Children And Divorce—

One out of every two marriages today ends in divorce and many divorcing families include children. Parents who are getting a divorce are frequently worried about the effect the divorce will have on their children. During this difficult period, parents may be preoccupied with their own problems, but continue to be the most important people in their children's lives.

Coping with anger:

·Give your children opportunities to express their anger openly and without judgment.
·Listen to your children. Try not to react to their anger with displays of your own anger or by taking it personally.
·Resist the urge to fix situations that are not fixable.

While parents may be devastated or relieved by the divorce, children are invariably frightened and confused by the threat to their security. Some parents feel so hurt or overwhelmed by the divorce that they may turn to the child for comfort or direction. Divorce can be misinterpreted by children unless parents tell them what is happening, how they are involved and not involved and what will happen to them.

Coping with shock and traumatic stress:

· Be patient with them.
· Ease into the new routines and living situations, if possible.
· Express your love for them.

Children often believe they have caused the conflict between their mother and father. Many children assume the responsibility for bringing their parents back together, sometimes by sacrificing themselves. Vulnerability to both physical and mental illnesses can originate in the traumatic loss of one or both parents through divorce. With care and attention, however, a family's strengths can be mobilized during a divorce, and children can be helped to deal constructively with the resolution of parental conflict.

Steps to take care of yourself:

· Take care of your health and your children’s health.
· Provide and eat a balanced diet.
· Pray, meditate or practice the relaxation response.
· Exercise and play to relieve stress.
· Build your support group. Old friends may become casualties in divorce battles.
· Avoid isolating yourself from people.

Talking to children about a divorce is difficult. The following tips can help both the child and parents with the challenge and stress of these conversations:

· Admit that this will be sad and upsetting for everyone.
· Be emotionally available to comfort them. Even if there has been much conflict in the home, children may deeply experience the loss of the leaving parent, or the loss of hope for reconciliation.
· Be respectful of your spouse when giving the reasons for the separation.
· Do not discuss each other’s faults or problems with the child.
· Do not keep it a secret or wait until the last minute.
· Keep things simple and straight-forward.
· Make plans to talk with your children before any changes in the living arrangements occur.
· Plan to talk when your spouse is present, if possible.
· Reassure your child that you both still love them and will always be their parents.
· Remind your children of your love.
· Tell them about changes in living arrangements, school or activities. Let them know when they will happen. But do not overwhelm kids with details.
· Tell them that your marriage problems are not their fault. Let them know they are not responsible for fixing them.
· Tell them the divorce is not their fault.

Steps to reduce traumatic effects of a divorce on your children:

· Allow your children to communicate openly. Encourage them to describe their feelings and express the sadness, fear and anger they may be experiencing. This gives you an opportunity to provide comfort and reassure them that they will be loved and continue to be cared for and safe.

· Be honest about the potential for emotional trauma on each of your kids. Some children respond to adversity by withdrawing emotionally or freezing. These quiet children may be more upset, and in greater need of help, than children whose emotional upset is obvious.

· Choose to focus on the strengths of all the family members.

· Develop an amicable relationship with your spouse, as soon as possible, and be polite in your interactions.

· Do not argue with your spouse in front of your children or on the phone.

· Find support for yourself and your children. It takes a village to get things right. Reach out and ask for help from friends, family members, religious and secular support groups, counselors and therapists.

· Offer your children choices, whenever possible, to increase their sense of power over their lives. These can include food choices, clothing choices and other choices that don’t disrupt your routines or endanger their well-being.

· Provide continuity. Children need the sense of continuity provided by a certain amount of structure such as dependable meal and bed times, leisure and work times.

· Refrain from talking with your children about details of your spouse’s negative behavior.

Parents should be alert to signs of distress in their child or children. Young children may react to divorce by becoming more aggressive and uncooperative or withdrawing. Older children may feel deep sadness and loss. Their schoolwork may suffer and behavior problems are common. As teenagers and adults, children of divorce can have trouble with their own relationships and experience problems with self-esteem.

Coping with anxiety:

· Listen patiently as they express their fears and worries, even if they repeat them over and over again.

· Provide as much stability, security and consistency as possible. An anxious child often appreciates a consistent routine, seeing familiar people and going to regularly visited places.

· Provide choices for children whenever possible. This will help to re-establish a sense of control over their lives.

· Respond honestly and supportively to their concerns. If their worries are well founded and may occur, acknowledge that fact as gently as possible.

Children will do best if they know that their mother and father will still be their parents and remain involved with them even though the marriage is ending and the parents won't live together. Long custody disputes or pressure on a child to "choose" sides can be particularly harmful for the youngster and can add to the damage of the divorce. Research shows that children do best when parents can cooperate on behalf of the child.

Coping with depression:

· Seek professional help. Short-term cognitive behavioral therapy helps many children deal with depression and correct false perceptions about themselves and life.

· Reassure them that these feelings will decrease over time and help them notice times when they seem to be feeling better. Let them know that it is OK to feel better and to move forward, even though their life circumstances are different.

· Promote physical activity.

· Encourage them to express their sadness as well as their anger with you, a favorite relative, or another responsible adult with whom they feel safe.

Parents' ongoing commitment to the child's well-being is vital. If a child shows signs of distress, the family doctor or pediatrician can refer the parents to a child and adolescent psychiatrist for evaluation and treatment. In addition, the child and adolescent psychiatrist can meet with the parents to help them learn how to make the strain of the divorce easier on the entire family. Psychotherapy for the children of a divorce, and the divorcing parents, can be helpful.

Kids also need skills to manage stress and coping with situations over which they have no control. Problem solving skills can help kids adjust to the issues of divorced families. Additional skills and support may come from:

· Faith-based counseling. Some religious organizations provide support for families that are going through a divorce or dealing with the effects of a divorce.

· Family friends. Visits or outings with family friends may also be helpful for kids who need help adapting to a divorce.

· Relatives. Sometimes aunts, uncles or grandparents may provide a familiar environment where kids can share their deeper feelings. When parents do not want their children to visit the ex-spouse’s relatives, it may help to honestly question if that decision is in the best interest of the child.

· School counselors. In some schools, counselors may provide services for a limited time.

· Teachers. Educators should be informed when parents are separating or divorcing. They can provide valuable support during the many hours your child is in school. It also helps them understand your child’s behavior and prevent problems with classmates and grades.

· Trained mental health professionals. A child or family therapist can help children express and work out their complicated emotions in a safe environment, and can help normalize and stabilize the child’s situation. Some therapists may also conduct counseling groups for children, which helps decrease the sense of aloneness in this new life problem.

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Bedwetting—

Most children begin to stay dry at night around three years of age. When a child has a problem with bedwetting (enuresis) after that age, parents may become concerned.

Bed-wetting, also known as nighttime incontinence or nocturnal enuresis, isn't a sign of toilet training gone bad. It's often just a developmental stage.

Children who've never been dry at night are considered to have primary enuresis. Children who begin to wet the bed after at least six months of dry nights are considered to have secondary enuresis.

Generally, bed-wetting before age 6 or 7 isn't cause for concern. At this age, nighttime bladder control simply may not be established.

If bed-wetting continues, treat the problem with patience and understanding. Bladder training, moisture alarms or medication may help.

Physicians stress that enuresis is not a disease, but a symptom, and a fairly common one. Occasional accidents may occur, particularly when the child is ill. Here are some facts parents should know about bedwetting:

· Approximately 15 percent of children wet the bed after the age of three
· Bedwetting runs in families
· Many more boys than girls wet their beds
· Most bedwetters do not have emotional problems
· Usually bedwetting stops by puberty

Persistent bedwetting beyond the age of three or four rarely signals a kidney or bladder problem. Bedwetting may sometimes be related to a sleep disorder. In most cases, it is due to the development of the child's bladder control being slower than normal. Bedwetting may also be the result of the child's tensions and emotions that require attention.

Bed-wetting can affect anyone, but it's more common in boys. It also tends to run in families. A child with two parents who wet the bed as children has an 80 percent chance of wetting the bed, too.

There are a variety of emotional reasons for bedwetting. For example, when a young child begins bedwetting after several months or years of dryness during the night, this may reflect new fears or insecurities. This may follow changes or events which make the child feel insecure: moving to a new home, parents divorce, losing a family member or loved one, or the arrival of a new baby or child in the home. Sometimes bedwetting occurs after a period of dryness because the child's original toilet training was too stressful.

