Mental health research has long focused on maternal depression as a risk factor for the development of psychopathology in children, but new research suggests that paternal depression should not be overlooked in children with behavioral or emotional problems.

Researchers from the NYU School of Medicine analyzed data from a sample of children, aged 5 to 17 years, using the Columbia Impairment Scale (CIS) to assess emotional or behavioral functioning of children and the Patient Health Questionnaire-2 (PHQ-2) to analyze maternal and paternal depressive symptoms. The Physical Component Scale (PCS) and Mental Component Scale (MCS) were used to investigate maternal and paternal physical and mental health. The study results were published online today in the December 2011 Pediatrics. The authors write:

This study, from a sample of 22,000 children and their mothers and fathers representative of the entire US population, demonstrates that living with fathers with depressive symptoms and other mental health problems is independently associated with increased rates of emotional or behavioral problems among school-aged children and adolescents. The ?ndings also indicate that the risks of child emotional or behavioral problems are much greater if mothers, rather than fathers, have such problems. Paternal mental health problems are independently associated with a 33 percent to 70 percent increased risk, depending on how assessed, whereas maternal mental health problems are associated with a 50 percent to 350 percent increased risk. Most striking, we believe, is the increase in child emotional or behavioral problems when both parents have such problems, with 25 percent of children living in such homes having behavioral or emotional problems.

“The paradigm needs to shift so burden is not always placed on the mother,” said lead author Michael Weitzman, M.D., over the phone. he went on to say that the role of the father needs to be considered when explicating the etiology or formulating approaches to behavioral or emotional problems in children. this may be especially important during a recession, as economic hardship may threaten a father’s perceived role as a provider and contribute to symptoms of depression, which are more likely to present as irritability, anger or substance use in men.

Limitations of this study include only sampling households with both a mother and father present, and using scales and questionnaires rather than diagnostic psychiatric interviews to assess for symptoms, making it difficult to generalize the results and stopping short of identifying specific emotional or behavioral problems in the children sampled.

In my clinical experience, most so-called ADHD children are not receiving sufficient attention from their fathers who are separated from the family, too preoccupied with work and other things, or otherwise impaired in their ability to parent. in many cases the appropriate diagnosis is Dad Attention Deficit Disorder (DADD). The ‘cure’ for these children is more rational and loving attention from their dads. Young people are nowadays so hungry for the attention of a father that it can come from any male adult. Seemingly impulsive, hostile groups of children will calm down when a caring, relaxed and firm adult male is around.

Many are quick to dismiss Dr. Breggin’s opinions as extreme, and by no means are all cases of childhood ADHD, anxiety or depression responsive to more emotionally or physically available fathers, but why does it seem inconvenient to consider it a possibility in some cases? What’s the downside to caregivers trying whatever they can, including treating their own depression or anxiety, to develop stable, loving relationships with their children?

They force their kids to stop doing homework at 1 a.m. and go to bed. They race them from practice to lessons, without time to eat dinner. and they see the worry in their children’s faces.

But Roger Medoff wasn’t sure if any other parents were going to come see a documentary about the high-pressure, test-centric culture in schools and the unbelievable amount of stress on kids. he was worried that he’d be sitting alone in the Slayton House auditorium in Columbia, out the screening fee and alone in his concerns.

The father of two from Columbia has long been upset about the test-based curriculum and the excessive amount of homework his 12- and 17-year-old daughters are required to do. But, he says, “I’m in a community where there are parents who don’t get it.”

But he found that there are also plenty who do. more than 150 tickets sold for the November screening of “Race to Nowhere,” an 85-minute collection of stories from educators, experts, parents and, most notably, students who became ill, cheated or just gave up when the stress of school became too much to bear. and 30 or 40 parents and teachers stayed after the film was over, and the community center was closing, to talk about the broader issues raised.

“That was encouraging,” says Medoff, an assistant attorney general for the state.Even if you haven’t seen the film (or heard of it), chances are you’ve given some thought to the amount of stress on your child. maybe you’re balancing the demands of sports and Scouts and homework, wondering when your son or daughter ever just gets to be a kid.

Maybe your son or daughter is in the midst of standardized testing at school or SATs or pre-SATs (or pre-pre-SATs.) and if not, there’s a good chance you’ll find yourself looking for a healthy approach to extracurricular activities and academics.

“It’s a big issue with kids being over-scheduled and being pressured in terms of testing,” says Jennifer Sober, a licensed marriage and family therapist in Cockeysville. “There’s such a push to have a well-rounded child.”

Yet, even “fun” activities such as sports can be a source of stress. Some teams expect daily practice and weekend games. and some are very competitive.

Parents might not realize it, Sober says, but “there is pressure on the kids.”

All this go-go-go has a price, she says. “They’re going to burn out.”

