Detached parents: How to help

 

While most of the parents you will see in your office will be thoughtful, engaged, and even anxious, occasionally you will encounter parents who seem detached from their children. Spending just a few extra minutes to understand this detachment could mean an enormous difference in the psychological health and developmental well-being of your patient.

It is striking when you see it: Flat affect, little eye contact, no questions or comments. If the parents seem unconnected to their children, it is worth being curious about it. Whether they are constantly on their phones or just disengaged, you should start by directing a question straight to them. Perhaps a question about the child’s sleep, appetite, or school performance is a good place to start. You would like to assess their knowledge of the child’s development, performance at school, friendships, and interests, to ensure that they are up to date and paying attention.

javi_indy/ Thinkstock

You also would like to know that they can engage in an emotionally attuned way with their children, even if during your visit they are not demonstrating this. If the parents are unable to offer reasonable answers to your questions or show some emotional engagement, you should speak further with them, preferably with their children out of the room.

Once alone, you might start by offering your impression of how the child is doing, then observe that you noticed that they (the parents) seem quiet or distant. The following questions should help you better understand the nature of their detachment.

Depression

Ask about how they are sleeping. If the child is very young or the parents have a difficult work schedule, they might simply be sleep deprived, which you might help them address. Difficulty sleeping also can be a symptom of depression. Have they noticed any changes in their appetite or energy? Is it harder to concentrate? Have they felt more tearful, sad, or irritable? Have they noticed that they don’t get as much pleasure from things that usually bring them joy? Do they worry about being a burden to others? Major depressive disorder is relatively common, affecting as many as one in five women in the postpartum period and one in ten women generally.

Men experience depression at about half that rate, according the Centers for Disease Control and Prevention. It is a condition that can cause feelings of guilt and shame, so many suffer silently, missing the chance for treatment and raising the risk for suicide. Infants of depressed mothers often appear listless and may be fussier about sleeping and eating, which can exacerbate poor attachment with their parents, and lead to problems in later years, including anxiety, mood, or behavioral problems. A parent’s depression, particularly in the postpartum period, represents a serious threat to the child’s healthy development and well-being.

Tell the parents that what they have described to you sounds like it could be a depressive episode and that depression has a serious impact on the whole family. Offer that their primary care physicians can evaluate and treat depression, or learn about other resources in your community that you can refer them to for accessible care.

 

 

Overwhelming stress

Is the newborn or special needs child feeling like more responsibility than the parents can handle? Where do the parents find support? Has there been a recent job loss or has there been a financial setback for the family? Is a spouse ill, or are they also caring for an aging parent? Has there been a separation from the spouse? Many adults face multiple significant stresses at the same time. It is not uncommon for working parents to be in “soldiering on” mode, just surviving. But this takes a toll on being present and engaged with the children, and puts them at risk for depression and substance abuse.

Acknowledge their stresses and point out that parents usually feel they simply must manage everything on their own. It can be so helpful to have access to a social worker who can help with resources, as parents may not have taken the time to seek help such as legal advice, an aide for the aging parent, or services for a disabled or chronically ill family member. It also can be powerful to offer them a few simple strategies for stress management. Point out that protecting time for sleep and a little time for exercise, relaxation, or pleasure (especially with the children) can feel good and leave them better equipped to manage their stress. It also models the kind of self-care they would like their own children to learn.
 

Traumatic stress

Have they recently experienced a crime or accident, the unexpected loss of a loved one, or threats or abuse at home? They may be grieving, or may be experiencing symptoms of posttraumatic stress disorder that lead them to appear distant and detached. Grief will improve with time, but they may benefit from extra support or from assistance with their responsibilities (a leave from work or more child care). If they have experienced a traumatic stress, they will need a clinical evaluation for potential treatment options. If they are being threatened or abused at home, you need to find out if their children have witnessed the abuse or may be victims as well. You can offer these parents resources for survivors of domestic abuse and speak with them about your obligation to file with your state’s agency responsible for children’s welfare. It is critical that you listen to any concerns they may have about this filing, from losing their children to enraging their abusers.

 

Beyond child neglect or abuse, if you suspect that parents are so detached that they may be unable to care for their children, you also can file. Ideally, this would raise parents’ awareness of the situation (chronic stress or depression) and offer them additional services that could address the underlying problem. Children with detached parents also will benefit from having as many caring, attentive adults as possible in their orbit. Find out who else is connected to them, from family members to teachers, coaches, or ministers. Suggest that their children would benefit from structured activities with a chance to connect with other caring adults.

A detached parent may make a child feel worried, worthless, or guilty. There is no substitute for a loving, engaged parent, and your brief interventions to help a parent reconnect with the child will be invaluable.
 

Dr. Swick is an attending psychiatrist in the division of child psychiatry at Massachusetts General Hospital, Boston, and director of the Parenting at a Challenging Time (PACT) Program at the Vernon Cancer Center at Newton Wellesley Hospital, also in Boston. Dr. Jellinek is professor emeritus of psychiatry and pediatrics, Harvard Medical School, Boston. Email them at pdnews@mdedge.com

 

While most of the parents you will see in your office will be thoughtful, engaged, and even anxious, occasionally you will encounter parents who seem detached from their children. Spending just a few extra minutes to understand this detachment could mean an enormous difference in the psychological health and developmental well-being of your patient.

