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

School Refusal: Exploring Why Children and Adolescents Refuse School

By Anita M. Schimizzi, Ph.D.

Wow!  It’s really that time of year again.  While there are a range of thoughts and feelings that students have about heading back to school, it is the students that have a true phobia about attending that I hope to reach in this post.  Hopefully, this will find its way to parents that have seen their child seriously resist school and it will provide other parents with good information so they recognize what they see if their child begins to truly resist school.

A preliminary study on children and adolescents that refuse school revealed that not only is this group more likely than their peers to suffer from an anxiety disorder, there is also a pattern in the way that they cope with their anxiety.  Researchers investigated something that psychologists call emotion regulation and they found that kids and teens that refuse school tend to have difficulty reframing safe situations as such and also hide their feelings about their fears from others.  These two phenomena are referred to as cognitive reappraisal and expressive suppression, respectively, and they both may contribute to a student’s ongoing school refusal.

The study took place in Australia and used a sample of children and adolescents in treatment at a school refusal clinic.  As opposed to truancy where students typically try to hide their absenteeism and also have behavior problems, this group of participants refused school for reasons of anxiety.  The study group was matched for age and sex to a same size group of peers that did not refuse school. 

As one might guess, the school refusal students had higher levels of anxiety when compared to their peers.  They met criteria for diagnoses such as generalized anxiety disorder, social phobia, and separation anxiety disorder.  Many of these students also had mood disorders (e.g., depression) and/or behavioral disorders (e.g., oppositional defiant disorder). 

The school refusal students were found to oftentimes view everyday situations as threatening in some way.   For example, something as routine as eating in the cafeteria or being called on in class could seriously overwhelm the students described in the study.  In addition, they were less able to reframe situations as safe.  In other words, they used cognitive reappraisal less frequently than their peers.  Also, the school refusal students hid their anxieties from others.  This expressive suppression is thought to serve two purposes.  One, the individual can avoid the uncomfortable emotion more easily.  Two, it can protect the individual from being ridiculed by others or other negative social consequences.

While the authors state that these results are just the beginning of understanding the possible role of emotion regulation in school refusal and that more research is needed in this area (including in the US), there are some takeaways worth noting.  First, school refusal in this study was closely linked to anxiety.  That anxiety was fueled further by an inability to reframe non-threatening situations as non-threatening.  Second, participants that refused school were also more likely to conceal their true feelings. 

Perhaps clinicians, parents, teachers, and others that encounter these students can bring some relief to them by working to increase a sense of emotional safety in the school environment as well as warmly and openly allow for honest discussion about the anxieties associated with attending school.  While this is where I would normally say more on recommendations, chronic school refusal problems would probably be best served by an experienced professional who is skilled at understanding and treating the underlying causes of school refusal.  This person could spend time getting to know your child as an individual and work directly with your child to help decrease anxiety, reframe the school experience in a more positive light, and promote effective emotional understanding, management, and communication.  Finally, he/she could work in conjunction with parents and school personnel and provide feedback and recommendations that can ease the transition back to regular school attendance.

Please bear in mind that this study is not describing the student that occasionally complains about going to school or wants to stay home now and then.  This post is addressing a much higher level of school refusal.  For any parent whose child is sometimes refusing school or tentative about going, however, looking at their worries about going may be a good place to start.

Thanks for reading.  -Anita

Source: Hughes, E. K., Gullone, E., Dudley, A., & Tonge, B. (2010). A Case-controlled Study of Emotion Regulation and School Refusal in Children and Adolescents, Journal of Early Adolescence, 301 (5), 691-706.

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Your child may not be sad, but is he happy?

By Nestor Lopez-Duran PhD

Historically, most academic and philosophical thinking about depression has been focused on sadness. For example, most interventions for depression attempt to reduce the thoughts and behaviors that make us sad. Likewise, many researchers are interested in examining the factors that make people feel sad or dysphoric. Yet, research studies from many laboratories, including my own research, are reaching the same conclusion: when it comes to depression, lack of happiness may be even more important than too much sadness.   Take a look for example the article I discussed last week showing that low levels parental happiness predicted teen depression, but high levels of parental sadness did not.

