Welcome to my blog, which speaks to parents, professionals who work with children, and policy makers. Through stories from my behavioral pediatrics practice (with details changed to protect privacy) I will show how contemporary developmental science can be applied to support parents in their efforts to facilitate their children’s healthy emotional development. I will address factors that converge to obstruct such support. These include limited access to quality mental health care, influences of a powerful health insurance industry and intensive marketing efforts by the pharmaceutical industry.

Tuesday, May 23, 2017

What Do Parents Want? Parsing Contradictions in The Zero to Three National Parent Survey

Zero to Three, the Washington, DC based organization whose mission is to advocate for infants and toddlers to have a strong start in life, just released results of their ambitious project to answer this question. The data from the current report, a collaborative effort with the Bezos Family Foundation, comes from a 50-question Internet survey in Spanish and English distributed to a national sample of 2,200 parents of children age birth to 5. The survey was developed out of 10 in-depth discussion groups with parents from a wide range of backgrounds. 

The Zero to Three report contains some striking, and in some places contradictory, data. Starting out with results suggesting that most parents think that parenting can be taught, they offer this statistic:
69% of parents say that if they knew more positive parenting strategies they would use them.
One might conclude that giving more parenting advice would be the solution, but another statistic suggests a different interpretation might be indicated:
63% of parents overall say "I am skeptical of people who give parenting advice and recommendations if they don't know my child and my situation specifically."
This finding suggests that while parents feel the need for something, and name that "something" as a wish for "strategies" they, at least in part, recognize themselves as the expert with regard to their child and so balk at advice that comes without full understanding of their particular circumstance.

Adding to that contradiction is this disturbing, though not surprising, finding that:"90% of moms and 85% of dads feel judged. 46% of moms and 45% of dads say they feel judged all the time or nearly all the time." These statistics suggests that the abundance of "expert" advice may in fact cause more harm than good.

A whole section of results titled "There is a Missing First Year" captures the fact that parents consistently underestimate the importance of the early months of life.
Parents also don’t realize how deeply [infants] can be affected by the way parents interact with them in the first months of life. A notable portion of parents miss the mark by months, or even years. 
One might conclude from this finding that parents need more information. However, a majority of parents say that knowing the importance of the early years is both motivating and terrifying, with 35% equally or more terrified than motivated. This finding suggests that offering information alone could be counterproductive. It is possible that parents do in fact know how important they are.  The fact that they cannot, due to a wide range of stresses, be available to their babies in ways they want to be, may make this knowledge intolerable.

The survey shows that parents perceive support to be lacking when they feel stressed or overwhelmed, with almost half saying they do not get the support they need and 8% say they get no support at all. 

So what is the nature of "support?" 

This survey brought to mind a lecture I attended a number of years ago by the late esteemed psychoanalyst Daniel Stern entitled, "What do Mothers Want?" While the significance of fathers is notably absent from his work∗, his insights on mothers, gleaned from in-depth clinical work with mother-infant dyads, add an important dimension to the Zero To Three findings and might help parse some of the contradictions and answer this question. 

In his talk he presented what he terms The Motherhood Constellation, or the themes that emerge in a woman's life when she navigates the transition to motherhood.

1. Can she maintain the life and growth of the baby?
2. Can she emotionally engage with the baby in her own authentic manner, and will that engagement assure the baby's psychic development towards the baby she wants?
3. Will she know how to create and permit the necessary support system to fulfill these functions?
4. Will she be able to transform her self-identity to permit and facilitate these functions?



Stern is calling attention to the enormity of the transition to parenthood, beginning with the basic question of being able to sustain the life of this new human being. Being fully present emotionally to facilitate the baby's development is tied to both having the necessary support and validation of how a woman's self-identity is transformed in a normal and healthy way.

So it could be that "support" equals "listening." Support means a different thing for every individual. For one it might mean playing with an older sibling while mom and baby nap. For another it might mean grocery shopping. For another engaging a withdrawn and perhaps depressed partner might be needed. For yet another it might mean finally addressing her own experience of abuse so that she does not repeat the pattern with her child. 

A growing body of evidence suggests a central role of parental self-efficacy in healthy child development. Each parent needs to have his or her experience validated with the aim of helping achieve a sense of self-efficacy and expertise with respect to his or her child. Advice, strategies, and information may have a role to play, but only within the context of time for listening.

∗A striking finding of the Zero to Three survey concerns fathers, 73% of whom say their lives began when they became a dad, with 63% feeling unrecognized and 40% feeling shut out. 

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