Thursday, September 8, 2011

Parental supervision of children and adolescents

parental supervision and injuries in children with high intensity behaviour
Parental supervision protects boisterous children from injury:
More time unsupervised corresponds to more injury 
“To my parents we were just two girls in the bedroom”. What exactly was going on? Without adequate supervision the parents of this teenager never found out; the memories returned to haunt her in adulthood. Studies comparing children with and without parental supervision show that lax parental supervision is associated with injury in toddlers and preschoolers; conduct problems in school going children; and road accidents, addictions, gambling and sexual risk taking in teenagers.

Parental supervision has three dimensions (Gitanjali 2004)
  1. Attention - watching or listening 
  2. Proximity - within or beyond reach 
  3. Continuity - constant, intermittent, or not at all 

Two factors determine the degree to which a child would be left unsupervised (Morrongiello 2008)
  1. Parent’s conscientiousness - the more conscientious the parent more the supervision
  2. Child’s propensity for risky behaviour - the more impulsive and sensation seeking the child the more likely the child will be kept in direct view. 

Distinguishing adequate from neglectful supervision is not straight forward. The consequences of lower levels of supervision are not uniform for all children. The consequences depend to a great extent on child attributes. For children with high sensation seeking, even close supervision is not adequate to prevent injury. For children who are high in behavioural control, even not supervising does not elevate risk of injury.

Whether or not children comply with their parents’ requests to behave in safe ways is a complex interaction of parenting style, attachment style,  and child temperament. The level of supervision necessary to ensure a child’s safety should finally be based on the child’s characteristics. The only reliable maxim is that the time children could be safely left unsupervised generally increases with child age.

Parental supervision of an adolescent differs from supervising a younger child (DeVore 2005). Direct parental observation gradually gives way to indirect parental ‘‘monitoring’. This indirect supervision involves ongoing communication between parents and adolescents about the adolescents’
  • Whereabouts
  • Friends they are with
  • Schedule to return home
  • Contact information enabling parents to directly communicate with adolescents. 
Effective supervision entails active participation of the adolescent, and honest communication between adolescent and parents.

Parental monitoring buffers negative peer influence. Strong peer attachments and increasing independence from the family is a normal part of adolescent development. Unfortunately, youth whose peers engage in high-risk behaviour are at high risk for the development of similar behaviours. Not only are high levels of monitoring protective, low levels of parental monitoring have been associated with numerous risk behaviours.

More unsupervised time is associated with more sexual activity in youth (Cohen 2002). In one urban study more than half of sexually active youth had sex at home after school. For boys, sex and drug-related risks increase with amount of unsupervised time. Trust and communication did not predict decreases in problem behaviour as strongly as did monitoring. Parental monitoring may be particularly protective for high-risk young urban adolescents; those who spend a significant amount of non-school time unsupervised. 

References 
  1. Cohen DA, Farley TA, Taylor SN, et al. When and where do youths have sex? The potential role of adult supervision. Pediatrics 2002; 110:e66 
  2. DeVore ER, Ginsburg KR. The protective effects of good parenting on adolescents. Curr Opin Pediatr. 2005 Aug;17(4):460-5. 
  3. Gitanjali S, Brenner R, Morrongiello BA, Haynie D, Rivera M, Cheng T. The role of supervision in child injury risk: Definition, conceptual, and measurement issues. Journal of Injury Control & Safety Promotion 2004;11(1):17-22. 
  4. Morrongiello BA, Klemencic N, Corbett M. Interactions between child behavior patterns and parent supervision: Implications for children’s risk of unintentional injury. Child Development 2008;79(3):627-638.  

Sunday, June 19, 2011

School bullying

School Bully


Bullying by children in schools has serious mental health effects on the victim and the bully. Up to 25% of high school students report being victimised by bullies. 13% of victims have considered suicide. In rural India 31% of middle school students report being bullied (Kshirsagar 2007). Bullying is twice more prevalent in coeducational schools than in girl schools. The prevalence of bullying increases from 13% in the 3rd grade to 46% in the 6th grade. Bullying is higher in classes with more retained students.

