’t think a new silverware tray would be the occasion of a tense reaction, but Esbryt went on to rage about all the injustices he had suffered at his mother’s hands.  She was thoughtless and uncaring, he said, and careless of his feelings.  He went on for a while until his mother finally convinced him to go to his room.  He would calm down there, she knew, with all his electronic devices, especially his videogame computer.

She knew it would be a problem when it was time for dinner.  Hopefully, it would only take five or six invitations to come down and eat, and when he did, she hoped he would only be surly.  She had made the only things he liked to eat: chicken tenders and tater tots.  His little brother had more conventional tastes, but she tried not to serve crunchy food because Esbryt complained that he made too much noise when he chewed food.  After he had eaten half of a chicken tender and three or four tots, he would say, Would you please make that moron chew food like a normal person?  She might say, Oliver, chew with your mouth closed, please, but it wouldn’t matter.  Esbryt would get up and go back to his videogame.  He usually used some unkind words as he did.

Esbryt said it made him sick to his stomach when someone made noise when they chewed.  Oliver wasn’t a particularly noisy chewer, his mother told me, but Esbryt had a delicate stomach. That’s why he only ate chicken tenders and tater tots.  Sometimes he ate pizza or grapes.   Esbryt was a smart child, but he was too young to report that unusual foods, like broccoli, upset the delicate balance of his intestinal microbiome.  Hopefully, he will never get to that point although I have met people who have.

The symptom, by the way, is misophonia.  For some reason, someone chewing, usually a younger sibling, is a common provocation.  Clicking ballpoint pens is another, although pens that click are less common than they used to be.  Nothing is worse to some kids than the sound of a classmate clipping his fingernails.  In my High School, there was a guy named Buonofusco who would do just that, every day in fact.  I thought it was a welcome break from the class routine and wondered why his fingernails grew so fast, but the clicking sound never bothered me.  People with misophonia notice things like that, sensory events that most of us hardly notice.  No one can stand the screech a piece of hard chalk makes on a blackboard.  Fortunately, there are not many of those around, either, but people with misophonia are unusually sensitive to minor auditory stimuli of the younger-brother-chewing kind.

Esbryt wasn’t here to see me because of his sensitive stomach or his auditory system.  He was an angry child.  He was unusually irritable and any affront would set him off.  Most of the things other people did around the house were perceived as affronts, or, worse, terrible mistakes.  It was his duty to react appropriately and set things right.  He considered appropriate reactions to be an icy, derogatory remark, or yelling and screaming, or banging his head on the wall, which he used to do when was younger.  

What makes a healthy child in a perfectly normal family get angry at least once every day; rage on and says the most horrible things; routinely wishing that one or another of his immediate family were dead; claiming that he must have been switched at birth from his real parents and asserting that his brother was a birth accident of an altogether different kind?   Esbryt’s parents had tried to find out.  A neurologist told them that the child didn’t have epilepsy and his rage attacks words were not the consequence of brain disease.  One of the psychologists who saw him thought he was autistic, or ‘on the spectrum’, as they say.  He accumulated a few more diagnoses: oppositional-defiant, bipolar disorder, disruptive mood dysregulation disorder, and ADD of course.  Although he was only eight, he had been on several psychotropic drugs, including Ritalin® and Prozac®.  The Ritalin didn’t have much effect and the Prozac made him wild.

I asked, Who in the family is a perfectionist?  Then I asked, Who in the family is a bit controlling?  You know you are on the right track when the question makes one of the couple thoughtful while the other answers quickly in the negative.  I wait for the thoughtful spouse to amend the answer, gently, but usually in hilarious detail.  You know how you do in supermarket, first the cans and boxes, then the meat, then bread and then vegetables on top.  You do supermarkets clockwise.  And you never by an ear of corn without stripping off the husk.  Sometimes mom is the perfectionist and dad is controlling, but the traits are divided equally, I think, between the sexes; some people are perfectionistic and controlling.  They are the traits of Obsessive-Compulsive Disorder; the disorder is rare but the traits are very common.  In Esbryt’s case, he got it from both sides.  His mother was controlling and his father was a real OC.

Did Esbryt have any idiosyncrasies?  Things that he has to do in a certain way were things that he says her does over and over?  Does he eat one thing at a time?  Does it bother him if his food touches, on the plate?  (No, he doesn’t, M says, but I used to do that.)  Is a picky eater?  Does he respond sharply to certain textures, like the way some clothes feel, or does he hate to wear socks, does he insist on wearing the same clothes every day, day in and day out.  Does he have trouble throwing things out?  When you clean his room do you find things that make you wonder?  Does he let you clean his room?   Esbryt was not so flagrant with his eccentricities, although he did hoard candy, not an unusual thing for child to do, except he seldom ate it, but just accumulated large quantities, which he organized according to certain principles that he was unwilling to disclose.  To loosen him up, I told him how I organize my bottle-cap collection, but it didn’t work.  (I don’t have a bottle-cap collection but if I did I know how I would organize it.)  Does he always have to have his own way?  Does he get angry when things don’t go the way he expected?  Is he intolerant of uncertainty?  Is he intolerant of fools?  Fools, that is, just about anyone who happens to be there.

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You know that there are controlling men and women, but you may not realize there are controlling children.   Esbryt was a controlling child.  He didn’t have OCD or any other mental disorder.  But he had an OC trait, the compulsion to be in control.  His senses were well-tuned to detect errors and to him, every error was an affront.  Thus afflicted, his emotional reactions were intense and he would lose control.  These are characteristics of a controlling disposition.

