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4/18/2015 12:00 AM

The brothers in the Boston Marathon bombing. Racketeer Whitey Bulger Jr. and his younger brother William, president of the Massachusetts Senate and then of the University of Massachusetts.

What do these two divergent tales of brothers teach us about sibling relationships? How is it that one pair of siblings bonds together to walk the same course while other siblings seek opposite pursuits?

On April 15, 2013, two homemade pressure-cooker bombs exploded near the finish line of the Boston Marathon. Three people, including an 8-year-old boy, were killed. Hundreds of others were seriously injured. The city of Boston was paralyzed by a gripping manhunt for two suspects — two brothers. Days later, 26-year-old Tamerlan Tsarnaev was killed during a shoot-out with police following the death of an MIT police officer and carjacking. Tamerlan’s younger brother, 19-year-old Dzhokhar Tsarnaev, was injured and subsequently captured. Dzhokhar was charged with using and conspiring to use a weapon of mass destruction resulting in death and malicious destruction of property resulting in death. Dzhokhar now awaits trial and is facing the death penalty in Massachusetts. At the time of the manhunt, the brothers allegedly were plotting together to detonate more explosives in Times Square in New York City.

Meanwhile in Boston, after decades on the FBI’s “Ten Most Wanted List,” James “Whitey” Bulger Jr. was about to stand trial on 32 counts of racketeering, money laundering, extortion, weapons, and murder charges. In the summer of 2013, Whitey was found guilty on 31 of the charges and was sentenced to two consecutive life terms. During Whitey’s trial, his younger brother, William Bulger, was in active retirement after 18 years as the president of the Massachusetts Senate as well as president of the University of Massachusetts, a position he resigned in the wake of controversy surrounding his refusal to testify about his brother. In contrast to Whitey, William was an army veteran and lawyer whose life was characterized by education and public service.

What do these two divergent tales of brothers teach us about sibling relationships? How is it that one pair of siblings bonds together to walk the same course while other siblings seek opposite pursuits?

Characteristics of sibling relationships

Children in the United States are more likely to grow up with their siblings than with their fathers. Over the course of their lifetimes, most children will spend more time with their siblings than they spend with anyone else, including their parents. Despite this reality, research and interventions for children focus on the parent-child relationship as the primary source of influence on child outcomes; the effects of siblings on child behavior and health are often underestimated. However, recent research reveals what brothers and sisters have recognized all along — that siblings play a key role in child development and behavior.

The differential power and roles between siblings are related to their broader cultural context. Cultures define who is considered a sibling, the meaning and importance of the relationship, and the obligations siblings have within the family and to one another. These cultural proscriptions are often dependent on immutable structural characteristics of the sibling relationship, such as birth order, gender, and age spacing. Prince William and Prince Henry (“Harry”) of Great Britain’s royal family provide a vivid public example of how the structural features of a sibling relationship can be institutionalized and shape expectations and life trajectories.

Sibling relationships are not elective; children pick their friends but not their brothers and sisters. Emotions between siblings are characteristically intense and can cycle rapidly between love and hostility. During early childhood, siblings are often primary companions as well as competitors. This is believed to provide a fertile training ground for the development of social skills and future relationships. The impact of a warm and supportive sibling relationship or a conflictual, unsupportive one is lifelong. Warmth in the sibling relationship is associated with significant social and emotional advantages in later life. For example, compared to only children, children who have at least one sibling at home display greater social competence and peer acceptance from kindergarten through their early school years. Adolescents who report positive sibling relationships have better peer relationships and fewer depressive symptoms later in life. Warmth and closeness in the sibling relationship are also associated with greater ease and intimacy in romantic relationships. Finally, during middle age and old age, mood, health, loneliness, and depression are related to how people feel about their sibling relationships. Having a close, positive relationship with one’s siblings is not only a source of life satisfaction, but can also provide a buffer from stressful events, such as parental absence, marital conflict, and illness. Younger siblings tend to imitate and “look up to” their older siblings. If the older sibling responds in an attentive and caring manner, the seeds of similarity are planted. If the older sibling is rejecting of the younger child, their paths are more likely to separate.

