8.44 | Child Development and Parents with Mental Illness

[blackandwhite]

Child Development and Parents with Mental Illness

As parents, we benefit from understanding the natural developmental stages our children experiences as they grow up. It's good to know that a toddler's "no" is most natural and necessary, for instance.

As parents, stepparents, grandparents, and other significant adults who may share in the care of children who have a parent with mental illness, an additional layer of understanding is also needed. How does the child's developmental needs intersect with the parent's mental illness? What are the impacts of a parent's mental illness during different developmental stages? How can we support children so they grow up as resilient as possible?

In this workshop, we will:

• Learn about developmental stages and in particular the developmental needs of the child at each stage

• Learn about the potential effects of parental mental illness on children at different developmental stages

• Relate this experience to what we have seen/are seeing in our own families

• Discuss how we can create positive experiences, solutions, and situations for the children in our lives

[/list]

Although examples and questions are welcome, let's refrain from venting about the parent with mental illness. It's a given that the behaviors caused by the mental illness are troubling and difficult for all involved; the focus of this workshop is on seeking information and positive ideas for helping kids.

B&W

[DreamGirl]

I'm so interested in this. 

What a wonderful suprise to see this when I opened this section of the boards this morning.

I have to be honest in I'm a little bit worried lately. My stepkiddos mama just went thru a divorce and moved into a 2 bedroom apartment. The two youngest are constantly on my mind lately. Especially the youngest who is 10... .who I feel is having her little personal boundaries impeded upon in several different facets.

Where do we begin?

[blackandwhite]

Where do we begin?

Great question, and I'm glad the topic of interest. I have to hand quite a bit of information on child development and how parental mental illness can affect the necessary developmental tasks that children need to complete. I'll be working through the developmental stages, providing summaries and points to consider.

As a way to start, how about if we assemble a "question and worry list" related to the children in our lives and how a parent's mental illness may be impacting them.

1. What are you worried about?

2. What questions do you have?

We'll try to connect the information to the worries and questions throughout the workshop. The information and discussion probably won't ease all worries or answer all questions, but it will be a start and help us all to look at these matters through a child development lens, which can be very useful.

So who's game to start?

B&W

[DreamGirl]

I want to point out that my stepdaughters are 10, almost 13, and 15. I'm sure there are different stages of development going on for all of us.

1. What are you worried about?

1. Lack of Boundaries/Enmeshment  

2. Emotional Incest - the youngest SD10 and mom share a bedroom

3. Parentifying - all three have taken on the role of caretaker to their mom (especially the youngest), the two youngest are being asked to stay with her because she is so "sad" without them.

4. The priority shuffle - when BPDmama isn't in a relationship the shift of the girls' importance becomes extremely high. A relationship will cause it to be low.

2. What questions do you have?

How do these kinds of "issues" affect their development? Their sense of independence and personality?   Emotional Intelligence?

I've seen charts in the past, is there one to reference to see the developmental stages (and where the kiddos might need help on the chart)?

[JustSaying]

1. What are you worried about?

I worry that nons expect (or hope) a child will be able to stand up to a pwBPD in a way we weren't successful or that is beyond their years. [I told T that X regularly yells at D14 when they are in the car and that scares D because she can't get away. T said D should wait till they've reached their destination and then say something. D and I both think, "Have you ever met a disordered person?"]

I worry that the only tools we have are beyond the capacity of a child to implement.

I worry that radical acceptance is different for kids than for adults. I can accept that x is what she is and will behave as she behaves. For a child, who does not have the capacity to think ahead to the future where they will be out of the house on their own, acceptance of the pwBPD probably feels like giving up and believing their life will always suck.

I worry that the kids are having to stay hyper-vigilant and as a result don't experience the carefree childhood they deserve.

I worry that for those in the legal process, too much of the outcome of custody depends on how the child expresses their own perceptions, and that so much weight is placed on their shoulders.

2. What questions do you have?

What are the stages of development of children as regards their understanding of a parent's behaviors, and what can be expected of them at each stage? A younger child might recognize yelling versus not yelling, while an older child might understand that yelling happens after the parent [drinks/pays bills/fights with grandma]. How do we recognize their stage of development and what might be expected of them with regard to a parent's behaviors?

What can a child do in the face of a rage, recognizing that a child can be punished for speaking up, walking away, etc.?

[mommasa]

My BPDmom watched my son 8 hours a day 5 days a week until I went NC when he was 2 1/2.  So my situation is a little different but I do have some questions:

1. What are you worried about?

I worry that he may have been alternately showered with affection and adored and then ignored/neglected when something else caught her attention.  I worry that he probably witnessed raging and screaming and scary emotional displays fairly often.  As a result of the above, I worry that my son might develop anger issues, problems processing emotions properly, suitable coping techniques for stress, difficulty socializing with peers.   

2.  What questions do you have?

a.  What impact would a mentally ill care provider have on a child aged birth to age 3? 

b.  At such a young age, how can one identify behaviors or development that might need to be addressed?

c.  Is there anything specific that can be done to reverse or mitigate any adverse impact that might result from having a mentally ill care-provider during these early years?

Thanks!

[swampped]

Thanks for starting this topic---I have so many concerns!  Our gd3 lives with her uBPDm, who is our dil.  She is separated from DS, who is somewhat intellectually limited.  We support them.  They are 300 miles away.  I have not seen gd3 in over a year, but get photos by email regularly, and occasional videos.   She appears to be loved, and developing normally, although I only am exposed to her during good times

 

What am I worried about?  Her isolation from family, and from others who might compensate for mothers rages and DS's limitations.  He loves her dearly, but sees her infrequently, mostly when he has money to give to UBPDdil.  They argue constantly when together; they are  separated, and we hope will file for divorce when his year's separation is up.  But in the meantime, how can we help gd3?

I worry about dh and my age (mid 60's) and our long term ability to provide for this little girl and our ds, who works minimum wage jobs, and will perhaps never be able to support her.

I worry about her chances of having a normal life, given the genetics and environment she has been left with. 

I know her parents love her; I know dh and I are in no way able to step in and parent her; but how can we help, other than with financial support, sending her gifts, communicating when we are allowed to, and praying?  I hate this disease, and hate what it does to the innocent children. 

