Your Parenting Mojo - Respectful, research-based parenting ideas to help kids thrive

Listeners have been asking me for an episode on supporting anxious children for a loooooong time, but I was really struggling to find anyone who didn't take a behaviorist-based approach (where behaviors are reinforced using the parent's attention (or stickers) or the withdrawal of the parent's attention or other 'privileges.'). Long-time listeners will see that these approaches don't really fit with how we usually view behavior on the show, which is an expression of a need - if you just focus on extinguishing 'undesirable' behavior, you haven't really done anything about the child's need and - even worse - you've sent a message to the child that they can't express their true feelings and needs to you. Listener Jamie sent me a link a book called Beyond Behaviors written by today's guest, Dr. Mona Delahooke, and I immediately knew that Dr. Delahooke was the right person to guide us through this. Listener Jamie comes onto the show for the first time as well to co-interview Dr. Delahooke so we can really deeply understand our children's feelings and support them in meeting their true needs - and overcome their anxiety as well.     Dr. Mona Delahooke's Books Beyond Behaviors: Using Brain Science and Compassion to Understand and Solve Children's Behavioral Challenges Beyond Behaviors Flip Chart: A Psychoeducational Tool to Help Therapists & Teachers Understand and Support Children with Behavioral Changes (Affiliate links).   [accordion] [accordion-item title="Click here to read the full transcript"] Jen: 01:28 Hello and welcome to the Your Parenting Mojo podcast. Today, we're talking about a topic that parents have been asking me about for ages and that is how to support children who are experiencing anxiety. Now, it's not super hard to find research on anxiety and on treatments for anxiety, but the hard part is finding someone who doesn't just see anxiety as an unwanted behavior that we need to extinguish using reinforcements and who actually sees anxiety as a potential cause for behaviors like having a bad attitude or lacking impulse control that we might typically think of as bad behavior rather than being caused by anxiety. So, we have a special guest today who's going to help us move beyond this view of anxiety and that's Dr. Mona Delahooke. Dr. Delahooke is a licensed clinical psychologist with more than 30 years of experience caring for children in their families. She's a member of the American Psychological Association and holds the highest level of endorsement in the field of infant and toddler mental health in California, as a Reflective Practice Mentor. She has dedicated her career to promoting compassionate relationship-based neurodevelopmental interventions for children with developmental, behavioral, emotional and learning difficulties and has written a book called Beyond Behaviors: Using Brain Science and Compassion to Understand and Solve Children's Behavioral Challenges. Welcome Dr. Delahooke.   Dr. Delahooke: 02:43 Thank you so much. I'm so happy to be here.   Jen: 02:45 Thank you. And we have another special guest here today as well. We've heard about her, we've heard her words and now we're going to hear her very own voice. Today, we have with us listener, Jamie. She's not listener Jamie to us. She's Jamie Ramirez in real life and she and her wife are the proud parents of now 11-month-old daughter Elliot. Jamie struggled with anxiety for a good deal of her life and has also read on this topic a lot. And she was the one who suggested that I read Dr. Delahooke’s book and so when Dr. Delahooke agreed to an interview, it was only natural to ask Jamie to join me as a co-interviewer and she enthusiastically agreed. Welcome Jamie.   Jamie: 03:22 Hi.   Jen: 03:23 Yey, you’re here. All right, so let's start kind of at the beginning I guess by talking about how Dr. Delahooke’s thinking about anxiety is different from the way that most researchers and psychologists think about it and treat anxiety and children. So Jamie, I wonder if you could start by reading one of your favorite passages from Dr. Delahooke’s book and then perhaps we can contrast this with the more common view on anxiety. So do you want to go ahead and do that?   Jamie: 03:48 Yeah.   Jen: 03:49 Okay.   Jamie: 03:50 “The truth is that we scrutinized children's behavior from the time that they're born. “She's such a good baby”, we might say of a newborn who is easy to care for, doesn't cry too much, sleeps through the night and whose moods are predictable and easy to read. Without realizing it, we are betraying our cultures understandable bias toward valuing behaviors that we can easily understand and that make our own lives easier as caregivers, teachers, or other providers. As children reach school age, we lavished praise in good grades on those who are good listeners, follow directions and can sit still and perform well on tests. We often reward these good behaviors with positive recognition, not realizing the messages we are sending to children whose natural tendencies fall outside of the easy child profile, particularly in the educational arena e.g. those who can sit still are better than those who cannot. Quiet is better than loud. While these messages may well serve the purposes of group education, they ignore the importance of understanding and appreciating and not judging the range of children's individual differences demonstrated through their behaviors.”   Jen: 04:57 That's such a powerful passage. I can see where it resonated with you. Yeah. And so Dr. Delahooke, I wonder if you can contrast that as sort of the way that you view anxiety with the way most psychologists think about anxiety. What do most psychologists think anxiety is?   Dr. Delahooke: 05:13 Well, the way I was trained and really I think the predominant thought still amongst most psychologists is that anxiety is understood as a disorder. And maybe we can understand that through understanding that the DSM, are you familiar with the DSM?   Jen: 05:35 Yeah. The Diagnostic and Statistical Manual. Just for listeners.   Dr. Delahooke: 05:38 Yes. For listeners, it's kind of the dictionary, so to speak, for labeling and diagnosing individuals along a set of criteria. So one shift that's happened in the last kind of less than a decade starting in 2013 was that the DSM that Tom Insel, who was the head of the National Institutes of Mental Health announced that the national institutes were going to be diverting funding away from straight DSM criteria and more towards looking at underlying causality. So the short answer to your question, the way many of my colleagues, I believe view anxiety is as a DSM disorder and the American Psychological Association defines anxiety as an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure. So anxiety is defined kind of loosely in a way as something that if you have a certain amount of characteristics or symptoms, then you have anxiety.   Dr. Delahooke: 06:51 And that's kind of how it's viewed now as a thing, as an actual like, oh, your child has anxiety. Well, there is no blood test for anxiety. Right? So it's not exactly like your child has diabetes, you know, your child's blood sugar level is above 105 or whatever. Anxiety, the way I was trained, I was really in my education in the 80s was that it seemed like anxiety was this thing that you treat with a certain protocol such as cognitive behavioral therapy and medication if needed. And that was what would help it go away. But what I wasn't taught was what's underlying all sorts of anxiety. Well, there's all these different subtypes and so it's really exciting to me that the shift is now not just looking at a symptom checklist, but looking at the brain circuitry and the domains, the dimensions of functions rather than these categories. And it's a really exciting shift.   Jen: 08:04 Yeah. And I just want to delve a little deeper into a couple of things you mentioned, you mentioned medication and cognitive behavioral therapy, and from the research that I've done, it seems as though each of those are effective in about half of the children that are treated. Is that right?   Dr. Delahooke: 08:19 Well this, yeah, generally speaking with the research you might find different percentages, but some percentages are about a third. Some go up to a half.   Jen: 08:29 Okay.   Dr. Delahooke: 08:31 But you think about half, that still leaves another half.   Jen: 08:35 Yes, it does. Yeah. And so what are some of the challenges of treating this anxiety in children?   Dr. Delahooke: 08:42 Well, now that I have a different protocol, I'm finding much way fewer challenges that I think that early in my career when I was using the standard protocols is that I found that for example, cognitive behavioral therapy, trying to talk to a child and help a child actively change their thoughts and their cognitions come up with the ways that their brain can help them shift their thinking and feel better. Right? Which are great ideas, super great ideas. But I've found that for many children that fall fell flat on its face. And that's when I went to look for answers as to why. Why would some children be able to shift their thoughts? And why would others just not have that capacity, especially in the heat of the moment? And that became one of my biggest clinical questions.   Jen: 09:39 Okay. And so just before we get to that, I want to briefly mention the study that came out of the Yale Child Study Center that got a lot of press, I think it was about within the last year or so and it found that a new program that teaches parents how to use reinforcements to treat their child's anxiety was as effective as traditional cognitive behavioral therapy. So again, it's working for about the third to a half of the people who are being studied. And so I'm just curious about what you make of that particular approach just because it's something that parents have probably heard of recently.   Dr. Delahooke: 10:10 Right. Well, first of all, parent involvement is fantastic. We know that parent involvement, parent-based treatment is really makes most sense from a neurodevelopmental perspective because the way human beings regulate their emotions and eventually their behaviors is through co-regulation, meaning other human beings who attuned to them and we develop our emotional capacities in our ability to self-regulate emotions through relationships. So, parent involvement is great. Now, I glanced at this study yesterday, but I think you said Jen, that it uses a behavioral paradigm.   Jen: 10:54 Yup. Yup.   Dr. Delahooke: 10:56 Okay. Okay, so here's where I think the research coming out of the lab of Jonathan Green is way more impactful and will have more efficacious results and that is because it's not based on the paradigm of behavioral reinforcement essentially. Now the idea of reinforcing behaviors we want to see and ignoring or punishing behaviors we don't want to see is a paradigm that was developed in the last century.   Dr. Delahooke: 11:28 And it started with studying animals, you know, in the lab. And it was exciting back then because you could figure out how to alter rats and dogs behaviors through reinforcement schedules. This was picked up to work with humans. And specifically one population that it was picked up on was for individuals, children and teens who are self-injuring at the University of Washington and later on at UCLA with Ivar Løvaas. So the science then was to protect and to try to of course try to help children improve their behaviors. But what is missing in my opinion and perhaps why the Yale study didn't get more than a 50% improvement rate so it equaled cognitive behavioral, is that it involved the paradigm, the older paradigm of reinforcing surface behaviors. And we now know that behaviors aren't the tip of the iceberg. So once you locate what is happening underneath the child's behavior, then you have a pathway to really helping them gain behavioral control and deal with their anxiety or their worries or their, whatever concerns they have that is much more natural and much more sympathetic with brain development. So essentially what this study apparently did not, it had--okay, the good part was that it was parent-based, but it was still along the lines of cognitive behavioral therapy because it involved the assumption that children's behaviors are deliberate and purposeful. We might think of that as willful and we can talk to them about it or put them on a reinforcement schedule for it. But to me that's the problem because not all behaviors are due to reinforcement.   Jen: 13:31 Yeah. I love this ‘cause it's a bridge from where we've been to where we're going. So what I'm hearing you say is that the reason the study was as successful as it was was because of the involvement of parents. And maybe this helped parents to attune to their children a little better than they were before, which helped them to better support their child. And the reason it didn't work better is because we were using reinforcement.   Dr. Delahooke: 13:54 That's a yes. Again, I'm not a researcher, but I'm going to go back and read that study. Yeah, I think that's a good guess because once you involve parents and especially if the parents have a gentle way with the child and look how were the parents doing the reinforcement, right? Was it gentle? Was it soothing? Was it calming the autonomic nervous system? Likely the artifacts of the study and the variables that they didn't measure may have been just as important as the reinforcements.   