Conflict and aggression between siblings is very common. It has been suggested that one way siblings learn to manage competition and conflict is by differentiating themselves, carving out different identities or roles within the family. Thus, one child becomes known as the reckless, defiant one, while the other sibling becomes the easygoing, conservative one. Even when siblings pursue very distinct identities and life courses, their bond can be very enduring. Think of the case of the Bulger brothers. One brother led a life of crime and the other a life of public service. William was not able or willing to overcome the sibling bond to testify about his contact with his brother, thereby forfeiting his position as president of UMass. Physical aggression occurs among siblings in the majority of families (i.e., 70% of families). Sibling conflict has been measured up to eight times in a single hour and is the number-one reason for discord between parents and children. However, parents will also dismiss levels of violence between siblings that they would never conceive of tolerating if they occurred outside the context of a sibling relationship. Violence between siblings is the most common form of child abuse and is significantly related to later substance use and delinquency.

Sibling – strong effects within the family

Sibling relationships do not occur in a vacuum. Siblings share parents, relatives, and school and other social environments, as well as their genes. Siblings raised in a home with authoritarian, harsh parents are more likely to be at odds with one another. How parents handle sibling conflict has a significant impact on the sibling relationship. When parents intercede in sibling conflict to determine which child is most at fault or “who started it,” the sibling relationship sours. Siblings often compare themselves to one another and compare how they are treated by others, particularly parents. When children perceive favoritism or unfair differential parental treatment, the quality of the parent-child and sibling relationships suffers. For the less favored sibling, differential parental treatment is associated with lower self-esteem, more depressive symptoms, and more antisocial and delinquent behavior, as well as more substance use.

One area of particularly strong sibling influence, even stronger than the influence of parents, is in the development of antisocial attitudes and conduct, and health risk behavior. The process of “sibling deviancy training” refers to the situation in which (generally older) siblings model, encourage, and reinforce antisocial behavior in their younger siblings. Younger siblings who shadow and hang out with their older siblings are introduced to their antisocial peers and behavior and begin to display negative behaviors more than siblings who do not hang out with their antisocial siblings. Eventually, the sibling relationship transitions from deviancy training to partners in crime; older and younger siblings begin to conspire together in more antisocial behavior and substance use. Even after controlling for the effects of parent substance use, siblings are four times more likely to smoke if their older sibling smokes, and are twice as likely to drink alcohol if an older sibling does. Finally, younger sisters are five times more likely to become pregnant if they have an older sister who was pregnant. The power of the antisocial or behaviorally risky older sibling is magnified when parents are unstable or absent. Think back to the Tsarnaev brothers, whose parents, after years of struggling in the United States, returned to Russia, leaving the younger brother under the influence of his elder, radicalizing brother.

Conclusions and implications

Siblings hold the power to inspire as well as corrupt. Given the intensity and longevity of their bond, how can we engage this power for positive change? It is time to move beyond family interventions that are directed solely at parents (i.e., mothers). When working with children and adolescents, inquire about siblings — their relationships, strengths, and challenges. How much time do they spend together? How are they similar and where do their interests overlap? Be attentive and responsive to reports of sibling violence; do not dismiss these as “normal” and, therefore, acceptable. Consider how recommendations regarding one child might affect other children in the family. Is the heightened attention expected from parent-directed intervention likely to plant negative feelings of differential parental treatment among the other children? Actively help families understand that the investment made early in the sibling relationship has value that lasts a lifetime.

3/6/2015 12:00 AM

Parents are often concerned by certain behaviors they observe in their kids, such as crying, tantrums, difficulty following directions, shyness, difficulty separating, troubles with transitioning, and so on. But when do these behaviors warrant intervention?

Ally follows her mother wherever she goes. Lately, Ally’s been more tearful around leaving for school in the morning and keeps complaining that her stomach hurts. Ally always thinks she’s getting sick and worries every time she is around anyone who coughs or sneezes.

Sam has a hard time following directions. His room is a mess, his homework is incomplete, and it’s a struggle to get him to do daily things like brushing his teeth. Sam frequently argues with his younger brother, and his mother feels like she has to yell in order to get anyone to do anything.

Parents are often concerned by certain behaviors they observe in their kids, such as crying, tantrums, difficulty following directions, shyness, difficulty separating, troubles with transitioning, and so on. But when do these behaviors warrant intervention? All of the above can be considered within the realm of normal childhood development. It is when these behaviors co-occur with other patterns of symptoms, have a negative impact on functioning, and cause distress in either the child or those around him/her that therapeutic intervention may be helpful and warranted. For example, with Ally, her parents may want to seek help if distress in the mornings continues to the point where it’s difficult getting to school or if she becomes so clingy to her mother that it’s hard for her mother to be able to work, run errands, or do things at home. With Sam, his parents may want to seek help if he starts doing poorly in school or if the level of conflict and overall stress at home remains high.

