OCWO ParentalBurnout 3674200 Report FINAL

May 2022
Pandemic Parenting:
Examining the Epidemic of

Working Parental Burnout
and Strategies to Help
OFFICE OF THE CHIEF WELLNESS OFFICER

and COLLEGE OF NURSING
Are you a working parent who is feeling exhausted, irritable,
emotionally detached or overwhelmed with parenting your children?
If so, you may be experiencing parental burnout.
When COVID-19 came into our lives, we were hopeful that the impact of the pandemic might only span
weeks or a few months at most.
Of course, it didn’t. The pandemic lasted for two years, stretching the limits of parents’ physical, mental,
emotional, fnancial and professional well-being. Many parents, especially working parents whose
children were sheltered at home with them for more than a year, feel the experience has taxed or broken
them in some way.
We have felt these challenges as well. Our families faced the realities that millions of others did: struggles
to fnd balance between work and home responsibilities, virtual schooling for young children while
dealing with a lack of viable and safe daycare, and/or the feeling that every day felt like a week, every week
like a month, every month like a year.
It is this shared experience that inspired us to develop a survey that contained a valid and reliable tool
to assess and quantify working parent burnout and the conditions that seemed to exacerbate it. We then
took the survey a critical step further and examined how working parent burnout might be associated
with certain types of parenting practices, as well as concerning emotions and behaviors in their children.
Our survey provided parents an opportunity to refect on their own mental and emotional well-being
and how it might be afecting their children while potentially providing motivation to do something
constructive about it to help the challenging situation. We know that all parents do the very best that they
can, but when current stressors outweigh their coping skills and resources available to deal with them, it is
understandable to experience burnout and the emotional toll that it takes on mental health and well-being.
The fndings of our survey are described within the pages of this report. Our easy-to-use working parent
burnout scale is also contained in this document so that you can assess your own level of burnout. In
addition, strategies and resources to lessen burnout are included so that you can start using them right
now to feel emotionally better and engage more efectively with your children.
This survey captures a snapshot in time, at the height of the pandemic, but we all know that the adverse
efects will linger for some time well into the future. Please know that you are not alone. It is a strength to
recognize when we need help, not a weakness. It is also natural to feel like COVID-19 changed something
within you and your families. Millions upon millions of parents feel the same way. It will take time to heal,
so be patient with and kind to yourself.
Within this report, we ofer you helpful strategies to start feeling emotionally better about yourself and the
way you deal with your children. We want to encourage you and cheer you on, every step of the way.
Warm and well regards,
Kate Gawlik, DNP, APRN-CNP, FAANP, FNAP

Associate Professor of Clinical Nursing
The Ohio State University
Bernadette Mazurek Melnyk, PhD, APRN-CNP, FAANP, FNAP, FAAN

Vice President for Health Promotion
University Chief Wellness Ofcer
Dean and Helene Fuld Health Professor of Evidence-based Practice, College of Nursing
Professor of Pediatrics and Psychiatry, College of Medicine
The Ohio State University
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Executive Summary:
Parenting stress is normal and expected. However, when chronic stress and exhaustion occur that
overwhelm a parent’s ability to cope and function, it is called parental burnout. Burnout ofen results from
a mismatch between perceived stressors and available resources and results in parents feeling physically,
mentally and emotionally exhausted, as well as ofen detached from their children. Working parents are
especially at risk to develop burnout due to the challenge of juggling multiple stressors and demands at
work and at home. The COVID-19 pandemic has exacerbated many of these stressors and limited many
parental resources, thus contributing to epidemic levels of parental burnout and exhaustion. Working
parents with children at home have been especially adversely afected due to the unpredictable nature of
school closures, quarantine, home- and virtual-schooling, childcare availability and continued demands to
perform at the same expected level in their work environments. This has resulted in many parents feeling
in an uncomfortable position of either being forced to leave the workforce or jeopardizing their standing
and credibility within their institutions and companies.
Parents – and especially working parents – are struggling.

The trickle down efect of parental burnout also is adversely
afecting their children.
This report highlights the results of a study that assessed parental burnout along with other important
measures, such as parent depression/anxiety and child behavior problems, conducted with working parents
who voluntarily and transparently answered our questions.
Here is what the study uncovered:
• Sixty-six percent (66%) of parents reported being burned out.

• Being female, the number of children living in the home, anxiety in the parent, having child(ren) with
the diagnosis of either anxiety or Attention Defcit Hyperactivity Disorder (ADHD) and parental concern
that their child(ren) may have an undiagnosed mental health disorder were strongly associated with
parental burnout.
• Burnout was strongly associated with depression, anxiety and increased alcohol consumption in
parents, as well as the likelihood for parents to engage in punitive parenting practices.
• Parental burnout is associated with children’s internalizing, externalizing and attention behaviors.
There are clear and strong relationships among working parent burnout and potential adverse efects on
both parents and children. It is critical to quantify, spotlight and acknowledge the presence of working
parent burnout as it ofen co-occurs with a mental health disorder, such as anxiety or depression.
This report will go more in-depth with the survey’s fndings. It includes tips, tools and resources that allow
working parents to assess their level of burnout, develop a better understanding about how to prevent and
deal with their burnout and guide their children through potential issues with anxiety, behavior problems,
depression, ADHD and stressful situations. Information is also included about an opportunity to participate
in a study that helps children/teens and their parents to learn mental resiliency/stress reduction techniques.
There is cause for optimism and hope: Recognizing and intervening for parental burnout have been
shown to improve both parent and child outcomes. Most importantly, steps must be taken to prevent it.
Bringing increased awareness to the issue of working parent burnout as a major public health issue will
help clinicians, parents, communities, institutions and companies recognize the condition and provide
preventive and targeted interventions to help parents and children to thrive and reach their optimal state of
mental health and well-being.
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This is what burnout sounds like from
working parents during the pandemic:
I am expected to be a superhuman that can be a full-time employee,

parent, elementary school teacher, pre-school teacher, cook, cleaner,
playmate and emotional support system. But I can’t do it any longer.
I feel like I am running I am just so tired. I am alone.

out of gas, but I don’t
see a gas station in sight
to let me relax and fll
up my tank again.
I don’t enjoy being with my kids anymore. I need a break.
I work 168 hours a week with no time of and no additional pay.

