Category: Emotions

What makes a child anti-social?

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The media is full of the rise of anti-social behaviour (e.g. violence, aggression, bullying, fighting, lying, stealing, vandalism, fire-setting, drug and alcohol abuse, cruelty to animals) in children and youth offending, but what is the cause of childhood antisocial behaviour and are all anti-social children the same? What is the role of parenting?

Are all anti-social children the same?

There is evidence that not all children with anti-social behaviour are the same. Some children may show a phase of anti-social behaviour in adolescence but this passes and they settle down in adulthood. Far more concerning are children with a life-long tendency to anti-social behaviour. These children tend to be anti-social from a younger age and behaviour is more extreme (e.g. cruelty to animals at age 5 years), but even amongst these children there is evidence of different subgroups. Much research is focused on differentiating groups of anti-social children to see if we can better understand them.

One differentiating factor found is lack of empathy. Empathy is the ability to share someone else’s feelings and experiences by imagining what it would be like to be in that person’s situation. Psychologically speaking, this requires two different types of processes: a “thinking” part: the ability to see things from another person’s point of view; and secondly a “feeling” part: the ability to recognise emotion in others and to feel it in oneself. People without empathy are described as being callous and unemotional. To be anti-social, violent or aggressive is easy if you do not empathise with the victim, so it is no surprise that >90% of children with callous-unemotional traits are involved in some form of anti-social behaviour.

How does empathy affect anti-social behaviour?

Researchers have been interested in children that lack empathy for a while now because of its links to extreme anti-social behaviour, and the definition of “psychopathy/ sociopathy” (this is a criminal justice not mental health term) includes having this lack of empathy. The childhood precursor to this psychopathy label is “callous-unemotional traits” (as it is pretty harsh and pessimistic to label kids as psychopaths), and even this terminology has recently been rebranded as “limited prosocial intent” so that it sounds less pejorative; but this is just semantics, we are essentially talking about the same thing: people that have shallow feelings with lack of empathy and guilt.

My colleague, Essi Viding does research into these traits and wrote a great summary paper (2012), the findings of which I wanted to share as I thought it was fascinating. It turns out that if you study ASBO kids (kids with anti-social behaviour), you will find that 50% of them have these callous-unemotional traits. These children don’t really care about others’ feelings and tend to show no remorse for wrong-doing. It is this group of kids that have the most serious and long lasting problems.

What is the difference then psychologically and biologically between children that commit antisocial behaviour with and without empathy?

In experiments where anti-social kids are hooked up to show responses (for instance heart, skin and eye-tracking monitors or brain scans) to photos/ voice recordings of other people in pain or grief, the children with callous-unemotional traits showed no or reduced physical or brain response. Most people will wince in shared pain if shown pictures or exposed to sounds of others in pain, but these children don’t. When these children were asked to play a game where not following the rules led to punishment, they continued to flaunt the rules and did not seem to learn from punishment. There is biological support for these findings with differences in brain scans in areas of the brain linked to emotion processing and reinforcement learning pathways in callous anti-social children.

In contrast, the anti-social children with empathy showed the same aversive responses as children not involved in anti-social behaviour to pictures and sounds of pain and grief, and learnt quickly from punishment. However when they are shown threatening faces, they over-respond with emotion and when they are shown neutral and ambiguous facial expressions, they identified them as being threatening. Brain scans back up these differences. The anti-social children with empathy tended to have abnormal amygdala development. This is the area of the brain involved in fear and anxiety processing. These anti-social children have normal empathy but have a heightened awareness of threat, which explains why they perceive neutral faces as threatening. In a world where everyone is viewed as threatening, hostile or an enemy, it can make sense to be combative, aggressive and violent. This is that bully in the playground that says “Are you looking at me?” – when you weren’t even looking at them.

Genetic studies have also supported this divide, finding that there is strong inheritance of callous nature, whereas anti-social behaviour without callousness was not inherited but generated by environmental factors such as harsh or inadequate parenting, or an interplay between these environmental factors and genes associated with anxiety or heightened emotion.

Finally, it has also been found that the children in the different groups respond differently to parenting strategies. Punishment and traditional sanction-based strategies (time-out, withdrawal of privileges) works well for empathic anti-social children, but has no effect on callous children. Callous children only respond to positive reinforcement (praise) and rewards.