What’s the next step?

The first step to effectively addressing concerning behaviors in kids is to do a thorough evaluation of the symptoms, circumstances, and functions in order to fully understand the nature of behaviors. For example, in children specifically, it is common for acting-out behaviors, such as arguing, temper tantrums, or anger, to be in reality driven by anxiety. Once the nature of symptoms is more fully understood, appropriate intervention can take place.

Cognitive behavioral therapy (CBT) is one of the most commonly evaluated treatments for a range of psychological problems in children and adolescents. CBT is a therapy framework that emphasizes the role and link between thoughts, feelings, and behaviors in order to improve functioning. While some youngsters may not be able to fully take part in the entirety of a CBT model of treatment due to their cognitive/developmental levels, tailoring components of CBT for a specific child and treatment focus can be helpful.

Components of CBT treatment

There are different components of CBT depending on the specific treatment model, but for the purposes of describing a general overview, they are conceptualized here by three overarching components: psychoeducation, coping skills, and behavior practice/management.

  1. Psychoeducation. This consists of helping to better understand emotions and normalizing the fact that people experience a range of them, which are sometimes advantageous (e.g., having some anxiety before a test so that you are alert and concentrating) and sometimes impairing (e.g., having so much anxiety before a test that you can’t focus on the questions). Psychoeducation also involves understanding similarities/differences between emotions and helping children learn to identify the cues in their thinking and in their body in order to correctly label the emotional experience. It’s also important to be able to differentiate between varying levels of emotions. If a child thinks of everything that makes him nervous/scared and sees it all as the same intensity of that feeling, it would be very overwhelming. In CBT, children learn to view their emotions as a thermometer where they can tease apart situations/stimuli that would create a “10” on their meter versus a “5” or a “1” so that tackling these experiences starts to seem more manageable.
  2. Psychoeducation also focuses on learning to identify the thoughts, feelings, and actions that occur in a situation so that kids can start to see how modifying one part can affect another. For example, if Ally thinks that the person next to her is sick because he sneezed, she will start to feel anxious that she will get sick too. But if Ally is able to come up with other thoughts, this could alter how she feels. How anxious would she be if she thought that the person next to her sneezed not because he was sick but because something just tickled his nose? In exploring thoughts, children start to recognize when they fall into thinking traps by identifying cognitive distortions and labeling them as such. Cognitive distortions can include thinking the worst will happen (catastrophizing), thinking you know what others are thinking (mind-reading), and believing something without any proof (jumping to conclusions), among others. By learning to recognize thinking traps, youngsters can start to challenge them and become more flexible in their thinking, which may then alter how they feel and act.

  3. Coping skills. After psychoeducation about thoughts/feelings/actions and the relationship between them, patients start to build a “toolbox” of skills to help them effectively manage emotional/physical distress. This component helps empower children to feel that they have the tools they need to conquer problems. Furthermore, in order to face stress-inducing situations, they may need to first learn to lessen their arousal level to the point where they can tolerate facing a stressful situation. The coping skills that are added to their toolbox may include things such as relaxation techniques (e.g., diaphragmatic breathing, progressive muscle relaxation, imagery) to help calm their bodies and minds enough to participate in treatment. Skills also include learning scripts to challenge cognitive distortions (e.g., “Do I know 100% that I will get sick?”, “Could there be other explanations why my brother threw the ball at me?”) so that ultimately children may become more flexible in their thinking instead of solely believing the automatic thought that comes to mind. Other distress-tolerance skills include proactive activities (e.g., taking a walk, listening to music, squeezing a stress ball) and positive thoughts to keep in mind in order to help manage distress.
  4. Behavior practice/management. The third component of CBT is where individuals get a chance to practice the skills that they have learned. It includes skill rehearsal, role-playing situations, and ultimately experiencing the situations. For some disorders, such as anxiety, the experiencing of a feared situation and habituating to it (i.e., anxiety lessening by remaining in the situation over time) is the key ingredient of treatment. However, some will need to use the psychoeducation and skills described above in order to even get to the point of being able to face a fear in any form. Another key aspect of this component of CBT is the idea of reinforcing a desired behavior, whether it’s facing a fear, complying with a direction, or reacting in a calm and appropriate way. Some children may respond to encouragement from adults and a feeling of self-efficacy, but most need external reinforcement in order to push through cognitive/emotional barriers to their goals. This typically involves parents setting up a reinforcement system in which kids can earn rewards for reaching certain goals. Rewards can be immediate or in the form of tokens that can be traded in for bigger rewards or privileges after earning a certain amount. It is essential that parents are always aware of what effect their response has on their child’s behavior so that they are not inadvertently increasing the likelihood of the problem behavior rather than the desired behavior. For example, if Sam argues around limits on videogame time, and his mother lets him keep playing so that he stops yelling, Sam has learned that the more he yells, the longer he gets to play. If Sam’s mother gives him a check mark for every time he turns off the game when prompted, Sam learns that by following directions, he earns tokens that he can then trade in for bigger rewards. Likewise, if Ally’s mother lets her stay home when she is crying, instead of fighting the anxiety, this will increase the likelihood that this pattern will continue. However, if Ally earns rewards for getting to school by a certain time, this may reinforce leaving home rather than staying home.