Jen: 14:27 Yeah. Okay. All right, so now I understand a bit about where we've been. Jamie, do you want to kind of take us forward from here and delve into some of Dr. Delahooke’s ideas a little bit?   Jamie: 14:35 Yeah, sure. I wanted to spend a good chunk of time drawing out your thinking on the idea that when we see behavior that is problematic or confusing, the first question we should ask isn't how do we get rid of it, but rather what is this telling us about the child? And I'd like to do this using a case study from your book of a child named Matthew.   Jamie: 14:54 So to summarize, Matthew was late to start speaking and was diagnosed with autism. You observed him in a session in school when he was trying to get the attention of his aide who was next to him. When she didn't respond, he touched her arm and then she followed his IEP or individualized educational plan, which says she wasn't supposed to respond to non-preferred behaviors. So she moved away from him. He continued to try to get her attention. So she moved behind him and when he leaned back in his chair to see her, he fell over. So then the aide took Matthew to the calm down room, which was a small closet with a padded floor and you watched him through the one way window looking really flattened sad with his aide ignoring any interaction with him. So let's talk about what's going on here. What do you think that the teacher and the aide are seeing in this situation? And do you think that they see Matthew as being in conscious, volitional control of his actions?   Dr. Delahooke: 15:48 Thank you for reading that Jamie. And it just brings, every time I hear it or listen to it, it brings me back to that moment to that classroom where I was sitting in the back of the room and using the lens that I now use. It felt like I was watching a slow moving car crash. So the answer to your question, did I think that they saw Matthew as being conscious and having volitional control of his actions? Absolutely. And let me just say that I have so much compassion for the teachers. I did and I do. And if anyone's listening today and you've heard me talk before, you know that this is a no blame, no shame space for me. I don't intend to have anyone feel bad about what they have done or the ways they approach children because it's in our cultural DNA to view behaviors on the surface.   Dr. Delahooke: 16:47 So I'll just say that out front I don't mean to offend anybody with what I'm saying. I just need to add a layer of understanding to our current approaches. So when I looked around the room, when I saw that Matthew, his initial bid for attention, which was to try to grab the arm of his aide, that was viewed as a bad behavior because she was wanting him to listen to the teacher who was giving the lesson. But this was a child who had individual differences that compromised his ability to easily ask for things he did not have the words to do that and his motor system was also kind of roughly connected to his intention system, so the very best he could do was swat at his aide. And I saw that as a brilliant adaptation to him letting her know he needed something.   Dr. Delahooke: 17:47 He either needed help or he was feeling uncomfortable or he needed to move. And when she moved away so that he couldn't touch her, I just thought, Oh wow, there we go, the behavior is being viewed as bad because it's noncompliant or because it's poorly understood. And what I wanted to do with that moment is say, let's celebrate that behavior. He needs you. Let's find out what this child needs at this moment. Anyway, as you read, when he started to increase his ability to grab her, then he's trying to grab her, which meant to me that his nervous system, his fight or flight system was engaged and he was actively trying to seek social engagement to feel better. She moved where he could not see her or touch her and he fell over and then they brought him to, it was called the calm down room, but it was really a timeout room.   Dr. Delahooke: 18:45 There was nothing soothing about that room. So when I looked around the room I expected to see, or I guess I hoped to see adults in distress going, Oh my gosh, this poor child who can take him out and see what he needs. And instead what I saw was everybody ignoring the situation, which was how they were trained. It was on the child's IEP to ignore non-preferred behaviors. And so I believe they absolutely saw Matthew’s behaviors as volitional and that he had control over them. And what I saw was a stress response that started off slow, what I call the light green zone like he was still in social engagement. He was looking at her, he was trying to touch her and the aide was trained to understand that as a noncompliant behavior and it went south very fast and he ended up being punished for trying to reach out and that's why I put that story in the book.   Jamie: 20:01 So, you wanna...

Dr. Rose defines a Dark Horse as someone who uses a variety of unusual strategies like understanding their 'micromotives' and not worrying about their overall destination and to focus instead on more immediate goals to create a fulfilled life. In his book he focuses on the paths adults have followed to become Dark Horses, which is almost invariably one of either: Child is successful in school, attends an elite university, achieves financial stability, realizes they feel unfilled, and switches direction mid-lifeChild flounders in school and barely graduates or doesn't graduate; gets married and has children or works a series of low-level jobs before discovering their path But I wondered: rather than following either of these (highly frustrating!) paths, could we instead support our children much earlier in life to discover how their passions can lead them toward a fulfilling life, rather than forcing them through a standardized system and then making them figure it out on their own later? Dr. Rose agreed that this would indeed be the preferable path, and we also talked about how to do this. Dark Horse: Achieving Success Through the Pursuit of Fulfillment can be purchased in your local bookstore or on Amazon. (Affiliate link)   Learning Membership Want to know what skills YOU need to raise a dark horse? The Learning Membership is here to help you. Make learning a fun adventure that not only strengthens your bond, but also nurtures your child’s intrinsic love of learning—an essential foundation for success in an AI-driven world. Get tools and strategies to support your child’s love of learning and future-proof their success in navigating whatever comes their way. No special skills needed—just a willingness to explore alongside them. All the usual stuff applies - sliding scale pricing, money back guarantee.   Click the banner to learn more!     Here is Dr. Rose's interview on The Art of Manliness, where you can learn more about how his approach could help you as an adult to become more of a Dark Horse     [accordion] [accordion-item title="Click here to read the full transcript"]   Jen 00:01:25 Hello and welcome to the Your Parenting Mojo podcast. Today's episode comes to us via a bit of a different route than they often do. A friend of mine actually heard our guests, Dr. Todd Rose on The Art of Manliness podcast and said, “Hey, you might want to listen to this because it sounds a lot like what you're trying to do with the way your daughter Carys learns”. And I listened to the episode and then I did something I've never done before. The message that I heard from Dr. Rose on the podcast made him feel like such a kindred spirit in terms of how we think about learning and work, that I reached out to him and asked him to talk with us even before I read his book. And rather than go over ground that's already been covered elsewhere, I'd really encourage you to go to this episode's page at YourParentingMojo.com/DarkHorse to find a link to that episode on The Art of Manliness because there's so much there to help adults discover and follow their passions if you're feeling unfulfilled in the work that you do and that you might need some help charting a different course.   Jen 00:02:20 So, today we're going to look at the outcomes for what Dr. Rose calls dark horses, but we'll specifically focus on how we can support children in navigating their path to becoming a dark horse, which involves identifying your skills and true motivations and harnessing those to do work that you're truly passionate about. And on the related note, I wanted to let you know about a pilot program that I'm running that's open for signups right now. It's called Your Child's Learning Mojo and it will help parents to support their children's intrinsic motivation to learn. If your child is in the early preschool years right now, then you're probably inundated with their questions about the world, but research shows that by the early school years, children learn that their own questions aren't really valued anymore and what counts is whether they know the answers to questions that other people have asked and yet the ability to formulate questions and ask them and know how to find some initial answers and then circle back to a deeper level of questions and explore ideas with both depth and breadth and demonstrate that learning to communities that care about the topic is going to be a foundational set of skills for life 20 years from now and in the age of search engines, the ability to recall an answer is already pretty well obsolete.   Jen  00:03:25 If we're worried about our children's success when they graduate from school and maybe college, then we might be tempted to teach them a skill like coding and while there are plenty of apps and afterschool clubs and summer camps that have popped up, which imply that if you aren't teaching your child to code, then you're making an error that says fundamental is not teaching them how to read. Developers tell us that coding isn't about getting the syntax of code right. It's about having an idea, proposing a solution, seeing if it works, delving deeply into an issue, developing creative solutions to problems and sticking with it when it repeatedly fails while you try different approaches and improve on them each time you take another run at it. Teaching the syntax of coding doesn't teach any of those skills, but harnessing your child's natural intrinsic motivation to learn does support the kinds of skills that will be needed to learn coding and complex problem solving and critical thinking and creativity and all of the other skills the experts know are really going to be important in the future.   Jen 00:04:20 In their book Becoming Brilliant that we looked at way back in episode 10 psychologists, Dr. Roberta Golinkoff and Dr. Kathy Hirsh-Pasek argued that schools are doing really well at preparing our children for the kinds of jobs that existed in 1953 and there are some places where schools are beginning to shift their approach. But in general, being in school means mostly being tested on your ability to remember facts rather than developing the critical skills. So, if we want our children to have these critical skills, it's really on us as parents to make it happen. And the good news is that children come out already prime to develop these skills. We know they have boundless curiosity and they want to delve deeply into topics that interest them, whether it's dinosaurs or beading or construction. And if we can just learn how to become their guide on the side, who connects them to resources and helps them to deepen the work they're already doing, rather than the sage on the stage who provides all the answers, then we'll be able to help our children become the profoundly fulfilled dark horses that Dr. Rose will describe.   Jen 00:05:20 I took a career coaching course a while back and I'm still in its Facebook group and almost without fail, the people who sign up for the course and introduce themselves, give some variation of the story, “I did well in school and I got a good job and I made quite a bit of money and now I'm approaching midlife I realized I'm really unsatisfied and I'm here to discover my true passion so I can live a life that feels meaningful to me.” So, as good as that career coaching course was and it was really good, my goal with this episode and with Your Child's Learning Mojo membership is to make that course obsolete for that purpose because instead of getting to midlife and realizing they're incredibly unfulfilled, our children will engage in activities and learning that fulfill them from the very beginning and as they live their lives, they'll continually reassess their passions and whether their work is in service of their passions and have the knowledge and ability and desire to make micro adjustments as they go along.   