How to Tone Down Parent Conflict During Separation and Divorce to Help Your Kids Adjust

By Anita M. Schimizzi, Ph.D.

Time and again, research suggests that parental conflict is a strong predictor of how children will do following parental separation and divorce.  Parents’ ability to cooperatively co-parent without exposing their children to ongoing conflict can provide a critical foundation for healthy adjustment.  Conversely, parents who remain hostile toward one another and continue to openly battle are likely to pave the way for their children’s maladjustment.

This makes sense, right?  Children who must face ongoing fighting and conflict between their parents while they also endure all of the changes prompted by their parents’ separation or divorce would probably struggle more and have more anxiety and depression than those children who go through the separation or divorce but do so within a low conflict, cooperative parenting arrangement.  So you may say, “Fine.  I get it.  But how on earth am I supposed to peacefully parent with my kids’ other parent when the very reasons that we got divorced still cut so deep and he/she continues to act like such a [insert your choice of words here]?!”   The simple answer is STAY FOCUSED.

Below, I explain in more detail what I mean by staying focused.  One caveat:  I know that there are situations where some of these suggestions are simply not feasible.  They are, by no means, have to’s but rather pieces to consider, to look at from different angles to see if maybe, just maybe, there is some way to make them happen in a way that benefits your children.

1. Seek support for yourself.  Your relationship with your children’s other parent has now shifted in a dramatic way.  I have never heard of an intimate relationship terminating with the involved parties feeling totally unscathed.  Whether you turn to therapy, family, friends, spiritual leaders, a combination of these, or something entirely different that helps you find your way, it is critical that you reach out and allow yourself to be supported during this time of tremendous adjustment.  Being able to move forward with greater inner peace can do a whole heap of good for being able to effectively parent with your ex-partner.

2.  If at all possible, use a mediator to come up with and agree on a parenting plan.  Do everything that you can to stay out of courtroom battles with your children’s other parent.  This type of litigation can often leave both parents in a state of high conflict and that energy trickles down to your kids.

3. If you are unable to come to a good working relationship with your children’s parent and you do find yourself back in the courtroom time and again, it could be useful to use a certified parenting coordinator.  Your attorney and/or local family court should be able to help you locate one.  Sometimes the family court judge will even appoint one in an effort to help parents develop a less litigious and more cooperative co-parenting partnership.  As with all professionals, there are good fits and bad fits.  Look for a parenting coordinator that you feel really gets you and your children’s other parent and is able to remain level-headed, fair, and focused on the best interests of your children.  Oftentimes, parental hostilities can cloud judgment and it can be extremely helpful to have a neutral third party assist in ironing out differences in opinion and be a sounding board that keeps you focused on your children rather than each other.

4. Look for signs of distress in each of your children.  If you are thinking that your child is doing just fine in the midst of your dynamic with your ex, but you begin to notice some differences in behavior, emotion (including a lack of emotional expression), somatic complaints that can signify stress (e.g., headaches, stomachaches, sleep difficulties), or other changes, it might be time to reexamine the level of tension and conflict.  (Please know that most children will be distressed as they go through this process.  They’ll have ups and downs, but their overall distress should ease up over time.  If it instead starts getting progressively worse, then it’s definitely something that should be explored.)

5. Maintain good boundaries when it comes to your relationship with your children’s other parent.  While it is critical to come to an agreement on the big stuff, like school and health, you don’t need to agree on all of the little stuff.  Each of you will need room to parent as you see fit without the meddling of the other.  For example, you may have different rules about chores.  One parent may want them all done on the weekend and the other may want them done daily after school with none on the weekend.  Neither is right or wrong.  They are simply different and each parent has the right to make that call.

And also on boundaries, remember that you and your children’s other parent are not together anymore.  That means knocking before entering her/his place of residence, or remaining in the car if that is what is asked of you, when you go to pick up your children for their time with you.  That means not bombarding your children with questions about their other parent.  That means talking with your ex in the absence of your children when you need to work something out¸ keeping the discussion where it belongs – with the grown-ups.

6. Demonstrate as much respect toward your children’s other parent as you can possibly muster.  That means using respectful language about and toward him/her, ESPECIALLY if your children are anywhere in earshot…and that means anywhere on your property because they have amazing radars that pick up on this language from long distances and when they seem immersed in activity.  That means maintaining the boundaries discussed above.  Remember, your children’s other parent is a part of your children.  Respecting him/her is a way of respecting your children and making sure that you do not place them in a loyalty conflict, feeling the need to choose between you and their other parent.

