Summer 2002

Overweight Kids

Passive activity and overeating are not a healthy long-term partnership. The best advice medicine and psychology have to offer overweight people is to make lifestyle changes which lead to an increase of activity and a change of diet. Of course, debates loom over which diet and what activities are best to normalize weight. However, being overweight has now become a considerable childhood problem. For example, more children are acquiring diabetes. Type 1 diabetes was also referred to juvenile diabetes, because it usually began in childhood and its origin was not in diet. Children are now diagnosed with Type II diabetes, usually reserved for adults. Moreover, adults with Type II diabetes are at considerable risk for cardiac and other health problems.

Passive behavior may be responsible for a portion of the increased incidences of childhood obesity. According to the Center for Disease Control, about 43 percent of American children watch two hours of television per day. About 14 percent of children are obese or overweight (with higher percentages in minority groups). The good news is that programs like the Coordinated Approach to Child Health (CATCH), which involves a school based initiative to decrease fat in available school meals and increase healthier lifestyle choices in children, show that some children can lose weight and increase exercise. Recently, the CDC has noted the need for more exercise and less sedentary time for children and encouraged communities to make riding a bicycle or walking to school a safe alternative.

While decreased activity level may be one reason for the increase in childhood obesity, mass marketing of food that is high in calorie and fat content, and made easily available at school and in the community is likely another. It is difficult for most children to comprehend a menu. Additionally, most do not have the ability to anticipate consequences involved in eating food with high calories and fat content, because the ability to abstract this sort of data requires social and intellectual development that does not occur until the teen years or beyond. Children require guidance and their caretakers and environment have to be responsible for maintaining balanced nutrition and encouraging healthy activity.

There are a few changes parents and caretakers can make that will assist children with normalizing weight. First, a medical checkup is useful to rule out potential medical issues involved with being overweight. Second, a technique called self monitoring may be useful. This involves keeping a log of activity and eating patterns. Programs that are successful with weight stabilization, such as Weight Watchers, teach this approach to adults. This promotes awareness of eating patterns, such as type of foods that tend to be highly caloric or high in fat. Third, nutritional education or cooking classes may be helpful. It may be helpful for the child to become more active in the kitchen to gain a better understanding of food preparation. Fourth, encourage activity when possible and reward a child’s attempts to be more active though praise and attention. Finally, set realistic, small steps in achieving normalized weight and avoid long term goals like “losing 20 pounds.”

Reactive Attachment Disorder (RAD)

Attachment theory began with the work of John Bowlby, a physician who observed that children form secure or insecure attachment to their caregivers. Bowlby felt that infants developed “internal working models” of their attachment relationships. He felt attachment was a biological necessity in that animals also exhibit attachment behavior. Thus, Bowlby felt that attachment served an evolutionary purpose in that it allowed both humans and animals a feeling of protection and security when young. He felt that humans develop internal working models based on their attachment relationship. People carry this basic trust and sense of protection (or lack of it) into the wary world at large. If the attachment that was developed was secure, the child grows up with a healthy sense of his or her self and thrives in relationships. To the degree the attachment was insecure, a child would suffer with separation anxiety, separation depression or detachment in their personal and social life.

Other researchers observed an attachment style they labeled as disorganized attachment. This differed from the two basic types of attachment that John Bowlby and others had discussed. Findings regarding disorganized attachment came from work with abused and abandoned children. These children came from backgrounds of severe neglect and abuse or environments with significant chaos. Because of their background of maltreatment or lack of empathic care, these children developed working models that were deficient regarding an established sense of protection or basic trust. Reactive Attachment Disorder (RAD) falls into this disorganized, early chaotic environment category in which there is an attachment deficiency.

Reactive Attachment Disorder is included in the psychiatric guidelines for diagnosis. There are two types of reactive attachment recognized; the inhibited type where a child is excessively inhibited, hypervigilant, or highly ambivalent to relationships or the disinhibited type, in which the child is very indiscriminate with others and may be excessively familiar with strangers. A young child of this later type often attempts to hug or sit on the lap of strangers. The diagnostic manual of psychiatry (DSM-IV-TR) emphasizes that pathogenic care is evidenced by persistent disregard of the child’s basic emotional needs for comfort, stimulation and affection and persistent disregard of the child’s basic physical needs. There also may be repeated changes of primary caregiver that prevent the formation of stable attachments.

The American Psychiatric Association (APA) has issued a statement regarding RAD. This statement was likely a response to so-called rebirthing therapy, that lead to the death of 10 year old Candace Newmaker in Colorado. Two therapists were convicted of child abuse resulting in death following a trial.