It is striking when you see it: Flat affect, little eye contact, no questions or comments. If the parents seem unconnected to their children, it is worth being curious about it. Whether they are constantly on their phones or just disengaged, you should start by directing a question straight to them. Perhaps a question about the child’s sleep, appetite, or school performance is a good place to start. You would like to assess their knowledge of the child’s development, performance at school, friendships, and interests, to ensure that they are up to date and paying attention.

javi_indy/ Thinkstock

You also would like to know that they can engage in an emotionally attuned way with their children, even if during your visit they are not demonstrating this. If the parents are unable to offer reasonable answers to your questions or show some emotional engagement, you should speak further with them, preferably with their children out of the room.

Once alone, you might start by offering your impression of how the child is doing, then observe that you noticed that they (the parents) seem quiet or distant. The following questions should help you better understand the nature of their detachment.

Depression

Ask about how they are sleeping. If the child is very young or the parents have a difficult work schedule, they might simply be sleep deprived, which you might help them address. Difficulty sleeping also can be a symptom of depression. Have they noticed any changes in their appetite or energy? Is it harder to concentrate? Have they felt more tearful, sad, or irritable? Have they noticed that they don’t get as much pleasure from things that usually bring them joy? Do they worry about being a burden to others? Major depressive disorder is relatively common, affecting as many as one in five women in the postpartum period and one in ten women generally.

Men experience depression at about half that rate, according the Centers for Disease Control and Prevention. It is a condition that can cause feelings of guilt and shame, so many suffer silently, missing the chance for treatment and raising the risk for suicide. Infants of depressed mothers often appear listless and may be fussier about sleeping and eating, which can exacerbate poor attachment with their parents, and lead to problems in later years, including anxiety, mood, or behavioral problems. A parent’s depression, particularly in the postpartum period, represents a serious threat to the child’s healthy development and well-being.

Tell the parents that what they have described to you sounds like it could be a depressive episode and that depression has a serious impact on the whole family. Offer that their primary care physicians can evaluate and treat depression, or learn about other resources in your community that you can refer them to for accessible care.

 

 

Overwhelming stress

Is the newborn or special needs child feeling like more responsibility than the parents can handle? Where do the parents find support? Has there been a recent job loss or has there been a financial setback for the family? Is a spouse ill, or are they also caring for an aging parent? Has there been a separation from the spouse? Many adults face multiple significant stresses at the same time. It is not uncommon for working parents to be in “soldiering on” mode, just surviving. But this takes a toll on being present and engaged with the children, and puts them at risk for depression and substance abuse.

Acknowledge their stresses and point out that parents usually feel they simply must manage everything on their own. It can be so helpful to have access to a social worker who can help with resources, as parents may not have taken the time to seek help such as legal advice, an aide for the aging parent, or services for a disabled or chronically ill family member. It also can be powerful to offer them a few simple strategies for stress management. Point out that protecting time for sleep and a little time for exercise, relaxation, or pleasure (especially with the children) can feel good and leave them better equipped to manage their stress. It also models the kind of self-care they would like their own children to learn.
 

Traumatic stress

Have they recently experienced a crime or accident, the unexpected loss of a loved one, or threats or abuse at home? They may be grieving, or may be experiencing symptoms of posttraumatic stress disorder that lead them to appear distant and detached. Grief will improve with time, but they may benefit from extra support or from assistance with their responsibilities (a leave from work or more child care). If they have experienced a traumatic stress, they will need a clinical evaluation for potential treatment options. If they are being threatened or abused at home, you need to find out if their children have witnessed the abuse or may be victims as well. You can offer these parents resources for survivors of domestic abuse and speak with them about your obligation to file with your state’s agency responsible for children’s welfare. It is critical that you listen to any concerns they may have about this filing, from losing their children to enraging their abusers.

 

Beyond child neglect or abuse, if you suspect that parents are so detached that they may be unable to care for their children, you also can file. Ideally, this would raise parents’ awareness of the situation (chronic stress or depression) and offer them additional services that could address the underlying problem. Children with detached parents also will benefit from having as many caring, attentive adults as possible in their orbit. Find out who else is connected to them, from family members to teachers, coaches, or ministers. Suggest that their children would benefit from structured activities with a chance to connect with other caring adults.

A detached parent may make a child feel worried, worthless, or guilty. There is no substitute for a loving, engaged parent, and your brief interventions to help a parent reconnect with the child will be invaluable.
 

Dr. Swick is an attending psychiatrist in the division of child psychiatry at Massachusetts General Hospital, Boston, and director of the Parenting at a Challenging Time (PACT) Program at the Vernon Cancer Center at Newton Wellesley Hospital, also in Boston. Dr. Jellinek is professor emeritus of psychiatry and pediatrics, Harvard Medical School, Boston. Email them at pdnews@mdedge.com

 

While most of the parents you will see in your office will be thoughtful, engaged, and even anxious, occasionally you will encounter parents who seem detached from their children. Spending just a few extra minutes to understand this detachment could mean an enormous difference in the psychological health and developmental well-being of your patient.