Thanks for any ideas anyone can give me.     

[blackandwhite]

Lot of questions and worries on all our minds--not surprisingly.

Let's work through the information on development and see if we can get a framework for the developmental needs of kids and how mental illness in a parent might impact them at different ages--and what we might be able to do to help, knowing that we cannot fix everything.

Infancy and Toddlerhood

Developmental Tasks of the Infant

(0-8 months)

• The infant learns basic trust to prepare him/her for all future relationships.

• Connection and attachment play a crucial role in the development of the “self.”

Developmental Tasks of the Toddler

(9 months - 2 years)

• More awareness of the consequences of behaviour.

• Beginning of self-confidence.

• Time for exploration.

• The toddler begins to use symbols (images, words, or actions that stand for something else).

• Socialization and language development begin.

Developmental task and impact information from: SUPPORTING FAMILIES WITH PARENTAL MENTAL ILLNESS: A Community Education and Development Workshop, November 2002, British Columbia Ministry of Children and Family Development and Ministry of Health Services. www.health.gov.bc.ca/library/publications/year/200/MHA_Parental_Mental_Illness_Support.pdf



A few questions:

1. Did/does the child in your life have at least one trust-based relationship in infancy?

2. Many of the questions and worries described so far relate to inconsistency. Is/as inconsistent parenting (attention, mood, presence, ability to be attuned to baby) a big factor in the infancy of the child/children you have in mind?

3. Did/does the child meet developmental milestones in infancy according to his/her doctor?

4. Attachment theory highlights the importance of a "secure base" and "safe haven" for the child (consistency and safety from which to explore). If these are not present or not consistent in infancy or toddlerhood, the child will develop strategies to cope that may create difficulties in the form of mental health problems and troubled relationships. Do you see the child/children in your life developing coping strategies such as avoidance or anxiety over the presence or safety of a caregiver?

[qcarolr]

My dh and I have had custody of our gd6. GD has always lived in our home, mom was primary caregiver until about 8 mos when we took over daytime care. I often provided nighttime care. Agree inconsistent r/s with mom has always been a concern, and my own 'need' to keep mom in the picture. Some of this is per our legal custody stipulation requiring consultation about major life decisions. Some is the belief that gd is better off with some kind of r/s with her bio-parents (dad is in another state mostly in jail - infrequent letters or phone calls) Has this limited my ability to be consistent primary attachment for gd? Have I provided a good enough 'safe haven' for gd?

Gd has a lot of issues with being clingy when seperating from me - daycare, preschool, school when not on the bus (she seems to manage without so much sadness when on the bus with all her friends - cries after I drop her off if I need to take her). Is this a normal part of her temperatment/development? This seemed beyond the norm for her developmental stage - continued even after years at the same daycare/preschool. She is able to be with neighborhood families now without this hestiation. After I walk with her to ring the doorbell I can leave while she has a playdate.

DD expresses great concerns that our empathic parenting style will make gd into an easy target for bullies, and not prepared to 'make it' in the tough world. How much of this is DD's projection of her own issues and how much is accurate. DD refuses to participate in any kind of family counseling, read books or articles about developmental stage or parenting other than giving me articles she gets from the internet. Some of these are good articles, though she does not practice the ideas given.

How can we balance these differing parenting styles while all living in the same household? DD undercuts my authority as a parent figure, and accuses me of undercutting her authority. And this is inconsistent. If DD is focused on ourside r/s with friends she has little daily contact w/gd. If her other r/s are in distress she suddenly is all about us 'stealing her daughter' and turning gd against her.

I am just trying to keep gd safe. And I can see gd is able to stand up to her mom, leave the room (even though we a both 'punished' for this by DD's extreme tantrums) and express verbally her concerns and fears. I wonder if gd feels put in a caretaker position between DD and me.

THis is not structured as well as others replies - hope my worries and questions can be wiggled out of this.

qcr

[qcarolr]

A few questions:

1. Did/does the child in your life have at least one trust-based relationship in infancy?

My dh and I have done our best to provide this for gd. We also provided consistent, trusted daycare home for her starting at 18 months. She was home with dh from 9 to 18 months - he was in transistion between jobs. She was with her mom during the work day prior to 9 months, and I provided most of the care when home after the first 3 months (when daddy had taken a break for a couple months at a time).

2. Many of the questions and worries described so far relate to inconsistency. Is/as inconsistent parenting (attention, mood, presence, ability to be attuned to baby) a big factor in the infancy of the child/children you have in mind?

Yes, I do think this made gd's letting go harder later in her life. There were some attachement issues when she got to preschool age and she could walk away from our home. We had to actually lock her in our house, with a plan worked out with child/family T summer she was 5.

3. Did/does the child meet developmental milestones in infancy according to his/her doctor?

Yes she was on target for all these. Her mom never initiated any of these well-baby visits (or sick baby visits either) and stopped going along when it became painful for her as I had all the answers to the doctors questions - I was the one giving the care. Actually seemed to put more distance in her r/s with gd, not motivate her to work harder to be in gd's life.

4. Attachment theory highlights the importance of a "secure base" and "safe haven" for the child (consistency and safety from which to explore). If these are not present or not consistent in infancy or toddlerhood, the child will develop strategies to cope that may create difficulties in the form of mental health problems and troubled relationships. Do you see the child/children in your life developing coping strategies such as avoidance or anxiety over the presence or safety of a caregiver?

Yes, we have been working a lot with avoidance and anxiety issues with gd from an early age. These were especially evident after visits with DD when she was living away from the family home. When she was married with an infant son for 18 months, then again when DD was evicted and living homeless for 20 months. In some ways it is better with DD in the home, even given the 4-6 week cycles down into a raging state.

qcr

[qcarolr]

I read the link about attachment theory, and based on that gd has a good attachment to dh and I. As she has become better able to ask me questions and state her opinions and needs; I can see that this is a growing strength for her. I think we are doing OK. I have really stepped up to intervene with safety plan when DD is in meltdown state. Gd is also able now to verbally participate in her sessions with T, and looks forward to these. This may be a developmental shift, and also I am being more consistent an accepting in my role as her main parent. I have involved the local police as mediators when DD is in meltdown, often triggered by engagement of the safety plan - ie. gd or I leaving the room/house when DD is yelling, cursing, name calling etc. directed at me and dh. Often at how we are handling gd.