What is a controlling disposition?  Why is it so common, and why is it so common in children?  Is it something new, a new mutation, the consequence GMO food or the Internet?  If it is not a mental disorder, what is it exactly?  What’s so great about control, anyway?  And what can you do about it, Doctor?  I shall answer some of the questions in the coming pages.  It will alleviate the burden of having to explain the controlling child to parents who bring one to see me.  It happens at least once a week.

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A controlling disposition is a symptom of the obsessive-compulsive personality disorder.  Esbryt had a controlling disposition but he didn’t have OCPDO.  That condition is said to occur in 3-8% of adults.  People with the OCPDO tend to be rigid, angry and controlling.  They’re cautious, deliberate, hyper-rational in their approach to life.  They emphasize reason and logic at the expense of feeling and intuition, although their reasoning is usually a bit eccentric.  They aren’t quite so prone to overt obsessions and compulsions as patients with the Obsessive-Compulsive disorder (OCD) and if they were, they wouldn’t admit it.   Children, however, aren’t diagnosed with personality disorders because their personalities aren’t fully formed or fixed.     So, we say that kids like Esbryt have obsessive-compulsive personality traits, or OC traits for short.

The obsessive-compulsive personality disorder is related to obsessive-compulsive disorder.  The psychiatric manual draws a distinction between the two.  OCD is a mental disorder because it inflicts distress on the patient and disables him from doing the things he has to do.  Think of Howard Hughes, living for years in a bedroom in a hotel in Las Vegas, never leaving the room for fear of germs.  The OCPDO is a personality disorder because the patient is just that way.  If there is any distress involved it is what he inflicts on the people around him.  Think of the Jack Nicholson character in As Good As It Gets.  Such distinctions matter to psychiatrists, although they may be difficult to discern except under a very bright light.  

OC is a disposition, the way some people are.N1  An OC is an individual with OC behaviors and traits.  OC behaviors are similar to the symptoms of obsessive-compulsive disorder.  OC traits are like the characteristics of an obsessive-compulsive personality.  OC is not nearly so intense, disturbing or debilitating as OCD or OCPDO. That’s good, because it is so common.

OCD is a mental illness and thankfully rare.  Patients with OCD are disabled by obsessions, persistent ideas, thoughts, impulses, or images that are experienced as intrusive and that cause distress, and by compulsions, repetitive behaviors that are perceived to prevent a dreaded event.  OC behaviors are just like obsessions and compulsions but they aren’t disabling and don’t usually cause distress.  The compulsion to re-load the dishwasher after your spouse loaded it the wrong way isn’t intended to prevent a dread event.  It may be a waste of time, but some people are fussy about dishwashers.  Common obsessions and compulsions include germ-phobia, excessive washing, hoarding, counting, checking, ordering things and all manner of fidgets.  Almost everybody has some of that; some people more than others.

When you tease a friend and say You’re so OCD you’re probably not getting it right.  You ought to say, “You’re so OC.  It is a distinction with a great deal of difference.  OCD is a severe and debilitating psychiatric condition.  It is said to affect about 1-3% of the population, although I think that’s an overestimate.  Many of the people who are so diagnosed are just OCs who happened to be going through a bad time.  Children are actually diagnosed with OCD more frequently than adults are (5-8%), but most are just going through a phase and when they grow up, very few will have a mental disorder.  They will always be a bit OC, but most OCs are good OCs and useful to have around.  You don’t want an accountant or a cabinetmaker who is not a perfectionist, but if an accountant or cabinetmaker has OCD the job will take much longer to get done, if ever.

OC is incredibly common.  In a study from New Zealand, when children were followed from birth to age 32, no fewer than 42% said that they were bothered by obsessions and 45% by compulsions.  That is, 42 and 45% of normal healthy adults.  Similar numbers were found in studies in Switzerland, Egypt and Canada.  In Israel, 72% of teenagers who showed up for preinduction examinations said that they had had obsessions and compulsions.  In all the studies, the obsessions and compulsions were similar to those of patients with OCD but were less intense, less frequent, and rarely disabling.  There were innocent foibles, you could say, eccentricities, idiosyncrasies that almost everybody has.  In fact, most OCs are good OCs, though fussy and annoying sometimes.  Good OCs are conscientious, which happens to be the most healthful of all personality traits.  Bad OCs, on the other hand, tend to be controlling.  They blame you for not being as conscientious as they are.  Between good and bad OC, there is a continuum.  My guess is that at least a third of us are somewhere on the continuum.  Most, I think, are towards the good side.

The most troubling OC trait is the preoccupation with control, as in, He’s a real control freak.  OC personalities seek to exercise control, ‘both upon themselves but also on their environment’.  ‘Their environment,’ indeed.  It means you.

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My clinical experience with OCs and controlling children may be because of where I live.  My home is in a pleasant and unassuming part of the world that local boosters have given the unlikely name, The Research Triangle.  Why anyone would want to live in a triangle is a mystery to me, but the lure of geometry seems to have attracted a unique concentration of highly educated and conscientious people.  We have, for better or worse, more PhD’s and MDs as a proportion of the population than any other place in the world, except maybe Los Alamos, but without the mountains or the plutonium.  

What qualifies your writer as an advanced expert on the topic of OC is the fact that OC traits tend to gravitate towards the PhD’s and the MDs of the world, as if they were viral parasites that attached themselves to genes for academic achievement.  I suppose it is more accurate to say that OCs gravitate to IT, engineering, science and medicine.  You have to look hard in any of those occupations to find someone who isn’t a bit OC.

