The latest issue of Brookings and Princeton’s “The Future of Children” adds to the growing number of studies documenting that childhood disability rates are not only unexplainably increasing, but also that the way disabilities manifest is significantly changing. Where the poster child of disability in the 1960s was on crutches, the new face is a child with autism, attention deficit hyperactivity disorder or other problems that affect the developing brain.
Growing rates and shifting patterns of childhood disability challenge notions that U.S. children are generally healthy and suggest substantial changes in the risks children encounter. While disabilities are more common in children from lower-income households, a lack of family resources, education or other forms of social deprivation don’t explain all of what’s going on.
Some risk-hunting epidemiologists are considering whether any of the thousands of new chemicals in our environment are to blame, while others are examining the role that toxic stresses may play in jolting developing nervous systems onto an aberrant path.
The science of human development has taught us that while dramatic one-time events can leave their mark — serious infections, unusual chemical exposures or adverse experiences — child development is more commonly influenced by the ordinary and mundane. Ann Masten, president of the Society for Research in Child Development, suggests the ordinary magic of daily experience is what usually provides the consistent scaffolding children need to develop.
Similarly, ordinary inattention and common adversities, often repeated and then compounded, can send a child on a downward developmental path. While the causes of increasing rates of developmental disabilities may be due to a bad molecule or some yet-to-be-discovered risks, they also may be hiding in plain sight.
On a recent trip, I observed two everyday and seemingly unremarkable episodes between children and parents that may provide a lead.
The first happened in the airport. I watched as a young, middle-class mother in her early 20s placed her happy 9-month-old on her lap. The adoring mother engaged the infant in beautifully playful, expressive dance. They modeled textbook interactions so crucial for healthy attachment and emotional development. The mother smiled in response to the baby’s smile. As the mother spoke, baby cooed in response. I could almost see the invisible rays of emotional energy transmitted from mom to baby.
After about three minutes, Mom’s phone rang and she took a short call — during which she continued to smile, mouth words, touch and play. But instead of putting her phone away, Mom began texting. What I witnessed next was what I observe in young babies with mothers who are drug addicts, depressed or disengaged for other reasons.
The baby found Mom was no longer responsive, smiling or interacting. Baby cooed and tried to get Mom’s attention, but there was little response. To the infant, her mother now resembled someone who was severely depressed. The baby gradually became agitated, fussy and unresponsive to a few gentle pats from mom in place of real attention. I imagined the baby’s right frontal cortex, associated with positive emotions, powering down as the left frontal cortex, which responds to adversity, powered up.
After a few more minutes, the distressed and agitated infant stuck her hand in her mouth, organized herself around the sucking that was now substituting for real-time interaction and gazed listlessly at the lights overhead, emotionally exhausted and distraught. Ten minutes later, Mom finished texting, rebundled her disengaged child and boarded the plane.
That night, I dined near a young couple and their 18-month-old toddler. Their son seemed happy, active and engaged, clearly enjoying time and pizza with his parents, both professionals. At the end of dinner, Mom got up to run an errand, handing over care to Dad.
Dad quickly drew his phone from his holster, flipped through messages and disengaged as a barrage of pizza-crust projectiles whizzed by. Then Dad got up, swung the high chair around and played with his son face-to-face.
After a couple of minutes, Dad put the child on his lap and both watched a video on his phone until Mom returned. She did, to the obvious delight and relief of both males, and they left with their son clinging to Mom’s neck.
PARENTAL BENIGN NEGLECT
Both vignettes were ordinary, routine and unassumingly common. In both instances, what could have been many minutes of engaged social interaction was transformed into distress, in the case of the baby in the airport, and into distraction for the boy.
Was the infant’s experience of her mother’s Jeckyl-and-Hyde transformation an anomaly or a regular part of life? Were these the origins of an anxiety disorder for the little girl and ADHD for the little boy?
What does this all mean? Neither parent is guilty of anything more than being typical in 21st-century America; working, traveling and attempting to build families in a demanding, noisy, often chaotic and technologically dependent world.
Are these children suffering from parental attention deprivation disorder, an unintentional form of benign neglect? Should we pass laws like those that ban cell phones while driving? Should we put up signs that say, “No texting while parenting”? Is the quality of parenting any different whether Dad has a phone in hand, or any of the hundreds of other tools parents used in the past?
As disabling mental health, developmental and behavioral problems afflict more children, it is important we consider not only rare and unusual events, but also the ordinary inattention that has become so common it is barely discernible.
Little things — moments of deprivation, lack of attention — that compound over time really count when it comes to child development.
And it could be that the causes of rising rates of developmental disabilities and childhood mental health problems are more ordinary, simple and preventable than we think.
Neal Halfon, M.D. and M.P.H., is the director of the UCLA Center for Healthier Children, Families and Communities. He is also a professor at the UCLA Departments of Pediatrics, Health Services and Public Policy.