- The Empire Club of Canada Addresses (Toronto, Canada), 2 Feb 1995, p. 17-33
- Steinhauer, Dr. Paul, Speaker
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- The effects of stress in families on children and on youth growing up in Ontario. A report card on the present generation of children: their mental health, school achievement, and control of aggression with some statistics. Manifestations of stress. The predictable effects of poor outcomes for children and youth on Canadian society and our economy in the future. Why children and youth are experiencing so much stress. Major causes of family stress. Looking at contributing factors over the last 10 years. What we need to do to produce a generation of healthy, competent, productive children. What can society do about family stress and its consequences? Suggestions which include contributions from a number of different societal levels: the family, the workplace, the community, mainstream services and specialised services, and government. The African proverb "it takes a whole village to raise a child." What that means, and what it could mean for our society.
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- 2 Feb 1995
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- Dr. Paul Steinhauer, Professor of Psychiatry, University of Toronto
EFFECTS OF FAMILY STRESS ON CHILDREN
Chairman: John A. Campion
President, The Empire Club of Canada
Head Table Guests
Angus Scott, Honorary Director, The Empire Club of Canada; Joanne Hum, grade 13 student, Eastern High School of Commerce; John Krauser, Associate Director, Ontario Medical Association; The Rev. Kent Doe, Rector, St. Bartholomew's Church; Rich Bailey, President and CEO, YMCA of Greater Toronto; Eric Jackman, Ph.D., Psychologist, Honorary President, Ontario Psychological Foundation and Immediate Past President, The Empire Club of Canada; Denise Cole, Public Policy and Political Consultant, McFoy Cole & Associates and a Director, The Empire Club of Canada; Bryan Hayday, Executive Director, The Ontario Prevention Clearinghouse; Michael Valpy, Columnist, The Globe and Mail; and Peter Stephenson, Ph.D., C.Psych., Chairman, Ontario Psychological Foundation and Managing Director, Toronto RHR International.
Introduction by John Campion
Lemuel Gulliver was marooned by pirates on a small Pacific island. He lamented his apparently inevitable fate. But, as he sank into helpless despair, the floating Island of Laputa appeared and he rode up on a chain to safety.
The Laputans, Gulliver soon discovered, were an odd lot. They had an ethereal state of mind but their thoughts were so taken up with intense speculation that they could neither speak nor hear the words of others, unless explicitly aroused. Apparently, only music and mathematics excited their unworldly concentration. Their mathematical obsession extended to all spheres of life. Gulliver obtained for his first meal a shoulder of mutton, cut into equilateral triangles and a piece of beef cut into rhomboids and a dessert cut into a cycloid.
But mathematics had its negative effects. Instead of a blissful reverie about the perfection of a circle or the infinitude of a pi, the Laputans were frightened. Their calculations taught them that the earth very narrowly escaped a brush from the tale of the last comet, and the next which they had calculated for one and thirty years hence would probably destroy them. The Laputans lived in fear. When they met acquaintances in the morning, the first question was what hopes they had to avoid the stroke of the approaching comet.
We inhabitants of the latter half of the last decade of this millennium, have many tails of comets about which we have an uncontrollable fear. In our world, the creation and detonation of God's fire in the form of an atomic bomb, left all of us in a state of silent and helpless psychic fear. Who of our generation has read the book On the Beach and not gone to bed convinced that tomorrow's dawn would not be ours?
Somehow, we have learned to control that sense of impending apocalypse in our lives on such a grand scale, only to be brought daily images of death and mayhem in Bosnia, Rwanda, Grozny, Israel, Ireland, Texas and on our own roads. We have connected our lives by a plug in the wall to a world of inconceivable horrors and painful disasters, none of which we can directly affect or control. At the same time, many of us have disconnected our lives from the solace of institutional religion and we float from cult to personal hedonism.
In our own world, we worship external success, we search for ever more powerful antidotes to boredom and emptiness, we anxiously feel the intensity of a crowded world moving in on our economic and physical breathing space. We demand much of ourselves and more of our children. Sex is a substitute for love, passion a substitute for caring, the 20-second sound bite a substitute for careful thought. We have circuses on holy days. Best not to stop and think. We then can seemingly avoid the tails of our own personal and societal comets.