What causes anti-social behaviour?

This type of evidence has led to different theoretical models for two groups of children involved in anti-social behaviour.

Group 1: Genetic predisposition. Antisocial and callous kids: these children are thought to lack empathy as they do not find other people’s distress aversive and because they fail to be able to learn from punishment. It is easy to be aggressive and cruel if you are unable to feel guilt and if the suffering of others doesn’t bother you. It is easy to continue to behave in this way life-long if you are unable to learn from punishment. These difficulties are often inherited in brain structure.

Group 2: Environmental Causation: Anti-social but not callous kids: these children have abnormal socialisation because they have a heightened sense of threat, and view the world as hostile towards them. They exhibit aggression and cruelty as a result of living in unstable and threatening environments which has shaped their brains and psychology to respond in this way as a means of coping and survival. Their anti-social behaviour is often in the context of a peer group within which there is support and empathy.

What has this got to do with parenting?

Whether we like it or not, parents are the first line defence against anti-social behaviour in society. By better understanding the causes of anti-social behaviour and by understanding our children, we can best adapt our parenting to prevent our children becoming anti-social. Although children in group 1 with genetic predisposition are the more difficult to help, they can be supported by fostering self-esteem. They will respond better to motivation to act in a pro-social way, rather than harsh punishment which will not deter them. Anti-social behaviour in children with empathy can be prevented by strong loving families that place appropriate boundaries and sanctions. For these children, wider society has a great role to play in generating or preventing anti-social behaviour, as tolerant, peaceful and accepting societies can offer protection whilst violent, unstable and alienating societies can fuel them.

Reference:
Anti-social behaviour in children with and without callous-unemotional traits. Viding et al. (2012) Journal of the Royal Society of Medicine. 195-200.

Why parents should have zero-tolerance for sibling rivalry

jack n jill

I was recently asked for some advice, as is an occupational hazard. “We’re about to have a second child. How do we prepare our child for the arrival of a sibling, because of the inevitable jealousy?” To my surprise, even before I could answer; my husband who has been well versed in my opinions answered for me.

“She has zero-tolerance on siblings not getting along.”

I was surprised at his succinct synopsis of my position, but “yes”, that is indeed my view. For me, the bond that I have with my two sisters is very important. Even though personality-wise we probably would not have been in the same circle of friends had we been peers, as sisters we are closer than the pre-election polls. Even though I rarely socialise with my siblings outside family events, if anything in my life happened, they would be the first people that I would contact and vice versa. I would never be alone in a crisis because I know that they would be supporting me – come what may. Friendships and marriages may come and go, parents will pass away, but siblings are with you, living in your time and generation – for life.

This is not just me being whimsical but is born out in science. Warm, supportive sibling relationships that lack conflict are related to having better psychological wellbeing as children and into adulthood (Buhrmester and Furman1990; Buist et al. 2013; Kim et al. 2007). The reverse is also true; hostile and aggressive sibling relationships are associated with higher levels of anxiety, depression, low self-esteem and anti-social behaviour (Campione-Barr et al. 2013; Dunn et al. 1994ab; Padilla-Walker et al. 2010; Stocker 1994).

Maybe this is nothing to do with sibling relationship, but related to parenting and genetics? Argumentative parents have argumentative children that don’t get on and become argumentative and anti-social adults. This doesn’t seem to be the case. In fact, the literature suggests that warm, collaborative sibling relationships instill resilience (an invisible protective shield if you will) in children. For example, there is evidence that good sibling relationships protect children from all manner of adversity from bickering parents that fight all the time, negative life events (such as natural disaster and death of a loved one), high risk neighbourhoods, low-income backgrounds and bullying (Jenkins and Smith 1990; Tucker et al. 2013, Gass et al. 2007, Criss and Shaw 2005; Widmer and Weiss 2000, Bowes et al. 2010). Very recently published work suggests that siblings can even protect against the negative impact of parental mental health problems. Keeton (2015) found that in children of parents who met clinical criteria for anxiety disorder, the psychological impact of having a parent with anxiety disorder on children was moderated by the quality of the relationships between the children. In effect, the closeness of siblings allowed children to protect each other from the negative impact of a parent suffering a significant mental health problem. All in all, the evidence suggests that sibling relationships are just as important in a child’s psychological development as parents and friends.