Today I want to tell you about a study we recently published with my colleagues at the University of Pittsburgh (Dr. Tom Olino is the lead author of this study). In the study, we examined the development of positive affect (e.g., happiness) and negative affect (e.g., sadness) in 200+ children at familial risk of depression and their low-risk peers. These children are at familial risk for depression because at least one of their parents has a history of depression. We consider such children at high-risk because statistically they are significantly more likely than their peers to develop depression. In fact,  about 40-50% of children whose parents have a history of clinical depression will develop depression by the end of their teen years.

So given that many of these high-risk kids will develop depression, studying how they differ from their low-risk peers may help us understand what factors contribute to the development of depression. For example, we may find that these kids have a particular gene variation that their low-risk peers do not have, so we can speculate that such gene variation may be involved in the development of depression.

But in our study we were not looking at genes, but instead we wanted to see the natural developmental trajectory of positive and negative affect during early and middle childhood. That is, we wanted to examine changes in positive and negative affect across childhood. We know for example that positive affect increases from infancy into early adolescence. In contrast, negative affect decreases from infancy into early adolescence. This may sound familiar to most parents. Think about the frequency of crying that you child has displayed throughout the years. How often did she cry when she was 6 months? How about when she was 2 years old? How about when she was 7? Most kids probably cry every day at 6 months, just multiple times per week at 2 years, and only rarely at age 7.

So the question for our study was: Are kids at high-risk for depression different than their peers in their development of negative and positive affect? We were expecting that at risk kids would show more negative affect and less positive affect than their peers. Specifically, we were expecting that at risk kids would not show the typical increases in positive affect or the typical decreases in negative affect across the years that are observed in typically developing kids.

We were wrong. At least partially.

To our surprise, the high-risk kids show the same developmental trends as their peers. Specifically, their negative affect decreased over time and the positive affect increased over time as is expected in most low-risk kids. Also surprisingly, the levels of negative affect in any given year did not differ between the high-risk and the low-risk kids.  So, the negative affect of the high-risk kids decreased over time in a typical fashion and these kids were not any sadder than their low-risk peers. 

But we saw a real difference when we looked at positive affect. The high-risk kids looked just like their peers in that their levels of positive affect increased over time. Each year, the high-risk kids showed more and more positive affect as expected in most low-risk kids. But at any given year, the high-risk kids showed significantly less positive affect than their low-risk peers. So although their levels of happiness increased over time, high-risk kids were significantly less happy than their peers.

We believe then that high levels of sadness may not be playing an important role in the development of depression among these high-risk kids. Instead, it is low levels of happiness that may be a contributor to depression in these kids.

The clear implication to parents is that we should be attentive to kids happiness just as much as we are to their sadness. Your child may not be sad, but is he happy?


The Reference: Olino, T., Lopez-Duran, N., Kovacs, M., George, C., Gentzler, A., & Shaw, D. (2011). Developmental trajectories of positive and negative affect in children at high and low familial risk for depressive disorder Journal of Child Psychology and Psychiatry, 52 (7), 792-799 DOI: 10.1111/j.1469-7610.2010.02331.x

Special Editorial: Smoke Signals? How Second Hand Smoke Can Impact Your Child’s Mental Health

By Anita M. Schimizzi, Ph.D.

We have known for a long time that secondhand smoke can have a serious impact on the physical health of children.  Asthma, sudden infant death syndrome, respiratory tract infections, dental decay, and middle ear infections are just a few of the illnesses that children exposed to secondhand smoke develop at significant rates.  In case parents needed an even greater incentive to quit smoking, there is now a growing body of research that suggests that secondhand smoke negatively affects the mental health of children. 

Two recent studies published in the Archives of Pediatric and Adolescent Medicine looked at the exposure of children and adolescents to secondhand smoke and whether there was a significant link between the exposure and the development of mental health problems, such as ADHD, depression, and poor behavioral conduct. 

In Bandera and colleagues’ U.S. study, the researchers found that a large sample of 8-15 year-old non-smokers regularly exposed to secondhand smoke had significantly more symptoms related to attention-deficit/hyperactivity disorder, major depressive disorder, generalized anxiety disorder, and conduct disorder.  Boys and non-Hispanic whites tended to be most vulnerable to the development of mental health symptoms.  When examining children with ADHD diagnoses more closely, the researchers found that the most significant predictor was maternal smoking during pregnancy.

