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Religiousness and Altruism in Kids

microphoneLast week media outlets around the country reported on a study out of the University of Chicago on the relationship between religiosity and altruism in kids. The study can be found here. These are some of the headlines from last week: “Nonreligious children are more generous.” “Religion doesn’t make kids more generous or altruistic, study finds.” “Religion Makes Children More Selfish, Say Scientists.” How this research was portrayed constitutes a case example of what can go wrong when social science research is presented to the public.

The participants of this study were “…1,170 children aged between 5 and 12 years in six countries (Canada, China, Jordan, Turkey, USA, and South Africa).” The key determiner of altruism was how many stickers kids were willing to share with peers. Kids in the non-religious group were willing to share, on average, 4.1 stickers (out of 10) while kids in the Christian group were willing to share 3.3 stickers and kids in the Muslim group were willing to share 3.2 stickers. The researchers also determined that the correlation between the kids’ religiousity and altruism was -.173 (negative correlations mean that when one variable goes up, the other one goes down).

question mark over brainTo better understand the confusion in the reporting I need to explain the term “statistically significant.” Research is always done with samples that hopefully represent the population under study. So, let’s say I’m a researcher that believes that 10 year old boys who eat apples for a year will end up taller than 10 year old boys who eat onions for a year. I then put together a sample of 800 10 year-old boys, half of whom eat the apples and half of whom eat the onions for one year. A test for statistical significance tells me, at the end of my study, whether my sample of 10 year-old boys represents all ten year old boys (the population). Lets say at the end of the year my test of statistical significance says that my results are statistically significant. All that means is that my sample likely represents the entire population (the standard cutoff is 95% likely or higher). However, statistical significance tells me nothing about the meaningfulness of the difference. So, lets say in my study the boys who ate the apples were .84 inches taller than the boys who ate the onions. I can tell the media that there is a significant difference between my two groups, and that would be true. But the media, and the public equate “significant difference” with “meaningful difference” and that would be troubling, especially to onion farmers.

An example of a statistic that speaks to meaning is effect size; .20 is a small effect size, .50 is a moderate effect size and .80 is a large effect size. Moreover, to consider the meaningfulness of correlations, .10 is considered small, .30 moderate and .50 is large.

So, let’s return to the study in question. The effect size on the main analysis (which they didn’t report but which I calculated) is .348, closer to the small category than the moderate category (e.g., there was a .8 sticker difference between the non-religious kids and the Christian kids). Moreover, the negative correlation of -.173 correlation is small.

But, we need to return to my apple-onion study to consider another methodological issue. Researchers commonly collect data on other related variables that might moderate the results. Do the apples and onion diets have differing effects on boys who start out shorter than boys who start out taller? Do boys who are obese have a different outcome than those who are not? Are the results different for boys who exercise than those who don’t? Including measures like these helps researchers to further interpret the meaning and relevance of the results. In well-constructed studies such analyses are common.

In the study in question there were numerous potential moderators that were not investigated. These included the presence of mental health problems among the kids, the level of intelligence of the kids, and the number of siblings in each participant’s household, psychology disciplineto name a few. Moreover, a key potential moderator variable, socio-economic status, was assessed merely by determining the mother’s level of education. So, even though the results are statistically significant, the effect sizes are small and there are many unanswered questions regarding potential moderators of the findings.

Is this study interesting? Yes. Does it make a useful contribution to the literature? Yes. Does it suggest that parents should alter their religious practices based on its findings? Absolutely not. Moreover, there is a great deal of scientific evidence indicating that numerous physical and psychological advantages are associated with religiosity in children. In next week’s blog I will review some of that science.

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Summer: Great Time to Have Your Kid/Teen Get a Mental Health Evaluation

black kid skateboardFor many kids and teens (and by association, parents) the summer represents a reprieve. Of course, there is no school. But, other responsibilities usually lessen as well. For this reason, stress can lighten by a large margin; symptoms that your child may have demonstrated during the school year can either evaporate or lessen to manageable levels. This can cause just about any parent-lunatic to convince himself/herself that all is well now.