This makes sense to me. Much adolescent and adult unhappiness comes from feeling “alone”/ “unaccepted”/ “friendless”/ “unsupported”. I have met many unhappy adults in my time as an adult psychiatrist of whom I just thought “You know what? You’d be fine if you just had a supportive friend.” That’s just exactly what a brother or sister could and should be; and whilst as parents we have little or no say in who our children choose to be friends with in adolescence and adult life, we have much control over whether siblings get along or not, and are perfectly placed to ensure that our children, via their siblings, have a strong support network for life.

So why have we as a population of parents come to expect sibling rivalry and discord? When we see it happening, we shrug our shoulders and say “siblings –eh?” We may take some cursory action “Don’t hit your sister”, “Get off your brother’s back and put down that brick that you were using to pummel his head”, but all in all, we assume that this is run of the mill sibling behaviour. In effect, we at best tolerate it, at worst encourage it. Romulus and Remus were raised by a wolf. I am not sure what happened with the Millibands…

My own childhood experiences were different. My mother came from a family of 7 extremely close siblings. Even though they live on different continents and their ages outspan a decade, they still go on holiday together and skype each other regularly. They laugh, joke, bitch and support each other as much now as pensioners as they did when they were children. My mother told me that in her family the older children were each allocated a younger child to look after growing up. Second Uncle had to piggy back my mother on long outings and my mother in turn had to rock third Uncle to sleep. I am sure that this responsibility and encouragement of care fostered an affection that has lasted into their old age.

In turn, I remember very clearly my mother explicitly saying to my sisters and I as children “You three are best friends. You are all each other have and must support each other.” I remember thinking sulkily at the time; I am so not best friends with these two. That one has just pulled my hair, and that one has just scratched my face. But we moved several times as children, first from Taiwan to Wales and then Wales to London, changing primary schools 4 times in 8 years, and so it turned out to be true. While friends came and went, “Laurel and Hardy” as I liked to imagine them then or “The Two Ugly Sisters” (to my narcissistic Cinderella off course) were always with me. And guess what, as adults, we are like best friends.

So what of my own children?

Banker was right. I take a zero-tolerance view of siblings not getting along. Like my mother, I insist to them that “they are best friends” daily, whether they like it or not. Sure they fight all the time, but underneath I know that they love each other dearly. When Lil Bro had a hard day in the school playground, Big Sis gave him advice. When an umbrella at a cafe blew over and grazed Big Sis spilling her drink, Lil Bro immediately gave her his. And in the evenings when they snuggle up together, I swear, its the sweetest moment for a parent.

Here are a few other things that I did/ try to do, all of which being non-scientific and are just my interpretation of what might help siblings get along.

  • My number one advice is to ensure that your children feel loved and secure in themselves. Children who have “secure attachment” to their parents have all manner of better prospects throughout childhood and into adulthood. The more secure a child feels in themselves, the less prone they will be to jealousy, and the more generous they will be to their siblings. So ensuring a child grows up feeling secure from the outset helps a great deal.

 

  • Prepare for a new sibling. Throughout pregnancy, the prospect of Lil Bro’s arrival was talked about as a massive positive. A little brother for you to help me look after. A little brother to play with you. Read books about new babies and about siblings that get along (Topsy and Tim is good for this). Buy your child a baby doll and play together at looking after it. Be as realistic about this as possible as this will help role play and rehearse what is to come. Massively praise any caring actions and discourage rough handling.

 

  • Allow a bond to be made with a new sibling. I know that parents can be precious about babies, but being overly-guarded and excluding a child from their baby sibling can lead to loss of opportunity for siblings to bond, and also the older sibling feeling somehow excluded. Where possible, always involve siblings. Place the baby on the sibling’s lap and help them cuddle the new sibling and play with them. This is perfectly safe as long as children are well-prepped and you are supervising.