Hamer and colleagues conducted a study in Scotland, also with a large group of children (ages 4-12 years).  The researchers found that the higher the amount of secondhand smoke exposure, the higher the rate of reported mental health symptoms.  After controlling for variables such as SES, chronic illness, and physical activity, the participants with high secondhand smoke exposure reported significant symptoms of hyperactivity and conduct disorder.  

Hopefully, these findings have caught your eye.  Not only does secondhand smoke have detrimental effects on the physical health of children, it also appears to impact their mental health and this can, in turn,  affect other important areas of functioning such as school and social relationships.  Exposing children to secondhand smoke may be best thought of as a non-option.  The dilemma: smoking is one of the toughest addictions to battle.  Here’s the thing.  Your children need for you to quit smoking.

There are resources upon resources out there for people trying to kick the smoking habit.  And kicking it can take many tries.  In fact, it usually does.  In working with parents, therapists will sometimes ask them to keep a photo of their child(ren) handy so their purpose is always fresh in their minds.  So get that picture out and keep it with you.  Take it out when things feel really tough.  Know that it’s worth it.  And get lots and lots of support.  Here are a couple of sites that may be of use to you as you take on this extremely trying challenge: Webmd has some good information for quitting during pregnancy and the CDC has information for anyone trying to quit. 

A few years ago, a childhood friend of mine lost her mother to lung cancer after a long history of smoking.  She left behind a husband, two adult children, and two young grandchildren, not to mention a huge community of family and friends that were just crazy about her.  She was, to this day, one of the best mothers and spunkiest individuals I have ever encountered.  We would all rather have her here.  I write this post in her memory.  

Thanks for reading.  -Anita

Sources: Bandiera FC, Richardson AK, Lee DJ, He JP, & Merikangas KR (2011). Secondhand smoke exposure and mental health among children and adolescents. Archives of pediatrics & adolescent medicine, 165 (4), 332-8 PMID: 21464381

Hamer M, Ford T, Stamatakis E, Dockray S, & Batty GD (2011). Objectively measured secondhand smoke exposure and mental health in children: evidence from the Scottish Health Survey. Archives of pediatrics & adolescent medicine, 165 (4), 326-31 PMID: 21135317

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Smile! Parental happiness and teen depression and other summer updates.

By Nestor Lopez-Duran PhD

Hello everyone! It has been a while since my last posts and I have a few updates before I share with you some thoughts on a recent study on parental emotions and teen depression.

I wanted to start by thanking Dr. Anita Schimizzi, who has done an incredible job keeping child-psych running throughout the summer. We are very lucky that she is part of this project and I appreciate her very thoughtful and useful parenting posts. As Im sure you are too, Im looking forward to reading her posts every week.

Personally, my summer has been quite busy. Early this summer my job at the University of Michigan kept me away from child-psych. However, Im now back but my role at child-psych will change slightly. Dr. Schimizzi will continue to post about parenting issues in general, while I will focus most of my posts on issues related to childhood and teen mood disorders (my primary area of research), and to a lesser degree, early childhood disruptive behavior problems (my primary area of clinical work).

On a more personal note, my summer was also quite busy due to some exciting life transitions. On May 29 I got married to an amazing woman and we spent some time traveling in Thailand and Japan. We are now settling back at home and getting ready to start the new academic year in September.

Ok, now for some quick thoughts on parental happiness and teen depression.

The Journal of Abnormal Child Psychology recently published a research report of a study by a team at the University of Melbourne in Australia that examined the impact of parental expression of emotions on their teens risk for mood disorders.

In sum, teens and their parents were asked to complete a psychological evaluation as well as two laboratory activities designed to elicit different types of parenting behaviors. In the first activity the teen and the parent were asked to plan a pleasant activity. In the second activity, they were asked to try to solve a problem that had been the source of conflict (e.g., chores, curfew, etc). The sessions were videotaped and the behaviors of the parents were later analyzed and coded into 3 groups: 1) aggressive (anger, belligerent, cruel, provocative, annoying). 2) dysphoric behaviors (sadness, anxiety), and 3) positive behaviors (happiness, caring, etc). Around 2 to 3 years later, the teens completed a second psychological evaluation.

