Moms, Kids Anxiety

By Anita M. Schimizzi, Ph.D.

We know that maternal depression can have a profound impact on children.  But what about maternal anxiety?  A recent article in the Journal of Abnormal Child Psychology suggests that mom’s anxiety may tend to transfer to her young children.  Before I start, however, let me be clear that this post is in no way intended to blame moms for their child’s anxiety.  Rather, it is meant to provide information and ideas on this possible relationship.

Pass and colleagues took a look at around 60 mothers in the UK who were diagnosed with anxiety disorders (specifically, social phobia with about half also having generalized anxiety disorder) and 60 mothers who weren’t.  They compared information gathered on their children as they were getting ready to begin formal schooling (around 4 ½ years old).  After the children completed the first term of school, the researchers gathered more information from mothers and also from teachers.

At the first data gathering, the children were given a doll play activity (I continue to be amazed with how much children reveal about their inner lives through play) and several school-related scenarios to prompt their play.  Mothers were also asked to report on their child’s anxiety.  At the second data gathering, teachers reported on the students’ anxiety and mothers provided additional information.  Here’s what they found.

Children of anxious mothers gave “anxiously negative” responses during their play at a significantly higher rate than children of non-anxious mothers.  Further, children whose play was classified as anxiously negative were almost 7 times more likely to score in the borderline/clinical range on teacher reports of anxiety/depression and also more likely to score higher on teacher-reported social worry after completing the first term of formal schooling.

While the researchers predicted that there would be significant differences in the children of anxious mothers and those of non-anxious mothers in the areas of attachment (parent-child bonding) and behavioral inhibition (fear and avoidance of unfamiliar situations), the groups did not differ significantly.  In other words, children of anxious moms were just as likely to be securely attached and willing to enter novel situations as those of non-anxious moms.

As is typical in research, the focus remains on the mother-child link rather than bringing dads into the mix so we don’t know if and how dad’s anxiety can impact kids or if his lack of significant anxiety can act as a buffer.  What we see is that there seems to be a relationship between socially anxious moms and kids who view the school social experience in negative ways and are seen as more anxious, depressed, and worried than their classmates.

I have sat across from many parents who have sought therapy for their child’s anxiety only to realize that they themselves harbor many of the same characteristics.  As they launch into self-blame, my response is always the same: nobody is to blame.  Let’s work on understanding this and learn and practice techniques as a family.  And that is my suggestion to readers.  If you, as a parent, find that you have significant anxiety it might be time to take a look at your child, too.  Conversely, if your child seems to have a lot of anxiety, it might be a good idea to see if it also resides in you.  There are so many solid, research-supported ways to manage and decrease anxiety in people of all ages.  And doing so can open up a whole new world of being.

Thanks for reading.  -Anita

Source:  Pass, L., Arteche, A., Cooper, P., Creswell, C., & Murray, L. (2012). Doll play narratives about starting school in children of socially anxious mothers, and their relation to subsequent school-based anxiety. Journal of Abnormal Child Psychology. DOI: 10.1007/s10802-012-9645-4

Race and Spanking in the US: A Spank is a Spank is a Spank

By Anita M. Schimizzi, Ph.D.

Yes, it is no secret how we at child-psych.org feel about spanking.  Nestor and I have both posted on it before.  Still, there remain arguments that spanking is less detrimental for children when cultural context is taken into account.  That is, if spanking is more acceptable and part of the norm within a certain cultural group, then the negative behavioral fallout from spanking is lessened.  Gershoff and colleagues recently published a study in the journal Child Development and their findings suggest that this argument is bunk.

The researchers used data from a nationally representative sample of over 11,000 children gathered in the Early Childhood Longitudinal Study’s Kindergarten Cohort of 1998-1999.  Children included in the study were from one of four racial groups: White/Non-Hispanic, Hispanic, Black/Non-Hispanic, and Asian.  Using data from both kindergarten and third grade for the students, they collected information on spanking, child externalizing behaviors (e.g., arguing and fighting), and parent background (e.g., family income-to-needs, parent education, marital status, and employment status).

Information gathered at kindergarten showed that most mothers (80%) spanked their child at some point, but only 27% reported currently spanking their child.  Fifteen percent of mothers reported spanking their third grade child.  At both points in time, Black mothers reported significantly more frequent spanking than any of the other mothers.  Hispanic moms were more likely to spank during kindergarten than White and Asian moms.  Teacher reports showed that acting out was highest at both kindergarten and third grade for Black students.  White and Hispanic children acted out more than Asian children in third grade.

