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Good enough parenting for all children—a strategy for a healthier society
  1. M HOGHUGHI
  1. Newcastle General Hospital
  2. Westgate Road
  3. Newcastle upon Tyne NE4 6BE
  4. Department of Paediatrics
  5. Dryburn Hospital, North Road
  6. Durham DH1 5TW
    1. A N P SPEIGHT
    1. Newcastle General Hospital
    2. Westgate Road
    3. Newcastle upon Tyne NE4 6BE
    4. Department of Paediatrics
    5. Dryburn Hospital, North Road
    6. Durham DH1 5TW

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      Over recent years there has been a crescendo of political and public concern about a variety of issues which taken together suggest an impending crisis in our society. These include a rising incidence of *crime, violence, and delinquency and an ever increasing prison population, together with concern about deteriorating discipline in many schools. In addition there is increasing evidence that family breakdown through parental separation, divorce, or single parenthood has deleterious effects on the lives of children.1 Drug addiction and homelessness are increasing, as is the number of children living in conditions of poverty.2 There remains a continued background of concern about the high incidence of child abuse and neglect in all its forms, and confusion about society’s apparent failure to manage it effectively.3 (*Recorded crimes per year rose from l.6 million offences recorded by police in l970 to 5.6 million in l992; the figure for total crimes in l992 is estimated at about 15 million pa.)

      Over the last 10 years society has had to face the following dramatic examples that have each in their separate ways symbolised some form of failure in society: (a) The death of Jamie Bulger at the hands of two 10 year old boys; (b) the murder and abuse of many children carried out over a long period of time by Fred and Rosemary West; (c) the Dunblane massacre; (d) the stabbing of the headmaster Philip Lawrence outside his school, and his wife’s call for a national revival of morality; and (e) the apparently racist killing of Stephen Lawrence.

      All these dramatic examples have increased the sense of crisis in society. Unfortunately in none of the above cases has there been a proper analysis of the lessons that can be learnt for the good of society.

      The response of politicians of both main parties has been to compete as to who can sound toughest on crime, who will build the most prisons, and keep the most prisoners locked up the longest. When not being purely punitive, politicians unite in calling for a need to strengthen “family values”. There is also much talk about various forms of symptomatic treatment, such as punishing parents for their children’s wrongdoing and introducing “morality” into the National Curriculum. Yet, “one cannot hope to abolish suicide by legislating against the existence of tall buildings and the sale of rope”!

      It is unfortunate that politicians in their resort to sound bite solutions should ignore the vast amount of knowledge that is available which could form the basis for a rational and cost effective strategy for a healthier society. In this article we intend to concentrate on the issues of child rearing. We accept that wider economic and social issues are also involved (such as the problems of unemployment, poverty, homelessness, and deprivation) but these are outside the scope of the article. The concept that improving child rearing is a vital recipe for the prevention of delinquency and crime in later life is not new. For a fuller development of this theme we highly recommend a publication on this topic by the Family Studies Centre which reviews much of the extensive literature on the subject.1 In this article, we are concentrating on an analysis of the concept of “parenting”.

      It is reasonable to start from the premise that the needs of children are best met by being raised in “families”. However, it is naive to assume that as long as all children are brought up in their natural/biological families there will be no problems. One of the common threads linking most of the above examples is how spectacularly natural families can fail to provide normal happy childhoods. There is nothing foolproof or sacrosanct about natural families as a recipe for a healthier society.

      Families (whether natural or substitute) can only meet the needs of children if they provide them with good (or “good enough”) parenting.

      Concept of good enough parenting

      To the best of our knowledge, the concept of “good enough parenting” was first used by Winnicott.4 In doing so he was recognising that it is unhelpful and unrealistic to demand perfection of parents, and to do so undermines the efforts of the vast majority of parents who are in all practical respects “good enough” to meet their children’s needs. Of course, society has already had to face up to the fact that some parents are “not good enough” by recognising the problem of child abuse and neglect and setting up structures to deal with it, and where appropriate, providing alternative parenting.

      Concept of parenting

      Despite its frequent use the concept of parenting is difficult to define. We use it to refer to a relationship, a process, and a group of activities. “To parent” is an active verb which denotes positive activities undertaken by parent figures towards children. Although the noun “parent” usually implies a natural or biological parent, it should be stressed that “good enough” and indeed “super” parenting can be delivered by non-biological parent figures.