Yes, kids can grow out of symptoms with time and maturity. However, unless there has been some dramatic and substantive change (e.g., peace was rendered in a significant relationship that had been troubled, treatment caused a significant breakthrough), it is unlikely that your child or teen has grow out of a problem, or problems, in the matter of a few weeks. It is more likely that the abatement of school-year based stress has caused the problem(s) to go underground and that such are likely to return, in a stronger and more entrenched variation, in the fall. (In my clinical experience this often happens by the first report card and nearly always by the holidays.)

This makes the summer a great time to get an evaluation, and for at least four reasons:

  1. Being under less stress will make it easier for a child psychologist to two boys thumbs upaccess the reasonable side of your child or teen.
  2. If your child or teen demonstrates problems at both school and home, the summer affords the opportunity to focus on home-based challenges exclusively. This portends to leave everyone feeling stronger and better equipped to deal with school-based issues in the fall.
  3. If your child suffers from mood disturbance or anxiety symptoms, it can be much easier to assess and treat such in the summer. Actually, the same thing goes for most kinds of problems (e.g., difficulties with attention, disordered eating).
  4. With the decreased stress, it may be easier for everyone to better appreciate and discuss your child or teen’s strengths.

glasses and bookThe only typical downside to a summer evaluation is that it can be more challenging to get teachers to complete behavior rating scales. However, my experience is that most teachers are generous with their time as long as you approach them in a respectful manner. Here’s a sample ask: “Dear Mr./Ms. X, I’ve arranged for Dr. Y to evaluate Aiden so that I may better understand his opportunities for growth. Dr. Y. has indicated that your opinion is very important in helping him to do a good job. I appreciate that you are off in the summer, so if you don’t have the time to fill these forms out, no worries. But, if you can fill them out I would be most grateful!”

I hope you will consider an evaluation if your child or teen has been demonstrating problems either now or during the last school year. Doing so will leave your child or teen less likely to number among the majority of those youth who need mental health care but do not get it. (For a referral click here.)

 

Communicating About Adoption With Your Child

asian boy looking up white backgroundOver two million kids in the United States are adopted; these kids come to that status from a variety of origins (e.g., foster care, over seas adoption). This entry is designed to offer some general guidance for communicating with your child, and other family members, about his or her adoptive status.

It’s generally a good idea to let your child know that s/he is adopted as young as possible.

Keeping the adoptive status a secret suggests that it is something wrong, harmful or shameful. Moreover, knowing the birth families medical and psychiatric history can be helpful (e.g., there is a family risk for breast cancer). The younger your child is when you discuss this, the less dramatic it will likely be. Kids’ language and cognitive skills can vary across the same age group, as can their vulnerabilities. But, generally speaking, a healthy 4-5 year old is probably ready to start this discussion.

As you affirm your love and commitment, don’t be afraid to say, “I don’t know.”

Many adoptive kids fear that they are not with their birth parents because there is something wrong with them; kids often think in egocentric terms like this. So, it’s common to hear things like, “why didn’t they want me?” If you know the reason, you can offer an age-appropriate answer (e.g., “she wasn’t an adult yet and didn’t feel ready to be a mommy. It had nothing to do with how beautiful you are.”). But, if you don’t, it’s okay to say “I don’t know” perhaps followed up with something like, “sometimes adults feel sick and don’t feel well enough to take care of someone as beautiful as you.”

Eschew all implicit and explicit efforts to subordinate your child’s status in the black man with sonsfamily.

You may have birth children in the family. Or, you may have birth nieces and nephews. Or, there may be other circumstances when someone is disposed to demote your child as a function of his or her adoptive status. It’s important that all such efforts be resisted. For example, it should be made clear to birth children that no such language will be tolerated, not because it regards a sensitive truth (e.g., like mocking someone who is missing a limb) but because it is not accurate (that being an adoptive child means that someone is less important or less loved).

Accept your child’s curiosity about his or her birth family.

