Parental Warmth and Responsiveness for Children with Emotional Health Challenges - Calm Kid Central

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Parental Warmth and Responsiveness for Children with Emotional Health Challenges

The importance of parents and caregivers acting in warm, loving, caring and interested ways towards their children might seem obvious towards us as health/education professionals today, but it has only been in the last 50 or 60 years that these concepts have been discussed by researchers interested in child development in any depth.
This article examines the concepts of warm and responsive parenting and loving, “securely attached” child/parent relationships, how they have developed over time and the research behind with them.

DEFINITIONS OF PARENTAL WARMTH AND RESPONSIVENESS
Despite some variation in how the concepts of warmth and responsiveness are defined by different writers, warm and responsive parents/caregivers are usually thought to be those who consistently:
1. Act in loving, affection, interested and positive ways towards a child (sometimes differentially referred to as parental warmth)- and who;
2. Notice and respond in caring ways to the child’s emotions and experiences (sometimes referred to as parental responsiveness).
While some writers differentiate between warmth and responsiveness, others discuss the two concepts interchangeably.  These concepts are also referred to as “sensitive parenting”, “positive parenting” or “attachment” parenting (more on this last concept in a minute).

EARLY RESEARCH ON WARMTH/RESPONSIVENESS
Studies from the 1930’s to the 1960’s examined a number of specific parenting practices and how they were related to child well-being.  In the late 1960’s Diana Baumrind identified two dimensions of parenting, one of which she called “responsiveness” and one she called “demandingness”.   Baumrind defined responsiveness as the degree to which parents “respond to their child’s or teenager’s needs in a supportive and accepting manner”.  A higher degree of responsiveness was theorized to lead to better emotional health in the young person.   Baumrind defined demandingness as the degree to which parents expect their children to act in positive ways.  A higher degree of demandingness was also theorized to lead to better emotional health in children.  On the basis of these dimensions, the four types of parenting are as follows:

1. High responsiveness and high demandingness was characterized as authoritative parenting;
2. Low responsiveness and low demandingness was identified as neglectful parenting;
3. High responsiveness and low demandingness was identified as permissive parenting and;
4. Low responsiveness and high demandingness was identified as authoritarian parenting.
Authoritative parenting was theorized being best for children, while authoritarian (and permissive and neglective) parenting was theorized as leading to bad outcomes for children (with the unfortunately similar words describing diametrically opposite things from this point onwards, confusing psychology students everywhere!).

Around the same time, John Bowlby was studying the mental health of homeless children who had been separated from their parents during World War 2.  In 1951 he published a seminal paper for the World Health Organisation, in which he recommended that “the infant and young child should experience a warm, intimate, and continuous relationship with his mother (or permanent mother substitute) in which both find satisfaction and enjoyment”.
Over the next two decades, Bowlby went on to develop what he called “attachment theory” – in which he proposed that children are evolutionarily designed to be connected to one parent figure for protection against predators, that parents should act in warm and supportive ways in order to facilitate this connection and that this attachment was also essential for child psychological well-being and normal emotional development.   In the 50’s and 60’s, Mary Ainsworth was heavily influenced by Bowlby’s work and developed the theory of children/parenting having varying “attachment styles” depending on their relationship with each other.  She used the now classic “strange situation” experiment (in summary – observing how children interacted with their parents after new people came in the room) in an attempt classify children as having “secure” or “anxious/avoidant” attachment styles with their parents/caregivers.    Ainsworth and others proposed that children who have loving and reassuring parents would be “securely attached” and this type of attachment would result in long term more positive outcomes for children.
In the 1980’s, William and Martha Spears – also greatly influenced by Bowlby and also by Ainsworth – published their seminal book on attachment parenting, and suggested that parents (and especially mothers) should follow principles of “child led” parenting, including but not limited to having bonding opportunities after birth, breast feeding, responding to crying, avoiding “sleep training” and warm and responsive talking to children.