 

  • Deal with jealousy. Jealousy between siblings will be inevitable at times even with secure children, but how you manage it can dampen or amplify its existence. Firstly, you must anticipate situations where this may occur and notice it when it happens. Then, rather than ignore it, it should be addressed as soon as possible. For instance, when there is competition for attention, this should be verbalised, acknowledged and problems solved. “I know you want me to play with you, but I am feeding your brother. But tell you what, he will be asleep after this, and then I can play with you.” Or when they get older “I know I am spending the day with your sister because I am taking her to see her favourite ballet, but next week, I will take you to the zoo.” Many young children feel angry and frustrated when they feel excluded or unfairly treated in favour of another, but cannot understand the reasoning behind it or be able to label it as “jealousy”. It’s up to parents to notice it and label it and explain it. Jealousy is a natural emotion; it is how we handle this emotion that needs to be addressed rather than attempting to avoid or suppress an irrepressible natural feeling. Unaddressed jealousy may lead to lashing out, aggression towards their sibling, or deliberate misbehaviour in order to get attention which is never a good thing.

 

  • Behavioural management always applies. The tenet of behavioural management is to heavily praise and reward behaviours you wish to see again and to ignore and discourage behaviours that you do not wish to see again. If you wish to see caring behaviour between your siblings, you need to reinforce it with praise and rewards. If you would rather they did not bicker and fight, there need to be consequences each and every time this happens. I know that some parents think that siblings should “just naturally love each other” and I am as happy-clappy as the next person, but even I know that “love” can be manipulated to some extent. Some people refuse to praise and reward things that they “expect” children to do naturally, but I’m a great fan of praise (see my previous blog post on this) and evidence shows that behavioural management works.

 

  • Us vs them. During my family therapy training I read somewhere that the only healthy grouping of people within a family is parents vs children. Families that have any other combination are more vulnerable e.g. a family which splits into two with a mother and son vs father and daughter or mother and children vs father. Keeping the healthy dynamic should always be borne in mind. Using this dynamic, it is possible to foster closer sibling unity as people tend to unite against a common oppressor. Yes, you the parents are the oppressor in this scenario. Don’t be tempted to side with a child, enjoy your role as the villain and reap the rewards of sibling cohesion.

 

  • Encourage collaboration. Treating children as a team can be helpful to collaboration. Rewards can be given to both children as a team, punishments doled out to both as a team. This will facilitate helping behaviour and help siblings see each other as partners rather than competitors. Encourage mutual praise. For families in a rut that come to see me for therapy, I tend to suggest that before bedtime, each child is to say something good that the sibling has done that day and praise them. It may be forced praise to begin with, but even forced praise is better than no praise and over time it may and likely will become genuine and overspill into the everyday (particularly with young children).

 

  • Promote exposure and shared experience. One way to help them get along is to allow them to have common experiences and exposure to each other. This is not possible if they attend different schools. This may be a bit unpopular in the UK where for some reason boys and girls from 4 onwards are farmed off to single sex schools, or siblings of different abilities are segregated early on into selective schools. I am totally and whole-heartedly in favour of keeping siblings in the same school, especially at primary school where I think education should play second fiddle to social and emotional development. A close sibling relationship is more important to me than KS2 results. A supportive sibling is there for life, who of us can remember our primary school grades? My children go to co-ed school. This way, their support for each other can start young. I am delighted to hear that Big Sis crosses the playground to give her Lil Bro a kiss and hug when he needs it. Not possible if she is not there.

 

  • Adopt a policy of zero-tolerance on siblings not getting on. Expecting and or accepting that siblings do not need to get on, and that this is “normal” is the main reason for inaction. So this last point is probably the most important, because action is the first step.

 

References

Bowes, L., Maughan, B., Caspi, A., Moffitt, T. E., & Arseneault, L. (2010). Families promote emotional and behavioural resilience to bullying: evidence of an environmental effect. Journal of Child Psychology and Psychiatry, 51, 809–817.

Buhrmester, D., & Furman, W. (1990). Perceptions of sibling relationships during middle childhood and adolescence. Child Development, 61, 1387–1398.

Buist, K. L., Dekovic, M., & Prinzie, P. (2013). Sibling relationship quality and psychopathology of children and adolescents: a meta-analysis.Clinical Psychology Review, 33, 97–106.

