How to deal with your kid's weird friends

Your child is hilarious, interesting, clever—frankly, he's all-around delightful. But his friends are ...well, we're all adults here, so let's just come out with it: Some of them are weird.

You don't get them, and you suspect that the other grade school students don't either. You want to deal with the situation in the most unobtrusive and sensitive manner possible, and you definitely don't want to hurt anyone's feelings, but you don't want to ignore warning signs of an unhealthy and possibly toxic relationship either.

To find out how to manage this parenting dilemma, we called Matthew Goldfine, PhD, a clinical child psychologist at the Columbia University Clinic for Anxiety and Related Disorders. He treats children, teens and adults. We asked him for advice on five types of friends.

1. The (potentially) bad influence How you'd describe them: They act out, make the kinds of poor choices that you're always cautioning your children about, and are often reprimanded by the teacher.
How your child would describe them: "FUN!"
How you should handle this situation: Goldfine says this is the type of friendship that tends to worry parents the most—with good reason. "Studies show that delinquency can be almost contagious," he says. Your task is to figure out what kind of troublemaker this one is. There's no magic trick to help you with this, but you can start with the list of behaviors that are unacceptable to you and your spouse, and if you hear that this new friend is engaging in them—and worse, egging on your kid—then you shouldn't feel bad about breaking up the friendship ASAP.

Goldfine says that other warning signs are "clear intentions that this child wants to make other people angry, unhappy or hurt through their actions." Be on the lookout for a child who often responds to a teacher's instructions by shouting, "NO! And you can't make me!" There's a difference between a mean-spirited kid snapping rules in half and posing direct challenges to authority, and a rambunctious or energetic one bending the rules a little.

If you just aren't sure whether this kid is a bad influence, Goldfine strongly advises talking to the other child's parents. Hold off on judging their disciplinary techniques and, instead, fill them in on the kinds of things the kids do when they're at your house. Most likely, they'll reciprocate, which will give you another perspective. If not, you'll get a sense of how involved the parents are. Assume that the parents are as well-meaning as you are and make an effort to build a relationship with them.

Be sensitive to the fact that any discussion of either kids' behavior holds such dramatic potential that it was the subject of a Broadway play (the movie version of God of Carnage, with Kate Winslet and Jodie Foster, comes out this fall).

Barring dangerous behavior, Goldfine thinks it's okay to let your (ostensibly good) kid pal around with the class clown or the goofy troublemaker. Worried about how they'll grow into those teen years together? "Just because they're hanging out now doesn't mean they'll be best friends forever," he says.

2. The unhygienic kidHow you'd describe them: Remember Pig-Pen, Charlie Brown's filthy friend?
How your child would describe them: "His mom never makes him take a bath."
How you should handle this situation: "These are often the cases where I think it's helpful for parents to supervise and monitor, but maybe not intervene," says Goldfine. Your child is clearly overlooking this other child's flaws. Good for them! Goldfine suggests waiting until the child comes to you and asks why her friend smells funny or wears stained clothes, or talks to you about how the other kids treat him.

"This could be a good opportunity to talk about the importance of good hygiene, of wearing clean clothes and of taking care of one's self." He adds that kids are more socially aware than we give them credit for, even if it might take them longer to figure things out.

As long as this child is not in danger, or putting your child's health and safety in jeopardy, step back and let the friendship run its course. He reminds us that the best behavioral models children have are their parents. "What kind of message do you want them to get from you? It's probably something like, 'As long as this person is nice to me and fun to be around, then I don't care about what other kids say.'"

3. The obsessive How you'd describe them: They get hung up on things, like insects, or sentient life on Mars, or opening and closing drawers over and over and over...
How your child would describe them: "They have cool toys." 
How you should handle the situation: Goldfine says he often hears parents try to diagnose other people's children with psychological or developmental disorders like obsessive-compulsive behavior, autism or Asperger's syndrome.

Granted, he practices in Manhattan, where every third person on the subway is either a therapist or on their way to an appointment with one. But this unhelpful habit extends far beyond the city limits. "These are heavy words, and even trained professionals are very careful with how they use them," he says. And what if this is a case of true Asperger's or OCD?

"It's not contagious, and there's absolutely no harm to your child in hanging out with another kid who has one of these psychological diagnoses," says Goldfine. "In fact, it's good for them to have a variety of different kinds of friendships."

Goldfine reminds us to be aware of the impression that we're giving our kids when we criticize their friends—they really pick up on those signals. When deciding how to deal with a child whose creepy behavior bothers you more than it does your daughter or son, recall Mad Men and how Betty Draper dealt with her daughter Sally's friendship with the creepy neighborhood boy, Glen. Betty forbade Sally from hanging out with Glen, which only made Sally more eager to spend time with him. Even worse, Betty's actions made her look like an insensitive mom, pushing Sally further away.

4. The hanger-on How you'd describe them: She can't get enough of your daughter.
How your child would describe them: "She calls me her sister."
How you should handle the situation: Congratulations! Your kid is popular. Grade school children tend to lack subtlety in their social interactions, so this clingy behavior is likely a sign that your child is the kind of person that others are drawn to.

"In this case, I'd advise following your child's lead," says Goldfine. If she seems to enjoy the other kid's company (however shadowlike it may seem to you), then let them be. But if your child says that she wants to spend time with other kids, or is giving off frustrated cues by treating this friend poorly, start a conversation with her about other people's feelings.

