- Christy Kleinsorge, PhD
- Lynne M. Covitz, PhD, ABPP
Drs Kleinsorge and Covitz have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
Divorce has become a common part of the fabric of American life, and its impact on children has been studied extensively, with findings revealing that a multitude of factors predict both short- and long-term adjustment.
After completing this article, readers should be able to:
Understand the impact of developmental stage on children's adjustment to divorce.
Understand the influence of developmental stage on children's adjustment to blended families.
Be aware of custodial issues and their effect on child adjustment.
Be aware of the impact of parental behaviors and adjustment on child adjustment.
Understand the role of the primary practitioner in providing guidance around divorce issues.
Divorce in America affects children of every ethnic background, religion, and socioeconomic status. Approximately 50% of all first marriages will end in divorce, with over 1 million children being affected per year. The most recent data published by the Centers for Disease Control and Prevention (CDC) reveal a divorce rate in 2009 of 3.4 per 1,000 total population across the United States (six states excluded from the CDC numbers), equaling ∼1 million divorces in that 12-month period. (1) The CDC reported that in data sampled across five states, 26.6% of adults over 18 years old reported experiencing parental divorce or separation during their own childhood. (2) If the number of marriages that end in long-term separation but not divorce is considered, the rate of children being affected by parental separation is even higher.
Of course, just as the American populace is not homogenous, neither are the data on divorce and separation. Data from the National Survey of Family Growth suggest that African American women are more likely to suffer marital separations and divorces and are less likely to remarry than are white or Hispanic women. Women of Asian descent have significantly lower rates of marital disruptions. The data also reveal that socioeconomic factors may be predictive, in that increased poverty and lower levels of education in communities and neighborhoods increase the likelihood of separations and divorces. (3)
Divorce has become a common part of the fabric of American life, and its impact on children has been studied extensively, with findings revealing that a multitude of factors predict both short- and long-term adjustment. In this article, we will focus on the contribution of developmental stage to emotional and behavioral adjustment to the divorce itself, visitation issues, and new family configurations.
Concerns Across Developmental Stages
The fact that a child experiences the divorce of his or her parents does not in and of itself doom that child to significant adjustment problems. A number of parental choices and behaviors are important to emphasize regardless of the developmental stage of the child. First and foremost, children are more likely to have healthy emotional adjustment if parents refrain from exhibiting their conflict in front of them. This association is true for children with married or divorced parents.
When children are regularly subjected to the hostility that frequently accompanies the circumstances of divorce, they are exposed to high levels of stress that can lead to physiologic reactions, such as increases in cortisol levels. (4) Increased cortisol is known to be associated with anxiety, sleep problems, weight changes, and irritability. Children who frequently hear negative comments from one parent about the other may suffer disruptions in parental attachment and perceive pressure to declare loyalty to one parent or another, or both.
Research has revealed that when high-conflict parents are able to contain their conflict and not expose their children to it, these children are not significantly different in terms of postdivorce adaptation as compared with children of low-conflict divorced parents or even low-conflict married parents. (5) Conversely, children exposed to high-conflict parental interactions are significantly more likely to exhibit externalizing behavioral problems, emotional dysregulation, and decreased academic performance.
Concerns Specific to Developmental Stages
Parents should be encouraged to take into consideration the developmental stage of each of their children as they work to minimize the negative impact of divorce. A child's awareness of changes related to the divorce and understanding of the divorce process will depend very much upon their age and stage of cognitive development. In addition, warning signs of adjustment difficulties may look different at different developmental stages.
Infants obviously are not able to understand the concept of divorce, but they are able to notice changes in their environment, including changes in caregivers and in caregiver routines. Infants need stability in their daily routine and sufficient contact with a primary caregiver to allow for the development of secure attachment. Attachment may be an especially important consideration because early secure attachment on a dependable caregiver is thought to form the basis for future relationships. (6) Infants may show signs of distress, which can take the form of fussiness or irritability or can present as withdrawal or listlessness. Changes in sleep and appetite patterns also may be caused by distress, and in situations characterized by extreme stress or neglect, infants may be delayed in meeting developmental milestones. (7) Infants will benefit from consistency in routine, physical affection, and positive social interactions.
