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This is another of those topics I really wish I didn’t have to do. In this interview with Dr. Jennie Noll of Pennsylvania State University, we discuss the impacts that sexual abuse can have on a child (even many years after the event itself!), and we talk extensively about what parents can do to prevent abuse from happening in the first place. If you want to be sure to remember this info, there’s a FREE one-page cheat sheet of the 5 Key Steps Parents Can Take to Prevent Sexual Abuse available here: Get the FREE Guide!   [accordion] [accordion-item title="Click here to read the full transcript"]   Jen: 01:26 Hello and welcome to the Your Parenting Mojo podcast. We have a pretty serious topic to cover today and it's what I've been thinking about for a long time now. In 2016 the USA gymnastics sexual assault scandal broke and we learned that Dr. Larry Nassar had been sexually assaulting gymnast for years as he claimed to be providing them legitimate medical treatment. Now obviously there were failings at so many levels here. This was reported and ignored and covered up at many levels. But one thing that stuck in the back of my mind was an interview with gymnast Aly Raisman where she said she really thought this was what medical treatment was like and I want to be 100% clear that I'm not blaming Raisman or any other gymnast who had this awful experience, but I just couldn't get my head around how and why she didn't know she was being sexually abused.   Jen: 02:11 I realized that it's at least partly because we live in a culture where we don't talk about this. We don't teach children to watch for warning signs and we don't look out for them ourselves as parents or we pretend we don't see them. We just stick our head in the sand. So today's episode is probably not one you want to listen to with children around because we're going to be very explicit and discussing sexual abuse and how to prevent it. I also want to give a shout out to listener Christine who helped me to think through some great questions to ask my guest today. I spent a really long time looking for someone to talk with us about this and finally found the right person. Dr. Jennie Noll is Professor of Human Development and Family Studies and Director of the Child Maltreatment Solutions Network at Penn State University.   Jen: 02:52 She earned her Ph.D. in Developmental Psychology and Statistical Methodology from the University of Southern California. The reason I’m so interested to talk with her about this topic is because she has active research projects on two topics that are very important to us, the long-term health outcomes for victims of child sexual abuse and programs for the prevention of that abuse. Welcome Dr. Noll.   Dr. Noll: 03:13 Thank you very much for the opportunity.   Jen: 03:16 So before we get started, I actually also want to mention that I took the training that Dr. Noll studies and it's called Stewards of Children and it's published by an organization called Darkness to Light. I've created a free one page guide to preventing sexual abuse that you can download from this episode's page at YourParentingMojo.com/SexualAbuse. So we're going to talk a lot more about the Stewards of Children program today I imagine. But I wonder if we can get started by looking at the mental health or the general health actually impacts of sexual abuse because I was really surprised to find out how many of these there are. Can you walk us through these and do we have any indication of how likely they are to occur in a child who is chronically abused for years versus one who experiences abuse that it's discovered or reported fairly quickly.   Dr. Noll: 03:58 Yeah, very good. So what we've understood and this has been my work for the last 30 years, what we've understood really well as sort of the mental health and emotional health consequences of abuse. We have pretty good trauma informed treatments for mental health. These are things like persisting posttraumatic stress disorder, other anxiety disorders, depression, other sorts of attachment related disorders in terms of not being able to attach to a partner, relationship difficulties, and substance abuse. These kinds of things that we normally think about as mental health or emotional health. But what we're learning I think in the last decade is something that surprised a lot of us and that is just how we see sort of physical health consequences that we didn't really anticipate when we were just studying mental and emotional health and these are things like physical health disorders, these are heart attacks, obesity, strokes, stress-related diseases like inflammation, interferences with disease processes. Dr. Noll: 05:04 These are the kinds of things that we see in chronically stressed populations like PTSD Vietnam vets, people who have endured long and chronic stressors in their lives early on. And we think about this as how does stress sort of get under the skin and impact physiology? And we're talking about not just disease process but brain development, right? Other sorts of major organs, systems, the stress response system. So after studying survivors, which I have done for over 30 years and across generations, we're really starting to see a strong causal influence of early sexual abuse on long-term health outcomes because of the early and chronic exposure to stress and the stress hormone cortisol and other assaults on the stress response system.   Jen: 05:57 Wow, that's incredible. So that completely makes sense from the sort of chronically abused perspective, if the stress is ongoing for a really long period of time. Do you see similar effects in people who have this experience maybe once or twice and it's discovered fairly quickly?   Dr. Noll: 06:13 Yeah, that's a great question. It has two parts to the answer and my answer would be it depends. It sort of depends on what outcome you're looking at. For example, when we look at things like, sexual development, promiscuity, teen pregnancy, sort of more sort of sexual outcomes, right? Those are not necessarily tied to physical health, but something to do with the severe sexual boundary violation that has happened in the context of sexual abuse. I actually have some papers that really show clearly that it doesn't matter all that much if it's happened chronically or one time or several times or at what age, but more the fact that there was a sexual boundary violation and some kind of trust that was violated early on. So I don't like to put things on a continuum from mild to severe or one time to chronic. It's more about the interpretation of that violation and how it happened and the context in which it happened that helps us understand the sequelae and how to treat this kind of survivor.   Jen: 07:20 Okay. So that leads me to think about, what's the prevalence of these kinds of problems among children who are sexually abused? We actually did an episode on Intergenerational Trauma and how that's passed down through the generations and it's amazing. Some people can experience incredible trauma and not pass it onto the next generation and the vice versa happens as well. So I'm wondering, do most children manage these transitions to adolescence and adulthood kind of okay, kind of normally as it were or are problems really common?   Dr. Noll: 07:49 I think problems are a lot more common than we initially had thought about because of our work, not just mine, but others in the field where we follow survivors through time and we're able to compare those to kids of a normal developmental trajectory. And what we see is as much more common in survivors than in the normal population. Things like I've talked about and things like sexual outcomes, depression, mental health, and also these physical health outcomes. So much more common, significantly more common than would be accounted for by chance than the general population. But you're right, the road to resilience I think is under studied and under understood. And we are trying to look at models now of those who do not have affects. Those do not seem affected and what can we learn from those trajectories. Those are things like having a really good support system early on in life, having someone who believes in you, having some good evidence based trauma treatment early on, and also revisiting these issues as different developmental transitions happen.   Dr. Noll: 08:53 For example, getting married often triggers some effects of sexual abuse as memories or sort of clarified and uncovered and even experienced differently in the context of a new relationship or a new sexual relationship. Also the birth of a child can trigger a trauma symptoms as well. So we often suggest revisiting of treatment as survivors go through their lives. These are the kinds of success stories that we hear. In terms of intergenerational transmission, let me just say one thing quickly. We don't see necessarily victims of sexual abuse going on to sexually abuse their children. That's not the kind of intergenerational transmission we're talking about. We're talking about sexual abuse victims recreating an environment for their children were adversity persists or where other people have access to their kids who might be exploitive individuals who then pass sexual abuse on to those kids or physical abuse or neglect. So what happens with a survivor when they become a parent, if they have substance abuse issues or other mental health issues, children suffer because of those kinds of issues. Not necessarily because they are being sexually abused by a person who's a survivor. So let me just make clear, it's about the environment that's recreated or abuse and neglect are allowed to persist in that environment as opposed to someone sending that perpetration per se along to their kids. Does that make sense?   Jen: 10:26 Yeah, it does. So it sort of sets up a potential problem for researchers, isn't it? If you're not necessarily in studying the next generation, but in the current person who's experienced that abuse, if they are also in an environment where physical abuse is common and neglect is sort of ongoing, how do you and how do other researchers untangled these effects of the sexual abuse compared to the other co-occurring adverse child experiences that the child might be going through?   Dr. Noll: 10:51 Yeah. Another great question and I think what we have to do is look carefully at the research that's out there and how it's designed. I am chiefly charged with doing just what you said, how do I create models and research designs that actually parse out the impact and the causal impact of sexual abuse when accounting for all of the other adversities, other types of abuse, etc. that are happening in the lives of survivors. So our models are very, very comprehensive. We monitor and model all kinds of adversities and we do what we call statistical controls for those to see if there's a variation above and beyond other adversities that can only be explained by the experience of sexual abuse. We indeed have long-term longitudinal studies that actually show the effects of sexual abuse being different. As always, it depends. It depends how you're looking at. This is particularly pronounced when we're looking at sort of sexual context outcomes like teen pregnancy, teen motherhood and sexual activities.   Jen: 11:55 Okay. So I'm wondering, are there factors that can protect children who have been sexually abused from some of these outcomes? Or is it sort of inevitable that they might happen depending obviously on the abuse and the person's individual circumstances?   Dr. Noll: 12:11 Oh, this is far from inevitable and if that's one message I could get through that.   Dr. Noll: 12:17 These kinds of problems persist when the environment doesn't change. So there's a lot of propensity toward revictimization. So that is someone who might've been a survivor of sexual abuse ends up in an abusive relationship when they get older or they're raped or they're in a domestic violence situation, etc. etc. because the basic environment never changes, right? And the basic coping mechanisms and coping skills never change. But with adequate support from caregivers, from mentors, from other strong women and men in the lives of survivors, these trajectories can change, these environments can change and as well as really good evidence based trauma treatments, right? These are all things that target exactly the mechanisms that we see complicating the lives of survivors.   Jen: 13:06 Okay. So I want to get really practical. What form does this support take? Who is this coming from? What does a parent do when their child has experienced something like this?   Dr. Noll: 13:14 Oh, the very first thing in the paramount of everything that we talk about with survival is believing the victim. This is a basic tenant of prevention as well. Being able to listen, being able to understand what abuse really is, and then being able to really listen to the survivor and make that report to the official so that it stops. Stopping it and believing, those are the important features of the road to recovery. So that's the very first thing and then continued support, right? Continued monitoring throughout development, throughout the various developmental stages that’s the survivor might accompany like say transition to puberty, transition through adolescence, transition to adulthood. These kinds of milestones often trigger trauma symptoms and there should be supports in place at every single one of those transitions so that survivors continually feel the support. It can be a parent, a sister, an aunt, a boyfriend, a husband, a caring individual who understands and that survivors can confide in, a really good therapist, a clergy member who's trusted. These are the kinds of support systems that often do show up regularly in success stories.   Jen: 14:30 Okay. So what these people are specifically doing is, I mean in the short term, believing that it happened and in the longer term providing empathy and a person to talk to. Are there specific things other than that sort of general, I'm here if you need to talk kind of thing that successful support systems exhibit?   Dr. Noll: 14:48 Just like in any support system, it's sort of holding the person accountable to their treatment. Right? Going to treatment, making sure that it happens. Having the right kind of insurance coverage, those kinds of things parents can do for their children. But also making sure they go to the sessions, making sure they adhere, going with them if need be. And also looking for other ancillary systems like substance abuse, right? Problematic relationships. If these things sort of crop up at certain periods, that might mean the coping mechanisms are breaking down and that treatment should be revisited. So just looking at the lives of survivors and just loving people through. That's what we do in a caring society.   Jen: 15:28 O kay. So I want to make a shift here because I think this is important to parents as well. Talking about the prevention of sexual abuse. So firstly, can we talk about how common it is for children to be sexually abused?   Dr. Noll: 15:40 Oh boy. It depends. I'm sorry, I keep saying depends because it's important to understand the nuances of the question if you're really going to understand how to prevent it. So there are two ways at looking at the incidents, let's say. And that is sort of what do we know about confirmed cases in the US, right? So we see about (I don't remember what the numbers are today) but we see about it is tens of thousands per year in the US where we have confirmed cases of sexual abuse that meet the criteria of substantiation in various jurisdictions. But if you look at the CDC stats and what the CDC says about the incidents of sexual abuse, they estimate that based on retrospective reports of adults looking back over their lives, that about one in 10 women will experience sexual abuse by the time they are 18 and about 1 in 5 men. So those numbers are largely, you know, there's a large discrepancy between the cases that we know about that reach protective services and the cases that adults say happened when they were children. So somewhere in between is my guess.   Jen: 16:55 Okay. So what you're saying here is that there are probably a lot of cases that are never reported.   Dr. Noll: 17:00 That's what the CDC says based on the discrepant findings. And that says a lot about our society. So are people not coming forward? Are people not recognizing that they were abused until someone asks when they're an adult? Are there not good support systems out there built in for survivors to come forward? There's layers and layers of reasons why there might be these discrepant numbers.   Jen: 17:25 Yeah. Okay. So I think we have this sort of perception because we latch onto these sort of, you know, one of media events or things that happen in the media, latch onto them and really over report them. And we have this idea in our minds that most abuse is happening or same as kind of kidnappings that somebody snatching my child off the street. It's somebody who I don't know and I have no idea that this could have happened. Whereas I was shocked in the training that I took from Darkness to Light, the Stewards of Children training, that the vast, vast majority of abuse is actually perpetrated by either a family member, which is less common admittedly, but somebody that the family knows and trusts. So I'm wondering why do young children have trouble recognizing what “good people” who do “bad things” as being abusers?   Dr. Noll: 18:18 Yeah. This is sort of the biggest question and how to prevent, because if you study these cases and the Nassar cases is a good example. What perpetrators do is they gain access to kids. They need that access and in order to gain access, they have to be trusted by the parents and they have to be in the lives of the family on a regular enough basis to be able to gain at that access. It's not just gaining access, it's deciding which child might be, let's call it groomable. When we study Sandusky, Nassar and priests, etc. etc., we learned that they first try to figure out who might be a likely candidate. So the grooming behaviors like who's amenable, who will take the gifts, who's trust can they gain, right? Those are the kinds of things, and it's not just the child, but the parents, which parents are going to allow their kids to be seen alone by the doctor, to stay the night alone with the coach, right?   Dr. Noll: 19:20 To be left alone in the company of a babysitter who might be exploiting the children. So there's lots of layers of access. And when that access happens, there's a level of trust that gets built. This is how it works. They gained the trust. You listened to Aly Raisman and she talks about this was the most trusted physician in the country for this kind of injury, right? So that trust is built and when trust is built, it's much more difficult to discern the difference between the good guys and the bad guys. When we're taught about stranger danger, that's easy. Strangers are the guys who offer you candy and snatch you off the street. They're really...