Whether or not to be in touch with the birth family is a complicated question that depends upon a myriad of factors (e.g., how easy it is to identify them, how well they are, how well your child is, how open they are to it, whether there are potential legal consequences), so there is no easy answer to that concern. However, it is important to let your child know that you are not threatened by curiosity about his or her birth family. The best way to communicate this is to openly and calmly discuss his or her questions. A good script for those discussions is to endorse your child’s curiosity, give empathy for whatever s/he is thinking or feeling and acknowledge what you know and what you don’t know.

Integrate relevant cultural experiences into your family.

line of kidsLet me suggest that all families, whether there are adoptive children or not, whether they are multicultural or not, do well to imbue a quest for multicultural exposure and dialogue into the family’s culture (enter the term “diversity” in the search engine above for a related discussion). That said, if your adoptive child comes from a different culture, and especially if that difference is visible to others, seek out opportunities to learn and to experience that culture as a family. Moreover, seek out mentors for your child from that same cultural background. As parents we often want to believe that we can offer everything our child needs. However, it really does take a village. And, a multicultural village.

Consider getting expert help if this seems very complicated or is interfering with the quality of anyone’s life

Blogs can only cover the most basic of generalities. When things become difficult or complicated, it’s best to seek out the services of a qualified child psychologist. For a referral, click here.

(Thanks to my student Rachel Kester for her help with developing this blog topic and article.)

For Readers That Enjoy Movies

moviesWhen I first launched this blog I intended to include lighthearted content as well. I’ve gotten away from that theme for a while. So, I’d like to return to it this week in sharing the top baker’s dozen (+1) movies that I recommend and have viewed repeatedly. In no particular order:

  1. Ordinary People
  2. Good Will Hunting
  3. The Color Purple
  4. Aliens
  5. The Big Lebowski
  6. The Godfather, 1 & 2
  7. It’s a Wonderful Life
  8. Unforgiven
  9. Rocky, 1 & 2
  10. The Good, The Bad and The Ugly
  11. Kill Bill, 1 & 2
  12. The Breakfast Club
  13. I Am

Honorable mentions: Star Wars, Lord of the Rings, Harry Potter and Dirty Harry flicks, and Pulp Fiction.  What am I missing?

There are so many other possible lists: top TV shows, documentaries, comedies, and epic films to name a few. Encourage me and I’ll list these later 😉

What is Cognitive-Behavioral Therapy?

stressed boyCognitive-behavioral therapy (CBT) is often the talking treatment of choice for juvenile anxiety, depression, and various kinds of problems that result from poor stress coping. The word “cognitive” refers to strategies that deal with thoughts and thinking. The word “behavior” refers to strategies that deal with behavioral choices. This blog entry will review some of the major strategies that often comprise CBT.

Externalizing the problem: kids and teens develop a name for their anxiety, depression, or the primary problem area. As Stephen King once wrote: “Monsters are real, and ghosts are real too. They live inside us, and sometimes, they win..” Youth are taught that their symptoms of anxiety and depression no more constitute their personhood than symptoms of diabetes or asthma define the personhood of someone suffering from those conditions. Moreover, youth are taught to recognize how their internal enemy attacks them and what specific and effective countermeasures they can deploy.

Behavioral activation: this strategy involves arranging to do fun things on a regular basis. When youth are depressed or stressed out they often get into a rut where they wait for a good mood to do something fun. This CBT strategy teaches a youth that s/he can manipulate his or her mood by forcing himself or herself to do something that stands to be pleasurable. Youth are also taught that fun activities that are novel, social and involve physical activity tend to be the most effective (e.g., to avoid getting into a rut with fun activities as well).

√ Physiological calming: this is a term for learning how to relax muscles in theboys praying back to back body and to belly breath. Most youth overestimate their ability to relax their bodies. In CBT they learn strategies for becoming super relaxed. Moreover, they learn that a relaxed body and anxiety are like oil and water: they just don’t mix. Some practitioners also employ methods for measuring a youth’s success (e.g., through the use of biofeedback).

√ Coping or happy thoughts: this strategy involves developing a list of true and adaptive thoughts that promote positive feelings. Kids are taught that they can swap out uncomfortable thoughts just like they can swap out uncomfortable jeans.

