Lest We Forget the Parent in the Parent-Adolescent Dance!

Abstract

Adolescence is a developmental stage with rapid, and dynamic, biological and social changes in an individual. These changes add to the vulnerabilities for mental health morbidity. Adolescents today live and grow at the center of a layered, globalized, hyper-connected world where proximate and distal environments constantly influence each other. Parenting is part of the most proximate of the environmental layers, and is purported to have a protective and supportive role for adolescents. This editorial reflects upon challenges in parenting adolescents, and the need for nuanced re-examinations of the role of parenting in today’s globalized, hyper-connected, yet isolating, constantly changing environments.

Adolescence is a biological and a social construct. Puberty brings about hormonal shifts with widespread physical and physiological changes in the body, including in the brain. The physical changes, alongside increasing chronological age, and the socio-cultural expectations (as at times amplified by the globalized media) mediate changing social perceptions of self and others. The rapid dynamics of adolescence, and the associated set of complex psychosocial tasks, position it as a key period of vulnerability for the development of a broad range of mental and physical disorders. ¹ According to the recent Global Burden of Disease estimates, nearly 15% of adolescents are at risk for mental health morbidity, largely common mental health problems (anxiety and depression ~ 40%), conduct problems (20%), and neurodevelopmental disorders like attention deficit hyperactivity disorder (20%). ² Given the homotypic and heterotypic continuities ³ of adolescent onset mental health problems, as well as the impact on long-term morbidity and socio-occupational functioning, young people require support and systematic interventions that cater to their unique challenges.

The psychosocial environment plays a prominent role both in the determination and management of the commonest mental health problems. Systemic interactions between individual vulnerabilities (genetic, temperamental and developmental) and environmental (ecological and social) influences through the lifespan ⁴ are imperative in a child and adolescent mental health professional’s formulation of the variety of clinical presentations and treatment responses they encounter in everyday practice. Bronfenbrenner’s time-tested socioecological model places a young person at the center of layers of environment (systems), the first of which is the immediate family, followed by larger cultural and regional social networks, and, finally, the broader socio-economic-political realities of a time. ⁵ In the complicated and layered environments that adolescents inhabit, the family environment is the most proximate. Clinical presentations and treatment responses in child and adolescent mental health vary highly based on parental knowledge, attitudes, and practices regarding mental health and developmental challenges in a young person.

Parental care, manifested in parenting behaviors, varies across and within species, vis-a-vis the form it takes, its level, duration, involvement of mother and father. ⁶ Lee Gettler, a noted anthropologist at the University of Notre Dame remarks that compared to other species on earth human beings are unique in engaging in “costly forms of care” that are perhaps necessary for survival and successful adaptation of human offspring. ⁷ In defining parenting as “…socialising child(ren) to conform to necessary demands… while maintaining (a) sense of personal integrity,” Diana Baumrind identified an imperative “socializing” role of parents in a child’s life, the “necessary” nature of parenting demands, alongside the need for parents to not be completely consumed in their parenting role. ⁸ The personal integrity of parents involves a recognition of their own intellectual, social, and emotional needs and desires that must not be relinquished in the face of parenting demands. The specific role for parenting, as a key socializing tool and a buffer for the impacts of distal environmental layers is determined by the age and life-stage of a child. The role of parenting changes as a child’s dependence on a caregiver for survival and developmental actualization reduces with age. By adolescence, a young person’s intellectual capacities and social and emotional functioning are almost adult-like. Their nurturing needs diminish, and parental limit-setting starts to fail with increasing autonomy of the adolescent. However, adolescents need and desire parental support as they hone and master developmental skills through experiences within their micro (family) and macro (school, socio-cultural setting, etc.) environments. In early years, children are relatively more passive recipients of parenting attitudes and practices that could have a direct impact on their development and well-being. During adolescence the bidirectionality in parent-child interactions increases, as they act out on more longitudinally conceived notions of relationships, ⁹ wherein adolescents are more capable of reflecting upon their own and parental attitudes and behaviors over time and in different contexts. An adolescent needs their parent to support their exploration of their own skills when faced with complex developmental tasks, and “be with” them when they seek out their parent so that the parent can help the adolescent organize their feelings. ¹⁰ Unlike a child, an adolescent may not wish to be “told,” but needs to be “heard and understood.” This parent-adolescent “dance” influences key developmental attributes like self-control, ¹¹ which is a predictor of personal, social, occupational role functioning, ¹² as well as a trait vulnerability for internalizing and externalizing behavior problems.^13,14