A couple of months ago, when I was interviewing listener Rose Hoberman for her Sharing Your Parenting Mojo episode, she casually mentioned after we got off air that her father in law – Dr. Benard Dreyer – is the immediate past president of the American Academy of Pediatrics, and would I like her to make a connection? I almost coughed up my water as I said yes, please, I very much would like her to make a connection if he would be interested in answering listener questions about the AAP’s policies and work.  Dr. Dreyer gamely agreed to chat, and in this wide-ranging conversation we cover the AAP’s stance on sleep practices, screen time, discipline, respect among physicians, and what happens when the organization reverses itself… Read Full Transcript Jen 00:01:37 Hello and welcome to the Your Parenting Mojo podcast. Regular listeners might recall that I launched a new segment of the show a couple months back called Sharing Your Parenting Mojo where I interviewed listeners about what they've learned from the show and what parenting issues they’re still struggling with. My second interview for this segment was with listener Rose Hoberman and at the end of our conversation she just kinda casually threw out, “so, you know, my father in law is actually a past president of the American Academy of Pediatrics. So let me know if you'd like to interview him.” And I was kind of shell shocked for a minute and I just said, yes, if you could set that up for me as soon as you can, I'd really appreciate it. So here with us today is Dr. Benard Dreyer who's Director of the Division of Developmental and Behavioral Pediatrics and also a Professor in the Department of Pediatrics at the Hassenfeld Children's Hospital, which is part of New York University Langone. Jen: 00:02:26 Dr. Dreyer works closely with children who have autism spectrum disorder, ADHD, language delays, genetic problems and behavioral difficulties in school. Dr. Dreyer received his M.D. from New York University and he held a variety of leadership positions within the AAP before serving as its president in 2016 and he continues to serve as its Medical Director for Policies. Dr. Dreyer has also hosted the SiriusXM Satellite Radio Show On Call For Kids, a two-hour show that has run two to three times a month since 2008, which is incredible coming from a podcast perspective. Welcome Dr. Dreyer. Dr. Dreyer: 00:03:02 Pleasure to be here. Jen: 00:03:03 So I solicited most of the questions from this interview from people who are subscribed to the show via my website and who get emails from me and they were able to email me back and send me their questions as well as those who are in the Your Parenting Mojo Facebook group. One thing that really stuck out to me as the questions started rolling in was the extent to which parents, at least in the US to some extent abroad, really like to know what the American Academy of Pediatrics says about a particular topic. And they might not always agree with the AAP’s position and they might even make a decision to ignore the AAP’s advice, but they always like to know what the AAP says before they do that. So the position that AAP takes really does carry a lot of weight. I wonder if you can walk us through what it's like to make one of these recommendations that are probably based on hundreds of studies with conflicting results and boil it down into something like no screen time for children under 18 months and no more than one hour a day for children ages two to five. How does that work? I guess starting at the beginning, how do you decide what studies to include? Dr. Dreyer: 00:04:06 Well, I think even before we decide what studies to include, there is the question of what topics should we have like policies or recommendations on. I think we choose topics based on what we think are the important issues for both pediatricians and practice where they're dealing with issues and so we hear from them and also what factors or issues are very important to parents. Then we look to see if there is enough evidence for us to actually make a recommendation, not every aspect of childcare, etc. is enough evidence for us to feel confident that we are making a recommendation that's based on it. So having said that, for each topic, we do a literature search through the medical and psychological and educational literature and we gather all the studies that exist there, the authors of each policy, review all those studies and throw out some of those studies because they're poorly designed, but include all the studies that are well designed from the research perspective so that we can be sure that their findings are useful. Dr. Dreyer: 00:05:31 As you said, sometimes these studies are conflicting and also sometimes we don't have complete information and we have to use whatever information we have to make a recommendation. I mean we don't choose studies to include, we review all the studies on a topic. So for example, screen time, we reviewed all the studies on screen time for young children and looked at the evidence as to, you know, on the one hand what we know about child development. So there might be studies, for example, that show that children under 18 months of age don't learn from a flat screen. So there are scientists that have studied, for example, language development with adults speaking to children through a flat screen versus speaking the same way to them live so that the child recognizes them as another human being at that young age and showing that they actually don't learn language well from a flat screen experience and certainly in the first year of life, whereas when they're interacting on a live basis with an adult, they actually learn. So that kind of study informs our policies from the point of view of how the child's brain works. We may then have other studies which look at whether children given video games, etc. learn or don't learn from those specific video games or for those specific iPad or other kinds of activities. So that's a different kind of study that's basically testing an intervention to help children learn. So therefore, I mean, we use studies based on physiology or biology or brain function versus studies that actually test an intervention usually in a randomized control way. Jen: 00:07:46 Okay. So I'm curious about whether children's development is the only or the primary concern or is there any weight given to kind of the family structure and parenting relationship? So what I'm thinking through as an example here is okay, we acknowledge the child is possibly not learning very much by looking at a screen for half an hour a day or an hour a day. But if the parent is getting some much needed alone time in that period of time and thus the parenting quality improves for the remainder of time that the pair interacting, is there any weight given to sort of that aspect of the relationship between the parents and the child or is the weight entirely on what is the child developmentally getting out of this particular screen time experience? Dr. Dreyer: 00:08:31 So that's a great question by the way. We do get input from parents on many policies. I can't tell you the exact input we got on the screen time. I was not one of the writers there, but we have a group of families called Family Voices, which often review our policies and give us feedback on them before we put them out to the rest of the world. So, we do get input from families. I can tell you that our recommendations are part of a conversation with families. In other words, this is our recommendation that children don't learn from screen time. That there is no good amount of screen time for them to have. Parents then take that and integrate that into the way they do their lives. I don't think we've ever told a parent that if you put your kid in front of a screen for 20 minutes, their brains will be fried, you know what I mean? Dr. Dreyer: 00:09:32 But we also know that on the average, US children under the age of two have one to two hours of screen a day. So therefore when we come down on our recommendations, our recommendations are also based on what we know many parents in the United States are doing, which is allowing their children to have two hours of screen time. So, therefore we think that's a bad thing for people to be doing because that's bad in two ways. One is children really learn from interactions with their parents or other adult caregivers at younger ages. So we want parents to talk to their kids, to play with them, to read books to them, etc. That's how children learn. And we want to encourage that which we do. We also know that too much screen time is associated with behavior problems in children where they become distracted. Dr. Dreyer: 00:10:35 They developed symptoms like ADHD. I don't mean that it causes ADHD, but they become somewhat scattered. There’s somewhat more aggressive behavior with those kids who have a lot of screen time. So, we want parents to understand that a lot of screen time is not a good thing. I often have parents asked me for example, well what happens if I just want to go into the kitchen and finished cooking something and my kid is watching TV for 20 minutes, is that terrible? The answer of course is no, but that 20 minutes often becomes an hour. So we want parents to really understand that actually under the age of about 18 months, there is nothing your kid is getting out of that and if you want to use it as a babysitter recognize that you’re using it as a babysitter, but alive babysitter would be better. Dr. Dreyer: 00:11:35 Who can talk to the kid. Jen: 00:11:36 For sure. Dr. Dreyer: 00:11:37 Yeah, and also a lot of this image of the parents just putting their kid in front of a TV for 15 minutes while they go into the kitchen or the bathroom or whatever is somewhat of a fantasy. Most of the kids who get put in front of screens are there for quite a while. To be honest, it's not that safe to just stick your kid in another room in front of the screen while you're in another room in the kitchen. That kid should be in the kitchen with you or nearby where you can observe them. Again, we're talking about kids under 18 months of age. We're not talking about two or three year olds or four year olds. We don't want too much screen time. But that's a different question and that's one of the reasons we modified our recommendations is exactly what you're telling me about, which is we felt the original recommendations sounded so rigid that parents felt that either they followed them or they didn't follow them and that was not what our point was. Jen: 00:12:44 Yeah, that was actually another question that I had was around that sort of what is seen from the outside when the revised recommendations came out that that they were being revised because parents were not following them at all because the recommendation was so different from their daily lived experience. So I'm curious, I know the science is changing all the time, but was that changing recommendation primarily changed because of the discrepancy between the recommendation and what parents were doing rather than because the science had changed and suddenly indicated that it was safe for children to be having screen time at younger ages? Dr. Dreyer: 00:13:19 No. So let me put a little wrinkle on that comment. There was more science out there for us to look at. So our policy about our policies is that they should be updated every five years. The reason is there is new information out there. So our recommendations automatically should be changing