Child comorbidity, maternal mood disorder, and perceptions of family functioning among bipolar youth

OBJECTIVE: To examine the association between youth comorbid psychiatric disorders, maternal mood disorder, and perceptions of family cohesion and conflict among youth diagnosed with pediatric bipolar disorder (PBD). METHOD: Three hundred eighty-nine bipolar youths and their parents completed a diagnostic interview and instruments assessing family psychiatric history and functioning. Family functioning was assessed with the Family Adaptability and Cohesion Scales-II and the Conflict Behavior Questionnaire. RESULTS: The presence of a maternal mood disorder was associated with lower family cohesion. The presence of a youth externalizing disorder with or without a co-occurring anxiety disorder was also associated with lower family cohesion as well as higher family conflict. Furthermore, the negative relationship between maternal mood disorder and family functioning was stronger in the presence of a youth externalizing disorder. CONCLUSIONS: Youth comorbidity and maternal mood disorders appear to be associated with worse family functioning among bipolar youths. Family-based treatments with bipolar youths may need to integrate treatment of youth comorbidity and address maternal mood disorder for optimal results.     

Children's responses to low parental mood. II: Associations with family perceptions of parenting styles and child distress

OBJECTIVE: In an earlier article (part 1) the authors identified four patterns of children's responses to parental low mood: Active Empathy, Emotional Overinvolvement, Indifference, and Avoidance. They then hypothesized that these response patterns were related to parenting styles and to discrepancies in family members' perceptions of parenting and child mental distress. METHOD: A normal population sample of 990 twelve-year-old Finnish children and their mothers (843) and fathers (573) was used. Within-family multivariate analyses conducted in mother-father-child triads (470) were used to examine whether quality of parenting varied according to children's responses and whether parents' and children's perceptions of parenting and child distress were different. RESULTS: Children in the Active Empathy and Indifference groups experienced more positive parenting than those in the other two groups. Discrepancies in family members' perceptions of child distress and mothering and fathering were especially characteristic of the Emotional Overinvolvement group. Typical for the Avoidance group was a within-family agreement on poor parenting and severe child distress. CONCLUSIONS: Children's response patterns as regards parental low mood are related to family dynamics. The study suggests that discrepancies in parents' and children's perceptions of parenting and child distress can be meaningful in understanding family interactions and child development and well-being.     

West Indian adolescents' perceptions of family functioning

A total of 424 Barbadians aged 13-15 years completed the Family Functioning in Adolescence Questionnaire, developed in Australia by Roelofse and Middleton (1985). Findings revealed most adolescents, like their Australian peers, reported fairly favourable perceptions of their families. However, neither total nor sub-scale scores served to discriminate between sub-groups based on sex, age or household structure to any great extent. A re-grouping of items based on results of Varimax analysis also failed to yield many significant group differences, although some directions for future research were indicated. Adolescents not living with their fathers seemed to have a somewhat lower sense of personal security, but in other respects did not report their family life any less favourably than did those living with both natural parents.     

Vietnamese parental perceptions of child and adolescent mental illness.

OBJECTIVES: To determine the symptoms and behaviors in children which are considered psychopathological by Vietnamese parents, to identify professionals and agencies in the community whom Vietnamese parents would consult if their child had a mental illness, and to determine Vietnamese parents' awareness of existing community mental health services. METHOD: Structured interviews were conducted with a randomized community sample of 283 Vietnamese parents in Perth, Australia. Parents were asked to identify the symptoms and behaviors they considered psychopathological in children, where they would turn for help with a mentally ill child, their knowledge of community mental health services for children, and their understanding of the causes of child psychiatric disorders. RESULTS: Vietnamese parents identified psychotic symptoms, disorientation, and suicidal thoughts and behavior as psychopathological. They preferentially endorsed Western-style treatment approaches but had little awareness of existing community mental health services for children. A biological/chemical imbalance, traumatic experiences, and a metaphysical/spiritual imbalance were identified as the most likely causes of child mental illness. CONCLUSIONS: Despite a different cultural tradition, Vietnamese parents appear open to services provided by Western-trained mental health professionals. Their very limited awareness of child and adolescent mental health services in the community, however, may severely limit their utilization of such services.     

Executive functioning and emotion recognition in youth with oppositional defiant disorder and/or conduct disorder

Abstract

Objectives: Executive functioning and emotion recognition may be impaired in disruptive youth, yet findings in oppositional defiant disorder (ODD) and conduct disorder (CD) are inconsistent. We examined these functions related to ODD and CD, accounting for comorbid attention-deficit/hyperactivity disorder (ADHD) and internalising symptoms.

Methods: We compared executive functioning (visual working memory, visual attention, inhibitory control) and emotion recognition between youth (8–18?years old, 123 boys, 55 girls) with ODD (n?=?44) or CD (with/without ODD, n?=?48), and healthy controls (n?=?86). We also related ODD, CD, and ADHD symptom counts and internalising symptomatology to all outcome measures, as well as executive functioning to emotion recognition.