√ Thought testing: this is a strategy for determining whether a painful thought is true or not. Anxiety and depression attack thinking and cause a youth to believe painful thoughts that are not true. This technique is very helpful for helping youth to determine what painful thoughts are real (and which can be subject to problem solving) and which represent their internal enemy’s lie (and are to be disempowered).

Teen girl√ Problem solving: this strategy is useful when a problem is distressing a kid or teen. When suffering from anxiety or depression problems can become super magnified and overwhelming. This very powerful strategy disempowers over reactions and produces adaptive coping responses.

√ Exposures: this strategy involves having anxious youth deliberately put themselves into developmentally appropriate situations that make them anxious, in a measured and gradual way, so that they can use their CBT tools to accomplish mastery and to dominate their internal enemy.

It’s common for parents to be taught how to coach and reinforce the CBT techniques. Moreover, multiple strategies can be done together as a family (e.g., physiological calming, problem solving). The CBT might also include other techniques for specific problems affiliated with anxiety or depression (e.g., response prevention for OCD). Moreover, sets of related strategies than be imported into the CBT depending on the problem(s) the youth has. For instance, social skills training can be used for youth who struggle making and maintaining friends, behaviorally oriented family therapy can be used for defiant youth who refuse to practice their CBT techniques and strategies from positive psychology can be used to produce experiences of happiness and meaning (e.g., the use of gratitude, personal strengths, acts of kindness).

The research supporting the efficacy of CBT is well developed and suggests that mom and daughterparents would do well to consider making this treatment available for any child or teen who suffers from anxiety,  depression or an assortment of problems involving poor stress coping. To find a qualified provider near you click here.

Affluenza?! Phuleeze!!

frustrated man2This weekend a news story broke about a teen who was stated to be suffering from “affluenza.” The teenager reportedly got drunk, got behind the wheel of a car and killed four people. A psychologist reportedly then used the term “affluenza” to describe a condition from which the teen is suffering. “Affluenza” was indicated to have to do with things like not being made to experience consequences, having parents who don’t discipline sufficiently, and who resist the discipline efforts of others, and, in some cases, living with affluence. This condition was reported to have been used as a mitigating variable for determining the outcome of the teenager in court.

I’m not writing this blog to comment on the legal issues or what might constitute justice in this case, as those questions are outside the purview of my discipline. I am writing for two purposes: First, I wish to eschew mental health professionals making up their own terms and using them this way. Second, I wish to remark on the true psychological factors that sometimes can come into play in cases like this.

“Affluenza” is not only not an official diagnosis in either of the primary psychiatricquakery vs science diagnostic systems in the world (the DSM and the ICD systems), but it isn’t even a condition under investigation by researchers. In this context the term was justified by the psychologist, in an online interview, based on his “30 plus years of experience.” So, is that the criteria we use? Once a mental health professional gets enough years under his or her belt s/he can just start making up conditions and using them to mitigate legal consequences? How many years of experience before it’s okay to do that? What if someone with more years of experience disagrees? As someone who devotes his career to bringing quality mental health science to the public, and who finds that the public is confused enough already about real conditions, I find such behavior, if true, to be reprehensible. I don’t know more about the specifics of this case than what I saw and read reported on CNN.com. But, if it’s true that a psychologist, acting in his capacity as an expert witness, used this term, and the use of that term affected the outcome of the case, then I hope it will also be true that the licensing board(s) in any state(s) where that psychologist is licensed will ask him to explain himself.

character lots of booksI don’t pretend to understand the nuances of this particular case. Hardly. But, I can speak generally about the factors that can sometimes facilitate a teen acting in this manner. There are often at least two primary factors in play:

• #1: Poor monitoring. As readers of this blog, and my parenting book, know the research correlating an absence of effective monitoring and risky behaviors among teenagers is compelling. Moreover, unmonitored teens tend to associate with other unmonitored teens; this can then create a risk taking and destructive synergy.

