Dads Want to Co-Parent — And It Matters

When co-parents tend to their relationship first, everyone benefits.

Note: This blog post is primarily about fathers (in honor of Father's Day) and particularly fathers who are partnered with women. This is just one of the many types of family structures that exist and I'm interested in all types of family structures. However, much of the detailed research on co-parenting involves heterosexual relationships. The good news is that many of the findings here that apply to fathers in heterosexual relationships also apply to co-parents of all kinds.

photo credit E. Frost

photo credit E. Frost

Arms heavy with meals I had prepared, I crossed the sunlit porch, slipped off my shoes, and walked through the front door. I found my friends, new parents, standing quietly side by side in their darkened kitchen. Shaye, their tiny newborn, had just awakened from his nap and was resting on his mama’s shoulder. A hushed atmosphere of disheveled slumber lingered.

Jed, Shaye’s father, turned to investigate the food I’d brought, lifting lids from the containers and filling his plate with chicken. “Do you want some?” he asked Emily, his wife.

“Later,” she said, sitting down on the couch to talk. Little Shaye lay quietly on her lap, attentive to sights and sounds, while Jed ate beside us.

Soon it was time to breastfeed, and Jed stood to bring Emily a pillow and a glass of water. When feeding was finished, Jed brought Emily her lunch, took Shaye from her arms, and burped him; then they disappeared for a walk in the afternoon sunlight while Emily turned to talk with me. After a while, Jed came back in, changed Shaye’s diaper, and, standing, started to rock the baby back to sleep. When Shaye fussed, his parents passed him back and forth until he settled.

I was in awe of this ballet, of Jed and Emily’s seamless choreography. Each shift in task was preceded by a considerate, “Do you want…?” “Could you please…” Or a “How are you doing?” This was true partnership in action.

Co-parent collaboration is good for the entire family

Carolyn Pape Cowan and Phil Cowan, psychologists emeriti at the University of California at Berkeley, have studied families for over 40 years. Parenting is hard, they acknowledge, and the transition to parenthood is an especially vulnerable time. More than 50 studies worldwide show that, as joyous and welcome as a new child might be, trouble usually starts to brew in the parents’ relationship after a birth. There’s too much to do, sleep is short, and freedom is seriously curtailed—a recipe for conflict and dissatisfaction that can place everyone at risk.

But when parents tend to their relationship and learn to collaborate constructively, everyone is much more likely to stay on track and thrive. Through several major studies involving more than 1,000 couples in very diverse walks of life, the Cowans found that when parents nurture their own bond, it maintains relationship satisfaction across the challenge of parenting—for years. It also improves the parents’ relationships with their children. In turn, the children are happier, and more sociable, and secure. Notably, tending to the co-parents’ relationship creates more benefits for the family than even parenting classes, men’s groups, or moms’ groups that tend to overlook couples’ issues.

photo credit E. Dorrien

photo credit E. Dorrien

Why is nurturing the couple relationship so powerful, even for the children?

“The relationship between the parent figures creates the atmosphere in which children are growing,” replied Carolyn. “If parents have unresolved high conflict, it makes children nervous and preoccupied with their parents; they end up not doing as well socially or academically. But if parents are warm and respectful, and treat each other kindly and gently, the children feel secure and therefore, free to explore life. They also have a positive model for their own lives as to how relationships should work.”

Phil added, “There are ‘spillover’ effects. That is, if a partner is unhappy, it’s very difficult to turn around and be a nurturing, supportive parent to the child. And our research shows that when a couple functions effectively as a team, it helps them ward off stresses and strains from outside the family, like job stress, poverty, or difficult life events.”

A healthy relationship invites dads in

photo credit W. Johnson

photo credit W. Johnson

One of the benefits of this early collaboration, the Cowans report, is that fathers feel more welcomed into the emotional labor and rewards of parenting.

“We know from our own and others’ research that one of the best predictors of father involvement is the relationship with the mom,” says Phil. “And that’s true regardless of the family structure, whether they are biological parents, adoptive parents, stepparents, divorced, cohabitating, or married. If you improve the relationship between the co-parents, partners are happier, and it draws dads in, not only to the relationship but into the family.”

And dads matter.

They want to be involved in parenting. A recent survey on parents of 2200 Millennials and Generation Xers revealed that 90% of the fathers said being a parent was their greatest joy, and 73% said their lives began when they became a father.

“Most of the fathers we’ve worked with want to be more involved with their babies and young children than their fathers were with them,” said Carolyn. “Some of them say, ‘I want my son or daughter not to be afraid of me and be able to talk about anything with me.’ Regardless of ethnicity—African-American, Mexican-American, European-American—all the fathers we’ve worked with either want to emulate some aspect of their own father, or they’re really eager to do it differently.”

Parenting has benefits for fathers, too. Research shows that fathers who are more involved in their children’s lives have better physical and mental health, are more stable, and live longer. Kyle Pruett, a psychiatrist at Yale University who with Marsha Kline Pruett collaborated with the Cowans for the past 15 years, quipped that health insurance providers should lower premiums for men when they become fathers.

When fathers are involved, moms also benefit. Women are still spending an average of twice as much time than men providing care for young children, even though dads have increased their involvement over the last 30 years by 65%. More support from fathers is welcome.

Dads are just as capable as moms

photo credit K. Merchant

photo credit K. Merchant

For a couple of decades, research has shown that mothers and fathers are equally capable of parenting well. Both mothers and fathers:

  • Are warm and responsive to their babies’ smiles and happiness;

  • Provide comfort when their babies cry;

  • Encourage exploration;

  • Engage in developmentally sensitive teaching;

  • Encourage their children’s autonomy.

Research shows that, as a general rule, mothers and fathers are equally sensitive and attuned to their children’s feelings.

Natasha Cabrera, psychologist at the University of Maryland, has been studying fathers, especially poor fathers, for 20 years. Many dads she sees are very hands-on. “They know how much their child weighs or what makes their baby cranky,” she says. “In a study we have going on right now, almost half of the children are soothed better by the dads than the moms.”

According to Cabrera, sometimes people assume that dads are incapable, and sometimes dads hide their capability so the mothers don’t “look bad.” “But often dads can be more understanding of their children because they have less of an agenda. They’re more laid back, less stressed, so they see the child more clearly,” Cabrera explains.

