Saturday, 22 July 2017

What does research tell us parents can do when it comes to alcohol and does 'one size fit all'? Does your child's temperament make a difference?

Regular readers of my blog may have noticed that I've been a bit quiet over the past couple of weeks. Unfortunately, it's not because I went on holiday or did anything particularly exciting, sadly I was bed-ridden with shingles! Wow it's painful and I've been told that the only way you really get over it was to have complete rest, so that's what I did ... well, almost! The one thing that I have been able to do is to catch up with some reading ... I had a couple of books I wanted to get finished and a whole pile of journal articles that I have had on my desk for a while. I thought I'd share a couple of things that I found really interesting.

Every parent wants their child to have a healthy attitude around alcohol, whether they choose to drink in the future or not. Unfortunately, many continue to believe that they can do little to influence their child's drinking behaviour, particularly during the adolescent years, however, the evidence continues to say that this is simply not true. So what can parents do and in really practical terms, what does the research say works?

Earlier this year an Australian study (Yap et al, 2017) was published that conducted a review of longitudinal studies that examined a range of parenting factors (that could be potentially influenced or modified) that were associated with adolescent alcohol initiation and levels of later use or misuse. What the researchers were attempting to do was to identify what behaviours are protective (i.e., what things can parents do to delay drinking and future problems with alcohol?) and what factors are more likely to lead to drinking at an earlier age and lead to issues as they got older (i.e., what should be avoided)? They identified 12 parenting factors, including the provision of alcohol; parental monitoring; rules about alcohol; parental discipline; and favourable attitudes towards alcohol use.
It's a really great piece of work (based on a review of 131 studies in this area) and once you get through all of the statistical analysis, the authors identify four protective factors that parents should attempt to increase and they are as follows:
  • parental monitoring
  • parent-child relationship quality
  • parental support
  • parental involvement
There are no real surprises here but the authors are very clear in the following statement - "... by being more aware of their adolescents' activities, whereabouts and friends, parents can help to protect their adolescents from later alcohol misuse". This supports the mantra that I have been spruiking for many years - if you want to prevent, or at the very least, delay early drinking or even illicit drug use - 'Know where your child is, know who they're with and know when they'll be home!' I get it that's not always easy, particularly as they get older and you want to give them more freedom as they become young adults, but when they're 14 or 15-years-old, it's a must. As I always say, start this early and it won't be so difficult in the later years ...

When it comes to risk factors, the authors highlighted three behaviours that parents should attempt to reduce or avoid. Once again, there were no real shocks, but some parents may find them a little unsettling, with the following being identified:
  • provision of alcohol
  • favourable attitudes towards alcohol use
  • parental alcohol use
The authors acknowledged that a recommendation that parents should not allow their children to drink underage or provide them alcohol at home or for parties is a controversial one, particularly within cultures where giving children a sip at a family meal is regarded as appropriate and protective. That said, they state "this review provided clear evidence to back up policies and recommendations against parental provision in cultures where tolerance of binge drinking is the norm". This is a very clear statement to Australian parents as the evidence is very clear in this country that we are a nation of 'binge drinkers'.

Now when good quality research comes out like this, with very clear recommendations about what parents should and shouldn't do, I'm sure there are some people who sit there and say "But I did all that stuff and it didn't work for me!" I certainly hear from many distraught parents from who believe they 'did absolutely everything right' but still find themselves with a teen who is totally out of control. They've either been arrested for drug offences, sneaking out of the house at all hours of the night and sometimes not returning for days, been hospitalised after a drinking binge and the list goes on and on ... So often, in the conversations I have with them they inevitably say "I don't know where it all went wrong, we have had no issues with our other children ..."

Why is it that what we knows works for most teens simply doesn't have the same effect on others? Of course, every teen is different but is there something about some young people that just makes them more resistant to rules, boundaries and consequences? A month or two ago I wrote about a wonderful book I had started to read written by Robert MacKenzie called Setting Limits with Your Strong-Willed Teen - it really is a great read and I thoroughly recommend it to any parent struggling with an adolescent who is 'pushing all their buttons'!

MacKenzie doesn't talk about 'rules' per se, rather he discusses 'limits' and 'limit setting'. According to the author, all teens test the limits being imposed on them, (i.e., when a parent asks their child to do something or change their behaviour) and they do this by conducting what he refers to as 'research' (i.e., trying to establish just how much the person means what they say). This is often referred to as 'pushing the boundaries' by other parenting experts and is used by teens to see just how far they can go without crossing the line. Now I think it is well understood that not all teens test limits in the same way, but what I found fascinating in this book is how it stressed that 'teen temperament' plays a vital role in this area.

Three types of teen temperament and how they respond to 'limit setting' are discussed:
  • compliant teens (around 55% of teens match this profile according to Mackenzie) – these teens don't push their parents too much as their underlying desire is to please and cooperate. They accept the information their parents or teachers provide them and usually don't require a lot of consequences to complete their 'research', therefore accepting the limits imposed on them without too much conflict
  • strong-willed teens (10% of teens) – these young people test frequently and they require regular revision of consequences before they are willing to accept parents' authority and follow rules. MacKenzie provides an example of a strong-willed teen called Daniel and describes him as follows - "To him, the word stop is just a theory or hypothesis. He's more interested in what will happen if he doesn't stop, and he knows how to find out. He continues to test ..." I'm sure there are many parents out there who can relate to a teen like that!
  • fence sitters (35% of teens) – this is a mixed group that can go either way depending upon the situation. These teens are more likely to co-operate when they encounter clear, firm limits. However, they will have no issue testing rules and authority when the limits are unclear or when they see others getting away with something. The author stresses that this group requires "generous helpings of consequences to complete their research"
I'm sure many parents reading this will relate to at least one of these 'types' and if you have more than one child, I can almost guarantee that you have at least one of them that fits into a different category than the others! What MacKenzie stresses is that when you set limits (or create rules) for a teen it is vital that you need to acknowledge the different temperament you are working with ... and if you are lucky enough to have a 'strong-willed' one, well, it's going to be a heck of a lot tougher!

I cannot recommend this book strongly enough, not only to parents but to anyone who works with young people. If you find yourself with a teen who is 'strong-willed' and is testing you at every turn, this book is a must! It provides practical advice on how to set limits, how to develop appropriate consequences and even how to deliver them in a way that will hopefully minimise conflict. 

Research continues to show that parents continue to have a powerful influence on their child's attitudes and behaviours around alcohol use, even during their adolescence. Effective and age-appropriate parental monitoring during the teen years has been proven time and time again to be protective and the provision of alcohol to teens is a risk factor and should be avoided ('delay, delay, delay' being the key). That said, when it comes to rules and boundaries (or 'limit setting') in this or any other area, every child is different and their temperament is going to affect how you parent ... It's not going to be as simple as the evidence seems to suggest ...

Identifying and acknowledging what type of teen you have (and that if you have more than one, they may all be very different) is the first step in applying what the research says to your family situation. For some teens, simply setting rules and monitoring them will be enough to keep them protected and will likely instil positive values and attitudes without too much effort. Unfortunately, for others, they will continue to push boundaries and test you over and over again to see just how far they can go. It's not going to be easy but hopefully it'll be worth it in the end!

References
MacKenzie, R.J. (2015). Setting Limits with Your Strong-Willed Teen. Harmony Books: New York.
Yap, M., Cheong, T., Zaravinos-Tsakos, F., Lubman, D., & Jorm, A. (2017). Modifiable parenting factors associated with adolescent alcohol misuse: a systematic review and meta-analysis of longitudinal studies. Addiction 112, 1142-1162.

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