Raising an Emotionally Healthy Raising an Emotionally Healthy Child: How Not to be a Helicopter Child: How Not to be a Helicopter

ParentParentJennifer L. Jennifer L.

Derenne,M.D.Derenne,M.D.Assistant Professor of Assistant Professor of

Psychiatry, Medical Psychiatry, Medical College of WisconsinCollege of Wisconsin

Child and Adolescent Child and Adolescent Psychiatrist, Psychiatrist, Children’s Hospital of Children’s Hospital of WisconsinWisconsin

3/4/083/4/08

ObjectivesObjectives

Discuss the characteristics most often Discuss the characteristics most often associated with emotional health in children and associated with emotional health in children and adolescents, and identify ways to promote those adolescents, and identify ways to promote those characteristics and skills in your child.characteristics and skills in your child.Discuss parenting techniques that tend to be Discuss parenting techniques that tend to be most successful for children at different most successful for children at different developmental stages.developmental stages.Discuss strategies for "first line" ways to deal Discuss strategies for "first line" ways to deal with common childhood problems, and identify with common childhood problems, and identify situations that may require additional situations that may require additional intervention outside of the family.intervention outside of the family.

DisclaimersDisclaimers

There is no one “right way” to parent.There is no one “right way” to parent.

Each family has it’s own unique strengths Each family has it’s own unique strengths and challenges.and challenges.

Each parent/child relationship is different, Each parent/child relationship is different, even within the same family.even within the same family.

As a parent, you know your child/family As a parent, you know your child/family best.best.

““Helicopter Parenting”Helicopter Parenting”

Children these days are highly structured, Children these days are highly structured, and may sometimes be over-scheduledand may sometimes be over-scheduled– PlaydatesPlaydates– SchoolworkSchoolwork– Clubs, volunteer work, sportsClubs, volunteer work, sports

Well-meaning parents can take over many Well-meaning parents can take over many aspects of their child’s lives (intent is to aspects of their child’s lives (intent is to keep child “on course”)keep child “on course”)

““Helicopter Parenting”Helicopter Parenting”

When parents take over organizational aspects When parents take over organizational aspects of their child’s life, it may help the child “get of their child’s life, it may help the child “get ahead”, but does not help them learn the skills ahead”, but does not help them learn the skills they need to be successful as adultsthey need to be successful as adults– OrganizationOrganization– Delayed gratificationDelayed gratification– Autonomy/ResponsibilityAutonomy/Responsibility– InitiativeInitiative– Accepting disappointment and reformulating a planAccepting disappointment and reformulating a plan

““Helicopter Parenting”Helicopter Parenting”

Helicopter parents are overly involved in Helicopter parents are overly involved in children’s lives, and do not let them learn from children’s lives, and do not let them learn from their mistakes or from normal childhood their mistakes or from normal childhood experiencesexperiences

They may take on their child’s school projects, They may take on their child’s school projects, argue with teachers/professors about grades, argue with teachers/professors about grades, and choose their child’s college.and choose their child’s college.

The cell phone has been called “the world’s The cell phone has been called “the world’s longest umbilical cord.”longest umbilical cord.”

As a result, children do not learn to take on As a result, children do not learn to take on responsibility. They may get into a prestigious responsibility. They may get into a prestigious college or professional school, but may not be college or professional school, but may not be able to function effectively once they get there.able to function effectively once they get there.

Kids may become anxious/depressed under the Kids may become anxious/depressed under the stress.stress.

How can you help your child stay on pace with How can you help your child stay on pace with his/her peers, but also help him/her learn these his/her peers, but also help him/her learn these important skills?important skills?

