Sleep, Discipline and Childhood Behavioral Disorders

A couple of news stories about some new “studies” recently caught my eye. They illustrate the downright ungodly lengths certain segments of the mental health industry, as well as dope-dealing drug companies like Shire Pharmaceuticals, will go to distract both the field and the public from the real cause of many childhood behavioral problems: family interactions. They do so in order to justify their mostly ineffective and potentially toxic treatments. 

The stories were:

1    1. Poor Childhood Sleep May Lead to Behavior Woes in Adolescence by Molly Walker, Staff Writer, MedPage Today, December 04, 2017: Study suggests bidirectional association for some problems

“Young children who had greater sleep problems were more likely to have certain types of behavioral problems years later, Australian researchers found…There was a bidirectional association between sleep problems and externalizing difficulties, such as attention deficit-hyperactivity disorder, oppositional defiant disorder, and conduct disorder, in children when measured at particular time points through early adolescence, reported Jon L. Quach, PhD, of the University of Melbourne in Australia…Quach's group said that the directionality of the associations between sleep problems in children and later behavioral problems are "poorly understood," but argued that "addressing this knowledge gap will provide valuable information to inform the focus and timing of interventions aiming to improve children's sleep and behavior during the elementary school years...Sleep problems were defined by parent report. 

Of course they relied on parental reporting - to make use of parental denial to the maximum extent possible. 

“The directionality of the associations between sleep problems in children and later behavioral problems are ‘poorly understood?’” Poorly understood, my ass. See below.

       2.  ADHD and insomnia appear intertwined By: Bruce Jancin, Clinical Psychiatry News, November 30, 2017  (http://www.mdedge.com/clinicalpsychiatrynews/article/153175/adhd/adhd-and-insomnia-appear-intertwined?oc_slh=b7663e08a51cd61023636ca0354888a37f5bd7dbaf016b90aac8a66134946998&channel=296&utm_source=News_CPN_eNL_120417_F&utm_medium=email&utm_content=Self-harm+on+rise+in+U.S.+among+this+group)

“Converging evidence suggests that attention-deficit/hyperactivity disorder and sleep difficulties share a common underlying etiology involving circadian rhythm disturbance, J.J. Sandra Kooij, MD, PhD, declared at the annual congress of the European College of Neuropsychopharmacology…Having built the case for circadian disruption as an underlying cause of both ADHD symptoms and the commonly comorbid sleep problems…Multiple studies have shown that roughly 75% of children and adults with ADHD have sleep-onset insomnia.”

Shared etiology for sleep problems and certain childhood behavioral disorders like ADHD? Well, duh. Both are caused by parents who don't know how to discipline their kids. In the case of ADHD, they let them stay up half the night playing video games. And then the kids are too sleepy to concentrate the next day. 

This sleep pattern leads to the circadian rhythm disturbances (getting days and nights mixed up, in a way) described by Kooij. Of course, the discipline problems in the houses of these kids are hardly limited to bedtime. Inconsistent, abusive, and/or just plain absent discipline lead to children acting out. You know, “oppositional defiant disorder” and “conduct disorder.” Like I said, acting out.

Measuring the Nature of Parenting Practices in Studies

A "scientific" journal article entitled, “Which dimension of parenting predicts the change of callous unemotional traits in children with disruptive behavior disorder?” By Muratori and others in the August 2016 issue of Comprehensive Psychiatry attempted to determine whether parenting practices influenced the development of so called callous and unemotional (CU) character traits in children. Alternatively, are those traits – which are common in children with disruptive behavior –more genetic in origin? 

In the study, no significant relationship was found between "negative" parenting and CU traits; these two variables were also unrelated when "positive" parenting was considered in the same model. However, using a slightly different model, higher levels of positive parenting predicted lower levels of CU traits.

Although I would like to believe and tend to agree that “positivity” in parent-child relationships helps decrease acting out behavior in children, a huge problem with this type of study is how the hell can you precisely measure the nature of the relationship between parents and children? The biggest problems with that include the fact that these relationships are not constants but vary across time and situational contexts. Parents might be good disciplinarians when it comes to providing children with adequate curfews, for example, but terrible at allowing them to stay up all hours of the night. Furthermore, the disciplinary practices certainly change over time as the children get older.

Second, how does a study even attempt to measure the tone of parenting practices? This study used a measure called The Alabama Parenting Questionnaire (APQ) [40] – mother report. This parent report measure has five subscales: parental involvement, positive parenting, poor monitoring/supervision, inconsistent discipline, and corporal punishment. Items are rated on a 5-point Likert scale, ranging from 1 (never) to 5 (always).

They used the mother’s own report of her own disciplinary practices! If a mother were abusive or inconsistent, how likely do these authors think she would admit to it, even if she were very self-aware, which obviously many people are not. There is no way to be sure, of course, but the odds are very good that the amount of “negative” parenting is  higher than their study results would indicate, while the amount of “positive” parenting could be overestimated. 

And which particular types of those parental behaviors listed in the instrument were the most relevant to the question at hand? There is no way to know!

When it comes to assessing the effects of family interactions, details make a huge difference. And as I have maintained over and over again, in order to get these details, you would need a camera on both the parents and the children 24 hours a day over a significant time period. This type of study using absolutely no direct observation of what is purportedly being measured is a complete waste of time.