Dads and moms make different contributions to development

  • Language development: Cabrera has found that mothers and fathers talk to their children in different ways. One at a time, she gave moms and dads the prompt to “just talk to your child.” Then she recorded how many words were said, and which types of words were used. She found that fathers talked to their children in longer and more complex sentences and included more diverse kinds of words than mothers.

“The quality of their language was higher,” Cabrera said. “As a result, the two-year-olds knew more words, and more diverse kinds of words. So fathers are making important contributions to their children’s language development.”

  • Emotion regulation and risk-taking: Worldwide, dads seem to take on the role of exciting their babies. They’re more likely than mothers to engage in rough-and-tumble play, sweep the baby high into the air, or go for hysterical giggles, while still paying attention to what the baby can tolerate. Scientists think that this experience of excitement and energetic feelings—within the safety of the father’s watchful care—contributes to a baby’s emotion regulation and healthy willingness to take risks.

Fathers tend to hold babies differently—facing out, like a hood ornament, Kyle Pruett says—as if they’re “getting their child ready for the world.”

  • Less aggressive problem-solving: Ruth Feldman, psychologist at Bar-Ilan University in Ramat Gan, Israel, found that fathers who were sensitive and attuned to their children’s feelings and behavior benefitted their child’s social development. When these children, especially the sons, first encountered peer groups in preschool, their social problem-solving was more constructive and less aggressive or passive. These benefits continued into the early teens and were more attributable to fathers’ than mothers’ contributions. In other words, good fathering was critical to these children’s interpersonal problem-solving. They learned how to stand up for themselves respectfully, neither shying from conflict nor resorting to aggression.

Parents can relax and appreciate the diversity that each one brings to their parenting role,  Cabrera points out. “There are similarities, and differences, and they complement each other to contribute to a child’s development and resilience.”

There’s an early, sensitive period for fathers’ involvement

 Nature seems to draw fathers into parenting from the start.

Several studies examine the hormonal and neurological changes that occur in expectant and new fathers. For example, in a study of 34 couples, the hormones prolactin and cortisol—related to bonding behaviors in animals and humans—increased in women and men as childbirth approached. While the women’s cycle was driven by pregnancy, the men’s changes were related to their partner’s changes; that is, closer involvement with partners correlated more closely with men’s hormonal changes. And the greater the hormonal increases in men, the more “couvade” they experienced—i.e., the behavioral changes in weight, appetite, emotions, or energy some men experience during their partner’s pregnancy.

photo credit L. Daniels

photo credit L. Daniels

After the birth, men’s testosterone dropped to low levels, perhaps in preparation for their first interaction with their babies. And men who had higher prolactin before birth and lower testosterone after birth were more responsive to infants, looking, smelling, holding, and responding to their cries more. Other studies confirm that lower testosterone in fathers is related to a more sensitive “attunement,” or synchrony, with their babies in the first six months of life. While the caregiving system is “plastic”—e.g., adoptive parents bond just as closely as biological parents—nature seems to have provided this easy on-ramp to parenting.

Interestingly, men and women fall in love with their babies in different ways.

Women’s brains are primed by pregnancy, birth, and breastfeeding to get drawn into caring for their baby. Changes in the subcortical, “bottom-up” limbic regions of the brain connected to vigilance, mirroring, and emotional connections can even be identified in brain scans post-delivery.

By contrast, men’s brains are remodeled by their participation in caregiving. The more fathers engage in activities like soothing, changing diapers, and feeding, the more oxytocin (the bonding hormone) they produce, and the stronger the activation they show in the “mentalizing” regions of the brain. These are the more “top-down” processes from cortical regions that help a father to imagine and figure out what another person needs. And there doesn’t have to be a biological connection. Adoptive gay dads showed neurological changes similar to bio-moms and bio-dads.

The takeaways from the brain science are twofold. One, the caregiving system is “plastic,” and human brains are wired to change in ways that make room in a person's consciousness for caregiving, whether they're biologically related to a child or not. And two, dads shouldn’t wait until their children can talk to get involved in parenting.

“If you’re not involved in this sensitive period, it’s going to pass you by,” says Pruett.

About half of fathers—and mothers too—underestimate the importance of the earliest weeks and months of a child’s life. The hormonal and neurological changes that occur in fathers when they're involved with their pregnant partner, and later when they help with the physical acts of caregiving, actually pave the way for them to become more connected with their baby in ways that can have long-lasting effects.

What stands in the way?

 Unfortunately there are a lot of barriers to full father participation in America. Structural barriers like lack of paid parental leave force both parents to choose between their paycheck and caring for their baby. Even if fathers have paid leave from work, many fear taking advantage of it, lest they be punished or ostracized by employers.

The Cowans and Cabrera react when I ask them about barriers to father involvement.

“There’s a pervasive cultural bias against fathers,” says Phil Cowan. “Often, in social service agencies, men are the ‘bad guys,’ especially to providers who are used to seeing family violence. But most men are not violent and would like to be caring, involved fathers if we would just make space for them. Outreach programs tend to focus exclusively on moms, like the Maternal and Child Health Bureau. And in our own experience we’ve found that sometimes dads’ names are not even listed on a family’s file.”

Cabrera agrees saying that research findings have important implications for decisions society makes about fathers, including custody arrangements, mental health interventions for fathers, and incarceration.

“Fathers, especially poor men, are often considered optional except for the financial support they can provide, and often visitation is denied or strictly limited,” Cabrera says. “Or we’re more concerned about mothers’ mental health and depression than the mental health of fathers. In most cases fathers love their children, and now research shows they are important for children in ways besides financial. I think we’ve done a lot of injustices to many men who would be very capable.”

“And the bias is not just in family service agencies, it’s in psychology, too,” says Phil. “Ninety percent of the parenting research is on moms.”  

Cabrera agrees: “By using the maternal template for research, we miss things fathers do that might be interesting and required in kids’ development. Dads are not just babysitters, backups, or paychecks. They’re important for development.”

Mothers sometimes stand in the way. In a 2015 representative survey of parents, 40% of dads (versus 17% of moms) said they’d like to be more involved in parenting but their co-parent didn’t let them. And 43% of dads (versus 16% of moms) said their co-parent was too controlling.

What’s important about couple collaboration?

 The Cowans described the five aspects of collaboration they focus on in their work with parents of young children:

photo credit K. Merchant

photo credit K. Merchant

  1. Individual well-being of each parent: Are they anxious or depressed? What do they worry about? Do they feel effective, or not? How is each partner feeling?

