Letter: Parent-child dynamic is key to mental health

To the editor:

Patrick Kennedy's investment in children's mental health, as outlined in his May 10 op-ed page article, is heartening and encouraging. The proposed school-based interventions are critically important. However, he and co-author Linda Rosenberg use the term Adverse Childhood Experiences in a way that is potentially misleading in a significant way.

They write, "In a class of 25 students, its likely that five of them will deal with depression, anxiety, substance use disorders or other adverse childhood experiences that make learning a serious challenge." The term Adverse Childhood Experiences (ACE) comes from the longitudinal epidemiologic study sponsored by the Centers for Disease Control. It refers not to mental health disorders in the child, but rather the environment in which the child is raised.

A child who grows up in a home with parental mental illness, substance abuse, domestic violence, marital conflict, physical or emotional neglect or abuse is at greater risk for a range of negative outcomes in both physical and mental health. Our primary target of preventive intervention therefore should be the parent-child relationship.

When the parent-child relationship is disrupted, the child's ability to think clearly and manage emotions is compromised. True prevention lies not in screening children for psychiatric disorders but in supporting parent-child relationships starting in infancy. When we as a society provide time to support new parents, we offer opportunity to identify these issues early and treat them before they can exert their negative impact on the developing brain.

We need to listen empathically to both parent and child, normalizing and destigmatizing the challenges of the transition to parenthood. Population-based interventions that begin prenatally, as exemplified in our community by the Berkshire Baby Box, and extend through the first three years of life, offer the best opportunity for a preventive model of children's mental health care.

Claudia M. Gold, M.D.


The writer is a pediatrician and author of "The Developmental Science of Early Childhood: Clinical Applications of Infant Mental Health Concepts from Infancy through Adolescence" (Norton 2017).


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