Parents should remember that children rarely wet on purpose, and usually feel ashamed about the incident. Rather than make the child feel naughty or ashamed, parents need to encourage the child and express confidence that he or she will soon be able to stay dry at night. Parents may help children who wet the bed by:

· Avoiding punishments
· Encouraging the child to go to the bathroom before bedtime
· Limiting liquids before bedtime
· Praising the child on dry mornings
· Waking the child during the night to empty their bladder

Most kids are fully toilet trained between ages 2 and 4 — but there's no target date for developing complete bladder control. During the preschool years, about 40 percent of children wet the bed. By age 5, bed-wetting remains a problem for only 10 percent to 15 percent of children.

No one knows for sure what causes bed-wetting, but various factors may play a role:

· A hormone imbalance. During childhood, some kids don't produce enough anti-diuretic hormone, or ADH, to slow nighttime urine production.

· A small bladder. Your child's bladder may not be developed enough to hold urine produced during the night.

· Anatomical defect. Rarely, bed-wetting is related to a defect in the child's neurological system or urinary system.

· Chronic constipation. Sometimes children who don't have regular bowel movements retain urine as well. This can lead to bed-wetting at night.

· Diabetes. For a child who's usually dry at night, bed-wetting may be the first sign of type 1 diabetes. Other signs and symptoms may include passing large amounts of urine at once, increased thirst, fatigue and weight loss in spite of a good appetite.

· Inability to recognize a full bladder. If the nerves that control the bladder are slow to mature, a full bladder may not rouse your child from sleep — especially if your child is a deep sleeper.

· Sleep apnea. Sometimes bed-wetting is a sign of obstructive sleep apnea, a condition in which the child's breathing is interrupted during sleep — often because of inflamed or enlarged tonsils or adenoids. Other signs and symptoms may include snoring, frequent ear and sinus infections, sore throat and daytime drowsiness.

· Stress. Stressful events — such as becoming a big brother or sister, starting a new school or sleeping away from home — may trigger bed-wetting.

· Urinary tract infection. A urinary tract infection can make it difficult for your child to control urination. Signs and symptoms may include bed-wetting, daytime accidents, frequent urination and pain during urination.

The doctor may begin by asking questions about your child's health history and bed-wetting pattern. For example:

·Does the bed-wetting seem to be triggered by certain foods, drinks or activities?
·Does your child complain of pain or other symptoms when urinating?
·Has your child always wet the bed, or did it begin recently?
·How often does your child wet the bed?
·If you're divorced, does your child live in each parent's home and does the bed-wetting occur in both homes?
·Is there a family history of bed-wetting?
·Is your child dry during the day?
·Is your child facing any major life changes or other stresses?

Moisture alarms—

These small, battery-operated devices — available without a prescription at most pharmacies — connect to a moisture-sensitive pad on your child's pajamas or bedding. When the pad senses wetness, the alarm goes off. Ideally, the moisture alarm sounds just as your child begins to urinate — in time to help your child wake, stop the urine stream and get to the toilet. If your child is a heavy sleeper, another person may need to listen for the alarm.

If you try a moisture alarm, give it plenty of time. It often takes two weeks to see any type of response and up to 12 weeks to enjoy dry nights. Moisture alarms are highly effective, and they may provide a better long-term solution than medication does.

Medication—

If all else fails, your child's doctor may prescribe medication to stop bed-wetting. Various types of medication can:

· Calm the bladder. If your child has a small bladder, an anticholinergic drug such as oxybutynin (Ditropan) or hyoscyamine (Levsin, Levsinex) may help reduce bladder contractions and increase bladder capacity. Side effects may include dry mouth and facial flushing.

· Change a child's sleeping and waking pattern. The antidepressant imipramine (Tofranil) may provide bed-wetting relief by changing a child's sleeping and waking pattern. The medication may also increase the amount of time a child can hold urine or reduce the amount of urine produced. Imipramine has few side effects for bed-wetters. Caution is essential, however. An overdose could be fatal.

· Slow nighttime urine production. The drug desmopressin acetate (DDAVP) boosts levels of a natural hormone (anti-diuretic hormone, or ADH) that forces the body to make less urine at night. The medication is available as a pill or nasal spray. As of December 2007, however, only the pill form is approved to treat bed-wetting. DDAVP has few side effects. The most serious is a seizure if the medication is accompanied by too many fluids.

Sometimes a combination of medications is most effective. There are no guarantees, however, and medication doesn't cure the problem. Bed-wetting typically resumes when the medication is stopped.

Alternative therapies—

Therapies such as massage, acupuncture and hypnosis have been touted as helpful treatments for bed-wetting. More research is needed before such therapies can be proved effective, however.

Treatment for bedwetting in children includes behavioral conditioning devices (pad/buzzer) and/or medications. Examples of medications used include anti-diuretic hormone nasal spray and the anti-depressant medication imipramine. In rare instances, the problem of bedwetting cannot be resolved by the parents, the family physician or the pediatrician. Sometimes the child may also show symptoms of emotional problems--such as persistent sadness or irritability, or a change in eating or sleeping habits. In these cases, parents may want to talk with a child and adolescent psychiatrist, who will evaluate physical and emotional problems that may be causing the bedwetting, and will work with the child and parents to resolve these problems.

Although frustrating, bed-wetting without a physical cause doesn't pose any health risks. The guilt and embarrassment a child feels about wetting the bed can lead to low self-esteem, however.

Rashes on the bottom and genital area may be an issue as well — especially if your child sleeps in wet underwear. To prevent a rash, help your child rinse his or her bottom and genital area every morning. It also may help to cover the affected area with a petroleum ointment at bedtime.

Because your child's bed-wetting is involuntary, it's illogical to punish wet nights or reward dry nights. Try to be patient as you and your child work through the problem together. Tips:

· Adopt good habits. Limit your child's fluid intake during the evening. Make sure your child urinates before going to bed — and perhaps again when you turn in for the night. Remind your child that it's OK to use the toilet during the night if needed. Use small nightlights so that your child can easily find the way between the bedroom and bathroom.

· Be sensitive to your child's feelings. If your child is stressed or anxious, encourage him or her to express those feelings. When your child feels calm and secure, bed-wetting may become a thing of the past.

· Celebrate effort. Don't punish or tease your child for wetting the bed. Instead, praise your child for following the bedtime routine and helping clean up after accidents.

· Enlist your child's help. Perhaps your child can rinse his or her wet underwear and pajamas, or place these items in a specific container for washing. Taking responsibility for bed-wetting may help your child feel more control over the situation.

· Plan for easy cleanup. Cover your child's mattress with a plastic cover. Use thick, absorbent underwear at night to help contain the urine. Keep extra bedding and pajamas handy.

· Put your child to bed earlier. Perhaps surprisingly, an extra 30 minutes of sleep a night helps some children stop wetting the bed.

With reassurance, support and understanding, your child can look forward to the dry nights ahead.

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Teens define sex in new ways...

The generational divide between baby-boomer parents and their teenage offspring is sharpening over sex.

Oral sex, that is.

More than half of 15- to 19-year-olds are doing it, according to a groundbreaking study by the Centers for Disease Control and Prevention.

The researchers did not ask about the circumstances in which oral sex occurred, but the report does provide the first federal data that offer a peek into the sex lives of American teenagers.

To adults, "oral sex is extremely intimate, and to some of these young people, apparently it isn't as much," says Sarah Brown, director of the National Campaign to Prevent Teen Pregnancy.

"What we're learning here is that adolescents are redefining what is intimate."

Among teens, oral sex is often viewed so casually that it needn't even occur within the confines of a relationship. Some teens say it can take place at parties, possibly with multiple partners. But they say the more likely scenario is oral sex within an existing relationship.

Still, some experts are increasingly worrying that a generation that approaches intimate behavior so casually might have difficulty forming healthy intimate relationships later on.

"My parents' generation sort of viewed oral sex as something almost greater than sex. Like once you've had sex, something more intimate is oral sex," says Carly Donnelly, 17, a high school senior from Cockeysville, Md.

