1. Raising an Emotionally Healthy Child: How Not to be a Helicopter Parent
Jennifer L. Derenne,M.D.
Assistant Professor of Psychiatry, Medical College of Wisconsin
Child and Adolescent Psychiatrist, Children’s Hospital of Wisconsin
3/4/08

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

3. Disclaimers There is no one “right way” to parent.
Each family has it’s own unique strengths and challenges.
Each parent/child relationship is different, even within the same family.
As a parent, you know your child/family best.

4. “Helicopter Parenting”
Children these days are highly structured, and may sometimes be over-scheduled
Playdates
Schoolwork
Clubs, volunteer work, sports
Well-meaning parents can take over many aspects of their child’s lives (intent is to keep child “on course”)

5. “Helicopter Parenting”
When parents take over organizational aspects of their child’s life, it may help the child “get ahead”, but does not help them learn the skills they need to be successful as adults
Organization
Delayed gratification
Autonomy/Responsibility
Initiative
Accepting disappointment and reformulating a plan

6. “Helicopter Parenting”
Helicopter parents are overly involved in children’s lives, and do not let them learn from their mistakes or from normal childhood experiences
They may take on their child’s school projects, argue with teachers/professors about grades, and choose their child’s college.
The cell phone has been called “the world’s longest umbilical cord.”

7. As a result, children do not learn to take on responsibility
As a result, children do not learn to take on responsibility. They may get into a prestigious college or professional school, but may not be able to function effectively once they get there.
Kids may become anxious/depressed under the stress.
How can you help your child stay on pace with his/her peers, but also help him/her learn these important skills?

8. Traits Associated with Emotional and Psychological Health
The ability to feel secure in one’s relationships (attachment)
Positive self-esteem
A sense of self-efficacy (“I can make things happen for myself”)
The ability to withstand frustration and disappointment

9. Developmental Stages Infancy (0-2) Pre-school (2-6)
Latency (middle-childhood, school-age) (6-12)
Adolescence (12-18)

10. Infancy

11. Infancy This is a time of rapid development and growth
Physical
Cognitive (language skills)
Attachment is the major developmental milestone
Child feels protected by the mother
This safety enables the child to separate and start to explore the world

12. Pre-school

13. Pre-school Growth and development continue at a rapid pace
Child’s perception is that everything revolves are him/her
Magical thinking predominates
“I was bad, so daddy got cancer.”
Immature sense of body integrity
“My arm is broken, therefore I am broken.”

14. Latency

15. Latency Physical development slows
This is the time during which child begins to find his/her place in the world
Mastery in academics, athletics, arts
Child negotiates his/her status in the peer group
Increased organization, responsibility, cognitive and moral development
Children develop logical thinking, empathy, respect for rules

16. Adolescence

17. Adolescence
The time during which the child prepares for adulthood. Increased reliance on peer group to determine norms.
Puberty
Separation/individuation- teen starts to figure out his/her ideals, starts to think about separating from the family
Capable of abstract thinking
Very common to have tension during this time- parents feel protective, child wants increased autonomy.

18. Attachment
Experiences in very early childhood (0-3 years) determine our ability to trust others. (Consistent caregiving, food/water/shelter)
Once secure attachment is solidified, child is able to explore the world, knowing that a parent will always be there when needed.
Temperament of both parent and child has a significant effect on this process.

19. Temperamental Styles Chess and Thomas (1977)
Easy- positive mood, moderate activity level, adapt to change, regular biologic patterns
Difficult- very active, negative mood, overly persistent, intensely reactive, resistant to change
Slow to warm up (behaviorally inhibited)- cautious and shy, less reactive, less active, respond to stress by withdrawing emotionally

20. Attunement DW Winnicott “Good enough” parenting
It is not important that the parent/child relationship is perfect
It is important that the parent is tuned in to what the child needs
This may require the parent to rethink approach
ie- a “laid back” parent may not immediately see that a temperamentally “intense” child may need more time to transition between activities.

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

22. Your child may have different strengths and interests from you, your spouse, or his/her siblings.
Recognize this and support your child
Modify expectations accordingly (expect that child works up to his/her potential, but don’t demand straight As if that is not realistic)

23. Self-esteem
The manner in which we regard ourselves and our accomplishments
Generally most helpful when we see ourselves in a positive light, but we are realistic about our individual strengths and weaknesses
“I am a generous and loyal friend, but I sometimes have a short temper and need to work on ways to not get angry easily.”

24. Fostering Self-esteem
Make an effort to be positive, but don’t distort the truth.
Children know when they don’t measure up, and when adults lie to them, they begin to have difficulty trusting feedback from others.
The hard part is resisting the urge to be overly positive or critical

25. Example
Your 8 year old son is playing soccer. He is not the strongest member of the team, but clearly loves it. How to approach him after a game?
“Nice job- I was really proud of how hard you tried during that game, and it really looked like you were having fun!”
“That was amazing! You are really great at soccer!”
“You know, we might want to give basketball a try, I’m not sure that soccer is your thing. Unless you want to start practicing after school.”