  2. The couple relationship: What are some helpful strategies for problem-solving in the relationship? How can couples approach solutions and maintain their sense of calm?

  3. Parenting and co-parenting strategies: What is the authoritative parenting style and which specific strategies reflect that style? They encourage couples to make incremental changes and to plan time to reflect together on how things are going.

  4. Three-generational reflection: How have parents’ own childhoods, especially the relationship between their own parents, affected them? What approaches would they like to carry over from their childhood experiences, and what would they like to do differently?

  5. Stressors: Are there other stressors pressuring the family that should be addressed and where might they find support to lower their stress?

Six months after my first visit, I followed up with Emily, Jed, and little Shaye—and I experienced them as a solid, well-coordinated unit who were really enjoying each other. They were navigating the challenges of new parenting with thoughtfulness and care.

They recently helped their baby to sleep through the night. How? “We spent hours and hours arguing over strategies, and had months of conversations," Jed said. "Finally I said, ‘Emily, you need sleep. Something needs to happen here.’”

Now they’ve established a pattern where Jed manages much of the nighttime so Emily can sleep. He thaws and warms the breast milk, feeds Shaye, and then puts him down for sleep. If Shaye wakes up, Jed briefly comforts him, and then rolls back to bed.

“It can be challenging,” says Jed. “But the whole process is sweet and I love the interaction with him. It feels important to me that I can be that nurturing and effective.”

Juggling two work schedules and baby care without outside help is hard, and Jed is candid about that: “The most stressful part is when you’ve got 400 things on your mind and you’re racing against a deadline, and there’s nothing else you can do but be with your child. I’m more tired than I’ve ever been, and drink more caffeine now than in my entire life. I’ve hit my edges a few times, but it’s grown my capacity.”

"There’s not a lot of social support for new fathers," he continues. "Now I'm more interested in other dads. But it's not like we give a lot of advice to each other, it’s more like, ‘hey, what’s it like to be you right now?’”

How has fatherhood changed him?

“I feel more joyful and playful and fulfilled,” he says.

photo credit P. O'Conner

photo credit P. O'Conner

 

* * * * *

Additional resources

An Interview with Dr. Kyle Pruett, 2014

Conversation with Dr. Ruth Feldman and Dr. Kyle Pruett, 2014

More video talks by experts on the importance of fathers: Simms/Mann Institute

When Partners Become Parents: The Big Life Change for Couples, by Carolyn Pape Cowan and Philip Cowan

Do Fathers Matter? What Science is Telling Us about the Parent We’ve Overlooked (2014), by Paul Raeburn.

All In: How Our Work-First Culture Fails Dads, Families, and Businesses—and How We Can Fix It Together (2015), by Josh Levs

And for fun

Home Game: An Accidental Guide to Fatherhood (2009), by Michael Lewis

Pops: Fatherhood in Pieces (2018), by Michael Chabon

What is a Secure Attachment? And Why Doesn’t “Attachment Parenting” Get You There?

photo credit: Emily Dorrien

photo credit: Emily Dorrien

A few months ago, a young friend of mine had a baby. She began a home birth with a midwife, but after several hours of labor, the baby turned to the side and became stuck. The midwife understood that the labor wouldn’t proceed, so she hustled the laboring Amelie into the car and drove the half-mile to the emergency room while Amelie’s husband followed. The birth ended safely, and beautiful, tiny Sylvie emerged with a full head of black hair. The little family of three went home.

When the baby was six weeks old, Amelie developed a severe breast infection. She struggled to continue breastfeeding and pumping, but it was extremely painful, and she was taking antibiotics.[1] Finally she gave in to feeding her baby formula, but she felt distraught and guilty. “Make sure you find some other way to bond with your baby,” her pediatrician said, adding to her distress.

Piglet sidled up to Pooh from behind. “Pooh!” he whispered.
”Yes, Piglet?”
”Nothing,” said Piglet, taking Pooh’s paw. “I just wanted to be sure of you.
— A. A. Milne

Fortunately, sleep came easily to Sylvie; she slumbered comfortably in a little crib next to Amelie’s side of the bed. Still, at four months, Amelie worried that the bond with her baby wasn’t forming properly and she wanted to remedy the problem by pulling the baby into bed. Baby Sylvie wasn’t having it. When she was next to her mother, she fussed; when Amelie placed her back in the crib, she settled. Again, Amelie worried about their relationship.

“Amelie” is an amalgam of actual friends and clients I have seen in the last month, but all of the experiences are real. And as a developmental psychologist, I feel distressed by this suffering. Because while each of the practices—home birth, breastfeeding, and co-sleeping—has its benefits, none of them is related to a baby’s secure attachment with her caregiver, nor are they predictive of a baby’s mental health and development.

Attachment is a relationship in the service of a baby’s emotion regulation and exploration. It is the deep, abiding confidence a baby has in the availability and responsiveness of the caregiver.
— Alan Sroufe

“Attachment is not a set of tricks,” says Alan Sroufe, a developmental psychologist at the Institute for Child Development at the University of Minnesota. He should know. He and his colleagues have studied the attachment relationship for over 40 years.

Why the confusion about a secure attachment?

Over the last 80 years, developmental scientists have come to understand that some micro-dynamics that take place between a baby and an adult in a caring relationship have a lifelong effect, in very specific ways, on the person that baby will become.

“Attachment,” Sroufe explains, “is a relationship in the service of a baby’s emotion regulation and exploration. It is the deep, abiding confidence a baby has in the availability and responsiveness of the caregiver.”

A secure attachment has at least three functions:

  • Provides a sense of safety and security

  • Regulates emotions, by soothing distress, creating joy, and supporting calm

  • Offers a secure base from which to explore

In spite of the long scientific history of attachment, psychologists have done a rather poor job of communicating what a secure attachment is and how to create one. In the meantime, the word “attachment” has been co-opted by a well-meaning pediatrician and his wife, William and Martha Sears, along with some of their children and an entire parenting movement. The “attachment parenting” philosophy promotes a lifestyle and a specific set of practices that are not proven to be related to a secure attachment. As a result, the movement has sown confusion (and guilt and stress) around the meaning of the word “attachment.”

