AMERICAN ACADEMY OF DEVELOPMENTAL MEDICINE & DENTISTRY
BY H. BARRY WALDMAN DDS, MPH, PHD, STEVEN P. PERLMAN DDS, MSCD, DHL (HON),
AND MISHA GAREY, DDS
“When it comes to family arrangements, the United States has a North-South divide. Children growing up across much of the northern part of the country are much more likely to grow up with two parents than children across the South.” 1
TWO PARENT FAMILIES
There is a kind of “two-parent arc” that starts in the West in Utah, runs through the Dakotas and Minnesota, and then down to New England and New Jersey. Single parent families, by contrast, are
most common in a southern arc beginning in Nevada and extending through New Mexico, Oklahoma and the Deep South before coming up through Appalachia and West Virginia. These patterns are important because evidence suggests that children usually benefit from growing up with two parents. “It’s probably not coincidence, for instance, that the states with more two parent families also have higher rates of upward mobility.” 1
Recent research reported by Wilcox and Zill on the geography of American families runs counter to the conventional wisdom that, “… conservative states, for all their emphasis on family values, have long had high divorce rates. In the Northeast, California and Illinois, divorce is notably low… (with) families in blue states (being) more stable than families in red states”1,2 (Red states and blue states refer to those states of the United States whose residents predominantly vote for the Republican Party [red] or Democratic Party [blue]).
In the blue states, residents receive more education and earn higher incomes – and more educated, higher earning people tend to marry and stay married. In Minnesota, New Jersey, Massachusetts and Connecticut, at least 51% of teenagers are being raised by both biological parents, among the highest in the nation.
In the red states, educational attainment is closer to average and residents with deep religious beliefs are more likely to have commitment to marriage and to raising children within marriage. The lowest rates of two-parent families tend to be in states that don’t fit either model; red states with the lowest level of education or blue states with only average levels of education.
Boys who grow up with two parents seem to end up substantially stronger economically. Girls appear less likely to become pregnant as teenagers. “Kids thrive on stable routines.”1,2
Note: Emphasis on two parent families should not dismiss the “…heroic work that so many single parents do. Managing parenthood, work, and the rest of life without a partner is deeply impressive. Nevertheless, the sharp rise in single parent families has contributed to sky-high inequality…”1
“It’s important to keep in mind that just because a woman has a nonmarital birth that does not necessarily mean that another is ‘going it alone.’ For instance in the U.S., more than half of births that occur outside of marriage are to women who are cohabiting.”3 In 2012, 41% of U.S. births occurred outside of marriage. In Europe, the percent of births that occurred outside of marriage ranged from 3% in Turkey and 8% in Greece to 58% in Estonia and 67% Iceland.3
NOW ADD CHILDREN WITH DISABILITIES TO THE EQUATION
“Marriage is hard. Even in the best of circumstances, with a couple who is head over heels in love with each other, there will be difficult times. I think we have all heard the much touted statistic that states that 50% of all marriages end in divorce. This percentage jumps to between 80% and 90% for couples who have a child with special needs.”4
“Younger maternal age when the son/daughter with autism spectrum disorder was born and having the son/daughter born later in the birth order (i.e. number of children in the family) were positively redictive of divorce for parents.” 5 “Factors associated with an increased risk of divorce included history of antisocial behavior in the father, mothers with substantially less education than fathers, an earlier age of diagnosis of the child’s ADHD, children from racial or ethnic minority groups…” 6
“:..our results suggest that raising a child with autism does not often lead to the dissolution of the parents’ relationship, as is commonly believed.” 7
“Despite speculation about an 80% divorce rate among parents of children with an Autism Spectrum Disorder (ASD), very little empirical and no epidemiological research has addressed the issue of separation and divorce among this population. Data for this study was taken from the 2007 National Survey of Children’s Health, a population-based, cross-sectional survey… results … revealed no evidence to suggest that children with ASD are at an increased risk for living in a household not comprised of their two biological or adoptive parents compared to children without ASD in the United States.” 8
“(Comparing)… divorce rates among families of children with Down Syndrome to families of children with other birth defects and families of children with no identified disability, (it was reported that) divorce rates were lower (sic) among couples with a child with Down’s than in the other two groups.” 9
When divorce did occur in the Down syndrome group, it was more likely within the first two years after the child’s birth. Factors associated with increased risk of divorce among families of children with Down syndrome included younger age of parents, parents who were unable to complete high school, fathers with less education than mothers and couples living in rural areas. 9 Note: “… the level of understanding about autism in the community has progressed to the point that having a child with the condition has become more socially acceptable. The same is true of Down syndrome, which is caused by a specific chromosomal abnormality. Mental health is still a taboo topic. It’s less stigmatizing to have a kid with an autism spectrum disorder than a kid with a psychiatric disorder. (sic)” 9
COMPARING HOUSEHOLDS WITH TWO PARENTS AND THE PROPORTION OF CHILDREN WITH SEVERE DISABILITIES
Authors’ comment: Despite the conflicting reports in the literature regarding the occurrence of divorce in households with children with disabilities, and the lack of specific information regarding the causal relationships, we thought it would be a “slam dunk” to compare states with the estimated highest and lowest proportion of households with two parents and the estimated proportion of children with severe disabilities. Not so…
The percentage of children (<5 years and 5-17 years) with severe disabilities in the 10 states with the highest and the 10 states with lowest proportion of two parent households were compared.