Toddlers will be aware of changes in parental presence and may develop separation anxiety, increased irritability, and regression of skills. For example, a child who had given up thumb sucking may resume that habit, or a child who has been successfully toilet trained may begin to have accidents. Sleep and eating patterns may be affected by stress, and toddlers also may develop excessive fears. (8) Like infants, toddlers benefit from consistency in routines as well as quality time with their parents.
Preschoolers are better able to understand that one parent is no longer living with them. However, they still may not understand the permanency of divorce and may repeatedly ask questions about divorce. Repeated questions by preschoolers are not an indication of lack of understanding or memory but are a developmentally appropriate method of confirming the stability of what they have been told. These repetitive questions help in the processing of information. Difficulty coping with changes in schedule will continue during the preschool years, and preschoolers need to know what to expect.
Preschoolers may exhibit demanding behavior or attempt to control their surroundings in an effort to create order. Developmental regression is not uncommon in the aftermath of divorce, as is true with preschoolers’ reaction to any traumatic event. Some preschool-age children may show signs of reunion fantasies. (8) Parents can protect preschoolers and ease the adjustment period by providing one-on-one attention, keeping behavioral expectations constant, and providing honest and developmentally appropriate information about how the divorce process will affect their preschooler's day-to-day life.
School-age children experience tremendous cognitive growth and become better able to comprehend the concept of and permanency of divorce. School-age children are prone to blaming themselves for the dissolution of their parents’ marriage, and reunion fantasies continue to be common. Changes in mood may be noticed, especially increased sadness and anger. Difficulty with academic performance is common. School-age children also may act out in response to divorce, (9) possibly to test behavioral boundaries in their new situation. School-age children need reminders that divorce is final and that they are not at fault. They do best with consistent behavioral expectations and consistent consequences for rule violations. School-age children also need to be supported in maintaining relationships with both parents and will benefit from being allowed to express their feelings openly.
Adolescents are better able to understand abstract and complex issues surrounding divorce, may have difficulty accepting divorce, and may self-blame. Signs that adolescents are having difficulty adjusting to divorce include acting out, taking on excessive responsibility, and worrying about adult issues. Research has revealed that adolescents with divorced parents are more likely to have both externalizing problems (eg, drug and alcohol use, rule violations) and internalizing problems (eg, depression, anxiety, withdrawal from family or friends) than are their counterparts who have intact families of origin. Adolescents are in the process of finding their own identity, and their feelings about their parents’ divorce may affect the development of their own views on love and relationships.
Parents can ease the adolescent's adjustment to divorce by being open to calm conversation about their teenager's reaction to the divorce, by not including their adolescent children in conversation about adult topics (eg, legal and financial matters), and by having consistent expectations for their behavior. Adolescents with significant emotional and behavioral concerns also may benefit from group or individual therapy (Table 1).
Individual Differences in Adjustment
Several individual characteristics have been associated with resilience and the ability to cope with divorce, including easygoing temperament and average or higher cognitive abilities. Children endowed with these positive attributes are better able to seek out and obtain support from others and to adapt to change, whereas children with difficult temperaments or difficult behavior are more likely to struggle to adapt in the aftermath of divorce. In addition, children with developmental needs, chronic medical conditions, or behavioral problems may cause more parenting stress, which may exacerbate parent-child relationship problems and adjustment difficulties.
Unlike age or developmental level, gender has been shown to have fewer consistent effects on the immediate adjustment to divorce. When differences are reported, typically it is found that boys have more postdivorce challenges than girls, but the differences are relatively small. (10) Adolescent boys are more likely to struggle academically in the face of parental divorce than are adolescent girls. Further, girls are more likely to have improved emotional adjustment and increased personal accomplishments after divorce than are boys.
Most early research on the effects of age and gender on adjustment to divorce have compared children with divorced parents and children who do not experience parental divorce in a particular age range, without accounting for the timing of parental divorce. More recently, Lansford et al (11) have investigated developmental trajectories beginning 1 year before divorce and following children until 3 years after parental separation or divorce. Their results revealed that children in kindergarten through fifth grade at the time of their parents’ divorce were more likely to struggle with internalizing problems compared with young children whose parents did not divorce. Older children (sixth through 10th grade) whose parents divorced were more likely to struggle academically than their peers whose parents remained married, but were not different from those peers on measures of emotional and behavioral adjustment.