WHAT HAS HAPPENED SINCE THEN?
In the decades since Baumrind, Bowlby and Ainsworth’s first published their work  there has been an explosion in the number of books, programs and courses about the concepts of attachment parenting and warmth and responsiveness parenting.  The underlying principle of these programs/books/courses is that warm and responsive parenting (and “secure” attachments) leads to better outcomes for children and young people.
Over the last two decades in particular, a number of psychologists, academics and other writers in child development have gone further and theorized that not only is parental warmth and responsiveness good for children’s well-being, a lack of this type of caregiving will result in emotional and mental health disorders in children.
For example, it has been proposed that children who have difficulties with very challenging behaviour (for example those diagnosed with conduct disorder, and/or with callous unemotional traits), may have their difficulties at least partially caused through a lack of warm and positive parenting styles (with the theorized mechanisms being modelling effects, or a children’s subconscious search elsewhere for a sense of security).  Anxiety and depression in children has also been suggested as being exacerbated by a lack of parental warmth, with writers theorizing that when young people do not consistently feel secure and cared for by parental figures, they are more likely to develop symptoms related to worry, insecurity, sadness and hopelessness.  Several writers also suggest that a lack of warmth leads to identifiable neurological deficits. For example, many studies have examined the links between a lack of warmth and responsiveness in parents/caregivers and dysregulated dopamine/oxytocin systems and underdeveloped regions of children’s brains.

PROGRAMS AND INTERVENTIONS DESIGNED TO INCREASE PARENTAL WARMTH AND RESPONSIVENESS
Given the emphasis on warmth and responsiveness during the preceding decades, during the 80’s and 90’s, government funded parenting education campaigns and child mental health interventions started to include components designed to increase parental warmth and responsiveness and to promote a secure attachment between children and caregivers.
For example, the Circle of Security program, developed in the 90’s by Hoffman and colleagues (the second most commonly implemented parenting program run in Australia), was designed to assist parents to develop a “secure attachment” to their child by using sensitive, responsive and warm responses (“bigger, stronger, kinder, wiser”) to the child’s behaviours and emotions,  and to provide a “secure base” for them to return to after exploring.
Even parenting programs which some practitioners argue have a heavy focus on behavioural principles have a strong focus on warmth/responsiveness.  For example, Matthew Sanders, the developer of Triple P (the most commonly implemented and researched parenting program in Australia) says that “Triple P seeks to promote warm, responsive, consistent parenting that provides boundaries and contingent limits for children in a low-conflict family environment”.

WHAT DOES THE SCIENTIFIC RESEARCH TELL US ABOUT THE LINK BETWEEN WARMTH AND WELL-BEING?
Theories linking parental warmth and responsiveness to child wellbeing have been examined by hundreds of psychological studies over the last 50 years.   Most of these studies have a similar format which is as follows: researchers measure levels of parental warmth (using observational, self-report, child and parent measures) or the “attachment” between a parent and a child, and then measure various aspects of child well-being (educational outcomes, emotional outcomes, social skills, physical health and so on) and look at the strength of the relationship between the two concepts.
Almost all of these studies find significant relationships between parental warmth/responsiveness and positive child factors, with higher levels of warmth/responsiveness being associated with positive child characteristics and lower levels associated with negative child characteristics.
For example, studies have linked higher levels of parental warmth and responsiveness with the following: Lower levels of conduct problems, anxiety symptoms, drug and alcohol use, depression, learning problems and symptoms of impulsiveness and higher levels of warmth with higher levels of emotional regulation, school achievement, social/peer skills and self esteem
These associations have been consistently found in both cross-sectional studies (warmth and child characteristics examined in one point in time) and longitudinal studies (warmth and child characteristics measured at multiple time points).
There are also a small number of intervention style studies examining whether parenting programs designed to improve parental warmth and responsiveness lead to better child outcomes.  For example, there are a number of studies examining the efficacy of the Circle of Security program – which show that after these programs, children often have improved outcomes (for example improved emotional regulation skills and behavioural functioning) compared to wait list control families.
Finally, there are a few experimental studies using rats in which the rats have been experimentally placed into either more or less nurturing (animal) parental environments.  The animal equivalents of warm and responsive parenting leads to better outcomes for rats too.

