Conduct disorder is not caused by bad parenting

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I’m sure this adorable child never behaves badly.

 

Conduct disorder is when a child keeps behaving in a particularly bad way.  Behaviours indicative of conduct disorder in young children include lying, bullying, making threats, starting fights, damaging property, stealing, hurting animals, hurting people, and starting fires.  For older children, the list also includes sexual assault, staying out at night, and using weapons.

A recent longitudinal study in Massachusetts found that mothers’ level of warmth, over-reactivity or laxness had little to no association with early symptoms of conduct disorder in preschool children.  The researcher selected 197 children whose parents reported disruptive behaviour and followed them for three years, from ages 3-6.  Signs of disruptive behaviour were consistent across time as were parenting styles, but the two were mostly unrelated.  If anything, the study suggests that the children’s behaviour may negatively affect mothers’ warmth and lead them to over-react, rather than the other way around.  But even that’s a very weak relationship.

This finding goes against a deep running belief in our society that parents are to blame for their children’s behaviour.  It’s never been entirely clear whether the problem is supposed to be coercive parenting that sets a bad example or too lax parenting that makes children run wild.  But now it turns out it’s neither.  I’m not sure if it’s good news though because it would be nice to think that we could cure conduct disorder with no more than our own good behaviour.  The author does point to other studies that claim parenting makes a difference for older children, and for other behavioural problems such as defiance and attention-seeking.

Meanwhile, two researchers who interviewed snowboarding mothers note with dismay that motherhood leads to more cautious behaviour.  It’s true, it does.  Yes, voluntary risk taking can be a joyful thing, and yes, mothers are often depressed.  And yet… snowboarding mothers!  Snowboarding while pregnant!  I feel the shockingness, but maybe they’re right – maybe we restrict ourselves too much.

Most US mothers aren’t screened for depression

It turns out that most US clinicians don’t screen parents for depression.  Researchers followed seven clinics in Philadelphia over a 20 month period.  Clinicians were supposed to screen all caregivers who came for well-child visits between 12-36 months.  Over 8000 families were eligible for screening but only a minority (21%) were actually screened.

When asked why not, the main answer was time pressure.  One clinician said,

It is a tough question to ask … And when you’re behind and you’re going into a room and you have ten minutes, and you’re running an hour behind, it’s sort of like, oh, I don’t even want to open up that can of worms …

It’s a tough two questions.  The researchers used PHQ-2 (Patient Health Questionnaire) which only has two items relating to mood:

  1. Over the past two weeks, how often have you been bothered by little interest or pleasure in doing things?
  2. Over the past two weeks, how often have you been bothered by feeling down, depressed, or hopeless?

One particular comment caught my eye:

“One of the things about screening is that you shouldn’t screen unless you can do something about it. And so the doing something about it is hard, and that’s probably where people push back.”

This is something that has always bugged me about the rhetoric surrounding maternal depression.  You must ask for help!  It’s really important that we detect it!  But less clear is what kind of help the mother is to receive, whether it will make a difference, and what the costs are in getting that help.

Mothers too are under time pressure.  They are attention and sleep deprived.  They too a probably reluctant to open a “can of worms” and create drama by owning up to a depression diagnosis.  The researchers cite previous studies that show that even when mothers screen positive to depression, most of them are not referred onwards.  When the mothers themselves are required to set up the appointments for mental health, the rates are even lower.

I suppose the question is, does intervention work and is it worth the bother?  Lots of clinicians and parents seem to think that it is not, but are they right?  Because the public rhetoric of postpartum depression seems definitely otherwise.

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Reference

Guevara, J. P. & Gerdes, M. & Rothman, B. & Igbokidi, V. & Doughterty, S. & Localio, R. & Boyd, R. C. “Screening for Parental Depression in Urban Primary Care Practices: A Mixed Methods Study.” Journal of Health Care for the Poor and Underserved, vol. 27 no. 4, 2016, pp. 1858-1871. Project MUSE, muse.jhu.edu/article/634633