"Now that some kids are using oral sex as something that's more casual, it's shocking to (parents)."

David Walsh, a psychologist and author of the teen-behavior book Why Do They Act That Way?, says the brain is wired to develop intense physical and emotional attraction during the teenage years as part of the maturing process. But he's disturbed by the casual way sex is often portrayed in the media, which he says gives teens a distorted view of true intimacy.

By Don Ramp
Walsh

Sex — even oral sex — "just becomes kind of a recreational activity that is separate from a close, personal relationship," he says.

"When the physical part of the relationship races ahead of everything else, it can almost become the focus of the relationship," Walsh says, "and they're not then developing all of the really important skills like trust and communication and all those things that are the key ingredients for a healthy, long-lasting relationship."

"Intimacy has been so devalued," says Doris Fuller of Sandpoint, Idaho, who, with her two teenage children, wrote the 2004 book Promise You Won't Freak Out, which discusses topics such as teen oral sex.

"What will the impact be on their ultimately more lasting relationships? I don't think we know yet."

Casual attitude is worrying

Child psychology professor W. Andrew Collins of the University of Minnesota says a relationship "that's only about sex is not a high-quality relationship."

In a 28-year study, Collins and his colleagues followed 180 individuals from birth. His yet-to-be-published research, presented at a conference in April, suggests that emotionally fulfilling high school relationships do help teens learn important relationship skills.

The researchers did not specifically ask about oral sex, he says. But relationships that are focused more on sex tend to be "less sustained, often not monogamous and with lower levels of satisfaction."

Terri Fisher, an associate professor of psychology at Ohio State University, says oral sex used to be considered "exotic." After the sexual revolution of the 1960s, it was viewed as a more intimate sexual act than sexual intercourse, but now, in young people's minds, it's "a more casual act."

Beyond shock, many parents aren't sure what to think when they discover their children's nonchalant approach to oral sex.

"It doesn't cross your mind because it's not something you have done," Fuller says. "Most parents weren't doing this (as teenagers) in the way these kids are."

But if parents are looking for reasons to freak out, the health risk of oral sex apparently isn't one of them. Teenagers and experts agree that oral sex is less risky than intercourse because there's no threat of pregnancy and less chance of contracting a sexually transmitted disease or HIV.

"The fact that teenagers have oral sex doesn't upset me much from a public health perspective," says J. Dennis Fortenberry, a physician who specializes in adolescent medicine at the Indiana University School of Medicine.

"From my perspective, relatively few teenagers only have oral sex. And so for the most part, oral sex, as for adults, is typically incorporated into a pattern of sexual behaviors that may vary depending upon the type of relationship and the timing of a relationship."

Data don't tell whole story

A study published in the journal Pediatrics in April supports the view that adolescents believe oral sex is safer than intercourse, with less risk to their physical and emotional health.

The study of ethnically diverse high school freshmen from California found that almost 20% had tried oral sex, compared with 13.5% who said they had intercourse.

More of these teens believed oral sex was more acceptable for their age group than intercourse, even if the partners are not dating.

"The problem with surveys is they don't tell you the intimacy sequence," Brown says. "The vast majority who had intercourse also had oral sex. We don't know which came first."

The federal study, based on data collected in 2002 and released last month, found that 55% of 15- to 19-year-old boys and 54% of girls reported getting or giving oral sex, compared with 49% of boys and 53% of girls the same ages who reported having had intercourse.

Though the study provides data, researchers say, it doesn't help them understand the role oral sex plays in the overall relationship; nor does it explain the fact that today's teens are changing the sequence of sexual behaviors so that oral sex has skipped ahead of intercourse.

Kinsey Institute
Sanders

"All of us in the field are still trying to get a handle on how much of this is going on and trying to understand it from a young person's point of view," says Stephanie Sanders, associate director of The Kinsey Institute for Research in Sex, Gender and Reproduction at Indiana University, which investigates sexual behavior and sexual health.

"Clearly, we need more information about what young people think is appropriate behavior, under what circumstances and with whom," Sanders says. "Now we know a little more about what they're doing but not what they're thinking."

The $16 million study, which took six years to develop, complete and analyze, surveyed almost 13,000 teens, men and women ages 15-44 on a variety of sexual behaviors.

Researchers say that the large sample size, an increased societal openness about sexual issues and the fact that the survey was administered via headphones and computer instead of face to face all give them confidence that, for the first time, they have truthful data on these very personal behaviors.

"There is strong evidence that people are more willing to tell computers things, such as divulge taboo behaviors, than (they are to tell) a person," Sanders says.

More analysis needed

Researchers cannot conclude that the percentage of teens having oral sex is greater than in the past. There is no comparison data for girls, and numbers for boys are about the same as they were a decade ago in the National Survey of Adolescent Males: Currently, 38.8% have given oral sex vs. 38.6% in 1995; 51.5% have received it vs. 49.4% in 1995.

Further analyses of the federal data by the private, non-profit National Campaign to Prevent Teen Pregnancy and the non-partisan research group Child Trends find almost 25% of teens who say they are virgins have had oral sex. Child Trends also reviewed socioeconomic and other data and found that those who are white and from middle- and upper-income families with higher levels of education are more likely to have oral sex.

Historically, oral sex has been more common among the more highly educated, Sanders says.

Is intimacy imperiled?

Teens and oral sex Heterosexual oral sex among teenagers ages 15 to 19 varies by age and gender, with older teens more likely to engage in intercourse. percentage of teens who have had intercourse and their ages: Boys 15 — 25.1% 16 — 37.5% 17 — 46.9% 18 — 62.4% 19 — 68.9% Girls 15 — 26.0% 16 — 39.6% 17 — 49.0% 18 — 70.3% 19 — 77.4% percentage of teens who have had oral sex and their ages: Boys 15 — 35.1% 16 — 42.0% 17 — 55.7% 18 — 65.4% 19 — 74.2% Girls 15 — 26.0% 16 — 42.4% 17 — 55.5% 18 — 70.2% 19 — 74.4% Source: 2002 National Survey of Family Growth, Centers for Disease Control of Prevention

The survey also found that almost 90% of teens who have had sexual intercourse also had oral sex. Among adults 25-44, 90% of men and 88% of women have had heterosexual oral sex.

"If we are indeed headed as a culture to have a total disconnect between intimate sexual behavior and emotional connection, we're not forming the basis for healthy adult relationships," says James Wagoner, president of Advocates for Youth, a reproductive-health organization in Washington.

Oral sex might affect teenagers' self-esteem most of all, says Paul Coleman, a Poughkeepsie, N.Y., psychologist and author of The Complete Idiot's Guide to Intimacy.

"Somebody is going to feel hurt or abused or manipulated," he says. "Not all encounters will turn out favorably. ... Teenagers are not mature enough to know all the ramifications of what they're doing.

"It's pretending to say it's just sexual and nothing else. That's an arbitrary slicing up of the intimacy pie. It's not healthy."

A survey of more than 1,000 teens conducted with the National Campaign to Prevent Teen Pregnancy resulted in The Real Truth About Teens & Sex, a book by Sabrina Weill, a former editor in chief at Seventeen magazine. She says casual teen attitudes toward sex — particularly oral sex — reflect their confusion about what is normal behavior. She believes teens are facing an intimacy crisis that could haunt them in future relationships.

"When teenagers fool around before they're ready or have a very casual attitude toward sex, they proceed toward adulthood with a lack of understanding about intimacy," Weill says. "What it means to be intimate is not clearly spelled out for young people by their parents and people they trust."

Although governmental and educational campaigns urge teens to delay sex, some suggest teens have replaced sexual intercourse with oral sex.

"If you say to teenagers 'no sex before marriage,' they may interpret that in a variety of ways," says Fisher.

Talk is crucial

Experts say parents need to talk to their kids about sex sooner rather than later. Oral sex needs to be part of the discussion because these teens are growing up in a far more sexually open society.

Anecdotal reports for years have focused on teens "hooking up" casually. Depending on the group, teens say it can mean kissing, making out or having sex.

"Friends with benefits" is another way of referring to non-dating relationships, with a form of sex as a "benefit."

But not all teens treat sex so casually, say teens from suburban Baltimore who were interviewed by USA TODAY as part of an informal focus group.