Jen 00:06:09 So, they never reach that breaking point and instead they'll become dark horses who were truly connected to work that they find meaningful throughout their lives. So, if you'd like to learn more about how to do this, please do go to YourParentingMojo.com/LearningMojo to see how I will support you in this work. I'll teach you what's going on in children's minds when they learn and why the kinds of strewing activities that you see all over Pinterest are really just the very beginning of that process and don't help your children to learn much that's meaningful or connected to their own interests. We'll begin a learning journal that you can use to identify your child's interests and passions and then engage with these in a way that supports your child in developing the critical skills of the future. And we'll understand how to use nature as inspiration for developing questions and ideas and a sense of wonder.   Jen 00:06:52 You'll become a member of a learning community of parents who will support each other in developing our own skills so we can help our children. And of course you'll get my guidance as well. So if you're interested in participating, please head on over to YourParentingMojo.com/LearningMojo for all the details and just sign up. The group is currently accepting new members through January 31st and we'll get started on February 1st. So to make a formal introduction to our guests today, Dr. Rose is a lecturer on education and leads the Laboratory for the Science of the Individual at Harvard University. His work is focused on the intersection of individuality and personalization applied to help people learn, work and live. He's the author of the books, The End of Average and most recently Dark Horse: Achieving Success Through the Pursuit of Fulfillment. Welcome Dr. Rose.   Dr. Rose 00:07:36 Thanks for having me.   Jen: 00:07:37 And so before we kind of dig into the real meat here, I wonder if you can set the stage by telling us what is a dark horse?   Dr. Rose 00:07:45 Yeah. So from our work, we've found that sort of the traditional definition is really there are people who end up being successful that nobody saw coming, right? And that can be because they were viewed as failures early and then succeeded or because they end up being successful in one domain, but then make these pivots and ended up doing stuff that's completely different. And again, nobody sees them coming.   Jen: 00:08:09 And in some ways this resonated with me so much when I read it because in a way I think of myself as a dark horse. You know, I got degrees from Berkeley and Yale and a job at a prestigious consulting company and I really did enjoy what I was doing for a while in sustainability consulting. But the work that I find really so fulfilling came after I got a Master's in Psychology, which was focused on Child Development and then another in Education and sharing this through the podcast with other people that, I mean it just keeps me going, keeps me getting up in the morning and I would never have seen that coming.   Dr. Rose 00:08:43 You're hitting on something really important, which is like, you know, ever since the term dark horse was created quite a while ago to talk about things that are successful that no one sees coming, in our research in the dark horse project, this is exactly what we found, right? ‘Cause we were interested in why do these folks get off the beaten path and yet still end up surprising us and to a person, the thing that kept emerging was the way they thought about success in life. And rather than playing by sort of society's definition of success or somebody else's view, they were deeply focused on pursuing personal fulfillment. And given that it's so personal, it’s so individual, the things that light you up, it's not surprising in a standardized society that it often requires getting off the beaten path to make it happen.   Jen 00:09:29 Yeah. And okay, so let's talk about that standardization because I mean this is a question that seems like it should be really simple, but of course it isn't and it has so much to do with learning and how we think about school. And so how do children, and we're thinking about children, but of course it's applicable to all people as well, how do they learn best?   Dr. Rose 00:09:48 Yeah. It's funny, right? Because that seems like something that is so obvious, but in many ways it runs so counter to the way we actually educate. So if you think about some of the basics like it won't sound like rocket science, right? Not surprisingly, kids that are learning in ways that are engaging to them are going to learn better. That sounds almost silly, silly obvious, but it is surprising how much we neglect that. So if you're engaged, if you're motivated, which I think are related at the same thing, if the learning is contextualized in a relevant way, right? So it's not just abstracted away from your real life but deeply embedded into it when people are more active rather than passively learning. And one of the things that's really...

I’m taking a hiatus from the show; in this episode I explain why and what you can do to help make sure it comes back strong in 2020!Here’s the form to complete if you’re interested in learning more about the yet-to-be-named pilot membership to support children’s interest-led learning at home: https://forms.gle/GGKgdwaLkEfNfMA27

Do you ever feel ‘lost’ in your parenting?  Like you’ve read all the books (and even listened to the podcast episodes!) and you’ve agreed with them in principle, but somehow nothing ever seems to change?   Your family feels directionless; you just muddle along having the same old fights with your partner about the same old things: Should you praise your child when they do what you ask, so they’ll do it again next time? Or punish them for disobeying you?Should you worry about (quality or quantity of) screen time?Does it matter if you and your partner have completely different parenting styles?   In this episode I interviewed Kathryn, and discussed: The cultural differences between living in the U.K. and Canada (saying “please!” and certain differences in directness of humor)How to begin to approach differences in opinion about parenting with your spouse in a way that doesn’t get their back up, but instead focuses on your (and their) valuesThe value of interacting with parents who are a little ahead of you and who can give you advice, as well as parents with younger children so you can see how far you’ve come and offer some support to themHow to align your daily interactions with your child with your overall valuesThe importance of bringing fun and playfulness to your parenting in a way that feels relaxed to you (and the positive impact this can have on your child)How to problem solve with a child in a way that encourages them to bring their own solutions to the table   Parenting Membership  If parenting feels really hard, and it seems like you’ve read all the books and you’ve asked for advice in free communities and you’re tired of having to weed through all the stuff that isn’t aligned with your values to get to the few good nuggets, then the Parenting Membership will help you out.   The Parenting Membership is now open for immediate enrollment. Sign up now!       Jump to highlights 01:39 Introducing the guest 07:25 Differences in parenting between the English and the Canadian 15:43 Particular areas that were attractive to Kathryn in terms of the focus of the group 23:48 Transformations that she experienced in her family once she joined the group 32:08 What might have happened if she hadn’t joined the group 36:03 Final thought of Kathryn

This is the third episode in our series on parental relationships – and the lack thereof…  We started with episode 35, which was called “All Joy and No Fun,” where we learned how children can be one of the greatest joys of a parent’s life – but that all the daily chores and struggles can get on top of us and make parenting – both in terms of our relationship with our child and our spouse – something that isn’t necessarily much fun in the moment.  And if you missed that episode you might want to go back and check it out, because I walked you through a research-based idea I’ve been using to increase the amount of fun I have while I’m hanging out with my daughter, who was a toddler when I recorded that episode. Then we took a turn for the worse in episode 36 and looked at the impact of divorce on children’s development, and we learned that it can have some negative impacts for some children, although the majority are pretty resilient and do make it through a divorce OK.  For the last episode in the long-delayed conclusion to this mini-series we’re going to take a look at what happens after divorce – things like single parenting and remarriage and stepfamilies, that can also have large impacts on children’s lives.  We’ll spend a good chunk of the show looking at things that stepfamilies can do to be more successful.   Jump to highlights 01:01 Introduction of episode 02:15 The things we don’t understand well 06:37 30% of the children live with their unmarried parent 14:36 Impacts of remarriage on a child’s development 15:55 Lists of common areas where stepfather encounters problem after remarriage 17:21 What can we learn from the research 19:05 Definition of authoritative parenting 24:34 Models of blended family 35:44 2 different schools of thought 36:38 Dr. William Jeynes' conclusion of remarriage 38:38 Conclusion of the episode   References Braithwaite, D.O., Olson, L.N., Golish, T.D., Soukup, C., & Turman, P. 001). “Becoming a family”: Developmental processes represented in blended family discourse. Journal of Applied Communication Research 29(3), 221-247. Choi, J-K, & Pyun, H-S. (2014). Nonresident fathers’ financial support, informal instrumental support, mothers’ parenting, and child development in single-mother families with low income. Journal of Family Issues 35(4), 526-546. DOI: 10.1177/0192513X13478403 Coleman, M., & Ganong, L.H. (1997). Stepfamilies from the stepfamily’s perspective. Marriage & Family Review 26(1-2), 107-121. Fine, M.A., Coleman, M., & Ganong, L.H. (1998). Consistency in perceptions of the step-parent role among step-parents, parents and stepchildren. Journal of Social and Personal Relationships 15(6), 810-828. Fine, M.A., & Kurdek, L.A. (1995). Relation between marital quality and (step)parent-child relationship quality for parents and stepparents in stepfamilies. Journal of Family Psychology 9(2), 216-223.  Furstenberg, Jr., F.F. (1988). Child care after divorce and remarriage. In E.M. Hetherington & J.D. Arasteh (Eds.), Impact of divorce, single parenting, and stepparenting on children. Hillsdale, NJ: Lawrence Erlbaum. Ganong, L.H., Coleman, M., & Jamison, T. (2011). Patterns of stepchild – stepparent relationship development. Journal of Marriage and Family 73(2), 396-413.  Hequembourg, A. (2004). Unscripted motherhood: Lesbian mothers negotiating incompletely institutionalized family relationships. Journal of Social and Personal Relationships. 21(6), 739-762. DOI: 10.1177/0265407504047834 Hetherington, E.M. (1993). An overview of the Virginia longitudinal study of divorce and remarriage with a focus on early adolescence. Journal of Family Psychology 7(1), 39056.  Jackson, A.P., & Scheines, R. (2005). Single mothers’ self-efficacy, parenting in the home environment, and children’s development in a two-wave study. Social Work Research 29(1), 7-20.  Jeyes, W.H. (2006). The impact of parental remarriage on children. Marriage & Family Review 40(4), 75-102. Kumar, K. (2017). The blended family life cycle. Journal of Divorce & Remarriage 58(2), 110-125. Livingston, G. (2014, December 22). Fewer than half of U.S. kids today live in a ‘traditional’ family. Pew Research Center. Retrieved from: http://www.pewresearch.org/fact-tank/2014/12/22/less-than-half-of-u-s-kids-today-live-in-a-traditional-family/ Livingston, G. (2014, November 14). Four-in-ten couples are saying “I Do,” again: Growing number of adults have remarried. Pew Research Center. Retrieved from: http://www.pewsocialtrends.org/2014/11/14/four-in-ten-couples-are-saying-i-do-again/ Lucas, N., Nicholson, J.M., & Erban, B. (2013). Child mental health after parental separation: The impact of resident/nonresident parenting, parent mental health, conflict and socioeconomics. Journal of Family Studies 19(1), 53-69. DOI: 10.5172/jfs.2013.19.1.53 Maccoby, E.E., Buchanan, C.M., Mnookin, R.H., & Dornbush, S.M. (1993). Postdivorce roles of mothers and fathers in the lives of their children. Journal of Family Psychology 7(1), 24-38. Papernow, P.L. (1993). Becoming a stepfamily: Patterns of development in remarried families. Cleveland, OH: Gestalt Press. Papenow, P.L. (2017). Blended family. In J.L. Lebow et al. (Eds.), Encyclopedia of Couple and Family Therapy. Cham, Switzerland: Springer. The Henry J. Kaiser Family Foundation (2015). Poverty Rate by Race/Ethnicity: Timeframe: 2015. Retrieved from: http://kff.org/other/state-indicator/poverty-rate-by-raceethnicity/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D Twaite, J.A., Silitsky, D., & Luchow, A.K. (1988). Children of divorce: Adjustment, parental conflict, custody, remarriage, and recommendations for clinicians. Northvale, NJ: Jason Aronson. Weaver, S.E., & Coleman, M. (2010). Caught in the middle: Mothers in stepfamilies. Journal of Social and Personal Relationships 27(3), 305-326. DOI: 10.1177/0265407510361729  

I can hardly believe we made it to this point: the 100th episode of the Your Parenting Mojo podcast! Join me for a special celebration of the show, featuring questions (from you!) and answers (from me!), clips of some of my favorite episodes, some fun at NPR interviewer Terry Gross’ expense, the occasional Monty Python reference, a story about how Carys got her name that you won’t want to miss.

