Child murder by mothers: a critical analysis of the current state of knowledge and a research agenda

OBJECTIVE: Maternal filicide, or child murder by mothers, occurs more frequently in the United States than in other developed nations. However, little is known about factors that confer risk to children. The authors review the literature to identify predictors of maternal filicide and identify gaps in knowledge about maternal filicide. METHOD: Databases were systematically searched for studies of maternal filicide and neonaticide (murder in the first day of life) that were conducted in industrialized countries and were published in peer-reviewed, English-language publications after 1980. RESULTS: Women who committed filicide varied greatly by the type of sample studied. Neonaticide was often committed by young, poor, unmarried women with little or no prenatal care. CONCLUSIONS: The results of the review suggest that little is known about the predictors of maternal filicide and that a systematic, focused program of research on reliable markers for maternal filicide is needed to better prevent these events.     

The health and well-being of black mothers who care for their adult children with schizophrenia

This study compared the mental and physical health of two groups of black mothers aged 55 years and older: those who were providing care for their adult child with schizophrenia or schizoaffective disorder (N=30) and those who did not have a child with mental illness (N=263). The only demographic variable that was found to differ between the two groups was that the women who were providing care for their adult child with mental illness had more children than the women in the comparison group. Both groups of women had similar mental health status. However, the mothers who were providing care for their adult children with mental illness had higher rates of chronic health conditions, such as high blood pressure, arthritis, and eye problems.     

Tötung des eigenen Kindes in der Postpartalzeit

The parental killing of children constitutes a complex phenomenon which has been reported across numerous cultures and throughout history. Children in the 1st year of life are at the highest risk of filicide. Types of filicide in the postpartum period include altruistic filicide, extended suicide, fatal child maltreatment, and neonaticide. Babies are murdered more frequently by mothers who are psychiatrically disturbed. With high frequency, depressive and psychotic symptoms are related to the newborn or to the maternity itself. The knowledge about maternal factors associated with filicide is not homogeneous. Sociodemographic characteristics are presented in relation to the different types of filicide. Risk constellations that may lead to a child's murder are described.     

Affective disorder and homicide: a case of familial filicide theoretical and clinical considerations

This paper discusses a case of maternal homicide which occurred in the course of a major affective disorder. The relationship between mental illness and criminality is reviewed with a particular emphasis on affective disorder in relation to filicide. A number of significant issues are dealt with including consequences of failure to elicit positive family history of affective disorder, suicide and filicide. Indeed, a history of familial double filicide raises the question of possible hereditary influences. The significance of hypochondriacal symptomatology in the course of the illness and the role of steroids in precipitating or aggravating a psychotic depression also need to be explored. It primarily addresses the importance of prevention and recognition of risk factors associated with child murder committed by depressed parents.     

Onset of maternal psychiatric disorders after the birth of a child with intellectual disability: A retrospective cohort study

Mothers of a child with intellectual disability (ID) have more psychiatric disorders after the birth of their child than other mothers. However, it is unclear if this is because they have more psychiatric disorders before the birth or if the increase is related to the burden of caring for the child. We aimed to calculate the rate of new psychiatric disorders in mothers after the birth of their eldest child with ID born between 1983 and 2005 and to compare these with rates in women with a child with no ID or autism spectrum disorder (ASD) born during the same period. By linking data from Western Australian population-based registries, we selected women with no psychiatric history who survived the birth of their live-born child (N = 277,559) and compared rates of psychiatric disorders for women with a child with ID and women without a child with or ASD. Negative binomial regression with STATA 12 was used for all analyses. Mothers of children with mild–moderate ID of unknown cause had around two to three and a half times the rate of psychiatric disorders of mothers of children without ID or ASD. Mothers of children with Down syndrome and no pre-existing psychiatric disorder showed resilience and had no impairments in their mental health. Interventions and services are needed for mothers of other children with ID to improve their mental health. Further research is implicated to explore the mental health of mothers of children with ID and a pre-existing psychiatric disorder.     

A review of maternal and paternal filicide

Filicide, the murder of a child by a parent, is a multifaceted phenomenon with various causes and characteristics. This review of the existing literature delineates the present state of knowledge regarding filicide and illustrates similarities and differences between offenses perpetrated by mothers and by fathers. The importance of numerous reports of an association between filicide and parental pre-existing psychiatric disorders is compounded by indications that a significant number of homicidal parents come to the attention of psychiatrists or other health professionals before the offense occurs. As prevention implies the recognition of causes involved in particular situations, a better understanding of potentially fatal parental/familial dynamics leading to filicide could facilitate the identification of risk and enable effective intervention strategies.     

