Parenting

Parenting encompasses much more than feeding and clothing children, keeping them clean and warm, and protecting them from harm. The quality of relationships parents make with their infants and children is of paramount importance for mental health and wellbeing. Parent's emotions have an impact on infants in the womb, and in infancy key parenting skills include sensitivity to the infant, being able to read the babies' cues and mind mindedness (keeping the baby in mind).

After toddlerhood begins, boundary setting and positive approaches to discipline are also important. Parenting is done by non-biological parents and other carers. Consistency of relationship to a small number of carers is fundamental. Most parenting research has been carried out on mothers, but the research on fathers suggests their influence is just as important for mental health.

Aspects of parenting that have been shown to influence mental health

Attachment (1): The literature on attachment began with the observation of mother-infant relationships and attachment's refers particularly to the behaviour of the infant in relation to the mother at one year of age. Attachment research has since defined the following as important for parenting infants:

Sensitive, attuned care: a parent who is curious about and sensitive to their infant's needs and provides care in attunement with those needs.

Reflective function, mind mindedness, mentalisation: these terms describe a parent who recognises their infant as a person with his/her own needs and can keep these needs in mind throughout the day; these parents understand behaviour and internal feeling states, and can interpret what the infant is thinking and feeling.

Communication: parents who actively communicate with their infants, playing games, taking turns, sharing responses and emotions.

Containment: a parent who can contain their infant's distress with empathy, but without becoming distressed themselves. Such parents enable infants and children to develop the capacity to self-sooth and self-regulate.

Attachment disorder: Three categories of attachment disorder have been defined collectively affecting over a third of the population in infancy: avoidant, anxious and disorganised. These attachment patterns track through into adulthood where they are played out in the interpersonal relationships of adults. (2) (3)

Authoritative parenting: defined by Baumrind in the 1970s (4) in the context of educational achievement. It includes warmth, affection and support as well as clear and consistent age appropriate boundaries. From toddlerhood on, both are important. Absence of boundaries leads to behaviour problems, and absence of affection leads to underperformance in school and emotional problems.

Behaviour management: several groups of psychologists and social scientists interested in delinquency and criminality have investigated aspects of parenting leading to behaviour problems, conduct disorder, and to criminality and violence in adulthood. They have identified a similar combination of factors as protective, including warmth and affection, positive discipline and consistent rules. (5)

Abusive parenting: parenting that is defined in law as unacceptable. May include physical, sexual and/or emotional abuse.

Physical abuse merges imperceptibly into physical punishment and in some countries any form of physical punishment is now defined as abusive in Iaw. All physical assault infringes human rights and is a criminal offence in adults. It is an historical anomaly that such assault is still permitted with regard to the most vulnerable.

The Faculty of Public Health is campaigning with the Children are Unbeatable Alliance for a change in the laws in the UK to make physical punishment illegal. Emotional abuse may be as damaging as physical abuse but is more difficult to define and identify. Sexual abuse is mostly commonly perpetrated from within the family, but may involve others.

Neglectful parenting: parenting that is defined in law as unacceptable and describes a failure to provide emotional or physical care to a minimum level.

Parental mental illness and parental drug and alcohol misuse. (8) (6) The most damaging parenting, and a high proportion of abuse and neglect, is found in homes were parents are themselves suffering from mental illness or drug and alcohol misuse. Such parents often have histories of profoundly inadequate parenting, abuse neglect, or experience of statutory care outside the home as 'looked after children'. Whilst genetic transmission may play a part, parenting represents an important modifiable risk factor even in this group. (7)

These aspects of parenting have been shown to predict whether or not a child is affected by:

Conduct disorder in childhood
Personality disorder in adulthood
Criminality and violence in adolescence and adulthood
Depression, anxiety and suicidal ideation in later life
Peer relationships in school
Educational achievement
Unhealthy lifestyles in childhood, adolescence and later life
Physical health in adulthood.

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A good start in life

The scientific underpinning of childhood mental health

Parenting programmes

School mental health promotion

Parenting, Poverty and Deprivation

Policy and Provision in UK Addressing A Good Start in Life

References

1) Zeanah CH, Boris NW, Lieberman AF, Attachment disorders in infancy in Handbook of Developmental Psychology Sameroff AJ, Lewis M and Miller SM (eds). Kluwer Academic/LPlenumum Publishers, New York, 2000

2) Mickelson KD, Kessler RC, Shaver PR. Adult Attachment in a Nationally representative sample. J Personality and Social Psychology 1997;73:1092-1106

3)Van Ijzendoorn MH. Adult attachment representations, parental responsiveness and infant attachment: a meta-analysis on the predictive validity of the adult attachment interview, Psychological Bulletin, 1994;117:387-403

4) Baumrind D. Paerntal disciplinary patterns and social competence in children Youth and Society. 1978;9:239-75

5) Patterson G, DeBaryshe B, Ramsay E. A developmental perspective on antisocial behaviour, Amer J, Psychology 1989 44:329-325

6) Smith M. Parental mental health: disruptions to parenting and outcomes for children. Child and Family Social Work 2004;9:3-11

7) Vostanis P, Graves A, Meltzer H, Goodman R, Relationship between parental psychopathology, parenting strategies and child mental health. Findings from the GB national study. Social Psychiatry and Psychiatric Epidemiology.

8) Gopfert M, Webster J, Mary V. Seema Parental Psychiatric Disorder: Distressed Parents and their Families (eds), Cambridge, CUP 2004

Parenting

Aspects of parenting that have been shown to influence mental health

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Further reading

References