I can see DD as fitting the 'disorganized attachment' profile. How much of that was from my inconsistent availability to her as a young child? Undiagnosed bipolarII and PTSD that often was triggered by DD's 'disorganized' behaviors - and chicken and the egg paradox. I just did not know how to manage this child, and still don't know how to relate to her as a young adult.

As I parent gd I continuously compare this to how I parented DD. They are very different individuals - how much of this is due to my increased awareness of how I parent?

qcr

[mommasa]

1. Did/does the child in your life have at least one trust-based relationship in infancy? 

Yes

2. Is/as inconsistent parenting (attention, mood, presence, ability to be attuned to baby) a big factor in the infancy of the child/children you have in mind?

Yes - inconsistent attention, mood, and ability to be attuned to the baby from care provider

3. Did/does the child meet developmental milestones in infancy according to his/her doctor?

During infancy, yes.  During toddler years, teachers have noted a slight delay in speech compared to peers and difficulties with socialization compared to peers

4.  Do you see the child/children in your life developing coping strategies such as avoidance or anxiety over the presence or safety of a caregiver?   No - he appears to have secure attachment judging by most factors, but he did have exaggerated distress when separated from me from about 6 months through 2.5 years of age, he is getting better able to separate now - but will revert to extreme distress due to separation if other factors are involved (e.g., when he is sick or when we are traveling).   

[blackandwhite]

Thanks for all the great reflections and comments so far. 

There are some generalities that can be made about the effects of mental illness of children. Not all of these will be present and there are certainly factors that can mitigate them. But these are things to look out for in the early years:



Impact of Parental Mental Illness on the Infant

(0-8 months)

Children may:

1. Not receive necessary attention, may be neglected physically and/or emotionally, may experience tension or anxiety or have accidents due to caregiver distractibility.

2. Have deficits in stimulation (caregivers may miss cues). Excessive stimulation may occur during manic phase.

3. Show a lack of response (eye contact and connection). The child may develop more slowly cognitively.

4. Experience separation trauma (in relation to hospitalization, etc.).

5. Bond to a sibling, as extended family and community are more involved, a possible benefit.

Caregivers may:

6. Give less time for care giving, may end breastfeeding due to medication.

7. Misread cues (crying due to hunger, boredom, etc.).

8. Lack consistency in routine.

9. Not know or recognize the health needs of the child.

10. Neglect their own physical and emotional needs and, as a result, may be hospitalized and place extra stresses on the family.

(9 months-2 years)

• Previous tasks apply

Children may:

1. Experience general neglect as emotional and/or physical needs (hygiene) may not be met.

2. Feel the impact of poverty.

3. Be very adaptable to various situations.

4. Not be aware of social stigma at this stage.

Caregivers may:

5. Experience generalized stress and be inconsistent at setting appropriate limits.

6. Provide inadequate structure and safety required for learning new behaviours (toilet training).

7. Not meet child’s special needs (caregiver may not have emotional and/or physical energy/stamina).

8. Not explain hospitalization to the child.

9. Model some inappropriate behaviours (e.g. washing hands repeatedly).

10. Exert either too much or too little control, not allowing for exploring, curiosity or risk taking.

Developmental task and impact information from: SUPPORTING FAMILIES WITH PARENTAL MENTAL ILLNESS: A Community Education and Development Workshop, November 2002, British Columbia Ministry of Children and Family Development and Ministry of Health Services. www.health.gov.bc.ca/library/publications/year/200/MHA_Parental_Mental_Illness_Support.pdf



1. Have you seen any of these impacts? Which ones and how did/do they manifest?

2. What has helped to mitigate these impacts, either something you have been able to do or other factors (extended family, efforts on the part of the mentally ill parent, professional support, etc.)?

3. Did/do you see other impacts that concern you at this developmental stage?

[blackandwhite]

Members of this board have children in their lives at all developmental stages, and I will continue to add in information about developmental tasks and impacts (from www.health.gov.bc.ca/library/publications/year/200/MHA_Parental_Mental_Illness_Support.pdf unless otherwise noted). In general, the same self-reflection questions apply:

Self-Reflection

1. Have you seen any of these impacts? Which ones and how did/do they manifest?

2. What has helped to mitigate these impacts, either something you have been able to do or other factors (extended family, efforts on the part of the mentally ill parent, professional support, etc.)?

3. Did/do you see other impacts that concern you at this developmental stage?

At some stages, particularly as kids get toward adolescence, new questions apply and we can discuss them.



Developmental Tasks of the Pre-schoolers

(3-5 years)

• Autonomy and mastery.

• Socialization begins.

• Protection of the child at this stage is important.

• The need for safety to explore the environment.

Pre-School Years are the time for development of problem-solving skills and self control skills. Mentally ill parents may experience difficulty in teaching such skills as they try and cope with their own overpowering problems. Discipline can be inconsistent or absent leading to behavior control problems in the child. Ultimately, many children of parents with mental illness enter school with delays in emotional, social, and cognitive development. They may already be behind before they get started (Avison & Gotlib 1990).

A Lasting Impression: A Teacher's Guide to Helping Children of Parents with a Mental Illness, Canadian Mental Health Association.

Impact of Parental Mental Illness on Pre-schoolers

(3 - 5 years)

• Previous tasks apply.

Children may:

1. Feel shame and self-doubt if experimentation and exploration attempts are restricted; begin to be aware of social stigma; be confused about reality, theirs versus their caregiver’s.

2. Have difficulty with trust and confidence if caregiver’s world is one of mistrust, anxiety or paranoia.

3. Not experience complete safety at home (be prone to accidents, have fear of new experiences).

4. Compensate for caregivers who may be under involved – (exaggerated mastery or lost confidence and withdrawal).

5. Lack autonomy due to limited assistance from their caregiver throughout their lives (due to hospitalization).

6. Have unclear boundaries resulting from caregivers being strict one day and over permissive the next. They may not master new skills because of lack of consistent practice (loss of ability, delayed shutdown or exaggerated mastery when caring for the caregiver).