In this increasingly complex, globalized, technological world, it is challenging to characterize the environment. The “micro,” proximate family layer is intimately influenced by relatively distal socio-economic and political themes, and social and community networks, through the pervasive presence of, for example, social media. While adolescent explorations discover novel virtual spaces that transcend physical and social boundaries, parents might feel increasingly challenged by their relative lack of resources to adequately monitor these spaces. Not to mention the constant feeling of “being under the microscope” for each and every action of their child. And the deeply personal sense of helplessness and powerlessness when their child/adolescent struggles in any way or when they are not able to provide secure experiences that they’d naturally wish they could/could’ve. Parents, not immune to the temptations and distractions of globalization, can at times find themselves in “survival mode.” This then impedes frontal lobe capacities for creativity, reflection, stepping back, and looking beyond the “problem child/adolescent,” mentalizing their child/adolescent’s strengths and difficulties (or even likes and dislikes), and maintaining insight into emerging patterns and risks in relationships. Do parents today miss parenting templates required in these layered, hyper-connected, but equally isolating environments? Are conceptualizations of parenting as key socializing tools and buffers still valid? Or has the role of parenting changed in the presence of other mediators of socialization? One might argue that the world has always changed, yet at every change we find some homeostatic mechanisms in and for every generation. But is the pace of change in current times too quick for our homeostatic psychological, social, cultural, political mechanisms to work? The search for explanatory models and more effective interventions in adolescent mental health cannot overlook this important complex systemic influence.

Parenting in adolescence occurs in an expanded (and expanding) social context that includes the familial social network, peers, school environment, and access to multiple more distal environments through globalized media. These environments affect not only adolescents’ perceptions of their parenting needs, but also parents’ perceptions of their own supports and their own limitations in parenting their adolescent offspring.^15,16 Intriguingly, a longitudinal exploration from infancy to late adolescence found a lack of effect of long-term parenting on adolescents’ emotion regulation patterns. ¹⁷ The authors of this study discussed how the widening developmental context may explain this finding given that key developmental tasks during adolescence, ie social learning, integration, and competition, happen in relation to peers outside the family context. Emotion regulation changes through adolescence might therefore be dependent upon the peer environment rather than parenting. However, in other “wide” developmental contexts like socio-economic poverty and cumulative adversity, parental warmth and support are shown to promote adolescent development ¹⁸ and mitigate psychopathological risk. ¹⁹

Where do practicing clinicians find themselves in the midst of the above conundrums? Is working with parents making any difference to children and adolescents with mental health issues? There is systematic evidence for parenting interventions in young children.^20-23 There are recent systematic reviews into parent-based interventions^22,24-26 and parenting styles, ²⁷ as well as a proposed meta-analysis of RCTs of parenting programs ²⁸ related to adolescent mental health outcomes, too. While parenting finds itself as one among myriad environmental risk factors, for a clinician it could be the single most reliable protective factor. The need for more stringent, evidence-based parenting interventions in adolescence is clear. Such interventions need to consider parents as humans as well (!), who themselves are embedded in complex micro-, meso-, macro-systems, and should be considered as having a natural instinct and intent to nourish, nurture, and protect their offspring (of any age), on the one hand, but also a need to feel understood, respected, and not judged, on the other hand.

Nuanced examinations of parenting in adolescence must employ qualitative and quantitative approaches, looking at parenting goals, styles, practices, and challenges, ²⁹ alongside assessments for parental personality functioning and even their own adult attachment styles. ³⁰ Examinations of adolescent “characteristics,” ie developmental, temperamental, and social network attributes must accompany behaviors and outcomes of concern. Socio-epidemiological modeling ³¹ of parenting and adolescent characteristics could better inform interventions for unique parent-adolescent dyads stratified on risk profiles. In other words, there is a need to examine how parenting continues to make a difference to adolescent development and well-being after controlling for other environmental influences. This could inform more specific, and likely more effective, parenting interventions for adolescents.