Preschool self regulation predicts later mental health and educational achievement in very preterm and typically developing children

Abstract

Objective: To examine the extent to which preschool emotional and behavioral regulatory difficulties were associated with an increased risk of later mental health and educational problems. Of particular interest was whether early regulatory abilities contributed to later risk once baseline child behavioral adjustment and cognitive function were taken into account. Method: Data were drawn from a prospective longitudinal study of 223 children born very preterm (VPT; <32 weeks gestation, n = 110) and full term (37–40 weeks gestation). At corrected ages 2 and 4 years, children’s regulatory abilities were assessed using (1) direct observation of child behavior, (2) a modified version of the Emotion Regulation Checklist, and (3) tester ratings of child behavior during neuropsychological testing. At age 9 years, mental health and educational achievement were assessed using the Development and Well-being Assessment interview and the Woodcock Johnson-III Tests of Achievement. Results: VPT-born children had poorer emotional and behavioral regulation across all measures and time points. They also had higher rates of DSM-IV mental health disorder and educational delay at age 9. Across both study groups, poorer self regulation was associated with an increased risk of ADHD, conduct disorder, anxiety disorders and any disorder net of preschool child behavior problems and social risk. In contrast, only associations between early regulation and later language and any educational delay remained significant after adjustment for preschool cognitive functioning and family social risk. Conclusion: Early assessment of regulation in addition to behavioral screening may improve the early identification of preschool children at mental health risk.     

Filicide: a comparative study of maternal versus paternal child homicide

Background Filicide is the murder of a child by a parent. Historically, filicide was regarded as a female crime, but nowadays, in the West, men have become increasingly likely to be convicted of killing their child. Previous research on filicide has primarily focussed on either maternal or paternal filicide rather than comparing the two. Aim The aim of our study is to examine and compare the socio‐demographic, environmental and psychopathological factors underlying maternal and paternal filicide. Methods Data were extracted from records in a forensic psychiatric observation hospital in Utrecht, in the Netherlands for the period 1953–2004. Results Seventy‐nine men and 82 women were detained in the hospital under criminal charges in that period, having killed (132) or attempted to kill (29) their own child(ren). Differences between men and women were found with regard to age, methods of killing and motivation underlying the filicide. Conclusions The categories of filicide identified corresponded to those in studies from other countries, indicating that filicide follows similar patterns throughout the Western world. The fact that 25% of fathers had killed in reaction to threatened separation or divorce, and that over a third of men and more than half of the women were mentally ill at the time may suggest that increased monitoring by primary care physicians under such circumstances might have preventive value. Copyright © 2008 John Wiley & Sons, Ltd.     

Filicidal mothers and the impact of psychosis on maternal filicide

The objective of this study was to examine a sample (n = 55) of filicidal mothers to compare those with and without psychotic symptoms at the time of the filicide. Clinical data were gathered through retrospective chart review of filicidal women referred for criminal responsibility/competence to stand trial evaluations from 1974 to 1996 at Michigan's Center for Forensic Psychiatry. Most (52.7%) women had psychotic symptoms at the time of filicide. Women with psychosis were more likely than those without to have a history of substance abuse; to have past and ongoing psychiatric treatment; and to be older, unemployed, more educated, and divorced or separated. They were less likely to be first time mothers or to have had prior contact with Children's Protective Services. The psychotic mothers more often confessed, attempted suicide at the time of the filicide, used weapons, killed multiple children, and expressed homicidal thoughts and/or concerns about their children to psychiatrists and family before the filicide. Psychotic women were as likely as nonpsychotic women to have used alcohol or illegal drugs at the time of the filicide.     

Maternal mental health and child behaviour problems at 2 years: findings from the Pacific Islands Families Study

OBJECTIVE: The present study investigated associations between the timing and persistence of maternal psychological disorder and child behaviour problems in a cohort of Pacific 2-year-old children in New Zealand. METHOD: Mothers of a cohort of 1,398 Pacific infants born in South Auckland, New Zealand were interviewed when their children were 6 weeks, 12 and 24 months of age. Within the context of a wider interview, data regarding maternal mental health were obtained at these times and maternal reports of child behaviour were gathered when the children were 2 years old. RESULTS: Prevalence rates for internalizing problems were significantly higher in children of mothers who had self-reported symptoms of psychological disorder (11.9% in no symptoms, 27.8% in early symptoms of postnatal depression, 21.1% in late symptoms of psychological disorder and 42.9% in persistent or recurrent symptoms). The adjusted odds ratio (OR) of a child having internalizing problems was 1.38 (95% confidence interval (CI): 0.79-2.43) in those of mothers reporting early symptoms of postnatal depression, 1.45 (95%CI: 0.85-2.49) in late symptoms of psychological disorder, and 2.93 (95%CI: 1.54-5.57) in persistent or recurrent symptoms relative to the no symptoms group. For externalizing problems, the effects of maternal psychological disorder were not significant. CONCLUSIONS: Maternal persistent or recurrent symptoms of psychological disorder may contribute to the behaviour problems of children as young as 2 years old. However, the timing of disorder, whether it is infant or toddler exposure, does not appear to be as crucial. Improved understanding of the associations between maternal psychological disorder and early child behaviour problems may help maternal and child health professionals design appropriate and effective screening and intervention programs to help Pacific mothers and children.     