You can only imagine what happens while young men and women are pursuing advanced degrees.  Thrown together as they are in the labs, libraries, hospital units and data centers that festoon our neighborhood, the inevitable happens.  Boy and girl find in each other a common love for order and neatness, high achievement, string music from the Carolina mountains, Subarus and NPR.  Conscientious as they are, they settle into one of our many modest homes, as near as possible to a good school, and tend the garden.  You can only imagine what their children are like.

Good OCs, as it happens, beget little OCs, most of whom are very good.  They play soccer, field hockey and lacrosse – well, maybe not lacrosse, for fear of head injury.  They do well at school and thereafter are destined to repeat the cycle.  It’s the circle of life or something like that.  Life, though, does play tricks, and even the best, most conscientious OCs may generate a bad one.  Controlling children are bad OCs.  Maybe bad is too strong, but they are taxing.

Controlling children almost always have obsessions or compulsions, but since we are not talking about a mental illness, we should refer to them as peculiarities, idiosyncrasies or eccentricities.  Does the child eat one thing at a time?  Does he get mad if his food touches on the plate?  Does he have to be driven to school the same way every day?  Does he ask the same question over and over?  Does he worry if there is a change in routine?   Or get mad?  Does he notice everything?  Does he collect unusual things?  Well, you say, All children do those things, and you’re right, except maybe not all children.  What about this one: He can’t stand the sound of blowing his nose.  Or this one: She can’t abide the labels inside T shirts.  Or: When he walks down a hall he flicks his fingers against it.

Obsessions and compulsions are an ordinary part of childhood development.  Most children, however, are not controlling.  Most children are tolerant of the foolish and annoying things that other people do.  Most children learn how to deal with frustration and disappointment.  Most kids have a mild, accepting disposition.  They go with the flow.  Some children, however, are intolerant of fools.  They are intense and strongly reactive and hate to be frustrated or disappointed.  The flow, they believe, needs to flow their way.

OC traits and behaviors are ubiquitous, but the controlling trait is not so common at all.  However, controllers make up a substantial number of children who show up at the offices of psychologists and child psychiatrists.  I wish they would all read this book, because they usually misinterpret the problems that the children have.  They diagnose them with ADHD, oppositional-defiant disorder, bipolar disorder or autism; their therapies and medications are often misdirected.  I always recommend this book to the parents who bring their controlling child to our clinics.  It saves me a lot of explaining what a controlling child is, and what to do about it.  Controlling children may be bad OCs, but their personalities are malleable, and they don’t have to grow up to be controlling men and women.   The world is well served by the third of us who are good OCs.  One doesn’t have to be a bad OC forever.  

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OC covers a wide range of experiences and behaviors that a lot of people have – and, at one time or another, all of us have had.   Perhaps you suspect that I am making normal life seem pathological.   I have no such intention.  Nor am I inclined to invent a new mental disorder.  I have enough trouble with those that already exist, and you probably do as well.  Besides, what credit is there for describing a new form of insanity?  The risk is they’ll name it after you.  Your name will go down in history, embedded with one more egregious imbalance of the human condition.  Think of poor Dr Alzheimer; I say, No, thank you.  An entomologist who discovers a new kind of beetle can name it after his girlfriend.  An explorer who finds a mountain can name it after his wife.  I don’t think F would welcome the equivalent honor.  Frances!  I have discovered a new disorder characterized by irrational outbursts of violent rage and I named it after you.

Normal life is crazy enough, but it is not necessarily pathological.  The problem with a normal human disposition is that it can get complicated, especially in pre-pubertal children.  Children are prone to all manner of things that in an adult would be grounds for calling the authorities.  Suppose you caught your 40-year-old brother-in-law playing with matches in the straw under the front porch?  Or your wife playing doctor in the toolshed with the man next door?  Tantrums occur all the time in very young children but not in grown-ups, unless they’re drunk or smoking crack.   Kids have imaginary friends, night terrors, the expressed desire to marry one or the other of their parents, and the irrepressible belief there is an evil dwarf residing beneath the bed.  They have weird habits like eating snot, they like to spit bubbles and twirl round and round; not to mention the rituals, obsessions, compulsions and tics, which concern us here.  We don’t consider such events as incipient mental illness.  Psychiatric disorders usually begin during adolescence and early adult life.  The emotional problems and behavior disorders of children are only sometimes associated with mental disorders in adult life.

OC traits and behaviors are normal enough, but in children they can be troublesome, even problematic.  The most troublesome such trait is a controlling disposition.  Understanding it better will alleviate many of the problems that families have and help them guide the child more sensibly.  It would prevent a lot of irrelevant diagnoses and unnecessary drugs.  Therapists who see such children need to address the child’s need to be in control and where it comes from.

Controlling men and women will always be with us, and what do you think they were like when they were kids?  I said that the emotional problems and behavior disorders of children are only sometimes associated with mental disorders in adult life.  I would prefer that controlling children grow up to be controlling men and women less often than sometimes.  

K, an intelligent and well-educated woman, brought her son for a consultation.  He had been having rage attacks for several years and they were getting worse.  The boy was Colin.  He was nine years old, healthy and quite bright.  He was a handsome child, dressed more neatly than most nine-year-old boys and his short, fair hair was done back with gel.  He was sitting next to his mother in the examining-room, engrossed in a game on her mobile.

K had taken Colin to a lot of different doctors, but he was as surly as ever when someone annoyed him, which happened most of the time.  People are fools, he was probably thinking, And this one is likely a bigger fool than the rest of them.  How did I know?  Having observed children and their ways for longer than I care to say, I know.  He wasn’t playing the game in a placid, contented way.  He way playing his game at me.   When a child is engrossed, his emanations say, Don’t bother me, please or Don’t bother me, you moron.  