#2: Poor discipline. Again, I’ve written a lot about this. Discipline does not equal butt kicking. The etymology of the word is “to teach.” Effective discipline involves growing a kid’s capacity to do things when s/he doesn’t feel like it by using education, warmth and firmness. It also involves allowing youth, in most circumstances, to experience the consequences of their choices.

Tolstoy said it well “Happy families are all alike. Every unhappy family is unhappy black baby in parents handsin it’s own way.” Resilient kids and effective households not only employ effective monitoring and discipline, but they also:

• Do things to promote closeness between each parent and each child (e.g., special time).

• Engage in adaptive and regular rituals.

• Discover and promote each youth’s competencies.

• Collaborate effectively with other adults charged with important functions in each youth’s life.

dad with son on shoulder• Maintain good self and relationship care among the parents.

• Maintain good health habits (sleep, diet and physical activity).

• Promote adaptive thinking and independence in each youth.

• Get effective and appropriate help whenever a youth is showing signs of struggling.

These 10 strategies, which are a central them of this blog and my parenting book, operate as a science-based foundation for promoting resilience in kids. The more they are present in a family the lower there is the risk of symptom and dysfunction in youth. The more they are absent the more the soil becomes fertile for stories like we are reading and viewing this weekend on CNN.

Are Parents Sculptors or Shepherds?

At the risk of oversimplifying things, I find there are two parenting models out there: the sculptor model and the shepherd model. One of these models tends to be overwhelmingly subscribed to by parents (at least in my experience) while one is overwhelmingly favored by the extant science. Let me summarize each model and review implications.

sculptorSculptor Model

In this model children are born like a lump of clay. Parenting then sculpts the personality. This is thought to happen through direct interactions and the various choices that parents make for their children. The personality of the child, which the parent has created, then determines that child’s success across important domains (e.g., social life, extra curricular engagements and academics).

Shepherd Modelshepherding

Based on the spin of the genetic roulette wheel, children are born with temperamental strengths and vulnerabilities, as well as talents and weaknesses. These assets and liabilities are then manifested along a modest continuum of possibility based on the child’s experiences (the modest range is heavily influenced by genetics). Those experiences are comprised of many elements. A few of of these elements are in a parent’s exclusive control (e.g., how a child is disciplined). However, many others are only partially (e.g., the quality of the child’s education) or not at all in parents’ control (e.g., the parent is unable to generate more income and so needs to live in a city where crime runs high).

Implications

mom frustrated by depressed daughterIn the sculptor model parents often feel a great burden. There seems to be an endless stream of confusing and complex decisions to make. And, it often feels like the correct decision could generate highly positive outcomes while the wrong decision could result in a crushing experience. In this model parents beat themselves up for their child’s failings and failures (i.e., if only they had sculpted better). They also can be merciless with themselves about their mistakes; after all, it can feel like an undisciplined stroke of the chisel just caused a child’s arm to fall off.

In the shepherd model parents realize that their role is critically important. diverse mom and childHowever, they also realize that there are many aspects of their children’s outcomes that are outside of their control and influence. The latter realization doesn’t cause parents to dial it in. But, it can open the door to practicing psychological principles like the Serenity Prayer. Moreover, they realize that failure is a critically important part of a healthy childhood. Subscription to this model doesn’t do much to mitigate a parent feeling pain when a child experiences a poor outcome but it can mitigate feelings of guilt and shame.

In my experience most of we engaged parent-lunatics subscribe, intentionally or not, to the sculpting model. And, this makes us even more crazy than our default position. However, the available science overwhelmingly supports the shepherding model. (Disengaged parents may talk up the shepherding model, but that is just a rationalization for the fact that they are napping while the sheep are grazing.)

I’ll give you one brief illustration. I know a mom who experienced an upbringing that was mostly neglectful and abusive. Therefore, she took the SAT without any preparation; moreover, she took the test on the heels of a solidly average public school education. When it came time for her first born son to take the SAT she made sure that he had the tutors and study guides needed to well prepare. Moreover, his testing happened on the heels of a highly optimized education. However, the son ended up scoring only 90 points higher than the mom (the father never took the SAT). 90 points is about a 10 to13 percentile point difference. So, is that an important difference? Yes. Is it ultimately determinative? Hardly.

kid pointing for dadMy closing wish is that we can all remember that we are shepherds. Surely, we can study “effective shepherding” manuals. However, we can also realize that there is much about our children’s outcomes that is outside of our control and that we are destined to mess up a lot, but that won’t make him or her a homeless, drug addicted, serial killer with no friends and bad hygiene.