I wake up in the
morning wondering
how I am going to get
through the day again.
As a working parent, I feel like
Every day is a struggle.
this pandemic has broken me.
My work colleagues do not understand that I am having a hard time

keeping it all together. I have to make the choice of adhering to a
deadline and ignoring my kids or missing the deadline and being a
good parent. And I have to make that decision every day now. Either
way, I am sufering and my kids are sufering. I can’t keep doing this.
If you have felt little interest or pleasure in doing things and/or have been feeling down, depressed or
hopeless several or more than half the days in the past two weeks, please reach out to your primary
care nurse practitioner/physician or employee assistance program at work as you may be sufering
from depression. Someone at the National Suicide Prevention Lifeline (800-273-8255) is always
available 24/7 if you ever need to talk 4with someone when feeling depressed.
Key Finding #1
Study Approach
Sixty-six percent of parents reported being burnout.
An online survey was conducted.
Key Finding #2 Participants were parents with children
under the age of 18 living with them.
Our study found that being female, the number of children Results were collected between
living in the home, anxiety in the parent, having child(ren) January 19, 2021 and April 28, 2021.
The survey was anonymous and
with the diagnosis of either anxiety or Attention Defcit
voluntary. 1285 parents self-selected
Hyperactivity Disorder (ADHD), and parental concern that
to participate.
their child(ren) may have an undiagnosed mental health
disorder are strongly associated with parental burnout.
Females were more likely than males to have

parental burnout. Sixty-eight percent (68%) of
females reported burnout verses 42% of males.
Parental burnout was increased

in households with two or three
children, plateaued with four or
fve children and increased again
with six or more children.
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Seventy-seven percent (77%) of parents
who had a history of personal anxiety
reported burnout.
Parent burnout was reported in 77% of

parents who had a child with ADHD and
73% of parents who had a child with
anxiety.
Seventy-two percent (72%) of parents

who were concerned that their child
could have an undiagnosed mental
health condition reported burnout,
compared to 28% of parents who did
not report burnout.
Parental concern that their child may have an undiagnosed mental health disorder
carries a strong association with burnout in working parents.
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Key Finding #3
Parental burnout is strongly associated with depression, anxiety and increased alcohol consumption in the
parent. Burnout is also associated with dramatic increases in the likelihood that parents may insult, criticize,
scream at, curse at and/or physically harm their children (i.e. spanking).
Insult
Scream
Criticize
Spank
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Key Finding #4
The presence of working parental burnout is associated with parents’ reports of their children’s
internalizing, externalizing, and attention behaviors.
As part of the study, parents were asked to complete the Pediatric Symptom Checklist-17 (found in additional
resources section). This checklist assesses parents’ report of their children’s attention, internalizing and
externalizing behaviors. It is commonly used to help clinicians assess children for mental health disorders.
Examples of attention Examples of internalizing Examples of externalizing

behaviors include: behaviors are: behaviors include:
inability to sit still feels sad or unhappy fghts with other children
has trouble concentrating is down on themselves does not listen to rules
is easily distracted worries a lot teases others
The presence of working parental burnout is associated with all three of these behaviors in children. Parents
who identifed positive for burnout reported more attention, internalizing and externalizing behaviors in their
children than parents who did not report having burnout.
Caution must be used in interpreting this fnding as parents were reporting what they were perceiving in their children.
Further research is necessary to determine if what parents perceive is how the children are actually behaving by
observation; however, the Pediatric Symptom Checklist completed by parents reliably identifes children’s attention,
internalizing and externalizing behaviors.
Reference
1. Stoppelbein L, Greening L, Moll G, Jordan S, Suozzi A. Factor analyses of the Pediatric Symptom Checklist-17 with African-American
and Caucasian pediatric populations. J Pediatr Psychol. 2012;37(3):348-357. doi:10.1093/jpepsy/jsr103
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Check Yourself for Working Parent Burnout
The 10-item Working Parent Burnout Scale is a tool that can be used to help both parents and clinicians
determine whether a parent is experiencing burnout. This scale is free for use and should be employed more
readily in the clinical setting as part of routine visits, but especially if a child or parent is being seen for a
mental health condition. This scale has demonstrated validity and reliability to detect parental burnout in the
working parent population.
Step one: Complete the scale
Not at all A little Somewhat Moderately so Very much so
Item 1: I get/feel easily irritated

with my children.
Item 2: I feel that I am not the good

parent that I used to be to my
child(ren).
Item 3: I wake up exhausted at the

thought of another day with my
children.
Item 4: I fnd joy in parenting my

children.
Item 5: I have guilt about being a

working parent, which affects how I
parent my children.
Item 6: I feel like I am in survival

mode as a parent.
Item 7: Parenting my children is

stressful.
Item 8: I lose my temper easily

with my children.
Item 9: I feel overwhelmed trying

to balance my job and parenting
responsibilities.
Item 10: I am doing a good job

being a parent.
Scale Copyright, Kate Gawlik and Bernadette Mazurek Melnyk, 2021.

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Step two: Score each item on the scale
For all questions except questions 4 and 10, use these point values.
Not at all = 0 points
A little = 1 point
Somewhat = 2 points
Moderately so = 3 points
Very much so = 4 points
Questions 4 and 10 use reverse scoring. Use these point values for questions 4 and 10.
Not at all = 4 points
A little = 3 points
Somewhat = 2 points
Moderately so = 1 point
Very much so = 0 points
Step three: Calculate the total score

Add all points together for a fnal score.
Step four: Interpret the score

0-10 Points: No or few signs of burnout
11-20 Points: Mild burnout
21-30 Points: Moderate burnout
31+ Points: Severe burnout
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Step 5: Take the next steps
Score 31+: Severe burnout – Ask for help from your healthcare
provider or mental health professional; connect with family
members and friends. Utilize available resources.
Score 21-30: Moderate burnout – Take action! Start interventions