7. Have an unpredictable daily life. Caregiver may not always meet expectations in terms of lunches, field trips, duties, carpool, etc.

8. Have difficulty with socialization, exploration and interaction with outside world.

Caregiver may:

9. Not like change and may not have the flexibility to vary routine in order to meet child’s need for growth.

10. Have disorganized life style (frequent moves) especially if the caregiver’s management skills and financial resources are limited.

Note the growing emphasis on shame and self-doubt. Emotional validation and providing safe opportunities for the child to achieve mastery are critical to improving shame and self-doubt.

[KHat]

I'm late to this party but want to participate, both as a CASA and as a stepmother to two girls whose mother has indications of a Cluster B personality disorder.  Unfortunately, I don't know much about their lives before I entered them except what my husband has told me; I think that life for them all was normal (although very high-emotional drama, nothing ever good enough) until their mom had multiple miscarriages and then became terrified of losing her daughters in any way, including their affection.  I relate all of her behaviors towards her daughters to this insecurity.  The behaviors I see most often (and disturbingly) are inconsistent or nonexistent boundaries, a propensity to twist words or an interpretation of a situation around to suit one's needs, emotional parentification, a demonstrated inability to take accountability, a demand for unequivocal loyalty, and a desire to be more of the children's friend, including making them her equal or doing "cool" inappropriate things like letting SD13 drive a car, not requiring helmet use on bikes or skateboards, taking SD9 to R-rated movies, and feeding both of them junk food although SD9 has weight and health issues (very high cholesterol).  I am torn because I see the girls visibly relax and enjoy being children (and know what's expected of them as children) with us, but I also feel that their happiness and affection for my husband and me causes them additional difficulties at home with their mother.  I don't know whether or how to coach them to walk on eggshells there, whether or how to support/encourage my husband's pursuit of primary custody, and especially, how to validate their experiences with their mother without speaking negatively of her or conveying approval of what happens there.

I'll jump in when we get to a developmental stage at which I've known the girls but I will be saving the resources and notes as well.  Thanks so much for holding this workshop.

[oceanblue]

This is such an interesting thread.  I entered therapy just over a year ago due to the ending of a relationship with a BPDbf.  What I came to understand is that I am more tolerant of BPD behavior because my parents both had strong traits of BPD/NPD.  My childhood was all over the place - sometimes loving, sometimes hostile, very often and consistently completely neglectful.  My sibling and I were often left alone, me responsible for the sibling that was 5 years younger.  I remember frequently comforting my mother after huge fights with my father while she blamed me for the fight.

The sad truth is that the conditioning I received as a child has colored most of my adult relationships and left me very immature in important ways.  I realize now I have co-dependent behaviors.  The good news is that self-awareness has allowed me to at least intellectualize my behaviors/choices and hopefully the emotions will follow.  For example, I realize I didn't have a trust-based relationship until I was an adult.  It takes a lot of work for me emotionally to trust anyone to meet any of my needs and I'm still working on it.  But, at least, I now know what I am looking for.

[blackandwhite]

Join in anytime. 

Continuing with the developmental information:

Developmental Tasks of Middle Childhood

(6 - 12 years)

• Emotional development

• Development of concrete operational thought

• Educational adjustment

• Children become less dependent

• Increased association with friends

• Development of a sense of competence and importance

• Onset of puberty

The Early School Years of a child consist of dealing with people outside the family. The development of social skills are important to successfully interact with other peers and teachers. A child in a family disrupted by mental illness may have their needs neglected in favor of those of the affected parent. The parenting role can be further compromised by spousal discord and divorce which is more common in families with a parent with mental illness. The child may feel responsibility and guilt for the family disruption. At the same time, the child may have a strong desire to spend more time in a stable environment, such as at a friend’s house. This feeling of abandoning the mentally ill parent may be viewed as disloyal by the child leading to further guilt (Dunn 1993). Turmoil at home with lack of consistent stable environment can lead to poor academic performance and inappropriate behavior at school.

A Lasting Impression: A Teacher's Guide to Helping Children of Parents with a Mental Illness, Canadian Mental Health Association.

Impact of Parental Mental Illness on Middle Childhood

(6 – 12 years)

• Previous tasks apply

Children may:

1. Experience loss or disorganization at onset of illness or at hospitalization.

2. Become resilient.

3. Experience anxiety due to chaos and lack of structure and may be afraid to leave caregiver alone.

4. Feel anger toward caregiver for not fulfilling caregiver role, not providing what other caregiver provide.

5. Be vulnerable to stories of fear due to literal and concrete thinking.

6. Have their worldviews impacted by illness (Obsessive-Compulsive Disorder, Delusions).

7. Compete with ill parent for attention to get their needs met.

8. Be accustomed to hostility, violence and verbal abuse in the home.

9. Be emotionally neglected which impacts all aspects of functioning, (skills, learning relations with peers and teachers); develop depression; not experiment with their abilities, be afraid to take risks.

10. Have process of individuation interrupted. [Resulting in enmeshment and/or lack of maturity]

11. Have overdeveloped capabilities in care giving but lack emotional capability.

12. Internalize, become over-achievers, attempt to maintain order.

13. Use coercion (of caregiver or others to get needs met).

14. Continue to have safety issues.

15. Have behavioural problems and substance abuse issues.

16. Feel the need to belong (may feel alone and/or different).

17. Now be aware of a stigma of mental illness (shame, fear, guilt); may be reluctant to bring friends home.

18. Have difficulty trusting outsiders.

19. Feel isolated, or have limited resources, which prevents them from joining social and group activities (clubs, sports, etc).

20. Be under socialized, not aware of social expectations.

21. Straddle two worlds, two sets of rules, inside vs. outside home.

22. Learn and be more aware of normal/abnormal behaviours.

23. Have educational risks, too much or too little involvement.

24. Have difficulty concentrating due to chaos at home and may be seen as disruptive or having behaviour problems.

Self-reflection Questions:

1. Have you seen any of these impacts? Which ones and how did/do they manifest?

2. What has helped to mitigate these impacts, either something you have been able to do or other factors (extended family, efforts on the part of the mentally ill parent, professional support, etc.)?