Alex Trazkovich, 17, a high school senior from Reisterstown, Md., says parents don't hear enough about teen relationships where there is a lot of emotional involvement.

"They hear about teens going to the parties and having lots and lots of sex," he says. "It happens, but it's not something that happens all the time. It's more of an extreme behavior."

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The growing trend of teenagers abusing family members...

We often hear about teen violence. Usually, the perpetrators strike out at other teenagers or younger individuals. There has been a lot of media attention as to dating violence among teenagers and, of course, child abuse perpetrated on teenagers by adults.

But what if it is your teenager who is violent and the victim is you or other members of your family.

There is an alarming growing trend of teenagers abusing family members, including both parents and siblings. And while there is plenty of information regarding teenaged violence, most of it deals with teens who are violent against strangers. Violence against a parent by a son or daughter is discussed often; but most of the information pertains to elderly abuse.

Parents who are the victims of violent teenagers are in a quandary. On one hand, most parents love their children unconditionally and would rather cut off one of their limbs than harm their child. Unfortunately, these are the parents who are most prone to suffering from abuse, rather than getting their child help. Most parents who have been victimized by their violent offspring remain silent; out of shame or fear of having their child taken away from them. As parents, we are conditioned to protect our children, no matter what. Even if it means ignoring violent outbursts or abuse.

As is the case with most victims of violence, there is a degree of shame involved. The parental victims believe that they must have done something wrong to incur such wrath. They often remain in denial until something drastic occurs. In many cases, it's too late as the "drastic" occurrence may be the actual murder of a parent.

There are many reasons that factor into teen violence against parents. Contrary to popular opinion, most teens who perpetrate violent behavior towards family members are not themselves victims of physical abuse. Quite the contrary. Violent behavior is the result of a desire to control. And in many cases, the parents have transferred the control of the home to the teenager. This causes a sense of insecurity among young people who, although are not children anymore, are not yet adults and are not ready to assume such control.

In some cases, the violent behavior is caused by drug abuse. It's important for parents with violent teenagers to get them tested for drug abuse. However, this is only one cause for such behavior and not the only cause.

Calling the police is one answer. Violence against anyone is a crime. And while it might be difficult to dial 911 if your teenager hits you, in the long run, you may be saving not only them, but yourself and other members of your household. However, calling the police on your teenager can be the most difficult decision a parent can make. Although difficult, it is one of the most effective ways you can make your teenager realize that violent behavior has consequences.

If your child is a minor and accused of domestic violence, the court system will more than likely suggest family counseling. The purpose of this counseling is to teach parents how to maintain safety in their home as well as counsel the teenagers on acceptable behavior.

If you are the parent of a violent teenager, realize that you are not alone. There are things you can do to make your home safe, for both yourself and your other children. Remove all weapons, such as knives, tools or anything that can be used to inflict serious harm. Make sure you have a telephone accessible at all times.

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TWENTY NINE LINES TO MAKE YOU SMILE—

1. My husband and I divorced over religious differences. He thought he was God and I didn't.
2. I don't suffer from insanity; I enjoy every minute of it.
3. Some people are alive only because it's illegal to kill them.
4. I used to have a handle on life, but it broke.
5. Don't take life too seriously; No one gets out alive.
6. You're just jealous because the voices only talk to me
7. Beauty is in the eye of the beer holder.
8. Earth is the insane asylum for the universe.
9. I'm not a complete idiot -- Some parts are just missing
10. Out of my mind. Back in five minutes.
11. NyQuil, the stuffy, sneezy, why-the-heck-is-the-room-spinning medicine.
12. God must love stupid people; He made so many.
13. The gene pool could use a little chlorine.
14. Consciousness: That annoying time between naps.
15. Ever stop to think, and forget to start again?
16. Being 'over the hill' is much better than being under it!
17. Wrinkled Was Not One of the Things I Wanted to Be When I Grew up.
18. Procrastinate Now!
19. I Have a Degree in Liberal Arts; Do You Want Fries With That?
20. A hangover is the wrath of grapes.
21. A journey of a thousand miles begins with a cash advance.
22. Stupidity is not a handicap. Park elsewhere!
23. They call it PMS because Mad Cow Disease was already taken.
24. He who dies with the most toys is nonetheless DEAD.
25. A picture is worth a thousand words, but it uses up three thousand times the memory.
26. Ham and eggs...A day's work for a chicken, a lifetime commitment for a pig.
27. The trouble with life is there's no background music.
28. The original point and click interface was a Smith & Wesson.
29. I smile because I don't know what the hell is going on.

Appreciate every single thing you have, especially your friends!

Life is too short and friends are too few!

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The Child With Autism—

Most infants and young children are very social creatures who need and want contact with others to thrive and grow. They smile, cuddle, laugh, and respond eagerly to games like "peek-a-boo" or hide-and-seek. Occasionally, however, a child does not interact in this expected manner. Instead, the child seems to exist in his or her own world, a place characterized by repetitive routines, odd and peculiar behaviors, problems in communication, and a total lack of social awareness or interest in others. These are characteristics of a developmental disorder called autism.

Autism is a brain disorder that is associated with a range of developmental problems, mainly in communication and social interaction. The first signs of this disorder typically appear before age 3. Although treatment has improved greatly in the past few decades, autism cannot be cured. It persists throughout life.

Autism Spectrum Disorders (ASD), also known as Pervasive Developmental Disorders (PDDs), cause severe and pervasive impairment in thinking, feeling, language, and the ability to relate to others. These disorders are usually first diagnosed in early childhood and range from a severe form, called autistic disorder, through pervasive development disorder not otherwise specified (PDD-NOS), to a much milder form, Asperger syndrome. They also include two rare disorders, Rett syndrome and childhood disintegrative disorder.

It's estimated that three to six of every 1,000 children have autism. A recent increase in the number of autism cases in the United States may be the result of improved diagnosis and changes in diagnostic criteria.

The disorder occurs three to four times more often in boys than in girls. The severity of symptoms is variable. Some children with autism will grow up able to live independently, while others may always need supportive living and working environments.

Autism is usually identified by the time a child is 30 months old and always by three years of age. It is often discovered when parents become concerned that their child may be deaf, is not yet talking, resists cuddling, and avoids interaction with others.

A preschool age child with "classic" autism is generally withdrawn, aloof, and fails to respond to other people. Many of these children will not even make eye contact. They may also engage in odd or ritualistic behaviors like rocking, hand flapping, or an obsessive need to maintain order.

Many children with autism do not speak at all. Those who do may speak in rhyme, have echolalia (repeating a person's words like an echo), refer to themselves as a Ahe or Ashe, or use peculiar language.

The severity of autism varies widely, from mild to severe. Some children are very bright and do well in school, although they have problems with school adjustment. They may be able to live independently when they grow up. Other children with autism function at a much lower level. Mental retardation is commonly associated with autism.

Occasionally, a child with autism may display an extraordinary talent in art, music, or another specific area.

The cause of autism remains unknown, although current theories indicate a problem with the function or structure of the central nervous system. What we do know, however, is that parents do not cause autism.

Children with autism need a comprehensive evaluation and specialized behavioral and educational programs. Some children with autism may also benefit from treatment with medication. Child and adolescent psychiatrists are trained to diagnose autism, and to help families design and implement an appropriate treatment plan. They can also help families cope with the stress which may be associated with having a child with autism.

Although there is no cure for autism, appropriate specialized treatment provided early in life can have a positive impact on the child's development and produce an overall reduction in disruptive behaviors and symptoms.

Signs and symptoms—

In general, children with autism have problems in three crucial areas of development — social skills, language and behavior. The most severe autism is marked by a complete inability to communicate or interact with other people.

Because the symptoms of autism vary widely, two children with the same diagnosis may act quite differently and have strikingly different skills.