Is your child Highly Sensitive?  Does it sometimes feel as though you don’t understand them, and struggle to support them in the ways it seems they need to be supported?  Or does your child experience and process things more deeply than other children, but this is the first time you’re hearing about High Sensitivity? In this episode Dr. Michael Pluess helps us to understand how we can know whether our child is highly sensitive, and how to parent these children effectively so they can reach their full potential.   References Aron, E. N., Aron, A., & Jagiellowicz, J. (2012). Sensory processing sensitivity: A review in the light of the evolution of biological responsivity. Personality and Social Psychology Review, 16, 262–282. Aron, E. N., Aron, A., & Davies, K. M. (2005). Adult shyness: the interaction of temperamental sensitivity and an adverse childhood environment. Personality and Social Psychology Bulletin, 31, 181-197. Aron, E.N. (2002). The highly sensitive child: Helping our children thrive when the world overwhelms them. New York, NY: Harmony. Aron, E. N., & Aron, A. (1997). Sensory-processing sensitivity and its relation to introversion and emotionality. Journal of Personality and Social Psychology, 73, 345-368. Bakermans-Kranenburg, M. J., & van IJzendoorn, M. H. (2011). Differential susceptibility to rearing environment depending on dopamine-related genes: New evidence and a meta-analysis. Development and Psychopathology, 23, 39–52. Bakermans-Kranenburg, M. J., Van IJzendoorn, M. H., Pijlman, F. T., Mesman, J., & Juffer, F. (2008). Experimental evidence for differential susceptibility: dopamine D4 receptor polymorphism (DRD4 VNTR) moderates intervention effects on toddlers' externalizing behavior in a randomized controlled trial. Developmental Psychology, 44, 293-300. Belsky, J., & Puess, M. (2013). Beyond risk, resilience, and dysregulation: Phenotypic plasticity and human development. Development and Psychopathology 25, 1243-1261. Belsky, J., Bakermans-Kranenburg, M. J., & Van IJzendoorn, M. H. (2007). For better and for worse: Differential Susceptibility to environmental influences. Current Directions in Psychological Science, 16, 300-304. Bouvette-Turcot, A-A., Pluess, M., Bernier, A., Pennestri, M-H., Levitan, R., Skolowski, M.B., Kennedy, J.L., Minde, K., Steiner, M., Pokhvisneva, I., Meaney, M.J., & Gaudreau, H. (2015). Effects of genotype and sleep on temperament. Pediatrics 136(4), e914-e921. Pluess, M. (2015). Vantage sensitivity: Environmental sensitivity to positive experiences as a function of genetic differences. Journal of Personality 85(1), 38-50. Pluess, M. (2015). Individual differences in environmental sensitivity. Child Development Perspectives 9(3), 138-143. Pluess, M., & Boniwell, I. (2015). Sensory processing sensitivity predicts treatment response to a school-based depression prevention program Evidence of Vantage Sensitivity. Personality and Individual Differences 82, 40-45. Pluess, M., & Belsky, J. (2013). Vantage sensitivity: Individual differences in response to positive experiences. Psychological Bulletin 139(4), 901-916. Pluess, M., & Belsky, J. (2011). Differential susceptibility to maternal sensitivity. Maternal Sensitivity: A critical review for practitioners, 95-107. Retrieved from http://philosonic.com/michaelpluess_construction/Files/PluessBelsky_2010_Differential%20Susceptibility%20to%20Maternal%20Sensitivity.pdf Pluess, M. & Belsky, J. (2010). Differential susceptibility to parenting and quality child care. Developmental Psychology 46(2), 379-390.  

A few months ago a listener in my own home town reached out because a potentially incendiary device had been found on the elementary school property, and many parents were demanding disaster drill training in response.  The listener wanted to know whether there is any research on whether these drills are actually effective in preparing children for these situations, and whether it’s possible that they might actually cause psychological damage. In this episode we review the (scant) evidence available on drills themselves, and also take a broader look at the kinds of measures used in schools in the name of keeping our children safe – but which may actually have the opposite from intended effect. Read Full Transcript Jen 01:21 Hello and welcome to the Your Parenting Mojo podcast. We have another serious topic to cover today and it's probably one that you don't want to listen to with children around. I received a question from listener Selena about 6 months ago saying that an incendiary device had been discovered on the grounds of the public school that my daughter would actually going to be attend if we weren't going to homeschool. And that some of the parents who were very worried and were demanding video surveillance and disaster preparedness drills and she wants to know whether there was any research available about the impacts of drills to prepare children for things like active shooters. And I wanted to know are these drills effective? And then when I started researching this issue, I went down a complete rabbit hole related to the effectiveness of other kinds of school security measures as well as bullying, as a potential cause of violence in schools. Jen 02:08 And the kind of relational aggression that girls particularly to practice as well. So expect episodes on those topics soon in the coming months. But here to kick us off today on this mini series is Dr. Ben Fisher. He's Assistant Professor in the Department of Criminal Justice at University of Louisville. Dr. Fisher’s research focuses on the intersection of education and criminal justice, but particular focus on school safety, security and discipline. He approaches this research from an interdisciplinary perspective with a focus on inequality that is grounded in his Ph.D. in community research and action from Vanderbilt University, which prepared him to work on this view from a social justice orientation. Welcome Dr. Fisher. Dr. Fisher 02:46 Thank you. Glad to be here. Jen 02:47 And so before we get going with our conversation today, I do want to just take a minute and acknowledge that we're recording this in the week after a gunman killed 22 people in Walmart in El Paso, Texas, and then another gunman killed 9 people outside a bar in Dayton, Ohio. So, it feels very raw to me to be discussing this today. We're going to talk today about the likelihood that a child will be killed in a school shooting. And despite the impression that we might get from the endless news cycles that keep these kinds of incidents top of mind when they happen, our chances of dying from many other causes are far, far greater than dying during a mass murder. But despite this, I do believe there are too many guns in our society and not enough control over who has access to them and what they do once they have them. Jen 03:30 And I also think that these kinds of events are not the ultimate problems we need to deal with. Yes, we need to make it much more difficult to access guns. So, people who feel disaffected can't harm large numbers of people very easily and instituting tighter gun control in a country where so much of the political power is tied to the money provided by the gun lobby currently seems like a really insurmountable challenge. But in my mind, the far greater challenges, the one facing our families and schools where we need to address what is leading children and later adults to feel so disconnected from their families and communities, but the best tool they have to express their emotions is to kill people. So with that said, let's talk about some ways we might be able to do this. Okay. So let's start by putting this topic in context because I think many parents, myself included before I started this research, are probably under the impression that there's kind of an epidemic of violence and particularly violence perpetrated by people with guns in schools. Dr. Fisher, can you help us understand whether that is in fact the case? Dr. Fisher 04:26 Well, we certainly do have a problem with violence in our country as we've seen in very clear fashion this past week. However, the statistics also indicate that our countries become safer and safer over the past two decades in terms of crime and victimization rights. Schools in particular have not been as safe as they are in the past 20 years in terms of rates of all sorts of crime and violence in schools. So although violence certainly does continue to be a problem, particularly gun violence and many of its forms compared to where we were two decades ago, things are going fairly well. Jen 05:02 Yeah, I was really surprised by that. It seemed as though there was sort of a high watermark around 1992 and 1993 where the rate of homicide risk was much higher than it has been in the more recent years, I think with the exception of the year of the Sandy Hook shooting. And why do you think that is? Dr. Fisher 05:21 Well, it's been across the board with all types of crime and violence. It's not just gun violence, although it does include that. Part of that is most certainly regression to the mean where when stuffs gets really bad, it is going to get better on average. When stuffs going really well, it's going to get worse on average. So that's gotta be part of it in my mind. And I'm a little less familiar with sort of the broader sociological explanations around long-term reductions in crime, but we've seen parallel trends in community policing strategies where officers are more focused on building relationships with community members instead of going out and cracking skulls, only I say that and just mostly, but they're less concerned about, you know, just finding and responding to crime. There's a lot more of a proactive approach. So, there's that law enforcement perspective on it, but that's not too much of my area of expertise. So, I don't want to step away like too much here. Jen 06:19 No worries. A couple of the stats that stuck out to me as I was researching that was the deaths by different causes over that period. And bicycle accident was one of the highest ones at 2,400 and this is deaths of children by various causes, a fire accident of some kind 1900 and change, accidental fall around 1700, lightning strikes 251 and then school shootings 113 children. And then just to put that number in context, only about half a percent of the 24,000 children who were murdered in that period between 1999 and 2013 were killed at school. So I think there is still a lot of violence in our society and there are definitely children who are meeting an end way before their time is due, but only a tiny fraction of those are actually happening in school. I was I guess maybe I just hadn't thought about it, but those isolated incidents tend not to get the same coverage that the large scale incidents at school have. I think maybe part of it. Dr. Fisher 07:20 Yeah, that's right. Statistically speaking, schools are among the safest place for children and youth to be compared to other homes, neighborhoods, or almost anywhere else. Unfortunately, a lot of the media coverage around gun violence that occurs in schools, that's sort of gripped the public imagination and some degree, rightfully so because it's a sort of an absolute affront to the conscience to see the sort of gun violence happen in schools regardless of how common or uncommon it is. But in another sense there's been this sort of undue fear that has been stoked to where there's this idea that schools are dangerous places that need to be locked down