7. Recognize unresolved feelings.  If you are a couple of years out and you still find yourself feeling strong feelings like hatred toward your children’s other parent, then you have likely got some work to do to really move on with your life without him/her as your partner.  Your intimate relationship is over.  It is time to forge something that is more akin to a business partnership, where your children and their well-being are the focus at all times.  If you are focused instead on keeping score, denying your children’s other parent’s requests because you don’t want him/her to get his/her way, or caught up in regular arguments, screaming matches, or other hostilities, go back to #1.  Without superhero powers, it is nearly impossible for your children to thrive in the face of this dynamic.

A final word on staying focused as you work toward cooperative co-parenting: on a regular basis, ask yourself “Is this good for my children?”  Pause and really think about that.  “Is this good for my children?”  It can be helpful to keep a picture of your children on hand as you contemplate this and as you work through differences with your children’s other parent.

For readers interested in learning more about what children need during different ages, I still highly recommend Gary Neuman’s Sandcastles book.  Another great resource is Mom’s House, Dad’s House by Isolina Ricci.  This book has a supportive approach and a lot of good information on the grown-up stuff, how to work through the multiple transitions involved in moving through separation and divorce and on to effective co-parenting.  As with any recommendations that I make, please use what fits with who you are and what you need.

Stay focused.  –Anita

References:

American Psychological Association. An overview of the psychological literature on the effects of divorce on children. Retrieved from http://www.apa.org/about/gr/issues/cyf/divorce.aspx

Neuman, M. G. & Romanowski, P. (1998). Helping your kids cope with divorce the Sandcastles way. New York, NY: Times Books.

Ricci, I. (1997). Mom’s house, dad’s house: A complete guide for parents who are divorced, separated, or remarried. New York, NY: Fireside.

ADHD Outcomes: Being Rejected Can Have a Bigger Impact than Having Friends

By Anita M. Schimizzi, Ph.D.

As with any childhood disorder, we want to know what can protect the child from long-term negative outcomes.  When it comes to ADHD, studies demonstrate all sorts of long-term problems that we would rather prevent, such as delinquency, depression, and anxiety. 

As I mentioned in a recent editorial, data from the Multimodal Treatment Study of ADHD (MTA) revealed some surprising results about long-term outcomes for children with ADHD.  Among the results include a finding that what we typically do to treat ADHD (medication and/or psychosocial treatment) does not significantly improve peer problems.  And long-term peer difficulties can lead to a host of externalizing and internalizing problems that can last into the adult years.

A recent study published in the Journal of Abnormal Child Psychology looked at two different areas of peer relationships in children with ADHD: peer rejection and friendship.  The authors predicted that children with ADHD that were rejected by peers and did not have friends would suffer poorer outcomes in adolescence.  They further predicted that having friends would help lessen the impact of peer rejection and thereby lead to better outcomes.  Their results revealed a surprising finding: friendships did not have the protective impact that they thought they would find.  Peer rejection was the big dog in negative outcomes, period.

Mrug and colleagues used MTA data to look at peer rejection and friendship in about 300 children with ADHD that were in 1st to 4th grade and received treatment for 14 months.  They then studied follow-up data 24 months and six and eight years later.  They took a look at things like ADHD symptoms, delinquency, alcohol use, cigarette smoking, marijuana use, depression, anxiety, and global impairment (defined as impairment across emotional, behavioral, interpersonal and task-related functioning).

The findings revealed that rejected youth were more likely to have higher rates of cigarette smoking, delinquency, anxiety and global impairment at the six-year follow-up and higher rates of global impairment at eight years.  These findings occurred even if the child had a reciprocal friend at the 24-month follow-up.  An interesting tidbit, at the six-year mark the kids with at least one friend were more likely to smoke cigarettes, which the authors suggest may be due to a tendency to be drawn to other rejected youth that are more likely to engage in antisocial behavior.  All of these findings occurred even while controlling for a bunch of other factors, such as ADHD symptoms.

The researchers discuss a variety of reasons that may have led to these outcomes.  One, children who are rejected lose out on important social interactions regardless of whether they have learned new social skills in treatment.  Without the opportunity to practice them in real-world situations, the child is left right where he started in the social arena.  Two, childhood friendships can shift quickly and a child that had a friend at the 24-month data collection may have not had that friend or any others for long enough to act as a buffer for peer rejection.   Three, peer rejection tends to be long-lasting and experiencing it over the long haul can lead to a sort of cyclical effect where rejected kids withdraw and/or act out in order to cope with the inner turmoil that being rejected can cause, which then leads to more rejection.