The APA’s stated position is that children with RAD need a comprehensive assessment and an individualized treatment plan. The APA recommends working with the child’s family in order to facilitate an attachment to their child. Parents and caregivers should feel free to seek a second opinion if they have questions or concerns. The APA statement cautions that there is no easy way to treat RAD and these children pose challenges to therapists who are working with them.

Working To Reduce the Impact of Divorce: A Study

In some states, joint legal custody is routinely granted to parents as the court awarded custody arrangement of their divorce, while joint physical custody is less commonly awarded by judges. The only statistic information I am aware of in this area is from the National Center for Health Statistics, a group associated with the National Center for Disease Control. The NCHS reports that in 1995, 72 percent of divorce/custody cases were awarded to the mother and 9 percent were awarded to the father. 16 percent of the court-ordered arrangements were joint physical custody. A cautionary note to this report is that only 19 states reported such information to the NCHS.

A recent article in the Journal of the American Medical Association looked at intervention developed for divorced mothers who are awarded physical custody of their children. The study evaluated two groups (one group of with mothers only, one groups with mothers and children) and compared them to a control group.

In the “mother only group” counseling intervention consisted of helping mothers improve the quality of their relationship with their children, use more effective discipline, increase the child’s contact with their father and reduce conflict between the parents. In the “mother and children group”, the counseling addressed coping with divorce and improving the quality of the parent-child relationship.

The study looked at a six year follow up of the children of these mothers, who were now adolescents. The average age at the time of the follow-up study was 16. Researchers wanted to know if the counseling and educational type of intervention made a long-term difference. The researchers measured teen drug and alcohol abuse, the number of sex partners that the teens reported and their mental health symptoms. Both groups, the mothers only and the mothers with children, were helped significantly. The study showed that children who were considered high risk at the beginning of the intervention (when they were children) had lowered behavior problems at 16. Teens where their mother had also participated, reported fewer sex partners than in the control group and the program in which mothers were the only client, teens evidenced lowered rates of substance abuse.

The implication of this study is that interventions are worthwhile and can have long-lasting impact on the children of divorce. A limitation to this study is that the primary client group was white, middle class mothers and children. I like how the intervention used in this study encouraged mothers toward keeping the father’s involved, despite the custodial arrangement. This is because previous research has clearly demonstrated that children who have parents embroiled in conflict have significantly more behavior problems than children whose parents have a peaceful resolution to thier divorce. Some researchers have found that children of high conflict divorces resemble children from families with mentally ill parents. Reducing the level of parental conflict, gives these children breathing room, so that they can develop and adapt appropriately.

The best way to cheer yourself up is to try to cheer somebody else up.
— Mark Twain

Divorce Reconsidered

E. Mavis Hetherington has published a study in her book, “For Better or Worse: Divorce Reconsidered” (Norton, 2002). Her study of divorce was started in 1970. She not only studied divorced families, but non-divorced couples, too. In her studies, she had families use many different means of collecting data including diaries, charts and video taping. She found that there was significant diversity with regard to children’s divorce adjustment. She points out that 10 percent of children with intact families have serious emotional problems, while 20 to 22 percent of children who come from divorces families have serious emotional difficulties. Dr. Hetherington indicates this means 75 percent or so of children do well! Boys and men do worse initially, while girls and women do better, at least, initially. In the long run, women benefit more from a divorce than men, though her studies find women have significant financial problems following the family break up.

Her findings indicate that children in very high conflicted families often do better after a divorce. Children’s may find great relief from the daily grind of fighting and arguing between their parents and experience, for the first time, a more peaceful and stable environment.

Dr. Hetherington also found that there are different types of married couples. While she indicates that much research shows the problems of single parent households over married households, she also is quick to state that married partners are extremely diverse with regard to their problems and their dynamics. For example, she discusses the operatic couple who fight in a dramatic way and are always on the emotional edge and the disengaged couple who drift apart; though disengaged couples have few conflicts, they have little or nothing in common. She points out that mutual respect is a glue that keeps couple together. She finds that the most satisfied people often feel that their spouse is their best friend.

Many years ago, a divorce person carried a social stigma and like any other labeling process, people often read the labels and did not inspect the package contents personally. To me, this study/book helps us look beyond some of the residue of the long lasting stigma that says divorce is necessarily bad or harmful to parents and children and helps family and marriage counselors to better understand the dynamics of families experiencing difficulties. I highly recommend you allow Dr. Hetherington to share her knowledge with you.

Being deeply loved by someone gives you strength; loving someone deeply gives you courage.
— Lao Tsu