K had taken her son to several therapists and she had him tested several times.  One of the psychologists thought he might be autistic.  Not really autistic, you know, but on the ‘spectrum.’  She and her husband had taken him to pediatric neurologist who did the obligate MRi and an EEG.  He wasn’t having seizures –the child, that is, not the neurologist – but Why not try an anticonvulsant for his rage attacks?  He may have a temporal lobe syndrome.  His amygdala, you know.  So the boy was on Tegretol® for a while.  His anger attacks got worse.  Some seizures actually get worse on Tegretol, said the neurologist, so he tried Keppra®, another anticonvulsant.  On that particular drug, the child started to hallucinate and was admitted to a psychiatric hospital.  

There, a psychiatrist told K and her husband, R, that the boy was ‘bipolar.’  He prescribed Abilify® and Seroquel XR®.  The two drugs cost $1400 per month but at least the boy didn’t have so many rage attacks.  At the cost of sleeping all the time and he gained 15 pounds in four weeks.

K had already seen a pediatrician, who treated him for ADD, to no particular effect, then to another pediatrician who was an expert in ADD.  She had taken her son to several psychologists, an occupational therapist and a couple of other psychiatrists.  One psychiatrist recommended BuSpar for his anxiety and another, Prozac for his mood disorder.  

One of K’s friends told her she needed to take her son to a neuropsychiatrist.    Nothing worked very well, of course.  So why not a neuropsychiatrist?  They are the ones, after all, who understand behavior and the brain. 

I’m not sure that the neuro- prefix on one’s shingle by itself confers deep understanding of brain or behavior.  In my career I have met neuro-chiropractors, neuro-optometrists and at least one neuro-lawyer.  If I live long enough, I’ll probably meet a neuro-neurologist.  But I did know what the matter was with Colin.  

Colin was ten years old but had already consumed more mental health services than most of us do in a lifetime.  That‘s because he was impulsive, unpredictable, willful and stubborn.  He was prone to smacking another kid, usually his little brother, in response to any perceived offense which usually was just being there.  He was also prone to explosions of anger, banging doors and running around the house screaming and throwing things.  The tantrums might go on for an hour.  Afterwards, he was as if nothing had happened.  

He was a healthy child and had a keen mind.  He didn’t have any developmental problems, although when he was a baby he was colicky and then he was resistant to new foods his mother tried to introduce.  He never liked to take naps.  At Day Care, he was bossy with other kids and they didn’t like to play with him, but he didn’t mind as long as he got the toy he wanted to play with.  That was usually a toy that some other kid was playing with.  Even when he was very young, he was good company when it was just he and one of his parents doing something that he liked to do, but he hated to be denied.  Once, K and R had to rush home when the baby sitter called.  Colin told her he was going to spray her eyes with acid.  He was seven years old at the time.

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‘Controlling child’ is not an established medical diagnosis.  It’s not in the DSM-5 or the ICDM-10.  When controlling children are evaluated as patients, they are usually consigned to one or another diagnostic category.  They don’t capture the essence of their difficulties, just descriptions of what the child is like, not what makes him so.  Diagnostic categories like autism spectrum disorder, oppositional defiant disorder and mood dysregulation disorder are too broad to be meaningful.  They aren’t diagnoses.  ‘Diagnosis’ means ‘thorough understanding’ not simply a restatement of the obvious.

‘Controlling Child’ is a clinical diagnosis, based on the clinical history and examination and a few neurocognitive tests.  The presenting complaint is usually anger.  Controlling children look normal and healthy children and they tend to be bright.  They are irritable and intolerant of disorder or disappointment.  They react sharply to ordinary events, are intolerant of fools and get very angry very often – once per day is the norm.  They also have a lot of OC behaviors and more than one OC in the family.  

Once you know that there are controlling children, it is easy to identify them.  These are notes for a child one of my colleagues saw in July:

I saw Davis today.  He is eight years old and his psychiatrist told Jordan, his mother, that he had oppositional-defiant disorder.  He is defiant, impulsive, irritable, easily frustrated and given to angry outbursts just about every day.  He doesn’t do well in school, although he is a smart kid.  He is in summer school and doing better because it is a small class and in person, but he cant keep his hands to himself, does not understand what is appropriate behavior, thus is disliked and picked on by his peers. He argues with his peers and has trouble establishing friendships. His pediatrician gave him Ritalin® and then Adhensio® and the psychiatrist gave him Abilify®.  He needed a stimulant because he was so easily distracted.  He may put on one shoe, get distracted and forget to put on the other.

He is sensitive to certain foods and sounds like a hair drier or the vacuum cleaner. Things have to be just so and people cannot touch his stuff. If the air fryer is open then it must be closed or gets upset. He counts things such as lines on lamps or doors. Change is difficult for him, he may stomp, yell, and scream. Parents deny germ phobia or excessive hand washing. He doesn’t like buttons or zippers on pants, loud noises like hand driers, he has a preferred route to the pew in church and is preoccupied with what time it is. His F, Brad, is a perfectionist and controlling.  His M is an auditor.  

He has always been healthy.  As a child, ADHD and ODD diagnoses were given and he was treated with medications and therapy (a handful of times).  Initially Ritalin was tried. His mother noticed no difference. For mood swings and irritability, Abilify was added and it appeared to help with behavior though there were remaining problems and he gained weight. Guanfacine was added because the Adhensio was helping in the day, but they wanted more help with the evening. They are happy with the two medications he is taking now. 