Campione-Barr, N., Greer, K. B., & Kruse, A. (2013). Differential associations between domains of sibling conflict and adolescent emotional adjustment. Child Development, 84, 938–954.

Criss, M. M., & Shaw, D. S. (2005). Sibling relationships as contexts for delinquency training in low-income families. Journal of Family Psychology, 19, 592–600.

Dunn, J., Slomkowski, C., & Beardsall, L. (1994a). Sibling relationships from the preschool period through middle childhood and early adolescence.Developmental Psychology, 30, 315–324.

Dunn, J., Slomkowski, C., Beardsall, L., & Rende, R. (1994b). Adjustment in middle childhood and early adolescence: links with earlier and contemporary sibling relationships. Child Psychology and Psychiatry and Allied Disciplines, 35, 491–504

Gass, K., Jenkins, J., & Dunn, J. (2007). Are sibling relationships protective? A longitudinal study. Journal of Child Psychology and Psychiatry, 48, 167–175.

Jenkins, J. M., & Smith, M. A. (1990). Factors protecting children living in disharmonious homes: maternal reports. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 60–69.

Kim, J., McHale, S. M., Crouter, A. C., & Osgood, W. (2007). Longitudinal linkages between sibling relationships and adjustment from middle childhood through adolescence. Developmental Psychology, 43, 960–973.

Padilla-Walker, L., Harper, J. M., & Jensen, A. C. (2010). Self-regulation as a mediator between sibling relationship quality and early adolescents’ positive and negative outcomes. Journal of Family Psychology, 24, 419–428

Stocker, C. M., Burwell, R. A., & Briggs, M. L. (2002). Sibling conflict in middle childhood predicts children’s adjustment in early adolescence.Journal of Family Psychology, 16, 50–57.

Tucker, C. J., Holt, M., & Wiesen-Martin, D. (2013). Inter-parental conflict and sibling warmth during adolescence: associations with female depression in emerging adulthood. Psychological Reports, 112, 243–251

Widmer, E. D., & Weiss, C. C. (2000). Do older siblings make a difference? The effects of older sibling support and older sibling adjustment on the adjustment of socially disadvantaged adolescents. Journal of Research on Adolescence, 10, 1–27.

All You Need is Love

Love

Simple isn’t it?

Cheesy as it is, I believe in this; so much so that this was the song that was played as my husband and I exited the church at our wedding. But if love is all you need, then in terms of parenting how and why do we sometimes get it wrong?

I think that sometimes people forget that “love” is like money; it’s no good in theoretical or inaccessible form. Having a million pound Trust Fund accessible when you reach the age of 85 years is not of much use to anyone; ultimately you need to be able to FEEL the power of it for it to have value. In my line of work, almost all parents will say that they love their children and I believe this to be true. However, the percentage of children that FEEL that their parents love them is way lower. It is therefore one thing to love your children. It is another to make them believe/ feel in their hearts/ know to the core/ have no doubt of the fact that they are loved. The former can be done from the office or at the kitchen sink; the latter is much harder work.

Knowing that you are loved/ lovable is at the core of our function. In Cognitive Behavioural Therapy for depression in both adolescents and adults, when we search back with clients for “core negative beliefs” (the fundamental cognitive processing bias in people with depression), it is amazing how predictable and limited the core beliefs are that cripple so many good people; the most common being “I am not good enough/ I am unlovable”.

When are these core beliefs formed?

In early childhood.

Who/ what contributes to the formation of these core beliefs?

Parents.

I think that sometimes parents get confused about love. They confuse it with something that needs to be earned, won or is conditional. They think that unconditional love is excessive; an extravagance that will “spoil” children, denying it may be a motivator. They, and in turn their children come to believe that achievement (or something that they need to be or do) leads to love. Many great and successful people have grown up believing this model. It makes sense that achievement leads to “being worthy of love” and self-esteem is built on achievement and love. Many people are driven to success with a desire to “make their parents proud”.

Love Model 1

But there is a second model where a fundamental core of love (unconditional and for no reason other than being) can lead to self-esteem in its own right and this self-esteem on a basis of love can drive achievement all on its own. The unconditional love and support of parents is commonplace in acceptance speeches for awards of all kinds from Nobel prizes to Oscars.

