The Marshmallow Test Grows Up

New research has made the famous 1972 marshmallow test even more compelling. The original Stanford University study on delayed gratification, which promised children an extra marshmallow if they could resist the one in front of them for 15 minutes, analyzed whether a child’s ability to delay gratification had any correlation on future success. Today, researchers have taken that information a step farther – finding that a child’s ability to resist temptation isn’t innate, but highly influenced by environment.

Researchers from the University of Rochester gave five-year-olds used crayons and one sticker to decorate a piece of paper. One group of children was told they would receive a new set of art supplies, but never received it. For the second group, however, researchers made good on their promise and provided the children with new crayons and better stickers. Both groups were then given the marshmallow test.

The children who were promised the supplies and never received them waited an average of three minutes before eating their marshmallows. The children who had received the supplies promised resisted temptation for an average of 12 minutes, leading researchers to believe that experience plays into a child’s ability to delay gratification. Wait times reflected not just the child’s self-control abilities, but suggest a child’s reasoning of the stability of the world around them and their understanding of whether waiting to delay gratification would ultimately pay off. According to researcher Celeste Kidd, delaying gratification is only a rational choice if the child believes that the second marshmallow is likely to appear. Though children do not monitor every single action of the adults around them, they do have an overall sense of the reliability or unreliability of the people around them.

The group found that children may have more sophisticated decision-making abilities based on their environments than originally thought.

Words Will Never Hurt Me?

The old playground rhyme got it wrong. Although sticks and stones do break bones, words can have devastating consequences as well. And when those words come from a child’s parent or caregiver, the repercussions for the child’s psychological and emotional health can be long lasting.

A recent clinical report from the American Academy of Pediatrics (Pediatrics, July 20, 2012) describes the behaviors of emotionally abusive parents/caregivers and outlines the risks to children who are subjected to this abuse. Lead author Roberta Hibbard, MD, director of child protection programs at Indiana University and Riley Hospital for Children in Indianapolis, asserts that the emotional maltreatment of children deserves the same level of attention that physical and sexual abuse is given.

Hibbard and her coauthors describe the different forms that psychological abuse of children can take, including:

  • spurning, that is, belittling or ridiculing the child in public;
  • terrorizing, or exposing the child to dangerous or chaotic situations;
  • isolating, or shutting the child out of interactions or relationships;
  • exploiting or corrupting the child; and
  • neglecting the child’s health or education.

According to the report, emotional abuse by a parent/caregiver may be verbal or nonverbal, active or passive, and with or without intent to harm. But regardless of the form or intent, these behaviors are harmful to a child’s cognitive, social, emotional, and even physical development. “Psychological maltreatment has been linked with disorders of attachment, developmental and educational problems, socialization problems, disruptive behavior, and later psychopathology,” says Hibbard.

In her July 30 article, “Childhood Mental Abuse Under the Radar?,” MedPage Today staff writer Nancy Walsh summarizes the AAP report and describes some of the challenges for mental health care providers in identifying and treating emotional abuse. “Although it can be difficult to determine the actual prevalence of psychological and emotional maltreatment of children, an estimated 4% of men reported having experienced some form of this abuse as children, as did 8% to 9% of women,” says Walsh. “The problem most often is found in families with high levels of conflict, and where substance abuse, violence, and parental mental health difficulties such as depression exist.”

Support for parents and early intervention may be the key to reducing these numbers, according to the AAP report. “Prevention before occurrence will require both the use of universal interventions aimed at promoting the type of parenting that is now recognized to be necessary for optimal child development, alongside the use of targeted interventions directed at improving parental sensitivity to a child’s cues during infancy and later parent-child interactions,” says Hibbard. “Intervention should, first and foremost, focus on a thorough assessment and ensuring the child’s safety. Potentially effective treatments include cognitive behavioral parenting programs and other psychotherapeutic interventions.”

What do you think? What can be done to increase awareness about the emotional maltreatment of children and to support parents who may be at risk for these behaviors? PAR wants to hear from you, so leave a comment and join the conversation!