approximately every five years or at least we should review the information and sometimes we review the information and say there's really nothing new here. We can keep these recommendations for another five years and we will check it five years later. But we do automatically in fact look to change our recommendations approximately every five years because there's new science that informs our decisions and we may have to change our decisions. In the case of, I don't want to focus the entire show on screen time, but in the case of screen time, we kept basically our recommendations for the first 18 months. Dr. Dreyer: 00:14:29 We’ve said there should be no screen time except skyping with your grandparents. We allow skyping with grandparents. We used to get calls like is screen time with grandma in Iowa good? The answer is sure, that's not what we're talking about. First of all, that's interactive. You are going to be with your kid. That's a good thing. So we wanted to sort of explain what we were talking about and we kept basically that we don't recommend, we didn't say we forbid but we don't recommend screen time for the first 18 months. We dropped it from two years because 18 months to two years is a transitional period. There were some kids who can benefit from certain kinds of use of iPads or watching shows on TV that are geared towards children that are entertaining or that they learned something from. Dr. Dreyer: 00:15:27 So we did modify our recommendations based on new information and new studies, which allowed us to be a little more nuanced and graded in our recommendations. Then sometimes we make recommendations which are based on very little evidence. So we had to make a decision like after 18 months or two years, how much screen time should a child be watching? And we don't have hard evidence about exactly what that amount is. That's why we chose like one hour for younger children just to make the point that children should not be in front of the TV or sitting on an iPad or computer for hours a day when they're that young, they still need to be with adults or other children in play. Jen: 00:16:19 Okay. So that was another question that listeners had was it's not that one hour is a magic number, it's more that this is an idea that children benefit more from interacting with parents because parents were wondering, well is the number low because the AAP knows that if they say two hours is okay then parenting can end up doing four hours. Dr. Dreyer: 00:16:40 Yeah. Yeah. But also I think as a parent and a grandparent, I'm going to talk, as well as a pediatrician who takes care of families with children, there isn't really much for children to spend more than an hour a day on an iPad really at the age of three. If they are doing that then they're probably missing out on other activities which would be more beneficial for them. Jen: 00:17:10 Okay. Dr. Dreyer: 00:17:11 But you're right, one hour is not based on some absolute study which showed and I think that's how it's stated in the policy. I decided I was not going to pull the policy stuff in front of me because I want the conversation not about this. I don't think we say one hour is an absolute, but I do think that we picked an hour based on some TV or some computer time or some iPad time or some smartphone time is okay, but not excessively. Jen: 00:17:43 Yeah. Okay, so leaving screen time behind and waiting even deeper into the murky waters, let's go and talk about safe sleep recommendations. So, I know a lot of parents are interested in this topic. So the AAP’s stand on this is pretty clear and that is the safest place for a baby is on a firm flat surface like a crib or a bassinet with no soft bedding in the same room as the parents but not on the same sleeping surface for the first six months. So I have a number of followup questions on this. Firstly, is it true to say that the risk of infant death is always higher when bed sharing than when the child is sleeping on their own sleep surface on their back, in a crib or a bassinet? In other words, is there no way to make bed sharing as safe as the child's sleeping alone on their back in a crib? Dr. Dreyer: 00:18:35 So let me just say in general, I'm all for bed sharing. I mean as a general principle not for the first six months of life. Because we do know that the incidents of sudden infant death syndrome is much higher with bed sharing and also that it's decreased coincident with less bed sharing and less prone sleeping and prone sleeping is probably the biggest issue. But bed sharing can also be an issue. So there are ways of making pseudo bed sharing safe. So there are parents who can buy these extensions to their beds with a flat cribs that kind of attaches to the bed so that the child is there close to them, but on his own flat surface on the back. And what’s good about that is especially for breastfeeding parents, the child is right there. So when they want to breastfeed, they don't have to get out of bed. Dr. Dreyer: 00:19:44 They can just pick up the child, breastfeed, put the child back. That's not bed sharing, but that's why I use the term pseudo bed sharing, and that is in fact what I recommended to the famous Rose Hoberman who was on your show on your podcast, which brought me here and that's the kind of setup that they have. Now regarding sleeping on the back versus the belly, it's really a matter of parent persistence and point of view. Parents who believe that their kid should sleep on their back and encourages the kids sleep is fine. Parents who every time the kids cry feels that they are better off on their belly, once you start putting kids on their belly and then convince yourself that that's the only way they'll sleep, well then that's the only way they’ll asleep. But I can tell you, I have many, many families who are firmly convinced that the baby sleeping on their back is safer and babies sleep on their back fine. Dr. Dreyer: 00:20:58 It doesn't make them cry all night. It doesn't wake up the parents all night. I mean, babies often wake up parents. My usual joke with parents is your baby will sleep through the night sometime before college, because parents sleep, babies sleep is like one of the big issues for most new parents. But that's separate from saying it's related to sleeping on their back. But once parents start moving them to their belly and then want to turn them back to their back then that causes problems. But babies from the get go who are put on their back and sleep there, sleep fine, and there's no evidence that they need to sleep on their belly. Again, remember we're talking about the first six months or so of the baby's life. We're not talking about the first five years of their life. Jen: 00:21:58 Okay. So for that period, after the first six months, is the AAP stands that bed sharing can be done safely? Dr. Dreyer: 00:22:06 I think I'd have to pull up the policy, but I think that we focus on the first year as being of somewhat concerning for bed sharing. Most SIDS cases occur in the first six months, but some do occur later in the first year and so we don't encourage bed sharing for the first year. After that, I don't know if we have a policy that says yes or no for bed sharing. Jen: 00:22:34 Right. Dr. Dreyer: 00:22:35 Remember our safe sleep recommendations are really for the first year, not for the rest of the child's life. We do recognize that many cultures have bed sharing from the get go. That doesn't mean it's safe and many kids do want to be in their parents' beds. It's comforting to them. Though once the risk of SIDS is over, I think that's up to the parents to decide whether they want a kid in their bed or they don't want the kid in their bed. Many parents don't want their kids in their bed because they want to have a good night sleep. Their bed is their bed, but other parents would like their kids in their bed. And I don't know that we're...

My guest on today’s episode in the Sharing Your Parenting Mojo series is Dovilė Šafranauskė, who joins us from Lithuania. Dovilė has discovered respectful parenting and her husband is on board, but many of the central tenets of RIE go very much against how children are raised in Lithuanian culture. Dovilė wonders how she can work with her parents – who look after her children regularly – to help them feel more comfortable with RIE, as well as what to do with Aunty Mavis whom her toddler twins see a couple of times a year and who insists on a kiss as a greeting.   Dovilė is also a sensitive sleep coach with focus on following natural baby sleep paterns, advocating for gentle sleep interventions and finding tairored solutions that fit best with the needs of the whole family. Her business is called Miego Pelytes, which means Sleep Mice in Lithuanian, and refers to her twin daughters. Click here to learn about Sleep Mice   Parenting Membership  If parenting feels really hard, and it seems like you’ve read all the books and you’ve asked for advice in free communities and you’re tired of having to weed through all the stuff that isn’t aligned with your values to get to the few good nuggets, then the Parenting Membership will help you out.   Join the waitlist and we'll let you know when enrollment reopens in May 2026. Click the banner to learn more.    

Christine King, a certified trainer in Nonviolent Communication and K–12 teacher, shares her insights on fostering peaceful parenting. She explains how NVC helps parents understand their children's needs and emotions, emphasizing the importance of power-sharing rather than control. Christine introduces concepts like 'giraffes and jackals' to illustrate compassion versus criticism. She also discusses practical applications like making clear requests and validating feelings, equipping listeners with tools to enhance communication and emotional intelligence in family dynamics.

  Today we talk with listener Seanna Mallon about her struggles to be mindful when responding to her two spirited young sons (and I can confirm from direct experience that they are indeed spirited – we actually had to re-record the episode after we simply couldn’t continue the first interview due to her children’s continual interruptions!).   I share some basic tools for staying calm in difficult moments; for a deeper dive on this topic, do join the Tame Your Triggers workshop! Enrollment is now open.   We’ll help you to: Understand the real causes of your triggered feelings, and begin to heal the hurts that cause them Use new tools like the ones Katie describes to find ways to meet both her and her children’s needs Effectively repair with your children on the fewer instances when you are still triggered   It’s a 10-week workshop with one module delivered every week, an amazing community of like-minded parents, a match with an AccountaBuddy to help you complete the workshop, and mini-mindfulness practices to re-ground yourself repeatedly during your days, so you’re less reactive and more able to collaborate with your children.   Sign up for the waitlist and we'll let you know once enrollment re-opens. Click the image below to learn more.     Parenting Membership  If parenting feels really hard, and it seems like you’ve read all the books and you’ve asked for advice in free communities and you’re tired of having to weed through all the stuff that isn’t aligned with your values to get to the few good nuggets, then the Parenting Membership will help you out.   Join the waitlist and we'll let you know when enrollment reopens in May 2026. Click the banner to learn more.    