“Your body can only handle so much for so long before it shuts down,” she adds.

Children at that point run the risk of having anxiety disorders and depression.

Stress-related illness tends to peak in fifth and sixth grade as children become more socially aware and compare themselves to their peers, and again junior and senior years of high school as pressures about college and adulthood mount, experts say.

Not only are more children experiencing stress, but they are facing it at younger ages, says Dr. Kenneth Gelfand, director of Outpatient Psychology at Mt. Washington Pediatric Hospital in Baltimore.

“The pressures start earlier. … there are kids being prepped for college starting in elementary school,” Gelfand says.

Especially in elementary school, if your child’s homework takes more than an hour at night, it’s worth calling the teacher.

“You’re not looking for special treatment,” Sober says. “But you do want to look at what can be done.”

Kids who excel academically often have the most anxiety about tests and grades and even the slightest decline in a score or grade can be upsetting. The grades “become partof how they see themselves,” Sober says.

But parents can send messages that are more accepting of their children and help them keep things more in perspective, Sober says.

There should be time for physical activity and down-time. Even deep breathing exercises can make a big impact, she says.

“I know it sounds hokey but it can really work,” says Sober.

It’s also worthwhile to have conversations with your child such as “What would you change?”

Symptoms of stress aren’t always obvious. In fact, stomachaches and headaches are among the most common signs of stress in children.

If you suspect a problem, you’ll want to consult with your child’s pediatrician, but it’s also a good idea to talk with teachers and coaches and other adults with whom your child interacts, to see if they’re seeing signs of a problem, says Gelfand.

“It’s also really important to collaborate with your child,” he adds.Medication is rarely the answer, in part, because it deals with symptoms not causes.

Techniques such as positive self-statements, and changing environmental factors are very effective, Gelfand says.

The good news? “With treatment, children are likely to improve very rapidly,” he says. “They need time to relax.”

The loss of childhood is articulated well in the “Race to Nowhere” film. Children never just get a chance to play or have an unscheduled chance to read a book or paint a picture.

“So many kids have lost the love of learning,” says Anne Hollander, a mother of two from Bethesda. “I think that’s the saddest part to me.”

“Some families are better at stepping out of the race,” she says. “But for many, it’s hard not to get swept up in it.”

Fear is a powerful motivation for taking on so many activities and pushing children academically. “They’re afraid of falling behind,” says Hollander, whose son graduated from Walt Whitman High School in 2008 and now attends Oberlin College and whose daughter is a senior at Whitman.

Hollander chairs the “Stress Buster” committee at the school — a group that works closely with the guidance department and arranges such events as speakers, who discuss finding a college that is good fit as opposed to brand-name shopping, and arranging for the screening of “Race to Nowhere.”

She and other parents have found some support in schools. Guidance counselors often recommend that students not take on so many AP courses because of the homework load involved, for example.

“I do see the pendulum swinging back to a more a reasonable approach,” Hollander says.Medoff is hopeful that’s true. “My sense is that this is a slow process,” he says. “it might take years to establish significant change.”

But, in some cases, change can come quickly. Medoff was gratified to hear that one teacher decided to institute a no-homework policy after participating in the after-film discussion. She doesn’t teach a core subject and doesn’t have the pressure of standardized tests. But it was still a swift response.

“once school superintendents and administrators realize they have support of parents, it’s fairly easy to make changes,” says “Race to Nowhere” filmmaker Vicki Abeles, whose film has now been shown in three countries, 44 states and 800 locations from schools to community theaters.

There are school districts now moving away from teaching to the test, limiting AP classes and that are restructuring their schedules.

And, says Abeles, “Parents can do a lot just in their own homes.”

Symptoms of stress in children:

• Sleep disruption• Exhaustion• Stress-eating• Loss of interest in activities, friends and/or school• Depression• Anxiety (including such symptoms as hair pulling)• Stomachaches (frequent and often in the morning)• Headaches• Statements such as “My life sucks”• Making excuses not to do certain things• Making vague “not feeling well” and vague• “I don’t like anyone there” statements

Signs your child’s schedule might need adjusting:

• Symptoms of stress• Exhaustion (You and your child)• more than an hour of homework• find yourself frequently repeating, “We’ve got to go!”• Avoiding activities that used to be fun

Helpful Links:racetonowhere.comaap.org/stress/teen1-a.cfmhealthychildren.org/English/healthy-living/emotional-wellness/pages/Helping-Children-Handle-Stress.aspx

More Reading:“less Stress, more Success: A new approach to Guiding Your Teen through College Admissions and Beyond” — by Ken Ginsburg, MD, MS Ed, FAAP and Marilee Jones“You’re Accepted: Lose the Stress. Discover yourself. get into the College That’s Right for You” — by Katie Malachuk