26. Fostering Self-esteem
Make it clear that you love and value your child, even when he/she has misbehaved.
“I am very disappointed in what you’ve done, but I still love you very much.”
Model good self-esteem and healthy habits for your child. Make an effort to not be self-deprecating, and to treat yourself well.
Healthy eating, exercise, work/fun balance

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

28. Self-regulation
It can be tempting to jump in and “try to fix it”, but kids generally find it most helpful when parents listen, validate their concerns, and offer their assistance in a way that the child will find helpful.
Empathize with the child’s feelings and help them identify the emotion
“It sounds like you’re really disappointed that you didn’t get a part in the play. I’m sorry, that really stinks. What can I do to help?”

29. Example
Your 6 year old daughter comes home from school crying. Two older classmates were teasing her on the bus. What is the best way to initially approach the situation?
“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 bother you. It’s not a big deal.”
“Those kids were really mean. It’s natural that you would feel embarrassed about what they said. Do you want me to call Mrs. Smith?”

30. Delayed Gratification
Teach your children the value of time and money, the satisfaction of achieving something through hard work, and the importance of planning ahead
Meeting friends at the mall- don’t just drop everything to play chauffeur. Ask your children to schedule things in advance.
Activities- ask your children to choose carefully, and encourage them to stick with at least one over the long term
Clothes/toys- consider asking your child to pay the difference for special “designer” labels or to pay part of the cost of expensive video or computer game systems.

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

32. Family Structure
Parents ↓
Children
NOT
Parents = Children

33. Co-parenting
Parents need to present a “united front” with their children to avoid splitting (playing one parent against the other)
This becomes especially important in families where parents are divorced
Significant relationships (marriage, life partner, etc) are extremely important and need to be cultivated
Make time for your spouse or significant other
Neglecting the relationship to focus on the children can lead to problems down the road

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

35. Example
Your 14 year old daughter tells you she is going to a party over the weekend which will be thrown by a classmate who has been in trouble for possession of drugs and alcohol. You tell her that you are not comfortable with her going. She responds by saying, “I 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 you respond?
“Tough. You’re not going anywhere for a month.”
“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 guy here.” Ask your spouse/partner to support you in the decision.
“OK, fine, you can go. Just be careful.”

36. Limit Setting Clear Expectations Consistency
Consequences for failure to meet expectations
Important that both expectations and consequences are age-appropriate

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

38. Natural Consequences
These work well because child is able to see a link between the behavior and the consequence.
“Well, we can’t watch The Lion King tonight because you didn’t cooperate with your bath, and now it is time for bed!”
“I know you wanted to go to the mall with your friends, but you didn’t do your homework after school. I guess we’ll have to do it now, instead of going to the mall.”

39. Incentive Economies Sticker charts, token economy
Child needs to receive the sticker/token as soon as the task is completed in order to link the positive behavior with the reward
May choose to take tokens away when behavior is bad.
Child should be encouraged to exchange tokens for previously agreed upon rewards
The older the child, the longer they can wait for the reward- may chose to work toward bigger things.

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

41. Limit Setting Preschool Latency Adolescence
Consequences need to be immediate for child to link them to the bad behavior (time out can be done on a mat in a store)
Time out ~1min/year of age
Latency
Children can begin to delay gratification with incentive programs
Adolescence
Enforce limits for safety, but allow the adolescent to take on increasing responsibility as he/she is able to demonstrate ability to make good choices.

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

43. Be Patient Changes may not be immediately apparent
Bad behavior may escalate in the short term as child tries to see if they can persuade you to give in
Stay firm, consistent, and child’s behavior WILL begin to adapt over time.

44. Bottom Line
Allow your child to make mistakes and learn from them (within reason)
Model good self-regulation strategies
Teach your child to fight his/her own battles and solve his/her own problems
Teach your child to delay gratification. Teach the value of money, and the importance of hard work
Teach your child to live with the consequences of decisions

45. When to seek help There are two emergencies in child psychiatry
Child falls off his/her developmental trajectory
Not attending school
No meaningful social relationships
Acute safety concerns
Suicidal ideation
Homicidal ideation
psychosis

46. When to seek help
Academic concerns that do not improve with increasing structure, organizational strategies
Prolonged periods of depressed mood, labile mood, overwhelming anxiety
Weight loss, preoccupation with food
Seek help immediately for acute safety concerns (suicidality, homicidal ideation, psychosis)

47. Acknowledgements Eugene Beresin, MD Paula Rauch, MD
Steve Schlozman, MD
Michael Jellinek, MD
Laura Prager, MD
Bruce Masek, PhD
Joseph Biederman, MD
Susan Swick, MD
Paul Hammerness, MD
Steve Ablon, MD