This episode is part of a series on understanding the intersection of race, privilege, and parenting.  Click here to view all the items in this series.We’ve done a LOT of episodes specifically for White parents by now:White privilege in parenting: What it is and what to do about itWhite privilege in schoolsTalking with children about raceTeaching children about topics like slavery and the Civil Rights MovementDo I have privilege?In this episode we turn the tables: listener Dr. Elisa Celis joins me to interview Dr. Ciara Smalls Glover, whose work focuses on building the cultural strengths of youth of non-dominant cultures and their families.  We discuss the ways that culture is transferred to children through parenting, how parents of non-dominant cultures can teach their children about race and racism, and how to balance this with messages of racial pride.  Get notified when the Parenting Membership reopens in May 2025This isn't a course that you take once and forget, and things go back to the way they always were.Whenever you get off-track, or when a new challenge pops up, we're here to support and guide you for as long as you're a member.The membership information page has all the details on what you’ll get when you join - monthly modules of content, the not-on-Facebook community, monthly group coaching calls, weekly ACTion groups with five other members and a peer coach, occasional 1:1 coaching sessions with Jen. Click the image below to learn more about the Parenting Membership!  Click the button on the right with the microphone on it to leave me a voicemail for the 100th episode!>>> Read Full TranscriptJen: 01:36Hello and welcome to the Your Parenting Mojo podcast. Before we get started with today’s episode, I just wanted to briefly remind you about a couple things I mentioned in our last episode. Firstly, I’m reopening the Finding Your Parenting Mojo membership group to new members in July. It’s a group for parents who love listening to the podcast and are onboard with the ideas that I described in it, but who find there is a pretty big gap between hearing something on a podcast once and actually being able to implement the idea in their real lives with their real families. So if you join, each month you receive a PDF guide on the specific topic that we’re covering that month. It isn’t a massive amount of new reading, but rather it synthesizes the most important points and walks you through a series of exercises to think through how to apply the principles in a way that’s relevant to your real family.Jen: 02:22You have a group call with me in the first half of the month to help you overcome any initial problems. And then a second one towards the end of the month as you refine your approach and by the end of the month you haven’t just read about some new thing you’d like to try, you’ve actually thought through how you’ll really implement it. You’ve tried it, maybe tripped up a bit and tried again and received support from me and all the other amazing parents in the group and you’ve actually started to see a shift in the way your family members interact with each other. So, you can find more about the group at YourParentingMojo.com/Membership. Secondly, if you’d like to see how the group works, please do sign up for the free online Tame Your Triggers workshop that starts on July 8th, which will help you to understand why you feel triggered by your child’s behavior and what you’re gonna do to avoid feeling triggered in the first place, and also manage your feelings better on the fewer occasions where they do still crop up.Jen: 03:11I see so many parents in online forums looking for help with the frustration, anger they feel when their children do things that just push their parents buttons, but it turns out there’s actually an enormous amount that we parents can do to avoid and manage these feelings rather than waiting for our children to grow out of these behaviors or trying to change the way our children behave. So, if you feel triggered by your children sometimes or perhaps quite a lot, then do head over to YourParentingMojo.com/Triggers to sign up for this completely free online workshop. You’ll get one email a day for the nine-week days following July 8th, each one containing information on a different piece of this puzzle along with a homework assignment that might be completing a quiz or responding to a journaling prompt. Now, I’ve put hundreds of hours of work into developing this workshop and I know that if you put in a little time and effort with me over those nine days, the payoff in your relationship with your child can be huge.Jen: 04:04So, do go to YourParentingMojo.com/TameYourTriggers to sign up for that free workshop. And finally we are inching ever closer to our hundredth episode. This is episode 93 and if you’d like to record a message for me to play in the hundredth episode, whether it’s letting me know about something you’ve learned from the show and how it’s impacted your family or a question that you have about the research on parenting or child development or a question for me about my life or my family, then do go to YourParentingMojo.com and look for that record icon to send me a voicemail. If you can use a headset that came with your smartphone then other listeners will surely appreciate it because it will dramatically improve the sound quality, but if you need to just talk straight into your phone or your laptop, then that will work too.Jen: 04:46I can’t wait to hear from you. Now on to today’s episode. Those of you who have been with the show for a while have probably been following the series of episodes I’ve been doing on the Intersection of Parenting and Race. The majority of these have been focused on Whiteness, partly because I’m White and I felt that I needed to explore these issues for myself and partly because I know that a good chunk of my audience is White and needed to explore these issues as well, but also a decent number of review are people of nondominant cultures. And when listener Elisa Celis who’s Mexican reached out and said, “Hey, what about an episode for us and what it means to parent a child of a nondominant culture?” I said, absolutely and you should come and co-interview with me. Elisa is also known as Dr. Elisa Celis, Assistant Professor of Statistics and Data Science at Yale University where she studies the societal and economic implications of things like fairness and diversity and artificial intelligence and machine learning.Jen: 05:38Welcome Dr. Celis.Dr. Celis: 05:39Thank you. It’s great to be here.Jen: 05:41We are here today to talk with Dr. Ciara Smalls Glover, who is Associate Professor of Psychology at Georgia State University. Dr. Glover obtained her Ph.D. from the University of Michigan and she studies the role of identity and parenting on reducing risk for communities of color with particular emphasis on academic and psychosocial outcomes for African American youth. She’s investigating patterns of racial socialization and racial identity as factors that promote positive development and reduce the impact of racial discrimination, which contributes to the development of interventions that build on the cultural strengths of youth and their families. If you’re interested in this topic and would like to continue the conversation with her, you can actually reach her on Twitter @CSmallsGlover. Welcome Dr. Glover.Dr. Glover: 06:24Thank you for having me.Jen: 06:25All right, so let’s dig right into the meat of this. I’m really curious about parenting styles and what parenting style is appropriate for children of nondominant cultures because it seems to me as though the vast majority of this research is done on White children and for them it’s relatively unequivocal and more democratic style where the parents are setting boundaries, but explain their reasoning to the child and incorporate the child’s views promotes the best child outcomes. But I’ve also seen research showing that a more authoritarian style where the parent kind of lays down the law and doesn’t really explain their reasoning or consider the child’s input actually isn’t terrible for African American children. And Elisa also mentioned having heard parents ask their children (they’re presumably rhetorical question), but how would you know your parents care if they’re not yelling at you? And they see shouting is normal because everyone loses their temper. But timeout, which is recommended by pediatricians is downright cruel. So firstly, I guess if we could start with how the perceptions of the way a person is parented intersect with outcomes?Dr. Glover: 07:29Oh, okay. This is a really thoughtful question Jen. So, we’ll back up a bit and talk about the way in which parenting is associated with different outcomes for children of different backgrounds and I think it’s important to preface this conversation by recognizing the heterogeneity within children and even within children of a particular cultural background and it’s in fact one of the reasons why we do find differences in how parenting and parenting styles play out in terms of child outcomes. So you’re right. In terms of the field, a lot of the literature has looked at a thing we call authoritative parenting, which is usually warmth and quality time coupled with a firmness and discipline and understanding that there are going to be rules that have to be respected and authoritarian parenting takes on a little bit of a different approach and that there’s usually a less warmth or fewer perceptions of warmth while still having these firm rules.Dr. Glover: 08:36And often these firm rules are a little less open to the input of the child. There are at least two other types of parenting styles that we could add to this conversation as well. One of which is more of a permissive style where there are fewer rules, a lot more openness as essentially the child is determining what the household rules are. And I’m more of a parent-as-friend approach and I can tell you about (those are not the only ones but for the sake of time I’ll just kind of focus on those) where we have seen research looking at outcomes for children of color. We do find differences in these three and we find universally both for children of color and children from dominant backgrounds. The permissive parenting is problematic for children’s adjustment. Children need rituals, they need a bit of routine to develop trust.Dr. Glover: 09:33So, in homes where there’s less of that, it makes it harder for the children to establish them. Where there is less consistency then is between the authoritative and the authoritarian. In families where the cultural norm is a firmer rule, a firmer hand, if you will in the home, less openness to hearing what the child’s input is in setting the rules. It’s actually perceived as loving and understanding by the child. So, we don’t see the strength of the same negative outcomes for child adjustment for families of color as we do with majority families with respect to the authoritarian. I’ll give one caveat to that though, and that is the perception really does matter, right? So that in families where the child perceives the stronger hand is being used because the parent loves them or the caregiver loves them and they’re doing it to protect them and keep them safe.Dr. Glover: 10:37It offers a safeguard from some of those more negative adjustment outcomes that we see in the literature. But where there’s universal agreement that what the family or caregivers doing is not out of love. We also see consistency and how that’s associated with poor outcomes for children. So, this is very much the case that children understand the cultural norm. Children understand the norm of the family, the individual family, the norm of the individual neighborhood. And that’s important to recognize as we talk about heterogeneity in families that the differences we see in child outcomes related to authoritative and authoritarian parenting are both a byproduct of cultural norms of the individual family as well as the norms that are demanded by the neighborhood and the context that they’re in.Jen: 11:31Isn’t that fascinating? I’ve definitely seen that result in studies of Chinese children as well, where a much more sort of strict style is perceived by the child as warm and loving. So that sort of brings me to the next question, which is, is it more important then to parent kind of in a way that’s in line with your culture in a way that’s line with the way that everybody else around you is parenting or more in line with these studies and what’s known in the literature about authoritative parenting and that often having better outcomes?Dr. Glover: 12:04Well, this I think is a two-part question and that what we do in families, we often do based on our own experiences in our families. So when we talk about what’s typical and what’s expected, well oftentimes parents are relying on the way that they were raised to inform what they’ll use with their families and using that as experience. Either they appreciated the way that their parents raised them and they’re going to parent in ways that are consistent with that or they’ve reflected on it and decided they want to intentionally change some things. So, I think that’s an important piece to this conversation. The parents are weighing on their own experiences. They’re also weighing on, when we think about parenting and the goal of parenting is raising an independent child, I think many families are thinking about what’s going to help that child get to a level of independence.Dr. Glover: 13:00And that’s really motivating a lot of their strategies in raising that child. So that might include things like recognizing. In order for my child to get to a level where they can be independent, I need to keep them safe. I need to keep them out of trouble. That requires that I parent them in such a way that they stay safe and that’s going to be dictated by the neighborhood, by the context that they’re in, whatever the threats are to the safety of that child where that family is living. It would also be determined by what the parent perceives as the responsibilities the child should be able to take on that are of course, developmentally appropriate. And Jen, I know you’ve raised this question earlier as well, inspired by I think what could be perceived as this cultural difference, but are there thoughts that either of you have about the parent that does want to parent more in line with their culture?Dr. Celis: 14:03Well, I think, I mean one thing for me and I think for many people we as a family keep moving, right? So kind of the culture that one had growing up either for myself or for my husband is I think for many people quite different than the one you ended up in now. So there’s also a bit of tension between even things that perhaps worked really well for you. They worked really well for you in that context and now you’re not in that context. So there’s a little bit of tension as to, well, did it work because it objectively works or did it work because of the surrounding neighborhood and with all changes now that I’m in this kind of new place with perhaps a different surrounding culture, raising my children here.Dr. Glover: 14:49That’s such a great point. It actually reminds me of a few television shows that kind of capitalize on that where you see a family that’s relying on the way they were raised to inform the way they raise their children, but their children are in an entirely different context and that’s a source of humor for these television shows, right?Jen: 15:08Ok, what show are you thinking of here?Dr. Glover: 15:10Well, I’m thinking of a couple and I don’t know this might take you back but the first example I’m thinking of is old sitcom called the Bernie Mac show. If you know anything about Bernie Mac, he grew up in a very rough side. He’s a comedian, grew up in a very rough side of Chicago, primarily raised by his grandmother who rule with an iron fist, if you will, because the neighborhood dictated that. He brought that parenting style to where the celebrities live in California and just for the sitcom in raising his nieces and nephews who could not be raised by their parent, he raises them with the same authoritarian lens where they’re saying, we want to go out and play with our friends.Dr. Glover: 15:54And he’s saying, you can’t. He’s raising them as if they were still living on the south side of Chicago, but they’re not, right? They’re living in this very beautiful home where celebrities live and he’s living the life of a celebrity. Another I think more recent example would be, Black-ish has a little bit of the same theme where the father was raised in a very rough neighborhood and brings that perspective to raising his children who also live in this very lovely suburb in California where the neighborhoods not necessarily demanding that he raised them in the same way and they use it as a source of humor because his wife grew up in a very different context that didn’t have those same demands in terms of safety.Dr. Glover: 16:39They get into discussions often about how they’re going to approach different choices with their children because they come at it with different experiences. You talk about this happening in real life because it very much makes a difference and what we think is working and whether we choose to continue to use something or not. I don’t think I mentioned this at the beginning of the broadcast, but I also have a very young child and so this has been a wonderful opportunity for me to both think about my upbringing which wasn’t a very rough neighborhood originally and then moved to a much nicer neighborhood in conjunction with the research that I do and consume. I love reading research on families and strengthening families and then my child’s lived experience where I need to take into account that child’s personality, the context that they’re living in and recognize how different it is from the one that I grew up