(e.g., take time out of each day to do something for your mental
health and well-being), decrease stressors, use available resources
and consider asking for help. If your level of burnout is interfering
with your ability to function or concentrate, seek mental health
help immediately. It is a strength to recognize when help is needed,
not a weakness.
Score 11-20: Mild burnout – Start preventive interventions such

as taking short recovery breaks each day to do something for your
mental health and well-being, decrease stressors and identify
resources to help.
Score 0-10: No or few signs of burnout – you should continue to do

the things you are doing and remember to prioritize good self-care.
Overall, based on your defnition of burnout, how would you rate your level of burnout regarding being a
working parent?
☐ I enjoy being a working parent. I have no symptoms of burnout. (0 points)
☐ Occasionally I am under stress, and I don’t always have as much energy as I once did, but I don’t feel
burned out. (1 point)
☐ I am defnitely burning out from being a working parent and have one or more symptoms of burnout,
such as physical and emotional exhaustion. (2 points)
☐ The symptoms of burnout from being a working parent that I’m experiencing won’t go away. I think
about my frustration with being a working parent a lot. (3 points)
☐ I feel completely burned out from being a working parent and ofen wonder if I can go on. I am at the
point where I may need some changes or may need to seek some sort of help. (4 points)
A score of 2 or higher indicates you may be experiencing working parental burnout.
Copyright, Kate Gawlik and Bernadette Mazurek Melnyk, 2022

Trafc light graphic provided by Vecteezy.com 11
Strategies to Help
Stress and burnout looks diferent for everyone. Finding a balance that decreases personal stressors and
increases the access to and use of available resources can decrease rates of burnout.
Stopping to catch, check and change the negative automatic thoughts that ofen happen with parental
burnout can result in feeling emotionally better and can open the door to strategies and solutions that work
for you and your family. Perhaps you have children in half-day preschool who are home in the afernoons
while you work, or you’re shuttling older kids to multiple afer-school activities. Perhaps you stay up afer
your children go to sleep to do work for your job as you watch laundry pile up on the foor. Striking your right
balance may mean utilizing untapped resources and leveraging the village around you.
Here are fve other evidence-based strategies that can help you every day:
• Take good self-care (it is not selfsh!): Even a fve- to

ten-minute recovery break a couple of times a day
to enhance your well-being or engage in something
that brings you joy does wonders (e.g., drink a warm
beverage slowly; do a fve-minute meditation; get
some physical activity, such as dancing to your
favorite music or walking up and down the stairs).
• Be kind to yourself: Don’t set expectations too high.
Don’t overcommit or feel guilty for saying “no” to
something. Forgive yourself; everyone has strengths
and opportunities for improvement.
• Talk to someone you trust about how you are feeling:
Stay connected to family and friends.
• Build your mental resiliency and coping skills:
This can include practicing mindfulness, developing
cognitive-behavioral skills, practicing gratitude and
self-afrmations and deep abdominal breathing.
• Ask for help: If your level of burnout, anxiety and/
or depressive symptoms are interfering with your
ability to function or concentrate, talk to your primary
care provider or seek out mental health help. It is a
strength to recognize when we need help, not
a weakness!
Children’s emotions and behaviors are ofen a source of stress for parents. This survey found that parents who
were very worried about their children’s mental health had a higher level of burnout than parents who were
less worried. The Pediatric Symptom Checklist-17 (located in the additional resources section) is a 17-item
screen designed to help identify possible cognitive, emotional and behavioral problems so that appropriate
interventions can be started as early as possible. “Never” is 0 points, “sometimes” is 1 and “ofen” is 2. Items
that are lef blank are given a 0. A score of at least 15 suggests possible signifcant behavioral or emotional
issues. If your child scores a 15 or above, please talk to your child’s healthcare provider.
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Research study opportunity for parents and children to test online
stress reduction modules for children and teens
The authors of this report are conducting a research study with parents of children between 9 and
14 years old to determine the efectiveness of online stress reduction modules on child and parent
mental health and well-being.
If you are interested, please visit go.osu.edu/stressbusters
“With mad and love, love always wins.”

– Hunter, age 5
OFFICE OF THE CHIEF WELLNESS OFFICER

and COLLEGE OF NURSING
13
Additional
resources for
parents
1. Pediatric Symptom Checklist (PSC-17) for Parents
2. Information for Parents About Anxiety in Children

and Teens
3. Information for Parents About Behavior Problems in

Children and Teens
4. Information on Depression for Parents
5. Information for Parents About Attention Defcit

Hyperactivity Disorder (ADHD)
6. Information for Parents on How to Help Your Child/

Teen Cope With Stressful Events or Uncertainty
14
Pediatric Symptom Checklist (PSC-17) for Parents
Please mark under the heading that best describes your child:
NEVER SOMETIMES OFTEN
(0) (1) (2)
1. Feels sad, unhappy.................................................. □ □ □

2. Feels hopeless.......................................................... □ □ □
3. Is down on self........................................................ □ □ □
4. Worries a lot............................................................. □ □ □
5. Seems to be having less fun................................... □ □ □
6. Fidgety, unable to sit still....................................... □ □ □
7. Daydreams too much............................................. □ □ □
8. Distracted easily...................................................... □ □ □
9. Has trouble concentrating..................................... □ □ □
10. Acts as if driven by a motor................................... □ □ □
11. Fights with other children..................................... □ □ □
12. Does not listen to rules........................................... □ □ □
13. Does not understand other people’s feelings..... □ □ □
14. Teases others............................................................ □ □ □
15. Blames others for their troubles............................ □ □ □
16. Refuses to share....................................................... □ □ □
17. Takes things that do not belong to them............. □ □ □
Does your child have any emotional or behavioral problems for which they need help? __No __Yes
Reproduced with permission from Jellinek, M., & Murphy, M. (1986).