After controlling for a whole bunch of variables (e.g., child gender and age, family income and size, parent education, marital status, parent employment status, and race), the researchers found that early spanking predicted more externalizing behavior over time regardless of the child’s race.  And here’s an additional interesting outcome: increased acting out predicted more spanking.  So we have a spank-act out-spank-act out cycle.  In other words, the very behaviors that parents try to squelch with spanking increase with spanking and the impulse can be to, you guessed it, spank more!

It is worth speaking further on the findings for Black children in this study.  There is absolutely no refuting the fact that corporal punishment served as a survival technique for African Americans during earlier times in our society.  To not keep one’s child in line could literally lead to far harsher punishment and/or death at the hands of the slave-owner and under the not so distant Jim Crow laws.  It is more than understandable that African American parents would have done anything and everything to protect their children in this type of society.

What we know now, however, is that the desire to immediately put behavior in check through spanking appears to have an unwanted effect over time.  The very behaviors that parents want to end increase instead.  Old habits and doing as we were raised to do are hard to change, very hard to change.  No matter what your race is, it looks like it’s both time and worth it.  What, you may ask, in the heck do we do instead?  You can start with poking around the How To section on the site and see if something strikes a chord.  And please let me know if there is something else that you would like to see.  Post your questions and open up important dialogue with other parents.

Thanks for reading.  –Anita

Source:  Gershoff ET, Lansford JE, Sexton HR, Davis-Kean P, & Sameroff AJ (2012). Longitudinal Links Between Spanking and Childrens Externalizing Behaviors in a National Sample of White, Black, Hispanic, and Asian American Families. Child development, 83 (3), 838-43 PMID: 22304526

Special Editorial: Does your child need therapy? Thoughts on parental fears and why we need you involved

By Nestor Lopez-Duran PhD

Historically, psychiatry has not been kind to mothers. Early (and mostly wrong) ideas about what ‘caused’ emotional/behavioral difficulties and psychiatric disorders made it easy for clinicians to blame parents for all childhood conditions. Autism is a classic example. In the 1940s Leo Kanner, one of the most influential child psychiatrists of the time, stated that children with autism were kept in “refrigerators that did not defrost.” By refrigerators, he was referring to mothers, who he believed were emotionally and interpersonally distant. As most of you likely know by now, Kanner was wrong.

Since then, the attack on parents appears to be relentless. Our media outlets are filled with misinterpretations (and sometimes accurate interpretations) of research findings and statements by clinicians that directly or indirectly blame parental behaviors for their kids’ problems.

  • You cuddle your kids too much
  • You don’t love them enough
  • You are too strict
  • You are too permissive
  • You are too emotional
  • You are not emotional enough
  • You give too much freedom
  • You hover over them
  • You don’t praise them enough
  • You praise them too much

The list is endless.

The consequences of this parental blaming are devastating: parents full of either guilt and shame or anger and defensiveness, and worse, children who don’t get the treatment they actually need.

So I often find myself doing damage control with parents and explaining their new role in helping their kids improve. So today I wanted to share with you what I often tell parents who are either reluctant about therapy or are struggling with making decisions regarding their kids treatment.