Environmental changes related to divorce also may affect children's adjustment. Children may have to move to a new home and possibly a new community after divorce, and families may experience increased financial difficulties. Even under the best of circumstances, children need time to adapt to any significant change in their lives (eg, school placement, new homes). This adaptation is more challenging if the child's support system has been disrupted through separation from a parent, other family members, and other sources of support, as frequently occurs in the divorce process.
Across the United States, a wide variety of parenting arrangements are utilized in separated families and families of divorce. Traditionally, the mother would be the primary custodian and caretaker, with the father having periodic visitation, sometimes every other weekend, from Friday night to Sunday, and an additional visit during the week. As we entered the new millennium, however, the importance of the regular and consistent role of the father was increasingly emphasized and investigated, both in intact families and families of divorce.
As women more often took a role of significant, and sometimes primary, breadwinner, men assumed a more active role as caregiver of their children. Research reveals this paradigm to be of benefit to children because they are able to receive the unique contributions that each parent provides to their growth, development, and adaptation. Accordingly, legal and judicial systems across the country have increasingly granted more parenting time to fathers in the case of divorce or separation. Indeed, the terms “parenting time” and “parenting plan” are being viewed as more appropriate than “visitation time” and “visitation plan,” because fathers view their role not as visitors but as parents responsible for daily care and discipline.
Parenting plans continue to vary based on a number of factors, including age of the child, distance between the two homes, schooling and work logistics, the living arrangement of each parent, and parental emotional adjustment and mental health issues. Joint physical custody is awarded more regularly, with parenting time being split between one-third to one-half with one parent and the remainder with the other.
Although there is substantial literature comparing joint custody to sole maternal custody, there is a paucity of empirical evidence addressing the impact of specific visitation plans on child adaptation. (12) Pruett and Barker (13) found that children ages 4 to 6 years whose visitation plans included overnight visits with the nonprimary caregiver were reported to have fewer social problems, as well as internalizing and externalizing problems. For children ages 0 to 3 years, no significant relationship was found between overnights and the measured variables. The same study revealed that children whose visitation schedules were inconsistent had more social problems and internalizing symptoms.
There are three main pathways through which a parenting plan is devised: (1) agreement between two cooperating parents, (2) mediation, and (3) the courts. Parents who succeed through the mediation process tend to avoid escalation of conflict, improve coparenting cooperation, and save significant legal costs. Most importantly, research reveals that involvement of fathers in their children's lives increases up to 12 years postdivorce, as compared with parents who go through an adversarial court process. (12)
Adjustment to Blended Families
Approximately one-half of divorced adults remarry within 4 years of their divorce, and at least one-third of American children enter stepfamilies (primarily biologic mothers and stepfathers). (14) Divorce and remarriage are not acute events; rather they entail extended periods of adjustment. Parents may be in a series of committed relationships, and each relationship may or may not involve remarriage or cohabitation. Clearly, some children of divorce must cope with a continually evolving family structure. Although each situation and child must be considered individually, parents should be encouraged to give the timing and method of introduction to a new partner serious thought. Adjustment to new relationships may be smoothed if children are allowed adequate time to adjust first to the parents’ separation or divorce. The introduction of the new partner (and his or her children) should be done slowly and with sensitivity to the child's reactions.
Research indicates that both gender and age are related to differences in adjustment to parental remarriage. In general, younger children and older adolescents cope fairly well with a parent's remarriage, whereas early adolescents struggle more with the addition of a stepparent. Children of any age who have spent lengthy periods of time in divorced, single-parent households tend to have more difficulty accepting a parent's new relationship. In addition, girls are more likely than boys to oppose a stepparent and less likely than boys to benefit from the presence of a stepfather. (14)
In order to optimize their child's adjustment to a new stepparent, parents should consider carefully how they approach the child's parenting and discipline. In general, transitioning to blended families will be smoothest when stepparents do not take over responsibility for discipline of their stepchildren.
Effects of Parental Adjustment on Children
Previously, parenting ability has been assumed to decline before and during the divorce process (a phenomenon coined “diminished capacity to parent”), related to parents’ own distress or lack of availability to their children. More recent and prospective studies have revealed that parenting practices over time in intact two-parent families are not significantly different from parenting practices in families experiencing divorce. (15) It is an overgeneralization that all parents going through a divorce experience a decline in parenting skill due to distress and preoccupation with personal issues. However, children's emotional adjustment does tend to mirror the adjustment of their parents. When parents are able to maintain emotional stability after divorce, their children will fare better as well, and when parents are less stable, regardless of the cause, children's adjustment will be affected. In some cases, underlying parental psychopathology, rather than divorce, may be the main culprit causing children's adjustment problems.