3. Did/do you see other impacts that concern you at this developmental stage?

4. Are the kids able to socialize and have experiences that increase their feelings of mastery?

5. How are they learning to self-regulate their emotions?

People often ask me what factors contributed to my resilience [writes a daughter of a mother with bipolar and schizoaffective disorders]. I credit my mother. Despite 30 years of struggling with mental illness, she never insulted me and believed strongly in reinforcing children's self-esteem. One day, as a high school student, I teased my mother about her illness in front of one of her friends. The friend attempted to correct me, saying she did not allow her children to tease her. My mother stepped in, saying, "You have to understand, this happened to Margaret too, and she needs to laugh about it." She also acknowledged that sometimes my teasing hurt her feelings. I had not realized I was hurting my mother's feelings, and after that I stopped joking about her illness. But it was exactly my mother's awareness of my needs that contributed most to my recovery and health.

Maggie Jarry, M.S. A Peer Saplings Story: Lifting the Veil on Parents with Mental Illness and Their Daughters and Sons. Psychiatric Services. December 2009. Vol. 60. No. 12  Emphasis mine.

6. Is there a loving adult paying attention to and valuing the child's needs and perspective? Communicating that understanding and value? How?

Although a personality disordered parent may struggle to have the perspective to say the equivalent of "this happened to Margaret too, and she needs to [laugh, cry, forget for a while, grieve, etc.] about it, if someone else in the child's life CAN play that role, that makes a huge difference.

[doryswimsagain]

Chiming in... .at this age (7) I have noticed an express attempt to "cover up" BPD's behaviors, and the effects of her Dad's illness.  Loyalty is big, as D7 is constantly defending and making excuses for father's behavior. My concern is that she is therefore learning that bad behavior is acceptable, and should be tolerated.  She is already learning to mask feelings and bury her own needs to "save face."  Already a master of deception, and she has learned from me. Trying now to reverse the effects, but I don't know how beyond my own consistency. This strikes me as much too high of an expectation of a child, and one that must certainly have some very damaging results.

How do we teach them about countering unacceptable behavior, but expect them to understand that there are exceptions to that rule (i.e when walking on eggshells). I can barely undertand it myself. 

GREAT topic. Thanks.

[doryswimsagain]

1. Have you seen any of these impacts? Which ones and how did/do they manifest? Nearly all of them.

2. What has helped to mitigate these impacts, either something you have been able to do or other factors (extended family, efforts on the part of the mentally ill parent, professional support, etc.)? Extended family... .particulary those who played a smaller role prior to divorce and acknowledgement of the illness, or were not close with the BPD

3. Did/do you see other impacts that concern you at this developmental stage? Anger with "healthy" parent , for not "fixing" it... .worries me that lack of "hero" at this age will lead to lifelong pessimism. I think kids this age are smart enough to know that disordered person is wrong, but escapes punishment. But cannot yet understand the reasons for it.

4. Are the kids able to socialize and have experiences that increase their feelings of mastery?As much as possible, but their impact seems to pale in comparison to the more potent effects of the disordered person.

5. How are they learning to self-regulate their emotions? I am hoping that counseling will eventually help with this... .right now I firmly believe D7 is simply ignoring her emotions. Accepting help in counseling is accepted that her Dad has a problem. So she goes, but will not engage, 5 months in.

6. Is there a loving adult paying attention to and valuing the child's needs and perspective? Communicating that understanding and value? How? Yes. Bedtime chats about anything with an understood rule that no topic is off limits, and no anger will result from them being honest.

[blackandwhite]

Spotlight: What Is Theory of Mind and How Can It Help My Child?

Theory of mind is a cognitive skill where children starting at age 4 begin to understand that people can be motivated by beliefs regardless of whether those beliefs are true or false (Harris, de Rosenay, & Pons, 2005). Around ages 5-6, children also begin to understand that these true or false beliefs can also effect emotions of individuals (Pons, Harris, & de Rosenay, 2003). There is growing body of evidence that suggests that progress in linguistic abilities is a good predictor of development of theory of mind with the reverse not being true (Astington & Jenkins, 1999).

Deaf children who are born to hearing parents are slower in developing a theory of mind because of more difficult access to sign language, as their parents themselves take time in mastering sign language (Harris, de Rosenay, & Pons, 2005). By contrast, deaf children who are born to deaf parents develop theory of mind at the same speed as normal children because of easier access to sign language (Peterson & Siegal, 2000).

How mothers talk to their children also appears to effect their children’s development of a theory of mind. In one study, mothers who used more linguistic terms describing mental states like think, want, and hope had children that performed better on tests measuring theory of mind (Ruffman, Slade, & Crowe, 2002).

Talking to children about thoughts and beliefs of others can make a powerful impact in helping children develop a theory of mind. Hale and Tager-Flusberg (2003) discovered that when children were given verbal feedback in correcting them as they were told to read stories dealing with thoughts and feelings of characters in the story, their understanding of the idea that people can have false beliefs went up.

Using more mentalistic language helps children develop a theory of mind because of pragmatic features of the language, such as the enunciation of various perspectives (Harris,de Rosenay, & Pons, 2005). Using terms like think and know can help in development of theory of mind because when children themselves attribute false beliefs to others, they end up using similar linguistic constructions.

When mothers talk to their children about how others can have false beliefs, they also end up expressing various emotions that come by the virtue of having those beliefs (Harris, de Rosenay, & Pons, 2005). This is why use of mental terms in language not only helps in understanding of false beliefs but also understanding of how people can be affected by these false beliefs.

Gunjan Singh. "How language helps children develop a theory of mind." Cognitive Science Examiner. January 30, 2010. www.examiner.com/cognitive-science-in-national/how-language-helps-children-develop-a-theory-of-mind

Why is it important?