Results: Visual working memory and inhibitory control were impaired in the ODD and CD groups versus healthy controls. Anger, disgust, fear, happiness, and sadness recognition were impaired in the CD group; only anger recognition was impaired in the ODD group. Deficits were not explained by comorbid ADHD or internalising symptoms. Visual working memory was associated with recognition of all basic emotions.

Conclusions: Our findings challenge the view that neuropsychological impairments in youth with ODD/CD are driven by comorbid ADHD and suggest possible distinct neurocognitive mechanisms in CD versus ODD.     

Child temperament and parental perceptions of individual child adjustment: an intrafamilial analysis

The association between child temperament and mothers' and fathers' perceptions of child adjustment was investigated in a study of 70 married couples, each of whom had two children of the same gender--36 brother pairs and 34 sets of sisters. The parents' perceptions of their children's levels of activity, persistence, and emotional intensity were found to be related to their perceptions of child adjustment. Implications of the findings are discussed and directions for further research indicated.     

Adolescent perceptions of family scapegoating: a comparison of parental and sibling involvement

A self-report measure of being scapegoated in one's family was given to a non-clinical sample of 403 adolescents. Reports of scapegoating varied more with the type of family conflict scapegoated than with the family member(s) engaged in scapegoating. Scapegoating was also related to parental support, family conflict and adolescent adjustment problems.     

The autistic child and family functioning: A developmental-family systems perspective

Autism is a severe, long-term developmental disorder that potentially has substantial influence on different aspects of the family system. Principles from family-systems theory are considered as they relate to the autistic child within the family. A selective and critical review is presented of research findings on the influence of the autistic, child on the functioning and interactions of family members, including parents, siblings, and the family as a whole. Research findings are also reviewed on resources associated with successful family adaptation to the autistic child. Suggestions are offered for improved research to assess the relationship between certain child variables and measures of family functioning.     

The father's contribution to child care: effects on children's perceptions of parental roles

Adult role behavior and its effects on children were explored in a study of dual-career and traditional families. Fathers who were active in child care were found to be more nurturant and to partake in more housework. Fewer stereotypes about the maternal role were held by girls than by boys; and boys whose parents shared responsibility for child care held fewer stereotypes about the paternal role than did boys from traditional families.     

The role of child and parental mentalizing for the development of conduct problems over time

The current study aimed to investigate the role of parental and child mentalizing in the development of conduct problems over time in a community sample of 7- to 11-year-olds (N = 659). To measure child mentalizing, children were asked to complete a social vignettes task at baseline as a measure of distorted mentalizing. Parents (primarily mothers) were asked to complete the same task, guessing their child’s responses in the social scenarios as a measure of maternal mentalizing. Conduct problems were evaluated using repeated measures from multi-informant (self-, teacher-, and parent-report) questionnaires completed at baseline and 1-year follow-up. As expected, children who had an overly positive mentalizing style were more likely to be reported by teachers as having conduct problems at 1-year follow-up. These findings held when controlling for baseline conduct problems, IQ, SES, and sex. Findings for maternal mentalizing were significant for follow-up parent-report conduct problem symptoms at the bivariate level of analyses, but not at the multivariate level when controlling for baseline conduct problems and age. These findings extend previous reports by providing predictive validity for distorted mentalizing in the development of conduct problems.     

Parent and adolescent perceptions of family functioning: a comparison of clinic and non-clinic families.

In this paper two studies are reported which compare (a) the perceptions of family functioning held by clinic and non-clinic adolescents, and (b) the perceptions of family functioning held by adolescents and their mothers in clinic and non-clinic families. In Study 1, matched group of clinic and non-clinic adolescents were compared on their responses to a 30-item scale (ICPS) designed to measure three factors of family functioning: Intimacy (high vs. low), Parenting Style (democratic vs. controlled) and Conflict (high vs. low). Clinic and non-clinic adolescents were also compared on their responses to a multi-dimensional measure of adolescent self-concept. Although there was little difference between the two groups of adolescents in terms of their perceptions of family functioning, there were strong relationships between the self-concept variables and the family functioning variables. In Study 2, comparisons were made between the perceptions of family functioning held by mothers and adolescents for both clinical and non-clinic families. There were no differences between the two groups of adolescents in terms of their perceptions of family functioning, although there were clear differences between the two groups of mothers. In addition, clinic adolescents and their mothers did not differ in their perceptions of the family, whereas adolescents in the non-clinic group saw their families significantly as less intimate and more conflicted than did their mothers.     

Psychiatric and family functioning in children with leukemia and their parents.

The present study reports data from a cross-sectional investigation of the psychiatric and psychosocial functioning of 55 children diagnosed with acute lymphocytic leukemia and their families at three points in time: diagnosis (newly diagnosed), 1 year postdiagnosis, and 1 year after the completion of chemotherapy (off-therapy). Results reveal minimal psychopathology in these children and their parents based on self- and informant-reports and structured diagnostic interviews. These families appear to be functioning adequately and report more family cohesiveness and marital satisfaction after chemotherapy was completed. Coping strategies commonly used by children and their parents include problem-solving, a positive outlook, and good communication. Implications for psychiatric consultation are presented.     

