Parents of children with psychopathology: psychiatric problems and the association with their child’s problems

Knowledge is lacking regarding current psychopathology in parents whose children are evaluated in a psychiatric outpatient clinic. This especially accounts for fathers. We provide insight into the prevalence rates of parental psychopathology and the association with their offspring psychopathology by analyzing data on psychiatric problems collected in 701 mothers and 530 fathers of 757 referred children. Prevalence rates of parental psychopathology were based on (sub)clinical scores on the adult self report. Parent–offspring associations were investigated in multivariate analyses taking into account co-morbidity. Around 20 % of the parents had a (sub)clinical score on internalizing problems and around 10 % on attention deficit hyperactivity (ADH) problems. Prevalence rates did not differ between mothers and fathers. Parent–offspring associations did not differ between girls and boys. Maternal anxiety was associated with all offspring problem scores. In addition, maternal ADH problems were associated with offspring ADH problems. Paternal anxiety and ADH problems scores were specifically associated with offspring internalizing and externalizing problem scores, respectively. Associations with offspring psychopathology were of similar magnitude for mothers and fathers and were not influenced by spousal resemblance. Our study shows that both fathers and mothers are at increased risk for psychiatric problems at the time of a child’s evaluation and that their problems are equally associated with their offspring problems. The results emphasize the need to screen mothers as well as fathers for psychiatric problems. Specific treatment programs should be developed for these families in especially high need.     

A Unified Model Exploring Parenting Practices as Mediators of Marital Conflict and Children’s Adjustment

We examined positive and negative parenting practices and psychological control as mediators of the relations between constructive and destructive marital conflict and children’s internalizing and externalizing problems in a unified model. Married mothers of 121 children between the ages of 6 and 12 completed questionnaires measuring marital conflict, parenting practices, and child adjustment. Analyses revealed significant direct paths from destructive marital conflict to negative parenting practices, psychological control, and both children’s internalizing and externalizing behavior. In addition, psychological control was found to partially mediate relations between destructive marital conflict and children’s internalizing and externalizing behavior.     

The relation between self-concept and social functioning in adolescence

A model of the relation between self-concept and internalizing and externalizing problem behaviours in adolescence, with the self-concept influencing problem behaviours (S-->IE), was assessed using a sample of 277 Swedish adolescents. The model was tested in a path analysis with data from Youth Self Report (YSR) and Structural Analysis of Social Behaviour (SASB) questionnaires. Consistent with the model, a positive self-concept was found to be the most important factor for adjustment and for protection against common problem behaviour. A negative self-concept combined with female gender were risk factors for internalized problems. Self-control had only a direct effect on externalizing behaviour for boys. Adolescents of 15, 16 years of age had a stronger relationship between a negative self-concept and externalizing problem behaviour than younger and older adolescents. Internalizing problem behaviours such as anxiety and depression predicted aggressive and delinquent behaviour. These findings highlight the importance of promoting of a positive self-concept in every adolescent in various psychosocial contexts.     

Dutch adolescents from lesbian-parent families: How do they compare to peers with heterosexual parents and what is the impact of homophobic stigmatization?

In this study, we compared internalizing and externalizing problem behavior of 67 Dutch adolescents (M_age = 16.04) in planned lesbian families who were matched with 67 adolescents in heterosexual-parent families. We also examined whether homophobic stigmatization was associated with problem behavior in adolescents with lesbian mothers after taking into account demographic characteristics, mothers' scores on emotional involvement, and adolescents' earlier problem behavior (measured at age 4–8 years old). Standardized instruments measuring problem behavior were completed by parents and adolescent offspring, and questions about stigmatization were answered by adolescents with lesbian mothers. The results revealed no differences in internalizing and externalizing problem behavior associated with family type. Offspring in lesbian families who reported more experiences of homophobic stigmatization also demonstrated more internalizing and externalizing problem behavior.     