While childhood behaviors such as fears, tantrums, noncompliance, and the like may be part of normal development, patterns of behaviors may become distressing and start to impair functioning. When this happens, it’s important to seek help from a professional who can perform a thorough evaluation and determine appropriate intervention. CBT is an evidence-based treatment that can be applied to a variety of childhood problems. Developmental considerations, such as age and cognitive level, may determine whether treatment is more cognitive or behaviorally focused. CBT can be thought of as a skill set that children and parents both develop and improve over time with practice.


Christophersen ER, Mortweet SL. Treatments that work with children: Empirically-supported strategies for managing childhood problems. Washington, DC: American Psychological Association; 2001.

Creswell C, Waite P, Cooper P. Assessment and management of anxiety disorders in children and adolescents. Archives of Disease in Childhood 2014; 99(7):674–678.

1/30/2015 12:00 AM

When I was in second grade and living in Racine, Wisconsin, there was a rabies outbreak in the greater Chicago area that received extensive media coverage. Parents kept children indoors because of a perceived risk of marauding mad dogs, and stories about the horrors of having to undergo the treatment shots were widely discussed. Even though I loved dogs, I was petrified of being bitten by a rabid animal. A recurring image from the front page of the newspaper (which I still vividly recall) of a wild-eyed dog foaming at the mouth and fiercely biting the bars of its quarantine cage made it difficult to fall asleep many nights that fall. I’ve wondered whether that childhood experience of fearing a deadly illness I didn’t understand influenced my decision to go into medicine. I am certain, however, that a widespread concern about a scary disease, whether it’s rabies or Ebola, can affect children and adolescents in lasting ways.

While we can’t shield our children from everything that is worrisome, risky, or unpleasant, how we as adults react can have a greater impact on a child’s psyche than the actual reality of the situation. Nowhere is that more evident than in our societal response to the Ebola epidemic. The facts facing Americans (in contrast to many in West African countries) as I write this in late fall of 2014 contrast sharply with the anxiety, verging on panic, seen in some quarters.

The facts are fairly straightforward: Ebola is a viral disease we have known about for decades but not attended to intensely because outbreaks have only occurred in isolated areas of west and central Africa. It is contagious only from direct contact with bodily fluids (blood, vomit, diarrhea, etc.) of those showing symptoms of the illness; the sicker the patient, the higher the viral load and the more contagious he or she is. About half of those who contact Ebola will die, and they are especially contagious in the days immediately before and after their death. There is no specific treatment for Ebola, and effective vaccines, now being developed, will not be widely available for at least a year. Americans at the highest risk for Ebola are health care workers exposed to the virus when caring for sick patients; they comprise all of the handful of cases in the United States.

To judge from the media response and the way Ebola in the United States is consuming our consciousness way out of proportion to the current danger, facts seem to have little bearing on the American anxiety level. Scared parents, extreme governmental quarantine measures, and a national sense of panic are likely to cause unnecessary suffering for children; adult anxiety is more contagious than Ebola.