Parental depression may be present before divorce, and perhaps even play a causative role in the divorce, and depression also may occur as a result of the stressful divorce process. Indeed, parents have reported increased depressive symptoms in the immediate aftermath of divorce. Parental depression has been linked to a wide variety of negative outcomes for children, including increased risk for behavior problems, anxiety, and developing depression themselves; academic decline; physical health problems; and social relationship concerns. Parental depression is associated also with increased risk of substance abuse in adolescent children. Not surprisingly, parental depression is also linked to poorer parent-child relationships.
Divorce can be associated with improved parental functioning as well, particularly when a marriage's end reduces stress. In particular, women have reported experiencing increases in independence.
Long-Term Effects of Parental Divorce
In general, most children's adjustment difficulties are thought to resolve within 2 to 3 years after a divorce and 3 to 5 years after a remarriage. (14) However, in some cases, adjustment difficulties may fade and then return later in life or may persist through adulthood. For example, adult female children of divorce are more likely to attempt suicide than adult male children of divorce, even while controlling for a history of depression. This finding suggests that women whose parents divorced may be at elevated risk for a suicide attempt even without depressive symptoms. (16) Research in England has revealed that when father involvement is examined rather than parents’ marital status, boys and girls with father involvement at age 7 are less likely to have emotional and behavioral problems, and that girls whose fathers were involved in their lives at age 16 were less likely to exhibit psychological distress as adults. (17)
Early adolescents with divorced parents have been found to be more likely to date and to be more influenced by dating and romance than peers from nondivorced families. (18) Adolescents whose parents have divorced or remarried are more likely to drop out of school.
Adults whose parents divorced or remarried may attain somewhat lower levels of education and are more likely to be unemployed or underemployed than their counterparts who have had continuously married parents. In addition, adult children of divorce are more prone to interpersonal difficulties in all domains of their lives, and their marriages are more likely to end in divorce. Individual factors certainly can protect the adult child of divorce from these difficulties, (19) including choice of spouse and social support in general.
Researchers are beginning to look beyond the statistical occurrence of adjustment concerns in adult children of divorce and to consider qualitatively how adults think about their parents’ divorce. A recent Swedish study revealed adult children of divorce report both negative and positive perceptions of divorce. Negative perceptions were noted, related to disappointment in the lack of support from their parents and others related to the divorce. Positive perceptions also were common, including contentment with parents’ choices and with the belief that they and family members experienced satisfactory or even better lives. (20)
Interventions to Promote Positive Adjustment
In response to increasing divorce rates, many counties have adopted mandatory educational programs for parents at the time they file for divorce. These programs typically are very brief and didactic in nature, targeting how to help children cope during and immediately after the divorce process. More recently, programs of a more intensive nature have been developed for families who have experienced divorce. For example, the New Beginnings Program was established by Wolchik and colleagues (21) and consists of 11 parent group sessions and two individual sessions and targets mother-child relationship quality, effective discipline, conflict between parents, and children's access to their fathers.
A follow-up study shows that participation in New Beginnings yields improvement in the mother-child relationship, which in turn is related to decreased internalizing problems for children and improvements in self-esteem at a 6-year follow-up. Participation also was associated with more effective mothers’ discipline, which in turn was related to fewer externalizing symptoms in children and subsequent decreases in externalizing problems and substance abuse, and improved academic success in adolescence. (21) Parenting programs are important for reducing or eliminating detrimental long-term effects of divorce, with benefits lasting into adolescence and beyond.