Traits Associated with Traits Associated with Emotional and Psychological Emotional and Psychological

HealthHealthThe ability to feel secure in one’s The ability to feel secure in one’s relationships (attachment)relationships (attachment)

Positive self-esteemPositive self-esteem

A sense of self-efficacy (“I can make A sense of self-efficacy (“I can make things happen for myself”)things happen for myself”)

The ability to withstand frustration and The ability to withstand frustration and disappointmentdisappointment

Developmental StagesDevelopmental Stages

Infancy (0-2)Infancy (0-2)

Pre-school (2-6)Pre-school (2-6)

Latency (middle-childhood, school-age) (6-Latency (middle-childhood, school-age) (6-12)12)

Adolescence (12-18)Adolescence (12-18)

InfancyInfancy

InfancyInfancy

This is a time of rapid development and This is a time of rapid development and growthgrowth– PhysicalPhysical– Cognitive (language skills)Cognitive (language skills)

Attachment is the major developmental Attachment is the major developmental milestonemilestone– Child feels protected by the motherChild feels protected by the mother– This safety enables the child to separate and This safety enables the child to separate and

start to explore the worldstart to explore the world

Pre-schoolPre-school

Pre-schoolPre-school

Growth and development continue at a Growth and development continue at a rapid pacerapid pace

Child’s perception is that everything Child’s perception is that everything revolves are him/herrevolves are him/her

Magical thinking predominatesMagical thinking predominates– ““I was bad, so daddy got cancer.”I was bad, so daddy got cancer.”

Immature sense of body integrityImmature sense of body integrity– ““My arm is broken, therefore I am broken.”My arm is broken, therefore I am broken.”

LatencyLatency

LatencyLatency

Physical development slowsPhysical development slows

This is the time during which child begins to find This is the time during which child begins to find his/her place in the worldhis/her place in the world– Mastery in academics, athletics, artsMastery in academics, athletics, arts– Child negotiates his/her status in the peer groupChild negotiates his/her status in the peer group

Increased organization, responsibility, cognitive Increased organization, responsibility, cognitive and moral developmentand moral development– Children develop logical thinking, empathy, respect Children develop logical thinking, empathy, respect

for rulesfor rules

AdolescenceAdolescence

AdolescenceAdolescence

The time during which the child prepares for The time during which the child prepares for adulthood. Increased reliance on peer group to adulthood. Increased reliance on peer group to determine norms.determine norms.– PubertyPuberty– Separation/individuation- teen starts to figure out Separation/individuation- teen starts to figure out

his/her ideals, starts to think about separating from his/her ideals, starts to think about separating from the familythe family

Capable of abstract thinkingCapable of abstract thinkingVery common to have tension during this time- Very common to have tension during this time- parents feel protective, child wants increased parents feel protective, child wants increased autonomy.autonomy.

AttachmentAttachment

Experiences in very early childhood (0-3 Experiences in very early childhood (0-3 years) determine our ability to trust others. years) determine our ability to trust others. (Consistent caregiving, food/water/shelter)(Consistent caregiving, food/water/shelter)

Once secure attachment is solidified, child Once secure attachment is solidified, child is able to explore the world, knowing that a is able to explore the world, knowing that a parent will always be there when needed.parent will always be there when needed.

Temperament of both parent and child has Temperament of both parent and child has a significant effect on this process.a significant effect on this process.

Temperamental StylesTemperamental Styles

Chess and Thomas (1977)Chess and Thomas (1977)

Easy- positive mood, moderate activity level, Easy- positive mood, moderate activity level, adapt to change, regular biologic patternsadapt to change, regular biologic patterns

Difficult- very active, negative mood, overly Difficult- very active, negative mood, overly persistent, intensely reactive, resistant to persistent, intensely reactive, resistant to changechange

Slow to warm up (behaviorally inhibited)- Slow to warm up (behaviorally inhibited)- cautious and shy, less reactive, less active, cautious and shy, less reactive, less active, respond to stress by withdrawing emotionallyrespond to stress by withdrawing emotionally

AttunementAttunement

DW Winnicott “Good enough” parentingDW Winnicott “Good enough” parenting– It is not important that the parent/child It is not important that the parent/child

relationship is perfectrelationship is perfect– It is important that the parent is tuned in to It is important that the parent is tuned in to

what the child needswhat the child needs– This may require the parent to rethink This may require the parent to rethink

approachapproachie- ie- a “laid back” parent may not immediately see a “laid back” parent may not immediately see that a temperamentally “intense” child may need that a temperamentally “intense” child may need more time to transition between activities.more time to transition between activities.