Popes, Gay Marriage & The Bible: Talking To Your Kid About Spirituality and Values

spiritual manBetween the new Pope, the Supreme Court case on gay marriage and attention being garnered by the TV series, The Bible, there is an abundance of media attention being given to stories that reflect on values and spirituality. This entry is meant to offer a few suggestions for engaging your child on these issues. (By the way, when I say “spirituality” I mean the entire spectrum, including atheism.)

• As is a theme in this blog, set aside regular time with your child to see if s/he has any thoughts or perspectives on any of these issues (s/he may not, especially if s/he is young, but it’s always good to check). Allow your child to say his or her piece first, providing doses of empathy, before sharing your perspective.

• Let your child know what your spirituality is, using the principle of selective truth telling, to guide the breath and depth of your coverage (i.e., you share more or less based on your child’s age and wellness; see this blog entry for an elaboration on that principle).

• Empower your child to see the definition of a personal spirituality and personal values as a life-long journey that often includes confusing and mysterious segments, and that doubt is often sprinkled along the way (e.g., Mother Teresa’s cheerful familydiary included expressions of doubt about God’s existence).

• Keep in mind that the active practice of a spirituality can be associated with many important psychological and health benefits. The research supporting this assertion is compelling. (See Chapter Four, on rituals, in my parenting book for a review.)

• Ask your child to always consider some guiding principles:

√ That which is loving should always be prioritized over that which is not.

√ All people deserve to have their spirituality and values respected, as long as they do not hurt others, no matter how much we may personally look at things differently.

child hand cuts out adult hand sky√ One group’s spirituality should not be codified into laws that infringe on the civil rights of another group.

√ Learning about other people’s spirituality and values can be a fascinating and enriching enterprise, no matter how much we may personally look at things differently. (For my blog entry on talking about diversity with kids, click here.)

√ Using a spiritual model to hurt people is always wrong.

√ Humility in the quest for truth can leave one open to developing a spirituality that is beautiful, wise, uplifting and meaningful.

In closing I’d like to thank my wife Lia for her help with this entry 😉

What the Heck is Work-Life Balance?

work-life balanceIs it me or does the term “work-life balance” conjure up images of a parent putting in 40 hours at a rewarding job, then coming home, energized from a day of doing important things, and realizing an effective balance of completing household and parenting tasks, having fun with family and/or friends, soaking up the meaning of being a spouse and/or parent, eating a balanced diet, being physically active and getting a good night of sleep? Well I’ll tell you that in my 22 years as a psychologist and husband, and 17 years as a parent, I’ve never seen it. Actually, I think this concept has more value for employers (e.g., to be flexible with schedules and methods for reaching agreed upon goals) than it does for we working parents. One of the things I do in my parenting book is give accounts of what I believe are more typical sorts of days for working-parents. Click here to read one of these (hopefully both humorous and realistic) illustrations.

Rather than using terms like “work-life balance” I prefer a term like “living on the working at home momhigh road.”  IMHO these are the characteristics of a working parent living a high road life:

• In my vocational life (whether that be in the home or otherwise) I’m using my top strengths to resolve or address important human problems or needs, regardless of how the culture at large values these contributions. And, my kids see me living this way.

• I’m making (not finding, making) time each week to spend one-on-one with my spouse/partner and each of my kids who are living at home (I like to think of one hour as the floor). And, my kids see me living this way.