The attachment parenting philosophy inspired by the Searses and promoted by an organization called Attachment Parenting International is centered on eight principle concepts, especially breastfeeding, co-sleeping, constant contact like baby-wearing, and emotional responsiveness. The approach is a well-intentioned reaction to earlier, harsher parenting advice, and the tone of the guidance tends to be baby-centered, supportive, and loving. Some of the practices are beneficial for reasons other than attachment. But the advice is often taken literally and to the extreme, as in the case of my “Amelie,” whose labor required hospital intervention and who suffered unduly in the belief that breastfeeding and co-sleeping are necessary for a secure attachment.

Attachment parenting has also been roundly critiqued for promoting a conservative Christian, patriarchal family structure that keeps women at home and tied tightly to their baby’s desires. Additionally, the philosophy seems to have morphed in the public consciousness into a lifestyle that also includes organic food, cloth diapers, rejection of vaccinations, and homeschooling. The Searses have sold millions of books, and they profit from endorsements of products that serve their advice.

“These [attachment parenting principles] are all fine things,” observes Sroufe “but they’re not the essential things. There is no evidence that they are predictive of a secure attachment.”

Sroufe unpacks feeding as an example: A mother could breastfeed, but do it in a mechanical and insensitive way, potentially contributing to an insecure attachment. On the other hand, she could bottle-feed in a sensitive manner, taking cues from the baby and using the interaction as an opportunity to look, talk, and play gently, according to the baby’s communication—all behaviors that are likely to create secure attachment. In other words, it is the quality of the interaction that matters. Now, one might choose breastfeeding for its digestibility or nutrition (though the long-term benefits are still debated), but to imply, as Amelie’s pediatrician did, that bottle-feeding could damage her bond with her baby is simply uninformed.

There is also confusion about what “constant contact” means. Early on, the Searses were influenced by the continuum concept, a “natural” approach to parenting inspired by indigenous practices of wearing or carrying babies much of the time. This, too, might have been taken up in reaction to the advice of the day, which was to treat children in a more businesslike manner. There is no arguing that skin-to-skin contact, close physical contact, holding, and carrying are all good for babies in the first few months of life, as their physiological systems settle and organize. Research also shows that the practice can reduce crying in the first few months. But again, what matters for attachment is the caregiver’s orientation and attunement: Is the caregiver stressed or calm, checked out or engaged, and are they reading a baby’s signals? Some parents misinterpret the prescription for closeness as a demand for constant physical closeness (which in the extreme can stress any parent), even though the Searses do advise parents to strive for a balanced life.

“There’s a difference between a ‘tight’ connection and a secure attachment,” Sroufe explains. “A tight attachment—together all the time—might actually be an anxious attachment.”

And what of emotional responsivity? This, too, has a kernel of truth, yet can be taken too far. It is safe to say that all developmental scientists encourage emotional responsiveness on the part of caregivers: The back-and-forth, or serve-and-return, is crucial to brain development, cognitive and emotional development, the stress regulation system, and just authentic human connection. But in my observation, well-meaning parents can become overly-responsive—or permissive—in the belief that they need to meet every request of the child. While that is appropriate for babies in the first half to one-year year of life (you can’t spoil a baby), toddlers and older children benefit from age-appropriate limits in combination with warmth and love. On the other hand, some parents feel stressed that they cannot give their child enough in the midst of their other responsibilities. Those parents can take some comfort in the finding that even within a secure attachment, parents are only attuned to the baby about 30% of the time. What is important, researchers say, is that the baby develops a generalized trust that their caregiver will respond and meet their needs, or that when mismatches occur, the caregiver will repair them (and babies, themselves, will go a long way toward soliciting that repair). As long as the caregiver returns to the interaction much of the time and rights the baby’s boat, this flow of attunements, mismatches, and repairs offers the optimal amount of connection and stress for a baby to develop both confidence and coping, in balance.

What is the scientific view of attachment?

The scientific notion of attachment has its roots in the work of an English psychiatrist named John Bowlby who, in the 1930s, began working with children with emotional problems. Most professionals of the day held the Freudian belief that children were mainly motivated by internal drives like hunger, aggression, and sexuality, and not by their environment. However, Bowlby noticed that most of the troubled children in his care were “affectionless” and had experienced disrupted or even absent caregiving. Though his supervisor forbade him from even talking to a mother of a child (!), he insisted that family experiences were important, and in 1944 he wrote his first account of his observations based on 44 boys in his care. (Around the same time in America, psychologist Harry Harlow was coming to the same conclusion in his fascinating and heart-rending studies of baby monkeys, where he observed that babies sought comfort, and not just food, from their mothers.)  

Bowlby went on to study and treat other children who were separated from their parents: those who were hospitalized or homeless. He came to believe that the primary caregiver (he focused mainly on mothers) served as a kind of “psychic organizer” to the child, and that a child needs this influence, especially at certain times, in order to develop successfully. To grow up mentally healthy, then, “the infant and young child should experience a warm, intimate, and continuous relationship with this mother (or permanent mother substitute) in which both find satisfaction and enjoyment.”

But the attachment figure doesn’t have to be the mother or even a parent. According to Bowlby, babies form a “small hierarchy of attachments.” This makes sense from an evolutionary view: The number has to be small since attachment organizes emotions and behavior in the baby, and to have too many attachments would be confusing; yet having multiples provides the safety of backups. And it’s a hierarchy because when the baby is in need of safety, he or she doesn’t have time to analyze the pros or cons of a particular person and must automatically turn to the person already determined to be a reliable comfort. Research shows that children who have a secure attachment with at least one adult experience benefits. Babies can form attachments with older siblings, fathers, grandparents, other relatives, a special adult outside the family, and even babysitters and daycare providers. However, there will still be a hierarchy, and under normal circumstances, a parent is usually at the top.

In the 1950s, Mary Ainsworth joined Bowlby in England, and a decade later back in the U.S. began to diagnose different kinds of relationship patterns between children and their mothers in the second year of life.[2] She did this by watching how babies reacted in a sequence of situations: when the baby and mother were together, when they were separated, when the baby was with a stranger, and when baby was reunited with the caregiver after the separation. Ainsworth and colleagues identified the first three of the following patterns, and Mary Main and colleagues identified the fourth:

  • When babies have a secure attachment, they play and explore freely from the “secure base” of their mother’s presence. When the mother leaves, the baby can become distressed, especially when a stranger is around. When the mother returns, the baby expresses her joy, sometimes from a distance and sometimes reaching to be picked up and held (babies vary, depending on their personality and temperament, even within a secure attachment). Then the baby settles quickly and returns to playing.

