Image: The Informed Parent Book.
I recently spoke with the authors about their their approach to providing, and empowering parents with, information.
Shannon Rosa: You are upfront about wanting to give parents information, not advice. Why?
Tara Haelle: Advice implies that you fully understand another person’s situation and that you are telling them the best course of action based on their situation. That’s impossible to do for (hopefully!) millions of readers. Each family has different needs, circumstances, finances, values, beliefs, and, above all, different children, and what each family needs to do in their circumstances will vary based on all those things. The best we can hope to give is information they can factor in with those other considerations to determine for themselves what will likely be the best route for them, and we hope that they do seek advice from others who do know their family well, such as their pediatrician.
Emily Willingham: I think unsolicited advice is presumptuous, and I also think that once you acknowledge how idiosyncratic we all are—our families, our children, ourselves as parents—there's no way I'd be comfortable doling out anything that could be perceived as 'one-size-fits-all' parenting advice.
SR: Parents can mis-evaluate information if they don’t know the difference between correlation and causation. What are your favorite examples of why this distinction is so important?
TH: One of the classic examples used is that of polio and ice cream. There was a correlation in the '50s between ice cream sales and polio cases, which might make it appear as though ice cream causes polio, which of course it doesn’t. In reality, polio was a summer disease, often spread through water (such as swimming pools), and cases would spike in the summer. Summertime is also when ice cream trucks are trolling neighborhoods and more folks are cooling off with a cone. The two were definitely correlated, but neither was having any influence on the other. Rather a separate correlation—temperature—was the driving factor for both to some extent.
Tara Haelle: Advice implies that you fully understand another person’s situation and that you are telling them the best course of action based on their situation. That’s impossible to do for (hopefully!) millions of readers. Each family has different needs, circumstances, finances, values, beliefs, and, above all, different children, and what each family needs to do in their circumstances will vary based on all those things. The best we can hope to give is information they can factor in with those other considerations to determine for themselves what will likely be the best route for them, and we hope that they do seek advice from others who do know their family well, such as their pediatrician.
Emily Willingham: I think unsolicited advice is presumptuous, and I also think that once you acknowledge how idiosyncratic we all are—our families, our children, ourselves as parents—there's no way I'd be comfortable doling out anything that could be perceived as 'one-size-fits-all' parenting advice.
SR: Parents can mis-evaluate information if they don’t know the difference between correlation and causation. What are your favorite examples of why this distinction is so important?
TH: One of the classic examples used is that of polio and ice cream. There was a correlation in the '50s between ice cream sales and polio cases, which might make it appear as though ice cream causes polio, which of course it doesn’t. In reality, polio was a summer disease, often spread through water (such as swimming pools), and cases would spike in the summer. Summertime is also when ice cream trucks are trolling neighborhoods and more folks are cooling off with a cone. The two were definitely correlated, but neither was having any influence on the other. Rather a separate correlation—temperature—was the driving factor for both to some extent.
While this is a fun example, we also discuss in the book the correlation between early administration of Tylenol and later asthma in children. That would make it seem as though parents shouldn’t give their children Tylenol for a fever or pain lest they increase their child’s risk of asthma later on. Again, in reality, the kids who tended to need Tylenol more often in infancy and toddlerhood were those who got sick more, often with respiratory infections, which are also more common in children who develop asthma. So it wasn’t Tylenol causing asthma; it was the underlying predisposition for respiratory infections that was causing both the need for Tylenol and the increased risk of asthma. The danger here is that a parent might refrain from giving their child a medication to make the child more comfortable or get more sleep, or to lower a fever, out of an unfounded fear.
EW: I saw a data visualization on Twitter yesterday that made me think about the fact that some people tend to assert that anything that's been on the increase over the last 20 or 30 years must somehow be related to increased autism prevalence as well. Lots of things have changed—increased or decreased—in the last 20 or 30 years. Based on the visualization I saw, apparently banana consumption has increased quite a bit. So, based on correlation alone, we might be able to infer that bananas cause autism. Of course, we know from really digging into data that the 'increase' is attributable to diagnostic shifts and better recognition.
SR: I appreciated your empathetic take on the Dunning-Kruger effect (how we overestimate our own competency) in pediatrician’s office scenarios. Can you talk about how Dunning-Kruger applies to pediatric matters such as evaluating childhood vaccine benefits and risks?
TH: Parents understandably want to do as much research as possible on a topic that they worry about, and vaccines are something a lot of parents have reservations about. The problem with “doing your own research” is that the research on vaccines is pretty complex, involving immunology, pediatrics, epidemiology, biostatistics, public health, rheumatology, human development, and several other fields of medicine. Even the experts in these individual areas do not have specialized knowledge in the other areas, which is why so many studies on vaccines will often have many authors.