• I’m in the fight to have healthy habits (i.e., a balanced diet,  ≥4/5 hours a week of physical activity and about 8 hours of sleep a night); this doesn’t mean I become a paragon of fitness, speaking with an Arnold Schwarzenegger accent. It just means that I prioritize this goal and hit these marks more than I miss them. And, my kids see me living this way.

chaos• I’m comfortable with chaos. I said to a colleague recently: “Bill, just one week I wish I could get everything done that has to get done that week.” He replied “Well, Dave, that’s the week that we hold your wake.” High road life is engaged. And, at this place and time in the universe, that comes with chaos. I’ve never seen a working-parent, on the high road, who has everything zipped up and buttoned down. But, if I tell myself that I must be doing something wrong if my life is chaotic, I may be suffering needlessly.

• I’m routinely asking myself, “what’s the loving thing to do (and that means towards myself too)?” And, more often than not, I pull that off. And, my kids see me living this way. (Tapping into your internal well of wisdom can help.)

• I experience injustice but get the most out of that. To be in the world is to have the world in me; and, the world is filled with injustice. Do you know anyone, who has been impactful in this world, who has not experienced injustice? Doesn’t it also sometimes seem like those that get the most done experience the most injustice (just a wonderment of mine)? But, at the end of the day I morph the injustice into an actualization of this formula: crisis = pain + opportunity. I realize that, as a poet put it, pain is like a dragon guarding treasure. Andhappy black woman background, my kids see me living this way.

• I make (not find) time for self-care. What this means varies wildly. It could mean killing two birds with one stone in doing physical activity. It could mean hanging out with friends. It could mean a rich spiritual life. But, I have a plan for self care and, like most priorities, I hit the mark more than I miss it. And, my kids see me living this way.

• More often than not, my parenting promotes those factors that promote resilience in kids. I don’t have space here to review them but the top research supported ones are in my parenting book.

black man pointing, happy face• There are other aspects that may not be a part of everyone’s high road, but can facilitate getting there or staying there: humor, being stupid with friends, buckets of forgiveness (the unilateral and unconditional type is the purest sort), turning the other cheek (not the same thing as letting oneself be bullied), praising beauty and strength and savoring gifts. And, my kids see me living this way.

So, if your striving to do these things, and win more battles than you lose, you may be firmly planted on the high road, even though the last thing you often feel is that you manifest work-life balance ;-).

Defiance in a Young Child Needn’t Be Tolerated (usually)

defiant boyAn important study was published a couple of months ago in the Journal of the American Academy of Child and Adolescent Psychiatry titled “Psychosocial treatment efficacy for disruptive behavior problems in very young children: A Meta-analytic study.” The first author is Boston University professor Dr. Jonathan Comer. This study of studies examined 36 studies investigating 3,042 children. The high points from this study support the headline for this entry.

Backdrop for the study

The authors first reviewed some key findings in the research literature:

• About 10% of preschoolers meet criteria for a disruptive behavior disorder. These conditions exist across cultures and are associated with debilitating outcomes (e.g., profound family disruption, continued psychopathology).

• The rates of psychotropic medication treatments for preschoolers has experienced between a two and five fold increase despite the fact that “…controlled evaluations of the efficacy of antipsychotic treatment for early child disruptive behavior problems have not been conducted…(and) potential adverse effects of antipsychotic treatment in youth, including metabolic, endocrine, and cerebrovascular risks, have been well documented.”

• While only a minority of children with disruptive behavior problems have ever tantruming girlgotten evidence-based treatment, there is evidence of a decreasing trend of kids getting needed mental health care.

Results

When considering if interventions work, researchers calculate an effect size. A “0” score means no effect; .2 means a small benefit; .5 is a moderate benefit and .8 represents a large benefit (what one well known statistician described as “whopping”).

The average effect size was .8! Remember, this is across 36 studies and more than 3K kids.

• The largest effect sizes were found for treatments that took a behavioral approach (see the commentary section below).

bipolar child• There is evidence that many treatments offered to youth with disruptive behavior problems are not the ones with the most evidence supporting their use; moreover, when these treatments are compared to evidence-based behavioral treatments there is a large difference in favor of the behavioral treatments. As the authors note “…widely used approaches rarely show support.”

• “Treatment effects were consistent across samples of varying compositions of racial/ethnic minorities.”