IEP/accommodations have not been instituted yet, but mother is here for a diagnosis to start this process. He does poorly in most subjects but thrives in mathematics. Socially, struggles with his peers and enjoys karate where he has achieved a yellow-belt. 

Davis was a boy -- controlling children may be boys or girls but boys tend to have more problems with anger and aggression.  The smallest thing made him angry.  He was smart but didn’t do well in school.  He was easily distracted and his attention span was short.  He liked to have things his own way.  He had a lot of OC behaviors and both parents had OC traits.  He had from intact, advantaged family, and his parents were kind and attentive. He responded well to guanfacine, an alpha-2 agonist, and to methylphenidate, a stimulant.

We explain to his parents that Davis is a controlling child.  The diagnoses we have to give him, according to the ICD-10, is ADHD and obsessive-compulsive thoughts and actions.

Controlling children usually have conscientious parents, often professionals.  That’s one reason why their behavior is so perplexing.  Think of it this way: the genes for OC overlap with those for conscientiousness, and most people who are highly responsible, prudent, reliable and hard-working are at least a little OC.  If you inquire, you will always find someone in the family background who was a perfectionist or a bit controlling.  It’s simple arithmetic; after all, one-third of us have OC traits.

The exception is described in a later chapter, ‘The Curse of Your Ex-husband’.

Controlling children seem to be increasing in number.  I shall list the reasons why in the next chapter, but we shouldn’t be surprised that mental problems change their complexion from one generation to the next.

Controlling children are usually pretty smart but not always.  Autistic children and children with intellectual disabilities may also be obsessive and compulsive, controlling and prone to anger.  We see many such children in our clinic.  The kids who concern us here don’t have a development disability.  OC traits, ADHD and tantrums are developmental variants that cool down over the years.

‘Controlling child’ is a developmental variant, a mental problem.  It is not a mental disorder or a mental illness.  You can call it a ‘syndrome’, a number of traits and behaviors than run together. I call it a mental problem.N1

OC traits as well as a controlling habit are more common in children than adults. Some OC children grow up to be controlling men and women, AKA obsessive-compulsive personalities.  Such individuals grow more rigid, intolerant and controlling as they grow older.  That is not the usual fate of a controlling child.  Maturation usually makes people more flexible and tolerant.  Good treatment and proper guidance will also make a difference.

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The psychology of controlling children is not complicated.  

1. They have unusually active minds.  They are always thinking.  If they are distractible or inattentive it’s because what’s going on their minds is more compelling than what’s happening outside.  If they are surly or irritable, it’s because what’s happening outside is an intrusion.

2. They are unusually perceptive and their acute senses are tuned to perceive errors.  Inside their heads they have a ‘hyperactive error detector’

(1) And (2) are traits common to all the OCs.  Controlling children differ, however, because:

3. They tend to experience errors as affronts.

4. This excites a strong emotional reaction; anxiety sometimes but usually anger.

5. They have difficulty controlling their emotional reactions, especially anger.

6. The repeated occurrence of (3), (4) and (5) can have unhappy consequences.

Underlying these characteristics are two basic problems: high energy and low mood.  The guidance we give such children has to consider these elements and address them directly.    

ACTIVE MINDS

What is an active mind?  It’s not the same as intelligence, ordinarily defined as the ability to solve complex problems.  Some intelligent minds are quick and agile, others slow and ponderous.  Most of have minds that are quick and agile at some things, usually the things we do all the time, but slow and ponderous on other occasions, like when we’re trying to come up with a good excuse.

An active mind is smart and quick and agile.  It has unusual, impulsive energy.  Its neural connections run fast and in far-flung directions.  They may not be easy to follow and they may not always make sense, but they can also be unusually inventive.  

We usually associate intelligence with the ability to focus.  Children with active minds can focus really well when they are absorbed in something but much of the time an active mind ranges wide across the landscape of possibilities.  During the dull, boring exercises that happen all too often in school or work, an active mind daydreams.  That, supposedly, is a bad thing, and sometimes it is.  In fact, daydreaming is a healthy exercise for one’s brain. Minds are built to solve problems, to be sure, but they are also intended to wander.N2  

Active minds tend to wander, but they are also capable of intense focus, what is called hyperfocus.  That’s why they do better in adolescence and adult life, when they find an absorbing occupation.  It is why so many children with active minds gravitate to IT, science, engineering and medicine.  

Conventional intelligence is goal-oriented.  An active mind is goal-oriented only some of the time.  It is easily distracted, not necessarily by things going on outside, but distracted by its own thoughts.  Active minds have a lot going on inside, and the bearer gets lost in his thoughts.  The active minds of young children give rise to hours of happy imaginative play.  

Too much daydreaming, or doing it in the wrong place at the wrong time can have unfortunate consequences.  Children with active minds are usually smart, but academic achievement sometimes eludes them.  They may to do better on standardized tests because the tests are challenging.  Like games, they let the child mobilize his attentional resources.

Active minds are energetic and adventurous.  They often have active bodies attached to them, especially boys.  That is perfectly natural and a sign of good health.  Nevertheless, the combination of distractibility and high activity inclines towards the diagnosis of ADHD.  Stimulant drugs like Ritalin and Adderall® are sometimes useful if hyperactivity and short attention span are especially troublesome, but stimulants should be used with care.  Raising a child with an active mind is a special responsibility.  Her mind is a complex instrument and heavy-handed treatments are only likely to suppress some of its fine points.