The mothers who fall into this pattern are responsive, warm, loving, and emotionally available, and as a result their babies grow to be confident in their mothers’ ability to handle feelings. The babies feel free to express their positive and negative feelings openly and don’t develop defenses against the unpleasant ones.

  • Babies in insecure-avoidant attachments seem indifferent to the mother, act unstressed when she leaves, and exhibit the same behaviors with a stranger. When the mother returns after a separation, the baby might avoid her, or might “fail to cling” when picked up.

The mothers in insecure-avoidant attachments often seem angry in general and angry, specifically, at their babies. They can be intolerant, sometimes punishing, of distress, and often attribute wrong motivations to the baby, e.g., “He’s just crying to spite me.” One study showed that the insecurely-attached babies are just as physiologically upset (increased heart rates, etc.) as securely attached babies when parents leave but have learned to suppress their emotions in order to stay close to the parent without risking rejection. In other words, the babies “deactivate” their normal attachment system and stop looking to their mothers for help.

As toddlers, insecure-avoidant children don’t pay much attention to their mothers or their own feelings, and their explorations of the physical world are rigid and self-reliant. By preschool, these children tend to be more hostile, aggressive, and have more negative interactions overall. Avoidance and emotional distance become a way of dealing with the world, and instead of problem-solving, they are more likely to sulk or withdraw.

  • Babies with an insecure-ambivalent/resistant attachment are clingy with their mother and don’t explore or play in her presence. They are distressed when the mother leaves, and when she returns, they vacillate between clinging and angry resistance. For example, they may struggle, hit, or push back when the mother picks them up.

These babies are not easily comforted. They seem to want the close relationship, but the mother’s inconsistency and insensitivity undermine the baby’s confidence in her responses. This pattern also undermines the child’s autonomy, because the baby stays focused on the mother’s behavior and changing moods to the exclusion of nearly everything else. In insecure-ambivalent babies, separation anxiety tends to last long after secure babies have mastered it. Longitudinal studies show that these children often become inhibited, withdrawn, and unassertive, and they have poor interpersonal skills.

  • The last pattern of insecure attachment—which is the most disturbing and destructive—is disorganized attachment, and it was described by Ainsworth’s doctoral student, Mary Main. This pattern can occur in families where there is abuse or maltreatment; the mother, who is supposed to be a source of support, is also the person who frightens the child. Such mothers may be directly maltreating the child, or they might have their own histories of unresolved trauma. Main and her colleague write, “[T]he infant is presented with an irresolvable paradox wherein the haven of safety is at once the source of alarm.”

This pattern can also result when the mother has a mental illness, substance addiction, or multiple risk factors like poverty, substance abuse and a history of being mistreated. Babies of mothers like this can be flooded with anxiety; alternatively, they can be “checked out” or dissociated, showing a flat, expressionless affect or odd, frozen postures, even when held by the mother. Later these children tend to become controlling and aggressive, and dissociation remains a preferred defense mechanism.[3]

The emotional quality of our earliest attachment experience is perhaps the single most important influence on human development.
— Alan Sroufe and Dan Siegel

How important is attachment?

“Nothing is more important than the attachment relationship,” says Alan Sroufe, who, together with colleagues, performed a series of landmark studies to discover the long-term impact of a secure attachment. Over a 35-year period, the Minnesota Longitudinal Study of Risk and Adaption (MLSRA) revealed that the quality of the early attachment reverberated well into later childhood, adolescence, and adulthood, even when temperament and social class were accounted for.

One of the most important—and, to some ways of thinking, paradoxical—findings was that a secure attachment early in life led to greater independence later, whereas an insecure attachment led to a child being more dependent later in life. This conclusion runs counter to the conventional wisdom held by some people I’ve observed who are especially eager to make the baby as independent and self-sufficient as possible right from the start. But there is no pushing independence, Sroufe found. It blooms naturally out of a secure attachment.

In school, securely attached children were more well-liked and treated better, by both their peers and their teachers. In one study, teachers who had no knowledge of a child’s attachment history were shown to treat securely attached children with more warmth and respect, set more age-appropriate standards, and have higher expectations. In contrast, teachers were more controlling, had lower expectations, got angry more often, and showed less nurturing toward the children with difficult attachments—and who, sadly, had a greater need than the securely attached kids for kindness from adults.

The MSLRA studies showed that children with a secure attachment history were more likely to develop:[4]

  • A greater sense of self-agency

  • Better emotional regulation

  • Higher self-esteem

  • Better coping under stress

  • More positive engagement in the preschool peer group

  • Closer friendships in middle childhood

  • Better coordination of friendships and social groups in adolescence

  • More trusting, non-hostile romantic relationships in adulthood

  • Greater social competence

  • More leadership qualities

  • Happier and better relationships with parents and siblings

  • Greater trust in life

A large body of additional research suggests that a child’s early attachment affects the quality of their adult relationships, and a recent longitudinal study of 81 men showed that those who grew up in warm, secure families were more likely to have secure attachments with romantic partners well into their 70s and 80s. A parent’s history of childhood attachment can also affect their ability to parent their own child, creating a cross-generational transmission of attachment styles.

But early childhood attachment with a parent is not destiny: It depends on what else comes along. For example, a secure preschool child can shift to having an insecure attachment later if there is a severe disruption in the caregiving system—a divorce or death of a parent, for example. But the effect is mediated by how stressed and available the primary attachment figure is. In other words, it’s not what happens, but how it happens that matters. Children who were previously secure, though, have a tendency to rebound more easily.

Sroufe writes in several articles that an insecure attachment is not fate, either; it can be repaired in a subsequent relationship. For example, good-quality childcare that offers emotional support and stress reduction can mitigate a rocky start at home. A later healthy romantic relationship can offset the effects of a difficult childhood. And good therapy can help, too, since some of the therapeutic process mimics the attachment process. Bowlby viewed development as a series of pathways, constrained by paths previously taken but where change is always possible.

Without conscious intervention, though, attachment styles do tend to get passed through the generations, and Bowlby observed that becoming a parent particularly activates a parent’s childhood attachment style. One study looked at attachment styles over three generations and found that the mother’s attachment style when she was pregnant predicted her baby’s attachment style at one year of age for about 70% of cases.

What about parents who might not have gotten a good start in life and want to change their attachment style? There’s good news. Research on adult attachment shows that it is not the actual childhood experiences with attachment that matter but rather how well the adult understands what happened to them, whether they’ve learned some new ways of relating, and how well they’ve integrated their experience into the present. In other words, do they have a coherent and realistic story (including both good and bad) of where they’ve been and where they are now?

