Care and Feeding

My Husband and I Can’t Agree on Whether Our Son Needs a Behavioral Diagnosis

His tantrums are out of control. But my husband, an M.D., doesn’t want him labeled. What do we do?

A small child hides his face.
Photo illustration by Slate. Photo by lewisjackson/iStock/Getty Images Plus.

Care and Feeding is Slate’s parenting advice column. Have a question for Care and Feeding? Email careandfeeding@slate.com or post it in the Slate Parenting Facebook group.

Dear Care and Feeding,

My sweet, energetic, and articulate 3-year-old (“Sam”) has gone through a lot of change this past year—we moved to a very large, noisy city far from the quieter, smaller city where we lived before; we had a second baby boy; and I went back to work last month after several months of leave. Sam has always been challenging due to his energy level, but he is extremely affectionate and has been unfailingly kind and gentle to his baby brother. I have mostly borne the brunt of his anger about the big changes in his life. He definitely has good days where he listens well and is fun to be around, but then he also has really bad days where he is pretty out of control: huge tantrums that involve scratching, hitting, kicking, throwing hard things at my head, and running away down the street when the nanny picks him up from preschool.

These tantrums have gotten more frequent over the past six months. We have tried a range of disciplinary tactics like taking toys away for bad behavior and offering incentives for good behavior, but these don’t seem to work. His teacher and nanny say that this behavior is not normal and he should be “evaluated” for some kind of disorder (though the teacher was vague about what this would be), but my husband is adamantly opposed to an evaluation for fear Sam will receive a label. My husband, who is an M.D., says this is how he was when he was a child (very stubborn), there is nothing abnormal about our son, and there is a tendency these days to overdiagnose kids who really are in the normal range. I feel that even if the behavior is normal, it doesn’t hurt for Sam to get a little help managing his anger. However, I have a lot of respect for my husband (and he’s often right), and I also understand his worry about having our child labeled. I guess my question has two parts: 1) Is this behavior normal for a 3-year-old?, and 2) should I insist that he get the evaluation over my husband’s objections?

—Tired of Tantrums

Dear Tired,

There’s a step between “wait it out” and “get him formally evaluated,” and it’s the most important step of all: talk to his existing pediatrician, with or without your husband’s buy-in, and tell her what you’re seeing. It’s not like you pull a lever, and medication and a diagnosis pop out, crushing your son’s will.

Pediatricians see a tremendous range of 3-year-olds come through their office, some of whom grow up as “normal” as any of us, and some of whom do, yes, wind up with a diagnosis of some kind or another. Your husband is an M.D., but his familiarity with what toddlers “are supposed to be like” based on an old peds rotation will pale in comparison to your pediatrician’s breadth of experience.

What I would specifically say to your pediatrician, if I were you, is “We’ve been seeing x behaviors. My husband thinks it’s just kid stubbornness, but our nanny and his teacher suggested having him evaluated. Do you think this warrants a referral to a developmental pediatrician?”

If the answer at this time is “No,” great! Ask for some parenting strategies and ask what behaviors or failures to hit milestones should warrant you coming back early, before your next scheduled well-child visit.

If the answer is “Yes,” then you need to tell your husband that an actual doctor has given you a referral to a developmental ped, based on her observation of your son. He may still balk, but at that point, I think you’ll know what you have to do.

Pediatricians are not infallible (even developmental pediatricians!). Keep watching your son, listen to your gut, and also try to listen to your husband. It’s easy to try to make him the bad guy, but he’s coming from a place of worry just as you are—his worry is just pointed in a different direction.

Please do follow up with me. I know how scary this sort of process can be, even if nothing ultimately comes of it.

Dear Care and Feeding,

My issue involves my 8-year-old daughter and her aversion to hearing my 5-year-old son chewing. This has escalated to the point of her not wanting to sit at the table and eat with him, ever.

I do sympathize with her a little—I hate the sound of chewing too, honestly—but her reactions feel extreme. In the past, if she really threw a fit and was disruptive at the table, we sent her to her room, allowing her to cool down and come back to the table later. I’ve also made concessions like letting her change her seat and turning on some music for background noise, but those haven’t helped overall. My husband has less tolerance for this behavior, and has declared “If you don’t eat dinner with us, you don’t eat dinner at all.” That has not gone great.

I just want us to be able to sit down and eat dinner in peace. But watching her “suffer” until she throws a fit every night is exhausting, and denying her dinner is also not a long-term solution. Any ideas?

—He Needs to Chew!

Dear Chew,

I’m not a doctor, nor do I play one on TV, but I would suggest you (and your husband) Google “misophonia” and see if anything pings with what your daughter seems to be experiencing. Then make an appointment with your pediatrician to ask some questions.

In the meantime, I would absolutely allow your daughter to wear headphones (start with normal ones but upgrade to noise-canceling if necessary) during meals and see if that helps. If even noise-canceling headphones don’t do the trick, then this does indeed seem behavioral, and at this point, you would want to talk to your pediatrician about that anyway!

There are a lot of adults who got a lot of emotional reassurance from learning that the anger they’ve traditionally felt at hearing chewing/slurping noises is of clinical significance. I don’t know if your daughter is in that category, but I certainly know you don’t have anything to lose by asking about it.