I understand that this study paints a pretty bleak picture for long-term ADHD outcomes, but the authors also offer some sound recommendations. 

  1. Keep teaching all of those important social skills and make sure to couple the teaching with real-world experiences where they can be practiced.  (Role plays can only take you so far.)
  2. School is a big part of the child’s world, but not the whole world.  Find social opportunities outside of school where children can make friends.
  3. Monitor kids and teens for the negative outcomes mentioned earlier (e.g., depression, anxiety, delinquency) and intervene early and meaningfully.

I’ve stated it before and I’ll state it again.  Open the doors of communication so a child that is rejected by peers can at least find acceptance and understanding with an adult.  It matters. 

Thanks for reading.  -Anita

Source:  Mrug, S., Molina, B., Hoza, B., Gerdes, A., Hinshaw, S., Hechtman, L., & Arnold, L. (2012). Peer Rejection and Friendships in Children with Attention-Deficit/Hyperactivity Disorder: Contributions to Long-Term Outcomes Journal of Abnormal Child Psychology DOI: 10.1007/s10802-012-9610-2

My pediatrician wants my toddler to be in therapy!

By Nestor Lopez-Duran PhD

The American Academy of Pediatrics recommended a few years ago that all young children, including infants, be screened for possible delays in their social and emotional development. Traditionally pediatricians have been concerned primarily with the physical development of children. However, as we became more aware of the importance of kids social functioning for later development, pediatricians began to pay closer attention to childrens behaviors and emotional functioning. In fact, many pediatricians are now conducting screenings of all children to flag kids who appear to have behavior problems or have delays in their social or emotional functioning. When the evaluation suggests that a kid is at-risk due to the presence of some of these concerns, pediatricians usually recommend that the child receive intervention, such a seeing a child therapist who provides services for young children. In some cases the therapist works directly at the pediatricians office but in many cases the child is referred to someone in the community.

What is a parent to do?

When presented with this recommendation, many parents agree and seek intervention for their kids, while many others decline the recommendation, either because they believe it is not necessary or that the intervention would not do anything.

However, the evidence that these interventions work in improving social and emotional functioning continues to increase.

For example, this month the journal of the American Academy of Pediatrics published a study that examined 3,169 children (ages 6 months to 3 years) who were screened at a pediatricians office. Of these kids, about 711 or 22% were considered at-risk in that they showed signs of significant delays in their social or emotional functioning or had behavior problems, as reported by their parents in a screening questionnaires. Slightly more boys (25%) than girls (19%) were considered at-risk. These children were then offered the option to participate in an early intervention program that included either more monitoring, some intervention at the pediatricians office, or a referral to outside services in more severe cases.

285 parents declined the offer to participate in the intervention and 426 parents accepted the intervention. The authors then examined a group of kids who received a re-screening during a follow up visit (after the intervention). Specifically 170 children had this second evaluation. Of these, 67 (40%) came from the group who had declined the recommendation for intervention while the rest came from the group that accepted the intervention. This allowed the researchers to compare the kids who had the interventions with those who declined the intervention.

Did the intervention work?

About 56% of the kids who received the intervention showed a significant improvement in their social and emotional functioning. However, declining the intervention was associated with a 75% reduction in the probability that the child would show significant improvement during the second evaluation. The only exception was for kids with autism-style developmental delays who were referred to outside specialists and who unfortunately did not show improvement during the second evaluation.

Does this mean that the intervention worked? Most likely. The results clearly showed that the kids of parents who accepted the intervention were more likely to improve than the kids of parents who declined the intervention, which suggests that the intervention was effective for many of these kids. However, there are other possible explanations. For example, it is possible that families who accepted the intervention were more concerned about their kids and thus more likely to make other efforts to address these delays, such as making changes at home, seeking resources, etc, which may have resulted in the improvements. In this case, maybe it was not be the intervention, but the actions of the parents who agreed to the intervention, that resulted in improvements.

So should you accept the pediatricians recommendation for intervention? I would say YES. The evidence for the effectiveness of these early interventions is growing and I am yet to see evidence for any possible negative consequences that may come from receiving these early interventions.

Cheers, Nestor.