All of these comet tails have left us in a state of precarious mental health. We need to help ourselves. More to the point, we need to help our children. The stresses of our modern world are enormous. We need defences against their intrusion, strategies to find joy and quiet and connectiveness in our lives, to bring us back to a state of societal and individual health.
Dr. Steinhauer is a medical person who has spent his entire professional life dealing with the effects of stress and finding solutions for those injured precious birds who suffer from psychic disorder--our children. He brings a message that not only reflects on those patients whom he has seen, but also on all of us trying to cope with our overpopulated, dynamic, challenging and insecure world. Dr. Paul Steinhauer is a Professor of Psychiatry at the University of Toronto. He is a Staff Psychiatrist at the Hospital for Sick Children and a Psychiatric Consultant to the Children's Aid Society of Toronto. His academic background, previous employment, professional organisations and committee memberships, publications and speaking engagements are so extensive that he must be the catman of medicine--he has to at least have lived nine lives. He is deeply involved in the Sparrow Lake Alliance and the Coalition for Children, Families and Communities. Through those organisations and his career, he has made a major contribution to mental health services for families and children. I ask you to welcome Dr. Paul Steinhauer.
I think that that is the most elegant introduction that I have ever been privileged to hear in 33 years of practice. Good afternoon ladies and gentlemen. I'm going to talk to you a bit today about the effects of stress in families, on children and on youth growing up in Ontario. I want to begin by giving you a report card on the present generation of children. How are they doing when it comes to their mental health, to their school achievement, to their control of aggression? As to mental health, the Ontario child health study which was done in 1989 showed that over 18 per cent of Ontario's children in adolescence, that's almost 1 in 5, had one diagnosable psychiatric disorder. Two-thirds of those with one disorder had two or more disorders, and only one in six of those with a disorder had received any sort of service for that disorder in the past six months. A more recent study in 1994, by the same authors, found that 25 per cent of youth between the ages of 15 and 25 had a mental disorder. The suicide rate for adolescent males, according to the Canadian Institute for Child Health, is four times what it was 30 years ago and has doubled for boys between the ages of 10 and 14.
When it comes to school achievement, the corrected national drop-out rate--and by "corrected" I mean that they corrected the number of kids who drop out by adding back in the numbers of those who dropped back in or who had merely changed schools--is estimated at 18 per cent by Statistics Canada. We know that it is less than that in Ontario. However, we also know that high-risk background, such as either poverty or being a child in a broken family, doubles the risk of premature drop-out and we know that of those who do drop out 32 per cent have not gone beyond grade nine and 40 per cent were 16 or younger when they dropped out. We know also that 12 per cent of adults with only elementary schooling and 16 per cent of all adults in Canadian life lack the confidence and the reading skills necessary for the demands of daily life.
When it comes to delinquency and violence, we know that school violence and violent crime by youth continue to rise and that the cost of correctional services for youth has increased by 37 per cent over the last four years. We know also that the earlier a child begins to show violent or antisocial tendencies, the more severe and the more permanent that problem is likely to be. Most violent teenagers and violent adult males were aggressive as young boys. Even more frightening, a 1991 study in Eastern Ontario showed that 22 per cent of three-year-olds were unable to control their aggression, which is approximately three times the rate shown by a comparable study done 20 years earlier. So there are marked increases in reported rates of spousal and of child abuse. We know that growing up in a chronically conflicted and/or violent and/or abusive family, or in a disadvantaged area, increases the risk of a child entering a developmental projectory leading to conduct disorder as a child, to delinquency and violence in adolescence, and to psychiatric and/or antisocial disorder in adolescence and adulthood.
Now so far I've been talking about that substantial minority of children and youth, roughly one in three, in Ontario who aren't making it. But what about those who are making it? One study done in 1993 took a random sample of 800 mainstream youth. (By that I mean they were not street kids, they were not kids in group homes, they were not children on reserves) He found that 44 per cent of the girls and 18 per cent of the boys reported that at times they have trouble sleeping due to stress. Fifty-eight per cent said that they handled stress well, although the majority in special classes did not.