Exploring risk factors for the emergence of children's mental health problems

CONTEXT: Exploratory studies that generate testable models of how risk factors for childhood mental health problems work together over time are critical for developing effective prevention and treatment strategies. OBJECTIVE: To build models addressing the following 2 questions: (1) How early can we identify children at risk for mental health problems in third grade? (2) How do the risk factors work together over time? DESIGN AND PARTICIPANTS: We assessed a Wisconsin community sample 8 times, beginning during pregnancy. Three hundred seventy-nine families completed multi-informant reports (mothers, teachers, and children) of children's mental health symptoms in third grade. MAIN OUTCOME MEASURES: Symptom severity and directionality (externalizing vs internalizing). RESULTS: The hypothesis was generated that family socioeconomic status (SES) defined different pathways to symptom severity. In low/middle SES families, children were at risk if their mothers were distressed during the infancy period, which was then associated with more generalized maternal and child distress and dysregulation during the preschool period. In high SES families, the picture was more complex, beginning with parental histories of depression and family psychopathology, which then led to greater family stress in the infancy period and maternal and child distress and dysregulation during the preschool period. For all children, social and academic impairment during the school transition was an important mediator. Two pathways to later symptom directionality consisted of one beginning with child sex and the other with child temperament. CONCLUSIONS: Most risk factors predicted symptom severity and not directionality. The risk factors for internalizing and externalizing problems may be much the same, and the same preventive interventions might be effective for both classes of problems. Furthermore, at-risk children from high SES families might be identifiable as early as infancy, whereas those from lower SES families may be identifiable only as preschoolers.     

Can a valid diagnosis of disruptive behavior disorder be made in preschool children?

OBJECTIVE: Disruptive behavior problems are the most common reason preschool children come to mental health clinics. Yet consensus on the conceptualization and measurement of such problems in young children is lacking. DSM-IV is the most widely used nosologic system for children, but the majority of the validation sample consisted of school-age children and adolescents. It is debatable whether behavioral problems in young children should be considered within a diagnostic framework at all, since normative behavioral disruption occurs during the preschool period. Developing valid methods for assessing child behavior problems across development is critical for etiologic and prevention research. METHOD: The authors compare different approaches to conceptualizing disruptive behavior in young children, review evidence for the construct validity of DSM-based oppositional defiant disorder and conduct disorder in preschool children, and outline an agenda for future research. RESULTS AND CONCLUSIONS: Typical and atypical behavior problems can be differentiated in preschool children, and the DSM framework, with some modification to address the child's developmental level, appears to be a valid method for identifying preschool children with disruptive behavior that is impairing. Empirical investigation is needed to standardize modification of existing assessment tools so that they can be used with preschool children and to develop more clinically sensitive methods for using observational data in assessment and for establishing the child's level of development.     

Preschool children with intellectual disability: syndrome specificity, behaviour problems, and maternal well-being

Background Children with intellectual disability (ID) are at heightened risk for behaviour problems and diagnosed mental disorder. Likewise, mothers of children with ID are more stressed than mothers of typically developing children. Research on behavioural phenotypes suggests that different syndromes of ID may be associated with distinct child behavioural risks and maternal well-being risks. In the present study, maternal reports of child behaviour problems and maternal well-being were examined for syndrome-specific differences. Methods The present authors studied the early manifestation and continuity of syndrome-specific behaviour problems in 215 preschool children belonging to 5 groups (typically developing, undifferentiated developmental delays, Down syndrome, autism, cerebral palsy) as well as the relation of syndrome group to maternal well-being. Results At age 3, children with autism and cerebral palsy showed the highest levels of behaviour problems, and children with Down syndrome and typically developing children showed the lowest levels. Mothers of children with autism reported more parenting stress than all other groups. These syndrome-specific patterns of behaviour and maternal stress were stable across ages 3, 4 and 5 years, except for relative increases in behaviour problems and maternal stress in the Down syndrome and cerebral palsy groups. Child syndrome contributed to maternal stress even after accounting for differences in behaviour problems and cognitive level. Conclusions These results, although based on small syndrome groups, suggest that phenotypic expressions of behaviour problems are manifested as early as age 3. These behavioural differences were paralleled by differences in maternal stress, such that mothers of children with autism are at elevated risk for high stress. In addition, there appear to be other unexamined characteristics of these syndromes, beyond behaviour problems, which also contribute to maternal stress.     