The reference:
Briggs, R., Stettler, E., Silver, E., Schrag, R., Nayak, M., Chinitz, S., & Racine, A. (2012). Social-Emotional Screening for Infants and Toddlers in Primary Care PEDIATRICS, 129 (2) DOI: 10.1542/peds.2010-2211

Depression during pregnancy may lower your child’s IQ.

By Nestor Lopez-Duran PhD

Can depression during pregnancy impact your child’s intelligence? How about postpartum depression?

Maternal depression has some significant negative consequences on kids. Among them, some studies have shown that maternal depression may impact the cognitive development of the offspring. But it is still unknown how maternal depression impacts the child’s cognitive skills. For example, are there sensitive periods during the child’s early development that makes them more susceptible to maternal depression?

One could think that maybe the most important period is during pregnancy, since depression may expose the child to depression-related stress hormones that can affect the child’s early development. It is also possible that the most sensitive period is immediately after birth. For example, postpartum depression may impact the quality of mother-infant interaction during this time affecting the child’s development. It is also possible that depression during the pre-school years, a time when the child is rapidly learning complex cognitive skills, has the most negative impact on the child’s intellectual development.

The Journal of Child Psychology and Psychiatry recently published an excellent study examining this question. The study included over 5,000 families with 8-year-old children. These children completed a series of tests including a basic intellectual abilities test (IQ). The mothers of these children had completed a series of evaluations for depression during pregnancy, immediately after pregnancy, and when the child was in preschool.

The authors wanted to see if maternal depression was associated with lower IQ scores in their kids, and if so, whether this effect was due to having depression at a specific time, such as during pregnancy, immediately after birth, or during early childhood.

The results were intriguing. While adjusting for depression in all time periods, post-partum depression and depression during preschool DID NOT impact the child’s IQ at all.

The big player was depression during pregnancy!

In fact, having depression during pregnancy was associated with a drop of 3.34 IQ points by the time the child was 8 years old.

This effect was found even after controlling for a number of factors that may be associated with depression during pregnancy, such maternal age, smoking, drinking, socio-economic status, maternal education, child’s gender, child’s birth weight, and whether or not the mother breast fed the baby.

So it seems that depression during pregnancy may have a direct negative impact on the child’s intellectual development.

But why? What is it about depression during pregnancy that has such a negative impact on the child’s cognitive development?

One possibility is that depression during pregnancy exposes the child to high levels of the stress hormone cortisol, which may negatively impact the child’s brain development.

The authors also discussed another possibility: that depression during pregnancy may impact the way mothers respond to their kids after birth. That is, being depressed during pregnancy often impacts how the mother interacts with the infant once the child is born, such as by reducing the mother’s responsiveness to the infants, which in turn may negatively impact the development of the kids cognitive skills. However, if this is the case, why is it that post-partum depression did not impact the kid’s IQ, given that post-partum depression also has a significant impact on maternal behaviors, including responsiveness?

All in all, this study highlights the possibility that maternal depression during pregnancy may have a significant negative impact on the childs intellectual skills. Fortunately, we have very effective interventions for depression, so I highly recommend expecting mothers to discuss their symptoms with their physicians or health care providers and to seek a referral to a mental health provider if necessary.

For more information about depression during pregnancy I invite you to visit the University of Michigan Depression Center.

Nestor.

The Reference:
Evans, J., Melotti, R., Heron, J., Ramchandani, P., Wiles, N., Murray, L., & Stein, A. (2011). The timing of maternal depressive symptoms and child cognitive development: a longitudinal study Journal of Child Psychology and Psychiatry DOI: 10.1111/j.1469-7610.2011.02513.x

Spare the rod, save the child.

By Nestor Lopez-Duran PhD

Just some quick thoughts on some current events in case you missed it.

This week Ive been reading Steve Pinkers wonderful new book The Better Angels of Our Nature: Why Violence Has Declined, which provides some compelling evidence about the drastic decline in violence throughout history. According to Pinker, we live in an extremely peaceful world and that this is likely the most peaceful time in human history. The evidence that Pinker provides is vast and compelling, and he also provides some colorful graphic examples to make his point. One example stuck with me: just a few hundred years ago parents would take their kids to the towns plaza to watch people be tortured to death. That is right! Just a few hundred years ago, in many European countries,watching an execution or a torture session was not just entertainment, it was a family affair! Pinker argues that we have also become significantly less violent in much more subtle ways, from the abandonment of settling personal honor conflicts through deadly duels, to the reduction of executions in all industrialized nations (except the USA), to the drastic reduction in marital violence as well as parental violence against their children (aka spanking) in the western world.