Informant Agreement in Behavior Ratings for Children with Epilepsy

The purpose of this study was to determine the degree of informant agreement for behavioral ratings of children with epilepsy. Informants completed Achenbach's 1991 scales: parents completed the Child Behavior Checklist (CBCL), teachers completed the Teacher's Report Form (TRF), and youth completed the Youth Self-Report Form of the CBCL (YSR). Analyses included degree of concordance of ratings as a function of informant, child gender, and condition severity (active vs inactive epilepsy). Results indicated that across all four types of raters (mothers, fathers, teachers, and adolescents) there was a similar pattern. Mothers' ratings tended to be the highest and youths' ratings tended to be the lowest across scales. In general, agreement among adult raters was greater than between youth and adults. Mothers and teachers reported more internalizing symptoms than did youth; mother, father, and teacher ratings on externalizing symptoms were not significantly different from each other. There were no significant effects of gender and condition severity on concordance among ratings although there were some interesting trends.     

A study of parent ratings of internalizing and externalizing problem behavior in 12-year-old twins

OBJECTIVE: Studies on 3-, 7-, and 10-year-old twins' internalizing and externalizing problems have emphasized the importance of understanding sources of agreement and disagreement between maternal and paternal ratings. A psychometric model that assumes that each parent assesses rater-specific aspects of the child's behavior provided the best explanation for parental disagreement. This study investigates two models that have been used to explain the agreement and disagreement between mothers and fathers in the ratings of their children. METHOD: Child Behavior Checklists filled in by mothers and fathers were collected for a sample of 1,481 twelve-year-old twin pairs. Genetic and environmental influences on internalizing and externalizing problems were estimated using models that corrected for rater bias, rater-specific effects, and unreliability. RESULTS: The psychometric model fitted the data significantly better than a rater bias model. Significant influences of genetic, shared, and nonshared environmental factors were found for internalizing and externalizing behavior. Parent-specific views, rater bias, and unreliability were significant. CONCLUSIONS: The best-fitting model implies that disagreement between parents is due to the fact that mothers and fathers provide information from their own perspective. This information should be seen as important and adding to the diagnostic formulation rather than as a point of disagreement. The finding that internalizing and externalizing problems are influenced by genetic and environmental factors fosters the understanding that it is the interaction of nature and nurture that puts children at risk for common behavioral disorders.     

The continuity of psychopathology from early childhood to preadolescence

Objective To study the continuity of psychopathology from the age of 3–12 years. Methods In a population-based birth cohort, children’s emotional and behavioral problems were assessed at age 3 using the Child Behavior Checklist 2–3 (CBCL 2–3), and at age 12 by parents using the CBCL 11–18, and the Youth Self Report (YSR) completed by the children. Behavioral ratings were obtained from 800 subjects at both time points. Results externalizing problems at age 3 predicted both externalizing and internalizing problems among both genders in preadolescence. In girls, internalizing behavior at age 3 predicted parent-reported internalizing behavior, and associated negatively with externalizing behavior in self-reports at age 12. Aggressive behavior was found to be remarkably stable, and both aggressive and destructive behavior independently predicted a wide range of later externalizing and internalizing problems. Parent ratings of withdrawal showed stability from early childhood to preadolescence in both genders. Somatic complaints of 3-year-old girls independently predicted both externalizing and internalizing problems. Conclusions The results show the complexity of pathways in psychopathology from early childhood to preadolescence. In particular, aggressive and destructive behaviors in very early childhood predict later problems and necessitate early recognition and possible intervention at an early age. An instrument like the CBCL 2–3 is valuable in the early detection of children at risk of long-term problems.     

Early childhood internalizing problems,externalizing problems and their co-occurrence and (mal)adaptive functioning in emerging adulthood: a 16-year follow-up study

Purpose

A vast amount of studies suggest that internalizing or externalizing problems are related to individual functioning, and often co-occur. Yet, a focus on their additive and interactive effects is scarce. Furthermore, most research has focused on a limited number of developmental domains and mostly on maladaptive functioning. Therefore, the current prospective study examined whether early childhood (ages 4–8) internalizing and externalizing problems and their interaction were related to a broad range of (mal)adaptive functioning outcomes in emerging adulthood (ages 20–24).

Methods

Data from the Flemish Study on Parenting, Personality and Development were used. At Time 1 (1999) mothers of 374 children (45% boys) and fathers of 357 children (46% boys) rated internalizing and externalizing problems through the Child Behavior Checklist. Outcomes in emerging adulthood were measured through self-reports 16 years later across the following domains: psychological functioning, social functioning, work, physical health, and self-concept.

