CHILD DEVELOPMENT—Problems of Discipline,Authority and Rebellion

It is only through the love and approval of the significant adults in a child''s life that he is able to give up his primitive behavior for that which meets the demands of social living. Conflict over authority is only one of many conflicts. There are conflicts which arise inherently in a child''s development. The task of the parents in the education of the child in our society is to enable the child to tolerate a certain amount of frustration and also a necessary degree of control of impulses so that he can live in a group and in conformity with the required standards.Increased rebelliousness and defiance are normally characteristic of certain periods of development in healthy children. These are when concerted discipline begins, and in early adolescence. But other events also may reactivate or stimulate attitudes of defiance and rebellion. Even in his rebellion, a child needs and expects his parents to stand for order, as well as for love. He expects that the parent will save him from the consequences of his own destructive impulses, which he as yet may not have the strength to withstand.Deep-seated or submerged factors in the parents may play a significant role in the discipline to which they subject their children. True permissiveness means allowing a child to develop according to his own rate of speed and his own potentialities as a unique individual. It includes refusing the child any type of behavior that will bring danger to him or to others.A parent who uses harsh and rigid forms of discipline may force a child into submission, rather than acceptance and understanding. This produces only surface conformity which hides insecurity and violent underlying destructiveness.     

Parent development

Today's parents tend to be overwhelmed with advice from many sources. In his role as family counselor, the pediatrician must understand and consider the emotional development of parents in relation to their child's development; otherwise, his advice and counsel do not "take" and he becomes tired and frustrated and angry. PARENTS PROGRESS THROUGH DEFINITE STAGES OF DEVELOPMENT: Stage 1: Learning the cues-the struggle of the parents to interpret the infant's needs. Stage 2: Learning to accept growth and development-the parent learning to accept some loss of control of the toddler. Stage 3: Learning to separate-the parent learning to allow the child to develop independently. Stage 4: Learning to accept rejection, without deserting-the struggle of the parents not to intrude and yet to be there when needed. Stage 5: Learning to build a new life having been thoroughly discredited by one's teenager-the parent learning to live independently while the teenager struggles to develop his own identity.The pediatrician who is accepting, sensitive and a good listener and who keeps in mind that parents as well as children have capacities for growth and development, will be a potent factor in promoting good parent-child relationships and many times more effective in dealing with the child in health and disease.     

The Troubled Adolescent Patient—How the General Practitioner May Be Helpful

The disturbed adolescent is psychologically isolated from the worlds of childhood and adulthood. His sense of alienation results from both the upsurge of instinctual drives and his uneasy attempts to master changing physical attributes and new freedoms and responsibilities. The former result in conformity and in concerns about “normality.” The latter lead to confusion and to alternating rebellion and over-dependence.The general practitioner may be the first person consulted by the troubled adolescent or his parents. The physician''s sensitivity can be crucial in helping the family work together toward a solution. Persistent anxiety in either parent or child is in itself a problem. An understanding of those factors inherent in the adolescent experience may provide the physician with a recognition of disturbance denied by the adolescent with a facade of bravado or indifference.The physician must be prepared to help the adolescent accept a protracted period of stress, usually with only partial resolution of distressing problems.     

Exploring the Relation of Harsh Parental Discipline with Child Emotional and Behavioral Problems by Using Multiple Informants. The Generation R Study

Parental harsh disciplining, like corporal punishment, has consistently been associated with adverse mental health outcomes in children. It remains a challenge to accurately assess the consequences of harsh discipline, as researchers and clinicians generally rely on parent report of young children''s problem behaviors. If parents rate their parenting styles and their child''s behavior this may bias results. The use of child self-report on problem behaviors is not common but may provide extra information about the relation of harsh parental discipline and problem behavior. We examined the independent contribution of young children''s self-report above parental report of emotional and behavioral problems in a study of maternal and paternal harsh discipline in a birth cohort. Maternal and paternal harsh discipline predicted both parent reported behavioral and parent reported emotional problems, but only child reported behavioral problems. Associations were not explained by pre-existing behavioral problems at age 3. Importantly, the association with child reported outcomes was independent from parent reported problem behavior. These results suggest that young children''s self-reports of behavioral problems provide unique information on the effects of harsh parental discipline. Inclusion of child self-reports can therefore help estimate the effects of harsh parental discipline more accurately.     

Adoption and Children with Learning and Behavior Problems

One representative case study is used to illustrate the complex interaction of factors that can lead to tragic family dysfunction when an adopted child has learning and behavior problems. The presence of neurodevelopmental problems in an adopted child, special adoption issues and interparental and intraparental conflicts combine to place the child and his family at high risk. The child''s neurodevelopmental difficulties are expressed primarily as subtle learning and behavior problems which make him a focus for parental conflict. In addition, the adoption issues of difference, impermanence, feelings of mutual obligation and fear of abandonment are generally poorly understood and form the basis for the development of unique interactional patterns of communication. Finally, in the families studied, it was often found that the adopting parents had serious personal and/or marital difficulties.     