But this week we were sadly reminded that we are not as peaceful as we could be just yet. The New York Time published an article about two recent instances in which parents had killed their children by using violent discipline practices. In one case, an 11 year old adopted girl was found dead in her backyard due to hypothermia and malnutrition. It appears that her parents had punished her by making her sleep in the cold and withholding food. She also was often beaten with a plastic tube. In another case, a 7 year old girl was beaten to death by her parents, who apparently were following some extreme Christian teachings about how children should be punished. In fact, reportedly the parents often paused the beatings to pray.

These two cases have one thing in common: both parents had the book of a controversial Christian Pastor who preaches the virtue of beating your children.  In both cases, authorities believe that the Pastors teachings likely influenced these parents. Although you can blame these deaths on the acts of some violent parents, it is sad that some people in positions of authority within some religious communities openly endorse the use of violence against children.

I have already written extensively about spanking, so instead of repeating myself, I want to direct my readers to an editorial I wrote more than a year ago called Why spanking is never OK. My views as well as the research that led to that editorial have not changed. I invite anyone to comment or pose questions after reading the editorial.

Best wishes, Nestor.

HPV vaccines and teen sexuality

By Nestor Lopez-Duran PhD

Some brief thoughts on an issue I will be covering more intensively during the next few weeks. This week the CDC Advisory Committee on Immunization recommended that boys between the ages 9 to 26 be vaccinated against the HPV virus. This created a storm of controversy among some parents and politicians who are concerned that this vaccine can increase sexual activity among teens.

HPV infection is the most common sexually transmitted disease and is responsible for a significant number of cancers in women and men. HPV however, is highly preventable if individuals are vaccinated before they become sexually active. Thus, CDC believes that comprehensive vaccination against HPV before teens become sexually active can drastically reduce cancer rates and thus save thousands of lives.

Yet in the USA less than 1/3 of teen girls have been fully vaccinated against HPV, which is significantly below the level necessary to make a real impact on HPV rates. This number is worth repeating: less than 1/3 of girls in the USA are vaccinated against a highly preventable virus that is responsible for the death of thousands of women and men each year.

Why are these vaccination rates so low?

A number of studies have identified the factors that keep parents from vaccinating their kids.

In sum, the most common factors are:

1. The concern that vaccination could promote adolescent sexual activity.
2. The belief that vaccinations are too costly.
3. The belief that their teens are not at risk because they are not sexually active and thus should not get vaccinated.
4. The concern that vaccines are too risky.

Next week I will address these four issues and will present a number of research findings regarding these concerns. But in sum, there is no evidence supporting these concerns and the potential risks are not enough to outweigh the potentially life-saving benefits of this vaccine. Nestor.

References:

Brewer, N. T., Fazekas, K. I. (2007). Predictors of HPV vaccine acceptability: a theory-informed, systematic review. Preventive Medicine, 45(2-3), 107–114.
Davis, K., Dickman, E. D., Ferris, D., Dias, J. K. (2004). Human papillomavirus vaccine acceptability among parents of 10-to 15-year-old adolescents. Journal of lower genital tract disease, 8(3), 188.
Fazekas, K. I., Brewer, N. T., Smith, J. S. (2008). HPV vaccine acceptability in a rural Southern area. Journal of Women’s Health, 17(4), 539–548.
Zimet, G. D., Liddon, N., Rosenthal, S. L., Lazcano-Ponce, E., Allen, B. (2006). Psychosocial aspects of vaccine acceptability. Vaccine, 24, S201–S209.
Zimet, G. D., Mays, R. M., Winston, Y., Kee, R., Dickes, J., Su, L. (2000). Acceptability of human papillomavirus immunization. Journal of Women’s Health Gender-Based Medicine, 9(1), 47–50.

Give SpongeBob a break!

By Nestor Lopez-Duran PhD

This morning I turned on the news and found this headline: Pediatricians group finds fault with SpongeBob published by Reuters. In the article, the Reuters reporter states:

And Monday, the American Academy of Pediatrics will take aim at the 12-year-old Nickelodeon show, reporting a study that concludes the fast-paced show, and others like it, arent good for children.

From the title and the content of the news article, you could conclude that the American Academy of Pediatrics (AAP) is taking a position against the cartoon. I was initially shocked and wanted to see why the AAP would take such as drastic policy statement. After all, the AAP only takes positions on issues that have been extensively studied, such as their position against corporal punishment.