Instead of communicating dread and danger through what is said and through nonverbal communication (facial expression, affect, preoccupation), adults should present to children a measured and rational approach about Ebola. Knowledge is power, and helping children bolster their cognitive mastery skills goes a long way to allaying undue anxiety. The first step in this process is to create an open and supportive environment where children can ask questions and feel comfortable sharing what they know. Then we have to listen carefully and calmly to what they say. Youngsters’ ability to understand illness varies hugely with age, from a five-year-old’s magical thinking to many adolescents’ ability to deal with abstract concepts. It is critical to meet children where they are developmentally and to use words and concepts they can understand. Whatever the level of communication, it is important that the information we provide be accurate and honest, yet light on the graphic details. The horrible picture of the rabid dog stuck with me from my childhood because as an eight-year-old, I couldn’t understand the verbal explanations provided by the adults. We need to allow for repeated discussions of Ebola, as children can rarely process affect-laden information in a single session. Additionally, repeated questioning may be a child’s way of asking for reassurance. 

As with any challenge, the Ebola crisis presents children with an opportunity for mastery and growth. Understanding the conditions in Africa — while differentiating them from the situation in the United States — can promote empathy for those less fortunate. Appreciating the heroism of medical workers on the front lines of the epidemic helps to define courage and self-sacrifice. If children can contribute some of their own money to a charitable organization fighting Ebola, it reinforces their developing social conscience and allows a sense of active mastery.

We know from other crises what helps and what hinders children’s efforts to cope with unsettling news. In our approach to Ebola, we should manage our anxiety, monitor our behavior, and make decisions based on equal parts of science and compassion. Our children will be the beneficiaries.

5/30/2015 12:00 AM

Bullying is harmful to both the victim and the bully, but in teen sports, one of the main causes is jealousy. If your child is a competitive athlete, the bully may be on the same team, or in a solo sport like figure skating, may be a friend. In either case, the friendship or team-player attitude can dissolve under the powerful emotion of jealousy. And the bullying can take on a vicious aura because it is so taboo to sabotage your teammate or competition — unsportsmanlike to the nth degree — so it’s not overt.

Typical displays of this kind of “hidden” bullying involve ignoring the victim or telling lies about the victim behind his or her back. Ignoring can be quite active: one girl may go into the locker room and enthusiastically greet everyone sitting there except for the girl who is her target. Nobody knows what to say, everyone is uncomfortable, the target feels sad, and it happens day after day. The coach may not even know it’s happening; the parents may not know either. But for the victim, the pain is real, and the bully’s goal — to feel better about herself by hurting the one who’s making her jealous — has been achieved.

There are some general overall preventive measures that can be taken to protect your child against bullying. Research has shown that just spending 15 minutes a day talking to your child can help prevent bullying — and by that, researchers mean prevent active bullying, which damages the bully, as well as those being bullied and witnessing bullying.


Sometimes, when schools intervene with bullying, they do more than parents can do. In some schools, students submit written reports to an assistant principal when they experience problems with other students. The responsibility to resolve the problem is placed on the students, but the written report states what the problem is. The assistant principal gives the students an opportunity to discuss the problem and work it out on their own. If they can’t, the assistant principal will help.

This is connected to the sports issue. One phenomenon that takes place is extremely difficult for the bullied child to understand. When the bully doesn’t win in a competition, she becomes mean out of jealousy. But if she does win, or at least gets a better score than her victim, she suddenly becomes “lovey-dovey” with the victim. At this point, it’s important for the parent to make it clear to the bullied girl that jealousy is the main factor here.

Jealousy is the emotion that can kill sport. There’s no place for it. Unfortunately, some of the worst offenders are the parents — the adults who want their child to win at all costs. Both the children and the adults could easily say — if they could admit it — that they are acting like jerks because they are jealous. Instead, they say “you cheat” or “you’re selfish” or, if they can’t say any of those things truthfully, lie and spread rumors. The path for parents in sports must be the high road, as it is for parents everywhere.

What is bullying?

Bullying is, basically, being mean, over and over. But it can be insidiously covert. Spreading rumors, leaving out other children, and teasing are typical. But it should be remembered that children who bully may have their own problems. Research has shown that in the long run, bullies do suffer, with increased substance abuse, dropping out of school, and getting into fights.

Even bystanders can be hurt by bullying, because they don’t know how to respond. They may feel as if they will be targeted if they step in. It’s essential to have an adult step in to stop the bullying.

Girl bullying comes with its own special criteria: (1) ignoring and social exclusion, (2) spreading rumors/lies, and (3) wanting power over the victim.