Massachusetts General Hospital.
National Association of https://www.massgeneral.org/psychiatry/treatments-
Pediatric Nurse PractitionersSM
and-services/pediatric-symptom-checklist
CHAPTER 1 • Patient Handout: Pediatric Symptom Checklist (PSC-17) for Parents • 29

Lista De Síntomas Pediátricos (Pediatric
Symptom Checklist—PSC)
La salud física y emocional son importantes para cada niño. Los padres son los primeros que notan
un problema de la conducta emocional o del aprendizaje de su hijo(a). Ud. puede ayudar a su hijo(a)
a obtener el mejor cuidado de su doctor por medio de contestar estas preguntas. Favor de indicar cual
frase describe a su hijo(a)
Indique cual síntoma mejor describe a su hijo/a:
NUNCA ALGUNAS VECES FRECUENTEMENTE
(0) (1) (2)
1. Se siente triste, infeliz ............................................. _____ _____ _____

2. Se siente sin esperanzas.......................................... _____ _____ _____
3. Se siente mal de sí mismo(a).................................. _____ _____ _____
4. Se preocupa mucho................................................. _____ _____ _____
5. Parece divertirse menos.......................................... _____ _____ _____
6. Es inquieto(a), incapaz de sentarse tranquilo(a)... _____ _____ _____
7. Sueña despierto demasiado................................... _____ _____ _____
8. Se distrae fácilmente............................................... ____ _____ _____
9. Tiene problemas para concentrarse...................... _____ _____ _____
10. Es muy activo(a), tiene mucha energía................ _____ _____ _____
11. Pelea con otros niños.............................................. _____ _____ _____
12. No obedece las reglas.............................................. _____ _____ _____
13. No comprende los sentimientos de otros............ _____ _____ _____
14. Molesta o se burla de otros.................................... _____ _____ _____
15. Culpa a otros por sus problemas.......................... _____ _____ _____
16. Se niega a compartir................................................ _____ _____ _____
17. Toma cosas que no le pertenecen.......................... _____ _____ _____
Total___________________
¿Tiene su hijo(a) algún problema emocional o del comportamiento para el cual
necesita ayuda?....................................................................................................................__□ No __□ Sí
Reproduced with permission from Jellinek, M., & Murphy, M. (1986).

Massachusetts General Hospital.
National Association of https://www.massgeneral.org/psychiatry/
Pediatric Nurse Practitioners SM
treatments-and-services/pediatric-symptom-checklist
CHAPTER 1 • Patient Handout: Lista De Síntomas Pediátricos (Pediatric Symptom Checklist—PSC) • 31

Information for Parents About Anxiety in
Children and Teens
FAST FACTS
• Fear and anxiety are a normal part of growing up, but they should not interfere with your
child’s daily activities.
• Anxiety disorders are among the most common mental health problems in children and teens.
• Children and teens with anxiety experience severe and persistent distress that interferes with
their daily functioning; often these disorders are under-diagnosed.
• You might describe your child as a “worrier.”
• Children and teens will often report physical complaints or describe “feeling sick”
(e.g., stomach pain, headaches, chest pain, fatigue).
• Many times, children with anxiety also have problems with paying attention/staying
focused at school; they may have problems being “moody.”
• Many times, healthcare providers will mistake anxiety symptoms for attention deficit
symptoms.
See Table 3.4 for common signs of anxiety in children and teens.
Table 3.4. Common Signs of Anxiety in Children and Teens

Physical Behavioral Thoughts
Restlessness and irritability (very Escape/avoidant behaviors Worry about “what ifs . . .”
common in younger children)
Crying Always thinking something
Headaches terrible will happen
Clinging to/fear of separating
Stomachaches, nausea, vomiting, from parents Unreasonable, rigid thinking
diarrhea
Speaking in a soft voice
Feeling tired
Variations in speech patterns
Palpitations, increased heart rate,
Nail-biting
increased blood pressure
Thumb-sucking
Hyperventilation/shortness of
breath Always “checking out”
surroundings
Muscle tension
Freezing
Difficulty sleeping
Regression (bedwetting, temper
Dizziness, tingling fingers, weakness
tantrums)
Tremors
Anger/irritability
This handout may be distributed to families.

From Melnyk, B. M., & Lusk, P. (2022). A Practical Guide to Child and Adolescent Mental Health Screening, Evidence-Based
Assessment, Intervention, and Health Promotion (3rd ed.).
National Association of © National Association of Pediatric Nurse Practitioners
Pediatric Nurse Practitioners
SM
and Springer Publishing Company.
CHAPTER 3 • Patient Handout: Information for Parents About Anxiety in Children and Teens • 117
MEDICAL PROBLEMS THAT MIMIC ANXIETY SYMPTOMS
• low blood sugar,
• thyroid problems,
• seizures,
• irregular heartbeat,
• migraine headaches, and
• breathing problems.
MEDICATIONS/DRUGS THAT MAY CAUSE ANXIETY SYMPTOMS

• caffeine,
• nicotine,
• antihistamine (Benadryl),
• medications for asthma,
• marijuana,
• nasal decongestants, such as pseudoephedrine,
• stimulant medication (e.g., Ritalin),
• street drugs (e.g., cocaine), and
• steroids.
Prescribed medications to treat anxiety, when started, can cause effects that mimic anxiety symptoms,
but these symptoms often subside after a few days.
MANAGEMENT
• Talk to your primary care provider if you have concerns; describe what you are noticing
about your child.
• Ask your primary care provider for things to read or websites to visit to learn more about
your child’s symptoms.
• Therapy might be recommended to help treat your child’s symptoms. It could involve
individual, group, or family work (cognitive behavioral therapy or skills building is the type
of therapy that is supported by research to be effective for children and teens experiencing
anxiety and/or depression).
• Help your child to practice mindfulness (staying in the present moment).
• Consider what could be changed at home or in school to help your child deal with their
worries (e.g., set a regular bedtime routine or think about which activities are stressful for
your child and think about ways to handle them differently).
• Medication is often recommended as an alternative treatment if symptoms are interfering
with your child’s day-to-day activities. Your provider may recommend a class of medicines
called SSRIs, short for selective serotonin reuptake inhibitors.

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118 • CHAPTER 3 • Patient Handout: Information for Parents About Anxiety in Children and Teens
❍ Be sure to ask:
– What symptoms will the medication treat?
– How long will my child have to take this medication?
– How much medication will my child have to take, and how many times a day will
they have to take it?
– How often will we see and/or talk to you about how my child is doing on the
medication?
– What happens if my child misses a dose of medication?
– How do we stop the medication?
❍ SSRIs sometime take weeks to see the positive benefit; it is important for your child to
take the medication as prescribed. The most common side effects when starting an SSRI
is stomach upset/nausea, which tends to subside in a few days.
❍ Watch your child for any suicidal behaviors when being started on an SSRI.
❍ Never have your child abruptly stop the medication if placed on an SSRI.
• Your level of anxiety and stress will affect your child so seek help if you also are experiencing
anxiety to the point where it is interfering with your concentration, judgment, or functioning.
• Teach, practice, and reinforce coping skills, such as breathing exercises, mindfulness
meditation, visualization, positive self-talk, distraction with music or stories, and exercise.