  1. Does your child need help? Examine your childs academic, social, family, and emotional functioning to decide whether he needs help. If your kid’s behavioral or emotional difficulties are such that his functioning at home, school, or with peers is impaired, he may need help. You may ask, what is impaired functioning? There is no standard definition, but we usually become concerned when a child is unable to fulfill many of the basic tasks of being a kid: going to school, getting at least Cs in his courses, developing and maintaining friends, regulating his emotions, keeping himself out of trouble with the law, understanding and following basic rules, etc.
  2. Getting help does not necessarily mean medication or years of therapy! Getting help may simply involve an evaluation to determine what intervention, if any, may be beneficial to your child. So it is often less scary if parents think that the first step is simply to seek an evaluation or consultation, without any commitment to go beyond this initial consult. The process should not be any different than when taking your child to the pediatrician for an evaluation if your child is having some physical symptoms. If your child needs help, most of our current interventions are relatively short (20-30 sessions) and the times of keeping kids in never-ending years of therapy are gone (at least mostly).
  3. If you are concerned about your child’s functioning don’t accept a “he is just fine” answer from your pediatrician, especially if the pediatrician only asked you a couple of questions. I am always reluctant to say anything negative about other professionals, but the reality is that many pediatricians have little training in child psychology and psychiatry and especially in the proper evaluation of child psychological conditions. This is not just my perception. A comprehensive national survey of pediatricians revealed that about 70% of pediatricians feel that they lack appropriate training in diagnosing and treating mental health conditions and over 60% felt that they were not competent in proper diagnostic practices . So if you dont agree with your pediatricians opinion that your child is just fine, request a referral for a consultation with a child mental health provider, such as a psychologist, psychiatrist, or clinical social worker.
  4. In many, many, many, cases, what “caused” your child’s condition does not really matter. This is likely a controversial statement, especially with some traditional therapists, but I say it because parents are frequently overly concerned about finding out what “caused” their kids OCD or ADHD. Often parents feel guilty and want to know if they caused the problem somehow or they are seeking answers that help them understand and accept why things turned out this way. The reality is that in most cases the “cause” will never be known. Although good clinicians will have a deep understanding of the historical and current context (family dynamics, peer group, thinking style, etc.) that may contribute to some of the difficulties, what matters right now is what we do from this day forward to help your child improve. Remember, we can’t change the past but we can improve your child’s future.
  5. We can’t help your child without your help. There is very little we can do in one hour of weekly therapy without getting parents, and often teachers, involved in the treatment process. This is because the most effective interventions usually require that we make changes at home and in some cases at school. On that note:
  6. When we suggest a different parenting or discipline strategy we are not saying that what you were doing was wrong or that you caused the problem. There are many, many parenting styles that are effective for most kids. In fact, some researchers even use the term “good enough parenting” to refer to the phenomenon that most kids will be fine regardless of what you do as a parent. But we also have extensive research suggesting that in some cases, such as when a child has a specific disorder, some parenting behaviors are more helpful than others. In addition, the most effective treatments for some conditions require that parents implement specific discipline plans that may be very different from what comes naturally to some parents. So we may ask you to change how things work at home, but not because we are judging your practices or skills, but because we need you to help us implement a treatment that may involve doing things differently. It is really not any different than if your child had a food allergy and the pediatrician recommended that you change your cooking. You were not doing it wrong. You did not cause the problem. But you can help your child by making the changes that need to be made.

In sum, I want parents to know that clinicians want first and foremost to help your child, not to find someone to blame for your child’s problems. We ask you to be involved because that is the most effective way to help your child improve. We need you to be our allies because without your help and support there is often little we can do.

Nestor L. Lopez-Duran Ph.D. is a child clinical psychologist and researcher currently working as an Assistant Professor at the University of Michigan. Follow him on twitter at @nestorlld

APA Guidelines for Parenting Coordination for High Conflict Separated Divorced Parents

By Anita M. Schimizzi, Ph.D.

While splitting from a mate is rarely easy, it can be hugely difficult for couples that have children together. In this situation, it is most likely that you will still remain in one another’s life for a very long time in order to co-parent your children. For most couples, the stress and conflict of divorce gradually subsides to reasonable levels over the first few years. For others, however, the conflict rages on and oftentimes it is the children who suffer the most.

Research suggests that divorce in and of itself is not destructive to children, but rather it is ongoing parent conflict that takes the lead in negative child outcomes. For high conflict parents, those that cannot seem to work cooperatively and respectfully on behalf of their children, who drag out parenting decisions, spend inordinate amounts of time in litigation, and/or do not follow through with parenting agreements even when court ordered, there is a service worth considering. In fact, it will oftentimes be court ordered when the abovementioned get too severe. That service is parenting coordination.

Parenting coordination is intended to provide support, guidance, education, and sometimes decision-making for separated and divorced parents that are in long-term high conflict. In quick sum, it is put in place to help parents carry out their parenting agreement. The service is typically provided by an attorney or mental health professional who has completed intensive training in the area of parenting coordination. This person is called a parenting coordinator or PC.

While PCs have been practicing for years, there has been a lot of variation in the way that they practice due to a lack of universal guidelines. The Association of Family and Conciliation Courts (AFCC) is a major contributor to the formal development of parenting coordination services and released a set of guidelines developed in 2005. The American Psychological Association has now taken on the task of developing PC guidelines specific to psychologists that operate as PCs and they have published those in this month’s American Psychologist.

While the guidelines are designed for psychologists, they can be applied to PCs with other professional backgrounds as well. I write about these guidelines not just for the sake of PCs, but for those parents who work with PCs. My intention is to give parents a clearer picture of what goes into the process of parenting coordination as PCs attempt to move parents from entrenched conflict to cooperative, productive parenting.

The guidelines cover several key areas. They are not mandated. Rather, the guidelines are to be used as a framework for how a PC operates.