Results

Early externalizing problems were related to maladaptive outcomes on the psychological and social domains. With regard to adaptive functioning, externalizing problems were associated with lower satisfaction regarding general health on the physical domain. Early internalizing problems were not associated with any emerging adulthood outcomes. The interaction of (father reported) internalizing and externalizing problems was related to aggressive behavior.

Conclusion

Early childhood externalizing problems were associated with maladaptive and adaptive functioning over a time span of 16 years. The results add to studies on the implementation of prevention and intervention programs in early childhood and to the value for developing personalized interventions.

     

The Factors Predicting Stress,Anxiety and Depression in the Parents of Children with Autism

The factors predicting stress, anxiety and depression in the parents of children with autism remain poorly understood. In this study, a cohort of 250 mothers and 229 fathers of one or more children with autism completed a questionnaire assessing reported parental mental health problems, locus of control, social support, perceived parent–child attachment, as well as autism symptom severity and perceived externalizing behaviours in the child with autism. Variables assessing parental cognitions and socioeconomic support were found to be more significant predictors of parental mental health problems than child-centric variables. A path model, describing the relationship between the dependent and independent variables, was found to be a good fit with the observed data for both mothers and fathers.     

Children’s perceptions of dissimilarity in parenting styles are associated with internalizing and externalizing behavior

The purpose of this study was to examine the relationship between children’s perception of dissimilarity in parenting styles, and internalizing and externalizing problems in children. Children from the general population (n = 658) reported on the level of emotional warmth, rejection, and overprotection of both parents by filling out the child version of the Egna Minnen Betr?ffande Uppfostran (EMBU-C) and mothers completed the child behavior checklist (CBCL). Intraclass correlations were computed as measures of dissimilarity between parenting styles of mothers and fathers. Children’s perceived dissimilarity in parental emotional warmth is associated with internalizing and externalizing problems (β = 0.092, p < 0.05; β = 0.091, p < 0.05). Perceived dissimilarity between parents’ overprotection is associated with externalizing problems (β = 0.097, p < 0.05). Perceived dissimilarity between parenting styles is associated with externalizing and internalizing problems, over and above the effects of the level of the parenting styles. The results highlight the negative consequences of perceived dissimilarity between parents. To conclude, children have more internalizing and externalizing problems when they perceive their parents as more dissimilar in parenting styles.     

Patterns of agreement among parent, teacher and youth ratings in a referred sample

ObjectiveThe purpose of this study was to investigate the degree of agreement among parents, teachers and adolescents with respect to the Child Behavior Checklist (CBCL), the Teacher's Report Form (TRF), and the Youth Self Report (YSR). In addition we evaluated the suitability of these three forms (CBCL, TRF and YSR) in terms of their contribution to understanding internalizing and externalizing disorders in youths being referred to a child and adolescent unit of a psychiatric care facility.MethodsA total of 611 patients aged 11–18 years (mean age 13.0, SD 1.6) were assessed using the CBCL, the TRF and the YSR.ResultsIntraclass coefficients (ICC) showed low to moderate agreement among informants. Furthermore, the level of agreement was generally less among patients suffering from internalizing disorders than for young patients who displayed externalizing disorders. Logistic regression revealed that the TRF internalizing syndrome scale, the CBCL internalizing syndrome scale and gender were relevant prognostic factors for the occurrence of internalizing disorders in youth. The YSR internalizing syndrome scale, on the other hand, was not a relevant factor among adolescents of a clinical target population. Likewise, only the TRF externalizing syndrome scale, the CBCL externalizing syndrome scale and gender were relevant prognostic factors for the occurrence of externalizing disorders in youth.ConclusionsParticularly the CBCL and TRF are useful instruments in assessing internalizing and externalizing disorders in adolescents referred to a mental health setting.     

Internalizing and externalizing behavior of children with enlisted Navy mothers experiencing military-induced separation

OBJECTIVES: To examine whether children with Navy mothers exhibit higher levels of internalizing and externalizing behavior than children in civilian families and whether deployment affects children's internalizing and externalizing behavior. METHOD: Navy mothers who experienced deployment completed a measure assessing children's internalizing and externalizing behavior before and after a deployment (and at similar intervals for the Navy and civilian comparison groups). Data collection took place between 1996 and 1998. RESULTS: Navy children with deployed mothers exhibited higher levels of internalizing behavior than children with nondeployed Navy mothers. Navy children whose mothers experienced deployment were more likely to exhibit clinical levels of internalizing behavior than Navy children with nondeployed mothers or civilian children. Group differences, however, were modest and overall mean scores were in the normal range. CONCLUSIONS: Findings do not suggest greater pathology in children of Navy mothers; however, findings do indicate we should be particularly attentive of deployed mothers and their children.     