Support matters, too. In one of Sroufe’s studies, half the mothers were teenagers, which is usually a stressful situation. Sroufe found that the teenagers with good social support were able to form secure attachments with their babies, but if they didn’t have support, they were unlikely to form a secure attachment.

How to parent for a secure attachment and how to know if it’s working.

“The baby needs to know that they’re massively important,” says Sroufe. “A caregiver should be involved, attentive, sensitive, and responsive.”

“The baby will tell you what to do,” Sroufe explains. “They have a limited way of expressing their needs, so they’re not that difficult to read: If they’re fussing, they need something. If their arms are out, they want to be picked up. And if you misread them, they will keep on signaling until you get it right.” He gives the example of bottle-feeding a baby: “The baby might want a break, and she looks around. What does the baby want? To look around! If the parent misreads and forces the bottle back, the baby will insist, maybe snap her head away, or pull away harder.”

“How can I know if my baby is securely attached?” a client asked me about her six-month old. Clearly observable attachment doesn’t emerge until around nine months, but here are some clues that a secure attachment is underway:

0-3 months:

  • The baby’s physiology is just settling as the baby cycles quickly among feeding, sleeping, and alert wakefulness. Meeting the baby’s needs at different points in the cycle helps establish stability.

  • At this point, the baby has no clear preference for one person over another.

  • In her quiet, alert state, the baby is interested in the faces and voices around her.

4-8 months:

  • Attempts to soothe the baby are usually effective at calming her down. (Caveat: An inability to soothe might not be predictive of insecurity but rather point to one of a host of other possible issues.)

  • The primary caregiver has positive interactions with the baby where the back-and-forth is pleasant.

  • The baby has calm periods where she is interested in the world around her, and she explores and experiments to the extent she is physically able to—looking, grasping, reaching, babbling, beginning crawling, exploring objects with her mouth, hands, etc.

  • Infants begin to discriminate between people and start to show preferences. They direct most of their emotions (smiles, cries) toward the caregiver but are still interested in strangers.

  • They are very interested in the people they see often, especially siblings.

9 months:

  • The baby shows a clear preference for a primary caregiver.

  • The baby shows wariness toward strangers, though the degree varies with temperament.

  • The baby is easily upset when separated from her primary caregiver, though that, too, varies with temperament.

  • The baby is easily soothed after a separation and can resume her exploration or play.

9 months – 3 years:

  • The child shows a clear emotional bond with a primary person.

  • The child stays in close proximity to that person but forms close relationships with other people who are around a lot, too, e.g., babysitter, siblings.

Beyond this age, the attachment relationship becomes more elaborated. With language and memory, the rhythms of attachment and separation become more negotiated, talked about, and planned, and there is more of a back-and-forth between parent and child. By toddlerhood and beyond, an authoritative parenting style deftly blends secure attachment with age-appropriate limits and supports. A sensitive parent allows the changing attachment to grow and stretch with a child’s growing skills, yet continues to be emotionally attuned to the child and to protect their safety.

One of the best resources for how to parent for a secure attachment in the first few years of life is the new book Raising A Secure Child by Kent Hoffman, Glen Cooper, and Bert Powell, all therapists who have worked with many different kinds of families for decades. Their work is based squarely on the science of attachment, and they call their approach the Circle of Security. The circle represents the seamless ebb and flow of how babies and young children need their caregivers, at times coming close for care and comfort, and at other times following their inspiration to explore the world around them. The caregivers’ role is to tune into where on the circle their child is at the moment and act accordingly. Parenting for a secure attachment, the authors say, is not a prescriptive set of behaviors but more a state of mind, a way of “being with” the baby, a sensitivity to what they are feeling. The authors also help parents see the ways that their own attachment history shows up in their parenting and help them to make the necessary adjustments.

The neurobiology of attachment

“Attachment theory is essentially a theory of regulation,” explains Allan Schore, a developmental neuroscientist in the Department of Psychiatry at the UCLA David Geffen School of Medicine. A clinician-scientist, he has elaborated modern attachment theory over the last three decades by explaining how the attachment relationship is important to the child’s developing brain and body.

Early brain development, Schore explains, is not driven just by genetics. The brain needs social experiences to take shape. “Mother Nature and Mother Nurture combine to shape Human Nature,” he writes.

Infants grow new synapses, or neural connections, at a rate of 40,000 new synapses a second, and the brain more than doubles in volume across the first year. Genetic factors drive this early overproduction of neurons, Schore explains, but the brain awaits direction from the social environment, or epigenetic processes, to determine which synapses or connections are to be pruned, which should be maintained, and which genes are turned on or off.

One of the first areas of the brain that begins to grow and differentiate is the right brain, the hemisphere that processes emotional and social information. The right brain begins to differentiate in the last trimester in utero, whereas the left-brain development picks up in the second year of life. Some of the regions that process emotion are already present in infants’ brains at birth—the amygdala, hypothalamus, insula, cingulate cortex, and orbitofrontal cortex. But the connections among these areas develop in specific patterns over the first years of life. That’s where input from the primary relationship becomes crucial—organizing the hierarchical circuitry that will eventually process, communicate, and regulate social and emotional information.[5]

“What the primary caregiver is doing, in being with the baby,” explains Schore, “is allowing the child to feel and to identify in his own body these different emotional states. By having a caregiver simply ‘be with’ him while he feels emotions and has experiences, the baby learns how to be,” Schore says.

The part of the brain that the primary caregiver uses for intuition, feeling, and empathy to attune to the infant is also the caregiver’s right brain. So it is through “right-brain-to-right brain” reading of each other, that the parent and child synchronize their energy, emotions, and communication. And the behaviors that parents are inclined to do naturally—like eye contact and face-to-face interaction, speaking in “motherese” (higher-pitched and slower than normal speech), and holding—are just the ones shown to grow the right-brain regions in the baby that influence emotional life and especially emotion regulation.

The evidence for epigenetic effects on emotion regulation is quite solid: Early caregiving experiences can affect the expression of the genes that regulate a baby’s stress and they can shape how the endocrine system will mobilize to stress. Caregiving behaviors like responsiveness affect the development of the baby’s vagal tone (the calming system) and the hypothalamic-pituitary axis (the system that activates the body to respond to perceived danger). High quality caregiving, then, modulates how the brain and body respond to and manage stress.