This episode began out of a query that I see repeated endlessly in online parenting groups: “My child has a really strong preference for me.  They get on great with the other parent (usually the father, in a heterosexual relationship) when I’m not around, but when I’m there it’s all “Mommy, Mommy, Mommy!”  This is destroying my partner; how can we get through this stage?” So that’s where I began the research on this question, and it led me down quite a rabbit hole – I’d never thought too much about whether mothers and fathers fulfill unique roles in a child’s development and while it isn’t necessarily as prescriptive as “the mother provides… and the father provides… ,” in many families these roles do occur and this helps to explain why children prefer one parent over another. (we also touch on how this plays out in families where both parents are of the same gender). My guest for this episode is Dr. Diana Coyl-Shepheard, Professor at California State University Chico, whose research focuses on children’s social and emotional development and  relationships with their fathers.   Parenting Membership  If parenting feels really hard, and it seems like you’ve read all the books and you’ve asked for advice in free communities and you’re tired of having to weed through all the stuff that isn’t aligned with your values to get to the few good nuggets, then the Parenting Membership will help you out. Click the banner to learn more and join the waitlist!     Click the “Send Voicemail” button on the right >>> to record your message for the 100th episode: it can be a question, a comment, or anything else you like!   Read Full Transcript (Introduction added after the episode was recorded and transcribed): Before we get started with today’s episode on the unique role of fathers in children’s development, as well as why children prefer one parent over another, I wanted to let you know about three super cool things that I’m working on you. The first is about my membership group, which is called Finding Your Parenting Mojo. I don’t mention the group a lot on the show because I don’t like over-selling, but a listener who was in the group the last time I opened it to new members told me she actually didn’t know I had a membership group, so I’m going to tell you a bit more about it this time around! The group is for parents who are on board with the ideas you hear about on the podcast based in scientific research and principles of respectful parenting, but struggle to put them into practice in real life. So if you find yourself nodding along and saying yep; I agree with the whole ‘no rewards and punishments’ thing and I’m on board with working with my child to solve the problems we have, and I really want to relax a bit around my child’s eating, but on the other hand you’re thinking: but rewarding with story time is the only way I can get my child to brush their flipping teeth, and how do I even get started with working with my child to solve problems? And if I ever did relax around my child’s eating then all they would eat is goldfish and gummy bears, then the group is for you. We spend a month digging into each issue that parents face – from tantrums to figuring out your goals as a parent and for your child to getting on the same page as your partner (and knowing when it’s OK to have different approaches!)…raising healthy eaters to navigating screen time and supporting sibling relationships; we cover it all. I’ll open the group to new members in July, and it closes at the end of July and on August 1st we start digging into our first topic, which is reducing the number of tantrums you’re experiencing. The cost for the group is $39/month this time around which is locked in for as long as you’re a member - I increased the price from last time, and I may increase it again next time the group reopens. Or if you sign up before July 18th, you can pay for 10 months and get the last two months of the year free. If you’d like to learn more about joining the membership group you can do that at yourparentingmojo.com/membership – the doors will open on July 1st. So that’s the deal with the group. The second cool thing I’m working on is something to give you a taste of what it will be like to be in the group. I’ve heard a lot of parents talking about how their children’s behavior really “triggers” them, and I was going to do a podcast episode on this and then I realized that this is especially one of those topics that you can’t just listen to and expect a change to happen; but if you’re willing to do a bit of work, that you can see enormous payoffs. So I thought OK; how can I really make the greatest impact possible with this work? And I decided to put together a nine-day online workshop to walk you through it. So if you go to yourparentingmojo.com/tameyourtriggers and sign up, staring on July 8th you’ll receive an email from me on each of the next nine week days that walks you through an aspect of this issue. In the first week we focus on where these triggers come from and it might surprise you to learn that it’s not our child’s behavior that is actually the origin of this feeling in us, but it’s things we remember, half-remember, and maybe even don’t remember from our childhoods. The more we know about those, the better we can manage these feelings when they arise in us. In the second week we look at new tools we can use to reduce the number of times we do feel triggered, and on the rarer occasions when it does still happen, to manage our reaction so we don’t blow up at our children. Now, you might have done these kinds of online workshops or challenges before and sometimes they ask you to do really simple things and you’re thinking “but I already do that!”. This workshop will be different. Each day you will get homework that you could do in about 15 minutes, although if you find that you are feeling triggered very often you would probably make a huge amount of progress if you could spare 30 minutes a day for not every day, but some of the nine days of the workshop. And these are not always easy tasks to do – I’ll be asking you to take a hard look at some potentially pretty uncomfortable aspects of your childhood, so you may need to do this gently and carefully. I’ll be doing short live videos in the Your Parenting Mojo Facebook group every other day or so which you don’t have to watch, but which you may find illuminate the daily emails which I deliberately made as short and concise as possible. By the end of the workshop you should have a great deal of insight into what really causes you to feel triggered, and how you can feel triggered less often and less intensely. And we will probably have a pretty big group of parents who are working through this alongside you, who can offer support and encouragement as you work through this. Obviously this isn’t exactly how the membership group works – we don’t do nine-day series of emails and Facebook Lives every other day; I actually send out a Guide at the beginning of the month and I answer your questions on two live group calls each month. But that format really works better once you’re already committed, and I wanted to be able to help you make real progress on a real issue you’re struggling with, so I decided the workshop was the best way to show you the kind of support you get in the group, even if the format is a bit different. So if you’d like to join the workshop, just head over to yourparentingmojo.com/tameyourtriggers and sign up – we’ll get started on July 8th. FINALLY, the last thing before we get to today’s episode is that you might have noticed that this is episode 92 of the Your Parenting Mojo podcast, which means we’re only eight episodes away from reaching 100! When I started the show two years ago I really had no idea where it was going to take me, or even how long it could last. I’m always worried that I will run out of topics to discuss but I’m happy to say that two years in I actually have a longer list of topics that I still have to find time to cover than I did when I started. As I started thinking about this, I did some back-of-the-envelope calculations…if I figure that on average it takes me about 20 hours to prepare for an episode, by the time I get to 100 episodes that will have been 2,000 hours, which is 250 days, which is very slightly less than a year, which means I’ve spent just a bit less than a third of the last three years preparing podcast episodes for you! If I figure there’s an average of 15 books and peer-reviewed papers on the reference list per episode, that’s 1,500 books and papers that actually made the reference list, and since only about half of the books and papers I read actually make the reference list I’ve probably read somewhere close to 3,000 of them in three years. When I started the show I was really just putting an intention out in the world to see where it might lead, and now I see that this work is what I want to do. It has – without a doubt – made me a better parent, and I want to use tools like the membership group to support you in your parenting as well. I keep producing the podcast episodes because I know that for some of you, a free resource is enough – and I know that by the reviews that you leave me on iTunes and the emails you send me that quite a lot of you get quite a lot out of the show. So I want to do something special for the 100th episode, and I’d love to have your voice be a part of it. If you go to yourparentingmojo.com, you’ll see a button on the homepage that you can use to leave me a voicemail. You could tell me something you learned from the show that has made a difference for your family, or a question you have either about the research on the show or about some aspect of my life that you wish you knew more about. Depending on how many voicemails I receive I’ll put all of you or a selection of you in the 100th episode, in your own voices, and I’ll answer your questions as well. So if you want to do this, just head over to yourparentingmojo.com and hit the icon to record a message. You don’t need any special equipment to do it; you can just speak right into your computer’s microphone, although listeners would probably thank you if you could plug in a headset with a microphone as this will greatly improve the sound quality. It doesn’t have to be a fancy one – just the kind that comes with a smartphone is fine. So head on over to yourparentingmojo.com to record your message and while you’re there, sign up for the Tame Your Triggers workshop and check out the membership group as well. OK, let’s get on with today’s episode!   Jen: 01:20 It's pretty obvious when you're reading the scientific literature on parenting and child development that just as most of the research on children's development is conducted on White children and then the findings are discussed as if they're relevant to all children everywhere. Most of the research on parenting is conducted on mothers and then its applicability to fathers is either extrapolated or it's just simply ignored. So, what role do fathers play in children's development? Our fathers basically like slightly less important mothers or are there unique processes involved in the relationship between fathers and children? Here with us today to sort this out is doctor Diana Coyl-Shepherd Professor at California State University Chico. Her research focuses on mother-child and father-child attachment across the span of childhood and she's especially interested in social and emotional development and children's relationships with their fathers. Welcome Dr. Coyl-Shepherd. Dr. Coyl-Shepherd: 02:15 Thank you, Jen. Jen: 02:17 All right, so let's start with, I guess it's kind of the son of the father of attachment theory. The father of Attachment Theory was John Bowlby and so you interviewed his son, Sir Richard Bowlby a few years ago. That must have been pretty exciting. Dr. Coyl-Shepherd: 02:32 It was very exciting. Having been a fan both professionally and personally of Attachment Theory for a long time, it was very exciting to meet the son of the author of that theory. Jen: 02:44 Yeah. And so that interview is available for anyone to read in a journal article in early childhood development and care journal. And so I was really shocked to learn that Richard Bowlby actually didn't really talk with his father about Attachment Theory at all and only started learning about it after his father's death. And I was wondering if you could tell us about the different role that Richard Bowlby proposed for fathers and mothers and why mothers had been such a focus of research for so long? Dr. Coyl-Shepherd: 03:11 Certainly. Well, what Richard proposed was a model of dual attachment and in the case of heterosexual parents, they would serve complimentary roles in their children's lives. So, mothers would be that safe haven providing care and comfort when children are distressed and fathers, as he observed and other researchers have to, more often were used for secure exploration. So, it was that mothers sensitive responding to their children's distress that increases children's opportunity to turn to their fathers for support during exploration and during challenging tasks. So, what Sir Richard Bowlby explained was that, and this is again based on other people's research as well, that we're driven to explore and seek new experiences, but we need safety and a trusted companion to show us the way. And in our own research we often had children report that they felt safety from their fathers, but more often sought emotional comfort from their mothers. So, each parent can serve both functions of attachment, safety, security and reassurance as well as exploration. But among Western heterosexual couples, we tended to see that mothers and fathers specialized in these areas. Jen: 04:24 Ah, that's fascinating. And so I'm thinking about the ways that we assess this attachment in a lab situation and typically it's using this procedure called The Strange Situation where the mother is withdrawn for certain periods of time and then we look to see how distressed the child is and whether the distress is relieved when the mother comes back. And so it doesn't seem to be that if the child doesn't come to the father to relieve distress, that they're not attached, right? Or is it possible that the way that we are conceptualizing this and the problem is with our measuring tools and not with the attachment between fathers and children. Dr. Coyl-Shepherd: 05:03 Exactly right. So, in The Strange Situation that measures in part mother's sensitivity to their children's distress, what it doesn't really measure is what fathers contribute to their children's attachment. And so it was really the research of the Grossmann’s and their colleagues. They did a 16-year longitudinal study, 44 families, and they compared mother's and father's contributions to their children's attachment at ages 6, 10 and 16 and at when the children were toddlers, they had developed this measure called the sensitive and challenging interactive play scale. And what they found, and it's an observational measure of the way that mothers and fathers engaged with their children during play, that father’s play sensitivity was very consistent across the four years and it was father's sensitivity that was predictive of children's internal working models of attachment at when their children were 10 and only fathers play sensitivity, not mothers was predictive of adolescents attachment representations. So, their conclusion was that mothers and fathers are doing different things to support their children's attachment security and consequently we need different ways to assess that. Jen: 06:16 And so I'm just curious as to how this works in sort of real life with real families and whether it doesn't seem as though it's sort of a one person is one role and one person is the other role because I'm sort of the parent who's more likely to stand back and watch as my daughter is climbing up something high and just kinda ask her what's your plan to get down rather than my husband will probably be the one to shout, be careful and we'll both pillow fight with her if she asks us to. So, is it confusing to her at all that that we have this sort of dual role thing going on or not? Dr. Coyl-Shepherd: 06:48 I don't think so. I think children's expectations of their parents’ behavior are based on their typical interaction with that parent. So, whatever they usually experience is what they expect to experience. And so if you are engaging in exploration with your child and allowing her to take risks and your husband might be the more cautious of the two that I think she would anticipate that that's the way it goes. That when I want to explore, mom will be my companion and she'll support this. But typically, and in lots of research, fathers do this more than mothers. It’s not that mothers aren't capable of it, it's just typically fathers do it more often. Jen: 07:24 Yeah. Okay. In an article that you and your coauthors wrote in an Introduction to a Special Issue on Fatherhood and Attachment, you said “The link between father attachment quality and children's outcomes are often less direct complicated by individual characteristics like child gender, temperament and father's working models as well as familial and cultural practices.” And that's pretty dense. Can you help us to tease that part a bit? Dr. Coyl-Shepherd: 07:48 Yes. There's a lot there. Well certainly, we know that there's research that supports gender differences in the way that parents interact with their children. So for example, that mothers engage with their daughters more frequently and they do more kinds of emotional and social discussion than they do with their sons and fathers more often engage with their sons and the kind of ways that they engage with their sons are activity oriented. So, that sort of supports this model that we're seeing, this idea of father’s activation relationships with their children but more with sons than daughters typically. So, there's a piece there that leads to maybe differential outcomes for children in terms of their social and emotional development based on the way and how often they interact with each parent. But also in culture. Culture plays a role as well because it's really, and this was sort of the argument that Dr. Danielle Paquette made when he developed his measure of the activation relationship of measure he called the Risky Situation is the idea that in cultures where competition is a part of that culture, then what fathers do by the way they engage with their children what he described as rough and tumble kinds of play and security and exploration, that helps children meet the demands in a society where there might be competition. Dr. Coyl-Shepherd: 09:07 How do they manage that competition? How do they manage relationships with others? So, more research I think is pointing to the contributions of fathers and sometimes it's sort of an additional contribution beyond what mothers are doing to support their children's social and emotional development. Jen: 09:27 So, I had a lot of questions about that rough and tumble play and because it seems to be a really critical component of children's relationships with their fathers, can you help us understand what's the purpose of this kind of...