EW: I saw a data visualization on Twitter yesterday that made me think about the fact that some people tend to assert that anything that's been on the increase over the last 20 or 30 years must somehow be related to increased autism prevalence as well. Lots of things have changed—increased or decreased—in the last 20 or 30 years. Based on the visualization I saw, apparently banana consumption has increased quite a bit. So, based on correlation alone, we might be able to infer that bananas cause autism. Of course, we know from really digging into data that the 'increase' is attributable to diagnostic shifts and better recognition.
SR: I appreciated your empathetic take on the Dunning-Kruger effect (how we overestimate our own competency) in pediatrician’s office scenarios. Can you talk about how Dunning-Kruger applies to pediatric matters such as evaluating childhood vaccine benefits and risks?
TH: Parents understandably want to do as much research as possible on a topic that they worry about, and vaccines are something a lot of parents have reservations about. The problem with “doing your own research” is that the research on vaccines is pretty complex, involving immunology, pediatrics, epidemiology, biostatistics, public health, rheumatology, human development, and several other fields of medicine. Even the experts in these individual areas do not have specialized knowledge in the other areas, which is why so many studies on vaccines will often have many authors.
A parent who has a high level of education, such as a master’s degree or a doctorate, may believe their research skills from that education will be sufficient to make sense of all the studies. The plain fact of the matter is that their education isn’t sufficient. If it were, then the researchers doing these studies would not have had to attend eight or more years of school and work with other specialists to conduct these studies. Similarly, as much as a parent might research online, their knowledge will never come close to the years of medical school, residency, and professional clinical experience that their pediatrician has.
It’s therefore essential for parents to acknowledge what their limits are in understanding these studies and to rely on the experts who have actually spent years studying and practicing enough to really be able to make recommendations based on the evidence about vaccines.
SR: Why do recommended childhood visits include an autism screening at 18 months?
SR: Why do recommended childhood visits include an autism screening at 18 months?
EW: The idea is that early identification can mean early intervention and better outcomes. How much does that hold true individually? That's difficult to say because what constitutes early intervention and which of these interventions is actually effective at all, versus just browbeating autistic people into putting up a neurotypical front, is unclear.
SR: What do you think parents should know about autism causation?
Image: The Informed Parent Book .
Image: The Informed Parent Book.
EW: I think that they should know that direct causation is an elusive beast. There's very little that anyone can point to and say, "don't do that" or "do that" and you'll keep your child from being autistic. As the science stands now, their best option is to love, support, accommodate, and understand their child the best that they can, regardless of neurology.
SR: How do you think pediatricians can discuss autism without invoking the usual doom-and-gloom? And are there autism resources in the expanded online supplements to your book that address this matter?
EW: I think that the best thing pediatricians can do is to avoid the language of medicalization, approach the situation from one of understanding and trouble-shooting aspects of the diagnosis that relate to quality of life and function, and preferably come into the conversation with some education around presuming competence, punctuated development and different developmental trajectories, and awareness of the importance of positive support networks. Obviously, I'd recommend Autistic Self Advocacy Network and Thinking Person's Guide to Autism.
SR: The media is always throwing up its collective hands about childhood obesity. Are these concerns valid? And why is pizza the enemy food?
EW: My children eat A LOT of pizza once a week. They are not obese. I can't speak to pizza as an enemy.
Regarding childhood obesity, obviously, those rates are a concern. It doesn't help that the environments for our children don't promote enough healthy eating or physical activity in many cases. The best we can do is try to ensure diversity of food and activity to the best of our abilities. Personally, I try to make sure that my children spend time outside and moving around on a daily basis. At school, they do that regularly, so that leaves it up to us especially on weekends and through the summer, and we've have tried to make that a regular family practice for their entire lives—like literally from birth. But we're privileged that we're able to do that, and one thing that needs to be addressed is creating equal opportunities for that.
TH: The concern about childhood obesity is valid because obesity often follows a person throughout life and increases the risk of a wide range of health conditions, including heart disease, type 2 diabetes, sleeping problems, and mental health problems (among others).
TH: The concern about childhood obesity is valid because obesity often follows a person throughout life and increases the risk of a wide range of health conditions, including heart disease, type 2 diabetes, sleeping problems, and mental health problems (among others).
What’s not valid is the implication that childhood obesity is something for one parent or family to prevent or solve. It’s an incredibly complex problem, and our environment plays such a significant role in it that it will require top-level interventions in communities to really start addressing it. Parents can definitely implement practices and behaviors that reduce the risk of obesity in their children, but it’s undoubtedly an uphill battle in the “obesogenic environment” most of us live in.