Bullying occurs in a variety of settings that are an extension of your child's school life. Bullying can occur face to face, by texting or on the web (cyberbullying). Bullying is not a phase of growing up, it is not a joke, and it is not a sign that boys are being boys. Bullying can cause lasting harm - to the victim, the bully and the bully-victim (children who are bullied and also bully other children).

Bullying takes many forms
  • Verbal: Name calling, teasing
  • Social : Spreading rumours, leaving people out of groups on purpose, breaking up friendships
  • Physical : Hitting, punching, shoving (5% in Indian schools)
  • Cyberbullying

When is it bullying? It’s bullying when there are three features to the interaction
  1. Imbalance of power: People who bully use their power to control or harm. The victims may have a hard time defending themselves.
  2. Intent to cause harm: The person bullying intends to harm the victim
  3. Repetition: Incidents happen to the same person over and over by the same person or group
It’s not bullying when there are
  • Mutual arguments and disagreements
  • Single episodes of social rejection or dislike
  • Single episode acts of nastiness or spite
  • Random acts of aggression or intimidation

Effects of bullying

(www.stopbullying.gov)
Those who are victims are at a high risk for mental health problems
  • Higher risk of depression and anxiety with increased thoughts of suicide
  • More likely to have health complaints
  • Have decreased academic achievement
  • More likely to miss or drop out of school
  • More likely to retaliate (12/15 shooters have a history of being bullied)
Bullies are more likely to manifest behaivour problems that continue into adulthood when these behaviours manifest as criminality
  • Higher rates of alcohol/substance abuse
  • More likely to get into fights, vandalise property
  • More likely to be abusive towards partners, spouses or children later in life.
Bully-victims are the worst affected. They develop both mental health and behavioural problems

Is your child being bullied?

If your child has any of these features it is very likely they are being bullied in school
  • Comes home with torn clothing or missing belongings
  • Appears sad, moody, depressed or anxious especially on returning home from school
  • Prefers to be alone
These symptoms are also likely in victims of bullying
  • Is afraid of going to school
  • Vomiting
  • Sleep disturbances including insomnia and nightmares
These symptoms are commonest in victims
  • Frequently falling sick
  • Headaches
  • Bodyache is the next most common symptom in female victims. In male victims nightmares are the next most common.
Is your child a bully? Consider these common traits of bullies
  • Become violent with others, gets into physical or verbal fights
  • Get sent to the Principal’s office often
  • Has extra money or new belongings which cannot be explained
  • Will not accept responsibility for their actions
  • Need to win and be best at everything

Do’s and Don’ts

For parents whose children are victims of bullying (Carr-Gregg 2011)
Do NOT
  • Tell the your child to ignore the bullying. This allows the bullying and its impact to become more serious
  • Blame your child or assume that they have done something to provoke the bullying
  • Encourage retaliation
  • Criticise how your child dealt with the bullying
  • Contact the bully or parents of the bully
Do
  • Communicate with your child
    1. Listen carefully. Ask who was involved and what was involved in each episode
    2. Empathise and reinforce that you are glad your child has disclosed this
    3. Ask your child what they think can be done to help
    4. Reassure your child that you will take sensible action
  • Contact the teacher and/or principal and take a cooperative approach in finding a solution
  • Discuss the matter in a face-to-face meeting. Stay calm. Take along any evidence you may have gathered. Ask three key questions
    1. How will this matter be investigated?
    2. How long will this investigation take?
    3. When will you get a follow up meeting to discuss the results?
  • Contact school authorities if bullying persists and escalate your communications up the chain of command. Here’s where your paper trail comes in useful
Every child deserves an education free of fear
References
  1. Carr-Gregg M, Manocha R. Bullying - effects, prevalence and strategies for detection. Aust Fam Physician. 2011 Mar;40(3):98-102.
  2. V .Y. Kshirsagar, Rajiv Agarwal and Sandeep B Bavdekar. Bullying in Schools: Prevalence and Short-term Impact. Indian Pediatrics 2007; 44:25-28
  3. www.stopbullying.gov