Parenting matters!

Parenting Matters, Especially for “Difficult” Kids

We’ve been all over the map when it comes to the view of how much parenting style matters in the development of child behavioral problems and disorders.  From older days when cold mothering was thought to be the cause of autism to newer genetic hypotheses of behavior that make parenting sound almost irrelevant, we seem mostly to be moving towards a more balanced view that appreciates the crucial role of parenting in the context of many other mutually interacting factors.

Adding to this perspective, a new study attempts to combine the data of 84 other research studies that have examined the degree to which a child’s temperament modifies (or doesn’t modify) the association between parenting style and levels of child behavioral problems, cognitive skills, and social ability.  Parenting style was quite broadly divided into positive and negative, with negative parenting typified by more hostility and controlling behavior and positive parenting relating to more warmth and supervision. 

The main finding was that children whose temperament is more “difficult” (they were easily upset, less able to self-regulate) both benefit more from positive parenting and suffer more from negative parenting.  These effects were found for all of the domains examined, including behavioral problems, prosocial behavior, and cognitive/academic ability.

Interestingly, this study complements some new genetic findings that seem to indicate that certain genes that have been labelled as “risk” genes for things like depression and anxiety may be better conceptualized as genes that relate to a child’s sensitivity to his or her environment.

One reason why this study is so important is because it flies in the face of the conventional wisdom that children with more difficult temperaments have something “biological” going on that is not going to respond to “psychological” interventions like parenting and instead need things like medications.  It argues instead that we should be redoubling our efforts to support and guide parents of these challenging kids because the task is not only more difficult but also, it seems, because these children are more responsive to parent behavior “for better or for worse.”  It’s also important to state what this new study does NOT say, namely that child behavioral problems are the result of bad parenting.  The study also is not an invitation for parents of easier kids to let them go on autopilot. 

My home child psychiatry clinic has tried to embrace these ideas for years as part of a model called The Vermont Family Based Approach.  Here, we try to focus on parenting not from the assumption that child behavior problems result from bad parenting but rather that mothers and fathers of temperamentally more challenging kids require super-parenting skills that for most us, myself included, do not come naturally.   

@copyright by David Rettew, MD

David Rettew is author of Child Temperament: New Thinking About the Boundary Between Traits and Illness and a child psychiatrist in the psychiatry and pediatrics departments at the University of Vermont College of Medicine.

References

Slagt M, et al. (2016). Differences in Sensitivity to Parenting Depending on Child Temperament: A Meta-Analysis.  Psychological Bulletin 142:1068-1110.

Night terrors

What are night terrors?

Night terrors are a type of sleep disturbance. A child having a night terror may suddenly bolt upright in bed, cry, scream, moan, mumble, and thrash about with his eyes wide open without being truly awake. Because he's caught in a sort of a twilight zone between being asleep and awake, he's unaware of your presence and isn't likely to respond to anything you say or do.

Researchers think of night terrors as mysterious glitches in the usually smooth transitions we make between sleep stages each night. An episode can last anywhere from a few minutes to almost an hour, and when it's over your child may abruptly fall back to sleep with no memory of the incident.

Night terrors are more common in young children – from toddlers to grade-schoolers. A study of almost 2,000 children found that 40 percent of children between ages 2 1/2 to 6 years old experienced night terrors. Kids often grow out of them by about age 12.

How are night terrors different from nightmares?

If your child has a night terror, she won't remember it. On the other hand, a nightmare leaves your child truly awake. Not only can she remember her dream and sometimes talk about it, but she may also seek out and feel comforted by your presence.

Also, children commonly have night terrors during the first third of the night, during deep non-dream (non-REM) sleep. Children have nightmares during dream (REM) sleep, which usually happens during the last third of the night.

According to sleep expert Jodi A. Mindell, author of Sleeping Through the Night, the easiest way to tell the difference between a night terror and a nightmare is to ask yourself who's more upset about it the next morning. "If your child is more agitated, she had a nightmare. If you're the one who's disturbed, she probably had a night terror," says Mindell.

In other words, the "terror" of a night terror lingers far longer in the parent who watched it than in the child who lived it.

What should I do if my child has a night terror?

Don't try to wake him. And expect that your efforts to comfort him will be rebuffed – a child having a night terror really can't be calmed down, and if you try to hold him it may make him wilder.

It's unsettling to witness a night terror, but unless your child is in danger of hurting himself, don't attempt to physically comfort him. Just speak calmly, put yourself between him and anything dangerous (the headboard of his bed, for example), and wait for the storm to pass.

Before you go to bed, take the same precautions you would for a sleepwalker because children who have night terrors might also sleepwalk or tumble out of bed in the grip of a night terror. Pick up any toys or objects on the floor, install a gate at the top of the stairs, and make sure windows and outside doors are locked.

What causes night terrors, and can they be prevented?

There's no definitive way to prevent night terrors because no one knows exactly what causes them. What is known is that, on their own, night terrors don't mean a child has a psychological problem or is even upset about something.

Some factors make night terrors more likely – if your child has a fever or isn't getting enough sleep, for example. Solving any other sleep problems your child has, such as getting up in the middle of the night, and making sure she has a regular bedtime and gets enough hours of sleep may help ward off night terrors.

Certain medications or caffeine also can contribute to night terrors. Children are also more likely to have them if someone else in their family has night terrors or another sleep disorder, such as sleepwalking.

In some cases, night terrors can be triggered by sleep apnea, a serious but correctable disorder in which enlarged tonsils and adenoids (normal tissue in the throat) block airway passages during sleep, making it difficult to breathe and disrupting a child's sleep throughout the night.

Research suggests that certain conditions that keep your child from getting enough rest, such as restless legs syndrome or gastroesophageal reflux disease (GERD), may also trigger night terrors. Check with your child's doctor if you think one of these conditions might be contributing to your child's night terrors.

What is a scheduled awakening?

If you notice that your child's night terrors happen about the same time during the night, you can try something called scheduled awakening. This simply means that you gently and briefly wake your child about 15 or 20 minutes before she usually has a night terror. Some experts think this technique can change your child's sleep state enough to prevent a night terror. When done repeatedly, your child may learn to wake up automatically to avoid the night terror.

Scheduled awakening hasn't been well tested in preventing night terrors, however, and there's always the possibility that waking your child around the time of a night terror might trigger one.

source: babycenter