Psychiatrists Discuss Divorce, Disruptive BehaviorBy Sophia Glezos Voit
September 17, 2002
If you think rearing children can be difficult, you're not alone, according to Dr. Edgardo Menvielle, who splits his time between Children's Hospital and NIMH on research related to stress and violence in children, and Dr. Regina Smith James, NIMH special expert in research on attention deficit disorders in youth.
But whatever a parent's professional background, he or she needs to know when problem behaviors have crossed the line from occasional defiance and sassiness into pleas for professional intervention, said Menvielle and James, who spoke at separate sessions of the Seminar Café, held for NIH staff at the Neuroscience Center in Rockville.
It isn't always the child who needs the help, though. Disruptive behaviors (opposition, defiance, aggressiveness, etc.) sometimes end when parents get help for themselves whether to address their own symptoms, emotional conflicts or marital discord, or to improve parenting and communication skills. In other cases, however, it's the child who needs direct intervention, either in the form of psychotherapy, medication or both.
Menvielle, whose recent presentation was on the effects of divorce on children, confirmed that marital breakup isn't ever easy on anyone. But when parting parents put children in the middle, work against or undermine each other and compete with one another, they can expect their offspring to suffer whether emotionally or behaviorally he said.
Dr. Edgardo Menvielle of NIMH recently offered a seminar on the effects of divorce on children.
"It may seem basic," Menvielle explained, "but it's the quality of the co-parenting or the way parents deal with each other in relation to the child that's going to predict problems, rather than the specific custodial arrangement." The best predictor of a positive outcome for kids, he said, "is when the adults cooperate with each other, at least where the children are concerned."
He added that although research before the last decade showed many negative consequences of divorce on children, more current findings show ongoing marital conflict as the culprit. In fact, he said, some research has indicated that problems in social functioning, emotional adjustment and schoolwork experienced by children of broken families developed 4 to 12 years before the split implicating marital discord rather than divorce. But children who have pre-existing emotional and behavioral problems are at particular risk in stressful situations such as discord and divorce.
Given this, Menvielle said, some parents do well to enter couples therapy for a brief time, even well after the split, so they can learn strategies for putting their personal feelings aside in the interest of their children's parenting needs.
But there are far less clear-cut causes of bad behavior, which James discussed in her presentation in June on disruptive behaviors namely, the combination of genetic influences and environmental factors, such as family issues. Signs of a behavioral disorder, she reported, include deceptiveness, hostility, argumentativeness, blaming, theft, aggression toward animals or people, property damage, deliberate annoyance, running away, vindictiveness and/or violation of rules.
"There are still gaps in our knowledge regarding the contribution of the child, the family, peers and the whole school community," James said, "but we do know there's usually a dynamic interaction between the child and the environment" when disruptive behaviors are ongoing.
When behavior problems emerge early and persist, she said, the research suggests that for some children, genetic factors may contribute more than environmental factors, although favorable social influences can be protective.
The types of disorders usually associated with disruptive behaviors, according to James, are oppositional defiant disorder, attention deficit hyperactivity disorder, mood disorders, and conduct disorder some of which can co-occur.
Dr. Regina Smith James
Known risk factors in the environment include inadequate parental supervision and monitoring, poor limit-setting, weak bonding between parent and child, ongoing family conflict and/or violence, traumatic life experiences, head trauma and/or negative peer influences.
"The presence of risk factors doesn't mean a child is doomed," James cautioned, "nor does the absence of them signify protection. But although there are no quick, inexpensive and fail-safe solutions, we do have a better understanding of risks for disruptive disorders, and help is available when they do occur."
Treatments for disruptive behaviors include cognitive-behavioral therapy and social-skills training, both of which help the child gain new problem-solving and coping skills, learn how to manage anger more effectively and better tolerate frustration. Family therapy is also a common approach used in helping members better communicate with each other. In some cases, antidepressant and/or mood-stabilizing medications can also be effective. When ADHD is diagnosed, stimulant medications can improve behavior and self-esteem.
For families with children who exhibit antisocial, delinquent or suicidal behavior, James described a home-based intervention called multisystemic therapy that has helped many youngsters avoid hospitalization or incarceration.
For more information about children's mental health issues visit www.nimh.nih.gov/publicat/childmenu.cfm.
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