The logic behind the study is that the behaviors displayed by the parents during the laboratory interactions likely reflect stable parental tendencies that are used in many contexts, including at home. For example, a parent who is highly aggressive during the laboratory task is likely also highly aggressive at home (although parents who are very nice in the laboratory are not necessarily nice at home!). So the ultimate goal of the study was to determine if these parental behaviors predicted whether the teens would develop mental health problems.

The results:

  • High levels of parental aggression predicted increases in depressive symptoms among the teens within 2 years.
  • Low levels of parental positive behaviors also predicted increases in depressive symptoms within 2 years.
  • Surprisingly, high levels of parental dysphoric behaviors (sadness) did NOT predict teen depression within two years.

The authors also examined whether these behaviors predicted anxiety, but I will limit these thoughts to the findings regarding teen depression.

I have to admit I was a bit surprised by these findings. Why? Because parental depression is usually a very strong predictor of teen depression. In fact, about 50% of teens whose parents have a history of clinical depression will develop depression by the end of their teen years. So it was surprising to me that high levels of dysphoric behaviors, such as sadness, did not predict teen depression.

After my initial surprise, my thinking began to shift towards mechanisms. That is, we know that parental clinical depression predicts teen depression, but we know much less about the mechanisms of transmission: What are the mechanisms that explain how parental depression leads to teen depression? Clearly the answer to this question is complex and is part of my entire research program, but the results of this study provide some interesting insight. The common view is that depressed parents usually display dysphoric emotions (they look sad) and that these displays of sadness may contribute to the kid becoming depressed. Yet, this study suggests that is not frequent displays of sadness, but instead a lack of happiness that may contribute to these kids becoming depressed.  

Interestingly, such findings are completely in line with our own findings regarding young children of depressed parents. For example, next week I will be writing about a recent article I published with my colleagues at the University of Pittsburgh, which examined happiness and sadness among very young kids of depressed parents.

More next week. Its good to be back. Nestor.
The reference: Schwartz, O., Dudgeon, P., Sheeber, L., Yap, M., Simmons, J., & Allen, N. (2011). Parental Behaviors During Family Interactions Predict Changes in Depression and Anxiety Symptoms During Adolescence Journal of Abnormal Child Psychology DOI: 10.1007/s10802-011-9542-2

Children’s Perceptions of Their Parents: Can They Predict Later Mental Health Issues?

By Anita M. Schimizzi, Ph.D.

We all know how subjective most aspects of life are.  One’s perceptions carry an immeasurable amount of weight as we work to understand and interact with this world around us.  A recent study in the Journal of Child Psychology and Psychiatry demonstrated the importance of perceptions in looking at how kids view their parents.

Young and colleagues did a study on the perceptions of almost 1,700 11 year-olds regarding parents’ emotional neglect and control.  They then related the findings to the development of mental health issues at the age of 15 years.  Whether or not parents actually were emotionally neglectful and controlling was not known, but the researchers did demonstrate that merely perceiving parents as such significantly related to later psychopathology.

Based on 11 year-olds’ responses of “almost always” to items on a parenting questionnaire, the authors generated four parenting styles (percentages of the study participants follow each): optimal (20%), typical (54%), moderate (also known as tougher and stricter than the aforementioned styles; 23%), and neglectful and controlling (3% ).

The questionnaire included topics such as how helpful, loving, understanding, and controlling kids felt their parents were.  As could be anticipated, the “neglectful and controlling” group perceived their parents to be the least helpful, least likely to let them do things that they like, least loving, least understanding, least likely to allow them to make decisions, most likely to be controlling, most likely to treat them like a baby, and the least likely to make them feel better.

Regardless of gender, socioeconomic status, family structure, and previous psychiatric and social problems, the “neglectful and controlling” group was found to have significantly higher levels of psychiatric disorder at age 15, more than twice that of the “optimal” group.  Interestingly, the “typical” group had a moderate increase in odds for developing a disorder when compared to the “optimal” group.  Also, the “typical” and “moderate” groups had modest increases in symptoms related to anxiety, depression, conduct problems, and ADHD when compared to the “optimal” group. Those in the “neglectful and controlling” group far exceeded the others in psychiatric symptoms, however.

