Made for Children
Release Date: 09-23-2010
If everyone could grow up in the idyllic world that Rex Forehand did, well, Forehand might have a different career. It was more than the little Georgia town where he picked up his gentle accent. It was the family that surrounded him, the extra parental figures -- a grandmother and aunt who lived next door, an uncle in the house behind his and another across the street. It was the dozen children -- brothers and sisters and cousins, the clan eating together a couple of times a week.
"I had a phenomenal family influence from the start," says Forehand, Heinz and Rowena Ansbacher Professor of Psychology, director of the university's clinical training program, and co-author of the newly released third edition of the popular self-help book Parenting the Strong-Willed Child.
What keeps Forehand in the field -- and recently earned him the American Psychology Association's award for lifetime contributions to child clinical psychology -- is that he sees children struggling in a real world of stress and pain with troubling outcomes that he believes are largely preventable.
Over the last several years, with a grant from the National Institute of Mental Health, Forehand has been researching new interventions for families with a parent suffering from depression, a fact of life for an estimated 15 million children. Never easy, the challenge of caring for kids while experiencing a major depressive episode often leads to patterns of negative parenting that persist even when the depression abates.
Withdrawal, failure to respond to a child's needs, irritability, even over-involvement are common responses, all contributing to a chronically stressful environment for children that can lead to emotional and behavioral problems such as depression, anxiety, aggression and other forms of opposition. And since Johnny acting out rarely brings out a parent's best instincts, the cycle tends to perpetuate. The increased risk of problems for such a large population of children amounts to what Forehand and his collaborators on the study, Dr. Gary Keller, research assistant professor in the School of Medicine, and Bruce Compas, professor of psychology at Vanderbilt University, view as a significant public health priority.
All in the family
The current standard of care, if families are getting help at all, is most likely medication for the depressed parent. There's also been some research on working with kids. But to Forehand's and his colleagues' thinking, borne out in this cutting edge study, is that direct intervention with both children and parents can be crucial components to breaking the cycle.
Researchers at UVM and Vanderbilt recruited 184 families, each with a depressed parent and one or more children between the ages of nine and fifteen. Families were then divided equally into a group getting cognitive behavior intervention and a comparison group receiving self-study materials by mail. Those getting the intervention met in small, family groups once a week for eight weeks, with four monthly follow-ups.
The intervention included some information and education about depression, but the primary focus was on cognitive behavioral techniques, giving children tools to cope and teaching adults better parenting skills. One of the keys for kids is learning strategies for staying positive when a parent is unavailable, talking to a friend or playing outside -- above all to look after, rather than blame, themselves.
"One of the major things we want," says Forehand, "is for kids not to try to fix their parents. They really can't, and we want them to accept that."
For parents the facilitators emphasize the importance of praising children and spending time doing positive family activities even when it's difficult. They urge them to keep routines as normal as possible and not have children assume too many adult responsibilities.
The research team assessed outcomes after six-, twelve-, eighteen- and twenty four months, using intensive evaluation measures ranging from questionnaires to hours of coded videotapes of families interacting around two topics, one a fun activity the family had done together and one a discussion of how a parent and child had resolved a problem between them. Two years after intervention, the team found that not only did kids have far fewer acting out problems compared to the baseline group, but parents showed lower levels of depressive symptoms as well.
"We really think the package together is what's important," Forehand says. "Our big push was to do something with the parents and the kids."
The trick, he acknowledges, is how to disseminate findings once you've identified problems and developed interventions so that they might impact clinicians and policymakers who could make programs available to families who need them.
The clan that made up Forehand's childhood may have represented a sense of belonging, fun and security for him, but one imagines that for his mother and father it also meant a network of support that kept them off the couch (or maybe allowed for a little happy napping on it). It certainly meant a lifestyle few enjoy today, but one that would make positive parenting a lot easier for everyone, clinically depressed or not.
"A lot of parents are very stressed because I don't think in this country we've really figured out how to have both parents working and have a family -- and clearly people want to do that," Forehand says. "They're constantly searching for how to keep it all going. I would say many families are living a very delicate balancing act and they do it -- but the question really is: at what cost?"
As a society he believes we will eventually find a path, but we're clearly not there yet. In the meantime, Forehand offers bits of wisdom that he admits are easier offered than practiced: don't be hypercritical (the overly praised child often critiqued in the media is not the average child); be sensitive and honest about your parenting strategies (if you have a plan, like the one he presents in Strong-Willed Child, explain what you're doing); provide structure and rules with consequences for positive and negative behavior; give your children warm, meaningful time -- quality trumps quantity always.