LOW SENSITIVITY THRESHOLD 

Patients with OCD or the OCPDO have a hyperactive error detector.  That’s not a metaphor. There is an area in brain that is attuned to detect inconsistencies, internal contradictions and anything else that doesn’t seem to be quite right.  When brain scientists refer to ‘error detection’, they mean any event that one’s brain finds to be untoward, inconsistent or inappropriate.  Thank goodness, I say, that some part of me is doing it.  But in patients with OCD, this region, the anterior cingulum, is more active than it needs to be.

People with OC traits have not been studied with PET scans as OCD patients have, but they, too, are unusually perceptive, especially to errors.  Walking into a room for an important meeting, one OC immediately notices dust devils in the corners, another that the chairs are askew, and one more that a picture on the wall is tilted.  At a meeting once I was distracted by a Styrofoam cup under the table.  I frightened the woman next to me when I reached down to pick it up because she thought I was trying to touch her leg.  I wasn’t, of course, but I did retrieve the cup and she was relieved.  She was probably as OC as I am.  She told me to wrap it in a tissue, throw it away and wash my hands.

The difference between a good OC and a controller is this: when a good OC notices something wrong, she gets a bit anxious and tries to fix the problem.  When a controlling person notices that something is wrong, he gets angry.   A controlling child notices something wrong right away – his sister has been using his toothpaste.  With rapid fire, his mind visualizes the girl touching his toothpaste to her filthy toothbrush, stimulating outrage even if he isn’t germ-phobic.  His active mind recalls all the other indignities he has suffered at her hands.  Stricken with self-pity and moral indignation, he resolves to settle the matter in definitive manner.  What ensues doesn’t enhance the harmony and good-feeling that ought to pervade your happy home.  

His sister?  Well, if her little brother used her toothpaste, she would sigh and clean the tube and her toothbrush with peroxide.  

THEY TEND TO EXPERIENCE ERRORS AS AFFRONTS.

This is where controlling children begin to diverge from the mass of us who are just plain OC.  Error detection, to them, is an unpleasant experience.  It makes them mad.  Now, no one likes ‘errors’, by definition.  An error is anything one’s brain finds to be untoward, inconsistent or inappropriate.  The natural instinct is to fix it, and that’s what makes good OCs kind of fussy sometimes.   But to get mad?  If you got angry at every noisome event you encountered, you’d hardly have time, or energy, to do anything else.  You’d live your life in a stew, which unfortunately is what some people do.

What makes someone experience errors as affronts and blow up over it has to do with mood.  To someone in a bad mood, any bother – water dripping from a faucet, toothpaste mis-used, the sink not properly cleaned before bedtime – is likely to provoke a bad reaction.  The same thing happens to someone who has chronic pain or who is sleep-deprived.  Or to someone who is controlling.

A pervasive negative mood is the enduring characteristic of controlling children.  They are slow to adapt and resent the unexpected as intrusions or, worse, as threats.  They have a low threshold for bad reactions.  Their emotional set-point is biased towards anger.  Psychologists believe that each of us has a set-point on the spectrum between happiness and displeasure.  Some of us are born happy and stay that way, no matter what happens.  Some of us are born with the opposite disposition.  Hopefully, they will grow out of it but, if not, they need to find the right drug.

STRONG EMOTIONAL REACTIONS: ANXIETY, ANGER.

According to the psychologists who study this sort of thing, mood has two qualities: its valence, that is, whether it is good or bad, happy or sad, calm or angry.  The other is arousal, which refers to the intensity with which a mood is expressed.  Active minds tend to have high arousal; the children may be excitable or hyper.  An active mind readily goes into high gear.  It is hard to slow down.

Many infants are slow to adapt but they don’t necessarily react intensely. N3  Some children are prone to bad moods but they express them as anxiety or sadness.  We are less likely to worry about such children, because they are such familiar feelings and we know how to cope with them.  Controlling children have bad moods (negative valence) and react intensely (high arousal) and express them as anger.  Anger also is a familiar experience, but few of us are very good at dealing with it, in ourselves and especially in our children.  Anger is a form of aggression.  It makes one uncomfortable and it is hard to keep a level head when dealing with an angry person.

High arousal feeds on itself.  On that emotional continuum between good and bad, strong negative reactions just raise the ceiling for bad and allow subsequent reactions to be more intense.  So, how to deal with an angry child?  You have to identify the two components.  We mentioned the valence side, bad mood.  The other is the arousal side.  Once someone is highly aroused, there is little one can do.  When Oswell gets excited, you can’t reason with him and it’s hard to calm him down.  You have to identify the problem and deal with when the child is not in an exploded state.

THEY HAVE DIFFICULTY CONTROLLING THEIR EMOTIONAL REACTIONS, ESPECIALLY ANGER.

High arousal leads to loss of self-control.  It happens in love as well as anger.  It’s hard to expect a young child to exercise self-control when his emotions blow up.  The goal is to prevent it from happening, and parents of controlling children usually adopt a walk-on-eggs strategy to do just that.

One effective way to deal with it is to pop the child’s bottom and frog-march him to his room, and I have done that once to a couple of my children, but it is not an effective guidance method to use more than once or twice.  One reason why controlling children were never described years ago is that parents would meet anger and disrespect with physical reprisals.  It was an effective short-term control system, but it is not guidance, and probably accounts for the many controlling men who bedevil us now.  You can’t model self-control if you lose control yourself.  Yet, the only way to deal with a child in a tantrum is some kind of time-out; the problem is getting him there without inciting more rage.  