PARENT DEVELOPMENT

Today''s parents tend to be overwhelmed with advice from many sources. In his role as family counselor, the pediatrician must understand and consider the emotional development of parents in relation to their child''s development; otherwise, his advice and counsel do not “take” and he becomes tired and frustrated and angry.Parents progress through definite stages of development: Stage 1: Learning the cues—the struggle of the parents to interpret the infant''s needs. Stage 2: Learning to accept growth and development—the parent learning to accept some loss of control of the toddler. Stage 3: Learning to separate—the parent learning to allow the child to develop independently. Stage 4: Learning to accept rejection, without deserting—the struggle of the parents not to intrude and yet to be there when needed. Stage 5: Learning to build a new life having been thoroughly discredited by one''s teenager—the parent learning to live independently while the teenager struggles to develop his own identity.The pediatrician who is accepting, sensitive and a good listener and who keeps in mind that parents as well as children have capacities for growth and development, will be a potent factor in promoting good parent-child relationships and many times more effective in dealing with the child in health and disease.     

Collaboration between child psychiatry and medical genetics. Genetic diseases with an atypical beginning

When a children psychiatrist, faced to atypical psychological troubles, comes up against difficulties in establishing a precise diagnosis, he may consider a genetic etiology and ask for a genetic consultation. He may encounter many problems when he suggests this specialized consultation to the parents. These have often been prepared for a long time to the necessity of a psychiatric therapy in order to cure their child's troubles. The geneticist's diagnosis will induce the parents and the psychiatrist to have a different look on the child and mostly will set limits to the possibilities of treatment.     

Childhood malignancies and decision making.

Failure to obtain "adequate" medical care for a child constitutes child neglect, which may be used as the basis for prosecution of parents, removal of the child from the home, or court-ordered medical treatment. "Adequate" care is usually construed as that which is given by a licensed physician, but, in case of dispute, courts almost never engage in choosing one medical approach over another. The principle that parents may not refuse medical care, however, is made very difficult when children have malignancies--the long-term nature of the treatment means that, if the child is left at home, court order or not, the parents may flee with their child. Removing the child from the home, however, adds that trauma to the ill child's burdens. Questions should be asked before making a request to a court to order a therapy which will prolong but not save a child's life if the parents would prefer to spare their child the side effects. Parents, however, may always refuse to permit their child to participate in research studies, no matter how promising. Adolescents are increasingly believed to be capable of medical decision making; most courts, however, would not allow an adolescent to refuse life-saving treatment.     

Disentangling genetic, environmental, and rater effects on internalizing and externalizing problem behavior in 10-year-old twins.

Previous studies have emphasized the importance of rater issues in studying the etiology of variation in internalizing and externalizing problems in children. Earlier results indicate only moderate agreement between parents, and assume that parents assess a specific aspect of their child's behavior. In comparable samples of younger children, additive genetic effects are the main factor explaining individual differences in both internalizing and externalizing behavior. It is unknown whether this pattern of rater influences and variance decomposition will be consistent in older children. Child Behavior Checklists (Achenbach, 1991), completed by both parents, were collected in a sample of 2956 Dutch 10-year-old twin pairs. The etiology of individual differences in internalizing and externalizing syndromes was examined using a model that corrected for possible rater bias, rater-specific effects and unreliability. The best fitting model suggested that disagreement between the parents is not merely the result of unreliability and/or rater bias, but each parent also provides specific information from his/her own perspective on the child's behavior. Significant influences of additive genetic, shared environmental and unique environmental factors were found for internalizing and externalizing syndromes.     

Parental misclassification of child overweight/obese status: The role of parental education and parental weight status

Childhood overweight and obesity is a major public health challenge for policymakers in many countries. As the most common supervisors of children’s activities, parents have a potentially important role to play in obesity prevention. However, a precondition for parents to improve their children’s diets, encourage them to be more physically active, or take them to see a doctor about their weight is for the parent to first recognize that their child is overweight or obese. This paper examines the extent of parental misclassification of child weight status, and its correlates, focusing on the role of parental education and the parent’s own obesity status. We find evidence that, among non-obese parents, those who are better-educated report their child’s weight status more accurately, but among obese parents, the better-educated are 45.18% more likely than parents with lower secondary education to give a false negative report of their child’s overweight/obesity; this may reflect social desirability bias.     