Theory of mind, also called mentalization, is a skill that helps us understand ourselves and other people. It's a developmental achievement. With strong mentalization skills, a child (or adult) can reflect on their own and others feelings, thoughts, and actions. They can reframe, find more positive views, and change. Theory of mind is a key aspect of resilience, as it gives the child the ability to see his or her experience as a story that could have different endings; gives confidence that the child has some choices; enhances his/her ability to relate to others and move through a social world; increases self-efficacy and the child puts together thoughts, feelings, and actions into positive choices. Developing theory of mind doesn't guarantee a good outcome for anyone, but having it increase a child's options. One of things that people with borderline personality disorder struggle with is mentalization (thus the disorder is sometimes treated with mentalization-based therapy).

What can I do?

If you are in a role with a child that you can talk with him or her, talk explicitly about:

*perspective

*motivations

*what goes on in people's heads

*where feelings come from and what motivates them

*recognizing feelings

*choices we can make once we recognize our feelings

Read stories. Discuss them. Discuss movies, situations with peers, situations with public figures, what they may learn about history in school in terms of perspective, motivation, thoughts, feelings, behaviors, choices. Ask the child to speculate about the experiences of others. Play games that enhance these skills. Use these skills in relation to activities the child enjoys--sports is a natural arena for thinking and talking about strategy, feelings, and choices. If the child is interested in art, talk about the experience of the artist in making the art an the viewer in seeing it.

If you're not in a position to impact the child through discussion, your options may be limited. If you can encourage the child's participation in activities like sports, theater, book clubs, school-based programs that focus on emotional development, and therapy, do so.

[tog]

My SO's son is 12, and I see a lot of the problems raised during that developmental period. Fortunately, my SO was a stay at home Dad during the boy's infancy and pre-school years, so that may have mitigated some of the attachment stuff.

At 12, however, he is highly, highly anxious. Fearful about bad things happening to him, overwhelmed with anxiety at times. He's enmeshed with his mother and in danger of having the individuation short-circuited by this enmeshment. He does socialize but it is mostly controlled by his BPDmom (she sets up sleepovers and "playdates" still for him and seems to almost view them as HER friends, doesn't expect or allow him to be independent in this). She is treating him like a mini-spouse, telling him her worries and concerns, making it her and him against the world. He is definitely feeling pressure to defend her and to join with her against Dad.

Interestingly, my SO recently went in for surgery and the boy got very anxious and and somewhat disorganized before the surgery out of fear for his father and himself. The night before he came into the bedroom crying 3 times and needed reassurance as he was unable to cope with all the "what if's" going through his head.

We try to provide steady guidance to him and talk to him about his mother's behavior and reactions without bad-mouthing which is very tricky. He tends to ask to speak to me every night before bed and this seems to help him a lot as he sees me as "neutral". He's a very confused and anxious boy and I worry about the next few years. Will he stand up to her control and enmeshment and establish an independent identity? Or will he give in and become sheltered and enmeshed and more dysfunctional?

[qcarolr]

I can see the potential for so many of the impacts on my gd6. Even though my DD25 accuses me of 'stealing her daughter' by getting custody and sometimes limiting her contact with gd, I think this has been a big help in gd overcoming obstacles. I have also put a lot of energy into creating connections with other families in our neighborhood with kids. This exposes gd to some great role models of good parenting as well as the give and take of friendships. She is improving in her adaptability at school.

With my gs, I saw all of these impacts. He was in the household with my DD and her husband. There was a lot of neglect. We stepped back from this situation and he was placed in foster care at 5 months and was adopted at age 2 by his foster parents. The year of weekly visits with his dad, seperate from his mom, was very dysregulating for him. Of course DD blames me for this loss since we would not 'help' with her fussy baby. He is thriving as a 4 year old now. I have limited contact with the adoptive mom via email and her facebook page.  Gd misses having her brother - she also visited for that year.

qcr xoxo

[JustSaying]

at this age (7) I have noticed an express attempt to "cover up" BPD's behaviors

They learn it from somewhere, and most likely us. I see now how I'd cover for X, though I never saw it as that at the time. Be/c of her anxieties, I'd plan everything carefully to lessen her anxiety, I'd help her find items on a menu she could eat rather than sit for 30 min waiting, etc. D started doing the same. I made a point of stopping and letting X deal with the consequences herself, and I made a point of freeing D from the obligation to pick up where I left off.

But rather than make the point to D that X had a problem (which would get a sympathy response from D), I worded it as X is an adult and deserves the opportunity to do things for herself without our interference. She chooses her own path and we choose our own. And if someone's late because she couldn't get it together on time, or if the table's slow and hungry be/c she couldn't find one acceptable item on the menu, oh well. You still get yourself ready on time, D, and have your order ready, and let your mom do as she does. So covering for her is no longer necessary because fewer things are cast as my way versus her way.

Thinking about it, I can see both radical acceptance and mindfulness in this, maybe for the first time in a bit of a 'Eureka'. D covers for her mom/dad because we've always treated those behaviors as something that needs covering. What if they don't? If we can put into practice the lessons from Radical Acceptance for family members, then we are teaching our children the same, no matter what their age and stage of development. No?

[KHat]

Self-reflection Questions:

1. Have you seen any of these impacts? Which ones and how did/do they manifest?

* Yes, and they have differed according to child.  I entered my SDs' lives in this phase when they were just turned 8 and 12.  SD8 experiences the anxiety and fear of leaving her mother, she is very vulnerable to fearful stories and situations (and I understand that she has been since toddlerhood).  She also seems risk-adverse and overly sensitive to criticism (even as much as having her grammar gently corrected in the course of telling a story).  In addition, she seems awkward with emotional development, describing her feelings as "too big for her" and feeling confused as to how to express them appropriately.  More than SD13, SD9 escapes into her fantasy world, playing pretend.  It doesn't seem to faze her at all when DH and I have an argument; she seems not even to notice the noise of people screaming at each other.  SD13 experiences more of the anger and depression.  She seems to vacillate between rebellion and overachieving.  She is experiencing an intense need to fit in with her peer group.  She has expressed anger at her mother for things like not being able to eat a decent meal.  She has been evaluated for Oppositional Defiance Disorder.  She turns to self-harm to deal with emotional pain.  She engages in screaming and even sometimes physical matches with her mother.  However, she bounces more easily between our house and her mother's, transitioning between the sets of rules.