A persistent sour mood and long-term brooding can reset one’s self-control mechanisms.  Think of it as someone who is in chronic pain.  They spend every waking hour living with the most disagreeable sensations, and it absorbs all their energies.  They have little left for self-control.

Self-regulation is the most important thing a brain does.  It regulates one’s heartbeat and blood pressure, the level of stress hormones in one’s bloodstream, one’s reaction time, attention and ability to think clearly and the intensity of one’s emotional reactions.  It is a function of the front parts of one’s brain, which develops quite slowly, as it happens.  Your frontal lobes aren’t fully developed until about age 50, and before puberty they have very little impact on behavior.  So, one doesn’t expect babies, children or adolescents to exercise high levels of self-control.  That’s why we give them so much latitude.  If your sister-in-law started to cry because she was hungry you would think there was something wrong with her.  Or if your husband developed an obsession with a Korean boy-band.

THE REPEATED OCCURRENCE OF (1), (2), (3), (4) AND (5) CAN HAVE UNHAPPY CONSEQUENCES.

The unhappy consequences include family disharmony, difficulty getting along with other children, poor performance at school or and depression.  Controlling children make parents feel confused, frustrated, guilty.  Therapists who don’t understand controlling children make everybody feel worse.

Poor school performance and depression are the likeliest reasons a controlling child may be referred to our clinic.  Controlling children are usually a bit ADD and that is easy enough to deal with.  Depression is another matter.  Living in a world surrounded by fools can be demoralizing.  On the other hand, seething with anger can look like clinical depression.  The child is withdrawn, inactive, uncommunicative, somber or surly.  Is he really depressed or is it just another form of control?  Anyway, we don’t need to deal with the complications yet.  

There have always been people with active minds, but there are so many more now.  What has happened to make it so?  

The story begins two hundred years ago, when the nations of North America and Northern Europe began their long march to prosperity.  Soon thereafter, began a progressive improvement in the health and longevity of the population, then a dramatic reduction in maternal mortality and then, at the turn of the century, another dramatic reduction, in infant mortality.  The Modern Age began in the Industrial Revolution and its gifts are universal longevity and good health especially for women and children.

During the past millennia of human history, when life expectancy was less than 40 years, there were always individuals who lived to a ripe old age.  The 90th Psalm, written several hundred years before the birth of Christ, averred that The days of our years are threescore years and ten, or fourscore… Universal longevity, however, is a new thing; people in modern nations expect to live to age 80 or 90.

About a hundred years ago, a second event began to unfold.  The fruits of prosperity, unparalleled in human history, began to influence the intelligence of the human race.  Of course, there have always been intelligent people and brilliant ones.  In the 21st century, we are reaping the fruits of the Modern Age.  People are smarter than ever and our children are even smarter.  

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We know it’s true because the IQ tests that psychologists use to measure intelligence have to be re-standardized every ten years.  It’s called the Flynn effect and it has been going on for more than a century.  Hard data has accrued since the 1930’s when IQ tests began to be administered routinely to schoolchildren.  In order to maintain the average IQ at 100 – half of us higher, half lower – the tests have to be calibrated.  Every ten years since 1932, the tests have had to be re-calibrated because the average IQ has increased by about 3.3 points.  That may not sound like much, but if the tests hadn’t be re-standardized, the number of children with low IQs  would be cut in half and the number with high IQs  would double.  By 1932 standards, there are twice as many geniuses today than there were then.  

It’s not a statistical trick, meaningless playing with numbers.  The phenomenon of rising IQ scores has been replicated many times and in nations on every continent.  People are smarter than they used to be.  Children are getting smarter and there is no let-up in sight.  We have to reflect carefully on this extraordinary fact.  It is as dramatic a change in the human condition as the increase in life expectancy from 40 years to 80.  Why is it happening and what does it mean?

The story begins about 200 years ago with what is called the ‘birth of the modern’.  In the 19th century, the nations of Europe and North America began their long march towards universal prosperity.  Living conditions improved dramatically.  Books and periodicals were cheap and widely available.  More children were able to attend school and by the end of the century childhood education was universal in North America and Northern Europe.  

In 1850, human life expectancy also began to increase.  Nutrition improved and public health measures were finally able to control infectious diseases.  Since 1850, there has been a linear increase in life expectancy and it isn’t slowing down.  Life spans increased even faster after 1950, when modern medicine began to have an impact.  In the years since 1990, life expectancy has increased by about 5 years. N1 

Since 1850, the life expectancy of women has increased by three months every year.  Before then, about one woman in four died in childbirth.  Maternal mortality began to decline in 1850.  Today, it is vanishingly rare.   This was an extraordinary change in population dynamics; for the first time in history as many women as men lived long lives.  Before very long, they were living longer.  In fact, freedom from maternal mortality was probably the first and most important step towards gender equality.  It was important in its own right, but it had even more important impact on the health of children.  Fifty years later, at the turn of the 19th century, infant mortality began to decline.  It took two generations of healthier women before robust good health could be conferred to their children.N2  As women have grown healthier and better educated, they have transmitted more health and intelligence to their children.

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In the 1920s and 30s, IQ tests began to be administered routinely to schoolchildren, although estimates are that the secular increase in IQ probably began at the turn of the 20th century at about the same time that rates of infant mortality began to decline.  The reason often cited has been improved living conditions, especially advances in health and nutrition.  As humans became healthier, their children did, too, as smarter as well.  As the health and longevity of people has continued to improve, so has the health and intelligence of children.