But I rapidly realized that the AAP was not taking any position against SpongeBob at all, and that the AP article was entirely misleading (most likely because the reporter may not know how the AAP publication process works).

At issue is a small study that will be published this week in the journal Pediatrics, which is the main journal of the AAP. The AAP PR office sent a press release this weekend about the study, just as they do about many of the studies to be published this week. Such a press release is simply an attempt to get publicity for the journal but does not at any level imply that the AAP itself endorses the results of the study as conclusive.

Let me explain, the journal Pediatrics simply publishes the results of carefully conducted studies that are supposed to advance our knowledge of an issue. Then scientists can review the study and try to replicate it or improve it. That is, other scientists try to conduct the same experiment and try to get the same results. In many cases the findings are replicated and we can start to draw some narrow conclusions about the issue, but in many, many cases the findings are not replicated.


I have not read this specific study because it has not been provided to scientists yet (I hate that the AAP provides information of studies to journalists before it gives it to the scientific community). But from another AP report, it seems that the authors compared 4-year-old kids who completed 3 tasks: 1. Watch Spongebob for 9 minutes. 2. watch another slower-paced cartoon, or 3. draw pictures. After this experiment, the kids completed a task of inhibitory control, in which they had to wait before they could eat candy.

The results suggested that those who watched Spongebob were more impulsive (aka ate the candy sooner) than the kids in the other two groups. I may make additional comments about this study once I read it, but this is not entirely surprising given that SpongeBob is fast-paced and would increase physiological arousal, which in turn will decrease inhibitory control. I am surprised that the comparison group was not an active one, such as having the kids run around or make jumping jacks. In such a case, I would predict that the kids doing exercise would also have difficulty waiting for the candy and would perform similarly to the kids watching SpongeBob. Would you then conclude that exercise is bad for kids?

Despite the medias sensationalistic statements, it seems that the conclusions by the authors were pretty appropriate. They stated to the AP that the study suggests that parents should not have young kids watch SpongeBob or any other fast-paced TV show immediately before they need to do activities that require concentration, such as going to preschool or kindergarten. This makes sense, just as it makes sense that kids should not be running around before going to bed.

So the issue is not really about SpongeBob, but about the simple phenomenon that  excitement can reduce inhibitory control.

I say, give SpongeBob a break.

Cheers, Nestor.

Help yourself to help your child: Maternal depression and child trauma

By Nestor Lopez-Duran PhD

During case consultation meetings at most child psychotherapy clinics, a therapist presents a case and seeks recommendations from other clinicians. The clinicians discuss the specifics of the case and then offer suggestions that could benefit the child. I remember the first year I started attending these case conferences how surprised I was at how often the recommendation was for parents to also receive their own individual therapy. Sometimes the recommendation was simply intended to provide stressed parents with some resources that could benefit them. But often the parents were struggling with symptoms themselves and the group believed that addressing the parental symptoms would also help the child. The assumption was simple: children respond better to interventions if their parents are not struggling with psychological difficulties themselves.

Last night I read an interesting article just published in the Journal of Abnormal Child Psychology that provides some scientific support for such assumption. The article reported the findings of a study that examined the effectiveness of two different child therapies for Post-Traumatic Stress Disorder (PTSD). Specifically, the study compared an intervention called Trauma-Based Cognitive Behavioral Therapy (TB-CBT) against a similar intervention called Trauma Based Cognitive Therapy (TB-CT) (For my clinician readers, the TB-CT did not involve exposure).

I was not surprised at all at the fact that both interventions were very effective in reducing PTSD and other similar symptoms. What was most surprising is how much parents impacted the effectiveness of the intervention.

Specifically, maternal depression significantly impacted the effectiveness of the intervention among kids who presented with severe PTSD symptoms. See this graph:

That line reflects kids whose parents had low levels of depression.  You can see based on that line that the PTSD symptoms at the end of the treatment were very low regardless of whether the kids had severe or non-severe PTSD symptoms at the start of the intervention.  That is, after the intervention, most kids, whether they had severe or non-severe PTSD at the start of the treatment, had low levels of PTSD symptoms. In sum, the therapy worked.

However, the solid line reflects the kids whose mothers had high levels of depression. As you can see, the PTSD symptoms at the end of the treatment were really high for those kids who had severe symptoms of PTSD at the start of the intervention. That is, the therapy did not work for kids who had severe symptoms of depression at the start of treatment if their mothers were also depressed.