Pathways into single motherhood,re-partnering,and trajectories of antidepressant medication purchases

Single motherhood is known to be distressing, and to be associated with poor mental health. However, less is known about the pathways into and out of single motherhood, or about the mental health trajectories of single mothers. We used total population registry data on Finnish women who experienced the life events of separation (616,762), widowhood (43,355), or child birth (515,756) during the 1995–2018 period while between the ages of 15–64. Single mothers were compared with women who experienced the same life event, but without becoming a single mother. The results for women who separated showed that among single mothers, there was a substantial increase in antidepressant use at the time of separation, and only a moderate decline after separation. Among women who experienced widowhood, those who had underage children initially had lower antidepressant use than women without children, but this gap narrowed in the post-widowhood period. In addition, single women experienced more unfavorable mental health trajectories than partnered women around the time they gave birth. Re-partnering was associated with more favorable mental health among all groups of single mothers. Given the growing prevalence of single-parent households, our results underscore the need for context-specific interventions to support single mothers’ mental health.

     

Does maternal ADHD reduce the effectiveness of parent training for preschool children's ADHD?

OBJECTIVE: To assess the impact of maternal attention-deficit/hyperactivity disorder (ADHD) symptoms on the effectiveness of a parent training (PT) program for preschool ADHD. METHOD: Eighty-three 3-year-old children with ADHD and their mothers selected from two community cohorts living in Hampshire, England (1992-93 and 1995-96, respectively), completed an 8-week PT program. ADHD symptoms and a number of other parent and child factors, including adult ADHD symptoms, were measured prior to the start of treatment (week 1: T1), immediately after treatment (week 8: T2), and at 15 weeks follow-up (week 23: T3). RESULTS: Mothers were divided into three groups on the basis of their scores (T1) on the Adult AD/HD Rating Scale (high, medium, low). Children of mothers in the high-ADHD group displayed no improvement after PT, whereas the levels of ADHD symptoms of the children of mothers in either the medium or low ADHD groups reduced substantially (F(4,60) = 3.13, p < .05). This association persisted after other child and maternal factors were controlled for in multiple regression analyses (beta > .30, p < .05). CONCLUSIONS: High levels of maternal ADHD symptoms limit the improvement shown by children with ADHD after a program of PT. This effect was unrelated to other aspects of maternal mental health and child functioning. The treatment of parental ADHD may be a prerequisite for the success of psychosocial interventions for childhood ADHD.     

Mothers of children and adolescents with intellectual disability: social and economic situation,mental health status,and the self-assessed social and psychological impact of the child's difficulties

BACKGROUND: Few large-scale studies with well-constructed samples have compared the socio-economic circumstances and social impact of raising a child with intellectual disability (ID). The aims of the present paper were to: (1) compare the socio-economic situation of mothers raising a child with ID to that of mothers of non-ID children; (2) assess the contribution of raising a child with ID to negative psychological outcomes for mothers; and (3) identify variables associated with negative psychological outcomes among mothers of children with ID. METHODS: The 1999 Office for National Statistics survey, Mental Health of Children and Adolescents in Great Britain, 1999, collected information on a multistage stratified random sample of 10 438 children between 5 and 15 years of age across 475 postal code sectors in England, Scotland and Wales. Secondary analysis was undertaken of the social and economic circumstances, and stress reported by 245 mothers of sampled children with ID and a comparison group of 9 481 mothers of sampled children who did not have ID. RESULTS: The results indicate that: (1) families supporting a child with ID were significantly economically disadvantaged when compared with families supporting a child who did not have ID; (2) when compared with mothers of sampled children who did not have ID, mothers of sampled children with ID reported that their child's difficulties resulted in greater social and psychological impact; (3) having a child with ID marginally reduced the odds of mothers screening positive for having mental health problems (once all other variables were taken into account); and (4) among mothers of children with ID, mental health problems were associated with the child's difficulties having a greater social impact, having a boy, the child experiencing more than one potentially stressful life event, poverty, receipt of means-tested welfare benefits and 'unhealthy' family functioning. CONCLUSIONS: These results highlight the importance of combating poverty among children with ID and their families, and the need to develop more complex models of understanding and intervention.     