LINGERING RESEARCH QUESTIONS
Despite the many hundreds of studies as described above, it is still worth acknowledging that we don’t yet have the answers to some lingering questions.  Here are some of those.

1.  HOW IMPORTANT IS THE INFLUENCE OF PARENTAL WARMTH ON CHILD WELL-BEING COMPARED TO OTHER NON-PARENTING FACTORS?

Meta-analyses of studies examining the links between parental warmth and child well-being have concluded that there are “moderate to nearly large” effect sizes.   While this suggests the importance of parental warmth, for context it is worth remembering that many other areas of research also find the same size effect sizes in the relationships between child well-being and many other non parenting factors.  For example, these include (but are not limited to) genetic profiles, physiological characteristics, child nutrition levels, sleep, child cognitive styles, socio-economic factors and many others.
At this point research seems to suggest that child well-being is probably equally influenced by both parental warmth/responsivity AND a whole lot of other factors which have nothing to do with parent behaviour at all.

2.  DOES PARENTAL WARMTH *CAUSE* CHILD WELL-BEING – OR THE OTHER WAY AROUND?

Almost all of the research (except that on animals) in this area is (by ethical necessity of course) correlational.  In no study are parents/caregivers are assigned to provide “warmth” or “no warmth” caregiving to children.  This means we can’t know for sure that it warm and responsive parenting causes children to “do better” in all the areas examined.

Instead, it could be that something about these children who have positive characteristics and outcomes which caused their parents to be able to act in more warm and responsive ways.  In support of this idea, one recent study of parental warmth (they also looked at parental stress) and children’s personality traits in identical and non-identical twins found that 27% of the warmth shown by parents (and 48% of the stress) could be said to be “caused” by the child’s genetically determined temperament.   In other words, the results of this study suggested that it was not just that warm parenting caused good outcomes in children, but also that different children are born with easier/different temperaments which then caused their parents to either act in more or less warm ways towards them.
A second theory to explain the research finding associations between warmth and good outcomes for children, is that it is not parental warmth which causes good things to happen in children, nor is it that good things in children causes parental warmth – but instead that there is a third factor in families which causes both more warmth in parenting AND better outcomes for children.
For example, it might be that higher levels of social and financial resources (including access to good food, higher levels of education and more social supports) lead to parents providing more warm and responsive parenting, and also to children who have better outcomes.  Supporting this idea is a body of research showing higher levels of warmth and better outcomes for children in better resourced families.

3.  IS PARENTAL WARMTH AND RESPONSIVENESS MORE OR LESS IMPORTANT THAN OTHER POSITIVE PARENTING BEHAVIOURS?

Another question unanswered by the current state of research is whether parental warmth and responsiveness is a particularly important aspect of parenting – in other words is being a warm and responsive parent important “above and beyond” the importance of other potential positive parenting behaviours – or whether there are other aspects of parenting are equally (or perhaps even more?) important than being warm and responsive.

There are a number of theoretical models which suggest several other parenting behaviours or styles as equally important as warmth and responsiveness in leading to positive outcomes for children.  For example, Baumrind’s model of parenting suggests “high demandingness” (having rules for children, being aware of what they are doing, having expectations of them) is equally important to parental warmth.  Other writers call this “behavioural control” or “limit setting” and a similarly large body of research to the research on parental warmth suggests these behaviours are also linked to good outcomes in children.

Another set of parenting behaviours theorized as important is sometimes referred to as “autonomy supportive parenting”.  This phrase refers to parental behaviours which allow children to make their own decisions, be responsible for various aspects of their lives, to have their own independent thoughts and ideas.  Again, research suggests autonomy supportive parenting is also linked to better outcomes for children.

