Roughly 20% of all children will present with a psychiatric diagnosis before 18. Asking for a family tree of psychiatric problems at the first well baby visit might someday become part of pediatric screening and at some point, mapping out genetic susceptibility to psychiatric illness is probably a good idea for each child. But parents can prepare for psychiatric problems also by employing the best positive parenting practices—minimizing power struggles and simultaneously taking care to get to know their child’s motivations and feelings as well as possible.
We all know the 18-month-old who wants the candy or the 4-year-old who will not get dressed for school or the 10 year old who doesn’t want to do homework. My dad, Dr. Watkins, has a fun analogy about the extremes of parenting approaches. He notes that some parents view their children as though they are gentle flowers, and should be shaped by atmospheric forces as the parent watches them bloom, while other parents believe their child is a fierce beast who must be fastidiously tamed. Most parents live in the middle—they want to actively mold their character but allow the child room to make mistakes and experience life independently.
Either way, parents are often susceptible to power struggles, even in the very young child, and escalation of every struggle is a constant threat. You know the pattern, right?
“Get your shoes on, the pink ones.”
Nothing.
“Get your shoes, you know, the pink sandals. They’re right by the door, can’t you see them? You put them there yesterday. Put them on.”
Nothing, shrug maybe? Halfhearted look at shoes? Goes back to trying to fetch cereal out of the pantry.
“Look, (kid), put the shoes on right now! I’ve told you ten times! We’re gonna be late! This is not that hard. You are totally capable of putting your shoes on. Remember when you did that yesterday? They’re right by the door!! (yadayadayada on and on)”
Would you do something you didn’t want to do if your boss yakked and yakked on and on incessantly about it? And did this all day every day? And only talked to you when he or she wanted something?
Every age is different and the pattern of escalation within a power struggle changes with age. The toddler breaks down and tantrums very early within the struggle. Because you will not prevent power struggles with a specific reaction to the temper tantrum, the most important thing to do at that age is avoid the struggle altogether, predict and prevent tantrums. As kids get older, however, the struggle is more complex. It may be peppered with hyperbole or emotional pleas which seem unrelated to the direct argument at hand. But within every struggle, the child ultimately has the upper hand. And we watch teenagers escalate to the ultimate threat occasionally: a caring parent will always capitulate to a child who is threatening to kill him or herself. Note: I am not talking about truly suicidal children who are fighting severe clinical depression.
Children who struggle with underlying psychiatric disorders—autism and ADHD for example—are so much harder to parent to begin with and escalate within power struggles much more quickly and dramatically. A parent who is weary and depressed because they are constantly on guard, fighting battles at every turn, starting with the candy at 10 months and ending with the teenager who won’t go to school, becomes the dispirited parent who decides to ignore or avoid the child. The parent who cannot engage in meaningful communication because it leads to conflict may decide “no news is good news.” They do not enter the child’s room, and they assume that as long as they don’t hear from teachers or cops, things are going OK.
And children are very good at hiding mental illness, particularly as teenagers and pre-teens. That seemingly benign neglect borne of the disillusioned and exhausted parent leads to the quiet suicides, the violent outburst at school, drugs and teenage pregnancy.
OK, so that was depressing and scary. And makes it seem like even parents of infants are on the hook for de-escalation of power struggles! My aim is to stress the importance of skillful parenting from an early age. Certainly, most psychiatric illness is very hard to avoid altogether—kids will be depressed or anxious and struggle no matter how they are parented. But the kids who have had consistent, thoughtful, and creative parenting will fare much better at coping and dealing with their mental illness.
How do parents avoid these struggles and power through without enabling escalation? Many parents need help, especially with very challenging children. Behavioral therapists and parenting counselors are objective skilled experts who can be called to come in and observe a family dynamic, making recommendations of how to change parenting style. Parents who have changed their style multiple times and are “constantly trying something new” or “have tried everything” are often actually training their child to be resistant to their parenting. With each change, a child may become more skilled at avoiding conflict or engendering worsening conflict and getting what they want in the meantime.
Thus, it is important to have a consistent message between caregivers and to employ a method accurately. There are lots of books on parenting and every pediatrician probably has their favorites. Moreover, kids are different and parents often have to know their children well to think creatively about how to approach specific challenges given specific personality traits. Siblings will not respond the same way to the same discipline.
Some commonly loved books include Love and Logic, How to Talk so Your Children Will Listen and How to Listen So Your Children Will Talk, 321 Magic. These are starting places. But come in and talk to us if your family is feeling the weight of too many power struggles and worsening conflict. And let us know about the psychiatric problems which run in your family so we can be sure to screen for those issues at the ages they typically present.