  1. PCs are expected to understand and appreciate how extremely complex this role is.
  2. They are to receive ongoing training to keep up with the psychological and legal knowledge needed for the role.
  3. They are to practice only if they have competencies in the many skills and areas of knowledge (such as cultural awareness and domestic violence) required for parenting coordination.
  4. PCs are to work to ensure family safety and recognize when that safety is at risk.
  5. PCs are to adhere to APA’s ethical guidelines and seek guidance when needed to address issues related to diversity.
  6. PCs must maintain clear, complete, and timely record keeping.
  7. PC work and billing are to be done in a responsible and timely manner.
  8. PCs are to work collaboratively with other professionals involved in a case.

To read the full guidelines online, go here.

I’ve been exposed to PC work enough to know that many parents in the situation of having to have a PC are resentful of the presence of this person, feel as if their hands are tied and their parenting powers stripped. It is my wish that these guidelines can shed light on the true complexities and intentions behind the process and, hopefully, parents can work with their PC in a collaborative manner to move forward both for the sake of their children and of themselves. In other words, I hope that you can make your PC obsolete. Thanks for reading. –Anita

Sources:
AFCC Task Force on Parenting Coordination (2006). Guidelines for Parenting Coordination. Family Court Review, 44 (1), 164-181 DOI: 10.1111/j.1744-1617.2006.00074.x

American Psychological Association (2012). Guidelines for the practice of parenting coordination. American Psychologist, 67 (1), 63-71 DOI: 10.1037/a0024646

Aggression in the Toddler Can Be Traced to Hostility in the Marriage

By Anita M. Schimizzi, Ph.D.

It makes sense if you think about it.  Mom and Dad are angry and at each other more often than they care to admit.  In comes junior.  It may not be so easy to put aside the hurt and anger caused by the marital conflict and turn toward the tot with a warm and patient approach.

Stover and colleagues describe the “spillover” theory to explain this process.  That is, high conflict marriages can breed emotional distress in the parents that leads to decreased parenting quality.  Another interpretation of the theory is that the emotional arousal that happens in one family relationship (in this instance, marriage) can bleed into other family relationships (such as that between parent and child). 

 “But what if it’s just genetics?” you may ask.  I mean, perhaps parents with hostile and angry dispositions simply have hostile and angry children.

To answer this question, Stover et al. looked at 308 adoptive families (adoptive child, mother, and father) as well as the biological mothers.  Information from birth moms was gathered at three and six months postpartum, while information from adoptive families was gathered when the children were 18 and 27 months. 

Stover et al. didn’t look exclusively at the martial conflict, however.  They backed up the chain of events one step further to discuss perceived financial strain, which can then lead to marital stress, which can then lead to hostile parenting, which can then lead to childhood aggression.  Note that this perceived strain was independent of income; rather, it was the parents’ thoughts and emotional experience of their finances that led to the feeling of stress.

Using a variety of questionnaires, data on child aggression, marital hostility, parenting hostility, perceived financial strain, adoptive parent antisocial traits, and birth mom antisocial behavior was gathered.  Here is what they found.

Marital hostility, adoptive father and adoptive mother hostile parenting, and toddler aggression were significantly related.  Marital hostility did not directly link to toddler aggression, but rather it linked to hostile parenting, which then linked to toddler aggression. 

Throw perceived financial strain into the mix and the results revealed a significant link to marital hostility and toddler aggression.   To be clear, perceived financial strain was directly linked to toddler aggression, regardless of parenting. 

And when they looked at adoptive parent antisocial traits, there was a significant association with hostility in both the marriage and in parenting.  Interestingly, birth mother antisocial behaviors were found to be unrelated to toddler aggression.  In other words, nurture matters a whole lot here.

One could guess that negative spillover could easily continue in the absence of intervention.  So what can we do to disrupt this process, thereby decreasing the likelihood of toddler aggression?

For starters, when aggression is noted in a child it could be helpful for married parents to take an honest look at the dynamics that they have with one another.  There is the option to get support and make changes within a marriage.  Your children will thank you for it. 

The authors suggest that parents that tend toward anger and hostility can be impacted by interventions that help them change the way that they think about and respond to their child’s aggression. 

Finally, there is perceived financial strain.  In today’s economic climate, what are we to do with this piece?  Although no one can expect to be stress-free when basic needs are at stake, it may be possible to work on our thinking about and management of the stress.  Addressing the stress becomes increasingly important as we take a look at how our children are doing in the face of it.  Areas to consider can include untapped financial resources, emotional support, and ongoing self-care. 

Thanks for reading.  -Anita

Source:  Stover, C., Connell, C., Leve, L., Neiderhiser, J., Shaw, D., Scaramella, L., Conger, R., & Reiss, D. (2011). Fathering and mothering in the family system: linking marital hostility and aggression in adopted toddlers Journal of Child Psychology and Psychiatry DOI: 10.1111/j.1469-7610.2011.02510.x

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Boys With ADHD and Their Dads

By Anita M. Schimizzi, Ph.D.