PAR Supports Children’s Mental Health Awareness Day

National Children’s Mental Health Awareness Day, an annual event hosted by the Substance Abuse and Mental Health Services Administration (SAMHSA), will be celebrated on Wednesday, May 9, 2012.  PAR has always been a strong advocate for children’s mental health, and we are delighted to announce our participation as a “Champion Level”

co-sponsor of this year’s program.

On May 9, PAR will be joining SAMHSA for a special evening program at the George Washington University Lisner Auditorium in Washington, DC.  This program will be a tribute to honor children and youth who have demonstrated resilience after traumatic experiences, as well as their “Heroes of Hope,” people in their lives who have helped and inspired them along the way.  The American Art Therapy Association has put together a unique exhibit featuring artwork from students all across the country, which will be displayed during the event.  Kathleen Sebelius, Secretary of the U.S. Department of Health and Human Services, will present a Special Recognition Award to artist, advocate, and Awareness Day Honorary Chairperson Cyndi Lauper, whose work with her True Colors Fund and the True Colors Residence exemplifies the “Hero of Hope” spirit. Live performances by youth from around the country will also honor the young people and their heroes.

Since its inception more than 30 years ago, PAR has been giving back to our community in the form of volunteer time and financial support. We understand the importance of children’s mental health, and we are proud to work with organizations like SAMHSA to promote awareness of this vital issue.  Children and wellness have always been priorities, and through the years we have supported organizations that help families including the United Way, A Brighter Community, the PACE Center for Girls, the Children’s Home of Tampa, and many others.  To learn more about PAR’s community service work, please visit our Community PARtners page.

New Release – The Parenting Stress Index™, 4th Edition (PSI™-4)

PAR is proud to announce the release of the newly revised Parenting Stress Index. Designed to evaluate the magnitude of stress in the parent-child sys­tem, the fourth edition of the popular PSI is a 120-item inventory that focuses on three major domains of stressor source: child characteris­tics, parent characteristics, and situational/demographic life stress.

The PSI-4 is commonly used as a screening and triage measure for evaluating the parenting system and identifying issues that may lead to problems in the child’s or parent’s behavior. This information may be used for designing a treatment plan, for setting priorities for intervention, and/or for follow-up evaluation.

What’s new in the PSI-4

  • Revised to improve the psychometric limitations of individual items and to update item wording to more clearly tap into the target construct or behavioral pattern or to be more understandable. The original structure has been retained.
  • Validation studies conducted within a variety of foreign populations, including Chinese, Portuguese, French Canadian, Finnish, and Dutch, suggest that the PSI is a robust measure that maintains its validity with diverse non-English speaking cultures.
  • Expanded norms are organized by each year of child age. Percentiles— the primary interpretive framework for the PSI-4—and T scores are provided.

For more information about the PSI-4, visit our Web site.

April is National Child Abuse Prevention Month

The statistics are sobering.  According to a recent report by the U.S. Department of Health and Human Services:

  • approximately 695,000 children were victims of maltreatment in 2010;
  • more than 80% of those victims were maltreated by a parent; and
  • children younger than 1 year had the highest rate of victimization.

Adult survivors of child maltreatment are more likely to have a poor quality of life, with higher levels of chronic diseases and mental health issues, than non-abused adults. “Childhood exposure to abuse and neglect has been linked…to a lifetime trajectory of violence perpetration and victimization,” says Dr. Phaedra Corso of the University of Georgia’s College of Public Health (Prevent Child Abuse America, 2012). Child abuse can be a vicious circle, and some families under stress need support to help break the pattern of abuse.

Now in its 30th year, National Child Abuse Prevention Month is a time to encourage public awareness of child abuse and neglect, recommit resources to the cause, and promote involvement through national, state, and local activities.

Potential Early Indicators

The prevalence of child abuse and its long-term consequences—not only for the child but also for society as a whole—clearly demonstrates why prevention is so important.  An early indicator that a family may be at risk for child abuse is high levels of parenting stress, and research has clearly demonstrated that parenting stress is positively correlated to child abuse potential (Rodriguez & Green, 1997).