"You could ask, 'What's a nice way to tell someone that you want to have a playdate with someone else?'" says Goldfine. "Or you could talk about strategies: 'Let's hang out with this friend these days and other friends on those days.'" Consider this an opportunity to create a compassionate queen bee.

5. That little you-know-what How you'd describe them: They spilled the beans about the tooth fairy and the birds and the bees, and now they're teaching your kid dirty words—in German.
How your child would describe them: "He knows a lot of stuff." 
How you should handle the situation: This kid is a parent's stealth enemy because he often appears out of nowhere to steal your child's innocence. One night you're leaving the closet light on for a naïve 9-year-old, and the next he's talking like a pervy European bartender. It won't be long before he'll start begging you to let him watch Superbad—and you get the sense he and his new friend already sneaked a peek.

Goldfine says that this is another situation where it's important to communicate with the other child's parents. Let them know what the duo has been up to and get a sense of how they feel about it. As with the (potentially) bad influence, look for clear warning signs (cruel intentions, bullying) and draw the line at the behaviors that you deem off-limits.

If this child's annoying behavior doesn't extend far beyond dismantling beloved childhood myths, Goldfine suggests taking control of the situation. After overhearing him use curse words, explain what they are and why we don't use them. Recognize that you might have to push up the "sex talk" by a year or so.

"This may not have been your plan," he says, "but it's your chance to get in on the ground floor and correct any misconceptions about what your child has been told." It's also your chance to have a bigger influence over your child than this kid has. It will be very hard to keep your child away from a spoilsport, as that will only stoke further curiosity. Besides, the cat's already out of the bag—and meowing around the playground. It's unlikely that your child is the only one who has heard this kid's R-rated stories.

Is your doctor burned out?

Job burnout can strike workers in nearly any field, but a new study finds that doctors are at special risk.

Nearly 1 in 2 U.S. physicians report at least one symptom of burnout, with doctors at the front line of care particularly vulnerable, the study found -- a significantly higher rate than among the general working population.

Overtaxed doctors are not only at risk for personal problems, like relationship issues and alcohol misuse, but their job-related fatigue can also erode professionalism, compromise quality of care, increase medical errors and encourage early retirement -- a potentially critical problem as an aging population demands more medical care.

The new findings, published in the Archives of Internal Medicine, are based on a survey of 7,288 physicians conducted in June 2011.

Led by researchers from the Mayo Clinic and the American Medical Association, the study asked participating physicians to fill out a questionnaire asking about their feelings of burnout -- including "emotional exhaustion" or losing enthusiasm for their work; feelings of cynicism or "depersonalization"; and a low sense of personal accomplishment.

The 22-item questionnaire, called the Maslach Burnout Inventory (MBI), is considered the gold standard for measuring burnout; the doctors also completed a shorter, modified version of the MBI, the answers to which researchers used to compare with the general population.

Researchers also asked doctors how long they worked each week, how satisfied they were with their work-life balance, and whether they had any symptoms of depression or thoughts of suicide.

The data showed that rates of burnout were high: 45.8% of doctors experienced at least one symptom of work-related burnout.

When each symptom was considered separately, 37.9% of the physicians had high emotional exhaustion, 29.4% had high depersonalization and 12.4% had a low sense of personal accomplishment. U.S. doctors are burning out "at an alarming level," the authors write.

"Our finding is concerning given the extensive literature linking burnout to medical errors and lower quality of care," says study author Dr. Tait Shanafelt of the Mayo Clinic. "Most previous studies of physicians from individual specialties have suggested a burnout rate of 30% to 40%. Thus, the prevalence of burnout among physicians appears to be higher than in the past."

The study found that practitioners of front-line care -- including physicians in emergency medicine, general internal medicine and family medicine -- fared worst.

"Nearly 60% of physicians in those specialties had high levels of burnout," says Shanafelt. "This is concerning since many elements critical to the success of health care reform are built upon increasing the role of the primary care providers."

Doctors practicing pathology, dermatology, general pediatrics and preventive medicine (including occupational health and environmental medicine) had the lowest rates of burnout.

The researchers also compared physicians' job-related fatigue with that of 3,442 working American adults in the general population, and found that physicians were significantly more burned out overall. Among other working adults, only 27.8% were likely to experience burnout, 23.5% had high emotional exhaustion and 15% had high depersonalization.

The authors found also that physicians worked about 10 hours more per week than other people on average (50 hours a week versus 40), and were much more likely to work extra long weeks of 60 hours or more: 37.9% of doctors worked at least 60-hour weeks, compared with only 10.6% of the general population.

More than 40% of doctors reported dissatisfaction with their work-life balance, saying their jobs didn't leave enough time for a personal life or family, compared with 23.1% of non-doctors.

In addition, while higher levels of education were associated with less risk of burnout for people in other professions, doctors' advanced degrees didn't afford them the same protection from job-related stress.

"While individuals in other professions do experience burnout, it seems to be largely driven by the hours," says Shanafelt. "In addition to their high work hours, there appears to be factors related to the nature of the work that increase the risk for physicians."

"Unfortunately, little evidence exists about how to address this problem," the authors write, urging additional research to figure out what can be done to support doctors at the individual, organizational and societal level. "Policy makers and health care organizations must address the problem of physician burnout for the sake of physicians and their patients."