AttunementAttunement

Relationships in which the parent and child have Relationships in which the parent and child have different temperaments may be very challengingdifferent temperaments may be very challengingThe good news is, the parent doesn’t need to be The good news is, the parent doesn’t need to be perfect all the time- the relationship can be perfect all the time- the relationship can be repaired.repaired.When repairs are necessary, it is very important When repairs are necessary, it is very important that the parent be the one to initiate this, even that the parent be the one to initiate this, even when it might not be his/her “fault”. This gets when it might not be his/her “fault”. This gets back to the idea of attachment- teaches the child back to the idea of attachment- teaches the child that the parent can withstand his/her negative that the parent can withstand his/her negative feelings and that the child cannot destroy the feelings and that the child cannot destroy the relationship.relationship.

Your child may have different strengths Your child may have different strengths and interests from you, your spouse, or and interests from you, your spouse, or his/her siblings.his/her siblings.– Recognize this and support your childRecognize this and support your child– Modify expectations accordingly (expect that Modify expectations accordingly (expect that

child works up to his/her potential, but don’t child works up to his/her potential, but don’t demand straight As if that is not realistic)demand straight As if that is not realistic)

Self-esteemSelf-esteem

The manner in which we regard ourselves The manner in which we regard ourselves and our accomplishmentsand our accomplishments

Generally most helpful when we see Generally most helpful when we see ourselves in a positive light, but we are ourselves in a positive light, but we are realistic about our individual strengths and realistic about our individual strengths and weaknessesweaknesses– ““I am a generous and loyal friend, but I I am a generous and loyal friend, but I

sometimes have a short temper and need to sometimes have a short temper and need to work on ways to not get angry easily.”work on ways to not get angry easily.”

Fostering Self-esteemFostering Self-esteem

Make an effort to be positive, but don’t Make an effort to be positive, but don’t distort the truth. distort the truth.

Children know when they don’t measure Children know when they don’t measure up, and when adults lie to them, they up, and when adults lie to them, they begin to have difficulty trusting feedback begin to have difficulty trusting feedback from others.from others.

The hard part is resisting the urge to be The hard part is resisting the urge to be overly positive or criticaloverly positive or critical

ExampleExample

Your 8 year old son is playing soccer. He is not Your 8 year old son is playing soccer. He is not the strongest member of the team, but clearly the strongest member of the team, but clearly loves it. How to approach him after a game?loves it. How to approach him after a game?– ““Nice job- I was really proud of how hard you tried Nice job- I was really proud of how hard you tried

during that game, and it really looked like you were during that game, and it really looked like you were having fun!”having fun!”

– ““That was amazing! You are really great at soccer!”That was amazing! You are really great at soccer!”– ““You know, we might want to give basketball a try, I’m You know, we might want to give basketball a try, I’m

not sure that soccer is your thing. Unless you want to not sure that soccer is your thing. Unless you want to start practicing after school.”start practicing after school.”

Fostering Self-esteemFostering Self-esteem

Make it clear that you love and value your Make it clear that you love and value your child, even when he/she has misbehaved.child, even when he/she has misbehaved.– ““I am very disappointed in what you’ve done, I am very disappointed in what you’ve done,

but I still love you very much.”but I still love you very much.”

Model good self-esteem and healthy Model good self-esteem and healthy habits for your child. Make an effort to not habits for your child. Make an effort to not be self-deprecating, and to treat yourself be self-deprecating, and to treat yourself well.well.– Healthy eating, exercise, work/fun balanceHealthy eating, exercise, work/fun balance

Self-regulationSelf-regulation

The ability to tolerate frustration, The ability to tolerate frustration, disappointment, anger, sadnessdisappointment, anger, sadnessChildren need time, experience, and practice to Children need time, experience, and practice to learn to regulate their emotionslearn to regulate their emotionsAdults can help by modeling good coping Adults can help by modeling good coping strategies (distraction) and minimizing use of strategies (distraction) and minimizing use of maladaptive strategies (substance abuse, binge-maladaptive strategies (substance abuse, binge-eating, compulsive exercise)eating, compulsive exercise)Parents can use their own experiences to help Parents can use their own experiences to help kids when they are strugglingkids when they are struggling