So in summary: SD9 #3, 5, 8, 9; SD13 #2, 4, 7, 9, 10, 12, 15, 16, 24 most obviously; perhaps others also.

2. What has helped to mitigate these impacts, either something you have been able to do or other factors (extended family, efforts on the part of the mentally ill parent, professional support, etc.)?

SD13 is receiving therapy from someone who has been made aware of some of her mother's more challenging behaviors.  She is being redirected towards learning self-control and alternate means of expression, as well as takes an antidepressant.  Their father works with both children to help them recognize their feelings and work through expressing them, differentiating their actions/behaviors from who they are, and helping them recognize what they believe is true versus what they were told.

3. Did/do you see other impacts that concern you at this developmental stage?

Yes, mimicking traits they see like lying to justify behavior, lack of accountability, and expecting total loyalty from friends as are indicative of their mother's illness.

4. Are the kids able to socialize and have experiences that increase their feelings of mastery?

Yes, in fact to some extent they escape into their social lives.  But the "feelings of mastery" is a difficult one as both are particularly ready to give up anything they can't master immediately, and SD13 dismisses things and people as stupid when she experiences rejection.  Again, with these things they are often ready to dismiss even their father as disloyal if he challenges them with a question or alternate viewpoint.

5. How are they learning to self-regulate their emotions?

SD13 is the biggest challenge since her emotions threaten to consume her with rage, either turned outwards (warring against friends, hitting her mother) or inwards (depression and cutting).  She is being encouraged to express them in artwork.  Both girls seem to be challenged with expressing vulnerability, like sadness or fear - SD9 channels to anxiety and trying to control those around her; SD13 to anger.  We see far less of this in person than we hear about during their mother's time with them.

6. Is there a loving adult paying attention to and valuing the child's needs and perspective? Communicating that understanding and value? How?

Yes, their father is the primary person in this role, although it is limited to phone calls and EOW visitations.  He practices a lot of the theory of mind exercises described, teaches them how to listen to and trust their inner voice, and tries to train them to focus only on things they can control.  I am trying to help with this but having been in their lives such a short time, do not have the rapport quite yet so I do a lot of listening, coaching for my husband when he feels dejected or confused as to how to proceed, and help his family, who see them relatively rarely, know what they can do to help also. 

Interestingly, becoming involved in the children's lives has helped me get perspective about my own upbringing and how particular life challenges have manifested, like my own anxiety in unfamiliar situations.  My husband attending therapy with me and helping me work through things has prepared us both better for the girls.  In situations as minor as eating in a restaurant in which I'm not certain whether I'll like anything on the menu, he encourages me to lean into my anxiety, gives me a backup plan (we'll pick up fast food on the way home if you don't like your meal) and helps me navigate my uncertainty to a decision.  Recognizing this in me and learning techniques for dealing with it and allowing others to help has been really helpful in knowing how to deal with the children.

[blackandwhite]

Developmental Tasks of the Early Adolescent

(12 - 15 years)

• Accepting one’s physique and using the body effectively.

• Achieve new and more mature relations with age-mates of both sexes. Peer groups are becoming very important.

• Achieve emotional independence from caregivers, other adults.

• Desiring and achieving socially responsible behaviour.

Adolescent Years require the development of trust, strong friendships, and increasing autonomy from the family in order to move smoothly into adulthood. At this stage, the child who is not coping well with the problems of parental mental illness at home will have fragile self-esteem. While many such teens must deal with the same transitional problems as other adolescents, their parents are often struggling with the same problems of identity and are not a great resource. Social isolation, drug and alcohol abuse, attempted suicide, and the development of mental illness are the potentially negative outcomes during this period.

A Lasting Impression: A Teacher's Guide to Helping Children of Parents with a Mental Illness, Canadian Mental Health Association.



Impact of Parental Mental Illness on Early Adolescence

(12 - 15 years)

• Previous tasks apply

Adolescents may:

1. Live with secrecy and shame, be and/or feel reviled. This affects trust, spontaneity, and ability to feel pleasure.

2. Live with pain and anger. Have underlying anger at injustices. Experience unresolved loss of a “normal” caregiver.

3. Be at-risk for peer pressure and/or feel the need to belong. Have no involvement with peers due to embarrassment at caregiver’s condition.

4. Be confused in regards to relationship with ill caregiver. Experience possible dependence of caregiver on child (caregiver not able to let go) or child feels concern, fear and responsible for caregiver (child unwilling to let go). Grow up too fast – may be more mature than age-mates and have difficulty relating to them.

5. Be particularly sensitive due to hormonal and bodily changes. May experience decreased energy or demonstrate eating disorders.

6. Have poor body image and make poor health decisions, e.g., little exercise or sleep, poor nutrition.

7. Be at-risk for being unable to recognize and meet own needs. Low self-esteem.

8. Have difficulties due to poverty, limited opportunities.

9. Feel different, alone, and/or rejected. Feel distanced from caregiver and express it by running away, acting out, or engaging in substance abuse.

10. Live with intense emotion, emotional self-regulation affected. Walk on eggshells around caregiver. Have difficulties at school, may be busy taking care of things at home. Conversely, do very well at school, able to keep order in their lives. Have difficulties with relationships and establishing boundaries.

11. Not demonstrate socially responsible behaviour.

D covers for her mom/dad because we've always treated those behaviors as something that needs covering. What if they don't?

Very interesting observation, JS. You're pointing out one of the implicit rules that was operating in the family.

Spotlight: Family Rules

Every family has rules. Some are explicit: No cursing in our home. Some are implicit: Ann gets to boss Joe around because Ann is the favorite. Children are keenly aware of implicit rules, and it can take decades for adults to be able to look back on the rules and see that they are not always healthy. Taking an honest inventory of the implicit rules can help you see the world through the child's eyes and judge whether the rules need to change or if you want to acknowledge the rules (name the elephant in the room) and help the child process his thinking and feeling around the rules.

