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Children's Mental Health Explored
Panel Offers Primer on Rearing Happy Kids

By Rich McManus

On the Front Page...

If you are a parent, you felt fortunate to hear the four experts on childhood and human development who spoke at Dec. 5's Science for All session "Just Growing Pains? The Mental Health of Our Children," sponsored by the staff training in extramural programs committee. Speaking before a primarily female Wilson Hall audience, the panelists offered reassuring evidence that emotional peaks and valleys are the norm in family life; no one has an easy time of it and there are a plethora of competing biological and cultural pressures governing the route to maturity. While the great majority of humans complete the rollercoaster ride intact, a few stumble; those too were accounted for in the sweeping talks.


The first speaker, Dr. Ronald Dahl, associate professor of psychiatry and pediatrics at the University of Pittsburgh, covered the early years of development — "the pathway to socially responsible adulthood" — from infancy to adolescence. These are years preoccupied with balancing what one knows and learns with what one feels, with the goal of behaving in a desirable way. Too much emotional heat, Dahl explained, can interfere with learning self-control in a sensitive child, while a child with a bold personality may require stronger emotional messages from parents in order to learn self-control effectively. "Learning to control behavior reliably is a hard thing to do...The use of thoughts to control behavior is a difficult task, especially when this requires the consideration of possible future consequences."

In the tenuous dance he termed "emotional regulation," a person balances both feelings and an internal assessment about what to do with them, given certain goals. So called "hot" cognition occurs in situations of high arousal, and "cold" cognition accompanies milder emotions; the latter tends to fail spectacularly when feelings run high.

All of this balancing goes on in service of acquiring social competence. Dahl pointed out that one of the last areas of the brain to complete functional development is the prefrontal cortex, which is intricately involved in the self-control characteristics of fluency in cognition and emotion. Two recent trends — one biological, the other cultural — are colliding, perhaps for the first time in human history, he said, with this late-won maturity. The first is that people are reaching puberty at a much earlier age than ever before, and getting physically larger, and the second is that personal freedom is more extensive than ever before. Toss in the predilection for teens to stay up late and awaken very early to meet the schoolbell, combined with the negative effects of sleep deprivation on self-control of emotions and behavior, and suddenly the fact that mortality rates increase 300 percent between middle childhood and adolescence doesn't seem as surprising. Dahl noted that the major causes of mortality in adolescents — suicide, alcohol abuse, accidents, eating disorders, etc. — are "issues related to control of behavior and emotion...There's a reason car rental companies don't rent to people under age 25."

Assessing the teen years was Dr. Jeanne Brooks-Gunn, director of the Center for Children and Families at Teachers College, Columbia University. First she gave the recipe for successful adolescent development — the ideal would be a safe environment with caring adults (not just parents), sustained relationships and consistency in environment. Then she dashed that formula with a series of grim observations: "We have done a terrible job in the provision of safety in this country. About 15 percent of all children in the U.S. experience severe violence in the home. One-third of all kids, by the end of the teen years, will have been injured in an assault; one in 8 of these will require medical attention. This is a staggering number of kids, and it cuts across considerations of rural or city, wealth or poverty. Forty to 45 percent of kids have personally witnessed violent acts. The number of youth experiencing violence is almost inconceivable to me. If we say we want to provide a safe or caring environment for our kids, we're not doing it for about one-third of them. It's a public health epidemic."

Reporting on results of the Chicago Project, an NIMH-funded study of 6,000 kids from 80 neighborhoods over 8 years, Brooks-Gunn noted that the best deterrents to violence and delinquency were adult expectations of kids' behavior, and whether adults feel free to intervene if children misbehave. This so-called "collective efficacy" was a more important factor influencing the likelihood of violence or ill behavior than income or ethnicity, she said. "How do we boost collective efficacy in communities, now that its potency is recognized?" she wondered.

