There are conflicting perspectives on understanding and managing the behavior of children with
ADHD.  One important view is offered in ADHD and the Nature of Self Control.  Another view is reveled in an interview by Nancy Shute with Walnut Creek, California, pediatrician Lawrence Diller.  In this interview Dr Diller reveals his controversial ideas on ADHD, Ritalin, and spanking. Sparked by an article by Diller in which he asked, “Could it be that America would rather give unruly kids a pill than a swat?”  Shute had to know more. The following excerpts are from her recent interview.

Shute asked: Spanking is probably the most controversial issue in child rearing. You treat children with ADHD. What on earth compelled you to write that spanking may not be so bad?

Diller responded that he thought “please, please!” when a California assembly woman proposed making spanking a child under age 3 a crime. Diller’s reaction was due to his seeing issues of discipline cause 80 percent of the problems he sees. Diller says that families who struggle with a child’s behavior struggle with spanking, and “They figure if spanking is bad, then all forms of conflict are bad, and they hesitate to discipline their children. They wait too long before taking effective action. This doesn't have to be spanking; it could be removal of a toy or imposition of a timeout. I am talking about middle-class, upper-middle-class families that love their kids, that have the resources for their kids.”

These children, according to Diller, have “determination, stubbornness [and] a simple ‘no’ doesn’t work.” These children are also intensely happy when they’re happy, and intensely angry when angry.

Shulte asked: What form of discipline do you recommend to parents?

Diller responded that he keeps copies of the book 1-2-3 Magic, by clinical psychologist Thomas Phelan, in his office, and that he likes it a lot. The book contains a simple discipline system that involves counting to 3 and then putting the child in timeout. Diller gives “parents of 4-, 5- and 6-year-olds a guarantee that in 72 hours their child will be better if they follow these methods.”

Diller says that the component he added to this system is spanking or other physical intervention. He says this makes the system 80 to 90 percent successful for 6-and-under children. Diller states that “There's good solid evidence that when you give parents permission to give one or two smacks on the child's bottom if the child defies the rules of the timeout procedure, the family is more often successful with the approach. For parents still uneasy about a spank, they can use a specific restraint technique I call ‘the hold’ [holding a child against the parent's chest]. But kids actually prefer a spank because it's over with right away.”

Shulte stated: But spanking's not recommended in 1-2-3 Magic.

Diller responded that no, Phelan does not recommend spanking, but rather recommends that if the child won’t go into timeout, the parents restart the timer and add another consequence. Diller thinks “that [method is] extremely hard for small children to use to make the right decision.”

Diller says he prepares parents “for the likely initial very intense negative reaction from the child,” and that “with their understanding that they are not hurting their child long term and this is what's called for to demonstrate their consistent strength and steadiness, they are ready to persevere. When children are out of control, you may be sparing this kid and family months of treatment and the risk of being labeled mentally ill. If you don't deal with the bad behavior, it takes you to ADHD-land; it takes you oppositional-defiant-disorder-land, to generalized anxiety-land, and obsessive-compulsive-disorder-land.”

Shulte asked: One of the big concerns is that spanking will increase the physical abuse of children. Are there parents who shouldn't spank?

Diller responded that parents with major marital problems, substance abuse problems, or major depression should not spank, and that spanking in desperation or anger leads to “negative outcomes, like increased violence, associated with corporal punishment.”

Shulte asked: Aren't you worried that parents will say: Larry Diller says if I spank my kid, he won't get ADHD?

Diller responded, “That is my big worry. And that's why my friends tell me to keep my mouth shut.” He further clarified that “to say that all ADHD kids should be spanked is a misreading of my position. But I expect parents and schools to do something before we give out pills. And I give out pills.”

Diller goes on to say that, in mild ADHD, “a more organized and coherent system of discipline can make the difference in whether your kid will be on Ritalin or not. You don't have to spank. But if you're using spanking as one of an array of tools to get control of your kid, you're not hurting them in the long term.  Lively, impulsive, spontaneous kids who know when to shut up don't get medicine.”

Diller says that “nobody wants to be pro-spanking,” and that he is not pro-spanking, but thinks “a well-thought-out spank ain't so bad and shouldn't be banned.”