      Anyone concerned with the care of a child can be seen as part of the parenting process. Anyone concerned with any part of a child’s care, control, and development in any setting can be said to be engaging in parenting. Thus grandparents and other members of the extended family, family friends and neighbours, school teachers, family aides, community workers, and even doctors and nurses can all be seen as part of the parenting process.

      Far from widening the definition of parenting so far that it becomes meaningless, we believe that it is essential to recognise the wide continuum of parenting a child needs as he or she moves through childhood and adolescence to adulthood. Even adults have a need for parenting as every parent of “grown up children” knows.

      Importance of parenting and the needs of children

      It is generally accepted that the needs of children are at their most intense in the first five years of life when they are at their most dependent on parent figures for physical and emotional nurture and protection. Good enough parenting delivered consistently over this critical period enables attachment and fosters the child’s sense of basic security, which is essential for subsequent mental health and self esteem. Once acquired, these attributes constitute a firm foundation for the rest of childhood and adult life.

      The crucial role of secure attachment to a parent/parent figure in this context was highlighted as long ago as l95l by John Bowlby5 for whom the development of this theory constituted his life work. In general, the basic tenets of attachment theory have stood the test of time, although Rutter6 has summarised important changes of emphasis over the 30–40 years since Bowlby first proclaimed its importance. Tizard, in a study of adoption of older children, showed that although the concept of a critical period for attachment remained valid, the duration of this period can extend into later childhood.7

      Rutter also stressed that the extent to which distortions of attachment impacted on a child varied as a result of the child’s temperament, genetic endowment, and special needs.

      Components of good enough parenting

      We can define good enough parenting as a process that adequately meets the child’s needs, according to prevailing cultural standards which can change from generation to generation. Of course all children need physical care, nutrition, and protection. Over and above these basics, the child’s emotional needs can be regarded under the following three headings: (1) love, care, and commitment; (2) consistent limit setting; (3) the facilitation of development.

      It is vital to realise that the long term provision of all three aspects of parenting is essential to ensure that the child grows up into an emotionally secure, fully developed, and competent adult.

      (1) LOVE, CARE, AND COMMITMENT

      We make no apologies for the use of the word “love”. It is ironic that this most vital and easily understood concept is hardly to be found in the scientific literature. Children need to feel that they are loved consistently and unconditionally, and attachment behaviour is the natural consequence of this. If a child is severely emotionally deprived throughout early childhood, there is a risk of developing Bowlby’s “affectionless psychopathy” with all the social handicap that will result for both the individual and society. If the deprivation is partial, the child will be at risk of developing insecure attachments with subsequent disturbance of social and emotional relationships.

      Unfortunately some child care professionals seem to have lost sight of the crucial importance of “emotional deprivation” as highlighted by Bowlby. In child protection work the concept has been virtually lost, or subsumed within the category “emotional abuse”, which is really quite different, being a positive rather than a negative form of abuse. Paediatricians can document failure of physical growth in severe cases of non-organic failure to thrive. They (and child psychiatrists) are less good at recognising and acting upon “emotional failure to thrive”. Perhaps we need the equivalent of a blood test for “serum love”, which when low levels are recorded would indicate the need for urgent replacement therapy.

      (2) CONTROL/CONSISTENT LIMIT SETTING

      Control is concerned with setting and enforcing boundaries to help the child in his/her dealings with the outside world. Boundaries must be set to show what behaviour is unacceptable, with due allowances made for developmental stages. Enforcement involves clear actions of either reward or disciplinary sanctions to ensure compliance within these boundaries.

      “Good enough” control requires the setting of reasonable boundaries which are enforced in a consistent yet loving way so that the child eventually accepts the reality of the boundaries and incorporates them in its actions. Ideally the child learns to live within generally acceptable boundaries for behaviour, that is becomes socialised. If the boundaries are inherently unreasonable or control is applied inconsistently or too punitively this will be damaging to the child’s development. Many habitual delinquents have been the subject of an indulgent lack of discipline interspersed with unpredictable and sudden outbursts of harsh discipline.