This episode is part of a series on understanding the intersection of race, privilege, and parenting.  Click here to view all the items in this series. Each time I think I’m done with this series on the intersection of race and parenting, another great topic pops up! Listener Ann reached out to me after she heard the beginning of the series to let me know about her own journey of learning about her White privilege. Ann and her husband were a ‘normal’ White couple who were vaguely aware of some of the things they could do to help others (Ann works at a nonprofit) and saw politics as an interesting hobby. Then they adopted a Black daughter and had a (surprise!) biological daughter within a few months, and Ann found that she needed to learn about her privilege – and quickly. She’s had to learn about things like the features of a ‘high quality’ daycare for both of her daughters, how to keep them safe, and we get some feedback from Dr. Renee Engeln about how to help Black girls to see and be confident in their beauty. Ann is openly not an expert on this topic, and does not speak for adoptive Black children, or even for all White adopting parents. But she finds herself far further along this journey of discovering her privilege than the vast majority of us – myself included, until I began researching this series of episodes. Read Full Transcript Jen: 01:24 Hello and welcome to the Your Parenting Mojo podcast. When I started this series of episodes on the Intersection of Race and Parenting, I had no idea it was going to go on for so long. I had initially planned to do the episodes on White Privilege and Parenting with Dr. Margaret Hagerman and White Privilege in Schools with Dr. Allison Roda and then How To Talk About Race with Dr. Beverly Daniel Tatum. After the conversation with Dr. Tatum, I realized that we hadn’t talked a lot about what we should teach about topics like slavery and the Civil Rights Movement, and so we went on to cover that with Dr. John Bickford and then I got to chatting via email with Ann Kane who is a listener and who’s our guest today. And so before I tell you about Ann, I just wanted to tell you a snippet about my own journey toward learning about my privilege. Jen: 02:06 I was actually listening to an episode of The How To Get Away With Parenting podcast, which is published by my now friend, Malaika Dower. And in it Malaika made a comment about how it might not be safe for a Black toddler to have a tantrum in a store. And the implication was because the White parents would potentially find this threatening in some way. And if you’d ask me before that moment whether I had White privilege as a parent, I would have said, I really don’t think so because I’m really not sure I could have named a single way in which I experienced this. So uncovering my privilege has been a very deliberate exercise for me that’s taken a lot of hard work because the point of privilege is you don’t really see it. It’s there to protect you from having to see it. Jen: 02:48 But our guest Ann has been forced to confront her privilege in a completely different way. So Ann who is White, spent 10 years working in the field with Doctors Without Borders and she left to work in Program Finance for a nonprofit in New York City so that she and her White husband could raise a family and she adopted a daughter, Alice from the foster care system. Alice was 8 days old at the time and is now just over two and she is Black. And then Ann and her husband had a surprise baby named Audrey who is almost two and is White. So when Ann and I started emailing about this, she told me, “Raising Alice in a society that still has so much structural racism is my biggest parenting worry. I’m so afraid that my White privilege is going to harm her. There’s so much I’m unaware of. And as a White person, I don’t feel I can prepare her for all she’ll face.” Jen: 03:35 That’s when I knew I had to talk with Ann in an episode, because while she isn’t and doesn’t claim to be an expert on race or racism or raising a Black child, she’s been forced to confront her own privilege as a White person and as a White parent to a much greater extent than I have. And then I think probably many of my listeners have as well. So my goal for today is that perhaps you hear something in Ann’s journey that resonates with privilege you didn’t know you had, and maybe you’ll take an action to lift somebody else up who has less privilege than you. So with all that said, welcome Ann. Ann: 04:08 Thank you. Hi Jen. Jen: 04:09 Hi. Welcome to the backside of the microphone. Ann: 04:12 Okay. Jen: 04:13 So, we started each episode in this series with both me and my guests stating our privileges. And so you have heard this before and some of the listeners as well. So I’m just going to state mine really quickly. My Whiteness, my economic status in the upper middle class, heterosexuality, able-bodiedness, my education, and my presence on the land of the Chochenyo Ohlone native Americans to whom I pay a voluntary tax called the Shuumi Land Tax as a form of reparations. Could you please start by telling us some of your privileges? Ann: 04:43 Sure. I think I have pretty much all of the privileges. I’m White, my economic status is the upper middle class, I’m heterosexual enabled body. I have a Master’s Degree. My upbringing in a working middle class family back when it was more financially feasible to do so. I have two married parents who have always been supportive. I think the list goes on and on. Jen: 05:04 Okay. So, I wonder if you could tell us a bit about what you thought about racial prejudice and structural racism before you became a parent. Did you already have an understanding of your privilege? Ann: 05:16 I thought that I did. The more I learned, the more I realized how much I don’t know and how much I still need to learn. Before becoming a parent, I realized how unfair the world was to Black people, but it’s become so much more apparent as the parent of a Black child. Growing up, I was pretty clueless behind the basic history lessons of Martin Luther King and Rosa Parks. Race wasn’t something that was discussed in my family. However, as I get older, I moved to a diverse liberal city and started traveling internationally. So, I became more aware of our country’s long historical structural racism and how it still exists today. We knew when we became foster parents, it would most likely be for African American child. So, we did take that responsibility seriously and really tried to learn all that we can. But as I faced these issues on a daily basis with my daughter, I have learned how much I was unaware of and how much I still have to learn as she grows. Ann: 06:14 I don’t pretend to know anything about what it’s like to be a Black person in America, but being Alice’s mom has taught me a lot about my own privileges. Jen: 06:24 And so what are specifically some of the things that you’ve learned about your privilege as a person? Just as a White person, not even as a parent of a Black child over the last few months? Ann: 06:33 Sure. I think the main one is how much I didn’t have to think about things as I go throughout my life and have conversations in my job and with people on the street and I never have to question anything. I take it at face value that they’re talking to me as me and not as a minority or as how they view me because of my skin color as the dominant race in this country. I know that people are talking to me because of me and with Alice, I have these questions all the time. Is this because of her race or is it for something else that I’m not realizing? So that lack of understanding of how it’s in so many situations that race is a factor. Jen: 07:10 Yeah. I had one of those realizations recently. I went to an event at work, it was called a building bridges conversation and they started out with an exercise, they made us all dance around the room and of course as a profound introvert, this is extremely uncomfortable for me. And so I was kind of annoyed that they were doing this thing. Most of the people who work in a consulting firm are pretty extroverted. They get on well with clients and like socializing and that kind of thing. And I was annoyed that they were putting me in this situation. Jen: 07:41 And then I had a realization afterwards, what if this was how I felt at work all day, every day. The absolute discomfort with just being in this situation with people and also the annoyance that they would put me in that situation. And that was a really profound awakening for me. And I’m not sure that was the lesson I was intended to take out of it, but it was profound for me. So I wonder if we can go on and talk about some of the things you’ve learned since you became the parent of a daughter who’s Black. You told me that you can no longer live just anywhere and you have to live in an accepting community with people who look like Alice and so I think you live in Harlem right now (which for those of you who don’t live in the US is a neighborhood of New York that 60% Black and it holds a huge place in Black history and culture). Did you live there before you became a parent? Ann: 08:30 Yes, I moved here to go to Grad school roughly 15 years ago. Jen: 08:33 Oh, okay. And why did you pick that neighborhood? Ann: 08:37 It is near the university that I attended. It’s actually been gentrified quite a lot. I’m not far from a predominantly White university, but this area was within walking distance but still did not have a lot of White people. And I moved in basically for affordability issues and I have seen gentrification and how it’s affected my neighbors in my neighborhood as I’ve been there quite a while now. Jen: 09:01 Yeah. And so I’m curious about whether you’ve taken Alice to predominantly White neighborhoods, maybe to visit your family or friends and are the interactions between Alice and that community different than when you’re in Harlem? Ann: 09:15 Sure. We have been to various areas that are predominantly White and we grew up with White families. So, this is the norm for us. Most of the blatant things we’ve been warned about, for example, being followed around by (in stores) security guards, scary interactions with Police, obviously aren’t things that are happening to a 2-year-old. Most of her interactions go through us simply because she’s not old enough to have full conversations. We’ve heard this from other adoptive parents that they turned from cute children into adults quite quickly in the public’s eyes and you’ll start to see these things. But so far our interactions have been different in these areas, but not in that regard. In these areas, what we’ve noticed is there is a certain kind of othering. I feel like they pay more attention to Alice and not in a negative way, but they kind of fond over her in a way they don’t with our other daughter who’s only 5 months younger. Ann: 10:07 They tried to touch her hair, which of course we don’t allow and go on about how beautiful she is. I obviously don’t know their intention, but it feels like their way of saying they approve of her, our family without directly coming out and saying that, which is obviously a nice gesture and it’s better than the alternative, but other ways it seems unnecessary and we’re not asking for permission to be us or her. I’ve read these feelings from other transitional families, so I don’t think I’m totally imagining it. However, it goes back to some of the things I discussed earlier is when you’re a White person you never have to question your interactions with others. In this case, is it because she is cute? Obviously I think she’s cute. Are they only paying attention to her by chance or is this a racial thing where they’re trying to make us feel accepted? Jen: 10:52 And is this primarily White people who are doing this? The touching? Ann: 10:57 Yeah. Yeah. Mostly. Jen: 11:00 Okay. All right. Yep, that makes sense. And I’ve definitely heard about that as well, that White people feel as though they have to sort of exhibit this acceptance in ways that potentially aren’t so appropriate on the receiving end of it. I wonder if we could talk a little bit about daycare. What kind of setting do your daughters attend now and how did you choose that? Ann: 11:19 Sure. Our daughters are in a small in-home daycare run by an African American family. Making sure Alice was around people who looked like her was our number one priority with other priorities being of course, we want a loving environment that keeps the girls safe and happy. We also wanted something within walking distance to our home because we wanted to build a community within our neighborhood. And logistically taking two babies on the subway ride everyday didn’t seem doable. When searching, we didn’t find many places that had both Black and White children. There seems to be daycares with mostly all Black kids or daycares with mostly all White kids. And for the first year our daughter who’s White, Audrey was the only White child at the daycare. But now there’s one or two other White children. It’s been such a blessing, this daycare. I don’t know if I’m being honest, we probably wouldn’t have prioritize