A couple of months ago, I wrote about a study that looked at moms and children with ADHD.  Some readers responded with wanting more information on the role of dads in their child’s ADHD.  Well, I found an article in the Journal of Abnormal Child Psychology that studied dads and looked at the impact that their early relationships with their children have on later ADHD symptoms.  And, yes, the study suggests that the early father-child relationship does indeed seem to be related to middle-childhood ADHD symptoms.  (The study looked at the maternal role also, but I am going to focus on the paternal role here.  The citation is below if you’d like to read the whole study.)

The study took place in New Zealand and included 93 preschool boys that were placed in a “hyperactive” group, control group, or in another comparison group where symptoms were present but less severe and, thus, gave the researcher the ability to look at a wide range of ADHD symptoms.  According to the author, only boys were included both because of logistics and because they tend to have more observable behaviors linked to ADHD than girls.  Eighty-nine fathers participated.  Data was collected using parent observations, interviews, and questionnaires, as well as teacher questionnaires.  The study spanned three years, starting when the boys were an average of four years-old.   A second round of data was collected two and a half years later when the boys were an average age of seven.

The author, Louise Keown, looked at three areas of paternal responsiveness (sensitivity (e.g., being tuned into the son’s needs), intrusiveness (e.g., controlling son’s play), and positive regard (e.g., warmth and affection toward son)) and the presence of later ADHD symptoms.  The results took into account early ADHD and behavior problems.  In other words, the results looked at how fathers’ parenting impacted middle childhood ADHD above and beyond preschool problems in this area. 

Here’s what the study found.  Fathers that were characterized as more sensitive and less intrusive with their preschool sons had sons that were later found to be less hyperactive and impulsive at school, according to teachers, and more attentive at home, according to fathers.   Further, higher levels of paternal positive regard in early childhood were related to their sons showing lower levels of inattention at both home and school in middle childhood, according to teacher and maternal reports.

In her discussion of the findings, Keown discusses the importance of fathers learning how to sync up with their sons to give them what they need in any given moment.  For example, a son that gets frustrated and angry with trying to build a block tower that keeps tumbling down will likely have a different response to a father that reprimands him for the outburst as opposed to validating the son’s emotions (e.g., “Wow!  It’s so frustrating when you try to build a tower that keeps falling down.”).  Another example could be a preschooler that starts running around like a maniac at a birthday party because he is over-stimulated and rather than giving him some time and space away from the chaos to get settled again, his father tells him to slow down.  While the cues may be subtle, it is important to learn how to read them.

Keown also discusses the finding of paternal intrusiveness and hyperactivity-impulsivity at school.  She argues that fathers that disrupt their son’s activities and limit the amount of control that sons have over play may also be limiting their opportunity to learn how to self-regulate their behaviors.  In other words, sons that are controlled by an outside force may not learn to control themselves from within.

Last month, I posted on mindful parenting.  The results of the current study can also be applied to this concept.  When dads can step away from their agenda and allow a child’s activity to unfold, supporting them as necessary, it sends the message that the child’s desires are important and that there is a safety net in place when they need it.  Also, nothing can replace the important father-child interaction in a given activity.  The kind where you work together in a rhythm that feels good to both parties. Not only can this be a rewarding way to spend time with your child, but it can also be an opportunity for learning more about your child’s cues and how to meet him where he is.

This post is certainly not meant to criticize fathers.  On the contrary, I hope that fathers will recognize the importance of their relationship with their sons (and daughters!) and find the information to be useful.  Additionally, it is hoped that parenting partners and professionals can support fathers in their relationships with their kids in a way that reduces the chances of heightened ADHD symptoms in middle childhood and beyond. 

Thanks for reading!  -Anita

Source: Keown LJ (2011). Predictors of Boys ADHD Symptoms from Early to Middle Childhood: The Role of Father-Child and Mother-Child Interactions. Journal of abnormal child psychology PMID: 22038253

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What does my parenting have to do with how I behaved as a child?

By Anita M. Schimizzi, Ph.D.

There are many things that shape who we are as parents and Raudino and colleagues say that childhood behavior is one of them.  In their study of parents that had been followed in a longitudinal study since birth, they found that conduct problems (behaviors like aggression and defiance of authority) mattered a whole lot in how they parented years later.

Conduct problems are no small potatoes.  Raudino et al. reported that 10% of all kids have conduct problems and half of all child mental health referrals are due to this issue.  Several studies have looked at outcomes for kids with conduct problems and have found increased risk for issues such as adult antisocial personality disorder, social troubles, parenting difficulties, and intimate partner violence.