Prevalence and correlates of asthma in children with internalizing psychopathology

Our objective was to determine the prevalence rate of parent-reported asthma in children with internalizing disorders seeking psychological treatment, and to study the level of internalizing and externalizing problems in these patients compared to patients without asthma. Participants were 367 children (ages 5-18 years) with internalizing disorders seeking psychological treatment. Children's psychiatric diagnosis was established with the Anxiety Disorders Interview Schedule for DSM-IV-Child and Parent versions. Parents reported on their child's asthma diagnosis, medical history, and medication usage. Child psychopathology was assessed with the Child Behavior Checklist and by child self-report with the Multidimensional Anxiety Scale for Children and the Children's Depression Inventory. We assessed internalizing psychopathology of the mothers with the Depression Anxiety and Stress Scale. An additional diagnosis of parent-reported asthma was established for 15% of the children diagnosed with an Axis I internalizing disorder, a prevalence rate markedly higher than reported for current parent-reported childhood asthma in the U.S. population. Patients with asthma showed higher levels of internalizing problems than their nonasthmatic counterparts. Internalizing psychopathology was not higher for mothers of patients with asthma. Asthma is a significant problem within the population of patients with childhood internalizing disorders. It can be accompanied by a greater severity of internalizing problems and may require specific precautions in the treatment protocol. Though parent report of asthma diagnosis is commonly used in surveys of childhood asthma, our findings have to be viewed in the light of its limitations.     

Pre-Adoption Adversity and Self-Reported Behavior Problems in 7 Year-Old International Adoptees

To further investigate the long-term impact of pre-adoption adversity on international adoptees, externalizing and internalizing symptoms were assessed using a self-report measure at school-age in addition to mothers' reports. The sample consisted of 95 adopted children and their mothers. Children's health and developmental status were assessed soon after arrival in their adoptive family. At age 7, the Dominic Interactive, a self-report measure, was used to evaluate externalizing and internalizing symptoms while mothers completed the CBCL. Children's self-reports were compared to their non-adopted peers'. Adopted children reported more symptoms of specific phobia than their peers. A significant correlation was found between mothers' and children's reports but only for externalizing symptoms. Self-reported symptoms were related to indices of nutritional and psychosocial deprivation at arrival, such as low height/age and weight/height ratios. Our results emphasize the importance of considering international adoptees' perception of their psychological adjustment and the long-term impact of early risk factors.     

Do Antenatal and Postnatal Parental Psychological Distress, and Recognized Need of Help Predict Preadolescent’s Psychiatric Symptoms? The Finnish Family Competence Cohort Study

In a prospective population-based study, mothers and fathers of 1,247 children reported their physical and mental health during pregnancy, after delivery, within the child’s first 18 months of life, and at 12 years. Additionally, maternal health clinic nurses rated parents’ well-being and perceived need for support. At age 12, child outcomes were also measured using CBCL and YSR externalizing and internalizing scales. Results indicate that both ante- and postnatal maternal distress predicted future externalizing problems in offspring. Conversely, fathers’ postnatal distress predicted subsequent internalizing problems. Furthermore, mother’s depressed mood in the first trimester best predicted the child’s externalizing problems at age 12. Nurses’s ratings of mother’s antenatal and perinatal need for support, perinatal distress, and family’s need for support were associated with both internalizing and externalizing problems at age 12. Maternal antenatal distress increases the risk of offspring’s externalizing problems in preadolescense, and postnatal distress in either parent increases the risk of internalizing problems. Parental self-reports and indirect ratings from health care providers during pregnancy and infancy may therefore reliably recognize offspring at risk for subsequent psychiatric symptomatology.     