Regarding the “neglectful and controlling” group, the authors state that “the overwhelming experience of these children and young people is of being ignored and failing to have their needs met by their parents – but also of being controlled.”  They go on to cite previous research that found this group to be angrier and less compliant as older children.

What do these findings tell us?  While a lot of parenting is good enough, so to speak, there is a style that appears to lend itself to the development of a host of mental health problems in our children.  That would be the “neglectful and controlling” style described here.  What else do the findings tell us?  Our children’s perceptions of us as parents are important, which makes it critical for both parents and mental health professionals to know and understand what those perceptions are.

As I’ve stated before, talking and connecting with our kids is a must if we want to nurture them into emotionally healthy beings.  We also want to give them the space to make mistakes and learn from them, with us standing there ready to support them rather than rescue or overly control them.

For those of you who are curious about the “optimal” group.  Here is what these parents looked like, in the eyes of their 11 year-olds anyway.  They were the most helpful, most likely to let their kids do things that they enjoy, most loving and understanding, most likely to allow their kids to make decisions, second most controlling, least likely to treat their child like a baby, and most likely to help their child feel better.  Tall order?  Perhaps.  Worth it?  Probably.

Source: Young R, Lennie S, & Minnis H (2011). Childrens perceptions of parental emotional neglect and control and psychopathology. Journal of child psychology and psychiatry, and allied disciplines, 52 (8), 889-97 PMID: 21438874

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The Universe is a Great Teacher: How to Use Natural Consequences to Help Your Child Learn

By Anita M. Schimizzi, Ph.D.

The scene: Jamie, a fourth-grader, knows that he is responsible for remembering to put his lunch in his backpack for school.  He has forgotten it today for the umpteenth time, which his mom does not notice until the school bus is pulling away.  She sighs and puts the lunch in her car, again.  On her way to work, she stops at school and drops it off for Jamie, especially because she knows that he does not like the school menu for the day.

We’ve all been there.  Your child wants to do something or has forgotten to do something that you fear will result in unwanted consequences.  Your impulse is to assert your opinion, change the behavior, or otherwise involve yourself so your child does not have to suffer those undesirable outcomes.  It may be helping with last minute homework that the child knew needed to be done, bringing the winter clothes to the car that your child refused to take on a cold day, or contacting a teacher because you did not agree with a grade.  When this need to intervene becomes extreme, we call this parenting style helicopter parenting due to the image that it conjures of a parent hovering around the child ready to act the moment anything looks like it may go wrong.  Guess what?  We may be doing our child a disservice by stepping in.

In a 2010 study of 300 college freshmen conducted by Neil Montgomery and colleagues, they explored traits held by students who reported having helicopter parents (those that exhibit parenting behaviors that are viewed as overly involved or meddling) versus students who did not.  Yes, the study’s findings are preliminary and more research needs to be conducted in this area, but the results thus far are rather interesting.  While it is likely that helicopter parents mean to convey love and support of their children, their style of parenting may lead to unintended and costly effects.  For example, the study participants with helicopter parents were found to be more anxious, dependent, self-conscious, impulsive, and vulnerable than their peers without helicopter parents.  You may wonder where the balance is.  In other words, how do we develop self-sufficient, confident children without allowing them to fall too far into harm’s way?

Natural consequences are what happen when we allow our children to act and then see how the world responds.  For example, if a child does not wear matching clothes he may be made fun of at school.  If a child does not eat dinner she will be hungry when it’s time for bed.  I have always enjoyed using natural consequences as a teaching tool with my clients.  Sometimes, they were simply more willing to go and find out something for themselves than they were to listen to me offer my words of wisdom.  “Wow!  You decided it was worthwhile to throw a chair at the wall, causing property damage and now you have to pay for it with what little money you have left in your account?  Interesting decision.  Any take aways from that?”

Now that I am a parent, I can really attest that this stuff works.  For example, the other day my son decided to wear his favorite shoes on a muddy, wet playground.  He, of course, returned home with muddy, wet shoes.  They were so wet, in fact, that he was unable to wear them for the next three days.  When he inquired about them each morning, we took a look and saw that they weren’t dry enough yet, which he found to be very irritating.  The lesson: if you want to wear your favorite shoes every day, then it’s probably not a good idea to get them all wet and muddy.  Wear old shoes that you don’t care about instead when it comes to wet, muddy playgrounds.