Self-regulationSelf-regulation

It can be tempting to jump in and “try to fix It can be tempting to jump in and “try to fix it”, but kids generally find it most helpful it”, but kids generally find it most helpful when parents listen, validate their when parents listen, validate their concerns, and offer their assistance in a concerns, and offer their assistance in a way that the child will find helpful.way that the child will find helpful.Empathize with the child’s feelings and Empathize with the child’s feelings and help them identify the emotionhelp them identify the emotion– ““It sounds like you’re really disappointed that It sounds like you’re really disappointed that

you didn’t get a part in the play. I’m sorry, you didn’t get a part in the play. I’m sorry, that really stinks. What can I do to help?”that really stinks. What can I do to help?”

ExampleExample

Your 6 year old daughter comes home from Your 6 year old daughter comes home from school crying. Two older classmates were school crying. Two older classmates were teasing her on the bus. What is the best way to teasing her on the bus. What is the best way to initially approach the situation?initially approach the situation?– ““This is terrible! I’m calling the bus driver right now!”This is terrible! I’m calling the bus driver right now!”– ““The best thing to do is to just stop crying. Don’t let it The best thing to do is to just stop crying. Don’t let it

bother you. It’s not a big deal.”bother you. It’s not a big deal.”– ““Those kids were really mean. It’s natural that you Those kids were really mean. It’s natural that you

would feel embarrassed about what they said. Do would feel embarrassed about what they said. Do you want me to call Mrs. Smith?”you want me to call Mrs. Smith?”

Delayed GratificationDelayed Gratification

Teach your children the value of time and money, Teach your children the value of time and money, the satisfaction of achieving something through the satisfaction of achieving something through hard work, and the importance of planning aheadhard work, and the importance of planning ahead– Meeting friends at the mall- don’t just drop Meeting friends at the mall- don’t just drop

everything to play chauffeur. Ask your children to everything to play chauffeur. Ask your children to schedule things in advance.schedule things in advance.

– Activities- ask your children to choose carefully, Activities- ask your children to choose carefully, and encourage them to stick with at least one and encourage them to stick with at least one over the long termover the long term

– Clothes/toys- consider asking your child to pay Clothes/toys- consider asking your child to pay the difference for special “designer” labels or to the difference for special “designer” labels or to pay part of the cost of expensive video or pay part of the cost of expensive video or computer game systems.computer game systems.

Family StructureFamily Structure

Children and adolescents do best when there Children and adolescents do best when there are boundaries between parents and children. are boundaries between parents and children. Kids need parents, not “best friends”Kids need parents, not “best friends”Even though they may fight and scream, Even though they may fight and scream, children love structure and firm limit-settingchildren love structure and firm limit-settingIt can be especially challenging to enforce rules It can be especially challenging to enforce rules and limits when your child says that they hate and limits when your child says that they hate you, that they’ll lose all of their friends if they do you, that they’ll lose all of their friends if they do what you say, or that they’ll be depressed if you what you say, or that they’ll be depressed if you hold the limithold the limit

Family StructureFamily Structure

ParentsParents

↓↓

ChildrenChildren

NOTNOT

Parents Parents = Children= Children

Co-parentingCo-parenting

Parents need to present a “united front” with Parents need to present a “united front” with their children to avoid splitting (playing one their children to avoid splitting (playing one parent against the other)parent against the other)– This becomes especially important in families where This becomes especially important in families where

parents are divorcedparents are divorced

Significant relationships (marriage, life partner, Significant relationships (marriage, life partner, etc) are extremely important and need to be etc) are extremely important and need to be cultivatedcultivated– Make time for your spouse or significant otherMake time for your spouse or significant other– Neglecting the relationship to focus on the children Neglecting the relationship to focus on the children