• There were slightly smaller proportions of children (< 5 years) with severe disabilities in the states with greater proportions of two parent households. Note: Census Bureau reports for the < 5 year old children include only severe hearing and vision disabilities.
• Among the children (5-17 years) one state (North Dakota) had one of the highest proportion of two parent households and the lowest proportion of children with severe disabilities. Two of the states (Arkansas and Louisiana) had one of the lowest proportion of two parent households and the highest proportions of children with severe disabilities. Nevertheless, there was no consistency among the other states regarding the proportions of households with two parents and the proportions of children with severe disabilities.
The reality is that the multitude of disabilities are not alike; nor is the severity of the conditions, the capacity of the affected child, the ongoing inter-relations of the parents, the economic and social setting of the household, the support of the extended family structure and the endless known and unknown factors which also impact on the environment of a household with a child or children with disabilities. The report by Sobsey summed up the dilemma with the title, “Marital stability and marital satisfaction in families of children with disabilities: Chicken or egg?” 11 Is it the child with disabilities or the household?
WHEN PARENTS OF CHILDREN WITH DISABILITIES DIVORCE
“Each year, parents of a million American children divorce. Divorce affects everyone involved, but it is often the most difficult for children with disabilities. When custody determinations or modifications involve children with disabilities, the decisions regarding the “best interests of the child” can be even more complex.”12
The words “best interests of the child” have no one, single meaning, and the laws in most states define “best interests” by listing a number of factors for the court to consider. Common factors in many states include: the capacity of the parents to understand and meet the needs of the child, religion and/or cultural considerations, the child’s wishes, the need for continuation of a stable home environment, the relationship between the child and parents, siblings, and others important in his or her life, the child’s adjustment to school and community, the age and sex of the child and parental use of excessive discipline or emotional abuse. 12
In some families, parents do not agree about how to address the unique needs of a child with a disability. Sometimes, one parent may be in denial about the existence of a disability or may not agree with the other parent regarding the best approach needed to care for or seek appropriate supports and services to meet the needs of that child. Even as the child grows into adulthood, this may continue to be an issue. Children with disabilities often need supervised care as they get older. They need the continued support of both parents in the event of a divorce.12 (See reference for an extended and detailed review of factors to be considered in providing for a child with disabilities in a family faced with the prospects of a divorce.12)
GEOGRAPHY VS. REALITY
Dividing the country into north and south slices to describe the prevalence of one and two parent families is a convenient research tool and should not be dismissed out-of-hand as lacking substance in understanding the potential impact of these household arrangements on the support for children with disabilities. But so too is it essential to consider the individual household within these slices in terms of one and two parent arrangements and the impact on children with disabilities as these youngsters mature into adulthood. Ultimately, many parents may be faced with the difficult question: Will your life and the life of your child with a disability be better after your divorce?
ABOUT THE AUTHORS:
H. Barry Waldman, DDS, MPH, PhD – Distinguished Teaching Professor, Department of General Dentistry at Stony Brook University, NY; E-mail:h.waldman@ stonybrook.edu
Steven P. Perlman, DDS, MScD, DHL (Hon) – Global Clinical Director, Special Olympics, Special Smiles and Clinical Professor of Pediatric Dentistry, The Boston University Goldman School of Dental Medicine, Private pediatric dentistry practice – Lynn MA.
Misha Garey, DDS is Director of Dental Services at the Orange Grove Center.
1. Leonhardt D. A geographic divide on family life in America. NY Times, June 11, 2015, pA3.
2. Wilcox WB, Zill N. Red State Families: Better Than We Knew.Web site: http://family-studies.org/redstate-families-better-than-we-knew Accessed June 13, 2015.
3. Blow CM. Jeb Bush and single mothers. NY Times, June 15, 2015, pA19.
4. Families.com. School for Autism in NY. Divorce rate higher among couples with special needs children. Web site: http://www.families.com/blog/divorce-rate-higher-among-couples-with-special-needs-children Accessed June 12, 2015.
5. Hartley SL, Barker ET, Seltzer MM, et al. Separation of parents raising children with Autism
Spectrum Disorders Journal Developmental and Physical Disabilities, 2013;25(6):613-624.
6. Wymbs BT, Pelham WE Jr, Molina BS, et al. Rates and predictors of divorce among parents of youth with ADHD. Journal Consultation Clinical Psychology, 2008;76(5):735-744.
7. Baeza-Velasco C, Michelon C, Rattaz C, et al. Separation of parents raising children with Autism Spectrum Disorders. Journal Developmental and Physical Disabilities, 2013;25(6):613-624.
8. Freedman BH, Kalb LG. Relationship status among parents of children with autism spectrum disorders: a population-based study. Journal Autism Development Disorders, 2012;42(4):539-548.
9. Urbano RC, Hodapp RM. Divorce in families of children with Down syndrome: a population-based study. American Journal of Mental Retardation, 2007;112(4):261-274.
10. Census Bureau American Community Survey. Web site:http://factfinder.census.gov/faces/nav/jsf/pages/index.xhtml Accessed June 14, 2015.
11. Sobsey D. Marital stability and marital satisfaction in families of children with disabilities: Chicken or egg? Developmental Disabilities Bulletin, 2004;32(1):62-83.
12. Epperson B. When parents of children with disabilities divorce. Web site: http://www.americanbar.org/content/newsletter/publications/gp_solo_magazine_home/gp_solo_magazine_index/parentsdivorce.html Accessed June 14, 2015.