1. What are some of the implicit rules of the family of the child you're concerned about?

        Examples might be: We always take care of mom first. We are allowed to laugh and joke around unless Dad is in a bad mood; our mood must match his. Uncle Hal will get drunk and pass out on the floor; pretend he's not there.

2. Whose needs are the rules serving?

3. Does the child experience radically different sets of rules in different settings?

4. What resources are available to help the child cope with rules that may be unhealthy or with rules that are radically different in different settings?

[JustSaying]

Really good mention of implicit rules. Nice to have it named and put out there to contemplate.

Good list of 'Impact of Parental Mental Illness on Early Adolescence,' too. I can see the potential for any number of those if D had had to continue living with her mom. There's a reason she doesn't invite friends to her mom's place, even though it's a veritable resort--she doesn't know behaviors won't go haywire and embarrass her.

There are so many ways for things to potentially go askew, given this list. It feels like trying to plug a boat with 11 holes in the bottom. But knowing what to look for is a great start, and the obvious signs like rages and substance abuse are just the tip of the iceberg.

[qcarolr]

Reading back over this thread today I realize how much it brings up old pain and guilt for me in how I parented my DD25. And now I am trying to do it better with having custody of gd6 -- and still having DD25 here to cope with as well. In DD's life I was the one with mental illness (bipolarII), and can see myself in so many of the unhealthy impacts on DD. That is the pain. Wondering if her childhood struggles and current level of mental illness would have been less if I had been able to be where I am now back then - this is the guilt. In a phone session with the child T this week, she cautioned, or encouraged, me to let go of this guilt. It gets in the way of parenting gd. I find this takes so much effort to let go of, esp. when there is conflict in our home over how we are raising gd - 'soft' vs. 'tough' love parenting stlyes. It is so hard to find the middle. And to establish for gd's sake who is the really the parent - the grandparents with custody or the intermittent mommy.

I am processing all the questions here off-line to avoid a rambling cluttered reply. Thanks so much for this thread.

qcr xoxo

[Faded]

Possible to explore PAS a little?

Ive had to witness it in the past but 1st time myself and daughter experienced was when D become 13.

D left mum's abode when the abuse was directed at her and has only spent time at her home maybe 6 times in last 4 months and D only expresses that she is only wanting to go up there because she misses her brother and sister. D isnt really showing any emotion towards mum and the abuse/alienating towards D.

When D 1st dettached i was split between really wanting her and mum to re-connect and between supporting D's feelings and choices she made for herself.

I was kindly advised to support the D as she knows what is best for her and not force any support for MY wanting them to re-connect and help sort their differences.

Had i not supported my D in this way it would of been seen that i would of been dismissing my D's feelings and so was more encouraged to support her feelings as she is becoming a young adult.

Im not sure if this has any relevence here or if PAS is part of this thread structure.

My apologies if not.

[argyle]

1. Concerning stuff/Mitigation

Impact of Parental Mental Illness on Pre-schoolers

(3 - 5 years)

2. Have difficulty with trust and confidence if caregiver’s world is one of mistrust, anxiety or paranoia.

Toddler is a cautious little bugger.  But, I'm not sure how much of this is mother and how much of this is toddler being born a cautious little bugger.  Probably both./Success in new experiences - Judo last week.

3. Not experience complete safety at home (be prone to accidents, have fear of new experiences).

No real injuries.  But, the house can get scary dirty./Maids, cleaning.

5. Lack autonomy due to limited assistance from their caregiver throughout their lives (due to hospitalization).

Meh. Toddler does spend an awful lot of time cuddling a sedated mommy./Toddler is in school full-time.

6. Have unclear boundaries resulting from caregivers being strict one day and over permissive the next. They may not master new skills because of lack of consistent practice (loss of ability, delayed shutdown or exaggerated mastery when caring for the caregiver).

Would be a real problem. BPDw does not do discipline. I do.

7. Have an unpredictable daily life. Caregiver may not always meet expectations in terms of lunches, field trips, duties, carpool, etc.

A real problem. I handle school - which helps.

8. Have difficulty with socialization, exploration and interaction with outside world.

Actually, a pretty social child.  Still a bit leery of wrestling with strange babies.

Caregiver may:

9. Not like change and may not have the flexibility to vary routine in order to meet child’s need for growth.

Definitely.  That's why toddler's in preschool.

10. Have disorganized life style (frequent moves) especially if the caregiver’s management skills and financial resources are limited.

BPDw is quite disorganized.  Not sure what to do.

Implicit rules?

1. Accommodate mentally ill mommy sleeping until 2 PM. Be really quiet.

2. Be careful when mommy disregulated. (until we get out of the house... .)

Needs?

1. Mommy's - obviously.

2. Mommy - emotional control, Toddler - not being hit, Daddy - not divorcing mommy.

--Argyle

[oceanblue]

My parents both had strong traits of NPD/BPD.  Growing up - they were very variable in meeting even small amounts of my needs.  I routinely had to get to school myself, pack my own lunch, get rides to school events or walk miles to get there.  They were mildly to extremely neglectful most of my childhood.  From this I internalized that no one is available to take care of my needs.  I realize this has colored most of my adult relationships even with friends.  If someone does something for me, I get anxious waiting for "payback."  It's extremely hard for me to ask for help and even harder to accept it.  Part of my belief code is that relationships are hard, demanding and draining.  All of this conditioned me to have relationships with BPDs or NPDs growing up because it mirrored my childhood.  Just like my parents - if a BPD became disregulated because I asked for help or maybe had a need - I actually expected the blow out.  Not all of my adult relationships are with disordered people but I have a high tolerance for that behavior and will deal with it longer than most.

I also realize that I didn't have a "normal" role model because I was very isolated as a child.  I think having one normal, reliable caretaker would have made a difference.

I also learned through implied rules to walk on eggshells around my parents and to avoid setting them off by having needs - for as young as I can remember really.  This type of relationship rule has also played out in my adult relationships.

The good news is that I am far more aware of these patterns now so I can can work on these issues.  I've already gotten more aware in the day to day of being anxious around reciprocal relationships and trying to calm myself down when things are normal and not what I am used to.  I've also gone NC with my Dad and LC with my mom to minimize the critical voices and make room for healthier relationships.