and targets that need to be hardened in certain ways so that strangers or students with guns and ill-intentions can't do violence there. Jen 08:12 Yeah, I think parental fears are really key issue and some research that I saw in that said that somewhere between 25% and 30% of parents sort of have this sort of like a background level of fear about the researchers quiz them on their oldest child’s safety while in school in most years. And right after Columbine that spiked up to about 55% and then I guess there was another incident in Santee, which I think is in Florida, that was led to a spike in 45% and then only up to 33% right after Sandy Hook. So I wonder if people were sort of becoming a little bit immune to it. You know, the spikes were not quite so high each time above that baseline level, but still that's a very, I mean a third of parents almost are between a quarter and a third of parents have some kind of fear about their child's safety in school. Dr. Fisher 08:57 What I think was interesting is that a parallel research that has been conducted with students finds almost no effect of these shootings. So, I've conducted research where we measured students' levels of fear and feelings of safety at school and Sandy Hook happened to occur right in the middle of our data collection. So, we could compare those students right before or right after and there are similar research done by Lynn Addington around the Columbine shooting in 1999. And both studies found statistically significant effects, but ones that were so small as to actually be practically zero. So, essentially no changes in students' perceptions of safety or fear. So, this fear seems to be taking hold mostly in our adults and less so in our students. Jen 09:47 Do you have any sense as to why that is? Is it because the adults are watching these news cycles and that they're trying to protect the children from it and so the children aren't exposed to as much information or what's your sense on that? Dr. Fisher 09:59 I don't know. I don't have a strong sense of that. I can tell you that when I'm confronting potential danger, I'm usually more worried about the people I'm with than I am about my own safety. So it may be that sort of a factor, you know, parents love very few people in the world more than their own children and then maybe they just maybe sensitized to that. Jen 10:19 Yeah. Okay. And so as we heard about at the beginning of the episode is often parents who will then call for more security at schools, particularly after an incident at another school as sort of prompted their fears. And so I want to spend some time talking about what kinds of security are now in place in schools. So maybe we could walk through some of these and just talk about what they are and what kind of effects they have. So, the first one is the Gun-Free Schools Act that was enacted in 1994 and I think it calls for States to enact laws requiring that a student who brings a firearm or who possesses a firearm at school to be expelled for a period of not less than one year. How effective has that been? What do you know about that particular act? Dr. Fisher 11:01 Yeah, that act is credited largely with bringing in sort of this era of zero tolerance discipline into schools. And so it began with, as you mentioned, guns in schools and it quickly expanded to drugs as well. And then schools have followed that approach to extend it to other things such as fighting, even repeated offenses of more minor actions. So, when folks talk about zero tolerance, they sometimes talk about specific policies, like if you bring a gun to school, you're out. But a lot of researchers are also talking about this culture of zero tolerance where disciplinary strategies are bound up in the use of school security measures that are used to monitor and surveil students. And just sort of this sense that schools, yes are places of education, but also places of control. So critical scholars who look back to the Gun-Free Schools Act of 1994 largely point to that as legislation that has ushered in that era. Jen 12:04 Yeah, and I think on the face of it, it seems like a really valid thing to do. You know, yeah, no kid should have a gun in school. No child should have a knife in a school. Yes, they should be sort of things that are non-negotiable. But I think, 75% of schools now have these policies, but I read in an American Psychological Association report that found there is little evidence that this act is a deterrent firstly for people who are planning to do these kinds of things, they're going to bring it to school anyway. They don't increase school safety. They're disproportionately applied to students of non-dominant cultures. And you hear all the time in the news about, you know, some person who there was a kid who picked up her mom's lunchbox and her mom had a paring knife in her lunchbox so that she could cut an apple up at her work. And so the child finds it immediately, hands it in and gets kicked out of school. So once you look below the surface, how effective do you think this zero tolerance policies are? Are there instead of intended goal of reducing violence? Dr. Fisher 12:58 Well, they're not effective and I think some of us would even argue that their intention wasn't as much to prevent violence as it was to exert control. So, from a violence prevention perspective, they have been ineffective. From a control perspective, they've been highly effective. As you mentioned, there's a high degree of disproportionality in who is being excluded from our schools, this largely students of color, students with disabilities. In that sense, this sort of zero tolerance culture has reinforced ideas of what is considered normal. What is the status quo has maintained a lot of those cultural paradigms. Jen 13:39 Yeah. Okay. So let's talk about some of those more control and surveillance types of activities. I think 64% of public schools used cameras and this data is kind of out of date in the 2011-2012 school year. Is that increasing and what trends are you seeing around the use of cameras in schools? Dr. Fisher 13:56 Yeah, that's been to my knowledge, one of the largest increases over the past decade or so to where the vast majority of schools now use security cameras. I assume this is largely driven by sort of the advent of new technology that seems to be happening on a weekly, monthly basis. And cameras are becoming cheaper and cheaper. I just completed a study earlier this year with two of my graduate students where we examined a set of 850 schools that implemented cameras between time one and time two and what time one and time two varied a little bit, but it was all within the 2000. So, within that 850 schools, some implemented cameras, some didn't. Then we compared, you know, was there a reduction in crime when you implement cameras? Did it make a difference for violent crime, for property crime, for more routine things like a bullying or gang activities in the school? And across outcome after outcome we saw zero effect, zero effect, zero effect. Jen 15:01 Wow. Dr. Fisher 15:02 Even though cameras are becoming more and more prevalent, statistically we're not seeing any improvement in crime outcomes, at least in the data that we used. Jen: 15:11 Okay. So I want to sort of tease that out a little bit. I'm wondering, okay, so maybe there's this baseline level of crime and then cameras are implemented in the school. Is it possible that some children are deterred from committing crimes while other children are still committing them, but they're more likely to get caught? And so this sort of, you know, decrease in number but increase in number of people getting caught, are they canceling each other out and having that zero effect or do you think there’s something else going on? Dr. Fisher 15:38 Oh, that's certainly possible. I can't rule that out. I also wonder and speculate if young people today are so desensitized to being on camera with having one or two cameras on each of our cell phones that we use having so many in public spaces. I wonder if there's just not the deterrent effect that there may have been in earlier decades. Jen: 15:59 Oh, interesting. Yeah. It'd be interesting to compare that with an English dataset because you're on camera everywhere, everywhere you go in England. But that would be really interesting. Dr. Fisher 16:09 Fascinating. Jen 16:10 Yeah. So, I know that a lot of your researches focused on school security personnel and so there's a variety of forms these can take. There can be security guards, there can be actual police, there can be what's called school resource officers, which I think are police who are kind of deputized to the school. Can you talk a little bit about what your researchers found on those? Dr. Fisher 16:30 Sure. Yeah, so I think to begin there are maybe some useful working definitions that we'll give. And I will say that the definitions that I use differ slightly from the ones that other researchers use, which differ slightly from ones that practitioners and people in schools use, which differ slightly from ones that the public uses. So, I'll sort of define the terms as I'm speaking about them and folks can chime in and tell me I'm wrong afterwards. So, yeah, I see a sort of three types of security personnel. One being security guards who are not part of a police force, they are not sworn officers, they don't have arrest powers, but they're there to sort of address behavior issues in school to keep a general sense of order. There's police officers who are not SROs, who are not School Resource Officers where they do have arrest powers. Dr. Fisher 17:23 Typically, will carry a firearm. They’re assigned to a school maybe on a full time, maybe on a part time basis, but they don't have any sort of special training around working in schools or working with children and youth. Then finally School Resource Officers are a subset of police officers. So it's another form of school-based law enforcement. But when people talk about SROs, they typically talk about them in a context of folks who have had some sort of training around say, child and adolescent development or understanding the school system or things like that. On the ground, it’s not always the case that they have those sorts of trainings, but when people talk about them as a general idea. So most of the research that I have been involved in over the past two or three years has been with school resource officers. Dr. Fisher 18:10 I've been partnering with two different school districts, one in a very urban area, one in a rural and suburban area. And I've done interviews with around 75 officers. And I've looked at some administrative data in the suburban district, talked with a variety of other stakeholders, teachers, students, parents. One of the major themes that we've found has been that context really matters in schools. So the context, both in terms of the school context, but also the neighborhood and community really shapes what SROs do, how they understand their jobs and what effects they have. How other folks perceive them. Jen 18:49 Okay. And so I know that the incidents of having SROs in schools really increased dramatically after Columbine because the Federal Government made $475 million in grant money available to hire and train SROs despite any lack of empirical evidence of their effectiveness. So, I wonder if we can talk through what your research and the research of others has found about things like links between the use of SROs and other...