Love Model 2

This second model is infinitely stronger than the first model presented. In the first model if love is dependent on achievement, it can be a very bitter pill to swallow if achievements wane and self-esteem and love (which was built on the rocky foundation of achievement) is lost, leaving people in effect stripped of everything. Some parents of course will never be proud of their children, they don’t have it in them and people are left chasing a dream. This type of model can explain how many successful and amazing people can feel they have nothing or are perpetually “not good enough”. In the second model, even if achievements wane and the self-esteem is dented, love is untouched and the source of everything lives on.

Making some one feel loved is hard work, but for parents I think it is important to stress that the effort in love is front loaded. Just as at the start of a new romance you might abandon the grey bloomers for lingerie, refrain from passing wind, frequently ask about your new partner’s day, always go on holiday together, so “romancing” (putting extra elbow grease into making someone feel loved and special) your child is also required at the start. Once a secure loving relationship is established, then inevitable liberties will be taken, but if the work of the early years has been solid, then nothing can shake the secure foundations of love.

As I mentioned I am a great believer of the fundamental importance of love and with regard to my own children I am operating on the basis of the second model. I want my and my husband’s love to be the fuel for our children’s success (or failure, we will love them anyway). As a parent it is difficult to know “How to make children feel loved”, and believe it or not this is not a topic covered at medical school, in a psychology degree or psychiatric training. There is no scientific basis and don’t let any pseudo-science, pop-psychology book tell you otherwise. We as parents are all left to figure this out for ourselves and enact in the best way that we can. The things I figure are listed below:

1) Cuddles are good. Surely nothing says love as much as kisses and cuddles? Sod the Victorians and stiff upper lips, I’m for open affection. Often.

2) Laughing is good. What says “love” more than enjoying each other’s company? One of the vows I made when I worked full-time was that I would laugh with my children every day, and we did, and we still do.

3) Being there is good. I know that I can’t always be there for my children but I make sure that I (or my husband) am there every time it matters. School plays, sports days, class assemblies, concerts and parents’ days – we haven’t yet missed one. I wave like a frantic loon to ensure that they KNOW I am there. Embarrassing I know, but why take time off work to go if they don’t even know I made it…?

4) Being really there is better. It can’t be right just to show your face on the special occasions, part of “love” is about sharing the mundane. Being around at least some of the time to catch the joke, the thought, the upset in real time. Some things are lost in the re-telling. You can love from a distance but can you make someone FEEL loved without really spending much time with them?

5) Understanding matters. What says love more than knowing what the other person is thinking? I often finish Banker’s sentences; I can do this with the children now too. Talking about, listening and exchanging experiences and feelings regularly is the basis of being able to know and understand someone. Children’s experiences and feelings are just as significant as adult experiences even if they might seem less important. A child being told off by a teacher will hurt as much to them as an adult being told off by their boss.

6) Respect matters. I don’t think you can engender love without respect. This means listening and valuing your children’s opinions, even if they are wrong and never denigrating or humiliating them.

7) Saying it out loud matters. I am a big believer of the three words “I love you”. I think it is necessary even if it is not sufficient. Banker is shy of these words but if you want to engender unquestionable love why hold back? Go the whole hog. Say it every day, 5, 10, 20 times a day if you like – contrary to popular belief if you say it continually to the same people, the power is not diluted. At this age, children may not always understand nuance and behaviour and verbalising your emotions and intentions help to bring things home. Once after telling off Lil Bro, he cried and said “You don’t love me anymore”. Since then I have been extra good at verbalising and spelling it out:

“I will love you if you are clever, I will love you if you are not, I will love you if you are fat, I will love you if you are thin. I will love you if you are nice to me. I will love you even if you are horrible to me. Even when I am shouting at you, I love you. I love you for being you. You will always be beautiful and smart in my eyes. I am proud of you for being you. You will always have my support. I am always here for you. Nothing will change that. I love you.”

For an adult it comes across a bit stalker-ish I know, but for young children it’s good and clear (I hope).

This is by no means a correct or exhaustive list and until Big Sis and Lil Bro are adults, I will have no idea whether my list is effective at all. My consolation is that given that my intentions are blogged, they cannot say I didn’t think about this, and if I failed to let my love be truly felt, they will know that I failed trying.