Radino’s study looked specifically at parenting and intimate partnership.  I will focus mostly on parenting for this post.  The authors used data from New Zealand’s Christchurch Health and Development Study, a thirty-year longitudinal study that looked at a number of variables at birth, four months, 1 year, annually up to age 16, and at ages 18, 21, 25, and 30.  Over 300 parents (133 fathers, 204 mothers) participated in Raudino’s study.

Using data from the participants at ages 7, 8, and 9, the investigators looked at conduct issues reported by parents and teachers.  The participants were placed into one of four groups based on the severity of conduct disturbance (group 1 = 1st to 50th percentile, group 2 = 51st to 80th percentile, group 3 = 81st to 95th percentile, and group 4 = 96th to 100th percentile).  And then at age 30, when the participants were parents, they completed interviews and observations in order to gather information on their parenting and intimate partner relationships.  For the purposes of this post, I will focus primarily on parenting findings.

Very briefly, increased severity in childhood conduct problems was associated with lower intimate relationship satisfaction and investment, as well as increased intimate relationship conflict, ambivalence, and violence. 

Parenting outcomes revealed that the more severe the childhood conduct problems, the less warm and sensitive the participants were toward their children.  These parents also tended to be less equipped to effectively manage their children’s behavior and more over-reactive, punitive, and lax and/or inconsistent in their guidance of their children.  After controlling for a variety of factors, such as the participants’ family background, gender, education level, and emotional problems, all of these parenting  findings held true with the exception of lax/inconsistent parenting.

What we can take away from this study is more support for the body of research that suggests that early conduct problems can have very lasting effects, well into adulthood.  And as with many issues, early intervention and prevention may be key.  For example, equipping parents and teachers to effectively manage childhood misconduct, increasing children’s coping and social skills, and providing support throughout the developmental stages (including adulthood/parenthood) to children with increased levels of conduct problems can all be good ways to attempt to decrease negative outcomes for this group of children.  And, by extension, these interventions may just help the next generation from developing the same behavior patterns that our participants had.  Thanks for reading Anita

Source: Raudino, A., Woodward, L., Fergusson, D., & Horwood, L. (2011). Childhood Conduct Problems Are Associated with Increased Partnership and Parenting Difficulties in Adulthood Journal of Abnormal Child Psychology DOI: 10.1007/s10802-011-9565-8

Maternal and Child ADHD: Implications for Parenting

By Anita M. Schimizzi, Ph.D.

We know that there is a genetic component to ADHD.  If Sally has ADHD, then she is more likely than her peers without ADHD to have a close relative with it, too.  When it comes to mothers of children with ADHD, it is estimated that 17% have it themselves.  And we also know that maternal ADHD can have a serious impact on parenting, such as higher rates of over-reactivity and poor problem solving.   So what can be done to influence these outcomes so children and parents alike with ADHD have more positive family experiences? 

In a recent study in the Journal of Abnormal Child Psychology, Chronis-Tuscano and colleagues looked at parent and child outcomes after mothers of children with ADHD attended a brief parent training program.  The results revealed a critical piece of information.  Mothers with higher ADHD symptoms saw less progress in their children following parent training and this finding appeared to be due to negative parenting holding steady.  Behaviors such as making negative commands (e.g., “Cut that out!) and critical statements (e.g., “You’re an idiot.”), as well as negative touching (e.g., hitting), fell into the category of negative parenting.

In all, 70 mother-child dyads from diverse racial and socioeconomic backgrounds were included.  While mothers did not have to have an ADHD diagnosis to participate in the study, it was predicted that they would have more symptoms related to ADHD than mothers in the general population.  And they did.

Mothers attended a 5-session course created from a longer evidence-based training program for parents of children with ADHD and disruptive behavior disorders.  The researchers gathered data on maternal ADHD (14% met criteria for a formal diagnosis of ADHD) and child ADHD symptoms, child behavior outcomes, and parenting behaviors using both parent and teacher questionnaires and observations. 

Overall, the children’s reported disruptive behaviors went down significantly across environments after completion of the parent training; however, the higher the maternal ADHD symptoms, the less improvement in behaviors that mothers reported in their children from pre- to post-parent training. 

In terms of parenting behaviors, maternal ADHD predicted less improvement in the areas of involvement and inconsistent discipline.  It also predicted less improvement from pre- to post-training in negative parenting during observations of play and homework time, as well as making repeated commands before allowing a child enough time to respond to the first command.