Philosophy Behind Science: The European discoveries in prenatal ethnology and archeology of the mind

"On ne conna?t que les choses que l"on apprivoise, tu deviens responsable pour toujours de ce que tu as apprivoisé," Fedor-Freybergh once quoted in an editorial Saint-Exupéry. I remember Gupta quoting an old Indian physician on responsibility of the parents: "The somatic and mental characteristics of the child are predetermined. Valor, health, constitution, and intellect develop in the intrauterine child due to the physiological and spiritual harmony of his parents." The responsibility is not finished by medical observations or help to make the child become intelligent. I try to bring together some of the many ideas on prenatal life which grew during decenniums in Europe to blossom in sudden or quiet revelations and which are due to functions of the new being and the threefold or manyfold way behind him and his parents.     

The Educationally Handicapped Child—The Physician's Place in a Program to Overcome Learning Disability

Under California Assembly Bill 464, special classes may be provided by school districts for children designated as educationally handicapped. An educationally handicapped child is not mentally retarded or physically disabled. He may have neurological handicap or emotional disorder, but he must show impaired achievement in relation to his tested abilities.A physician may be asked to participate in the program, either as a specified member of the admissions committee of the school district or to provide a medical clearance for entrance of one of his own patients into the program.He does a thorough history and physical examination but adds special examination of attention, activity, coordination and attitudes.The educationally handicapped child is helped most by the physician who does not reject the idea of educational handicap even if the medical examination is negative; who treats his minor ills; who medicates, when it is indicated, for hyperactivity, distractibility or extreme anxiety; who cooperates with parents and school personnel.     

Brain-damaged children; the problem of relations in the family group

Children with minimal brain damage show a characteristic pattern of behavior. Often there are no physical signs of abnormality, but the diagnosis can be made from the history, electroencephalographic tracings, psychologic tests and repeated observations. The behavior is a composite of the effects of the brain damage and the response of the child to his environment. The behavior of the brain-damaged child is frequently so frustrating to parents that attitudes of rejection, withdrawal or excessive punitive measures occur. In the present study, when drugs were given and the child's behavior improved, the parents were better able to understand the needs of the child and create a better home environment in which there was less frustration and emotional pressure.     

Is There a Case in Favour of Predictive Genetic Testing in Young Children?

Genetic testing technology has brought the ability to predict the onset of diseases many years before symptoms appear and the use of such predictive testing is now widespread. The medical fraternity has met the application of this practice to children with caution. The justification for their predominantly prohibitive stance has revolved around the lack of a readily identifiable medical benefit in the face of potential psychological harms to the child. We argue that predictive testing can have important psychosocial benefits and that the interests of the child have been construed too narrowly. Proponents of a prohibitive stance also argue that testing in childhood breaches the child's future right to make the same decision as an autonomous adult and to maintain this information as confidential. We argue that predictive genetic testing of children is not necessarily a violation of the child's future autonomy. Indeed, in some cases, such testing may facilitate the development of autonomy in the maturing child. We argue that parents are generally best placed to judge what is in their own child's overall interests, and that a parental request for testing after appropriate genetic counselling should be respected unless there is clear evidence that the child will be harmed in an overall sense as a result of testing.     

The role of psychiatry in a craniofacial team

The psychosocial assessment of the child in the context of his family and community is, we believe, an essential factor in the decision for and the timing of major reconstructive surgery. A severe congenital facial deformity does not usually affect a child's body-image, but it can have a great impact on the total self-image (which is related to social reactions). Surgery should be performed ideally before the early school years, when the child is subjected to the most teasing, provided both parents and the patient have realistic expectations and really want the major reconstruction.     

Patterns of child fosterage in rural northern Thailand

Evolutionary theory guides an investigation of foster parent selection in two northern Thai villages with different biosocial environments: one village has high levels of labour migration and divorce, and growing numbers of parental death due to HIV/AIDS, while the other village has lower migration, divorce and parental mortality levels. Focus groups examine mothers' and fathers' motivations and ideals regarding foster caretaker selection, and quantitative family surveys examine real fostering outcomes: specifically, the laterality (matrilateral versus patrilateral) and genetic distance of the foster caretakers of all ever-fostered children in these two villages. As predicted, in environments of high marital stability and paternity certainty, parents seem to prefer close genetic kin from either side as foster parents for their children. In low marital stability and paternity certainty environments, parents trust their own lateral kin, regardless of genetic distance, over close genetic kin from the other side. The striking exception to this pattern, however, occurs in the case of parental death, in which case children are fostered to the deceased parent's kin, regardless of the child's sex or other factors. In general, the foster parents for girls are selected with more care, reflecting the daughter/female preference expected in traditionally matrilineal, matrilocal societies. An ordered decision-making pathway for foster parent selection is proposed, taking into consideration the key factors of (a) the circumstances driving the fostering decision, (b) the gender of the child, (c) the gender of the key decision-making parent, and (d) the degree of marital and population fluidity (and subsequent, paternity certainty) in the village.     