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CHAPTER 3 • Patient Handout: Information for Parents About Anxiety in Children and Teens • 119
Information for Parents About Behavior
Problems in Children and Teens
• Pediatric providers recognize how diffcult your role as parent is with this challenging child.
You still may want to remind us about how exhausting it is to have a child with behavior
issues.
• Please write down and tell us about every positive step that is being made as you parent
your child.
• Always build on your child’s particular positives; give your child praise and positive
reinforcement when he or she shows fexibility or cooperation.
• Your child’s problems are “loud” problems—they stand out for all to notice (as opposed to
anxiety, which is more of a private child problem). You may be bombarded by others in your
community telling you about your child’s behaviors.
• The journey of working with a child who has problem or disruptive behaviors can be
frustrating, draining, and isolating. This website connects you to a vast array of resources
and links that can help you better understand challenging children: www.livesinthebalance.
org/
• We want you to be well informed so you can teach others what you know. Your child’s
behaviors get “louder” and more obvious to others when they don’t have the skills to deal
with the demands being placed on them.
• Your child’s diffculties are complicated, and may have come with the child. Maybe it is in
their hard wiring—their brain anatomy and connections. Maybe it is in subtle temperament
qualities; maybe it is compounded with traumatic experience. Maybe your style of parenting
is perfect for one type of child but not such a “good ft” with this child’s strong personality
traits. Another signifcant factor is family stress, and family distress, including socioeconomic
status.
• Whatever the combination of factors, there is no blame; rather, there is assurance that your
child can learn to be more fexible, and can learn problem-solving skills, and can get better at
tolerating frustration.
• Recognize that, as Dr. Greene writes in the Explosive Child—children do well if they can.
• Your child longs for your approval, so provide it when your child does something positive.
• Because your child has some very real challenges with their “wiring” and temperament,
possibly genetics and early developmental stress, it is very likely that your child has trouble
with (a) fexibility, (b) frustration tolerance, and (c) problem-solving (from The Explosive Child
by Ross W. Greene, 2014), just as other children lag behind in acquiring academic or athletic
skills).

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CHAPTER 7 • Patient Handout: Information for Parents About Behavior Problems in Children and Teens • 243
• Some of the skills children similar to yours (with problem behaviors) have trouble with
include:
❍ Diffculty handling transitions—shifting from one mind-set task to another,
❍ Diffculty refecting on multiple thoughts or ideas simultaneously (disorganized),
❍ Diffculty considering a range of solutions to a problem,
❍ Diffculty considering the likely outcomes or consequences of actions (impulsive),
❍ Diffculty expressing concerns, needs, or thoughts in words,
❍ Diffculty managing emotional response to frustration in order to think rationally, and
❍ Chronic irritability and/or anxiety signifcantly impede capacity for problem-solving.
• One of the biggest favors you can do for an explosive child is to identify the lagging
skills that are setting the stage for his or her challenging behavior so that you and others
understand what is getting in his or her way. Also, identify what problems may be causing
explosive episodes and what helps to calm your child down. You and the teacher can keep a
journal of these observations.
• Build in some extra minutes for the child to comply with your request. Your child may have
trouble “switching gears” and moving to the new activity. Don’t add time for their time out
for every minute they stall on the way. That is the way they are wired; that is, they are slower
to process a change in activity.
• Take a break or time out if you are about to make the confict with your child worse. This is
good modeling for the child of using self-control strategies.
• The best parenting style is a warm and involved guiding approach—providing discipline.
Being consistent and frm, yet loving, is the best approach.
• Build on the positives of your individual child (an example would be the COPE exercise in
the Child Handout—where you and your child list three positive things particular to your
child, and you display those prominently and bring those up regularly and add to them).
• Dr. Greene writes, “Good parenting means being responsive to the hand you were dealt.”
• Your child likely had developmental “lags” or challenges in these areas:
❍ Diffculty seeing the “grays”: concrete, literal, black and white thinking,
❍ Diffculty deviating from rules or routine,
❍ Diffculty handling unpredictability, ambiguity, uncertainty, or novelty,
❍ Diffculty shifting from original idea or solution, or
❍ Diffculty taking into account situational factors that would suggest the need to adjust a
plan.
• Pick your battles. Prioritize the tasks you want the child to do, or habits you want to develop.
• Avoid power struggles. The child with ODD has trouble avoiding power struggles so you
may have to go the “extra mile” to avoid getting into the battle of wills.

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244 • CHAPTER 7 • Patient Handout: Information for Parents About Behavior Problems in Children and Teens
• Set up reasonable, age-appropriate limits with consequences that can be enforced
consistently. Review these with an expert you trust, such as your pediatrician or nurse
practitioner. Once these are set, feel confdent they are what are best for the child, and stick
consistently with your limits and consequences.
• All “adults” that are authorities in your child’s life should also know your rules and also
consistently enforce them. If the other parent disagrees, then there must be a plan made that
all of the important adults in that child’s life can consistently enforce.
• Your child has diffculty sorting out what to do if rules are not black and white.
Because of this diffculty—the adults caring for and parenting this child will have to be super
consistent in consistently enforcing the rules.
• Sticking to your expectations is very important. If you eventually give up your resolve and
give in, the child will learn to persist until you give in.
• Remember that the problem behaviors may escalate, get worse at frst, as the child “tests” the
new parenting approaches.
• Parents will need to make special efforts to care for themselves. The strong willed, explosive
child consumes so much of the parent’s time and energy, it is easy to become exhausted
physically and mentally. Maintain interests other than your child and ODD.
• Parents can seek out supports from other parents who are raising challenging children. When
you receive regular calls from the school or childcare setting with complaints about your
child’s behavior, you need sounding boards. You need people around you who support your
heroic efforts in parenting this child.
• Remember, much of the intense effort you are putting into your child is directly focused on
making sure that other people will want to be around them. You have a good parenting goal.
• Please know that your healthcare provider knows and applauds how much time and
energy you are investing—to make the tiny steps that seem undetectable but, in fact, are the
necessary steps for your child’s march toward success.
The Explosive Child book by Dr. Greene promotes a “collaborative problem-solving approach.” That
approach has been incorporated into this resource page for parents. There is an excellent website for
you to check out this approach to see if it fts with your family values/preferences.
www.livesinthebalance.org/
The research evidence to support “collaborative problem-solving” can be found on this website:
www.explosivechild.com
Fact sheet: Children with Oppositional Defant Disorder
https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Children-
With-Oppositional-Defant-Disorder-072.aspx
REFERENCE
Greene, R. W. (2014). The explosive child: A new approach for understanding and parenting easily frustrated, “chronically
infexible” children (Rev. 4th ed.). HarperCollins.