Recently a listener posted a question in the Your Parenting Mojo Facebook group asking about research related to children who are assigned to one gender at birth, but later realize that this assigned gender doesn’t match the gender they experience.   Another listener recommended Dr. Diane Ehrensaft’s book The Gender-Creative Child, and we are fortunate that Dr. Ehrensaft quickly agreed to speak. Listener Elizabeth co-interviews with me as we learn how to truly listen to our children when they tell us about their gender, and what we can do to help them navigate a world full of people who may know very little about – and even fear – children whose gender does not conform to expectations.   While we didn’t get a chance to discuss it (too many other topics to cover!), you might also be interested to learn about the “They-by” movement, which advocates for allowing children to choose their own gender when they feel the time is right, rather than the parents assigning a gender at birth based on the child’s genetalia.   Here are some especially recommended resources:   Human Rights Campaign’s Guide on supporting transgender children: https://assets2.hrc.org/files/documents/SupportingCaringforTransChildren.pdf?_ga=2.156922811.1499059672.1559845994-1938179427.1559845994   Recommended books for children – for ALL children, not just those actively exploring their gender identity (note: these are affiliate links): 10,000 Dresses The Adventures of Tulip, Birthday Wish Fairy My Princess Boy The Paperbag Princess Mama, Mommy, and Me Daddy, Papa, and Me Who Are You? The Kid’s Guide to Gender Identity I am Jazz Julian is a Mermaid Introducing Teddy   Read Full Transcript Jen: 00:01:21 Hello and welcome to the Your Parenting Mojo podcast. Today, we're going to talk about a topic that originated from a question in the Your Parenting Mojo Facebook group. Now, sometimes I have questions on my list for a long time, but other times when someone expresses an interest in a topic, they also point me toward a place to start the research, which really does speed things up and that's actually what happened with this episode. So, listener Elizabeth asked if I'd done an episode on children's gender identity and some other listeners chimed in with potential resources, one of which was Dr. Diane Ehrensaft’s book, The Gender Creative Child. And after I read the book, I knew that Dr. Diane Ehrensaft was the right person to talk to about this topic. So, she's here with us today. Dr. Ehrensaft is a Developmental and Clinical Psychologist in the San Francisco Bay Area and the Director of Mental Health and founding member of the Child and Adolescent Gender Center, a partnership between the University of California, San Francisco and community agencies to provide comprehensive into disciplinary services and advocacy to gender conforming and transgender children and youth and their families. She's an Associate Professor of Pediatrics at the University of California, San Francisco and the chief psychologist at the UCSF Benioff Children's Hospital Child and Adolescent Gender Center Clinic. Her research and writing focuses on the areas of child development, gender, gender nonconforming and transgender children and youth parenting, parent-child relationships and LGBTQI families. She also serves on the board of Gender Spectrum and National Organization offering educational training and advocacy services to promote gender acceptance for youth of all genders. Welcome Dr. Ehrensaft. Dr. Ehrensaft: 00:02:52 Thank you so much for having me. Jen: 00:02:54 So, to help us understand more about the research on this topic as well as what to do with it practically in our real lives as parents, listener Elizabeth is here as well. Her child, John was assigned a male gender at birth. John is now 4 and has been telling his parents pretty insistently for a while now that he is a girl, even though he still likes to use the pronouns he, him and his as well as the name his parents gave him at birth. Welcome Elizabeth. Elizabeth: 00:03:18 Thank you. I am glad to be here as well. Jen: 00:03:20 And so I do want to say briefly before we get started that even if your child seems fairly convinced that the gender they were assigned at birth is the one they want to express, that you might want to listen to this episode anyway because I'd say there's a reasonable chance that somebody in your child's class is probably somehow exploring their gender identity. And so knowing the information we're gonna discuss today will help both you and your child be a better friend and ally. So, let's start off with some terminology please, Dr. Ehrensaft because I didn't know a lot about this topic before I started researching it. And even now I find I have to constantly revisit the definitions to remember what's what. So, can you kind of give us a crash course in some of the terminology we’ll be using today, please? Dr. Ehrensaft: 00:04:00 Absolutely. So, we start out with what we call the sex designated at birth and the sex designated at birth is usually what you will see on a birth certificate and it's typically one or the other F or M and that essentially is based primarily on your chromosomes, whether you have XX or XY chromosomes. And it's usually determined by whoever delivered the baby, looking between the baby's legs and seeing what genitalia up here and then declaring the sex of the baby. It's often declared before birth these days in a sonogram, so that you can know early in your child's gestation what people think the sex of your baby's going to be. So it's just physical. Gender is the next thing. And that's very different than sex. We actually don't assign a gender at birth. We assign a sex at birth and that's the physical part. Dr. Ehrensaft: 00:04:58 Then the world around the baby comes in to match that sex with the gender. And the gender is really how we live out being male, female or other in the world and it's based both on inside and outside. And certainly has a very strong social component, looks really different from one culture to another, but I don't know any culture in the world that does not use some organization around gender, not necessarily into boxes. And when we understand gender, let’s divide that up. There's a gender identity and that is who I know myself to be as male, female or other. It's just an inner sense of being. Your gender expressions have more to do with how you do gender. For a little kid that might be the clothes they wear, the toys they play with, the kids they want to play with, the activities that they want to do, how they move and so forth. Dr. Ehrensaft: 00:06:00 And sometimes we lump the two together and it's really important to keep them separate. And those two things, again, needs to be kept separate from our sexual identities. And we often lump all three together, gender identity, gender expressions and sexual identity or orientation. They are absolutely different. Gender is one path, sexuality is another, then they cross, but really your sexuality is who you desire, who you are attracted to, who you want to be with. And it might be someone who is the same gender as you, someone who's opposite or different gender than you. All these things come in quite different combinations, which is the beauty of it all. Jen: 00:06:44 Okay. Already having a hard time keeping it straight in my head. So to summarize, I guess gender identity and expression is kind of about who you are. Is that a good way of thinking about it? And sexual identity and expression is about who you desire? Dr. Ehrensaft: 00:06:59 Mm-hmm. Jen: 00:07:00 Okay. Okay, super. That helps then. And so then we start talking about things like cisgender, gender-expansive. Can you talk a little bit about those? Dr. Ehrensaft: 00:07:08 Yes. The cisgender people in the world are the people who are experiencing the gender they lived at, usually starting out with who their parents assumed them to be based on their sex. And so their gender is the same and matches the sex designated to them at birth. So, those are our cisgender people. And then our transgender or gender-expansive people, people who are saying, I have a different match. It's not based in our culture, the gender binary boy, girl, man, woman. So it might be, for example, a little person who says, you all have it wrong. You think I'm a boy, but I am a girl, I am a girl with a penis. I'm an XY girl. So, transgender means a cross that your gender does not match the sex designated to you at birth and those are transgender children. Dr. Ehrensaft: 00:08:14 Gender-expansive children are also children who say, look, it's not an exact fit for me, so we're going to have to expand it some because it's not totally working for me. They may have a gender identity that's a good match for the sex designated at birth. So, maybe they were born, somebody said, oh, you have a boy. And they say, yeah, I'm a boy, but I don't like the rules for boy. And I like dresses. I like to play the Mommy in all my role play activities, but I am a boy and that’s the way I like to do. So, those would be different combinations that wouldn't be your fit under the cisgender umbrella. Jen: 00:08:59 Okay, that's really helpful. And so in the reading that I was doing about this, I think I learned that there's really no inherent problem with not feeling like the gender you were assigned at birth or I guess would it be more correct to say the sex you’re assigned at birth? Dr. Ehrensaft: 00:09:14 I like to use the sex assigned at birth. Jen: 00:09:15 Okay. Yeah. Yeah. Okay. That makes sense. So the sex you are assigned at birth, but we also have a diagnosable disorder related to this, right? Can you talk about that nuance, please? Dr. Ehrensaft: 00:09:26 There is a history of diagnosis for gender for children and it actually began when the diagnosis of homosexuality was taken out of the American DSM (Diagnostic Statistical Manual). And what took its place when homosexuality was removed from the books in the 1970s was a new diagnosis for gender. So, we now have gender identity disorder to basically pinpoint those people who did not feel cisgender as I just described it. And that diagnosis remained on the books for a long time. And then it was changed recently to gender dysphoria, which is a step up from gender identity disorder because it really just designates those people now who feel distress about their designated sex at birth, not being a good match for the gender they know themselves to be. So it's a step up, but from my perspective it's not good enough because there's still places that under the category of a mental disorder or a mental problem and it pathologizes what I call gender infinity, all different kinds of gender modalities, the rainbow of gender. Dr. Ehrensaft: 00:10:52 So, it is a controversial issue in the field right now. And I will disclose that I am a proponent of, particularly with children, removing the diagnosis from any mental health manual because the intent right now is to depathologize gender and say it's the beauty of humanity to have such a wide variation of gender and all its possibilities. And there is nothing that is unusual or mentally discordant about that. And I would like to give a new diagnosis and I call that social gender dysphoria. It’s the society that needs to be treated, not the child. Jen: 00:11:41 Yeah. And I imagine health insurance programs wouldn't pay for that, isn't it? But yeah, that was sort of where I was thinking on this was it seems to me that the dysphoria, which is sort of the discomfort, is arising from the lack of support that the child feels may be from their parents, may be from society and not from these sort of feelings of not feeling an alignment between their sex and gender. Dr. Ehrensaft: 00:12:04 I think that's absolutely correct. I will say that with all the support in the world, we still have some kids who feel uncomfortable about the poor body match for themselves. And I do think that this is exacerbated by continuing to say boys have penises, girls have vaginas, rather, there are penis-embodied people and vagina-embodied people and most vagina-embodied people identify as girls, but some are boys, etc., etc. So, I think we always will need to pay attention to people who would like to be able to bring their body in better alignment with the gender they know themselves to be. But we might want to get rid of the word dysphoria for that and just call it discordance. Jen: 00:12:59 Yeah. And so just kind of playing on that for a few minutes, I have a bit of