And this brings us to a second question, and that is: What are the predictable effects of poor outcomes for children and youth on Canadian society and our economy in the future? In general, I would suggest to you that poor outcomes for children are inevitably going to lead to poor outcomes for society. If our children don't have good attachments in their families, and if they end up learning not to trust and to relate trustingly to others, they will grow into adults with chronic relationship problems, which will affect their families, their workplaces, our society and their parenting of their own children. If we have children who don't do well in school and who drop out or remain illiterate, we are going to have adults who are poor job prospects, who have a higher rate of being chronically dependent on the rest of us, who are more likely to consume welfare and who are predisposed to adult antisocial behaviour. If we have teenagers who are alienated, antisocial and who have chronic emotional disorders, we're going to face increased costs of vandalism, violence, teenage pregnancy and the need for costly services. And if we have children who in their school years don't learn to be productive, we are going to face individuals who as adults have a much higher rate of being chronically unemployed. Our labour force will not have the skilled workers that it needs to maintain its and society's economic base. So we are going to end up with fewer resources to meet the cost of welfare and services. But you can look at these things sequentially too, because the more children don't learn to trust, the less likely they are to do well in school, the more likely they are to be alienated in adolescence, and the less productive they are likely to be in their adult lives.
Now this brings us to the next question, which is: Why are children and youth experiencing so much stress? There's no doubt that children are very aware of the sort of macro-stresses that Mr. Campion was talking about. However, I think an even more important thing is that the distress of children is a direct reflection of any pre-stress and pressure on families these days. And I think that comes from two main sources. The first is a high rate of marriage breakdown. In 1991, the divorce rate was 10 times what it was in the 1950s in Canada. And as a result of that, 20 per cent of families with kids are single-parent families, and of those single-parent families, seven out of eight are headed by women. And 60 per cent of mother-headed single-parent families are living in poverty. And if you grow up in a poor family, then you are over twice as likely to have poor school performance; you're almost twice as likely to have chronic health problems; you're almost three times as likely to have a conduct disorder; you're over twice as likely to be hyperactive and you're over twice as likely to have an emotional disorder. And 21 per cent of Canadian children at this point--that is 500,000 children more than in 1989 when the House of Commons voted unanimously to eliminate child poverty in Canada by the year 2000--are poor.
And don't think for a minute that just poor kids aren't making it these days. There are lots of kids from mainstream and affluent families who could be making it and should be making it but who aren't making it. And in addition to the problems that are related to being in a single-parent family, seven per cent of children come from blended families which, as was recently shown quite clearly in the Quebec child health study have a higher rate of child problems.
Now the second major cause of family stress is the major technological change, on scale with the Industrial Revolution, which has resulted from automation and computerisation. And this has led to globalisation of the economy, which has led to the loss of many well-paying jobs in the manufacturing sector and their replacement by poorly paying jobs in the service sector. As a result, in 1994 it took two or more earners working 73 hours a week to stay above the poverty line--something that one worker working 41 hours a week could do in 1976. And as a result, 75 per cent of families now require two incomes to stay above the poverty line and this has had a major effect in increasing the number of young families that are poor.
What has happened is that over the last 10 years, there has been a doubling of the number of young families, from 21 per cent to 41 per cent, that have remained poor. It usually isn't until families get into their forties that they're able to get their heads above water economically. Now, although 68 per cent of families, according to an Angus Reid poll back in June of last year, believed that having a full-time parent in the home is the best way to raise children, only 13 per cent of families with children actually do have a full-time parent in the home, even though 40 per cent wish that there was no need for both to work and 50 per cent feel that they lack a good balance between work and family.
Now I don't want to imply that children are damaged by having two working parents. They're not, as long as two conditions are met. The first is that the parents' work stress is not overwhelming. The second is that they receive high-quality childcare, both from their parents and also from the substitute care-givers who look after them during the rest of the day. But as a professor from Carlton University has pointed out, nine of 10 working parents who are responsible for arranging child-care experience some tension in juggling work and family responsibilities, and 20 per cent report that that tension is severe.