Schore points out that the ventromedial prefrontal cortex, a brain region in the right hemisphere, both has the most complex emotion and stress-regulating systems of any part in the brain and is also the center of Bowlby’s attachment control system. Neurobiological research confirms that this region is “specifically influenced by the social environment.” [6]

Stress management is not the only important part of emotion regulation. In the past, Schore explains, there was an overemphasis in the field of emotion regulation on singularly lowering the baby’s distress. But now, he says, we understand that supporting positive emotional states is equally important to creating [what he quotes a colleague as calling] a “background state of well-being.” In other words, enjoy your baby. It’s protective.

A baby’s emotion regulation begins with the caregiver, and the Goldilocks principle applies: If the caregiver’s emotions are too high, the stimulation could be intrusive to the baby, Schore explains. Too low, and the baby’s “background state” settles at a low or possibly depressive emotional baseline. Just right, from the baby’s point of view is best.

And babies are surprisingly perceptive at registering their feeling environment. Hoffman, Cooper and Powell write:

The youngest babies can sense ease versus impatience, delight versus resentment or irritation, comfort versus restlessness, genuine versus pretending, or other positive versus negative responses in a parent when these reactions aren’t evident to a casual observer. Little babies may pick up on the smallest sigh, the subtlest shift in tone of voice, a certain glance, or some type of body language and know the parent is genuinely comfortable or definitely not pleased.

Schore explains that in a secure attachment, the baby learns to self-regulate in two ways: One he calls “autoregulation” which is self-soothing, or using his own mind and body to manage feelings. The second is “interactive regulation” which is going to other people to help up- or down-regulate feelings. This twin thread of self-reliance and reliance on others, then, begins in the earliest months, becomes very important in the first two years of life, and continues in more subtle ways throughout the life span.

This all might sound daunting for a new parent, who could still be tempted to overdo the focus on the infant and how the connection is going—potentially leading to the same kinds of stress and guilt that the attachment parenting movement creates.

But fortunately, the caregiver doesn’t have to be 100% attuned to the baby and ongoing repairs are an important part of the process:

“The idea that a mother should never stress a baby is problematic,” Schore says. “Insecure attachments aren’t created just by a caregiver’s inattention or missteps. It also comes from a failure to repair ruptures. What is essential is the repair. Maybe the caregiver is coming in too fast and needs to back off, or maybe the caregiver has not responded, and needs to show the baby that she’s there. Either way, repair is possible, and it works. Stress is a part of life, and what we’re trying to do here is to set up a system by which the baby can learn how to cope with stress.”  Optimal stress, he explains, is important for stimulating the stress-regulating system.

Still, both Sroufe and Schore acknowledge the emotional labor of parenting. And they are vehement that parents need to be supported in order to have the space and freedom to care for babies.

“It takes time for parents to learn to read their baby’s signals,” Sroufe said.

Schore calls America’s failure to provide paid family leave—and we’re the only country in the world that doesn’t—the “shame of America.”

“We are putting the next generation at risk,” he explains, pointing to rising rates of insecure attachments and plummeting mental health among American youth. Parents should have at least six months of paid leave and job protection for the primary caregiver, and at least two months of the same for the secondary one, according to Schore, and Sroufe goes further, advocating for one full year of paid leave and job protection. And a recent study showed that it takes mothers a year to recover from pregnancy and delivery.

Intellectual and cognitive development have been privileged in our society, but it is our emotion regulation that organizes us, our existence, and how we experience life, Schore says. A study from the London School of Economics draws the conclusion that “The most important childhood predictor of adult life-satisfaction is the child’s emotional health…. The least powerful predictor is the child’s intellectual development.”[7] 

So where does this leave my friend Amelie?  The hard part will be navigating the distracting advice and creating the workarounds she needs for the lack of cultural support. But she enjoys her baby immensely, and I’m confident that she’ll form a secure attachment with Sylvie, as she trusts her own “right-brain” flow of empathy, feeling, and being, and tunes in to Sylvie’s own unique ways of communicating.

And Sylvie will do her part to draw her parents close. Because regardless of babies’ individual personalities—and whether they cry a lot or sleep very little, whether they’re breastfed or bottle-fed—they draw you in with their wide-open gaze, their milky scent, and their tiny fingers that curl around your big ones. Before you know it, they light you up with their full-body smile that’s specially for you, and they draw you near with their plump little arms clasped around your neck.

And the sweet elixir of the attachment relationship is underway.


References:

[1] While many medications are considered safe to take while breastfeeding, complete side effects may not be fully understood. For example, recent research suggests antibiotics may change the test baby’s microbiome (the implications of which are unclear), and some antibiotics are thought to discolor developing teeth.

[2] This section refers to primary caregivers as mothers since this research focused just on mothers.

[3] This section was adapted from the chapter on Attachment, in D. Davies’ Child Development: A Practitioner’s Guide, Guilford, 2011.

[4] Sroufe, A. & Siegel, D. “The verdict is in: The case for attachment theory.”

[5] From Schore, A. (2017). Modern attachment theory, in APA’s Handbook of Trauma Psychology, p. 6.

[6] Schore, A. (2017). “Modern attachment theory.” In APA Handbook of Trauma Psychology: Vol 1 (publication pending).

[7] http://onlinelibrary.wiley.com/doi/10.1111/ecoj.12170/full p. F720, in Layard,R., Clark, A.E., Cornaglia, F., Powdthavee, N. & Vernoit, J. (2014) What predicts a successful life? A life-course model of well-being. The Economic Journal, 124, p. F720-F738.

What Happens to Children When Parents Fight

When I was a child, my parents’ fights could suck the oxygen out of a room. My mother verbally lashed my father, broke jam jars, and made outlandish threats. Her outbursts froze me in my tracks. When my father fled to work, the garage, or the woods, I felt unprotected. Years later, when my husband and I decided to have children, I resolved never to fight in front of them.

“Children are like emotional Geiger counters,” says E. Mark Cummings, psychologist at Notre Dame University, who, along with colleagues, has published hundreds of papers over twenty years on the subject. Kids pay close attention to their parents’ emotions for information about how safe they are in the family, Cummings says. When parents are destructive, the collateral damage to kids can last a lifetime.