SM
CHAPTER 7 • Patient Handout: Information for Parents About Behavior Problems in Children and Teens • 245
Information on Depression for Parents
WHAT IS DEPRESSION?
Depression is an unhappy mood that affects daily functioning, including thoughts, feelings, behavior,
and overall health. When depression is too severe or lasts too long, it is considered an illness that can
be treated. Left untreated, depression can take the joy out of life and even take away the desire to live.
Everyone experiences minor upsets, but this does not mean that everyone is depressed. To have true
depression, the symptoms must be present for at least 2 weeks.
HOW COMMON IS DEPRESSION?

Depression in children and teens is far more common than most people realize and affects school-age
girls and boys equally. After puberty, girls are twice as likely as boys to be depressed. Ten out of 100
teens get seriously depressed each year, and many more have mild levels of sadness or the blues.
About one in 10 children without known problems has suicidal thoughts.
WHAT ARE THE SIGNS OF DEPRESSION?

The most important signs to look for are feelings of sadness and hopelessness. While every child or
teen is sad some of the time, no child should feel sad all of the time. If you notice that your child is
unhappy and can’t seem to have fun, think of this as a sign of depression. To be hopeless or without
hope means to feel that nothing can go right, that nothing will change, and that no one can help.
Poor self-esteem is another important sign of depression. This is the teen or child’s attitude toward
himself or herself. If your child’s self-esteem is poor, he or she may feel stupid, ugly, or worthless.
Another sign is a change in school performance. If your child was a good student and now wants to
stay home, or if his/her grades suddenly fall, he/she may be depressed. Other signs include sleep
problems, appetite changes, irritability, anger, crying, and aches and pains, such as headaches or
stomachaches.
What would your child say if he or she is depressed? Don’t expect your child to say much, because you
can’t count on him/her telling you how he/she feels. While your child may talk of being unhappy, he
or she probably won’t say, “I’m depressed” the way an adult will. So, you want to be aware of the signs.
WHAT IF MY CHILD SHOULD MENTION SUICIDE?

Sometimes a child mentions that he or she does not want to live. If your child mentions suicide: Take
it seriously. Talk to your child. Ask if he or she has made a plan for suicide. If so, it is more serious. If
suicide is mentioned or if an attempt is made, seek professional help immediately. Do not assume your
child is just looking for attention. Don’t ever dare a youngster who mentions suicide to “go ahead.”
You may think it’s a bluff, but he or she may take the dare.
HOW CAN A PARENT HELP?

You can be very helpful to your depressed child. Some suggestions include: Be supportive – listen to
what your child has to say. Encourage him or her to keep talking. If your child can’t talk well with
you, perhaps he or she can talk with a sibling, aunt, friend, teacher, or healthcare provider. Encourage

SM
CHAPTER 4 • Patient Handout: Information on Depression for Parents • 157

your child to describe or write down how he or she feels. Don’t get angry if he/she describes unhappy
feelings. If the problem is severe, worrisome, or lasts more than 2 weeks, get professional help. Talk
to your child’s healthcare provider if you have any concern that your child may be depressed.
WHAT ARE THE CAUSES OF DEPRESSION IN CHILDREN?

There is no single answer to the cause of depression. It is probable that several factors combine to
create the condition. The child’s environment, especially if it is unhappy and stressful, is often a major
cause. Depression also may be triggered by difficult situations, such as a death or divorce in the family
or abuse. Another possible contributing factor is heredity. Studies show that depression frequently
runs in families, so genetics may play a part in the depression of some children. Yet other reasons are a
lack of a certain chemical in the brain, called serotonin, and a negative pattern of thinking (e.g., I can’t
do anything right; everything is bad).
WHAT ARE THE TREATMENTS FOR DEPRESSION?

• Treatment is possible and helpful. The choice of treatment depends on the cause of the
problem, the severity of the depression, and whether suicidal thoughts are present.
Psychotherapy, such as cognitive behavior therapy, is the primary treatment. By meeting
regularly with a therapist, your child can find out the causes of his/her depression, and then
learn ways to help deal with it. It is usually good for the family to become involved in the
treatment.
• Medication can be an effective part of treatment. Antidepressants have few side effects and
are not habit-forming or addictive.
• Finally, you should not feel guilty if your child is depressed. The important point is to realize
that there is a problem and to get help for it. If you are concerned, be sure to talk to your
child’s healthcare provider. Remember, depression in children and teens is treatable.
WHAT CAN I DO TO PREVENT OR HELP MY CHILD WITH DEPRESSION?

• Stay involved in your child’s life. Spend time with your child regularly, even if it’s only a
family dinner. Too often, parents respond to growing teenagers’ wishes for independence
by withdrawing from their teens’ lives. The most important thing for parents to do is to be
aware of and involved in their teen’s life.
• Support positive relationships by encouraging your teen to get involved in school, clubs, or
community events. Help your teen find interests and activities where he or she can connect
with other teens. Also, know where your teen is and what he/she is doing when they go out.
• Talk to your teen and listen when he/she talks to you! Parents should talk to their children
as often as possible so teens can talk about their problems and worries. Ask your teen about
school and friends. Listen to his/her troubles and help find solutions.
• Teach your child coping and problem-solving skills; it also is important for you to role model
positive ways of coping and dealing with stress.