It is striking when you see it: Flat affect, little eye contact, no questions or comments. If the parents seem unconnected to their children, it is worth being curious about it. Whether they are constantly on their phones or just disengaged, you should start by directing a question straight to them. Perhaps a question about the child’s sleep, appetite, or school performance is a good place to start. You would like to assess their knowledge of the child’s development, performance at school, friendships, and interests, to ensure that they are up to date and paying attention.

javi_indy/ Thinkstock

You also would like to know that they can engage in an emotionally attuned way with their children, even if during your visit they are not demonstrating this. If the parents are unable to offer reasonable answers to your questions or show some emotional engagement, you should speak further with them, preferably with their children out of the room.

Once alone, you might start by offering your impression of how the child is doing, then observe that you noticed that they (the parents) seem quiet or distant. The following questions should help you better understand the nature of their detachment.

Depression

Ask about how they are sleeping. If the child is very young or the parents have a difficult work schedule, they might simply be sleep deprived, which you might help them address. Difficulty sleeping also can be a symptom of depression. Have they noticed any changes in their appetite or energy? Is it harder to concentrate? Have they felt more tearful, sad, or irritable? Have they noticed that they don’t get as much pleasure from things that usually bring them joy? Do they worry about being a burden to others? Major depressive disorder is relatively common, affecting as many as one in five women in the postpartum period and one in ten women generally.

Men experience depression at about half that rate, according the Centers for Disease Control and Prevention. It is a condition that can cause feelings of guilt and shame, so many suffer silently, missing the chance for treatment and raising the risk for suicide. Infants of depressed mothers often appear listless and may be fussier about sleeping and eating, which can exacerbate poor attachment with their parents, and lead to problems in later years, including anxiety, mood, or behavioral problems. A parent’s depression, particularly in the postpartum period, represents a serious threat to the child’s healthy development and well-being.

Tell the parents that what they have described to you sounds like it could be a depressive episode and that depression has a serious impact on the whole family. Offer that their primary care physicians can evaluate and treat depression, or learn about other resources in your community that you can refer them to for accessible care.

 

 

Overwhelming stress

Is the newborn or special needs child feeling like more responsibility than the parents can handle? Where do the parents find support? Has there been a recent job loss or has there been a financial setback for the family? Is a spouse ill, or are they also caring for an aging parent? Has there been a separation from the spouse? Many adults face multiple significant stresses at the same time. It is not uncommon for working parents to be in “soldiering on” mode, just surviving. But this takes a toll on being present and engaged with the children, and puts them at risk for depression and substance abuse.

Acknowledge their stresses and point out that parents usually feel they simply must manage everything on their own. It can be so helpful to have access to a social worker who can help with resources, as parents may not have taken the time to seek help such as legal advice, an aide for the aging parent, or services for a disabled or chronically ill family member. It also can be powerful to offer them a few simple strategies for stress management. Point out that protecting time for sleep and a little time for exercise, relaxation, or pleasure (especially with the children) can feel good and leave them better equipped to manage their stress. It also models the kind of self-care they would like their own children to learn.
 

Traumatic stress

Have they recently experienced a crime or accident, the unexpected loss of a loved one, or threats or abuse at home? They may be grieving, or may be experiencing symptoms of posttraumatic stress disorder that lead them to appear distant and detached. Grief will improve with time, but they may benefit from extra support or from assistance with their responsibilities (a leave from work or more child care). If they have experienced a traumatic stress, they will need a clinical evaluation for potential treatment options. If they are being threatened or abused at home, you need to find out if their children have witnessed the abuse or may be victims as well. You can offer these parents resources for survivors of domestic abuse and speak with them about your obligation to file with your state’s agency responsible for children’s welfare. It is critical that you listen to any concerns they may have about this filing, from losing their children to enraging their abusers.

 

Beyond child neglect or abuse, if you suspect that parents are so detached that they may be unable to care for their children, you also can file. Ideally, this would raise parents’ awareness of the situation (chronic stress or depression) and offer them additional services that could address the underlying problem. Children with detached parents also will benefit from having as many caring, attentive adults as possible in their orbit. Find out who else is connected to them, from family members to teachers, coaches, or ministers. Suggest that their children would benefit from structured activities with a chance to connect with other caring adults.

A detached parent may make a child feel worried, worthless, or guilty. There is no substitute for a loving, engaged parent, and your brief interventions to help a parent reconnect with the child will be invaluable.
 

Dr. Swick is an attending psychiatrist in the division of child psychiatry at Massachusetts General Hospital, Boston, and director of the Parenting at a Challenging Time (PACT) Program at the Vernon Cancer Center at Newton Wellesley Hospital, also in Boston. Dr. Jellinek is professor emeritus of psychiatry and pediatrics, Harvard Medical School, Boston. Email them at pdnews@mdedge.com