can lead to problems down the roadcan lead to problems down the road

Cultivating Important RelationshipsCultivating Important Relationships

Allow yourself uninterrupted time with your Allow yourself uninterrupted time with your partner every day (30-60 minutes to catch partner every day (30-60 minutes to catch up on your day, discuss family events, etc)up on your day, discuss family events, etc)Schedule a “date night” every 1-2 weeksSchedule a “date night” every 1-2 weeksWorking parents often feel the need to Working parents often feel the need to spend all of the time they are home with spend all of the time they are home with their children, but it is important to make their children, but it is important to make time for yourself as well (and models good time for yourself as well (and models good lifestyle balance)lifestyle balance)

ExampleExample

Your 14 year old daughter tells you she is going to a Your 14 year old daughter tells you she is going to a party over the weekend which will be thrown by a party over the weekend which will be thrown by a classmate who has been in trouble for possession of classmate who has been in trouble for possession of drugs and alcohol. You tell her that you are not drugs and alcohol. You tell her that you are not comfortable with her going. She responds by saying, “I comfortable with her going. She responds by saying, “I hate you! Are you trying to ruin my life? Everyone is hate you! Are you trying to ruin my life? Everyone is going. If I can’t go, I’m going to stop eating.” How might going. If I can’t go, I’m going to stop eating.” How might you respond?you respond?– ““Tough. You’re not going anywhere for a month.”Tough. You’re not going anywhere for a month.”– ““Look, I know this isn’t going to make me popular, but I care Look, I know this isn’t going to make me popular, but I care

enough about you and your safety that I’m willing to be the bad enough about you and your safety that I’m willing to be the bad guy here.” Ask your spouse/partner to support you in the guy here.” Ask your spouse/partner to support you in the decision.decision.

– ““OK, fine, you can go. Just be careful.”OK, fine, you can go. Just be careful.”

Limit SettingLimit Setting

Clear ExpectationsClear Expectations

ConsistencyConsistency

Consequences for failure to meet Consequences for failure to meet expectationsexpectations

Important that both expectations and Important that both expectations and consequences are age-appropriateconsequences are age-appropriate

Limit SettingLimit Setting

Reward good behavior! This will increase Reward good behavior! This will increase the chances that good behaviors are the chances that good behaviors are repeated.repeated.Avoid inadvertently rewarding bad Avoid inadvertently rewarding bad behaviors (behaviors (ie- ie- giving in to a temper giving in to a temper tantrum at the grocery store)tantrum at the grocery store)Inconsistency with limits increases bad Inconsistency with limits increases bad behavior- child will “up the ante” until the behavior- child will “up the ante” until the parent gives inparent gives in

Natural ConsequencesNatural Consequences

These work well because child is able to These work well because child is able to see a link between the behavior and the see a link between the behavior and the consequence.consequence.– ““Well, we can’t watch Well, we can’t watch The Lion King The Lion King tonight tonight

because you didn’t cooperate with your bath, because you didn’t cooperate with your bath, and now it is time for bed!”and now it is time for bed!”

– ““I know you wanted to go to the mall with your I know you wanted to go to the mall with your friends, but you didn’t do your homework after friends, but you didn’t do your homework after school. I guess we’ll have to do it now, school. I guess we’ll have to do it now, instead of going to the mall.”instead of going to the mall.”

Incentive EconomiesIncentive Economies

Sticker charts, token economySticker charts, token economy– Child needs to receive the sticker/token as soon as Child needs to receive the sticker/token as soon as

the task is completed in order to link the positive the task is completed in order to link the positive behavior with the rewardbehavior with the reward

– May choose to take tokens away when behavior is May choose to take tokens away when behavior is bad.bad.

– Child should be encouraged to exchange tokens for Child should be encouraged to exchange tokens for previously agreed upon rewardspreviously agreed upon rewards

– The older the child, the longer they can wait for the The older the child, the longer they can wait for the reward- may chose to work toward bigger things.reward- may chose to work toward bigger things.