In recent years, the health of human embryos is protected as never before.  The bread supply is fortified with folate to prevent spinal cord defects.  Pregnant women are advised to avoid cured meats in order to prevent childhood cancers.  They are told not to smoke or to drink and even to eschew caffeine.  Fifty years ago, such advice would be regarded as monkish and absurd but the intelligent, well-educated women of the 21st century know better.

Drinking, smoking, caffeine and cured meat have very small effects of children, effects that have only become obvious with the advanced research methods that were developed towards the end of the 20th century.  Small effects, however, may well be felt in brain.  In the embryo’s brain, 100 trillion neurons are being born, migrating vast (for them) distances to just the right part of brain and making transient connections to other neurons as they do.  Nature has arranged to protect the embryo during this astonishingly complex process, but perinatal vitamins and avoiding mild toxins like caffeine and alcohol help nature along.  So do 21st century mothers, who are healthy and fit and regard their one, two or three pregnancies not as inevitable burdens but as the miracles they really are.

After birth, the developing brain is provided better nutrition and relative freedom from the interference of fevers and infectious disease.  Modern parents continue to help Nature along.  They decorate an infant’s crib, not with ribbons and teddy bears painted on the headboard but with brightly colored mobiles and electronic devices to ‘provide sensory stimulation’.  Kids’ toys are even getting smarter, for heaven’s sake.  When I took my grandson to one of those smart-kids’ toy stores I asked the clerk if they had flashcards for integral calculus.  She took me seriously.

Nor is it possible to minimize the effects of radio, cinema and TV on the growth of human intelligence during the 20th century.  Banal as they seem, give them credit for conveying an extraordinary volume of basic knowledge and vocabulary.  They expose audiences to the wide world of culture and different ways of thinking.  If radio and TV had such an effect, think of what the Internet and all our electronic devices are doing.  There has never been a time in human history when so many energetic and ambitious minds have had so much to feed on.

Mothers transmit intelligence, health and longevity to their children directly by improving their own epigenetic profiles,N3 by staying healthy and keeping their children healthy.  They are also having babies when they are older and that also makes a difference.  Older mothers have something called ‘greater physiological reserve’; it is reflected in the health and intelligence of their children.  Families are smaller.  Fathers are expected to lavish as much attention on their kids as mothers are and are happy to do so or pretend to be if they know what’s good for them.  

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Modern parents are also doing a couple of things of fundamental importance to the evolving human genome.

One is called heterosis and it may be the best thing we humans have done since the 19th century began.  Heterosis means the same as hybrid vigor or heterozygote advantage.  It goes like this: the modern age has seen the movement of populations from small villages where people chose their mates from a limited gene pool.  When large numbers of people moved to cities they had the opportunity to find mates if not with good genes then at least with better genes than in their inbred country town.   Heterosis also includes something called exogamy.  During the 20th century, marriages were less and less confined to people with the same religious, ethnic or racial background.  Heterosis has been going on for two centuries among the restless peoples of the Americas and Europe and exogamy is now more the rule than the exception.  It’s the kind of environmental change that only enriches the human genome.

The second change is assortative mating.  Modern parents choose one another on the basis of education/intelligence and personal values.  They are freed from the restrictions of class backgrounds or skin color.  Good genes are able to find one another.  

Our story began with the secular increase in longevity, segued to the health and education of women and arrives at an extraordinary event in the evolution of the human race, that human beings are smarter than ever.  The connections are not spurious.  As it happens, IQ is related to longevity.  People who are more intelligent live longer, and not only because they have higher living standards, a better diet and better medical care.   The reason why humans are living longer is that we are smarter.  And our children are smarter than ever.

Children of the 21st century are unusually intelligent, unusually healthy and well-looked after.    The status of children is higher than it has ever been in human history.  It is as if we parents regard them as equals.  We consult them and make decisions together.  I have known parents who declined the most desirable promotion because their daughter was unwilling to change schools.  Or a gymnastic coach.  Not only do we allow children to have opinions, we respect their opinions.  We try to understand their feelings even when they are annoying.  Discipline has been supplanted by guidance and gentle teaching.  Because I said so is not the way today’s parent wins a child’s compliance, at least most of the time.  Explanation and reasoning is the usual way, even with very young children whose thinking processes are pre-rational.  There have always been enlightened families.  What is different about our times is that, diverse as we think we are, educated people in different countries and from different racial, ethnic and religious backgrounds are remarkably similar in their behavior and regard for children.  It is not only because we are better educated ourselves.  We are adapting to children who are even smarter and eager to participate in the full and rich lives of 21st century adults.  Children are more special than they have ever been.  But not just because we treat them so.  They are special.

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Think once more about those 100 trillion little neurons, about how delicate they are and how tenuous are the connections they form with other neurons.  The developing brain is resilient but it is also quite delicate.  Noxious events – infections, poor nutrition, neglect – don’t necessarily hurt the brain an overt way but they do interfere with its optimal development.    Everything about modern, developed societies and the parents who live there allow young brains to achieve their optimum.  

Why, then, do so many things seem to go wrong?.  Why do so many young children have learning disabilities or ADHD, anxiety, OC or a controlling disposition?

Children born in the year 2000 have a 50% chance of living to 100.  That’s convenient because they take so long to grow up.  They are cultivating a delicate instrument whose scaffolding is determined by their genes but whose innards are formed by experience.  Trial-and-error is how they learn and if, for a time, errors seem to be in the ascendance, it is only the normal variation that accompanies development and maturation of an exceedingly complex mind.  Children with active minds happen to be bit more prone to aberrations as they develop their exquisite perceptual apparatus and learn to control their highly sensitive reactions.  It takes a while, but they are going to live 100 years.