      (3) FACILITATION OF DEVELOPMENT

      This third aspect of parenting involves fostering the child’s development to enable the child to fulfil his/her full potential. This involves every area of functioning, from the physical and intellectual to the moral, aesthetic, and spiritual. The child has a fundamental need for a secure base from which to explore his/her environment. “Good enough” care involves providing rich and varied stimulation in early childhood followed by involvement and support for the child throughout later years until adulthood is reached.

      Consequences of not good enough parenting

      Children can suffer deficiencies in any or all of the above aspects of parenting, and considerable overlap is common. However, if one postulates pure deficiencies of each modality in isolation the following patterns would be expected.

      TYPE A

      Defective loving care and commitment throughout early and middle childhood is a barrier to normal attachment. This will be expected to produce an insecure personality with low self esteem, and problems with peer relationships, marriage, and parenting. One or more types of personality disorder may be the consequence,6 with the most extreme result being “affectionless psychopathy”.

      TYPE B

      Children brought up without controls or with totally confusing controls are at risk of future conduct disorder, delinquency, and criminal behaviour.8

      TYPE C

      Children whose early development is blighted by neglect and understimulation are at risk of subsequent educational failure and social handicap.

      Of course, many children are subjected to a mixture of all three forms of defective parenting and end up with a combination of any of these end results. Each of these three end results has been shown to be strongly associated with subsequent criminal behaviour.

      Possibility of predicting criminality

      If we consider the above end results of “not good enough” parenting, together with evidence from criminological literature, it becomes apparent that there is strong evidence for the concept that juvenile delinquency and adult criminal activity can be predicted. If criminal behaviour can be predicted early enough and its aetiology understood in sufficient depth, then there should be excellent opportunities for a preventive strategy. This is arguably the current state of affairs regarding crime, but what is lacking is a consensus on how to intervene effectively and where the resources are to come from.

      Much of the best evidence in the UK comes from the Cambridge Study in Delinquent Development by Farrington and West.9 They found that one of the best predictors of later delinquency was the teacher’s assessment of “troublesomeness” at the age of 8–l0 years. Nearly half of a series of recidivist delinquents had been previously identified as troublesome by their primary school teachers.

      Similarly evidence from Norway has shown that 60% of known school bullies had committed a criminal offence by the age of 24, and that bullies were four times likelier than non-bullies to become recidivist criminals.10 Poor parenting was seen as the basic underlying cause of these problems. However, such examples of prediction apply to a relatively late state in a child’s development. If prevention is possible, logic dictates that the sooner it can be instituted the greater the chances of success. Accordingly, predictive factors that can be identified earlier in childhood are needed. The Cambridge study again yields valuable evidence, to the effect that four other factors were found to be strongly and independently associated with future delinquency, each to roughly the same extent.9These were: (i) poor parenting; (ii) economic deprivation; (iii) family criminality; and (iv) educational failure.

      Economic deprivation is obviously important but is outside the scope of this article. Family criminality does not lend itself easily to a preventive strategy (other than adoption!) Educational failure manifests itself late in a child’s development, and a preventive strategy based on this should be aimed at the preschool period. Anyway, much of the educational failure that is preventable is probably secondary to poor parenting.

      This leaves poor parenting itself as the single factor most likely to respond to a preventive strategy, because it is (a) easily identified early in a child’s life and (b) very likely that its association with subsequent criminality is a causative one (see above).

      Evidence from the Newcastle 1000 Family Study endorses this view.11 This showed a strong association of criminal behaviour in adults with their having been exposed to “multiple deprivation” as children. However, it was found that children from deprived backgrounds who did not acquire a later criminal record had almost all received “good parenting”. The authors concluded “Good parenting protects against the acquisition of a criminal record”.

      Economic arguments for prevention by targeting parenting

      Presumably one of the functions of the criminal justice system is to prevent crime by the deterrent effect of detecting crimes and punishing criminals. However, it has failed to prevent a 300% increase in crime over the last 30 years so by any standards it is a near total failure. Unfortunately it is also an extremely expensive failure.