And work stress has been shown to be a strong predictor of overall stress levels, of absenteeism at work and of physical and mental health problems. Over the last three years there have been three studies, which have shown that workers with good jobs, that is, middle or senior managers and skilled technicians, are likely to work harder and to work longer. Now some may choose to do so, but others have no choice. It goes with the job. I would remind you that the longer they work, the less time and energy they are going to have for their partners and their children.
Now it's the combined pressures of the increased family breakdown and the increased work demands that have led to what has been called the family--time famine. And studies in the United States have shown that the actual amount of time that parents and children spend together is less today than at any point in the 60 years in which statistics have been kept. And Canadian studies confirmed this--the 3,000 calls today to Child-Help Phone, the work of the Premiers Council here in Ontario and of the Coalition of Children and Youth in an Angus Reid poll. A U.S. study has shown that the more time that senior public school students spend unsupervised, the more likely they are to abuse drugs and the less likely they are to do well in school. And research has shown that how well children do in school at age 14 has less to do with what's going on in their schools than it does with what's going on in their families.
That brings us to the question: What do we need to do to produce a generation of healthy, competent, productive children? We know that there are things we can do at every level of development--during pregnancy, throughout infancy, during the pre-school years, and during the school years, that have repeatedly been shown in empirical studies to increase both the effectiveness and the efficiency of improving outcomes for children. I want to tell you briefly about just two.
One was a home-visiting programme in the state of Hawaii, the purpose of which was to decrease child abuse. This was carried out largely by volunteers. Professional psychologists developed a series of questionnaires which volunteers took to the homes of every mother in all the islands (except for Maui) who had given birth within the last week, and to mothers in high-risk communities in Maui. On the basis of that questionnaire, they broke these down into two groups: those who they thought were at high-risk and those at low-risk for child abuse. They paid no more attention to the low-risk ones. They had their own support systems, but the high-risk ones they visited on a regular basis to decrease their sense of isolation, to increase their understanding and to encourage them to meet the needs of the baby and to recognise early any problems that were coming up in the child or in the mother-child relationship. They succeeded in cutting down the rate of child abuse in the high-risk group by over 50 per cent. When you cut down child abuse like that, you also cut down teenage violence and school failure and you also cut down costs--the costs for remedial education, crime control, foster care and subsequently welfare.
The second example is from the Parry pre-school project, which is a head-start programme of high-quality childcare and education for extremely disadvantaged three- to six-year-olds, who were exposed, in this case, to multiple-risk factors. What was different about this particular study was that they followed these kids through to age 27. At age 27, they found that the graduates of the programme, as compared to controls, had 50 per cent fewer arrests and convictions. A third more had graduated from high school, four times as many were earning $2,000 a month or more, three times as many owned their own homes, twice as many hadn't been on welfare at any time over the past 10 years, significantly more were paying taxes and significantly more were committed to their partners. And the estimate is that every dollar spent on that day-care programme paid off seven dollars and 16 cents down the pipe in terms of the reduced need for remedial services and the decrease in welfare as offset by the increased amount of taxes that the graduates were paying.
Now, with 75 per cent of families needing two incomes to avoid poverty, we need a whole range of extra-familial resources to make available high-quality childcare. And I don't particularly care whether it is day care or home care or nanny care. I just want it to be good care for the children of families who don't have the extended families or their own support systems to provide it.
And I'd just like to remind you about the different effects of high-quality as compared to poor-quality childcare. High-quality childcare for pre-schoolers increases their social confidence. It increases their language and play development. It increases their control over their aggression. It decreases the number of behaviour problems in grade one (as reported by their teachers). It increases their compliance to adults. It increases their willingness to learn and their having the cognitive, emotional and behavioural skills that will allow them to be good students in school. It increases their further school readiness.
On the other hand, bad childcare decreases social confidence in pre-schoolers. It decreases their language and play development. It decreases their control over their aggression. It decreases their compliance with adults. It increases the number of behaviour problems in grade one. It decreases their will and their skills that would allow them to be ready for school when they come to grade one.
This brings us to the last and the most important question: What can we as a society do about it? How can we make possible a healthy, competent, productive generation of children?
Well, my first bit of advice is: Don't leave it to government or professionals--partly because it is too important and partly because we cannot abdicate our role as parents and as members of the community and expect government and professionals to bring up our kids for us and have them succeed.