For clinicians and parents the implications are the same. It is extremely important that parents and clinicians pay attention to parental depression when dealing with a child who has been traumatized. Parents should know that it is common for them to feel many symptoms of depression when their child has experienced trauma. But in such cases, it is important for the parent to receive help for their own symptoms in order to help their child recover from the trauma.

Cheers, Nestor.

The reference: Nixon, R., Sterk, J., Pearce, A. (2011). A Randomized Trial of Cognitive Behaviour Therapy and Cognitive Therapy for Children with Posttraumatic Stress Disorder Following Single-Incident Trauma Journal of Abnormal Child Psychology DOI: 10.1007/s10802-011-9566-7

Kids nowadays get away with everything! Has parenting really changed?

By Nestor Lopez-Duran PhD

I always find it amusing when people talk nostalgically about the good old days when arguing that todays generation is out of control. Todays kids are so violent When I was a kid I would have never gotten away with that!, I hear often. The argument is that todays youth are out of control because parents do not parent anymore and parental expectations have declined. But is this really true?

Let us for a moment bypass the important question of whether kids today are worse than previous kids, because it is actually a complicated issue. For example, although there is some evidence of increasing parental-perceived conduct problems and youth incarceration during the last 50 years, there are many possible explanations that suggest that actual conduct may not be that different. For example, increasing parenting expectations may result in todays parents reporting their kids as worse than they were themselves even though the actual behavior is similar. Likewise, increased policing and stronger drug enforcement can result in greater incarcerations, which makes it look like todays kids are getting in trouble more often when it fact they are just simply getting caught more often.

But again, lets assume that todays kids are truly getting in trouble more often than previous kids. Is this the result of worse parenting? Has parenting really changed during the last decades?

The Journal of Abnormal Child Psychology just published a study that examined parenting changes among thousands of parents of 16-year-old teens in 1986 and fairly similar parents in 2006.

I will focus here on two specific questions. First, have parenting practices changed from 1986 to 2006? Second, are the perceived increases in conduct problems the result of changes in parenting?

Lets tackle the first question. Below are the scores of parental expectations and behaviors in the two years of the study.

As you can see when comparing the 1986 to the 2006 columns, the study suggests that as compared to the 1986 parents, 2006 parents have greater expectations in relation to going to school, doing homework, being polite, telling parents where they will be going, etc. In addition, 2006 parents are more likely to monitor their teens as compared to 1986 parents.

These results do not suggest that todays parents are more permissive or relaxed than parents in 1986. In fact, they seem to report having higher expectations and monitoring their kids more than parents did 25 years ago.

The authors of the study also examined whether any changes in conduct problems between the 1986 and the 2006 teens could be due to parenting changes. The results were actually surprising. The answer was yes, but not in the way you think. The authors found that changes in parenting practices from 1986 to 2006 actually made an impact on teens behavior: they seemed to have decreased the amount of conduct problems.

But how could parenting changes in the last 30 years have reduced the conduct problems among kids if conduct problems among kids apparently got worse? That is, if teens got worse, how is it that parenting made it better? The authors argue that parenting changes made the problem less worse: Yes, kids appear to be having more conduct problems, but these problems would be even worse if parents had not changed since 1986.

The authors conclude:

The findings of this study do not support the view that a population-wide ‘decline’ in quality of parenting has led to an increase in youth antisocial behavior. As anticipated, lower levels of parental control and responsiveness were strongly associated with risk for conduct problems; longitudinal analyses for the first cohort also showed that they predicted future risk of adult crime (supplementary Table 3). However, as noted, quality of parenting appears if anything to have improved and these changes may have been protective. Models suggested that increases over time in conduct problems might have been greater had it not been for observed changes in parental control and responsiveness.

So this study seems to conclude that parenting is not responsible for the high levels of conduct problems observed in todays youth.

The reference:
Collishaw, S., Gardner, F., Maughan, B., Scott, J., & Pickles, A. (2011). Do Historical Changes in Parent–Child Relationships Explain Increases in Youth Conduct Problems? Journal of Abnormal Child Psychology DOI: 10.1007/s10802-011-9543-1

Divorce, abuse, or depression.. what is worse for your child?