GroundingGrounding

Generally best to take away privileges for Generally best to take away privileges for a time-limited period, and to be clear about a time-limited period, and to be clear about the timeframe.the timeframe.Take away privileges that are going to be Take away privileges that are going to be meaningful to the child (computer, cell meaningful to the child (computer, cell phone, time with friends).phone, time with friends).Younger children do not benefit from Younger children do not benefit from taking away privileges for extended taking away privileges for extended periods of timeperiods of time

Limit SettingLimit Setting

PreschoolPreschool– Consequences need to be immediate for child to link Consequences need to be immediate for child to link

them to the bad behavior (time out can be done on a them to the bad behavior (time out can be done on a mat in a store)mat in a store)

– Time out ~1min/year of ageTime out ~1min/year of age

LatencyLatency– Children can begin to delay gratification with incentive Children can begin to delay gratification with incentive

programsprograms

AdolescenceAdolescence– Enforce limits for safety, but allow the adolescent to Enforce limits for safety, but allow the adolescent to

take on increasing responsibility as he/she is able to take on increasing responsibility as he/she is able to demonstrate ability to make good choices.demonstrate ability to make good choices.

Once the consequence has been Once the consequence has been enforced, and you’ve had a conversation enforced, and you’ve had a conversation about why the behavior was not about why the behavior was not acceptable, let it go.acceptable, let it go.It is generally not helpful to keep bringing It is generally not helpful to keep bringing up the incident in the futureup the incident in the futureMake it clear that the behavior is Make it clear that the behavior is problematic, but that does not change your problematic, but that does not change your love for him/her.love for him/her.

Be PatientBe Patient

Changes may not be immediately Changes may not be immediately apparentapparent

Bad behavior may escalate in the short Bad behavior may escalate in the short term as child tries to see if they can term as child tries to see if they can persuade you to give inpersuade you to give in

Stay firm, consistent, and child’s behavior Stay firm, consistent, and child’s behavior WILL begin to adapt over time.WILL begin to adapt over time.

Bottom LineBottom Line

Allow your child to make mistakes and learn Allow your child to make mistakes and learn from them (within reason)from them (within reason)Model good self-regulation strategiesModel good self-regulation strategiesTeach your child to fight his/her own battles and Teach your child to fight his/her own battles and solve his/her own problemssolve his/her own problemsTeach your child to delay gratification. Teach the Teach your child to delay gratification. Teach the value of money, and the importance of hard value of money, and the importance of hard workworkTeach your child to live with the consequences Teach your child to live with the consequences of decisionsof decisions

When to seek helpWhen to seek help

There are two emergencies in child There are two emergencies in child psychiatrypsychiatry– Child falls off his/her developmental trajectoryChild falls off his/her developmental trajectory

Not attending schoolNot attending school

No meaningful social relationshipsNo meaningful social relationships

– Acute safety concernsAcute safety concernsSuicidal ideationSuicidal ideation

Homicidal ideationHomicidal ideation

psychosispsychosis

When to seek helpWhen to seek help

Academic concerns that do not improve Academic concerns that do not improve with increasing structure, organizational with increasing structure, organizational strategiesstrategiesProlonged periods of depressed mood, Prolonged periods of depressed mood, labile mood, overwhelming anxietylabile mood, overwhelming anxietyWeight loss, preoccupation with foodWeight loss, preoccupation with foodSeek help immediately for acute safety Seek help immediately for acute safety concerns (suicidality, homicidal ideation, concerns (suicidality, homicidal ideation, psychosis)psychosis)

AcknowledgementsAcknowledgements

Eugene Beresin, MDEugene Beresin, MDPaula Rauch, MDPaula Rauch, MDSteve Schlozman, MDSteve Schlozman, MDMichael Jellinek, MDMichael Jellinek, MDLaura Prager, MDLaura Prager, MDBruce Masek, PhDBruce Masek, PhDJoseph Biederman, MDJoseph Biederman, MDSusan Swick, MDSusan Swick, MDPaul Hammerness, MDPaul Hammerness, MDSteve Ablon, MDSteve Ablon, MD