If your child has autism, he or she may develop normally for the first few months — or years — of life and then later become less responsive to other people, including you. You may recognize the following signs in the areas of social skills, language and behavior:

Social skills:

• Appears not to hear you at times
• Appears unaware of others' feelings
• Fails to respond to his or her name
• Has poor eye contact
• Resists cuddling and holding
• Seems to prefer playing alone — retreats into his or her "own world"

Language:

• Can't start a conversation or keep one going
• Does not make eye contact when making requests
• Loses previously acquired ability to say words or sentences
• May repeat words or phrases verbatim, but doesn't understand how to use them
• Speaks with an abnormal tone or rhythm — may use a singsong voice or robot-like speech
• Starts talking later than other children

Behavior:

• Becomes disturbed at the slightest change in routines or rituals
• Develops specific routines or rituals
• May be fascinated by parts of an object, such as the spinning wheels of a toy car
• May be unusually sensitive to light, sound and touch
• Moves constantly
• Performs repetitive movements, such as rocking, spinning or hand-flapping

Young children with autism also have a hard time sharing experiences with others. When someone reads to them, for example, they're unlikely to point at pictures in the book. This early-developing social skill is crucial to later language and social development.

Possible Indicators of Autism Spectrum Disorders:

• Does not babble, point, or make meaningful gestures by 1 year of age
• Does not speak one word by 16 months
• Does not combine two words by 2 years
• Does not respond to name
• Loses language or social skills

Some Other Indicators:

• Poor eye contact
• Doesn't seem to know how to play with toys
• Excessively lines up toys or other objects
• Is attached to one particular toy or object
• Doesn't smile
• At times seems to be hearing impaired

As they mature, some children with autism become more engaged with others and show less marked disturbances in behavior. Some, usually those with the least severe impairments, eventually may lead normal or near-normal lives. Others, however, continue to have severe impairments in language or social skills, and the adolescent years can mean a worsening of behavior problems.

The majority of children with autism are slow to acquire new knowledge or skills. However, some children with autism have normal to high intelligence. These children learn quickly yet have trouble communicating, applying what they know in everyday life and adjusting in social situations. An extremely small number of children with autism are "autistic savants" and have exceptional skills in a specific area, such as art or math.

Screening—

About half of parents of children with ASD notice their child's unusual behaviors by age 18 months, and about four-fifths notice by age 24 months.^[19] Deficits in joint attention seem to distinguish infants with ASD; for example, they may not follow when a parent points and says "Look!"^[73] As postponing treatment may affect long-term outcome, any of the following signs is reason to have a child evaluated by a specialist without delay:

• Any loss of any language or social skills, at any age.^[22]
• No babbling by 12 months.
• No gesturing (pointing, waving goodbye, etc.) by 12 months.
• No single words by 16 months.
• No two-word spontaneous phrases (not including echolalia) by 24 months.

The American Academy of Pediatrics recommends that all children be screened for ASD at the 18- and 24-month well-child doctor visits, using autism-specific formal screening tests.^[73] In contrast, the UK National Screening Committee recommends against screening for ASD in the general population, because screening tools have not been fully validated and interventions lack sufficient evidence for effectiveness.^[74] Screening tools include the Modified Checklist for Autism in Toddlers (M-CHAT), the Early Screening of Autistic Traits Questionnaire, and the First Year Inventory; initial data on M-CHAT and its predecessor CHAT on children aged 18–30 months suggests that it is best used in a clinical setting and that it has low sensitivity (many false-negatives) but good specificity (few false-positives).^[19] Genetic screening for autism is generally still impractical.^[75]

Diagnosis—

Diagnosis is based on behavior, not cause or mechanism.^[23][76] Autism is defined in the DSM-IV-TR as exhibiting at least six symptoms total, including at least two symptoms of qualitative impairment in social interaction, at least one symptom of qualitative impairment in communication, and at least one symptom of restricted and repetitive behavior. Sample symptoms include lack of social or emotional reciprocity, stereotyped and repetitive use of language or idiosyncratic language, and persistent preoccupation with parts of objects. Onset must be prior to age three years, with delays or abnormal functioning in either social interaction, language as used in social communication, or symbolic or imaginative play. The disturbance must not be better accounted for by Rett syndrome or childhood disintegrative disorder.^[77] ICD-10 uses essentially the same definition.^[8]

Several diagnostic instruments are available. Two are commonly used in autism research: the Autism Diagnostic Interview-Revised (ADI-R) is a semistructured parent interview, and the Autism Diagnostic Observation Schedule (ADOS) uses observation and interaction with the child. The Childhood Autism Rating Scale (CARS) is used widely in clinical environments to assess severity of autism based on observation of children.^[21]

A pediatrician commonly performs a preliminary investigation by taking developmental history and physically examining the child. If warranted, diagnosis and evaluations are conducted with help from ASD specialists, observing and assessing cognitive, communication, family, and other factors using standardized tools, and taking into account any associated medical conditions. A differential diagnosis for ASD at this stage might also consider mental retardation, hearing impairment, and a specific language impairment^[78] such as Landau-Kleffner syndrome.^[79] ASD can sometimes be diagnosed by age 14 months, although diagnosis becomes increasingly stable over the first three years of life: for example, a one-year-old who meets diagnostic criteria for ASD is less likely than a three-year-old to continue to do so a few years later.^[19] In the UK the National Autism Plan for Children recommends at most 30 weeks from first concern to completed diagnosis and assessment, though few cases are handled that quickly in practice.^[78] A 2006 U.S. study found the average age of first evaluation by a qualified professional was 48 months and of formal ASD diagnosis was 61 months, reflecting an average 13-month delay, all far above recommendations.^[80]

Clinical genetics evaluations are often done once ASD is diagnosed, particularly when other symptoms already suggest a genetic cause.^[81] Although genetic technology allows clinical geneticists to link an estimated 40% of cases to genetic causes,^[82] consensus guidelines in the U.S. and UK are limited to high-resolution chromosome and fragile X testing.^[81] As new genetic tests are developed several ethical, legal, and social issues will emerge. Commercial availability of tests may precede adequate understanding of how to use test results, given the complexity of autism's genetics.^[75] Metabolic and neuroimaging tests are sometimes helpful, but are not routine.^[81]

Underdiagnosis and overdiagnosis are problems in marginal cases, and much of the recent increase in the number of reported ASD cases is likely due to changes in diagnostic practices. The increasing popularity of drug treatment options and the expansion of benefits has given providers incentives to diagnose ASD, resulting in some overdiagnosis of children with uncertain symptoms. Conversely, the cost of screening and diagnosis and the challenge of obtaining payment can inhibit or delay diagnosis.^[83] It is particularly hard to diagnose autism among the visually impaired, partly because some of its diagnostic criteria depend on vision, and partly because autistic symptoms overlap with those of common blindness syndromes.^[84]

The symptoms of autism and ASD begin early in childhood but are occasionally missed. Adults may seek retrospective diagnoses to help them or their friends and family understand themselves, to help their employers make adjustments, or in some locations to claim disability living allowances or other benefits.^[85]

Causes—

The cause of autism isn't clear, and there's no cure. But intensive, early treatment can make a difference.

Autism has no single, identifiable cause. The disorder seems to be related to abnormalities in several regions of the brain. Researchers have identified a number of gene defects associated with autism.

Families with one autistic child have a one in 20 chance of having a second child with the disorder. In some cases, relatives of autistic children show mild impairments in social and communication skills or engage in repetitive behaviors.

Children with symptoms of autism have a higher than normal risk of also having:

• Epilepsy
• Fragile X syndrome, which causes mental retardation
• Tourette's syndrome
• Tuberous sclerosis, in which tumors grow in the brain

Some people believe autism is caused by vaccines — particularly the measles-mumps-rubella vaccine (MMR), as well as vaccines containing thimerosal, a preservative that contains a very small amount of mercury. But extensive studies have shown no link between vaccines and autism.

Older fathers and autism risk: Is there a connection?

A growing body of evidence suggests that a father's age (paternal age) may play a role in autism risk.

A large study published in the Archives of General Psychiatry in 2006 examined the relationship between advancing paternal age and autism risk. Researchers reported that children born to men 40 years or older were almost six times more likely to have autism spectrum disorder than were children born to men younger than 30 years.

The reason for this increased risk of autism isn't clear. One theory is that as men age, their genetic material loses some ability to repair itself. As a result, spontaneous mutations in genes may be passed on rather than corrected — potentially leading to an increased risk of brain abnormalities in their children. Researchers have identified a number of gene mutations associated with autism.

On a related note, advancing maternal age appears to have little effect on autism risk.