a long sort of statement/question before we start getting into the super practical stuff and pulling Elizabeth in for that. So, we talked about how the diagnostic and statistical manual does list this gender dysphoria as a pathological condition and in the previous 4th edition of the DSM, the diagnosis was gender identity disorder in children abbreviated to GIDC. And so the shift is that in the 4th edition it was the cross-gender identification itself that was the problem. Whereas now it's discomfort without identification is the problem. And so I just want to tip my hat to Dr. Jake Pyne, who is a postdoctoral fellow at the University of Guelph for putting some things into words that were kind of swirling around in my mind and I couldn't quite figure out. Jen: 00:13:44 And so Dr. Pyne notes that Dr. Ken Zucker, who was a big proponent of this GIDC diagnosis defends it based on “expert consensus”. So in other words, if a bunch of experts think that something is an illness, then it's an illness. And the threat of social ostracism is cited as sufficient rationale for treatment. And Dr. Zucker said that children often misclassify their own gender and he believes a child who disagrees with a clinician is inherently wrong. And it isn't society's phobia of gender variant people, but rather the active being gender variant itself that causes distress in children. And this diagnosis is the result of poor parenting. It's up to the clinician to save the child from their inevitable fate as a social outcast and remake the child into a normal person. And so this shows up in places like the DSM, which has this unstated but nevertheless powerful view of what normal is, which is White and heterosexual and male. Jen: 00:14:38 And so it's kind of unfortunate that it's the psychologists who carry a lot of the weight of responsibility for the way that gender variant people have been persecuted since it’s their theories that legitimize the actions taken by people like teachers and social workers who control what a child does as well as parents who are taught to surveil their children and administer this humiliation and a desire for success in normalcy. And while the three of us on the call today are all White, I also want to acknowledge the Black and Brown youths who face an incredibly potent combination of threats. There was one researcher whose work I read said that I quote “I always marvel at the ways in which non-White children survive a White supremacist US culture that prays on them. I'm equally in awe of the ways in which queer children navigate a homophobic public sphere that would rather they did not exist. The psychic survival of children who are both queer and racially identified as non-White is nothing short of staggering.” Jen: 00:15:32 And so Dr. Ehrensaft, I know you were co-interviewed with Dr. Zucker for an NPR show in 2008 where you acknowledged that his approach to treating GIDC was still the most prevalent one, but his clinic has since been closed down after it emerged the children he treated were not experiencing positive outcomes. And your model of embracing gender variance is becoming much more normalized. So, I'm sorry to put you on the spot here, but I wonder if you could speak just briefly to the way in which gender variance has been kind of problematized over the years. And we as a society have tried to make gender-variant people fit into our norms rather than adapting our norms to fit this huge variation in the human experience. Dr. Ehrensaft: 00:16:12 So, I want to start out by having my field be accountable and that is the field of psychology, mental health, gender studies, and we are the best of the worlds and the worst of worlds. And some of the so-called experts who based the shaping of a diagnosis on research should be humbled enough now to say they were wrong. The research was flawed and history is proving them wrong and I would say going back to the interview on NPR in 2008, at that time I remember being put on the spot around the question about whose model is more prevalent and I had to be honest and I think I gave a nervous laugh and said, oh, Ken’s. If you ask me now in 2019 and not just because his particular clinic has been closed, but because what has happened in this last decade, I will tell you without a doubt that our model which is the gender affirmative model is the ascendant model of care throughout the world right now and I'm very happy to be able to say that because I think we are repairing what did great damage to gender-expansive people, particularly children throughout history and continues to damage children every time someone tries to employ reparative or conversion therapy with the child to make them conform to what society wants them to be. Dr. Ehrensaft: 00:17:42 The challenge to that that we are offering is to basically enhance these kids resilience and the adults around them and the Trans Community and also to both educate and increase the gender literacy in the world around them because it's the support of others and their own resilience, persistence and gender creativity that's going to make such a better world for everybody. As you said in the introduction, this is not just about children who are gender-expansive. This is about any child who has a gender and every child in our culture has a gender and the acceptance in the room at the table for everybody as not just being but it is dividing will hopefully challenge the kind of intersectionality of oppression that you mentioned before that can happen no matter what it is that creates you as a category of being other than what someone else said was normative. Jen: 00:18:50 Yeah, and thank you for addressing that. And I'm wondering what happens to a child if we don't permit them to live as the gender that they perceive themselves to be? Dr. Ehrensaft: 00:19:01 The data coming in is simple, elegant and common sense....

This is another of those topics I really wish I didn’t have to do. In this interview with Dr. Jennie Noll of Pennsylvania State University, we discuss the impacts that sexual abuse can have on a child (even many years after the event itself!), and we talk extensively about what parents can do to prevent abuse from happening in the first place. If you want to be sure to remember this info, there’s a FREE one-page cheat sheet of the 5 Key Steps Parents Can Take to Prevent Sexual Abuse available here: Get the FREE Guide!   [accordion] [accordion-item title="Click here to read the full transcript"]   Jen: 01:26 Hello and welcome to the Your Parenting Mojo podcast. We have a pretty serious topic to cover today and it's what I've been thinking about for a long time now. In 2016 the USA gymnastics sexual assault scandal broke and we learned that Dr. Larry Nassar had been sexually assaulting gymnast for years as he claimed to be providing them legitimate medical treatment. Now obviously there were failings at so many levels here. This was reported and ignored and covered up at many levels. But one thing that stuck in the back of my mind was an interview with gymnast Aly Raisman where she said she really thought this was what medical treatment was like and I want to be 100% clear that I'm not blaming Raisman or any other gymnast who had this awful experience, but I just couldn't get my head around how and why she didn't know she was being sexually abused.   Jen: 02:11 I realized that it's at least partly because we live in a culture where we don't talk about this. We don't teach children to watch for warning signs and we don't look out for them ourselves as parents or we pretend we don't see them. We just stick our head in the sand. So today's episode is probably not one you want to listen to with children around because we're going to be very explicit and discussing sexual abuse and how to prevent it. I also want to give a shout out to listener Christine who helped me to think through some great questions to ask my guest today. I spent a really long time looking for someone to talk with us about this and finally found the right person. Dr. Jennie Noll is Professor of Human Development and Family Studies and Director of the Child Maltreatment Solutions Network at Penn State University.   Jen: 02:52 She earned her Ph.D. in Developmental Psychology and Statistical Methodology from the University of Southern California. The reason I’m so interested to talk with her about this topic is because she has active research projects on two topics that are very important to us, the long-term health outcomes for victims of child sexual abuse and programs for the prevention of that abuse. Welcome Dr. Noll.   Dr. Noll: 03:13 Thank you very much for the opportunity.   Jen: 03:16 So before we get started, I actually also want to mention that I took the training that Dr. Noll studies and it's called Stewards of Children and it's published by an organization called Darkness to Light. I've created a free one page guide to preventing sexual abuse that you can download from this episode's page at YourParentingMojo.com/SexualAbuse. So we're going to talk a lot more about the Stewards of Children program today I imagine. But I wonder if we can get started by looking at the mental health or the general health actually impacts of sexual abuse because I was really surprised to find out how many of these there are. Can you walk us through these and do we have any indication of how likely they are to occur in a child who is chronically abused for years versus one who experiences abuse that it's discovered or reported fairly quickly.   Dr. Noll: 03:58 Yeah, very good. So what we've understood and this has been my work for the last 30 years, what we've understood really well as sort of the mental health and emotional health consequences of abuse. We have pretty good trauma informed treatments for mental health. These are things like persisting posttraumatic stress disorder, other anxiety disorders, depression, other sorts of attachment related disorders in terms of not being able to attach to a partner, relationship difficulties, and substance abuse. These kinds of things that we normally think about as mental health or emotional health. But what we're learning I think in the last decade is something that surprised a lot of us and that is just how we see sort of physical health consequences that we didn't really anticipate when we were just studying mental and emotional health and these are things like physical health disorders, these are heart attacks, obesity, strokes, stress-related diseases like inflammation, interferences with disease processes. Dr. Noll: 05:04 These are the kinds of things that we see in chronically stressed populations like PTSD Vietnam vets, people who have endured long and chronic stressors in their lives early on. And we think about this as how does stress sort of get under the skin and impact physiology? And we're talking about not just disease process but brain development, right? Other sorts of major organs, systems, the stress response system. So after studying survivors, which I have done for over 30 years and across generations, we're really starting to see a strong causal influence of early sexual abuse on long-term health outcomes because of the early and chronic exposure to stress and the stress hormone cortisol and other assaults on the stress response system.   Jen: 05:57 Wow, that's incredible. So that completely makes sense from the sort of chronically abused perspective, if the stress is ongoing for a really long period of time. Do you see similar effects in people who have this experience maybe once or twice and it's discovered fairly quickly?   Dr. Noll: 06:13 Yeah, that's a great question. It has two parts to the answer and my answer would be it depends. It sort of depends on what outcome you're looking at. For example, when we look at things like, sexual development, promiscuity, teen pregnancy, sort of more sort of sexual outcomes, right? Those are not necessarily tied to physical health, but something to do with the severe sexual boundary violation that has happened in the context of sexual abuse. I actually have some papers that really show clearly that it doesn't matter all that much if it's happened chronically or one time or several times or at what age, but more the fact that there was a sexual boundary violation and some kind of trust that was violated early on. So I don't like to put things on a continuum from mild to severe or one time to chronic. It's more about the interpretation of that violation and how it happened and the context in which it happened that helps us understand the sequelae and how to treat this kind of survivor.   