Secondly, I would warn you that there is no single ~ answer. To produce a generation of healthy and competent and productive children will require contributions from a number of different societal levels--from the level of the family, the workplace, the community, from mainstream services and specialised services and from government.
I want to talk about a number of these in turn. First of all, the family level. We need families and we especially need fathers who realise that good parenting must be an active, and not just passive, process. It isn't enough for us to love our kids. They need our time and they need our involvement. And having an involved father has been shown to increase children's school achievement and to decrease problems in their control of aggression. And over time, there can be a problem here, because work pressures may certainly compete with the needs of children and the parent who isn't going to short-change his kid may be in a position of decreasing his rate of promotion. However, it isn't enough to say, "Well, I don't spend much time with my kids, but what I give them is quality time," because quality time doesn't just come when you plan it. As any person who has spent a lot of time with kids knows, it comes when you least expect it. It may come when you are driving somewhere in a car and all of a sudden something magically happens so that the boundaries are down and so that you and the child are close to each other. So you don't have quality time without quantity time. And it isn't enough just to be watching something that you want to watch on TV and having your kids in the room. That's not the kind of parenting the kids need.
So I would summarise. Those parents who aren't already doing so (and I would say especially fathers, since the literature shows that the bulk of the work is being done at this point by mothers and even the mothers who are working full-time still do more than 50 per cent of the housework and more than 50 per cent of the parenting) will need to give parenting a higher priority and make a greater investment in parenting, if they want to maximise the chance of their children achieving their potential.
Let's talk about the workplace level. For parents to have the time and energy to be parents effectively, we're going to need workplaces that are aware of and responsive to their employees' family responsibilities. But why should workplaces be family-centred? As one spokesman for management stated recently, during contract negotiations in a manufacturing firm in Southern Ontario, "Look, we didn't hire your child. The contract is with you and if you don't like what we offer there are lots of people out there who would jump at the chance to have your job."
We would suggest that there are two reasons for a family-centred workplace. The first is that businesses need to consider their obligation to the community and not just to their stockholders. And we would suggest that there is no better way for businesses to contribute to the community than by minimising unnecessary pressure on their employees, when those pressures are undermining their ability to be parents. There's another reason, though, for family-friendly policies: it pays. As the Royal Bank, the Bank of Montreal, MacMillan Bloedel, Bell Canada and many other firms have found, it pays through decreased absenteeism, through increased productivity, and through increased employee morale and loyalty. And now that companies can no longer offer life-time employment, all but the best-paying companies are much less able to command and to count on employee loyalty. Employees will pick and choose and family-friendly policies will be important in attracting and in keeping your share of the decreasingly available, highly skilled, female employees. The turnover rate with women is twice that of the turnover rate with men and family stress is the major reason that women change jobs. There are many qualified, desirable, responsible employees who are looking for the balance between work and family responsibilities, and if they don't find it, they will leave. And if they leave, you're faced with the cost of advertising, the cost of orienting and training new employees, the time lost for replacement and the time lost until new employees are working up to scratch.
Well, what is a family-centred workplace? We would suggest that it is one that offers its employees many or all of the following: flexible work hours, no-hassle relief time for family emergencies (including a sick child or the unexpected temporary breakdown of their day-care arrangements), job sharing on site, day care on site, available counselling around personal issues or issues related to parenting or care for aging and ill parents, no forced overtime for skilled technicians and managers (so that the employee has the option of not neglecting his family without putting his job on the line), the option for working at home via modem if the person is working on a computer and policies and (especially) managers who are sensitive to the family responsibilities of the worker.
Now at the level of the community, as I read this morning, "The old communities--family, village, parish and so on--have all but disappeared..." and so in order to produce a generation of healthy, competent, productive children, we need to regain the sense of community that has largely been lost. I remember, growing up in Toronto in the forties, that we would have died with mortification if one of our parents had come with us when we went out on Hallowe'en, but what responsible parent these days would send a group of young kids out without supervision? And I remember also how if your car was banged in a parking lot, you would come out to find a note of apology with the phone number. Now these things, I would think, are not common experiences these days. As the World Commission on Learning stated, "Many of the values that were supposed to hold society together" (and I would add, that did hold society together) "are no longer clear or universally supported." We've lost our shared sense of common values and ideals. We've lost our sense of trust and caring, our sense of connection with and commitment to our fellow citizens, and to the community and to the country as a whole. Ours has become a very polarised, us-versus-them society, and we have, as Dalton Camp has suggested, "lost the will to compromise." We've become a collection of pressure groups, each demanding what it wants, regardless of how that affects anybody else.