Problems That May Accompany ASD—

· Fragile X syndrome. This disorder is the most common inherited form of mental retardation. It was so named because one part of the X chromosome has a defective piece that appears pinched and fragile when under a microscope. Fragile X syndrome affects about two to five percent of people with ASD. It is important to have a child with ASD checked for Fragile X, especially if the parents are considering having another child. For an unknown reason, if a child with ASD also has Fragile X, there is a one-in-two chance that boys born to the same parents will have the syndrome. ⁶ Other members of the family who may be contemplating having a child may also wish to be checked for the syndrome.

· Mental retardation. Many children with ASD have some degree of mental impairment. When tested, some areas of ability may be normal, while others may be especially weak. For example, a child with ASD may do well on the parts of the test that measure visual skills but earn low scores on the language subtests.

· Seizures. One in four children with ASD develops seizures, often starting either in early childhood or adolescence. ⁵ Seizures, caused by abnormal electrical activity in the brain, can produce a temporary loss of consciousness (a “blackout”), a body convulsion, unusual movements, or staring spells. Sometimes a contributing factor is a lack of sleep or a high fever. An EEG (electroencephalogram—recording of the electric currents developed in the brain by means of electrodes applied to the scalp) can help confirm the seizure's presence.

· Sensory problems. When children's perceptions are accurate, they can learn from what they see, feel, or hear. On the other hand, if sensory information is faulty, the child's experiences of the world can be confusing. Many ASD children are highly attuned or even painfully sensitive to certain sounds, textures, tastes, and smells. Some children find the feel of clothes touching their skin almost unbearable. Some sounds—a vacuum cleaner, a ringing telephone, a sudden storm, even the sound of waves lapping the shoreline—will cause these children to cover their ears and scream.

· Tuberous Sclerosis. Tuberous sclerosis is a rare genetic disorder that causes benign tumors to grow in the brain as well as in other vital organs. It has a consistently strong association with ASD. One to 4 percent of people with ASD also have tuberous sclerosis.⁷

Treatment—

There's no cure for autism, and there's no "one-size-fits-all" treatment. In fact, the range of home-based and school-based treatments and interventions for autism can be overwhelming. Your doctor can help identify resources in your area that may work for your child. Treatment options may include:

• Drug therapies. Right now, there are no medications that directly improve the core signs of autism. But some medications can help control symptoms. Stimulants can help with hyperactivity, while antipsychotic drugs sometimes will control repetitive and aggressive behaviors.

• Complementary approaches. Some parents choose to supplement educational and medical intervention with complementary therapies, such as art therapy, music therapy, special diets, vitamin and mineral supplements, and sensory integration — which focuses on reducing a child's hypersensitivity to touch or sound. However, there is no scientific proof that these therapies work. It's important to talk with your child's doctor before trying any treatment.

• Behavioral and communication therapies. Many programs have been developed to address the range of social, language and behavioral difficulties associated with autism. Some programs focus on reducing problem behaviors and teaching new skills. Other programs focus on teaching children how to act in social situations or how to communicate better with other people.

Children with autism often respond well to highly structured education programs. Successful programs often include a team of specialists and a variety of activities to improve social skills, communication and behavior.

Guidelines used by the Autism Society of America include the following questions parents can ask about potential treatments:

• Are there assessment procedures specified?
• Has the treatment been validated scientifically?
• How will failure of the treatment affect my child and family?
• How will the treatment be integrated into my child's current program? Do not become so infatuated with a given treatment that functional curriculum, vocational life, and social skills are ignored.
• Will the treatment result in harm to my child?

The National Institute of Mental Health suggests a list of questions parents can ask when planning for their child:

• Will the program prepare me to continue the therapy at home?
• Will my child be given tasks and rewards that are personally motivating?
• What is the cost, time commitment, and location of the program?
• Is the environment designed to minimize distractions?
• How successful has the program been for other children?
• How much individual attention will my child receive?
• How many children have gone on to placement in a regular school and how have they performed?
• How is progress measured? Will my child's behavior be closely observed and recorded?
• How are activities planned and organized?
• Do staff members have training and experience in working with children and adolescents with autism?
• Are there predictable daily schedules and routines?

A child won't "outgrow" autism. But he or she can learn to function within the confines of the disorder, especially if treatment begins early. Preschool children who receive intensive, individualized behavioral interventions show good progress.

Can special diets help?

There's no evidence that special diets, such as restricting certain foods, are an effective treatment for autism.

Autism is a complex brain disorder that has no known cure. For this reason, many frustrated parents turn to unproven alternative treatments in an attempt to help their children. The most popular of these alternative treatments are diets that eliminate gluten or casein, or both.

Proponents of restrictive diets believe that casein, a protein found in dairy products, and gluten, a protein found in many grains, affect brain development and behavior, causing autism in some children. However, there's no scientific evidence that this is true or that restricting these foods improves autism. Furthermore, restrictive diets can result in nutritional deficiencies in growing children.

Dietary interventions are based on the idea that 1) food allergies cause symptoms of autism, and 2) an insufficiency of a specific vitamin or mineral may cause some autistic symptoms. If parents decide to try for a given period of time a special diet, they should be sure that the child's nutritional status is measured carefully.

A diet that some parents have found was helpful to their autistic child is a gluten-free, casein-free diet. Gluten is a casein-like substance that is found in the seeds of various cereal plants—wheat, oat, rye, and barley. Casein is the principal protein in milk. Since gluten and milk are found in many of the foods we eat, following a gluten-free, casein-free diet is difficult.

A supplement that some parents feel is beneficial for an autistic child is Vitamin B6, taken with magnesium (which makes the vitamin effective). The result of research studies is mixed; some children respond positively, some negatively, some not at all or very little.⁵

In the search for treatment for autism, there has been discussion in the last few years about the use of secretin, a substance approved by the Food and Drug Administration (FDA) for a single dose normally given to aid in diagnosis of a gastrointestinal problem. Anecdotal reports have shown improvement in autism symptoms, including sleep patterns, eye contact, language skills, and alertness. Several clinical trials conducted in the last few years have found no significant improvements in symptoms between patients who received secretin and those who received a placebo.

Autism treatment: Can chelation therapy help?

There's no scientific evidence that chelation therapy is an effective autism treatment.

In recent years, some doctors and parents have recommended chelation therapy as a potential treatment for autism. Proponents believe that autism is caused by mercury exposure, such as from childhood vaccines. Chelation therapy supposedly removes mercury from the body, which cures autism.

But extensive studies have revealed no evidence of a link between mercury exposure and autism. In addition, chelation therapy is not approved as an autism treatment and can be associated with serious side effects, including liver and kidney damage that can result in death.

Coping skills—

Raising a child with autism can be physically exhausting and emotionally draining. These ideas may help:

• Take time for yourself and other family members. Caring for a child with autism can be a round-the-clock job that puts stress on your marriage and your whole family. To avoid burnout, take time out to relax, exercise or enjoy your favorite activities. Try to schedule one-on-one time with your other children and plan date nights with your spouse — even if it's just watching a movie together after the children go to bed.

• Seek out other families of autistic children. Other families struggling with the challenges of autism can be a source of useful advice. Many communities have support groups for parents and siblings of children with autism.

• Learn about the disorder. There are many myths and misconceptions about autism. Learning the truth can help you better understand your child and his or her attempts to communicate. With time, you'll likely be rewarded by seeing your child grow and learn and even show affection — in his or her own way.

• Find a team of trusted professionals. You'll need to make important decisions about your child's education and treatment. Find a team of teachers and therapists who can help evaluate the options in your area and explain the federal regulations regarding children with disabilities. Make sure this team includes a case manager or service coordinator, who can help access financial services and government programs.