Jen: 07:20 Okay. So that leads me to think about, what's the prevalence of these kinds of problems among children who are sexually abused? We actually did an episode on Intergenerational Trauma and how that's passed down through the generations and it's amazing. Some people can experience incredible trauma and not pass it onto the next generation and the vice versa happens as well. So I'm wondering, do most children manage these transitions to adolescence and adulthood kind of okay, kind of normally as it were or are problems really common?   Dr. Noll: 07:49 I think problems are a lot more common than we initially had thought about because of our work, not just mine, but others in the field where we follow survivors through time and we're able to compare those to kids of a normal developmental trajectory. And what we see is as much more common in survivors than in the normal population. Things like I've talked about and things like sexual outcomes, depression, mental health, and also these physical health outcomes. So much more common, significantly more common than would be accounted for by chance than the general population. But you're right, the road to resilience I think is under studied and under understood. And we are trying to look at models now of those who do not have affects. Those do not seem affected and what can we learn from those trajectories. Those are things like having a really good support system early on in life, having someone who believes in you, having some good evidence based trauma treatment early on, and also revisiting these issues as different developmental transitions happen.   Dr. Noll: 08:53 For example, getting married often triggers some effects of sexual abuse as memories or sort of clarified and uncovered and even experienced differently in the context of a new relationship or a new sexual relationship. Also the birth of a child can trigger a trauma symptoms as well. So we often suggest revisiting of treatment as survivors go through their lives. These are the kinds of success stories that we hear. In terms of intergenerational transmission, let me just say one thing quickly. We don't see necessarily victims of sexual abuse going on to sexually abuse their children. That's not the kind of intergenerational transmission we're talking about. We're talking about sexual abuse victims recreating an environment for their children were adversity persists or where other people have access to their kids who might be exploitive individuals who then pass sexual abuse on to those kids or physical abuse or neglect. So what happens with a survivor when they become a parent, if they have substance abuse issues or other mental health issues, children suffer because of those kinds of issues. Not necessarily because they are being sexually abused by a person who's a survivor. So let me just make clear, it's about the environment that's recreated or abuse and neglect are allowed to persist in that environment as opposed to someone sending that perpetration per se along to their kids. Does that make sense?   Jen: 10:26 Yeah, it does. So it sort of sets up a potential problem for researchers, isn't it? If you're not necessarily in studying the next generation, but in the current person who's experienced that abuse, if they are also in an environment where physical abuse is common and neglect is sort of ongoing, how do you and how do other researchers untangled these effects of the sexual abuse compared to the other co-occurring adverse child experiences that the child might be going through?   Dr. Noll: 10:51 Yeah. Another great question and I think what we have to do is look carefully at the research that's out there and how it's designed. I am chiefly charged with doing just what you said, how do I create models and research designs that actually parse out the impact and the causal impact of sexual abuse when accounting for all of the other adversities, other types of abuse, etc. that are happening in the lives of survivors. So our models are very, very comprehensive. We monitor and model all kinds of adversities and we do what we call statistical controls for those to see if there's a variation above and beyond other adversities that can only be explained by the experience of sexual abuse. We indeed have long-term longitudinal studies that actually show the effects of sexual abuse being different. As always, it depends. It depends how you're looking at. This is particularly pronounced when we're looking at sort of sexual context outcomes like teen pregnancy, teen motherhood and sexual activities.   Jen: 11:55 Okay. So I'm wondering, are there factors that can protect children who have been sexually abused from some of these outcomes? Or is it sort of inevitable that they might happen depending obviously on the abuse and the person's individual circumstances?   Dr. Noll: 12:11 Oh, this is far from inevitable and if that's one message I could get through that.   Dr. Noll: 12:17 These kinds of problems persist when the environment doesn't change. So there's a lot of propensity toward revictimization. So that is someone who might've been a survivor of sexual abuse ends up in an abusive relationship when they get older or they're raped or they're in a domestic violence situation, etc. etc. because the basic environment never changes, right? And the basic coping mechanisms and coping skills never change. But with adequate support from caregivers, from mentors, from other strong women and men in the lives of survivors, these trajectories can change, these environments can change and as well as really good evidence based trauma treatments, right? These are all things that target exactly the mechanisms that we see complicating the lives of survivors.   Jen: 13:06 Okay. So I want to get really practical. What form does this support take? Who is this coming from? What does a parent do when their child has experienced something like this?   Dr. Noll: 13:14 Oh, the very first thing in the paramount of everything that we talk about with survival is believing the victim. This is a basic tenant of prevention as well. Being able to listen, being able to understand what abuse really is, and then being able to really listen to the survivor and make that report to the official so that it stops. Stopping it and believing, those are the important features of the road to recovery. So that's the very first thing and then continued support, right? Continued monitoring throughout development, throughout the various developmental stages that’s the survivor might accompany like say transition to puberty, transition through adolescence, transition to adulthood. These kinds of milestones often trigger trauma symptoms and there should be supports in place at every single one of those transitions so that survivors continually feel the support. It can be a parent, a sister, an aunt, a boyfriend, a husband, a caring individual who understands and that survivors can confide in, a really good therapist, a clergy member who's trusted. These are the kinds of support systems that often do show up regularly in success stories.   Jen: 14:30 Okay. So what these people are specifically doing is, I mean in the short term, believing that it happened and in the longer term providing empathy and a person to talk to. Are there specific things other than that sort of general, I'm here if you need to talk kind of thing that successful support systems exhibit?   Dr. Noll: 14:48 Just like in any support system, it's sort of holding the person accountable to their treatment. Right? Going to treatment, making sure that it happens. Having the right kind of insurance coverage, those kinds of things parents can do for their children. But also making sure they go to the sessions, making sure they adhere, going with them if need be. And also looking for other ancillary systems like substance abuse, right? Problematic relationships. If these things sort of crop up at certain periods, that might mean the coping mechanisms are breaking down and that treatment should be revisited. So just looking at the lives of survivors and just loving people through. That's what we do in a caring society.   Jen: 15:28 O kay. So I want to make a shift here because I think this is important to parents as well. Talking about the prevention of sexual abuse. So firstly, can we talk about how common it is for children to be sexually abused?   Dr. Noll: 15:40 Oh boy. It depends. I'm sorry, I keep saying depends because it's important to understand the nuances of the question if you're really going to understand how to prevent it. So there are two ways at looking at the incidents, let's say. And that is sort of what do we know about confirmed cases in the US, right? So we see about (I don't remember what the numbers are today) but we see about it is tens of thousands per year in the US where we have confirmed cases of sexual abuse that meet the criteria of substantiation in various jurisdictions. But if you look at the CDC stats and what the CDC says about the incidents of sexual abuse, they estimate that based on retrospective reports of adults looking back over their lives, that about one in 10 women will experience sexual abuse by the time they are 18 and about 1 in 5 men. So those numbers are largely, you know, there's a large discrepancy between the cases that we know about that reach protective services and the cases that adults say happened when they were children. So somewhere in between is my guess.   Jen: 16:55 Okay. So what you're saying here is that there are probably a lot of cases that are never reported.   Dr. Noll: 17:00 That's what the CDC says based on the discrepant findings. And that says a lot about our society. So are people not coming forward? Are people not recognizing that they were abused until someone asks when they're an adult? Are there not good support systems out there built in for survivors to come forward? There's layers and layers of reasons why there might be these discrepant numbers.   Jen: 17:25 Yeah. Okay. So I think we have this sort of perception because we latch onto these sort of, you know, one of media events or things that happen in the media, latch onto them and really over report them. And we have this idea in our minds that most abuse is happening or same as kind of kidnappings that somebody snatching my child off the street. It's somebody who I don't know and I have no idea that this could have happened. Whereas I was shocked in the training that I took from Darkness to Light, the Stewards of Children training, that the vast, vast majority of abuse is actually perpetrated by either a family member, which is less common admittedly, but somebody that the family knows and trusts. So I'm wondering why do young children have trouble recognizing what “good people” who do “bad things” as being abusers?   Dr. Noll: 18:18 Yeah. This is sort of the biggest question and how to prevent, because if you study these cases and the Nassar cases is a good example. What perpetrators do is they gain access to kids. They need that access and in order to gain access, they have to be trusted by the parents and they have to be in the lives of the family on a regular enough basis to be able to gain at that access. It's not just gaining access, it's deciding which child might be, let's call it groomable. When we study Sandusky, Nassar and priests, etc. etc., we learned that they first try to figure out who might be a likely candidate. So the grooming behaviors like who's amenable, who will take the gifts, who's trust can they gain, right? Those are the kinds of things, and it's not just the child, but the parents, which parents are going to allow their kids to be seen alone by the doctor, to stay the night alone with the coach, right?   Dr. Noll: 19:20 To be left alone in the company of a babysitter who might be exploiting the children. So there's lots of layers of access. And when that access happens, there's a level of trust that gets built. This is how it works. They gained the trust. You listened to Aly Raisman and she talks about this was the most trusted physician in the country for this kind of injury, right? So that trust is built and when trust is built, it's much more difficult to discern the difference between the good guys and the bad guys. When we're taught about stranger danger, that's easy. Strangers are the guys who offer you candy and snatch you off the street. They're really...