Behav. Res. T/w. Vol. 31. No. 3, pp. 239-247, 1993 Printed in Great Britain. All rights reserved 0005-7%7/93 66.00 + 0.00 Copyright 0 1993 Pergamon Press Ltd zyxwvutsrqpon INVITED ESSAY PUTTING THE FAMILY BACK IN THE CHILD BARBARA G. MELAMED Ferkauf Graduate School of Psychology, Clinical Professor in Psychiatry, and Epidemiology and Social Medicine, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY 10461, U.S.A. (Received 16 July 1992) Summary-As clinicians and scientists we see daily the close tie between parental competence and emotional functioning and how children succeed with many of life’s stressors. Inadequate attention has been paid to the theoretical underpinnings of predicting children’s emotional reactions to stress from a systems perspective. Longitudinal developmental studies of parental influence on children’s ability to cope with life’s frustrations, through reciprocal interactions and genetic predispositions, are mandatory. Theoretical frameworks are already developed which must be drawn on to derive the best predictions of when and how to involve our child patients with family support. The current essay will attempt to bridge family systems and social network theories to the understanding of children’s coping with medical stressors. Parents’ emotions reflect the health of parentshild relationships. “They are the barometers for the quality of parenting, the developmental outcomes that are likely for children, and the impact that environmental stresses and supports are having on the family” (Dix, 1991). Yet, the mechanism by which this operates is poorly understood. Conceptions of parents’ emotions have been so undifferentiated, and often treated as stable traits, that the specific processes responsible for their relations with other variables have not been illuminating. Researchers have seldom examined what causes them, or how and why they change. The emphasis on distressed families, and the many studies focusing on negative emotion, places undue emphasis on disorganization and its dysregulatory effects. In fact, many investigators of emotions (Johnson McGillicuddy-Delisi, 1983; Zahn-Waxler, Radke-Yarrow, King, 1979) have suggested that negative emotions may be adaptive for parenting if they are not excessive or chronic. It may be that agitation signals action-taking and, if effective problem solving occurs, the child may be encouraged to mobilize coping resources. It has been empirically demonstrated across a number of situations in which there is little control over painful events, that reassuring parental comments trigger anxiety and disruptiveness. The contributions of many teams, including Blount, Corbin, Sturgis, Wolfe, Prater and James (1990), Bush, Melamed, Sheras and Greenbaum (1986) and Jacobsen, Manne, Gorfinkle, Schorr, Rapkin and Redd (1990) have provided systematic tools for evaluating behaviors in dyads sequentially as they interact in unique ways in the parent-child dyad or, in many cases, with the health care professional. In order to “put the family back in the child” influences both reciprocal and perhaps causal need to be identified. The model I will present is based on research which takes into account knowledge about the confronting task, parenting and the individual children’s characteristics. It forces us to consider the dyads of mother-child, mother-father and child-child interactions. The model is a transactional systems modification of the Melamed (1990) conception, which views the coping resources as part of the schemata involving interaction of the individual with the transactions of the environmental agencies (including physicians and parents) in order to provide balance. The literature suggests that the preparation of a particular child must be based on a number of factors: the nature of the procedure, the age and previous experience of the child, and the parental influence in understanding the childs needs. The child’s coping style, temperament, anxiety level and level of understanding should influence how information might best be imparted. Melamed, Siegel and Ridley-Johnson (1988) pointed out the necessity for understanding the event itself and establishing a taxonomy of what is stressful depending upon the age of the child, the anxiety of the caregiver and the future implications of the procedure (i.e. should it be an ongoing or a single procedure and is it likely to minimize future discomfort and enhance well being). 239