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158 • CHAPTER 4 • Patient Handout: Information on Depression for Parents

• Know the warning signs of depression and be aware if your child shows any of these
signs while talking to you, especially if he or she mentions suicide. Praise your teen’s
accomplishments rather than finding fault with things he/she does. Teens need to feel that
their parents care about them and that what they are doing is recognized.
• It is mainly your job to make sure that your child receives the treatment he or she needs.
Make sure that your teen takes his/her medication and goes to counseling. Be supportive.
• For more information about depression, contact the school counselor, psychologist, or social
worker at your child's school, or contact your child’s doctor or nurse practitioner.

SM
CHAPTER 4 • Patient Handout: Information on Depression for Parents • 159

Information for Parents About Attention Defcit
Hyperactivity Disorder (ADHD)
WHAT IS ADHD?
ADHD is the name of a group of behaviors found in many children and adults. People with ADHD have
trouble paying attention in school, at home, or at work. They may be much more active and/or impul-
sive than what is usual for their age. These behaviors contribute to significant problems in relationships,
learning, and behavior. For this reason, children with ADHD are sometimes seen as being “difficult” or
as having behavior problems. ADHD is common, affecting 4% to 12% of school-age children. It is more
common in boys than in girls.
WHAT ARE THE SYMPTOMS OF ADHD?

The child with ADHD who is inattentive will have six or more of the following symptoms:
• Difficulty following instructions.

• Difficulty keeping attention on work or play activities at school and at home.
• Loses things needed for activities at school and at home.
• Appears not to listen.
• Doesn't pay close attention to details.
• Seems disorganized.
• Has trouble with tasks that require planning ahead.
• Forgets things.
• Is easily distracted.
The child with ADHD who is hyperactive/impulsive will have at least 6 of the following symptoms:
• Runs or climbs inappropriately.

• Is fidgety.
• Can't play quietly.
• Blurts out answers.
• Interrupts people.
• Can't stay in seat.
• Talks too much.
• Is always on the go.
• Has trouble waiting his or her turn.

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CHAPTER 5 • Patient Handout: Information for Parents About Attention Defcit Hyperactivity Disorder • 193
WHAT CAUSES ADHD?
Children with ADHD do not make enough chemicals in key areas in the brain that are responsible for
organizing thought. Without enough of these chemicals, the organizing centers of the brain don't work
well. This causes the symptoms in children with ADHD. Often there is a family history of ADHD.
Things that don't cause ADHD: poor parenting (although a disorganized home life and school envi-
ronment can make symptoms worse); too much or too little sugar, aspartame, food additives or color-
ings; lack of vitamins; food allergies or other allergies; fluorescent lights; video games; or too much TV.
WHAT CAN I DO TO HELP MY CHILD WITH ADHD?

A team effort, with parents, teachers, and doctors working together, is the best way to help your
child. Children with ADHD tend to need more structure and clearer expectations. Families may
benefit from talking with a specialist in managing ADHD-related behavior and learning problems.
Medicine also helps many children. Talk with your doctor or nurse practitioner about treatments he/
she recommends.
WHAT MEDICINES ARE USED TO TREAT ADHD?

Some of the medicines for ADHD are methylphenidate, dextroamphetamine, atomoxetine guanfacine,
or clonidine. These medicines improve attention/concentration and decrease impulsive and overac-
tive behaviors.
WHAT CAN I DO AT HOME TO HELP MY CHILD?

Children with ADHD may be challenging to parent. They may have trouble understanding directions.
Children with ADHD are often in a constant state of activity. This can be challenging. You may need to
change your home life a bit to help your child. Here are some things you can do to help:
• Make a schedule. Set specific times for waking up, eating, playing, doing homework, doing
chores, watching TV or playing video games, and going to bed. Post the schedule where
your child will always see it. Explain any changes to the routine in advance.
• Make simple house rules. It’s important to explain what will happen when the rules are
obeyed and when they are broken.
• Make sure your directions are understood. Get your child's attention and look directly into
his or her eyes. Then tell your child in a clear, calm voice specifically what you want. Keep
directions simple and short. Ask your child to repeat the directions back to you.
• Reward good behavior. Congratulate your child when he/she completes each step of a task.
• Make sure your child is well supervised. Because they are impulsive, children with ADHD
may need more adult supervision than other children their age.
• Watch your child around his or her friends. It’s sometimes hard for children with ADHD to
learn social skills. Reward good play behaviors.

SM
194 • CHAPTER 5 • Patient Handout: Information for Parents About Attetion Defcit Hyperactivity Disorder
• Set a homework routine. Pick a regular place for homework, away from distractions such
as other people, TV, and video games. Break homework time into small parts and allocate
frequent breaks.
• Focus on effort, not grades. Reward your child when he or she tries to finish schoolwork,
not just for good grades. You can give extra rewards for earning better grades.
• Talk with your child's teachers. Find out how your child is doing at school—in class, at
playtime, at lunchtime. Ask for daily or weekly progress notes from the teacher.

SM
CHAPTER 5 • Patient Handout: Information for Parents About Attention Defcit Hyperactivity Disorder • 195
Information for Parents on How to Help Your
Child/Teen Cope With Stressful Events or Uncertainty
The most important thing that you can do to help your child/teen cope with stressful events is to
remain as calm as possible when you are with them. Children pick up on their parents’ anxiety very
quickly. If they sense you are anxious, they will be anxious as well. Therefore, if you are having diffi-
culty coping with a stressful situation, it is a good idea to reach out to resources to help you, such as
friends, family members, support groups, clergy, or healthcare professionals. Taking care of your own
stress so that you are less anxious will help your child to stay calm.
RECOGNIZE SIGNS OF ANXIETY/STRESS IN YOUR CHILD