Parental help

Interestingly, many bullies, when confronted with a retort, back down quickly. Actually, even making eye contact can make them retreat. There’s no real courage there — just a huge lack of security. Parents can help by giving words to say. “Just work harder and you can win, too.” “You’re trying to turn my friends against me — shame on you.” “I’ve been a good friend to you. You have not been to me. I don’t need you. We are finished.” These words can totally demolish a bully.

Finally, if, as a parent, you are confronted by a bully’s parent, let it rip. Your child counts on you to protect him or her.

Some signs that may indicate a child is being bullied:

  • Frequent headaches or stomachaches, feeling sick, or faking illness
  • Changes in eating habits — some children don’t eat lunch at school because they are afraid of cafeteria bullying
  • Problems sleeping, including nightmares
  • Not wanting to go to school
  • Avoiding social situations

Why children don’t ask for help

Bullies quickly target the “tattletale” when it comes to getting turned in. This means that if your own child wants to tell you about a problem caused by a bully at school or in a sports club, he or she won’t because of fear of extra bullying due to “tattling.” There will be backlash from the bully, they think. Bullying is humiliating enough without having to drag adults into it, they think. And, most sadly of all, many children are afraid that their parents or teachers won’t believe them and will think it is their fault if they are being bullied. Finally, they fear that other children will ally themselves with the all-powerful bully and they will be even more lost, with their own friends deserting them if they “tattle.”

There are many positive ways to combat bullying. In addition to parent communication, there is adult modeling. If adults treat people with kindness and respect, children will follow.

For more information, go to, which is managed by the federal Department of Health and Human Services.

4/20/2015 12:00 AM

Because of parents who think that giving their children an MMR (measles, mumps, and rubella) vaccination can lead to autism, parents with babies too young to be vaccinated now have to be afraid that putting their child in day care or going on a vacation to Disneyland will put them at risk for the disease. Every year, there are outbreaks of measles in this country — despite the fact that there is a vaccine that is safe and effective.

Why is this happening? It started more than a decade ago when Andrew Wakefield, a now-discredited physician in England, published a study that suggested a link between the MMR vaccine and autism. That study has been retracted. Wakefield lost his medical license. Pediatricians who went blue in the face explaining to parents at the time — before the retraction — that the MMR vaccine was safe are still having to convince some parents that there is no link between the MMR vaccine and autism. And sometimes, they fail.

Here’s what measles is: rash, high fever, cough, runny nose, and, in rare cases, encephalitis and death. This is what happened to Roald Dahl’s daughter, who died at the age of 7 in 1962, before there was a vaccine available. The beloved children’s book author wrote a poignant public letter afterwards, urging parents to vaccinate their children, noting that 1–2 out of every 1,000 children who gets measles will die, and there is nothing physicians can do about it. They can, however, prevent it. (For his letter, go to Measles can also lead to deafness and brain damage.

Autism is a horrible disease too — and there are parents who believe it is much worse than measles. But it’s not a choice between one or the other. Their logic is wrong: MMR doesn’t cause autism.

There are also many, many anguished letters from parents who are watching their children struggle with autism, who are struggling with the initial diagnosis, struggling with ongoing problems, and deeply unhappy about what they see as a disease that even the experts don’t understand. Can it be prevented? Probably not, at least not yet. There are very good treatments, and children with autism need these treatments, as do their families.

But measles is different. It can be easily prevented.

Parents who have relied on “herd immunity,” which takes place when the vast majority of a population is immune to a highly contagious disease like measles, can no longer do so.

“A family vacation to an amusement park — or a trip to the grocery store, a football game or school — should not result in children becoming sickened by an almost 100 percent preventable disease,” said AAP Executive Director/CEO Errol R. Alden, M.D., FAAP, in a January call to action on MMR vaccinations. “We are fortunate to have an incredibly effective tool that can prevent our children from suffering. That is so rare in medicine.”

To the parents who don’t trust the AAP, saying it is in the pockets of the vaccine industry, consider this. Of all of the medical societies, it is the one that consistently lobbies for the benefit of the moneyless patients: children. It doesn’t lobby for the pediatricians. Like child psychologists and psychiatrists, pediatricians have the best interests of the child, not the vaccine company, at heart. The huge amount of time they spend trying to convince parents to have their children vaccinated is unreimbursed. The amount they are paid for administering a vaccine is negligible.