this as much and we might have missed out on the chance to go to this school that our girls love and that we love. They really treat them like family. The grandma (all the kids call her grandma Barbara) helps us with Alice’s braids, something that I’m still working on and we’ve just been very lucky to have found such an important place in our life. Jen: 12:31 Yeah. So, I’m curious about whether you think Audrey might have benefited in the same way from attending that daycare if Alice wasn’t in the picture, you were still living in that neighborhood anyway. It was still an option. What direction do you think you might’ve gone in for Audrey’s care? Ann: 12:46 Hard to say, but our number one priority wouldn’t have been diversity. We would have looked for it, but in our experience we didn’t find it. It was mostly all Black or mostly all White were the two options. Audrey has us that look like her, so we felt like we’d prioritize that for Alice. And she definitely benefits from being there. It’s an amazing environment filled with people that take good care of her and her friends. At the age of two, she loves it very much. So, I think she’ll learn to be with people that looked different than her as she grows also. Jen: 13:20 Yep. And how are you preparing both Alison and Audrey for school? What kind of school environment do you think you’ll choose and how are you getting ready for that? Ann: 13:29 Sure. We will most likely go public schools, there’s quite a few public charter schools in our neighborhood that we’ll be looking into. My husband and I are products of public schools and had positive experiences that we would want to give our children, New York City and our neighborhood. Those are the most diverse options which would be our top choice. Again, it’s what we’ll have to prioritize to make sure Alice sees people that look like her on a daily basis. I think picking schools, our definition of what a good school because we have a Black child has changed. Maybe in the past we would have focused only on test scores or other indicators that most White parents are using. But now while those things we will look at, they’re not our number one priority. Jen: 14:11 And so is it that you see diversity as more important or is it that you see that test scores are not necessarily an indicator of what is good about a school? Ann: 14:22 I think both. I think it’s reprioritizing what you think is the best opportunity for your child. And while I want both of my girls to get good grades and learn all the textbook facts, I think it’s more important that they’re good people. And I think the way to do that is to have them around people who look different than them and have different religions and have different viewpoints so they can learn from their experiences also. Jen: 14:46 Okay. So your sort of understanding of this and your approach to school has probably shifted a little bit because you’ve had this experience, right? You’re not necessarily going to look for the public school with the highest test scores, which you might have done previously? Ann: 14:59 Exactly. And I think it is another area that shows my White privilege in a different way. I haven’t seen a lot of research that says if you put a White child in an adequate school, as long as they have adequate supports at home, they’re mostly going to do okay. So, we would have certainly searched for Audrey, but it doesn’t seem that it’s as important or significant as it feels with Alice. We have to get this question right with Alice, because there is a lot of research that shows that many schools are failing the country’s Black children, and I wanted to make sure she’s not facing that. Jen: 15:31 Yeah. We definitely learned in our episode on White Privilege in Schools which will have been released by the time this episode goes out that more than half of parents say they value diversity in national surveys, but they aren’t willing to travel further to attend a diverse school and possibly less of a concern in New York City where everything’s a little closer together. Although it might involve a subway ride with young children, but there are definitely parts of the country where you’re going to be bused across town if diversity is important to you. And so I think what parents need to think through is do you think it’s going to be critical to your child’s success? And I think there’s a lot of indicators that say that content knowledge and being able to pass the test is one part of being successful. And that being able to get along well with other people and not just get along with them, but know how to collaborate with them is going to be an even more critical skill in the future. So, I think that your approach of selecting for diversity is actually going to end up benefiting both of your children more than potentially a school that just has high test scores. Ann: 16:34 That has been my experience with a lot of these things like I mentioned with the daycare, we wouldn’t have found it, but it’s been such a blessing. So, diversity isn’t always easy and sometimes there’s some uncomfortable with it while it’s happening, but in the long run it’s better for our whole family. Jen: 16:50 Okay. I wonder if we can just dig into that for a minute. What kinds of discomfort do you experience that other White parents who might be thinking about this might be thinking, yeah, I could make that extra step, but it just doesn’t feel right. It feels as though my child is going to be missing out. How would you describe how that’s played out for you and what would you say to those parents? Ann: 17:08 Sure. For us it feels like we’re learning what Alice might feel like. We do go to preschool events and the graduations and things and we’re the only White people in the room and that’s the norm for Alice in her life because her family is White and her grandparents are White. And that’s what she’s going to have to deal with. We want to counteract that as much as possible by getting other people that look like her around her. But it’s not going to be a reality. It’s not the reality of many Black people in many workplaces and then in many cities. So, I think recognizing when it feels like to be the person who’s not in the majority has helped us when we...

This episode comes to us courtesy of my friend Jess, whose daughter has Sensory Processing Disorder (SPD) and who is on a mission to make sure that as many parents as possible learn about it. She says that every time she describes it to a parent they realize that they know someone who exhibits behavior that looks like SPD that warrants following up. I have to say that I was highly ambivalent about doing this episode, because I don’t usually deal with topics that result in medical diagnoses as I’m (obviously) not a doctor. But the more I looked into this the more I realized that helping parents to understand the mess of research on this topic is exactly the kind of thing that I usually do on this show, and that an episode on this topic could probably be useful to a number of you. And here’s the love letter to John McPhee that I mention in the episode     Read Full Transcript Hello and welcome to the Your Parenting Mojo podcast. Today’s episode on Sensory Processing Disorder comes to you courtesy of my friend Jess, and I’m going to tell you a little about Jess and her daughter as a way to introduce the topic. Jess told me that her daughter likely had a mini-stroke either in utero or during birth that affected the left side of her body, and Jess figured this out around the time her daughter was 10 months old. So her daughter started physical therapy for that, but Jess still felt as though something wasn’t quite right, and while she already had a pediatrician, physical therapist, and neurologist, six months or so of Jess being (in her words) “a crazy parent,” along with the support of her mother who happens to be a pediatric physical therapist, to convince her daughter’s support team that something wasn’t right, and finally her daughter was evaluated for sensory processing disorder. Her daughter received occupational therapy treatment and is now doing very well. Jess realized that if she hadn’t been especially vocal, and if she hadn’t had her own mother’s expert support, then it’s possible that her daughter’s issues would have gone undiagnosed. Jess told me she has started talking with anyone who will listen about this topic and whenever she mentions it a lightbulb goes off with whomever she is talking with about either a child in their lie or a friend of a friend who is having similar issues, so she asked me to do an episode on it so more people could learn about it. Now I have to say that as much as I love Jess I did hesitate before taking this on. I don’t usually deal with topics that result in medical diagnoses because I’m obviously not a doctor or a psychiatrist. But the more I looked into this the more I realized that helping parents to understand the mess of research on this topic is exactly the kind of thing that I usually do on this show, and that an episode on this topic could probably be useful to a number of you. So, to reiterate, I am not a doctor or a psychiatrist, and this episode is not intended to diagnose, treat, cure, or prevent any disease. In fact, for reasons we’ll get into in the episode, it’s actually kind of difficult for a doctor to diagnose as well. So we’ll talk about diagnoses, and about the efficacy of treatment for SPD, and finally about how to chart a path forward if you suspect that your child may have difficulties processing sensory information. So let’s get into it! For those of you who haven’t heard of it before, what is sensory processing disorder, and where did it come from? The research in this field was pioneered by Dr. A. Jean Ayres, who was an occupational therapist active from the 1960s to the 1980s. Dr. Ayres’ classic book is called Sensory Integration and the Child, and was re-released in 2005 in a 25th anniversary edition. In the book, Dr. Ayres describes sensory integration, which is the organization of our senses, which give us information about the physical conditions of our body and the environment around us. She says that the brain has to organize all of these sensations if a person is to move and learn and behave in a productive way – for example, by making your eyes, nose, mouth, skin, muscles, and joints work together to peel and eat an orange, and that an adaptive response to a sensory experience is a purposeful and goal-directed one. When we have an adaptive response we master a challenge and learn something new. Until the child is about 7, they are primarily a sensory processing machine – they sense things and respond, without having many abstract thoughts and ideas. Dr. Ayres says that the brain’s mental and social functions in the later years are based on this foundation of sensorimotor processes, and if sensorimotor processes are well organized in the first 7 years, the child will have an easier time learning mental and social skills later on. Dr. Ayres died in 1989, and Dr. Lucy Jane Miller has carried the flag on this work. Dr. Miller is the director of the Sensory Therapies and Research Center in Denver, Colorado, and has written her own book called Sensational Kids: Hope and Help for Children with Sensory Processing Disorder. In Dr. Miller’s book she shifts Dr. Ayres’ original six syndromes of sensory integration dysfunction into three main “pattern types” with a number of subtypes. Pattern Type 1 is Sensory Modulation Disorder (SMD), and results when a person has difficulty responding to sensory input with behavior that is appropriate to the degree, nature, or intensity of the sensory information. Dr. Miller’s book describes SMD as having three main subtypes, although her own peer-reviewed research has only found support for two of these – sensory seeking, and sensory underresponsivity. In Subtype 1, Sensory Overresponsivity (so the one that doesn’t have peer-reviewed research support), people respond faster, with more intensity, or for a longer duration than people with typical sensory responsivity. It may occur in only one sensory system (like not wanting to be touched) or in multiple systems. Difficulties are most often seen in new situations and during transitions, and the responses may appear as willful behavior, seemingly logical, and inconsistent. For example, a child with this subtype may not be able to tolerate being jostled as coats are being put on at preschool for the transition to outdoor play, and may lash out at another child in response. Behavior may also result from cumulative stresses, so the jostle while putting coats on might just trigger the response that has built up as a result of a whole morning of being jostled and touched through normal interactions. People with Subtype 2, Sensory Underresponsivity, disregard or do not respond to sensory stimuli. A child may seem apathetic, lethargic, and lacking an inner drive to socialize and explore. They might not notice bumps, falls, or cuts, or extreme eat or cold, and may be labeled ‘lazy’ or ‘unmotivated.’ As an infant, the child might have been considered a ‘good baby’ or an ‘easy child’ but when they become older they may not be able to maintain enough arousal to participate in family or school life. People with Subtype 3, Sensory Seeking/Craving, crave an unusual amount or type of sensory input, possibly including spicy food, loud noises, visual stimulation, and constant spinning, which can lead to socially unacceptable or unsafe behavior and can be perceived as demanding or attention-seeking. They may become explosive or aggressive when they are unable to meet their sensory needs – for example, when they are asked to sit still and be quiet at school. This subtype can be confused with, and even co-occur with, attention deficit hyperactivity disorder, or ADHD. People with Pattern 2, Sensory Discrimination Disorder, have trouble interpreting qualities of sensory stimuli and tell how they are similar and different; this characteristic may be present in just one or more than one sense. SDD in the tactile, vestibular, and proprioceptive systems, which tell you where your body is in the world, results in awkward motor abilities. SDD in the visual or auditory systems can lead to learning or language disabilities. There are two sub-types to Pattern 3, which is Sensory-Based Motor Disorder. In Subtype 1, Postural Disorder, the person has difficulty stabilizing the body during movement or at rest. The child may have low muscle tone, inadequate control of muscles and movement, and poor balance. In Subtype 2, Dyspraxia, the person has difficulty conceiving of, planning, sequencing, and executing actions. They may appear awkward and poorly coordinated in their gross motor skills like running and jumping, fine motor skills like drawing and painting, or oral-motor skills like chewing and swallowing. They seem unsure where their body is in space, have trouble with ball sports, and any actions involving coordinated timing. Where does SPD come from? Dr. Ayres herself acknowledged that we don’t really know what causes SPD, but she goes on to make quite a variety of speculations. She says “Many people think that the increase in environmental toxins, such as air contaminants, destructive viruses, and other chemicals that we take into our bodies may contribute to the dysfunction,” without offering a shred of supportive evidence from these “many people.” She hypothesizes that hereditary and chemical factors may be combined in some children, and that genetic factors in certain children may allow environmental toxins to interfere with sensory integrative development. Some babies do not get enough oxygen at birth, which may affect brain function, and that children who lead very deprived lives – like the children in the Romanian orphanages from the 1980s who had very little human contact – don’t develop adequate sensory, motor, or intellectual functions. But lest you start blaming yourself for your child’s problems, she goes on to say that most of the children with minor irregularities in brain function have had normal sensory experiences, and their parents or guardians did do a good enough job of raising them to allow for good brain development so the parents did not deliberately or accidentally produce the dysfunction. When I was researching this episode I got a question in the Your Parenting Mojo Facebook group about whether there’s any evidence about how children’s diets impact their sensory processing, and I have to say that this view is VERY popular in the online community groups related to SPD but I’m afraid there is zero evidence whatsoever in the peer-reviewed research, or even in the books by Dr. Ayres and Dr. Miller, that implicates children’s diets in causing or worsening SPD. The only potential connection I could see is that a child may be unwilling to eat if they find the textures of some foods to be difficult to deal with, but there is zero evidence that SPD is caused by gluten intolerance or eggs or sugar or food coloring or any other kind of food. I want to put a couple of side notes in at this point. Firstly, I’m also looking at doing an episode on Dr. Elaine Aron’s work on Highly Sensitive People, and in one of her papers Dr. Aron actually expressly makes the distinction that being a Highly Sensitive Person is different from Sensory Processing Disorder. In her book The Highly Sensitive Child, Dr. Aron says that many parents have told her they have found sensory integration to be helpful for their highly sensitive children, but she doesn’t think that being sensitive as she defines it is a problem to be treated, much less cured. Secondly, a couple of listeners have been in touch about unintegrated reflexes, and since the topic has a bit of an overlap with this one I’d like to address that here too. All babies have reflexes – one of the more famous ones is the Moro reflex which is when the infant spreads their arms and hands out and then pulls them in, usually while crying, when they feel they’re falling. In most infants this reflex goes away, which we call becoming “integrated,” by around four or five months of age but in some children this reflex doesn’t become integrated and the child will still produce it when they feel like they’re falling. There is quite a bit of evidence showing that unintegrated reflexes are *correlated* with a variety of developmental disabilities, but I’m afraid that’s pretty much where the evidence ends on this topic. It’s a bit hard to get your head around because nobody seems to have done any kind of meta-analysis to synthesize the results except the Wisconsin Department of Health Services which briefly reports that this therapy remains an “untested treatment, as there are no studies that have tested its effectiveness. There is no evidence to suggest that it is harmful.” Also, the main figure doing the research is Dr. Svetlana Masgutova is the creator of the Masgutova Neurosensorimotor Integration Method® and she’s also done a good chunk of the research on the effectiveness of the eponymous method. Unfortunately, methodological problems abound in the paper she’s done that’s most relevant to us, which is on the use of the Nurosensorimotor Integration Method in treating symptoms of Autism Spectrum Disorder. In that study she trated 484 children with autism, but the control groups were only 72 children with Autism who weren’t treated, and 483 children with neurotypical development. A more robust methodology would have compared the treated children with a much larger group of children who received comparable attention from a therapist and traditionally accepted treatment to compare the reflex integration treatment with traditional treatment, rather than with no treatment. It’s well-known that just attention from a therapist can produce a therapeutic effect even when the treatment itself doesn’t have any effect at all. And the results produced changes in reflex patterns, which were correlated with improvements in cognitive abilities, but since there’s no mention in the study of the children being randomly assigned to treatment or control groups, we can’t say with any certainty that the treatment *caused* these improvements. So that’s that. And while we’re on the topic of co-morbidity, which is two or more chronic diagnoses in the same individual, some authors estimate that the majority of children with autism spectrum disorders have SPD, although not all children with SPD have autism. SPD is also very difficult to diagnose, and this topic brings me to the part of the episode where I’m not going to just recite what Dr. Miller and Dr. Ayres say but bring a bit more of a critical perspective. SPD is actually not included in the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders, which is abbreviated as DSM-V, which is the standard diagnostic guide for psychological diagnoses, although I should acknowledge that what makes it into the DSM is as much a political issue as a diagnostic one – the first and second editions of the DSM included homosexuality as a mental disorder and it wasn’t removed until 1973. Dr. Ayres developed a Sensory Integration and Praxis test which has been described as “the most comprehensive and statistically sound means for assessing some important aspects of sensory integration, most notably praxis and tactile discrimination,” but apparently five of the 17 subtests are unstable, which means that the same child is likely to get different results each time they are tested. Dr. Ayres reported that scores on the test were different for children with and without learning disabilities, although subsequent analyses of her work showed there were actually no reliable differences between the scores of children with and without learning disabilities, which is a pretty big problem. The American Academy of Pediatrics published a position paper in 2012 stating “it remains unclear whether children who present with findings described as sensory processing difficulties have an actual “disorder” of the sensory pathways of the brain (and I will note, Dr. Ayres says they do), or whether these deficits represent differences associated with other developmental and behavioral disorders. Specifically, the behavioral differences seen in children with autism spectrum disorders, attention-deficit/hyperactivity disorder, and developmental coordination disorders overlap symptoms described in children with sensory processing disorders. Studies to date have not demonstrated that sensory integration dysfunction exists as a separate disorder distinct from these other developmental disabilities. Furthermore, numerous challenges exist for evaluating the effectiveness of sensory integration therapy, including the wide spectrum of symptom severity and presentation, lack of consistent outcome measures, and family factors, which make response to therapy variable.” The APA officially recommends that “At this time, pediatricians should not use sensory processing disorder as a diagnosis.” Dr. Miller’s team published a paper in 2014 describing the development of a new scale to diagnose SPD, but it focused on only some of the sub-types and the study was conducted on only 20 children, and only 10 of those actually had a developmental disorder, with the other 10 being typically developing children in a comparison group. Dr. Miller does acknowledge that “the standardization of a reliable and valid scale to assess SPD is essential for the field to move forward” but at the moment, we don’t have one. So I want to set this issue of diagnosis aside for a bit and talk about prevalence and treatment, because that is, after all, how we got here in the first place – after occupational therapy was successful for my friend Jess’ daughter. The most widely cited study on the prevalence of SPD was conducted by Dr. Miller and her colleagues, where the researchers sent surveys out to the parents of one suburban public school asking about whether their children exhibit symptoms of SPD. Only 39% of the parents responded, and the researchers were conservative in assuming that none of the parents who didn’t respond who had children who had these symptoms, and based on this they came up with a prevalence rate of 5.3%. If you assume that the children of the non-responding parents had symptoms at the same rate as the responding parents then the prevalence rate goes up to 13.7%. Of course, there are a variety of problems with this – firstly, that this is a suburban school district of mostly white, middle class parents who may be more likely to look for symptoms in their children and report these to a set of researchers. The second problem is that 39% of parents from one school really is a pretty low response rate to base this kind of determination on, even if you are going to assess the results conservatively. Thirdly, the researchers didn’t make any attempt to study comorbidity, which is the concept of having more than one infliction at once, and as we already know SPD has a LOT of symptoms in common with other potential diagnoses. And, finally, there’s the predictable issue we see with so much other research on this show – we see a heavily caveated result in a paper that gets grasped by other researchers and reported as if it were fact: for example, a 2013 paper reports that “Mental health practitioners, however, may have limited information or understanding of [SPD]. This is concerning, as [the disorder] is estimated to occur in 5% of the general population (Ahn et al. 2004), equating to three million children in the United States (United States Census Bureau 2008).” Another set of researchers report that “In fact, Ahn, Miller, Milberger, and McIntosh found that 5-15% of children in the general population of kindergarten-age children demonstrate difficulties with sensory modulation” when in fact it would be irresponsible to generalize from...

In this second episode of Sharing Your Parenting Mojo we talk with Rose, who is American but lives in Germany, about discussing math with girls – as well as with managing her daughter’s sugar intake. Here’s Rose’s blog, where she discusses what she thought of my Parenting Beyond Pink and Blue episode. If you’d like to be interviewed for Sharing Your Parenting Mojo, please complete the form located here and I’ll be in touch if there’s a fit…