Author Dr. Robert Saul

Raising Young Citizens in the Age of Columbine

Are we asking the right questions?

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I have spent my lifetime attending to children and families.  That is good news and “bad” news.  The good news is that I get the opportunity to continually be learning and helping.  The “bad” news is actually good news—I have to be continually learning how to help others and do it in meaningful ways. My introspective journey over the last 30 years has pushed me to seek answers to various issues, but to effectively seek answers, we are required to formulate the right questions.  These questions pose the salient issues to be addressing if we are indeed committed to look for the right answers and the path forward.

James Ryan, president of the University of Virginia, wrote about the essential questions to be considering for our lives and our interactions with others1  –

  • Wait, What?
    • We should be seeking understanding by being particularly attentive (active listening) to others.
  • I wonder why (or if)?
    • Wonderment is essential for curiosity, and curiosity is essential to understand the people and the world around us.
  • Couldn’t we at least?
    • To pursue progress, we have to looking to compromise or meet others in a place of understanding.
  • How can I help?
    • The practice of empathy is critical to our ability to seek and understand how we can help others, for the latter is our role and duty as citizens.
  • What really matters?
    • It is so important to pursue lives of meaning, engaging in actions that make a difference in the lives of others.

Many folks see the often erratic or unfortunate behavior of some children as enigmatic (difficult to understand) and posit “What is wrong with you?”  Such a question explicitly states that there must be something wrong with the child that engages in unproductive behavior in the eyes of the observer. Well, in my now retired (but not unengaged) state, I have a different question – “What happened to you?”

Back in 2018, Dr. Andy Garner and I published a book looking at the science behind early brain and child development that has been the work of so many devoted scientists and physicians.2 Dr. Jack Shonkoff and the Center on the Developing Child have provided crucial work in this field. 3 Oprah Winfrey recently co-authored with Dr. Bruce Perry (also a pioneer in the field) a series of engaging discussions regarding “what happened to you.” 4

We have become more enlightened about early brain and child development, recognizing how early trauma has indeed affected brain growth and brain connections.  Too many children have been exposed to some form of trauma. And alterations in brain growth and brain connections can have significant effects on subsequent behaviors, mental health and physical health. Asking the right question – “What happened to you” – allows us to switch the focus from blaming children for their behavior to a place of understanding and allows us to be more impactful with our attempts at helpful interventions.

The way forward is trauma-informed care, care that seeks to understand past and present circumstances and seeks to engage in meaningful ways to acknowledge and integrate these circumstances into a plan of action. This is incredibly tough work and uses multiple modalities in the analysis of the situation and the execution of the various therapies.  Dr. Heather Forkey and colleagues recently put together a handbook that is extremely comprehensive and useful in this work.5 Our goal is resilience – a dynamic process of positive adaptation to, or in spite of, significant adversity. 6

But our goals are never obtainable without the proper questions. My lifetime of medicine has taught me that the proper questions are key to diagnosis, treatment and supportive care. My assumptions are no substitute for an honest-to-goodness discussion with the child and family as I seek to be a trusted partner in addressing their concerns.

Ryan’s questions are important, but let’s not neglect our children any further by blaming them for maladaptive behavior.  We can do so much more if we seek answers and solutions to the crucial question – “What happened to you?” That compassionate approach acknowledges our common humanity and searches for joint solutions.

  1. Ryan J. Wait, What? And Life’s Other Essential Questions. HarperOne. 144 pp, 2017.
  2. Garner AS, Saul RA: Thinking Developmentally: Nurturing Wellness in Childhood to Promote Lifelong Health. AAP publishing, 175 pp, 2018.
  3. https://developingchild.harvard.edu
  4. Winfrey O, Perry BD. What Happened to You? Conversations on Trauma, Resilience and Healing. Flatiron Books, 304 pp, 2021.
  5. Forkey HC, Griffin JL, Szilagyi M: Childhood Trauma and Resilience: A Practical Guide. AAP Publishing, 224 pp, 2021.
  6. https://mychildrenschildren.com/adversity-resilience-and-flourishing-oh-my/