Prognosis—

There is no cure.^[5] Most children with autism lack social support, meaningful relationships, future employment opportunities or self-determination.^[28] Although core difficulties remain, symptoms often become less severe in later childhood.^[87] Few high-quality studies address long-term prognosis. Some adults show modest improvement in communication skills, but a few decline; no study has focused on autism after midlife.^[101] Acquiring language before age six, having IQ above 50, and having a marketable skill all predict better outcomes; independent living is unlikely with severe autism.^[102]

A 2004 British study of 68 adults who were diagnosed before 1980 as autistic children with IQ above 50 found that 12% achieved a high level of independence as adults, 10% had some friends and were generally in work but required some support, 19% had some independence but were generally living at home and needed considerable support and supervision in daily living, 46% needed specialist residential provision from facilities specializing in ASD with a high level of support and very limited autonomy, and 12% needed high-level hospital care.^[6] A 2005 Swedish study of 78 adults that did not exclude low IQ found worse prognosis; for example, only 4% achieved independence.^[103] Changes in diagnostic practice and increased availability of effective early intervention make it unclear whether these findings can be generalized to recently diagnosed children.^[4]

Related Information—

• Treatment of Children with Mental Disorders
• Information about medications
• Autism Spectrum Disorders Information and Organizations from NLM's MedlinePlus (en Español)
• Center for Disease Control and Prevention (CDC) Autism Information Center
• Autism Information on Department of Health and Human Services (HHS) Web site

* References provided by request.

ONLINE PARENT SUPPORT
David Ayoub, M.D. goes through the relations of Mercury to Autism as well its connections to “National Security Study Memorandum 200”; for population control. Showing its shocking connections to today’s G.A.V.I. Are powerful forces really trying to help the poor people or could it be for another agenda; the sterilization of the poor? This is an upsetting video, so brace yourself.

Daycare: The Effects on Children

With the successes of welfare reform and the high turnout of female college graduates, mothers are increasingly entering the workforce. As affirmed by the Wilson Quarterly (Autumn 98, Vol. 22 Issue 4), “Ben Wildavsky, a staff correspondent for the National Journal (Jan. 24, 1998), provides statistical background. In 1997, nearly 42 percent of women with children under six were working full-time, 5 percent were looking for work, 18 percent had part-time jobs, and 35 percent were not working outside the home” (p.115). Using these figures it is said that 65 percent of women with children aged younger than six are working or would like to be. Daycare is a necessity for the majority of working American mothers.

Within the past 20 years child social developmentalists have accumulated evidence to show that unless children gain minimal social competence by the age of six years, they have a high probability of being at risk throughout life. (Denham & Burton, 1996) Thus peer relationships contribute a great deal to both social and cognitive development and to the effectiveness with which we function as adults. Others suggest that the number of caregivers and the amount of time children spend away from parents’ harms parent-child relationships thus, weakening cognitive and emotional development (Kelly, 2000). This paper will discuss the effects of daycare on children and how to choose one of high quality.

Many daycare opponents believe bonding, a strong emotional attachment that forms between a child and parent, is disrupted when mothers and fathers rely on others to be substitute parents. Children who are securely bonded to parents are more confident in their explorations of their environment and have a higher sense of self-esteem than children who are insecurely bonded to their parents. Dr. Stanley Greenspan, a professor of psychiatry and pediatrics at George Washington University Medical School, who has authored several books including the recent book, The Irreducible Needs of Children says, “A warm, loving human relationship is very important for intellectual development. Children form their capacity to think and self-image based on these back-and-forth interactions. Fewer of these are happening, because families are so busy and more care is being done outside the home. Studies [show] that for all ages, 85 percent of day care is not high quality” (Kelly, 2000, p. 65).

It has been further proven that the issue is, the quality of the care given in daycare that makes the difference in regards to cognitive, language, and socio-emotional functions. The more quality care the more positive the functional developments. Placing a child in daycare does not exclude them from forming warm, human relationships in contrast it gives them the opportunity to form numerous bonding encounters with other adults and it also permits the formation of strong peer attachments.

A stark reality facing many parents is that quality daycare is hard to find or too expensive. Quality daycare includes a well-trained staff that serves children in small groups. This allows for successful interactions between the caregiver and child. These interactions may be related to cognitive functioning and language development. Preschoolers that have experienced positive interactions given at quality daycare demonstrated better language skills and cognitive functioning than preschoolers who did not experience such childcare as infants. (Burchinal, Lee, and Ramey, 1989) Without these interactions children who receive lower quality daycare or children reared at home scored lower on measures of academic achievement when tested against those children who were experienced.

In the study done at State University of New York College in Buffalo, they explored the relation between time spent in daycare and the quantity and quality of exploratory and problem-solving behaviors in 9-month-old infants. It was hypothesized that, given the presence of high quality care, infants who spent greater amounts of time in center-based care would demonstrate more advanced exploratory and problem-solving behaviors then infants who did not spend as much time in center-based care (Schuetze, Lewis, and DiMartino, 269). The results suggested that the amount of time spent in center-based care predicts more frequent and varied exploratory behaviors and the more successful problem-solving abilities. Infants are motivated to affect and master their environment and high quality daycare centers provide infants with age-appropriate play materials and responsive caregivers who, presumably, are frequently encouraging them to explore their surroundings which, in turn, affords them the opportunity to develop exploratory strategies. (Schuetze, et al, 273).

“Emotional competence is central to children’s ability to interact and form relationships;” as stated in the opening paragraph of the study done by Susanne A. Denham and Rosemary Burton from George Mason University (1996). Their study focuses on the importance of children being able to (1) form a secure attachment with a primary caregiver, (2) acquire the ability to consciously recognize and label emotion and (3) develop skills to problem solving with peers. For when a child forms a secure attachment the child feels confident to explore the social world. When a child has the ability to consciously recognize and label emotion the child has a vehicle with which to regulate emotions. The child who can consider alternative solutions to problems is less likely to take a toy out of the hands of another without consideration of the others desires (Denham, 1996). All of these abilities are better learning in a center based environment were there are more opportunities to develop and master these skills. Early research did support that there were some adverse effects on development for infants attending daycare, such as emotional competence deficits. But these findings presumably are more strongly related to a daycare of poor quality that would neglect social development instead of enhancing it. Recently, research has suggested that infants reared in a daycare setting do not suffer any long-term consequences from center-based care (Clarke-Stewart, Gruber, and Fitzgerald, 1994; NICHD Early Child Care Research Network, 1997).

There are some aspects of daycare that may increase the probability that children will behave in socially inappropriate ways. The relationship between daycare and aggression is currently unclear at the present because of the numerous conflicting conclusions. “Honig and Park (1993) assessed aggressiveness in preschoolers using ratings by head teachers as well as ratings of videotaped free play behaviors in the daycares. They reported that children who had been in daycare longer received higher ratings of instrumental physical, and verbal aggression. In contrast, Hegland and Rix (1990) found no significant difference in observer ratings of aggression when comparing children who had been attending daycare to children with no daycare experience” (DiLalla, 1998, p. 224). Thus, when investigating children who have attended daycare, it appears overall that children who began younger or have been in daycare longer seem to interact more with peers, both prosocially and aggressively. To define this more clearly, prosocial behavior is “behavior that is designed to help or benefit other people” (Kohlberg, 1984, p. G-7) and aggressive behavior is “behavior that intentionally harms other people by inflicting pain or injury on them” (Kohlberg, 1984, p. 649)

A comprehensive review by Clarke-Stewart (1989) pointed out that it is critical to explore the individual differences in children that may contribute to or protect them from aggressive behaviors in terms of how these individual differences interact with environmental variables such as daycare experience. One obvious factor that should mitigate or exacerbate the deleterious effects of daycare experience might be child temperament. This has not been studied in depth and should add considerably to our understanding to how daycare experience can be related to later aggressiveness as well as later prosocial behavior. (DiLalla, 1998)

The study done by Lisabeth F. DiLalla, failed to demonstrate the importance in considering temperament as a moderator of daycare experiences for the prosocial behaviors in children. Neither daycare experience nor temperament were significantly related to lab ratings of aggression during the first 10 minutes of the experiment, although aggressiveness of the second half of the testing session, boys were more aggressive than girls, and peer aggressiveness was still significantly correlated with proband (subject) aggression; daycare experience and temperament ratings were still not significantly related (DiLalla, 1998).

While daycare advocates are concerned about the general well being of children in daycare and are continuously adopting new policies and regulations nationwide to ensure the safety successes of children in daycare. Over the past decade or so child abuse in daycare settings has increased significantly. With 1983 as a landmark year, because it was then that children first began disclosing allegations of sexual and ritual abuse in the McMartin pre-school in California (Waterman, Kelly, Oliveri, and McCord, 1993). The affects on children are both far-reaching and detrimental. Some of the risk factors that are associated with child abuse are such as large staff ratios, locations in rural areas, lack of education of day care providers, the presence of adolescent males, and the lack of job satisfaction (Schumacher and Carlson, 896).