She reserved special criticism for middle school, calling it "the biggest educational mistake ever in American education. It's the worst possible setting for kids of that age (grades 5-8). The old K-8 system was much better." Middle school, she charged, "is essentially a disaster. It puts kids in their transition years in with older peers, and they're susceptible to peer influence." Overlarge classes (with not enough connection between youngsters and teachers), an "insane" schedule of class and room changes that leave kids never in the same subject at the same time each day, and other factors — including teachers' tolerance of bullying — conspire to make middle school "the most difficult school transition kids face — it's associated with huge declines in self-esteem and huge increases in depression."

The transition is especially harsh on early-maturing girls, she said. "They have the biggest problems with older boys, who push for 'older' behavior than these girls are ready for emotionally or socially. These girls pay a great price."

Brooks-Gunn admitted to a penchant for memorable formulations: there were TLC's of family development (time, limit-setting, connectedness/caring), the ABC's of good schools (appropriate environment, behavior, connection), and a rhyme for community assets (face, place and space); she invited the audience to contribute more. But throughout, she emphasized the theme that American youth need more adult supervision and interaction, "even if it just means hanging out."

The most somber notes of the afternoon were sounded by Dr. Madelyn Gould, an epidemiologist and professor in the departments of psychiatry and public health at Columbia University College of Physicians and Surgeons. Suicide, she reported, is the third leading cause of death in adolescence (behind accidents and homicide), and causes more death in youth than cancer, leukemia and all other natural causes combined in the U.S. And, since the 1960's, it has increased dramatically.

"Over the last three decades, suicide has become less common in middle age and among the elderly, but more common in the young," she said.

The most vulnerable age range is 15 to 24. Before age 14, the ratio of boys to girls who commit suicide is about equal; later on, 4 or 5 boys complete the act for every one girl, though more girls make the attempt.

Gould said suicidal thoughts and attempts "have reached an epidemic level. About 20 percent of all kids have seriously thought of suicide." She said around 8 percent of U.S. high schoolers will have harmed themselves with intent to kill this year; 3 percent of those will reach an emergency room.

"The majority of parents don't know about suicide attempts," Gould said. "Another friend is the most likely to know." She urged youngsters who know of such leanings in their peers to report it to a responsible adult. "It's not a secret to be kept."

Ninety percent of adolescent suicides suffered from a psychiatric disorder before their deaths, Gould said. "The major risk factor is an untreated psychiatric disorder," the most common of which are mood disorder, alcohol or drug abuse (in boys especially) and conduct disorder.

"Most suicide in male teens is precipitated by being in trouble or by the breakup of a romantic relationship," said Gould, adding that most suicide victims had symptoms for months or years before their deaths.

There are such things as "suicide clusters" or "suicide contagion," she noted; some 40 studies show it, either as a result of media coverage or fictional dramatization. "Suicide contagion is not a myth."

The world of myth, however, was the topic of the day's final speaker, Dr. John Borkowski, chair of the psychology department at the University of Notre Dame. He exploded a slew of them: sure, parenting is hard in an era of earlier puberty, greater liberty, and a demonstrably unsafe environment, but were things any easier for parents who weren't landowners prior to the Civil War, or who suffered slavery, or who struggled through the Great Depression? "Throughout U.S. history, parenting has always been a formidable challenge."

He claimed at the outset to have come of age in mythical times — the "Ozzie and Harriet" era of the late 1940's and early 1950's, when, on the surface, domestic life appeared comparatively tranquil. "But we also had rampant racism, a 25 percent poverty rate and a great deal of hidden spouse abuse and child abuse," he said. "In even the best of times, there were major problems. But we're all here to prove that parents do matter."

The father of seven children, he noted that "very few [parents] consciously develop mental models of parenting." He reviewed a number of "golden rules" of child-rearing and lauded an NICHD draft document on successful parenting, emphasizing the importance of "emotional coaching" versus being emotionally dismissive. "We're doing a much better job with intellectual and cognitive development than we are in emotional development," he said.

A brief question-and-answer period offered a possible reason for the early onset of sexual maturity; Dahl theorized that an "energy imbalance due to an incredible volume of nutritious food coupled with little physical activity" could explain the phenomenon, but warned, "What triggers the cascade is not known at the mechanistic level." And Gould assured a questioner that it is okay to ask point-blank if a teen is considering suicide: "It's okay and effective if you have even an inkling of trouble," she said.

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