A good example, I think, is our response to the revision of the social security network. As a nation we only seem able to agree on two things: first of all, that the deficit and the debt must be brought under control and secondly, that somebody else should take the hit for doing so. So we badly need to rebuild and to recapture a sense of community. To do that, we need parents, grandparents and adults without children who are prepared to care about those in society who need help, be they children or their families. We need to establish new networks and communities based on common neighbourhoods, common workplaces, common religion, common interest, common problems, common anything. We need more people who are prepared to give of themselves, either through formal volunteering or through the informal provision of friendship and support to those in need.
Fourth, we need to come to grips with the global economy. We need to recognise that it's Canada's economy, not its social security system, that has broken down. If there were enough adequately paying jobs, there would be far fewer families and children in poverty and fewer demands for social assistance. Most people in the future, however, will never again be able to count on the security of having a life-time job. This has major implications for education. Life-long learning is going to become essential, because people are going to have to retrain themselves in between job contracts for whatever job is available out there at a particular time. And as Marshall Cohen, the President of Molson has said, "We need to change our very attitude towards work. With periods of unemployment between jobs becoming routine, we're going to have to learn as a society to base our self-esteem, which is currently rooted largely on the status of our job and how much we earn on something that is not job-related, or we are going to be faced with intolerably high and unnecessary levels of depression."
I want to talk briefly about the role of government. I'm going to leave the mainstream and specialised services. That's what I usually do when I am talking to teachers, child-care workers and people who are in the health and mental health professions. But I want to talk about the role of government. We can't continue to look to government to solve all our problems by coming up with more and more specialised resources. We can't and we will never as a society be able to afford enough therapeutic resources. We will have to increase our ability to help ourselves and each other, instead of leaving it to professionals to do what should be our responsibility for the care and raising of our children. But we can and we must demand that governments at all levels and the various ministries that plan and fund services for children get their act together and stop beating their own drum. In the last year here in Ontario, the Ministry of Health, the Ministry of Community and Social Services and the Ministry of Education have all come up with major service and policy reviews and they were all done largely, if not entirely, in isolation from each other. Also, various levels of government pass the buck to each other as if it were a hot potato. It goes from the feds to Queen's Park to the municipalities and the school boards and back again. We can't expect government to solve all our problems, but at least we should be able to expect it to stop aggravating them by turf wars between ministries or between departments within ministries, by their passing the buck, by their inefficiency and lack of accountability and by the kind of bunkering--in mentality whereby they talk about partnership but continue to reject any ideas regardless of the merits that are coming from outside the ministry and its internal research staff.
There's an African proverb that it takes a whole village to raise a child. When I first heard that, it made me feel good, but I didn't know what it meant. And I learned what it meant when I was watching that special on violence on PBS a couple of weeks ago. What that means is that if a child is surrounded by caring adults who are ready to meet his needs, when his parents are not available, adults in his home, in his neighbourhood, in his day-care centre, in his school, then the village is caring for the child. And if the children in our community were living in a situation where adults have that kind of caring, not just for their children, but for all children, I can guarantee you we would have many fewer kids with mental health problems, we would have fewer kids dropping out of school, we'd have much less delinquency and violence and we'd be faced with many fewer costs for custody and court costs.
And so, ladies and gentlemen, I think we, as a society, have a choice. We can do what is needed to give children the competence and coping skills they will need to be successful members of society. Or we can avoid doing so, and we can wait and pay later (and much more) for our short-sightedness, as we sit and experience the results of their failure.
The appreciation of the meeting was expressed by Eric Jackman, Ph.D., Psychologist, Honorary President, Ontario Psychological Foundation and Immediate Past President, The Empire Club of Canada.