Saturday, November 01, 2003

Parental Angst

Maybe it's just me but it seems as though the daycare kids in my child's kindergarten class are different. Not every one is this way but on the whole, they seem, well, more rowdier, less focused and more provocative. I hear stories of retaliatory behavior and other aggressive incidents, and it's not gender specific, by the way.

When I ran across this report about the relationship between relief of poverty and children's behavior via psycPORT, I was motivated enough to look up the source material in JAMA (October 15th, 2003, Vol.290(15):2023-2029; abstract here but full article is under lock and key online). An excellent summary in the NY Times is entitled: Rise in Income Improves Children's Behavior (this article is likely to fall into locked archives soon).

What distinguishes this study from so many others is that the researchers were able to take advantage of a 'natural experiment'. The significance of this is that causation/causality conundrum of the relationship between poverty and mental illness might actually be teased out.

So, in the middle of this long term study of rural children, the individuals in the American Indian subgroup were endowed with the gift of a trust fund from casino proceeds. The results, to summarize, were thus (from the NYT article):
    After four years, the rate of such behaviors had dropped to the same levels found among children whose families had never been poor. Children whose families broke the poverty threshold had a 40 percent decrease in behavioral symptoms. But the payments had no effect on children whose families had been unable to rise from poverty or on the children whose families had not been poor to begin with.

It takes getting the actual journal article to realize I had some questions. One was that the whole trust fund issue was not fully explained. Each child receives money in the trust fund, receiving full control when reaching age 18; but how does the child access the money before then and how does that affect the families income? Does the parent have all of the child's income for their disposal or just some?

I had some questions about the outcome measure, CAPA, since I'm not familiar with it. I did search the web for more info because the JAMA report does not address any sort of considerations regarding ethnic sensitivity of this measure. Measures in general are likely to be normed on a population that is not American Indian. This may make a big difference in results.

CAPA is a structured interview; both the parent and child self reports, though in separate settings, so the measure is dependent on how trusting and honest the respondents are. Past research has shown in general that ethnic minority respondents are more likely to be less trusting. I thought a measure of guardedness would have been interesting.

Still another consideration is that CAPA is based on the DSM. I think the DSM does not display extraordinary sensitivity to ethnic minority issues although to be fair the authors admit that they include ethnic and cultural considerations is a categorical limitation. They say this (p. xxxiv, DSM-IV-TR):
    Diagnostic assessment can be especially challenging when a clinician from one ethnic or cultural group uses classification to evaluate an individual from a different ethnic or cultural group. A clinican who is unfamiliar with the nuances of an individual's cultural frame of reference may incorrectly judge as psychopathology those normal variations in behavior, belief or experience that are particular to the individual's culture.
DSM-IV-TR also includes an outline and glossary regarding culture-bound syndromes.

Regarding the results, the authors of the study reported that behavioral symptoms decreased in kids who came out of poverty. They say that these symptoms were those included in the DSM-IV diagnoses of conduct and oppositional disorder. I wish there were more details about which specific behavioral symptoms. Diagnoses include an array of symptoms: which ones? Interestingly enough, it is the NYT article that contains more details, including "stubbornness, temper tantrums, stealing, bullying, and vandalism".

Some statistical limitations were brought up in the JAMA article as well: for instance, sample size was "not large". Another curious thing, also pointed out in a critique of this study (not available online: JAMA, V.290 (15) 2063-2065) was that only 14% of the income supplemented families rose out of the poverty classification. I didn't see much of a discussion of this puzzling result in the original research article. I was wondering whether it was only 14% because of the way the trust fund disbursed funds.

Now these kids in my child's class are most likely not by any definition below or at poverty level. But the results of this article teases out one particular intriguing aspect involved in the results: quality of parental supervision. From the NYT:
    The deciding factor appeared to be the amount of time parents had to supervise their children. Parents who moved out of poverty reported having more time to spend with their children. In the other groups, the amount of time the parents had on their hands was not much different.

Studies like this highlight the importance of damaging effects of poverty and underscores the need to look at how stressful poverty is on children and families. As the NYT article points out, these results speak loudly about the ramifications of current work welfare policy.

When I put my child in daycare, I know there would be more frustration, more acting out, more tantrums. I don't think I'll need a study to tell me why.