“Parenting stress is a universal phenomenon that all parents experience to one degree or another,” explains Dr. Richard Abidin, emeritus professor of clinical and school psychology at the University of Virginia and author of the newly revised Parenting Stress Index™ (PSI™-4). “What we have learned is that high levels of stress relate to a variety of dysfunctional parenting behaviors and negative child outcomes. Screening for and evaluating the sources of parenting stress allow for the implementation of prevention and early intervention in both primary health care and education systems.”

More Resources on Child Abuse Prevention and Parenting

  • The U.S. Department of Health and Human Services’ Child Welfare Information Gateway is an excellent starting point for information on preventing child abuse and neglect.
  • Prevent Child Abuse America is a nonprofit organization dedicated to building awareness, providing education, and inspiring hope to everyone involved in the effort to prevent the abuse and neglect of children. Information about PCA state chapters, as well as advocacy, research, conferences, and events, can be found on their Web site.
  • The Centers for Disease Control and Prevention’s Division of Violence Prevention Web site includes a wealth of information on child maltreatment prevention, including data and statistics, risk and protective factors, and prevention strategies.
  • An excellent source of general parenting information for sharing with families, the Child Development Institute offers strategies and tips on topics such as “Parenting 101,” socialization for kids and teens, parent-child communication, single parenting, divorce, and more.

What special programs or events are happening in your community to recognize National Child Abuse Prevention Month? Leave a comment and join the conversation!

What do mental health visits and asthma have in common?

According to a recent release from the government’s Agency for Healthcare Research and Quality (AHRQ), mental health disorders were among the five most commonly treated medical conditions in children in 2008. Coming in ahead of mental health treatment were acute bronchitis, asthma, trauma-related disorders, and middle-ear infections. About 40 percent of all children in the U.S. suffered from one of these five conditions in 2008, which accounts for about 60 percent of all children’s ambulatory care visits to a medical office or outpatient hospital.

Although mental disorders were the fifth most commonly treated condition, the average expense per child was the highest, billing out at about $2,480 per child. Five million children in the U.S. were treated for mental disorders in 2008, adding up to a total price tag of $12.2 billion in expenses. While private insurance paid the largest share of treatment costs for bronchitis (at about 55 percent of expenses), Medicaid picked up the largest share of treatment costs for mental disorders, at about 46 percent. Approximately 31 percent of treatment costs for mental disorders were paid for by private insurance, and just fewer than 14 percent of treatment costs were paid out-of-pocket by the family of the patient.

Diagnosing and Treating ADHD in Younger Children: New Guidelines

Guidelines from the American Academy of Pediatrics released in October suggest that attention deficit hyperactivity disorder can be diagnosed and treated in children as young as age 4, two years younger than the previous minimum age set by AAP a decade ago.

Mark Wolraich, the lead author of the ADHD clinical practice guidelines and a professor of pediatrics at the University of Oklahoma Health Sciences Center, told the Wall Street Journal recently that ADHD in a preschool-aged child is very different from the typically active behavior seen in most young children (www.online.wsj.com, October 17). A child with ADHD often doesn’t play well with other children, is prone to accidents, and is overactive much of the time. “It’s not the environmental things like parties triggering it,” Dr. Wolraich says.

According to the new guidelines, behavior management should be the first approach for treating preschool-aged children. But when behavioral interventions aren’t enough, the guidelines suggest that doctors consider prescribing methylphenidate (commonly known by the brand name Ritalin) for preschool-aged children with moderate to severe symptoms.

Other key recommendations include assessing children for other conditions that might coexist with ADHD, such as oppositional defiant and conduct disorders, anxiety, and depression.

“Treating children at a young age is important,” asserts Dr. Wolraich, “because when we can identify them earlier and provide appropriate treatment, we can increase their chances of succeeding in school.”

For more information, or to request a complete copy of the guidelines, visit www.aap.org.

What do you think about the new ADHD guidelines? Will they affect your practice? Join the conversation—leave a comment now!