• “These findings provide robust quantitative support for consensus guidelines suggesting that psychosocial treatments alone should constitute first line treatment for early disruptive behavior problems. Against a backdrop of reduced reliance on psychosocial treatments in this age range, and increased reliance on pharmacological treatments in the absence of controlled safety and efficacy evaluations, the present findings also underscore the urgency of improving dissemination efforts for supported psychosocial treatment options, and removing systematic barriers to psychosocial care for affected youth.”

• “Roughly 50% of U.S. counties have no psychologist, psychiatrist or social worker.”

Comment

Readers of this blog will note how much this study is consistent with a primary ball and chain runningpoint I’ve been trying to make (and quoting from my own previous entry):

“Psychological problems are akin to medical problems in so many ways: they are nearly universal by the time a kid reaches adulthood (about 90%), most of the time they are treatable in a short period of time, they are easier to treat the earlier they are caught and, if they are left unchecked, can cause very stressful and costly consequences. However, unlike medical problems, only about 20% of youth who need evidence-based mental health care get it.”

This is profound social injustice and it needs to stop!

character holding checkmark-bulletWhat can you do to help?

• Ask your pediatrician if s/he screens all children for mental health problems in her/his practice on well visits. If not, ask him or her to reconsider. If s/he says that s/he doesn’t screen because s/he would have no one to refer such children to, make a counterpoint and a suggestion. The counterpoint: parents deserve to know if their child could benefit from a mental health evaluation. So, even if no help can be found, the problem has been upgraded. The suggestion: contact your state’s psychological association and ask if they can help to identify a provider to whom your pediatrician may refer; it is highly likely that that they will be passionate in their efforts to assist. Should you convince your pediatrician to grow in this way, a quickly administered pediatric mental health screening tool is available in the public domain (i.e., it’s free): Pediatric Symptom Checklist.

• If your child’s defiant or disruptive behavior is causing anyone distress, get him or her help for it today. Besides tapping your state’s psychological association, you may also try here .

• Ask the mental health professional you interview at least two questions:

√ “In what types of problems do you specialize?” (This is a better question than question mark over brain“do you specialize in working with children?”) If you hear kids listed, that’s good. If not, ask if s/he knows of someone who does. Of course you may live in a community where this person is your only choice. So, you can ask if s/he has had success treating this problem.

√ Once you identify a viable clinician, ask “You obviously can’t know if my child has Oppositional Defiant Disorder at this point, but what is your treatment approach when you have diagnosed a child with Oppositional Defiant Disorder(ODD) and that’s the only problem?” There are synonymous terms for a good answer: “behavior modification,” “parent training,” (an unfortunate term in my view but it’s used), “behaviorally oriented family therapy,” and “behavioral treatment.” The clinician might also name some specific treatment manuals/approaches such as “Parent-Child Interaction Therapy,” “Incredible Years,” “Helping the Noncompliant Child,” “The Triple P-Positive Parenting Program,” and “The Defiant Child Program.” I would be very concerned if the first line of approach were a different one, including the use of medication treatment.

key in lockJust to give you an idea of what you might be in for, when I have a child who has ODD, and that’s the only problem, the treatment phase of the work (i.e., not including the evaluation phase), takes 8 sessions. In my own practice this cures the problem over 90% of the time. And, the two most common reasons I’ve found it doesn’t work are (1) the parent(s) don’t apply the techniques, usually because of personal pain and limitations or (2) there was another or different problem interacting with the ODD (e.g, the child really was suffering from an emerging case of bipolar disorder, the child was privately sniffing glue on a regular basis, a parent was substance dependent but tried to hide that). If a child truly has just ODD, and the parent does the techniques, it works.

The truth I/m reviewing here still seems to be too much of a secret, at least from most parents, teachers and pediatricians I’ve known. This leaves kids, parents and families suffering needlessly. As Jerry Garcia once noted: :Somebody has to do something, and it’s just incredibly pathetic that it has to be us.”

In closing let me share that you can also find multiple behavioral strategies in my parenting book as well as suggestions for identifying, and affording, quality mental health care.

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