Here is an important piece of information.  We see that maternal ADHD predicted lower levels of improvement across a variety of areas.  The researchers examined this finding more closely to discover that negative parenting (and not positive parenting) was the critical link between maternal ADHD and child outcomes.  That is, it appears that the mothers with ADHD saw less improvement in their child’s disruptive behavior after parent training because their negative parenting did not significantly improve.  Further, mothers in the study who were able to decrease their negative parenting saw more improvement in their child’s behavior.

Think about this.  In moments of impulsivity, which are common with ADHD, it can be very difficult to rein in behaviors before acting.  So if mothers with ADHD can receive interventions that harness impulsivity better, giving them time to think before acting, might we also see a drop in negative parenting and a subsequent improvement in child outcomes?

What we can gather from this study is that efforts in improving negative parenting in mothers with ADHD are going to be critical to the behavioral success of children who also have ADHD.  And just as in children with ADHD, psychoeducation, prosocial skill-building, medication, self-monitoring, and a host of other options to address ADHD and improve relationships can be considered in mothers with ADHD.  Most importantly, mothers with ADHD will likely be best served by considering all available options and finding those that feel right for them. 

To all of the clinicians out there treating children with ADHD, the high rate of maternal ADHD that accompanies these children is worthy of exploration and intervention.  You just may find a key to improving the functioning of entire families.

Thanks for reading.  -Anita

Source: Chronis-Tuscano, A., O’Brien, K., Johnston, C., Jones, H., Clarke, T., Raggi, V., Rooney, M., Diaz, Y., Pian, J., & Seymour, K. (2011). The Relation Between Maternal ADHD Symptoms & Improvement in Child Behavior Following Brief Behavioral Parent Training is Mediated by Change in Negative Parenting Journal of Abnormal Child Psychology, 39 (7), 1047-1057 DOI: 10.1007/s10802-011-9518-2

A Look at Bullying Prevention and Outcomes: The KiVa Program

By Anita M. Schimizzi, Ph.D.

I went to school with a guy that could be described as one of the most socially awkward human beings I have ever encountered. He had a strange walk and funny hair, talked to himself, pretended to talk in German, and had not a single friend. I don’t think that he went through so much as an hour during school without being relentlessly teased and tormented by students, and I don’t remember a single teacher or peer stepping in to do a thing about it. To this day, I wonder what happened to that guy. And I wonder what a difference it could have made in his life if bullying prevention efforts had been made.

It has not been that long that bullying has been taken seriously even though we have known for a long time that it can be destructive and sometimes very dangerous. There are now solid efforts being made to not only understand it but to change its course and to help victims and perpetrators alike.

The Journal of Abnormal Child Psychology recently published a study that takes a look at the KiVa Anti-Bullying Program, a Finnish program that sets itself apart from other programs because it addresses a critical piece that perpetuates bullying: group involvement. When witnesses either encourage or seem indifferent to the bullying it gives the bully more power and keeps the process going. The KiVa Program aims to teach kids how important their role in bullying is and teaches skills that help students defend victims. Research thus far on the program suggests that it has a positive impact on reducing bullying.

A little more on the KiVa Program: KiVa works on improving anti-bullying attitudes as well as empowering students to defend victims through skill-building and education.  It involves 20 hours of activities such as discussion, group work, films, role-playing, and computer exercises.  It also includes specific interventions for real cases of bullying at the schools where victims and bullies come together for discussions mediated by school staff and teachers.  An interesting component to this process requires victims to identify other students who could be allies and these students are then recruited to assist in stopping the bullying. 

Williford and colleagues looked at a specific set of outcomes from the KiVa Program: depression, anxiety, and peer perceptions. Why are these outcomes important? Being bullied has been linked to internalizing problems so if bullying is reduced students might feel better. Also, empowering students to reduce bullying can potentially improve peer perceptions. And if you feel more positive about your peers, then perhaps you won’t be so willing to stand by or cheer as these same peers are bullied.

The researchers studied data from almost 8,000 students attending 4th-6th grade at 78 schools.  Approximately half of the classrooms at these schools underwent the KiVa program and the other half served as a control group.  They collected data at three points over the course of two academic years (May 07, December 07-January 08, and May 08) to look at changes over time.   

The researchers compared peer-reported victimization, depression, anxiety, and peer perceptions for the KiVa group with the control group.  While reports of victimization were equal at the first data collection, they became statistically different at subsequent data collections with the KiVa group reporting continual decreases in victimization.

There were not significant findings for group differences in depression, which the authors attribute to an inadequate measure of depression as well as participants being younger than the age during which depression usually begins. 