Children should receive the MMR vaccine at 12 to 15 months, and again at 4 to 6 years. But if they missed those time slots, it’s not too late. And if you did fail to vaccinate your child, remember that herd immunity is no longer something you can count on. If there are thousands of unvaccinated people, someone is likely to have measles. It could be someone your child plays with at a birthday party or at camp, or someone who stands next to your child in the supermarket.

Some parents say they don’t want to have their child vaccinated because they are concerned about autism, but never seem to consider the fact that their child could be the one who gets measles — not to mention gives it to someone else. As for the rumored “measles parties,” we can’t even begin to consider that a parent concerned about autism would want their child to have measles. Measles has the most serious effects on the young.

Autism Speaks, a well-known autism advocacy group, in February urged parents to vaccinate their children with the MMR vaccine. “Over the last two decades, extensive research has asked whether there is any link between childhood vaccinations and autism,” said Rob Ring, chief science officer, in a statement. “The results of this research are clear: Vaccines do not cause autism. We urge that all children be fully vaccinated.”

Autism Speaks in the past has not been so forthright about science. A National Autism Association event in 2011, which Autism Speaks sponsored, included Wakefield as a speaker. In the past, Autism Speaks has been wishy-washy in its messages about immunization. Only last year did it include a link on its website to a study showing that immunization and autism are not connected.

Last summer, Pediatrics published a review on vaccine safety, noting that concerns have led parents to avoid vaccination, which in turn has led to a resurgence of disease. Reassuring parents about the safety of vaccines has become a public health issue (see Maglione et al. Safety of vaccines used for routine immunization of U.S. children: A systematic review. Pediatrics 2014 Aug. doi: 10.1542/peds.2014-1079). The review found strong evidence that the MMR vaccine is not associated with autism.

2/1/2015 12:00 AM

Negative parenting — such a high-flown phrase, linked in almost every study to poor outcomes for children — does not convey the anguish felt by many parents of children with various behavioral problems. When the child is sleeping peacefully, the parents plan on how they will respond only positively and with patience no matter what the next day — or hour if it’s a nap — brings. But whether it’s a developmentally appropriate temper tantrum in the supermarket by a 2-year-old or ongoing serious pathology such as oppositional defiant disorder, most parents “lose it” at some time or other when their child misbehaves. It’s normal.

So instead of condemning yourself, which just makes you feel worse (and doesn’t make you a better parent), look at what you can do objectively to make things better for your child and yourself. The keys are to be consistent and loving, while not “giving in.”

First, you probably already know intuitively what the studies say: young children — say, ages 4 to 7 — who are disciplined harshly and inconsistently are more likely to have more severe antisocial behavior.

Given the importance of positive parenting, it seems odd that there is so little guidance for new parents. Besides the pediatrician, who advises parents on how to deal with their child’s behavior? Typically, you don’t get help until there already is a problem, and then you are going to a child psychologist or some other provider who is treating the child.

Fortunately, more and more providers recognize the importance of family treatment, so once a child does develop pathology, even in the early stages, you can get advice on positive parenting to intervene in the progression of the problem.

But wouldn’t it be nice to have a “positive parenting” handbook for all new parents? Oddly, there seem to be more such books for pet owners. When you learn that positive reinforcement (treats, throwing a ball) is the standard training tool for dogs, maybe this makes sense. We’re so emotionally involved with the behavior of our children that we may not realize they have just as much individuality as dogs.

Children are different, because many parents view them as reflections of themselves, not as beloved pets. Some parents even resent being told to be less coercive: their view is that the child “belongs” to them (and, in fact, that’s true) and that it’s their right to enact whatever disciplinary methods they choose (which is also true, short of actual physical abuse).

Even these parents, when they see that negative parenting doesn’t produce results and positive parenting does, may change their minds. When they consider that positive parenting for a 2-year-old can affect his or her social behavior, and ultimately the child’s full development as an adult, they realize that the “power” they have as a parent is meant to be used for benevolent reasons.

Harsh discipline

Interestingly, some studies have found that parents who use harsh discipline are also more likely to lack involvement with their children — the children aren’t monitored closely, and their activities aren’t supervised. These parents fluctuate between being “permissive” by their lack of involvement and tending to be more violent and critical. Many researchers have concluded that hostile and punitive parenting is associated with antisocial behavior.