As a developmental psychologist I knew that marital quarreling was inevitable but I also knew that there had to be a better way to handle it. Cummings confirms: “Conflict is a normal part of everyday experience, so it’s not whether parents fight that is important.  It’s how the conflict is expressed and resolved, and especially how it makes children feel that has important consequences for children.” Watching some kinds of conflicts can even be good for kids—when children see their parents resolve difficult problems, Cummings says, they can grow up better off.

Read More

How to Raise Your Child's Intelligence before Kindergarten

We parents spend a lot of time, energy, and money to advance our children's intelligence. Researchers have just made that job a lot easier by identifying the four most effective things we can do before kindergarten to give our children the best start on their intellectual development.

Full disclosure, I'm not a fan of the focus on "intelligence." It is too narrow a concept--the tests for it are culturally biased in favor of White middle class kids, there are many ways to be intelligent and successful that the tests don't measure, it is not predictive of life success, and social and emotional skills are just as important as intellectual ability. That said, in the right hands an intelligence test can be a useful diagnostic tool, and the term intelligence  offers one way to talk about intellectual, or I prefer the broader term "cognitive," skills. But I admit, I couldn't help but peek at this research if even to compare it against how I nurtured these qualities in my own children. A common theme jumped out at me, which I'll get to.

New York University researchers John Protzko, Joshua Aronson, and Clancy Blair looked at 74 interventions that were designed to raise children's intelligence from the prenatal period to kindergarten with the goal of uncovering the most effective ones. They included only studies that met the gold standard of research design--the randomized control study--and they published their findings in the January issue of of Perspectives on Psychological Science.

What did they discover? Four significant building blocks of intelligence in early childhood:

1. Long-chain polyunsaturated fatty acids (LC-PUFA) supplements for pregnant mothers and newborns - IQ gains of more than three and a half points.

Pregnant mothers are encouraged to take many kinds of supplements but only LC-PUFA--found in foods rich in Omega-3s--raised young children't IQs, either when pregnant mothers were given the supplement or it was added to infant formula. The fatty acids are thought to be essential building blocks for nerve cells in the prefrontal cortex--and the body can't produce them on its own. One study showed that very young children who received the supplements for 8 weeks showed more activation in the prefrontal cortex than those who did not.

Read More

What Do Children Worry About and How Can Grown Ups Help?

When I was young, I worried so much that my parents called me Worrywart and bought me a stuffed toy with the same name. It wasn’t the best strategy—I was left feeling bewildered and wondering how to not worry—but what did parents know then? Research from the field of developmental emotion science finds that children who understand and manage their feelings are happier, have better relationships, and do better in school. But as a developmental psychologist I’ve often wished for resources to help parents deal with worrying in their children. So I was pretty excited when I found a lovely picture book recently at a professional conference: Is a Worry Worrying You?  by Ferida Wolff and Harriet May Savitz. This light-hearted problem solving “manual,” based on good emotion science, introduces young children to the idea that worry may be more optional and flexible than they believe—and that they may be able to do something about the suffering it causes them.

As a parent, I’m moved by the realistic examples in the book; as a developmental psychologist, I’m impressed by the sophistication of the advice contained it its slim 16 pages.

The cover illustrates the idea that we are more than our worries, and that worry is something that comes to us like an unwelcome visitor: “It doesn’t ask if it can enter. It just barges in. And it will stay as long as you let it.”

The feeling and qualities of worry are named and described. One of the first steps in managing a feeling is to recognize it—name it to tame it, we say: "A worry is a thought that stops you from having fun, from feeling good, from being happy." "Anyone can have a worry. Parents. Teachers. Brothers. Sisters. Friends." "You can feel tired from a worry. Or sad. Or sick. A worry can feel like a heavy sack is on your back. Only it isn’t there."

Most importantly, the authors offer many strategies for problem-solving. Research shows that young children ages 3-6 tend to ruminate, or spin their wheels, so they, especially, can benefit from help in problem-solving.  And older children who worry a lot believe they can’t solve the problem, though their problem-solving skills in other areas are equal to those of children who worry very little.

Read More

Is Empathy Learned--or Are We Born with It?

Twenty-three years ago, my husband and I were strolling with our toddler on the steamy streets of Yogyakarta, Indonesia, where we were taking a time-out before diving into our careers. At eighteen months, Zai was toddling ahead of us, and I watched as an elderly woman approached her, cupped hands outstretched, in the universal request for food or money. I held my breath as Zai offered the woman her most precious possession: her stuffed kitty. I did not want to interfere with Zai’s gesture of compassion—but the kitty was her security object. Empathy—a concern for others—is present in children from the beginning but not much has been known about how it unfolds early in life. Studies of newborn babies show that they cry more to the sounds of other babies’ cries of distress than they do to equally loud sounds of other types or even to recordings of their own crying. Psychologists believed that while this reaction foreshadows later empathy and suggests a hard-wired orienting to other people’s feelings, empathic distress throughout the first year of life was a more contagious, reactive, egocentric kind of response. Upset in others simply triggered, or got merged with, a baby’s own feelings of anxiety or fear.

Empathy in Children: The New Research

Until recently, researchers believed that true empathy doesn’t emerge in children until the second year of life, after 12 months of age, when a more separate sense of self begins to be consolidated. Psychologists believed that to accurately appraise how another person feels required greater cognitive complexity. Children needed to be able to separate what others might be feeling from their own internal experience. But three researchers were interested to see whether true empathy might actually be evident earlier, in the first year of life: Israelis Ronit Roth-Hanania at The Academic College of Tel Aviv-Yaffo and Maayan Davidov at The Hebrew University, and Carolyn Zahn-Waxler at the University of Wisconsin, Madison.

Roth-Hanania, Davidov, and Zahn-Waxler went into the homes of 37 mostly white, middle- and upper-middle class infants from eight to 16 months and set up three distressing situations:

  1. The mother pretended to hit her finger with a toy hammer and be upset for one minute (and she avoided eye contact with her child in this minute so as to not bias the child’s response).
  2. The mother walked toward the baby and pretended to bump her knee, again showing distress for one minute (and again without making eye contact).
  3. The baby was shown a video of another baby crying for one minute.

All of the infants showed genuine empathy in emotional and cognitive ways. The younger babies’ feelings of concern for their mothers’ pain registered on their faces, from a fleetingly furrowed brow to sustained looks of sadness. Many cooed or made other sympathetic sounds. As the babies tried to figure out what had happened, their glances bounced from the hurt body part up to the mother’s face and back.  Some made questioning sounds, or they looked to the face of another adult for interpretation.

Read More