Pizza itself isn’t really an enemy food—any kind of demonizing of food is unhealthy for a person’s relationship with food. It can often be a high-calorie food, and high caloric intake is the biggest driving mechanical factor of obesity (alongside genetics). The “problem” with pizza is that it’s a ubiquitous food. It’s at birthday parties and school parties and soccer game celebrations and so on. That’s not a problem is consumption is moderate or infrequent, but with any other high-calorie food, eating too much too often is going to add pounds. (Pizza also tends to be very high in sodium, but that has less to do with obesity.)
SR: Screen time is another contentious topic. And you do say that yes, well, it may be a factor in childhood obesity—but not for the reasons most people think. Can you elaborate?
TH: Most people think obesity results from inactivity—sitting around and not exercising enough. But inactivity results from obesity much more than the other way around. When you become larger and it’s more difficult and painful to do physical activities—and/or if your peers make fun of you when you try—you stop being physically active. So it’s not that kids are couch potatoes sitting around watching TV and not getting enough exercise. (And in fact, the physical activity kids get today isn’t really much lower than what kids got 50 years ago. It’s slightly lower, but not much.) If that were the case, kids would pile on the pounds while sitting and playing video games too, and the evidence doesn’t show that.
SR: Screen time is another contentious topic. And you do say that yes, well, it may be a factor in childhood obesity—but not for the reasons most people think. Can you elaborate?
TH: Most people think obesity results from inactivity—sitting around and not exercising enough. But inactivity results from obesity much more than the other way around. When you become larger and it’s more difficult and painful to do physical activities—and/or if your peers make fun of you when you try—you stop being physically active. So it’s not that kids are couch potatoes sitting around watching TV and not getting enough exercise. (And in fact, the physical activity kids get today isn’t really much lower than what kids got 50 years ago. It’s slightly lower, but not much.) If that were the case, kids would pile on the pounds while sitting and playing video games too, and the evidence doesn’t show that.
TV watching can contribute to obesity in two ways: first, it can interrupt or reduce sleep, and second, it can lead to increased calorie consumption. When kids stay up late watching TV, it’s harder for them to fall asleep and stay asleep, and they often get less sleep if they’re watching TV instead of snoozing. Getting insufficient or poor quality sleep is a risk factor for obesity, even if they’re not eating more calories during that time. One possible mechanism is that it messes with the hormones (leptin and ghrelin) that control hunger and satiety, but scientists are still working out the complexities of the relationship between obesity and sleep.
Meanwhile, when kids are watching TV, just like adults, they’re more likely to mindlessly eat. They don’t realize how much they’ve eaten, and it’s really easy to overeat. At the same time, they might be seeing commercials for sugary cereals or cookies or sports drinks or other snacks and sugary drinks that make them hungry and increase their interest in that food. That means they’re more likely to get up and go get a snack, and it means they’re more likely to choose a calorie-dense, less healthful snack—and that it will become a food they turn to more often. After all, it’s advertising, and it works.
EW: Meh. I don't lie awake at night worrying about screen time. Some days, we have movie marathons. Some days, we're outside all day. Our focus is diversifying activity, which can be difficult to do in the age of Minecraft, so we lay down some rules that limit that time. We definitely try to ensure some pre-bedtime screen darkening. We generally don't allow food in the room where our TV is, so our children don't eat and watch TV at the same time. They do not have computers or TV in their bedroom. We also emphasize spending a certain amount of time every day reading.
SR: You also mention that screen time right before bed actually can make it harder for kids to fall asleep. Why is this?
EW: Meh. I don't lie awake at night worrying about screen time. Some days, we have movie marathons. Some days, we're outside all day. Our focus is diversifying activity, which can be difficult to do in the age of Minecraft, so we lay down some rules that limit that time. We definitely try to ensure some pre-bedtime screen darkening. We generally don't allow food in the room where our TV is, so our children don't eat and watch TV at the same time. They do not have computers or TV in their bedroom. We also emphasize spending a certain amount of time every day reading.
SR: You also mention that screen time right before bed actually can make it harder for kids to fall asleep. Why is this?
TH: One reason is that the light from TV can suppress the release of melatonin, the hormone that tells us it’s time to go to sleep. Another reason is that staying up to watch TV displaces the time that could be spent sleeping. Third, TV can be stimulating. If a child is wound up from watching a funny or exciting or scary show, it’s harder for them to wind down for sleep.
EW: My children can still practically fall asleep standing up, even after a rousing movie, so individual mileage can vary a great deal on this. But in general, screen time right before bed—for any of us—is considered to lead to too much arousal for easy entry into sleep.
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Shannon Des Roches Rosa wishes she could go back in time and read The Informed Parent when her kids were teeny. You can read many of the mistakes she made without Emily's and Tara's guidance in the archives of ThinkingAutismGuide.com, BlogHer.com, and Squidalicious.com.
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