The function of friends in preschoolers' lives: at the entrance to the classroom

The function of friendships and peer attachment in preschoolers' everyday lives is examined from the ethological view point. It is postulated that a child invests time and energy in friends or play partners chosen by him/herself: the child collects information about the friends and attempts to influence their special behavioural tendencies to his/her own advantage. As a result of this long-term investment, the friends are more predictable, controllable, and cooperative. It is hypothesized that a child uses and benefits from the friends in attempts to reach his/her personal goals. This study examines whether a child benefits from friends in attempts to join in play. Seventeen German preschool children (10 boys and 7 girls) ranging in age from 36 to 79 months were observed on arrival at school on 18 preschool days. When friends were present in the classroom, children first approached peers more often than when friends were not present; otherwise they approached the teacher. Friends often actively initiated interaction with arriving children, for example by calling the child's name. Success in joining in play was highest when friends were chosen as the target of the approach. During approaches to friends, tactics were more frequently used which require specific information about the target. However, when friends were playing with nonfriends of the children, benefits such as initiation by the target and the larger range of alternatives in strategies were not observed. The results support the hypothesis that a child uses and benefits from friends. The results further suggest that the relationships of friends with other peers disturb the beneficial effects of friends and that such relationships even increases the costs in interactions with friends.     

SOME VIEWPOINTS ON CHILD PSYCHIATRY

There is a great tendency in recent years to seek psychiatric answers to well-nigh all kinds of child problems. This tendency is seriously questioned. The average child has splendid capacities to solve his own growth problems, within the limits of home, school, neighborhood. Evidence accumulates that the average parent who seeks counsel has done a rather respectable job; that in his fear of setting limits because of “how the child will feel,” there is more of psychological threat to the child than in daring to comfortably move ahead and make some mistakes.Psychiatric treatment of a child implies that the child is unable to meet situations as adequately as other children. Such treatment should be reserved, in the main, for use in situations in which the psychiatrist and parents are willing to underwrite the implications of treatment. Treatment aimed at the vague goal of making the child “happier” is dubious. Treatment by a psychiatrist is presumably medical treatment and carries with it the advantages and disadvantages inherent in this fact. When given without carefully defining the reasons for it and the goals at which it is aimed, within medical framework, it is potentially an undesirable procedure.     

From Darkness to Light

Not so long ago I happened to treat a Jewish eighth-grade gymnasium student brought to Petrograd from a province. It was fall and the following spring he was to take his qualifying examinations. The young man, who belonged to a prosperous family, had brilliant abilities and graduated from each class with excellent grades—what would you think his illness was? He suffered—in his own words—from the throes of creative writing. Days and nights he poured over a notebook with his compositions in search of the best form to express his thoughts. Only after applying incredible efforts could one tear him away from his note-books and send him to bed at five or six o'clock in the morning, and this happened on a daily basis. With each day his mental health grew worse. It was clear that the young man undermined his health by overstudying, and that he had reached the point where he needed to worry about his health, not his studies, because a serious mental illness was descending upon him. The young man was well liked by everyone in his high-school. The teachers considered him the best student, and having learned about his illness, they promised to petition to grant him the right to graduate from school without the final examination and with a certificate of excellent. But none of that helped. The young man could not relax, spending days and nights over his compositions and constantly tormenting himself with his "throes of creative writing."     

The cross-generation transmission of oxytocin in humans

Animal studies demonstrated that the neuropeptide oxytocin (OT), implicated in bond formation across mammalian species, is transmitted from mother to young through mechanisms of early social experiences; however, no research has addressed the cross-generation transmission of OT in humans. Fifty-five parents (36 mothers and 19 fathers) engaged in a 15-min interaction with their infants. Baseline plasma OT was sampled from parents and salivary OT was sampled from parents and infants before and after play and analyzed with ELISA methods. Interactions were micro-coded for parent and child's socio-affective behavior. Parent and infant's salivary OT was individually stable across assessments and showed an increase from pre- to post-interaction. Significant correlations emerged between parental and infant OT at both assessments and higher OT levels in parent and child were related to greater affect synchrony and infant social engagement. Parent-infant affect synchrony moderated the relations between parental and infant OT and the associations between OT in parent and child were stronger under conditions of high affect synchrony. Results demonstrate consistency in the neuroendocrine system supporting bond formation in humans and other mammals and underscore the role of early experience in shaping the cross-generation transmission of social affiliation in humans.