Finding quality childcare is one the biggest issues that parents face. The most important aspect in this multi faceted decision process is what kind of care that is needed for the child. There are different kinds of care settings that you might choose; a family daycare home, a childcare center, or in-home care, these various choices make it possible for you to find a good situation to fit best to your needs. Parents should also consider other issues such as availability, affordability, and quality in relation to these settings.

Most parents are unsure of where to look for good care. A good place to start in the search would be the yellow pages of the telephone directory under Child Care of Schools – Preschool. The licensing bureau for childcare centers and daycare homes in your area is another good source. Most parents typical rely on referrals from friends and family or neighbor-hood church sponsored centers.

It is recommended by Leisa Oesterreich an extension specialist in human development and family life at the Iowa State University Extension Childcare Program (1999) that parents visit as least three caregivers or childcare programs. They should be prepared to spend at least one hour. They should expect the following:

· a brief tour

· a warm greeting

· an explanation of fees and policies

· an invitation to stay awhile to see the daily routine and children playing

· short introduction to both adults and children

Some questions that parents should ask:

· Are children ever transported in a vehicle? Do you use seatbelts or car seats?

· Do you have CPR and First Aid Training?

· How do you discipline children?

· How do you handle emergencies?

· Please describe a typical day.

· What types of food do you serve for meals and snacks?

Another suggestion to parents by Iowa State University is that parents not be afraid to check references. Ask for at least two parent references. Most parents should be happy to share information with other parents and can be a wonderful resource.

Once you have selected the care, parents should begin to prepare their child for this new experience. If possible, parents should first with their child visit the caregiver in incremental time periods before leaving the child for all day. The skilled staff should be openly helpful in this transition for it may take the child several weeks to get used to the new situation (Oesterreich, 1999).

The National Network for Child Care says that it is important that parents know the regulations set by the licensing bureau in their state. A quality daycare provider would be credentialed as a Child Development Associate. This is a national early childhood professional credential, which requires that you complete 120 hours of specific training, and prepare a professional resource file. CDA candidates must pass a parent opinion survey, a written test, an oral interview, and an on-site observation. The following are statistics that the CDA advises:

RECOMMENDED STAFF: CHILD RATIO

Infants (0-9 months of age)	1:4
Toddlers (10-23 moths of age)	1:6
2-year-olds	1:8
3-year-olds	1:12
4 and 5-year-olds	1:15
6 years and over	1:20

MAXIMUM GROUP SIZE

Infants (0-9 months of age)	8
Toddlers (10-23 moths of age)	12
2-year-olds	16
3-year-olds	24
4 and 5-year-olds	30
6 years and over	40

(Wilson & Tweedie, 1996).

Quality childcare offers activities that are appropriate for each child’s age, interests and abilities. They do not require children learn certain things, to stand in line, or to sit quietly and listen for more than five to ten minutes. The classrooms are active and pleasantly noisy. Children choose their own play activities and play at their own pace. Rarely are the children doing the same thing at the same time. In developmentally appropriate programs, you see very creative are work. Appropriate programs welcome parents at anytime. Parents share their talents and culture with the group. Family members can come into the center or home and play with the children. Staff schedules time to talk with parents about their child’s development regularly (Wilson, et al, (1996).

If the child is happy and looks forward to going to the place of childcare than the parent knows they have made the right choice. With all of the information available to parents regarding social, cognitive and emotional developmental effects daycare has on children, parents still are left to make choices based on their individual lifestyle. Good childcare can improve the quality of life between parent and child. The experiences that children encounter with other caring adults can broaden the child’s development; the play with other children helps a child gain mental and social skills.

Making Day Care A Good Experience—

Child and adolescent psychiatrists recognize that the ideal environment for raising a small child is in the home with parents and family. Some experts recommend a minimum of six or more months leave for parents. Intimate daily direct parental care of infants for the first several months of life is particularly important. Since the ideal environment often is not available, the role of day care, especially in the first few years of the child's life, needs to be considered. Experts agree that when day care is used, the quantity and quality of the day care are significant in the child's development.

Before choosing a day care environment, parents should be familiar with the state licensure regulations for child care. They should also check references and observe the caregivers with the child.

Parents sometimes take their young child to the home of a person who is caring for one or more other children. Infants and children under two-and-one-half need:

• A caregiver who will play and talk with them, smile with them, praise them for their achievements, and enjoy them
• A lot of individual attention
• More adults per child than older children require
• The same caregiver(s) over a long period of time

Parents should seek a caregiver who is warm, caring, self-confident, attentive, and responsive to the children. The caregiver should be able to encourage social skills and positive behavior, and set limits on negative ones. Parents should consider the caregiver's ability to relate to children of different ages. Some individuals can work well only with children at a specific stage of development.

It is wise for parents to find out how long the individual plans to work in this day care job. High turnover of individuals, several turnovers, or any turnover at critical points of development, can distress the child. If parents think or feel the day care they have chosen is unsatisfactory, they should change caregivers. All parents have the right to drop in during the day and make an unannounced visit.

Many children, particularly after the age of three, benefit from good, group day care, where they can have fun and learn how to interact with others. Child and adolescent psychiatrists suggest that parents seek day care services have:

• trained, experienced teachers who enjoy, understand and can lead children
• staff that has been there for a long period of time
• space to move indoors and out
• opportunities for creative work, imaginative play, and physical activity
• lots of drawing and coloring materials and toys, as well as equipment such as swings, wagons, jungle gyms, etc.
• enough teachers and assistants, ideally, at least one for every five children, small rather than large groups if possible. (Studies have shown that five children with one caregiver is better than 20 children with four caregivers)

If the child seems afraid to go to day care, parents should introduce the new environment gradually: at first, the mother or father can go along, staying nearby while the child plays. The parent and child can stay for a longer period each day until the child wants to become part of the group. If the child shows unusual or persistent terror about leaving home, parents should discuss it with their pediatrician. Parents can help make day care more positive and less stressful for their child.

References—

· Burchinal, M. R., Lee, M. W., and Ramey, C. T. (1989). Type of Daycare and Preschool 2Intellectual Development in Disadvantaged Children. Child Development, 60, 606-620

· Clarke-Stewart, K. A. (1989) Infant Day Care: Maligned or Malignant? American Psychologist, 44, 266-273

· Clarke-Stewart, K. A., Gruber, C.P., and Fitzgerald, L. M. (1994). Children at Home and in Daycare. Hillsdale, NJ: Erlbaum.

· Denham, S. A. and Burton, R., A Social-Emotional Intervention for At-Risk 4-Year-Olds, Journal of School Psychology 34(3). (1996). 225-245.

· DiLalla, L. F., Daycare, Child, and Family Influences on Preschoolers’ Social Behaviors in a Peer Play Setting. Child Study Journal, 28(3) (1998). 225-245.

· Kelly, K. (2000, October 30). Child Docs to Parents: Stay Home and Save your Kids. U.S. News & World Report, 129(4), 65

· Oesterreich, L. Childcare Checklist for Parents: PM 1805 http://www.extension.iastate.edu/Pages/pubs/. (December 1999)

· Schuetze, P., Lewis, A., & DiMartino, D. Relation Between Time Spent in Daycare and Exploratory Behaviors in 9-month-old Infants., Infant Behavior & Development 22(2) (1999), 267-276

· Schumacher, R. B. & Carlson, R. S. Variables and Risk Factors Associated with Child Abuse in Daycare Settings., Child Abuse & Neglect, 23(9) (1999) 891-898.

· “The Battle Over Child Care,” Wilson Quarterly Autumn 98, 22(4), 115-116

· Waterman, J., Kelly, R. J., Oliveri, M. K., & McCord, J. (1993). Behind the Playground Wall: Sexual Abuse in Preschool. New York. Guilford Press.

· Wilson, E. and Tweedie, P. S. Selecting Quality Child Care. National Network for Child Care: http://www.nncc.org/Choose.Quality.Care/select.care.html. (December 1996).



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