Maternal filicide in Québec

In an eight-year review (1991 to 1998) of all consecutive coroners' files in Québec, Canada, the authors identified a total of 34 cases of victims who were killed by their mothers. Most victims were less than six years of age, and there were several cases in which multiple siblings were murdered. There were 27 mothers in the sample, and 15 of those women committed suicide after the filicide. A psychiatric motive was determined for more than 85 percent of the mothers, and most of the mothers had received previous treatment for a depressive or psychotic disorder. Based on the characteristics of this sample, the authors developed a filicide classification system that is flexible and simple to use but must be standardized to become a useful tool for clinicians.     

The Strengths and Difficulties Questionnaire (SDQ) for preschool children—a Swedish validation

Background: In Sweden, 80–90% of children aged 1–5 years attend preschool, and that environment is well suited to identify behaviours that may be signs of mental health problems. The Strengths and Difficulties Questionnaire (SDQ) is a well-known short and structured instrument measuring child behaviours that indicate mental health problems well suited for preschool use.

Aim: To investigate whether SDQ is a reliable and valid instrument for identifying behavioural problems in children aged 1–3 years and 4–5 years in a Swedish population, as rated by preschool teachers.

Methods: Preschools situated in different sized municipalities in Sweden participated. The preschool teacher rated each individual child. Concurrent validity was tested using the Child–Teacher Report Form (C-TRF) and Child Engagement Questionnaire (CEQ). Exploratory factor analysis was conducted for age groups, 1–3 years and 4–5 years.

Results: The preschool teachers considered most of the SDQ items relevant and possible to rate. For the children aged 1–3 years, the subscales ‘Hyperactivity’ (Cronbach alpha?=?0.84, split half?=?0.73) and ‘Conduct’ (Cronbach alpha?=?0.76, split half?=?0.80) were considered to be valid. For the age group 4–5 years, the whole original SDQ scale, 4-factor solution was used and showed reasonable validity (Cronbach alpha?=?0.83, split half?=?0.87).

Conclusion: SDQ can be used in a preschool setting by preschool teachers as a valid instrument for identifying externalizing behavioural problems (hyperactivity and conduct problems) in young children.

Clinical implications: SDQ could be used to identify preschool children at high-risk for mental health problems later in life.     

Maternal depression and treatment gains following a cognitive behavioral intervention for posttraumatic stress in preschool children

The evidence base for cognitive behavioral therapy (CBT) to treat child emotional and behavioral symptoms following exposure to trauma in youth is compelling, but relatively few studies are available on preschool children and on moderators of treatment outcomes. This paper examines maternal and child characteristics as moderators of posttraumatic stress (PTS) treatment outcomes in preschool children. Outcome data from a previously published randomized trial in three to six year old preschool children with diagnostic interview data from participating mothers were used. Hypotheses were tested via hierarchical linear modeling. Maternal depression was associated with higher initial child posttraumatic stress disorder (PTSD) symptoms, and was associated with increasing PTSD symptom trends at follow up suggesting potential child PTSD symptom relapse. Maternal PTSD symptoms similarly predicted differential child separation anxiety symptom change but not child PTSD symptom change. Targeting dyads with child PTSD symptoms and maternal depression or PTSD symptoms with enhanced interventions may be a useful strategy to improve treatment maintenance.     

Are oppositional defiant and conduct disorder symptoms normative behaviors in preschoolers? A comparison of referred and nonreferred children

OBJECTIVE: The authors' goal was to test the hypothesis that DSM-IV symptoms of oppositional defiant disorder and conduct disorder can be validly applied to preschoolers. METHOD: Using a semistructured diagnostic interview, they assessed rates of symptoms of DSM-IV oppositional defiant and conduct disorders in 2.5-5.5-year-old children who were referred to a psychiatry clinic and a comparison group of nonreferred children. RESULTS: Clinically referred preschool children had significantly higher rates of oppositional defiant and conduct disorder symptoms than nonreferred children. Among nonreferred preschoolers, rates of all oppositional defiant and conduct disorder symptoms were at or below 8%. CONCLUSIONS: DSM-IV symptoms of oppositional defiant and conduct disorders distinguish referred from nonreferred preschool children in a pattern consistent with that seen in older children. Preschool children who are not seeking mental health services do not have high rates of disruptive behavior problems. The DSM-IV nosology appears to be a valid diagnostic system for discriminating between typical and atypical disruptive behaviors in preschool children.