Having been doing this work for a while, I have noticed some trends in mental health treatment. The word “trauma”, for instance, seems to have blended into the everyday vernacular, which is concerning since trauma is a very specific experience in the individual and shouldn’t be normalized. The idea of validating a child’s feelings to the point of pathologizing them is also rather new. This is not always helpful in terms of mental health outcomes for kids or families. But the one I want to talk about today is the practice of accommodation. Let’s call this the Accommodation Trap.
Accommodation typically occurs when a child’s behavioral output overloads a parent and/or educational environment. To the parent, behavior can appear to be a pathological presentation, something that must have a diagnosis because it can’t possibly be normal. The mental health system is complicit in this concept (heck, we probably started it), and often the direction of mental health treatment for dysregulated children is accommodation.
This comes in the form of feedback to parents to not hold children accountable, do not allow them to face consequences, and for Heaven’s sake, don’t take their phone away.
Let’s be clear: the term dysregulated child is redundant. Kids are terrible at self regulation. It is developmentally normal for a child to dysregulate for any number of reasons. We can teach kids effective regulation skills in outpatient mental health treatment, but they may not engage those skills when it would be most helpful. I’ve witnessed this in the work that I’ve done directly with families, and it’s an interesting evolution of behavior: the child clearly has capacity but won’t use it. Accommodation, then, occurs when the parent (or therapist) believes that the behavior is something extra normal, the result of some kind of a diagnosable issue. Often what is identified ideologically is ADHD, mood or regulation disorder, autism ; “Pediatric Bipolar Disorder” has always been a favorite as well.
It is important that we recognize that children may dysregulate for any number of reasons, most of which have nothing to do with a mental health issue. If we think about children’s behavior in general, we should be able to answer the question: “What’s in it for them?” Often, a child will get more of what they want (control) by dysregulating, rather than regulating. What they learn, then, is that, in order to gain access to what is important to them, they have to be the worst versions of themselves. Kids do not feel good about this, but will return to it over and over. Accommodating a child’s behavior in these circumstances reinforces it, which creates a very unhealthy parent-child interaction spiral.
Think about it, won’t you?