By Nestor Lopez-Duran PhD

Today I read one of the most interesting studies Ive read in a while. It included an examination of the long term health effects of having a number of childhood adversities, such as divorce, abuse, or experiencing childhood depression or anxiety. Are stressful events and mental health problems in childhood associated with medical problems as an adult?

What is fascinating about this study is that it addressed a number of limitations of previous studies. One important issue is that most previous studies have looked at either the effects of stressful life events (e.g., divorce) or the effects of mental health problems (e.g., depression). In this study, the author examined both, stressful events and mental health, in a way that allowed them to control for the effects that they have on one another. For example, they could now see whether depression has an impact on later medical problems while controlling for the effects of other stressful events.

Another fascinating thing is that this study was conducted by the World Health Organization with over 18,000 people from ten different countries, including the USA, Colombia, Mexico, Belgium, France, Germany, Italy, the Netherlands, Spain, and Japan. In sum, the researchers examined the long term health effects (heart disease, asthma, diabetes, chronic pain, severe headaches, etc) of 11 adverse events including:

  • Physical abuse
  • Sexual abuse
  • Neglect
  • Parental death
  • Parental divorce
  • Other loss of parent
  • Parental mental disorder
  • Parental substance abuse disorder
  • Violence in family
  • Criminal behavior in family
  • Family economic adversity

They also examined the effects of having any of 5 mental health conditions in childhood, including:

  • Major depression
  • Generalized anxiety
  • Social phobia
  • PTSD
  • Panic disorder

Here are some of the results showing how each event increased the relative risk of selected physical conditions. In the first column you will see the childhood events, such as experiencing childhood depression (first row). In the rest of the columns you will see the percentage increase in risk for that specific condition that is due to the event in that row when compared to people who did not experience any event in childhood. For example, those with childhood depression (defined in this study as before age 21) were 82% more likely than their intact peers to develop heart disease as adults. By intact peers I mean those who did not experience any of these events in childhood. If you see a 0 it means that the results were not statistically significant, so the event did not impact the risk for that condition.

Heart Disease Asthma Diabetes
Depression 82% 111% 0
Anxiety 0 0 0
Social Phobia 80% 0 0
PTSD 139% 95% 0
Panic Disorder 132% 106% 0
Physical Abuse 82% 92% 52%
Sexual Abuse 291% 0 0
Neglect 0 0 0
Parent Death 34% 34% 0
Parent Divorce 0 0 37%

 

Where to start? This table is so rich that it can be the source of some interesting discussions, so I will just highlight a few findings.

1. The risk for heart disease appears to be extremely sensitive to childhood adversity. On the other hand, the risk for diabetes does not seem to be impacted much (although with some exceptions) by such adversity.
2. Several mental health problems, including childhood depression, PTSD, and panic disorder appear to have a major impact on the risk of heart disease and asthma, but do not appear to impact the risk for diabetes.
3. Physical and sexual abuse have also a significant impact on health. For example, sexual abuse had the most severe impact on heart disease when compared to any other event. Specifically, those who experienced sexual abuse as kids were close to 300% more likely to develop heart disease than their non-abused peers.
4. Divorce had a surprising minimal impact on health. It did not impact the risk for heart disease or asthma, but it increased the risk for diabetes slightly by 37%.


This last finding related to divorce is quite interesting. It seems that other childhood events and mental health problems have a greater negative impact on physical health than parental divorce. In line with this finding, there are several studies that have shown that after adjusting for some variables, the long term negative impact of divorce is minimal. In some cases, such as when there is significant amount of conflict and aggression in the marriage, divorce may actually result in better outcomes for the children. In fact, recent researchers have argued that the negative impact of divorce on children may actually be due to the marital conflict that was happening before the divorce took place (see for example Kelly 2000 Childrens Adjustment in Conflicted Marriage and Divorce: A Decade Review of Research doi:10.1097/00004583-200008000-00007). This is why in some cases, when parents are concerned about the effects that their divorce may have on their children, clinicians often remind them to also consider the effect that living with parental conflict may have on children.

– Nestor.

The reference: Scott, K., Von Korff, M., Angermeyer, M., Benjet, C., Bruffaerts, R., de Girolamo, G., Haro, J., Lepine, J., Ormel, J., Posada-Villa, J., Tachimori, H., Kessler, R. (2011). Association of Childhood Adversities and Early-Onset Mental Disorders With Adult-Onset Chronic Physical Conditions Archives of General Psychiatry, 68 (8), 838-844 DOI: 10.1001/archgenpsychiatry.2011.77