I have several parameters for determining when it is a good idea to use natural consequences:

  1. It is never appropriate to allow your child to be put in true danger (e.g., seatbelts are non-negotiable).
  2. It is best to use natural consequences when you are not in a hurry.  It can take extra time to allow your child to manage a situation on his/her own and a time crunch can add extra stress to the situation.
  3. If something is extremely important to you, then it is not the time for natural consequences (e.g., going to a formal wedding in dirty overalls probably isn’t the way to learn about socially-appropriate attire).
  4. If you can afford to be flexible and you sense a good learning opportunity on the horizon (e.g., cutting an outing short when a child has refused to bring along mittens and the playground is cold), then that is the time to use natural consequences.

The primary goal of natural consequences is to allow our children to learn first-hand how to wisely navigate the world rather than feel the way the college freshmen in Montgomery’s study did.  The use of this method requires a lot of flexibility on the part of parents and the ability to let go of the need for our kids to be perfect or to never experience hurt.  Dr. Wendy Mogel has written a wonderful book on parenting based on her many years as a psychologist and educator.  It is called The Blessing of a Skinned Knee and while it is based on Jewish teachings, one need not be Jewish in order to find some very valuable information.

The Blessing of a Skinned Knee

In it, she includes a chapter on natural consequences.  She states, “Real protection means teaching children to manage risks on their own, not shielding them from every hazard.”  She goes on to say, “If parents rush in to rescue them from distress, children don’t get an opportunity to learn that they can suffer and recover on their own.”  As much as we don’t want our children to have emotional and/or physical pain, it is part of life and they must learn how to manage it.

In using natural consequences, the sooner the better.  We want our children to start thinking ahead about potential consequences from a young age so they don’t find themselves in a truly terrible situation.  It takes a lot of practice to develop this type of thinking.  Parents can anticipate many bumps in the road along the way.  It is preferable to have these bumps be less costly and they usually are when kids are younger.  For example, it is less costly to learn the lesson of thinking ahead when rain boots are forgotten than it is to drive 90 miles an hour on a curvy road at night.  In other words, the potential for true danger generally increases with age as there is access to more and more of the world.

Let’s conclude with one last example by revisiting our opening scene.  Jamie forgets his lunch and his mom notices it as the school bus pulls away.  This time, she decides that it’s more important for Jamie to learn something from continually forgetting his lunch.  After all, how will he learn if she keeps delivering his lunch to him?  So she decides to leave it right where she found it and leaves for work.  It would be nice to not have to rush her commute in order to stop at the school.  Jamie calls her cell and tells her that he forgot his lunch.  His mother empathizes with him since she knows that he doesn’t like what is on the menu.  He asks her to bring his lunch to school.  She tells him that she must get to work instead and wishes him well for the day.  Infuriated, Jamie hangs up the phone.  Later that day, he gets an IOU from the cafeteria to purchase the school lunch and eats what little he likes.  He feels hungry and grumpy.  The next day, he remembers to take his lunch.


Mogel, W. (2001).  The blessing of a skinned knee: Using Jewish teachings to raise self-reliant children. New York: Penguin Books.

Montgomery, N (2010, October 11). Parents Protecting Their Investments. The New York Times. Retrieved June 29, 2011 from http://www.nytimes.com/roomfordebate/2010/10/11/have-college-freshmen-changed/parents-protecting-their-investments

Raising the Chronically Ill Child

By Anita M. Schimizzi, Ph.D.

While many of us are fortunate enough to have healthy children, not all families are so lucky.  They must confront the chronic illness of a child on a daily basis.  What are some key factors that can help them do this successfully?  Read on about an article that I came across. 

Marchs APA Monitor included an article about caring for children and adolescents with chronic illnesses.  The author, Elizabeth Leis-Newman, looks at the difficulty parents have with the switch from doing all of the child’s day-to-day treatment to having the child/teen manage his/her own treatment.   She discusses three things that are linked to parents handing over treatment responsibility, sometimes too early: not fully understanding the illness and treatments, the difficulty of raising the chronically ill adolescent, and parent depression and anxiety. 

