Blaming the victims...even the children

In the mid-1800s, people thought that if you came down with cholera, a disease caused by bacteria, it was your fault. Those who came down with cholera "deserved" it. Some people thought it was caused by immoral living, including not attending church. During New York City's cholera epidemic in 1832, according to New York Times reporter John Noble Wilford, the director of New York City's historical society wrote:

 “Those sickened must be cured or die off, & being chiefly of the very scum of the city, the quicker [their] dispatch the sooner the malady will cease.”

In the 1980s, the same reaction occurred when the AIDS epidemic, caused by a virus, came to light. It was commonly regarded as a disease of gay men, whose "immoral" lifestyle was to blame.

People who are violent and/or victims of violence, especially within families, are generally regarded as entirely to blame for their actions. Men are "evil" or "bad" because they abuse (most abuse in families is carried out by men). Women are "stupid" for staying in the relationship. But epidemiological, neurobiological and epigenetic research is showing that behaviors, brains and genes are shaped early in childhood, and that without intervention or support, the likelihood of a child who witnesses and/or experiences abuse continuing on a path to abusing or becoming a victim of abuse increases substantially.

So, it's no wonder that, generally speaking, if children behave "badly", our systems blame them for it and slap labels on them: attention deficit hyperactivity disorder (ADHD), conduct disorder (CD), mood disorder (MD), oppositional defiance disorder (ODD). They also hold the child responsible for changing her or his behavior -- either with drugs or therapy -- and, except in cases of obvious and repeated child abuse, don't look to see if the environment in which the child lives needs to change, too.

Some interesting research is emerging that's taking a more holistic approach. According this recent MedPageToday.com overview of a study of 2,422 children who were treated at four Indiana pediatric clinics, researchers at the Indiana University School of Medicine in Indianapolis found that "children exposed to both parental violence and depression before the age of 3 were significantly more likely to be diagnosed with attention deficit hyperactivity disorder (ADHD) before they were 6..."

In another MedPageToday.com overview of a study at the University of Utah in Salt Lake City, researchers following 320 children found that in "children whose families were investigated by child protective services for suspected abuse and where there had also been reports of intimate partner violence, cessation of the violence led to an 11.9% decrease" in withdrawal and depression in children, and nearly a 20% decrease in aggression and anger. These changes lasted throughout the length of the study -- seven years.

The researchers also asked the caregivers who'd been investigated for abuse and violence how many had received referrals or services to help them stop the violence -- only 11.5% had. That's a shockingly low number, but not unexpected since in many communities, domestic violence is not yet considered child abuse.

One of the most interesting studies to appear recently comes from two researchers: Dr. Stephen Scott, a child psychiatrist at King’s College London Institute of Psychiatry and director of the National Academy for Parenting Research in London, England; and Thomas O'Connor, director of the Wynne Center for Family Research, Department of Psychiatry, University of Rochester Medical Center in New York City.

They divided 112 five- and six-year-olds with emotional problems and their parents into two groups: one control group that had no intervention, and the other in which parents participated in a 12-week Incredible Years program and were given additional resources and assistance.

The results: A year later, the kids who had been identified with "emotional dysregulation" -- and whose parents had changed their own behaviors as a result of participating in the Incredible Years program -- had fewer angry outbursts and irascible behavior problems. The researchers wrote: "Parent interviews revealed that compared with controls, intervention parents were warmer, less critical, used more play, praise, and less harsh discipline (spanking and prolonged exclusion) at follow up."

Note that there's no labeling of "good" parents and "bad" parents here. More often than not, parents with children who are angry, depressed, anxious or moody aren't "bad" parents. They're modeling behavior that they learned from their own parents, and if they don't make a conscious effort to change or aren't taught skills that help them alter their interactions with their children, they pass on their own childhood adversities, especially if they're under stress.

Toward the end of their publication (IncredibleYears.pdf), the researchers added this interesting observation: "While not all children would be expected to respond similarly to parenting interventions, it is perhaps surprising that we do not yet have robust evidence of many child moderators of treatment response to parenting interventions."

That's because, for the most part, our systems are still too focused on holding kids alone responsible for their behavior. But a slow shift is occurring in child welfare agencies, schools, juvenile justice, medical practices, mental health services and youth services as people understand that kids with behavior problems aren't being intentionally bad. There's an emerging awareness that a child's uncontrolled outbursts, anxiety, moodiness or severe depression are normal responses to a difficult, dysfunctional or abusive environment in which they are trapped. Most children act out or withdraw because they can't describe with words what's happening -- they're too young to understand that abuse, neglect or other family dysfunction isn't normal or healthy, and they're not in a position to change their environment to get what they need.

As one children's advocate noted: "Sometimes the kids are just doing their job, and we just don't understand it."