Unfortunately, few studies seem to have compared the relative importance of different types of parenting behaviours – and those which do are unable to find differences between them (probably because most studies find they have high correlations between them).   The intervention studies (referred to in the sections above) showing that parenting programs designed to increase warmth do lead to improved child outcomes usually show that other potentially positive parenting behaviours (behavioural control, autonomy granting) tend to increase at the same rate as parental warmth, making it difficult to conclude that the increase in parental warmth is the factor responsible for better outcomes for children following these programs.
If interventions designed to specifically increased warmth/responsiveness were compared to interventions specifically designed to increase other parenting behaviours, then we might be able to answer this question.  Unfortunately, even the highest quality parent intervention studies published almost always compare their parenting intervention to a wait list control (actually most don’t even have a control condition) and don’t analyse different aspects of the program.  This leaves us to still wonder – what WAS it about that parenting intervention which was helpful – and what did the parenting intervention do which helped – was it that parents became warmer?  Or perhaps it was that parents became more “relaxed”?  Or more “strict”?

As with most psychotherapy interventions, it seems that a lot of what we do can be helpful to a lot of people, but we are still learning about which things we do are most important (and indeed, which therapists can do it best and why).

4.  HOW “MUCH” OR “OFTEN” DOES WARM AND RESPONSIVE PARENTING NEED TO HAPPEN – AND FOR WHICH CHILDREN?

A final question we don’t have an answer to is “how much” of warm and responsive parenting is likely to make a difference to different children’s levels of wellbeing.
There are few studies looking at this question.  One recent study suggested that the “moment to moment responsiveness” was not as an important factor for secure attachment as being available to children when they were particularly distressed – in other words, parents/children can be connected well to each other even if parents/caregivers were not constantly being warm and responsive – provided they provided support when they were most upset.
Another recent study examined how often parents needed to respond supportively to a crying infant and found that if this responsive support was done at least 50% of the time, the parent/child relationship was judged to be “securely attached”.
We also don’t know whether all children have equal needs for warm and responsive parenting.  There are some studies to suggest that some children seem to “do fine” with almost any kind of parenting, while other children are likely to react particularly negatively to poor parenting practices.  This too is an emerging area of research without any clear conclusions.
Some writers discuss a concept of the “good enough” to suggest that warmth and responsiveness is needed some of the time – but not all the time – and different children need different parenting.

WHAT SHOULD WE DO AND/OR RECOMMEND WHEN WORKING WITH CHILDREN WITH CHALLENGES?
Although as outlined above, there are still a number of unknowns about parental warmth and responsiveness, the research which has been conducted suggests it is very likely that at least some measure of parental warmth and responsiveness will be very important for most children and young people.
Therefore, it seems that it would be important for those of us interested in child and adolescent well-being to prioritise helping parents/caregivers increase the frequency of their warm and responsive caregiving.  And this may be particularly important when we are working with parents/caregivers who have children with mental/emotional health challenges.
Here are some ways we might do this:

1.  TEACH AND EXPLAIN SPECIFIC TYPES OF RESPONSIVE/WARMTH BEHAVIOURS

First, it’s important to help parents know what warmth and responsive parenting actually looks like.  Here are the specific behaviours psychologists/researchers have used as examples of high parental warmth and responsiveness when they are measuring this concept.
1.      Asking questions and show interest in children’s opinions and lives.
2.      Noticing and saying positive and caring things about what children and young people do, say and think (genuine compliments/praise, saying thank you, expressing love and appreciation)
3.      Showing physical affection towards children
4.      Spending regular “child/young person led” time with children (following their lead about what they’d like to do or talk about, paying positive attention to them during that time)
5.      Paying attention to when children/young people are experiencing difficult times and difficult emotions
6.      Saying and showing empathy when we notice these difficult times happening (saying we care and are sorry they are having a tough time rather than ignoring it or just trying to solve the problem)
7.      Making sure children do not feel shamed, fearful, physically or psychologically hurt when helping them to behave in more positive ways