In looking at parent knowledge of the illness, the author cites a study by Kristin A. Riekert, PhD and colleagues (2003) where the researchers found that poor doctor-parent communication led to less treatment adherence for asthma.  For example, when parents were not fully informed of the need for regular medication use they would discontinue it when the child appeared to be symptom free. 

 A current longitudinal study by Avani Modi, PhD at Cincinnati Children’s Hospital Medical Center is tracking treatment follow-through in young patients with epilepsy.  Current findings show that parents are often inconsistent with giving medication to their child.  Modi also talks about “white coat compliance” where parents restart medication when it is time to visit the doctor, oftentimes giving incorrect readings of drug levels and risking being prescribed the wrong dose.  

The bottom line appears to be that doctors and other medical professionals must take the time to fully discuss the details of the illness as well as the importance of keeping up with day-to-day treatments.  On the other hand, it would probably be a good idea for parents to ask their child’s health care providers as many questions as it takes to feel that they understand the child’s illness, ongoing treatment needs, and the risks of making any changes to day-to-day regimens.

Modi states that the rocky adolescent years can be quite exhausting for parents to cope with, especially when that adolescent has a chronic illness that must be managed.  Due to the challenges of this age group, adolescents may end up with more responsibility than they can actually handle.  While teens may resent it when they feel that parents are meddling in their lives, Alexandra Quittner, Ph.D. reports that her research shows that when parents are simply physically present it can make a big impact on whether or not the teen does the treatment and does it correctly.  In other words, just being in the same room matters.

Caring for a chronically ill child comes with many challenges and a lot of times caregivers, which are most frequently mothers, may not have the support they need and this can lead to more depression and/or anxiety.  Suzanne Bennett Johnson, PhD reported that research suggests that as mothers are more depressed, treatment adherence tends to go down.  Quittner concluded that medical professionals will need to watch out for signs of depression and anxiety and screen for it not only in the ill child, but also in caregivers so that good supports can be put in place. 

To sum up, parents of chronically ill children and teens would likely benefit from having a strong connection with medical providers.  Parents are encouraged to take small steps as teens work to take on more control over their treatment.  It is also recommended that parents stick around during treatment time even when the teen can do treatments on his/her own.  Finally, if parents are feeling overwhelmed with the medical, financial, and/or emotional stresses that can come with having a child with a chronic illness, do not hesitate to seek support.  It is out there.

Source: Leis-Newman, E. (2011, March). Caring for Chronically Ill Kids: Many Parents are Struggling to Manage Their Children’s Care. Here’s Why. Monitor on Psychology, 42 (3), 36-39

Depressed Dads and Their One Year-Olds

By Anita M. Schimizzi, Ph.D.

There has been a lot of research done on maternal depression and we know that it can have a big impact on children.  We don’t know as much about paternal depression because, quite frankly, there just hasn’t been the same focus on this issue.  I was excited to come across an article by Davis and colleagues, who recognize the importance of fathers’ well-being in their recently published research on paternal depression and behavior toward one year-olds.

Why is it important to explore depression in fathers?  The research that has been done shows that paternal warmth and sensitivity can go down in depressed dads while conflict, hostility, and rejection toward their kids can go up.  Additionally, children’s psychosocial functioning goes down when dads are depressed.  Other research found that direct father-child interactions have a strong relationship with the health and development of their children.

The current study used a nationally representative sample of fathers of one year-olds, 1,746 dads in total.  The men answered questions in four different areas: interactive play (e.g., peek-a-boo), speech and language interactions, reading to the child, and spanking.  Whether or not the fathers had talked with their child’s pediatrician during the past year was also assessed.

Seven percent of the fathers in the study reported being depressed during the past year.  Seventy-seven percent of these dads also had spoken with the pediatrician over the past year.  The chart below shows the results in the four different areas.  As can be seen, there were no differences between fathers that were not depressed and those that were in their reports of playing interactive games and singing songs/nursery rhymes with their children.  Depressed dads were less likely to read to their one year-olds and much more likely to spank them.