Of course, parents and children exert an influence on each other. Just as a parent’s negative tactics can have a deleterious modeling effect on a child, the child can also learn that misbehaving can lead to parental attention — and the unfortunate situation in which parents try to appease the behavior. This leads to a downward negative spiral in which the child’s misbehavior and the parent’s negative actions reinforce one another.

Some of the most troubling behaviors in early childhood are oppositional, aggressive, and hyperactive behavior. One study by Stormshak et al. narrowed down five distinct parenting practices that are associated with disruptive behavior in their children:

  1. Punitive discipline (yelling, nagging, and threatening)
    • Low levels of warm involvement were associated with oppositional behaviors. Punitive parenting practices were practices that included punitive interactions that were associated with elevated rates of all child disruptive behavior problems.
    • Lack of warmth and positive involvement were particularly characteristic of parents of children who showed elevated levels of oppositional behaviors. Physically aggressive parenting was linked more specifically with child aggression. In general, parenting practices contributed more to the prediction of oppositional and aggressive behavior problems than to hyperactive behavior problems, and parenting influences were fairly consistent across ethnic groups and sex.
  2. Inconsistency
  3. Lack of warmth and positive involvement
  4. Physical aggression (hitting, beating)
  5. Spanking

Many researchers think that disruptive behavior problems start with oppositional behaviors such as whining, noncompliance, and talking back. This is the first step, and parents can avoid punitive and inconsistent responses to these behaviors and intercept the progression from opposition to outright physical aggression.

When your child whines, don’t yell. When your child doesn’t whine, reward.

The highest levels of child aggressive behavior are, not surprisingly, correlated with the highest levels of physically aggressive parenting.

Warm involvement, love

Even parents who are not forcefully negative but who have low levels of warmth may contribute to problem behaviors, mainly due to feelings of insecurity and the lack of any opportunity for emotional regulation in the child.

Negative parenting — or a lack of parental support — can also lead to depression in children, researchers have found. A study by Dallaire et al. examined the combined and cumulative effects of supportive–positive and harsh–negative parenting behaviors on children’s depressive symptoms. A diverse sample of 515 male and female elementary and middle school students (ages 7 to 11) and their parents provided reports of the children’s depressive symptoms. Parents provided self-reports of supportive–positive and harsh–negative parenting behaviors. Structural equation modeling indicated that supportive–positive and harsh–negative parenting behaviors were nearly orthogonal dimensions of parenting, and both related to children’s depressive symptoms. Supportive–positive parenting behaviors did not moderate the relation between harsh–negative parenting behaviors and children’s depressive symptoms. Results have implications for family intervention and prevention strategies.

There’s a lot of research showing that supportive or positive parenting moderates a variety of issues, both how closely the parent supervises the child, or how strict the parent is, and the child’s own traits. Even parents who are “controlling” but warm have children with fewer behavior problems than parents who are controlling but not warm.

And if you need an “excuse” to be happy, consider this: maternal well-being has been proven to mitigate against antisocial behavior, even in the presence of negative parenting.

Here are some basic tenets to remember when it comes to avoiding negative parenting:

  • Your goal is to build family relationships, no matter how old the child.
  • Being a parent is a learning experience — you won’t be perfect the first time.
  • Each child is different, so no matter what you have heard about “the rules,” only trial and error will tell you what works with your child.
  • Your child is also learning; you cannot expect him or her to be perfect either.
  • As the parent, it is your right to decide what behavior is acceptable and what isn’t, but that isn’t the same as control. When your child gets older — preteen and teen, and even earlier — that child will gradually develop autonomy.

Bottom line: No matter what, love your child. You do anyway, regardless of the research. Just let him or her know you do. And stop beating yourself up about it. It’s not about you — or it shouldn’t be.


Dallaire DH, Pineda, AQ, Cole, DA, et al. Relation of positive and negative parenting to children’s depressive symptoms. J Clin Child Adolesc Psychol 2006 Jun; 35(2):313–322.

Stormshak EA, Bierman KL, McMahon RJ, Lengua, LJ. Parenting practices and child disruptive behavior problems in early elementary school. J Clin Child Psychol 2000 March; 29(1):17–29.


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    Gregory K. Fritz, M.D.
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    Dr Fritz is a professor of psychiatry and director of child and adolescent psychiatry at the Brown University School of Medicine, where he conducts research and teaches.
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