Anxiety decreased in both groups.  While the groups reported similar levels of anxiety at the first data collection, however, the KiVa group decreased more and was statistically different from the comparison group at the third data collection.  The authors state that the intervention may have created a more positive social climate where fear of being bullied went down and anxiety went down along with it.  Also, the program incorporated important social skills and confidence-building components that could have potentially reduced anxiety.

Interestingly, peer perceptions went down overall in both the intervention group and the control group (although the KiVa group went down less and was significantly different from the control group by the end of the study), which the authors argue is likely related to the phase of development of the students.  At this age, peer perceptions are complex at best and shift quickly. 

Finally, the authors looked at reports of victimization over time and found that the greater the drop in perceived victimization, the more that anxiety, depression, and peer perceptions all improved. 

When I think back to the guy at my school, I have regrets for my role (or non-role, if you will) in preventing his victimization.  Had I been given the tools to help create a better outcome, I don’t know that I would have used them, but at least I would have had them and could have made an informed decision.  A big takeaway from KiVa is that as a culture, we must make bullying unacceptable and we must equip ourselves and our children with the skills and confidence necessary to be an active part of the solution.  There is no such thing as not being a part of the problem if we are doing nothing.

If you’d like to read more on bullying, please refer to Nestor’s previous posts on the topic. And if you’d like to learn more about the KiVa program please visit the program website.  Thanks for reading, Anita

Source: Williford A, Boulton A, Noland B, Little TD, Kärnä A, & Salmivalli C (2011). Effects of the KiVa Anti-bullying Program on Adolescents Depression, Anxiety, and Perception of Peers. Journal of abnormal child psychology PMID: 21822630

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Spillover Between Teens’ Conflict with Family and Friends

By Anita M. Schimizzi, Ph.D.

Parents of teens probably know this all too well. A conflict at home can mean sending your teen out the door in a funk, which can spur negative interactions outside of the home. Conversely, teens can come in the door having had a conflict with a friend and that means anyone in his or her path is in for it, too. This dynamic is what a recent study in the journal Child Development studied.

Chung and colleagues set out to examine whether or not there was spillover between conflict with parents/family and conflict with peers. As one may guess, the researchers found that when teens had a conflict with a parent or other family member they were more likely to report having a conflict with a peer, and vice versa. They referred to this phenomenon as “spillover”.

The authors discuss spillover in the context of a “transmission of negative emotions” and an extreme and negative quality that can color the adolescent emotional experience. Teens simply experience emotions with an intensity that is specific to being a teenager. With all of the changes that teens go through (remember puberty?), it would make sense that they would experience some fierce emotions.

The authors collected daily diary entries for two weeks from over 500 ninth-grade males and females from diverse backgrounds. Study participants reported on family and peer conflict, as well as emotional distress. Because the entries were subjective, the results certainly need to be interpreted within the framework of perception. That is, the diaries were the information that the teens reported to be their experiences. Asking someone else could have potentially offered different information.

In each situation of conflict, same predicted same at the highest rates. In other words, peer conflict predicted peer conflict more than family conflict predicted it. Conversely, family conflict predicted family conflict at a higher rate than peer conflict predicted it.

Although the effects were smaller, family conflict still significantly predicted same-day and next-day peer conflict. Interestingly, it also significantly predicted peer conflict two days later. Now that’s some spillover! Peer conflict significantly predicted same-day and next-day family conflict. Effects were stronger for girls than for boys and girls reported the experience of arguing with family members as being more stressful than arguing with peers.

Nobody suggests that parenting a teen is a walk in the park. On the contrary, it is a challenging time for both parent and teen and brings with it a host of trying situations unique to this phase of life. While parents can’t be there to keep peer conflict from happening, they do have some control over parent-teen conflict. And improving parent-teen conflict, according to this study, may have the added bonus of improving teen conflict with peers.

So what can parents of teens do to bring down the conflict at home? Oftentimes, learning how to talk about tough (or even not so tough) topics in a different way can make an amazing difference. I know, I know. Teens are especially clever at knowing exactly which buttons to push to make your face turn purple and your voice raise an octave or two. If you’d like to, in turn, be clever by learning some new ways to defuse these situations and make them productive rather than meet them with conflict, I definitely recommend Faber and Mazlish’s book “How to Talk So Teens Will Listen & Listen So Teens Will Talk”. It’s chock full of different techniques and strategies that both parents and teens can use to increase respect and decrease conflict while helping teens become more responsible individuals. Enjoy! -Anita

Source: Chung GH, Flook L, & Fuligni AJ (2011). Reciprocal Associations Between Family and Peer Conflict in Adolescents Daily Lives. Child development PMID: 21793820