      A Home Office working party has attempted to quantify the total economic cost of crime to society.12 The official costs of the criminal justice system in l992 were £9 billion, a 100% increase since l978. If the costs to victims and property are included the cost of crime is thought to roughly equal the entire cost of running the National Health Service (£18 billion in l988). Yet staggeringly, only 3% of offences committed by adults result in a perpetrator being cautioned or prosecuted.13 The figures for juvenile crime are probably even lower. The Audit Commission report Misspent Youth has recently highlighted this gross misdirection of public money.14

      While many of the measures needed for a preventive strategy will require considerable resources, in view of the expensive failure of the criminal justice system, it is not a question of “Can we afford a preventive strategy” but “Can we afford to carry on the way we are going?”.

      Although a preventive strategy aimed at providing better parenting for all vulnerable children in society will be expensive, it is likely to be vastly more cost effective than continued reliance on the criminal justice system.

      Governments as parents of society

      Governments should be regarded as the parents of society. A “not good enough parent” of a government will show a general lack of care for the whole population, will put its own interests first, will discriminate against some of its “children” in favour of others, and will react excessively punitively when some if its children misbehave. A “good enough parent” of a government will truly care for all its children and will seek to promote their welfare, while still being firm and fair in applying sanctions for unacceptable behaviour. It will also be interested in using available knowledge to understand and ameliorate problems arising in society, like a well meaning family accepting they have problems and seeking appropriate help. A preventive strategy aimed at promoting good enough parenting is the treatment that British society would seem to need as a matter of urgency. A central aim should be to instil the idea that we are all responsible for society’s children.

      Good enough parenting for all children

      We offer the following policy proposals for consideration as part of a preventive strategy.

      Firstly, it should be recognised that the vast majority of parents in society are already providing good enough parenting, and accordingly a strong degree of targeting is in order. Health visitors are already perfectly capable of detecting poor parenting in early childhood, but they lack support for effective intervention. (The features of the whole spectrum of parenting are well described by Cooper.15)

      The majority of not good enough parents should hopefully benefit from early and intensive support, enabling them to become good enough parents. Supportive measures could involve: (a) universally available nursery placements; (b) well resourced and expert social work help/family aides/respite care; (c) parenting classes for teenage parents; (d) easier access to child guidance/child psychiatry services; (e) early referral from nursery/infant school for children with remediable problems such as attention deficit hyperactivity disorder, dyslexia, and severe behavioural problems; (f) effective antibullying strategies in schools; and (g) strategies for prevention of teenage pregnancies.

      The school health service as a whole has a potentially crucial role in the development of the above strategies. (In this context it is extremely worrying that in many areas school health services are currently under threat.) However, considerable resources will also be needed for health visiting, social services, child psychiatry, and education to reverse the low morale and near despair that years of underfunding have caused. Hopefully this will allow the professionals to recharge their batteries to the extent that they can tackle these problems effectively on a population-wide basis. It is essential that multiagency responses are coordinated so that identification of problems by health visitors, school doctors, etc can lead to effective intervention.

      Important and innovative work by Davies et al has shown that it is possible to achieve significant improvements in families in areas of high deprivation in London.16 This programme involved extra training and supervision of health visitors and school doctors and did not require major new resources. Extending programmes like this on a nation-wide basis would seem a practical way of beginning to tackle the major task we are considering.

      Finally, society and professionals should face up to the fact that not all parents can respond to professional intervention to a degree sufficient to meet their children’s needs. The Kempes’ concept of “the untreatable family” is relevant here.17 Society and social workers accept the need to remove severely battered or sexually abused children from their natural families for good. However, society finds it harder to accept that there is a far larger number of children who suffer significant harm from neglectful parenting to their detriment and to the future detriment of society. Most of these children never even get on to an at risk register, let alone have a protection/nurture plan drawn up. Child A in the Bulger case is a dramatic example. All the features of his emotional deprivation were well known to professionals for several years before the murder yet no action was taken. There is ample evidence that the conditions associated with poor parenting are becoming more widespread.18 There are strong hints that our politicians are at last waking up to the central importance of good parenting, as evidenced by the formation of the All-Party Parliamentary Committee on Parenting, and the recent document on parenting from the Labour Party.19 However, unless this leads to a coherent strategy supported by adequate resources, we seem doomed to continue current policies of “too little, too late”.

      References

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