• Children and teens typically regress when stressed. That is, they go back to doing things
they did when they were younger to help themselves feel more comfortable and secure. For
instance, a preschool child may go back to sucking their thumb and a school-age child or
teen may act more dependent upon the parents or have difficulty separating from them.
• Other common signs of anxiety in young children include: restlessness/hyperactivity, temper
tantrums, nightmares, clinging behaviors, difficulty separating, and distress around new
people.
• Common signs of anxiety in older school age-children and teens include: difficulty concentrating
and sleeping, anger/irritability, restlessness/hyperactivity, worry, and physical complaints,
such as stomachaches or headaches.
• At age 9 years, children realize that death is permanent. Fears of death or physical violence
and harm are often common after this age.
• Signs and symptoms of anxiety such as these are usually healthy, temporary coping
strategies that help your child to deal with stress. However, if these symptoms persist
for several weeks or interfere with your child’s functioning, talk to your child’s primary
healthcare provider about them. Your child’s doctor or nurse practitioner will know what to
do to help.
• Be honest and give age-appropriate and developmentally appropriate explanations about
stressful events when they occur.
• For young children (under 8 years of age), only provide answers to questions they are
asking and do not overwhelm them with too much detail. Use language that young children
can understand. Do not expose young children to visual images in the newspapers or on
television that may be terrifying.
• It may be easier for young children to express how they are feeling by asking them to talk
about how their stuffed animals or dolls are feeling or thinking.
• Help children and teens to express how they are feeling about what they have seen or heard.
If children have difficulty verbally expressing their feelings, ask them to make a drawing
about how they are feeling. Older school-age children and teens can benefit from writing
about how they feel.

SM
CHAPTER 3 • Patient Handout: Information for Parents on How to Help Your Child/Teen Cope • 121
• Ask your child/teen, “What is the scariest or worst thing about this event for you?” or
“What is worrying you the most right now?” and take time to really listen to what they have
to say.
• Reassure children that they did nothing wrong to cause what happened. Toddlers and
preschool children especially feel guilty when stressful events happen.
• Tell children and teens that what they are feeling (e.g., anger, anxiety, helplessness) is normal
and that others feel the same way.
• Decrease anxiety in your child by reassuring them that you will get through this together.
Emphasize that adults are doing everything possible to take care of the stressful situation
and that they are not alone.
• Help your child/teen to release tension by encouraging daily physical exercise and activities.
• Continue to provide as much structure to your child’s schedules and days as possible.
• Recognize that added stress/anxiety usually increases psychological or physical symptoms
(e.g., headaches or abdominal pain) in children/teens that are already anxious or depressed.
• Young children who are depressed typically have different symptoms (e.g., restlessness and
excessive motor activity) from those experienced by older school-age children or teens who
are depressed (e.g., sad or withdrawn affect; anger/irritability, difficulty sleeping, or eating;
talking about feeling hopeless).
• Use this opportunity as a time to work with your child on their coping skills (e.g., relaxation
techniques, positive reappraisal, prayer). Children watch how their parents cope and often
take on the same coping strategies. Therefore, showing your child that you use positive
coping strategies to deal with stress will help them to develop healthy ways of coping.
• Be sure to have your child or teen seen by a healthcare provider or mental health professional
for signs or symptoms of persistent anxiety, depression, recurrent pain, persistent behavioral
changes, or if they have difficulty maintaining routine schedules or the symptoms are
interfering with functioning.
• Remember that stressful times can be an opportunity to build future coping and life skills as
well as to bring your family closer together.

SM
122 • CHAPTER 3 • Patient Handout: Information for Parents on How to Help Your Child/Teen Cope

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May 2022

Examining the Epidemic of

OFFICE OF THE CHIEF WELLNESS OFFICER

Warm and well regards,

Kate Gawlik, DNP, APRN-CNP, FAANP, FNAP

Bernadette Mazurek Melnyk, PhD, APRN-CNP, FAANP, FNAP, FAAN

Parents – and especially working parents – are struggling.

Here is what the study uncovered:

• Sixty-six percent (66%) of parents reported being burned out.

I am expected to be a superhuman that can be a full-time employee,

I feel like I am running I am just so tired. I am alone.

I work 168 hours a week with no time of and no additional pay.

My work colleagues do not understand that I am having a hard time

Females were more likely than males to have

Parental burnout was increased

Parent burnout was reported in 77% of

Seventy-two percent (72%) of parents

Examples of attention Examples of internalizing Examples of externalizing

Step one: Complete the scale

Not at all A little Somewhat Moderately so Very much so

Item 1: I get/feel easily irritated

Item 2: I feel that I am not the good

Item 3: I wake up exhausted at the

Item 4: I fnd joy in parenting my

Item 5: I have guilt about being a

Item 6: I feel like I am in survival

Item 7: Parenting my children is

Item 8: I lose my temper easily

Item 9: I feel overwhelmed trying

Item 10: I am doing a good job

Scale Copyright, Kate Gawlik and Bernadette Mazurek Melnyk, 2021.

Step three: Calculate the total score

Step four: Interpret the score

11-20 Points: Mild burnout

21-30 Points: Moderate burnout

31+ Points: Severe burnout

Score 21-30: Moderate burnout – Take action! Start interventions

Score 11-20: Mild burnout – Start preventive interventions such

Score 0-10: No or few signs of burnout – you should continue to do

☐ I enjoy being a working parent. I have no symptoms of burnout. (0 points)

A score of 2 or higher indicates you may be experiencing working parental burnout.

Copyright, Kate Gawlik and Bernadette Mazurek Melnyk, 2022

• Take good self-care (it is not selfsh!): Even a fve- to

If you are interested, please visit go.osu.edu/stressbusters

“With mad and love, love always wins.”

OFFICE OF THE CHIEF WELLNESS OFFICER

1. Pediatric Symptom Checklist (PSC-17) for Parents

2. Information for Parents About Anxiety in Children

3. Information for Parents About Behavior Problems in

4. Information on Depression for Parents

5. Information for Parents About Attention Defcit

6. Information for Parents on How to Help Your Child/

1. Feels sad, unhappy.................................................. □ □ □

Reproduced with permission from Jellinek, M., & Murphy, M. (1986).

CHAPTER 1 • Patient Handout: Pediatric Symptom Checklist (PSC-17) for Parents • 29

(0) (1) (2)

1. Se siente triste, infeliz ............................................. _____ _____ _____

Reproduced with permission from Jellinek, M., & Murphy, M. (1986).

CHAPTER 1 • Patient Handout: Lista De Síntomas Pediátricos (Pediatric Symptom Checklist—PSC) • 31

1. Se siente triste, infeliz ............................................. ___ _ ___