A frequent question posed to pediatricians and other child health professionals is to what extent children should have input into parenting plans. This participation will be strongly dependent on the child's developmental maturity and the specific situation. Sanchez and Kibler-Sanchez (22) advocate for involving children in the mediation process and outline an intervention model for this involvement, although no empirical data on the effectiveness of this program has yet been collected. An Australian research group has implemented and studied a child-inclusive divorce mediation program that solicits direct input from the child in the mediation process, surrounding custody and visitation decisions. The study reveals that this structured and therapeutic method of including the child in the process resulted in reduced levels of conflict and improved dispute management. (23)
Recommendations for the Primary Practitioner
Pediatricians are many times the first professional with whom parents talk regarding the impact of divorce on their children. When possible and appropriate, the pediatrician should spend some time speaking alone with the child during any routine appointments in the weeks and years after the divorce. Continual monitoring of the child's adjustment over the years after divorce is warranted because over time new issues usually evolve and the child experiences the family situation differently at different stages of development. Given the limited amount of time most pediatricians have during a single visit, discussion must be clear and succinct, as well as compassionate and nonjudgmental. In summary, salient points of discussion to a parent might include:
Divorce does not have to lead to maladjustment.
The best way to increase the likelihood of positive adjustment is to avoid exposing the child to parental conflict and to engage in cooperative coparenting.
Lengthy and adversarial litigation regarding custody or support issues is associated with less involvement of one parent and with poorer child adjustment.
Good parental self-care, making sure that any mental health issues are being addressed, will have a positive impact on the child's psychological well being.
A strong support system for both parent and child can be protective. Pediatricians can talk with parents about how to maintain existing support sources and develop new ones. Among the most important support networks for the child is the school. Parents may need counseling on approaching the appropriate school staff to share pertinent information so that staff can understand any behavioral or emotional changes in the child and thus be prepared to provide quick and effective support and intervention.
Children of all ages must be listened to and their feelings validated. Parents may need to make decisions that the children do not like, but the fact that the parents listen to their viewpoint will help their children adjust to these decisions.
Children going through the divorce of parents are already dealing with many changes. Therefore, it is important to retain as much consistency in parenting techniques and discipline as possible as a way to promote stability and predictability. Parents understandably have regrets about the impact of the divorce decision on the children and may be tempted to loosen up rules and to try to compensate for emotional distress by indulging more of the child's material wishes. Parents should be counseled that although this approach may seem to help the child's mood in the short-term, it may lead to difficulties when the parent attempts to return to previous limits and expectations.
The child is served best if the pediatrician can avoid taking sides or overidentifying with one parent versus another. Parents may be inclined to share their negative feelings regarding the other parent in an appointment, and it is essential that the doctor listen while helping the parent to focus on what can be done to facilitate the child's adjustment. This advice might include reminding the parent he or she can control only his or her own actions and decisions related to the child, and will not be able to control most of what goes on when the child is with the other parent. The ability to “let go” of the idea of being able to control the ex-partner takes much practice and self-reminding but will pay off in reduced stress levels for both the parent and the child.
Fortunately, many of the daily issues or decisions on which the parents disagree will not have significant negative impact on the child. However, if there is suspicion of abuse or neglect, significant parental substance abuse, or significant parental mental health problems, the pediatrician must counsel the parent on the appropriate resources to consult. And the pediatrician always needs to be aware of the laws of his or her state regarding mandatory reporting for suspected abuse or neglect. Medical professionals should be careful to refrain from providing legal advice and refer those questions to the parent's legal counsel.
Pediatricians are encouraged to utilize well-child visits as an opportunity to monitor the emotional and behavioral adjustment of children of divorced parents. Standardized measures of general child adjustment may assist the practitioner in screening for adjustment issues in need of further evaluation.
Although divorce can have significant negative impact on children, a variety of protective factors can increase the likelihood of long-term positive psychological adjustment.
Exposure to high levels of parental conflict is predictive of poor emotional adjustment by the child regardless of the parents’ marital status.
Epidemiologic data reveal that custody and parenting arrangements are evolving, with more emphasis on joint custody and access to both parents by the child.
Pediatricians’ knowledge of childhood development is essential in providing anticipatory guidance to parents throughout the divorce process and beyond.
HealthyChildren.org Parent Resources From the AAP
The reader is likely to find materials to share with parents that is relevant to this article by visiting these links:
- 1.↵US Department of Health and Human Services, Centers for Disease Control and Prevention. Births, marriages, divorces and deaths: provisional data for 2009. National Vital Statistics Report. 2010;58(25):1–6
- 3.↵Centers for Disease Control and Prevention. Cohabitation, marriage, divorce, and remarriage in the United States. Vital and Health Statistics. 2002;23(22):1–103
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- Copyright © 2012 by the American Academy of Pediatrics