In fact, when further analyses were done, depression in fathers predicted reading to their one-year olds at a rate that was less than half of what non-depressed fathers reported and spanking at a rate almost four times that of non-depressed dads.  These findings occurred regardless of variables such as fathers’ age, race, education level, and household income.

Why is this study important?  For starters, paternal reading early on had been associated with positive language development.  The research on spanking overflows with negative consequences for children, such as increased aggression later on.  (Take a look at Dr. Lopez-Duran’s post on spanking for more information.) 

And then there is the obvious.  Depressed dads need and deserve support just as much as depressed moms do.  Parenting is hard enough when we’re feeling well.  Being depressed can make it feel like an unmanageable challenge.  The researchers argue for regular screening of paternal depression during pediatric visits, as most of the fathers in the study report talking with their child’s pediatrician.  Referrals for services can then be made as a result.

I would go further to encourage fathers that are dealing with depression to consider some/all of the following: develop and stay connected to a support network, take time for yourself to do things that bring you joy (even if it’s just a little bit), consider joining a support group for dads, learn alternatives to corporal punishment (see my earlier blog post), take a parenting skills class to get ideas that can be carried out at home, take on a project that can be done in small steps, and make eating well and getting enough sleep a priority.  And remember, you are one of the most important people in your child’s life.  He/she wants you to feel better, too.

Source: Davis RN, Davis MM, Freed GL, Clark SJ (2011). Fathers depression related to positive and negative parenting behaviors with 1-year-old children. Pediatrics, 127 (4), 612-8 PMID: 21402627

Special Editorial: Does Early Enrichment Still Let a Kid Be a Kid?

By Anita M. Schimizzi, Ph.D.

The New York Times recently published an article about Junior Kumon, a Japanese developed tutoring program brought to the U.S.  The author sets the scene with a three year-old that is practicing writing double-digit numbers for which she gets a sticker when completed correctly.  Most students attend the program a couple of times a week for up to an hour each time and they have nightly homework to be completed with their parents.  It is easy for me to respect the program’s goal: cultivate globally competitive students who can then become globally competitive professionals.  Here is where I started having difficulty: the Junior Kumon program enrolls students from two to five years of age and primarily utilizes a drill and kill methodology designed to provide early reading and math enrichment.  The primary problem that I saw was that the author could find no evidence that this method actually leads to these little people growing into big people with greater chances for professional success.  In fact, the research overall seems to be lacking.  For example, the US Department of Education explored several studies of Kumon Math and could not draw any conclusions on the effectiveness of the program due to both a limited number of studies and research flaws.  The Kumon approach also makes me wonder about the potential impact that these methods may have on the development of other important skills, such as creativity and reasoning.

The author reported information from the fields of psychology and child development.  The consensus?  True, Junior Kumon can help children learn math facts and literacy skills.  The rest of the feedback from the experts suggests that the Kumon approach misses the beauty of early childhood learning.  Okay, so those are my words, but there really wasn’t support for the program’s approach while there was a lot of support for good old experiential learning.  You know, the kind that happens when junior is stacking blocks, making a castle in the sand, sorting objects by color, or working with a friend on building a fort out of the sofa cushions.  The creativity, critical thinking, and interpersonal skills that go into these types of early experiences pave the way for future academic and social development, which lies at the heart of why play has been so valued for so long.  A 2008 article by the National Association for the Education of Young Children (NAEYC) reviewed research on play and found that social interaction during play enhanced vocabulary and social skills, exposure to print in play fostered early literacy, and the use of materials such as blocks helped with spatial relationships and logical thinking.

Programs like Junior Kumon remind me of the predicament that public schools have faced since the onslaught of standardized tests designed to leave no child behind.  Teaching to the test at the expense of rich learning experiences, reduced participation in the arts and other subjects deemed to be not academic enough, and less time spent outside going bonkers in the fresh air are some of the side effects of this shift in public education.  Good intentions?  Yes!  The best we can do for our children to help them flourish into smart, critical thinkers capable of working on teams to generate ideas that propel our world to a better place?  Not so sure…but probably not.

Source: Zernike, K (2011, May 13).  Fast-tracking to Kindergarten? The New York Times. Retrieved May 15, 2011 from http://www.nytimes.com/2011/05/15/fashion/with-kumon-fast-tracking-to-kindergarten.html#