TOP > Projects > Past Projects > brownU > Vol.22, No.1, January 2006 - Keep Your Eye On...preoperative anxiety in children eased by clown doctors - Editor's Commentary: Youth Sports


Vol.22, No.1, January 2006 - Keep Your Eye On...preoperative anxiety in children eased by clown doctors - Editor's Commentary: Youth Sports

Children who undergo surgery often experience extreme preoperative stress. According to a new study, approximately 60% of children suffer anxiety during the preoperative period. This anxiety is characterized by feelings of tension, apprehension, nervousness, worry, fear of separation from parents, loss of control, as well as fear of the hospital surroundings and surgical instruments. While pharmacological and behavioral interventions are available to treat children's anxiety before surgery, a novel intervention using clown doctors before the induction of anesthesia helps to ease anxiety not only in the children but also the parents who accompany the child until he/she is asleep. A total of 40 children took part in the study. Twenty children were entertained by clowns who used a variety of methods to amuse and distract the children. The other group of children was not exposed to any clown entertainment. According to the researchers, the presence of professional clown doctors was an effective intervention for managing the child's and parent's anxiety during the preoperative phase, and the group of children entertained by clown doctors was significantly less anxious than the control group. While the researchers would encourage this type of intervention in treating anxiety in children before surgery, they also point out that there may be resistance by some medical staff to carry out this type of intervention in the operating room. To help counter such resistance, more information on the benefits of the treatment should be given to medical staff, and further investigations should be carried out to consider whether clown intervention could significantly slow the anesthesia induction process. [Vagnoli L, et al. Pediatrics 2005; 116(4):563-567.]

Editor's Commentary
Youth Sports
By Gregory K. Fritz, M.D.

In Rhode Island, the front-page headlines on Thanksgiving Day dealt with high school football games. Traditional interdistrict rivalries are a big deal, involving whole communities as well as the players and their families. Perhaps it was the lack of heavier news, but it got me thinking about youth sports and the role they play in children's development.

I've had some direct experience in this realm, as my oldest daughter was an avid and talented athlete throughout her school years (clear proof that genetics are not all-determining). For her and many youngsters who play sports, athletic involvement was profoundly important in shaping her growth as a person. She developed an enviable confidence in her body and her physical abilities, leading to an active lifestyle that persists into adulthood. Several coaches were important, non-parental adult influences in her life, largely for the good. Her sports participation taught the importance of teamwork, the appropriate channels for aggression, and the ability to be resilient after disappointment.

The need to juggle practices and academic responsibilities made her an efficient student. In college, her athletic team was a built in social center and a source of friendships. In short, I believe youth sports played an essential and beneficial role in my daughter's adolescence.

It's not a slam dunk to be an appropriately supportive parent regarding youth sports. Sure, it's easy for a thoughtful mental health professional to describe what the ideal parent does: you take pride and satisfaction in helping your children develop their abilities; you understand your child's needs and goals regarding sports - and distinguish them from your own; you value the process of athletes, not just the outcome; and you provide noncontingent love that does not vary with the child's level of success in sports. Putting this knowledge into practice as a parent, however, is much more challenging.

Examples abound of adults' unbecoming or reprehensible behavior around youth sports. When a coach and her parents allow a 13-year-old gymnast to compete with a broken bone, they are obviously not thinking about her needs as a child. As was painfully illustrated in the movie "The Great Santini," highly competitive fathers are seen berating their children for not being tough enough to win. A recent survey of young athletes, coaches and parents revealed that 8% of coaches acknowledged encouraging athletes to hurt an opponent and 7% to cheat in a game. An item in the press a few years ago described how a parent gave $2 to a 10-year-old little league pitcher to hit a batter with a fastball. Last year, two teachers were arrested for fighting at a girl's basketball game, where a parent also punched a referee. This past April, a father of a Texas high school football player shot the boy's coach because his son was not getting enough playing time. The degree of outrageousness varies - fortunately, shootings are still extremely rare - but the impression remains that inappropriate adult involvement in youth sports is increasing.

At the same time, informal sports among children, "pick-up" or sandlot games lacking adult supervision or organization, are becoming uncommon. It used to be that the Little League field got more use by neighborhood children after the "official" season than during it. Games were modified to adapt to smaller numbers of players and various skill levels - successfully negotiated without any adult input. Perhaps because of safety concerns, a lack of free time after school, or parental ambitions, organized sports leagues with lots of parental involvement are now the rule, starting as early as preschool.

Overly intense, abusive adult behavior in youth sports is common enough to be named: it's been labeled "Little League Parent Syndrome (LLPS)", though it is not limited to baseball. Adults' excessive vicarious living though a child's athletic success has been called "Achievement by Proxy Distortion (ABPD)" - derived from the psychiatric diagnosis, "factitious disorder by proxy" in which a parent causes medical symptoms in a child.

Named or not, mild or extreme in intensity, inappropriate parental involvement in youth sports is bad for kids. Out-of-control parental behavior embarrasses children and takes the fun out of the game. Encouraging a child to focus solely on excelling in a single sport narrows childhood experiences and relationships. Parents who berate the opposing team, argue with referees, interrupt the coach, or scream instructions to their child during the game, are modeling such behavior for the next generation, in effect creating a "farm team" of uncontrolled, overly aggressive sports fans.

In the extreme, when family life comes to revolve around one child's training and athletic success, everyone suffers. Siblings feel ignored, the high achieving child becomes a commodity, and ultimately roles are reversed: the child is nurturing and supporting the adults' needs. When it gets to this point, coaches, institutions, sponsors, etc., collude with parents; though it's hard to prove and prosecute, many believe this constitutes a form of child abuse.

Fortunately, most children obviously lack the potential to become elite athletes and most parents are mature enough to temper their pride in, and ambitions for, their child's athletic accomplishments. In Rhode Island, they go to the Thanksgiving game even if it's freezing and snowing and agree that it makes the turkey taste better.


The Brown University Child and Adolescent Behavior Letter, January 2006
Reproduced with permission of John Wiley & Sons, Inc.
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