Relationship between youth and parent perceptions of family environment and social anxiety.

This study concurrently examined the relationship between adolescents' perceptions of their parents' child-rearing styles and family environment and their reports of social anxiety. Adolescents reporting higher levels of social anxiety perceived their parents as being more socially isolating, overly concerned about others' opinions, ashamed of their shyness and poor performance, and less socially active than did youth reporting lower levels of social anxiety. Parent perceptions of child-rearing styles and family environment, however, did not differ between parents of socially anxious and nonsocially anxious adolescents. Results are comparable to studies using adult retrospective reports and are discussed with regard to the role of the family environment in the development of social anxiety.     

Family-based treatment for transition age youth: the role of expressed emotion and general family functioning

ABSTRACT

The aim of this study was to investigate changes in family functioning and parental expressed emotion (EE) in parents and transition age youth (18 to 25 years old) with Anorexia Nervosa participating in Family-Based Treatment for Transition Age Youth (FBT-TAY). Further, we examined whether perceived family functioning and EE were associated with changes in eating disorder behaviour and weight in participants at end-of-treatment and three months post-treatment. Generalized estimating equations revealed that changes in family functioning significantly improved from baseline to end-of-treatment (p = .0001), and baseline to three months post-treatment (p = .0001) in parents; and from baseline to end-of-treatment (p = .011), and baseline to three months post-treatment (p = .0001) in transition age youth. The level of parental EE did not differ significantly from baseline to end-of-treatment (p = .379), or baseline to three months post-treatment (p = .185). A series of Ordinary Least Square regression models demonstrated that changes in perceived family functioning and EE were not significantly associated with changes in eating disorder behaviour and weight restoration of transition age youth at end-of-treatment and three months post-treatment. Overall, perceptions of family functioning improved during the course of FBT-TAY, but EE did not.     

Parent and child report of family functioning in a clinical child and adolescent eating disorders sample

OBJECTIVE: To investigate parent and self-report of family dysfunction in children and adolescents with eating disorders. Further, to investigate family functioning differences across the eating disorders diagnostic groups; anorexia nervosa, eating disorders not otherwise specified (EDNOS) and bulimia nervosa, and between the restricting and binge-purge eating disorders behavioural subtypes. METHODS: The Family Adjustment Device General Functioning Scale (FAD-GFS) was administered to 100 children and their parents who presented consecutively at an eating disorders assessment clinic. DSM-IV eating disorders diagnoses in this group included 42 children diagnosed with anorexia nervosa, 26 with EDNOS, 12 with bulimia nervosa and 20 diagnosed as having no eating disorder. RESULTS: Both the parent and child FAD-GFS report demonstrated high internal consistency supporting the suitability of this instrument for research with this sample. Parent and child reports were moderately positively correlated. Total scores for all eating disorders diagnostic categories were significantly higher than community norms. Anorexia nervosa, EDNOS and bulimia nervosa groups did not significantly differ on parent or child reports. FAD-GFS profiles for restricters and binge-purgers suggest higher levels of family dysfunction in the families of binge purgers. CONCLUSIONS: The FAD-GFS has suitable psychometric properties for use as a summary instrument with young people diagnosed with an eating disorder. However, more informative instruments assaying a greater range of constructs, especially in the impulsive, dyscontrol domain, are required to investigate differences among eating disorders diagnostic groups and behavioural subtypes.     

Behaviour and emotional problems in toddlers with pervasive developmental disorders and developmental delay: associations with parental mental health and family functioning

Background Behavioural and emotional problems occur at a high rate in children and adolescents with intellectual disability, often from a young age. Some studies have indicated that children and adolescents with autism present with even higher rates. Less is known about the presentation, development and family impact of these difficulties in young children with autism. This study aimed to explore these issues in toddlers with pervasive developmental disorders (PDDs), those with delay without a PDD, and their families. Methods Participants were 123 children aged 20–51 months, referred to a developmental assessment clinic. Parents completed a checklist on child behavioural and emotional problems, and individual questionnaires on family functioning, their own mental health, and stress in relation to parenting their child. The child’s language and cognitive skills, adaptive functioning and behaviour were assessed by standardized measures. Measures were repeated 1 year postdiagnosis. Behavioural and emotional problems in young children with a PDD were compared with those in children with developmental delay without a PDD, and their impact on parental outcomes explored over time. Results Initial and follow‐up measures of child behaviour and emotional problems, parent mental health problems, parent stress and family functioning were significantly correlated, providing some evidence of stability over time. Child emotional and behavioural problems contributed significantly more to mother stress, parent mental health problems, and perceived family dysfunction than child diagnosis (PDD/non‐PDD), delay or gender. Compared with mothers, all fathers reported significantly less stress in relation to parenting their child. Conclusion Results highlighted the importance of addressing emotional and behavioural problems in very young children with autism and/or developmental delay. The need for early support and intervention for mothers, fathers and families in this context was also evidenced. As research has shown that behavioural and emotional problems persist into adolescence and young adulthood, understanding of these issues in very young children and their parents has important implications for intervention and long‐term outcomes.