Prenatal smoking and internalizing and externalizing problems in children studied from childhood to late adolescence

ObjectiveTo study whether prenatal smoking only relates to externalizing problems or whether it is associated with both internalizing and externalizing problems from childhood into late adolescence.MethodChild Behavior Checklist-derived, parent-reported internalizing and externalizing problems of 396 children were longitudinally assessed at ages 5, 10 to 11, and 18 years. The influence of self-reported prenatal smoking on the course of internalizing and externalizing problems over these ages was assessed, controlling for the co-occurrence of internalizing and externalizing problems and co-occurring pre- and perinatal risk factors, demographic characteristics, maternal mental health, and child social and attention problems.ResultsChildren whose mothers had smoked during pregnancy had increased levels of both internalizing and externalizing problems over the period of ages 5 to 18 years when compared with children whose mothers did not smoke during pregnancy. These associations remained significant after controlling internalizing for externalizing and vice versa and possible confounding variables.ConclusionsMaternal smoking during pregnancy is a predictor of internalizing as well as externalizing psychopathology in offspring. The association between prenatal smoking and internalizing and externalizing problems persists throughout childhood and late adolescence. J. Am. Acad. Child Adolesc. Psychiatry, 2008; 47(7):779–787.     

Psychiatric Comorbidity in Learning Disorder: Analysis of Family Variables

Objective This study aimed to evaluate the role of parental relational styles on the development of psychopathological disturbances in children with Learning Disability (LD). Method Fifty-six children aged 7–12 diagnosed with LD were evaluated on the basis of the Children Behaviour Check List (CBCL) completed by parents. Parents completed an Attachment Style Questionnaire (ASQ) and a family relationships internal representations questionnaire (Family Attitudes Questionnaire, FAQ). Multiple regressions were performed, using parental FAQ and ASQ scores as predictors and children’s CBCL scores as criterion Results Sixty percent of children in the sample obtained a clinical score in at least one of the two syndrome groups. Internalizing behavior in children was predicted by father’s Relationships as Secondary and mother’s Need for Approval and Preoccupation with Relationships scores. Externalizing behavior was predicted by both father and mother’s Need for Approval scores. Conclusions Insecure attachment styles in parents appeared associated with maladaptive emotional–behavioral strategies in their children and may be interpreted as a risk factor for the development of the latter. More specifically, internalizing behavior in children appeared associated with dimensions pointing to dismissing attachment in fathers and to preoccupied attachment in mothers, while externalizing behavior appeared associated with dimensions indicating preoccupied attachment in both parents. Possible interpretations of these data within the LD population are put forward.     

Psychological disturbance among 5- to 8-year-old school children: a study from India

This paper presents findings on the prevalence of psychological disturbance among a sample of 5- to 8-year-old Indian school children. The study was cross-sectional with a two-instrument, two-phase design. In the first phase (screening), 48 teachers rated 1535 children (810 boys and 725 girls) drawn from five schools in Bangalore city on the 26-item Children's Behaviour Questionnaire (CBQ). This resulted in 281 children being identified as disturbed, giving a prevalence of 18.3%. In the second phase, 279 of the children identified as disturbed on the CBQ and a matched group of 272 'non-disturbed children' (182 boys and 90 girls) were again rated by teachers, this time using the Child Behaviour Checklist – Teacher Report Form, yielding a corrected prevalence rate of 19.8%. In the same phase, 166 of the disturbed children and a matched group of 169 non-disturbed children were rated by parents using the Child Behaviour Checklist, yielding a corrected prevalence rate of 31.7%. A larger proportion of boys than girls were identified as disturbed by teachers, whereas parents identified a large proportion of disturbed girls. Boys were found to manifest externalizing problems more often, while girls more frequently showed internalizing problems. Learning problems were identified in a substantial number of disturbed boys and girls. Accepted: 8 October 1996     

Emotion Regulation and Parent Co-Regulation in Children with Autism Spectrum Disorder

Children with autism spectrum disorder (ASD) often exhibit emotional problems, which can be associated with emotion regulation (ER) difficulties. Parent co-regulation is often associated with child ER and emotional problems, though little work has been done with reference to youth with ASD. This study investigated the association among parent co-regulation, child ER, and internalizing and externalizing problems in 51 parents and school-aged children with ASD. Parent co-regulation strategies and scaffolding were not associated with parent-reported levels of child internalizing problems. Parent scaffolding and child ER predicted externalizing problems, after controlling for child age and IQ. Suggestions for future research on parent involvement in the emotional development of children with ASD are discussed, as well as implications for ER-focused interventions.