Dear Care and Feeding,

I don’t like my teenage stepson. At all. I work with kids his age, so for the purposes of this letter, I’ll ask you to trust that his level of rude, ungracious, and mean-spirited behavior has gone beyond the pale. I’ve tried to be mindful of where this is coming from: Before I married his father (and when he was a sweet kid), I was in and out of his life a few times, he now has a younger sibling, and his mother is an alcoholic. A lot of his acting out comes from my husband’s and the mother’s abject inability to co-parent. While my dislike for this kid has been increasing over the last few years, until recently I managed to put on a happy parent face, remained calm in the face of the almost-daily outbursts, and attempted to help my husband navigate behavioral issues behind the scenes.

The last straw came when my stepson told me and my husband that he felt we weren’t financially supporting him enough and announced a harebrained plan to sue us. My reaction to that pronouncement was rather less than reserved, and since then, all my anger and resentment for this kid have welled to the surface and show no signs of subsiding, even though his behavior is noticeably somewhat less odious now that he’s in college.

Is it OK that I can’t stand this kid? Can I get over it? Should I? Can I do something different to improve my outlook? Thanks for your insight.

—Can’t Stand My Stepson

Dear CSMS,

I’m so sorry, this sounds so difficult. Since you describe your stepson as both a teenager and in college, it seems like you are smack dab in the middle of a transition that can be hard on everyone even under better circumstances.

I strongly recommend getting yourself an individual therapist (a couples therapist, potentially, if you feel that your marriage is being negatively affected by disagreements about your husband’s son, which is unclear from your letter) and focusing on ways to emotionally detach and set boundaries for yourself and your home.

If he is living with you while going to school, which is not the immediate sense I get from this letter, then you and your husband need to sit down and hash out (first together, and then with the young man in question) what your baseline is for acceptable conduct to live in your home. If he’s not living with you, then you can joyfully kick him out if he’s visiting and becomes disrespectful.

I’m so sorry that your husband and his ex have made such a hash of co-parenting. It’s too late now to fix that and pointless to assign blame. What matters is this: He’s on his way out the door, and if you can keep that flashing EXIT sign in the forefront of your mind, it may very well make this time more tolerable.

You do not have to like him. It sounds like you used to like him, and then things went south over the next decade or so. I want you to feel free to focus on yourself and your own right to be treated with respect, and to be transparent with your husband that these are your current goals.

His threat to sue you is almost certainly just a dick move, but my nonprofessional advice is: Should you actually get served, even if it’s blatantly ridiculous and will be tossed out on sight, you need to show up and act like it’s serious. Too many people wind up with default judgments against them because they ignored a frivolous lawsuit.

Hang in there, friend.

Dear Care and Feeding,

My only son got married this fall to a woman he loves and has spent the last five years dating. I really like my new daughter-in-law, but I can’t get past her rudeness, and it’s starting to cause problems.

“Jane” seems to have no sense of etiquette around gifts. I’ll send her a present, a heartfelt email, or some other token of my affection, and I don’t hear anything from her. I recently made her a lovely pair of homemade mittens, and while my son called to say that she loved them, I didn’t hear a word from Jane about it.

It’s not just gifts. When she comes to my house, she doesn’t make the bed, leaves towels on the floor, and doesn’t clean up her water glasses. These are obviously small things, but I feel like it speaks to a general sense of entitlement and disrespect that is wearing on me.

When she doesn’t email me back or say thank you to the gifts I send, it makes me feel like she doesn’t love or respect me, and my feelings are getting hurt. The holidays are coming up and I don’t know if I should talk to her directly about my expectations, or if I should tell my son about my problems.

My daughter says Jane was just raised differently with different expectations, and if I’m not getting the reactions I want from her, I should stop sending presents.

I feel like most adults know that a homemade gift merits at least a thank-you. I don’t want to make too many waves, because I don’t want my son to feel like he needs to pick sides, and I worry that if I have problems with this woman, she will restrict my access to my grandchildren down the line. What is the best way to handle issues with my daughter-in-law without compromising any family dynamics?

—Why Do I Even Bother?

Dear WDIEB,

I think your daughter is right. If your son (or Jane!) notices there’s been a steep decline in gift-giving and asks about it, you can say that you hadn’t heard anything about your many previous gifts and assumed they were unwanted or unnecessary.

There’s not much point in trying to parent an adult woman who isn’t even your kid.
Should she thank you for these gifts? Absolutely. Is there a natural consequence of not thanking you for them? There sure is, and an extremely easy one for you to enact.

Now, her thoughtless behavior while a guest in your home—well, that’s another story altogether. I wouldn’t lose my mind about the bedmaking (please keep in mind that your son is equally not-making the bed, and he is your kid, so feel free to tell him to make it when they visit), but there’s no reason you can’t say, “Jane, before you leave for the day, can you hang your towels up and bring any dishes to the sink?” There are a lot of people who do actually need to be told what we feel are Basic Etiquette Things. If she blows off your actually stated requests, then she’s just being rude, and you can go from there. But it’s highly likely she’ll look surprised the first few times and then pull up her socks going forward.

Please send me the homemade mittens instead. I will send you lovely thank-you notes.

—Nicole