2.  PROVIDE SUPPORT TO PARENTS/CAREGIVERS TO HELP THEM IMPLEMENT WARM AND POSITIVE BEHAVIOURS

Providing parents with information is of course, not sufficient.  We need to do the problem solving, supporting and working with families to assist them to make behavioural changes.
This might include some or all of the following.
1.      Provide information and research (carefully and only within the bounds of what we know) to increase motivation and engagement for parents/caregivers to act in these ways.  For example, providing information/research as to why these behaviours might matter for their child – and why they can be tougher to do with some children than others (explaining reasons related to genetic factors, temperament, parental resources available etc) .
2.      Helping parents/caregivers find examples and models of this behaviour – we might do this ourselves with children in therapy with them watching, support them to find family members/friends for them to watch and observe, help them notice warmth/responsivity in their friendship relationships or even via media/TV shows.
3.      Brainstorming and workshopping specific phrases and examples of warm/responsive parenting and ways/times these might be implemented which suits an individual family (and their values) – with a specific focus on adjusting these for the child’s challenges and parent resources/temperament/values.
4.      Problem solving how parents/caregivers will be able to remember, find the energy and be motivated to act in these ways (asking what makes this hard, empathizing and working on solutions)
5.      Encourage goal setting which aims for small but consistent changes over a long period of time

3.  ADDRESS PARENT GUILT AND ANXIETY

Even if we are moderate and balanced in our explanations about this concept, it is worth noting that any discussion of parenting behaviours which may contribute to child mental health is likely to result in at least some parents experiencing high levels of worry and guilt – with some parents/caregivers feeling like it is “their fault” that their children are struggling.
This guilt and anxiety may lead to disengagement with services, more distress and therefore ultimately and ironically less ability to provide warm and responsive parenting to their children.
This doesn’t mean we shouldn’t raise the importance of these behaviours.  But we do need to be aware of parental guilt and take steps to mitigate it.
Here are some the steps we can take to address parent guilt and anxiety when we are working through this issue.

1.    Assess for and affirm parents/caregivers for the warm parenting which is being provided
Given much of the work we do involves a focus on problems or deficits, it is possible that professionals often “miss” or are unaware of the warm and responsive caregiving which is being done.  In my experience many parents/caregivers are warmer in their natural environments than how they present to us as mental health professionals in clinic settings – where they are focused on trying to communicate the concerns they have about their child.
It can be helpful to ask questions such as:  “when is it easiest to talk positively about X”, “what are the good times you have together”, and “when do you feel able to provide sympathy to X” etc – and then to affirm this:  “I can see how much she/he loves being with you”, “When you did X, I can see that Y happened”

2.      Assess for and affirm other positive parenting behaviours or styles – for example, autonomy granting, limit sitting, skill building)
While we are assessing for and affirming warmth/responsiveness, we should also be looking for other potential parental behaviour strengths, such as parents who capably support autonomy in their child, or who appropriately and gently set appropriate limits.

3.      Provide education about the range of factors which are likely to promote child wellbeing – including not just parental warmth, but also parental autonomy building, parental limit setting, sleep, nutrition, child skill building, peer factors, medical/physical health treatments and so on.
In other words, we need to take care to be moderate in our explanations of what contributes to child mental health and talk about all the different ways in which parents/caregivers can support their child’s mental health.

4.      Encourage parent/caregiver self-compassion and self-care
Supporting parents/caregivers to find ways to be kind to themselves and prioritise their well-being is usually helpful for their children and young people in the long run.

I hope this provides an overview and balanced picture of the concept of parental warmth and responsiveness.  All the best in the important work with families to support secure, loving and attached relationships.

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