The role of psychopathology in the parenting of drug-dependent women

This paper explores the parenting of drug-dependent women and the contributions of comorbid psychopathology to their parenting. A sample of 32 children whose mothers were dependent on opioid drugs during pregnancy and 37 children whose mothers were not drug users were followed from birth to middle childhood. Multivariate regression analyses were conducted contrasting whether maternal substance abuse or psychopathology was more closely linked to parenting behaviors and continuity in parenting over time. Maternal drug dependence was related to whether mothers were able to remain primary caregivers for their children over time, even after controlling for psychopathology. Maternal drug use was related to unresponsive and negative parenting behavior during mother-infant interaction, but this relation was largely accounted for by the effects of comorbid maternal psychopathology on parenting, particularly symptoms of antisocial and related personality disorders. For those children whose mothers continued to care for them into middle childhood, perceptions of their mothers as rejecting were related to maternal antisocial personality and maternal depression. Substance-abuse treatment for women should be integrated with interventions addressing their mental health and parenting needs.     

Predicting future antisocial personality disorder in males from a clinical assessment in childhood

It is essential to identify childhood predictors of adult antisocial personality disorder (APD) to target early prevention. It has variously been hypothesized that APD is predicted by childhood conduct disorder (CD), attention-deficit/hyperactivity disorder (ADHD), or both disorders. To test these competing hypotheses, the authors used data from a single childhood diagnostic assessment of 163 clinic-referred boys to predict future APD during early adulthood. Childhood Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987) CD, but not ADHD, significantly predicted the boys' subsequent APD. An interaction between socioeconomic status (SES) and CD indicated that CD predicted APD only in lower SES families, however. Among children who met criteria for CD, their number of covert but not overt CD symptoms improved prediction of future APD, controlling for SES.     

Parental bonding and adult psychopathology: results from the US National Comorbidity Survey

BACKGROUND: Research using the parental bonding instrument (PBI) has suggested that lack of parental care and/or overprotection may be important risk factors for adult mental disorders. Much of this research, however, has relied on clinical populations with one or two disorders, or has used highly select community samples. METHOD: The association between parenting experiences and the occurrence of 13 common mental disorders in adulthood was evaluated in the US National Comorbidity Survey (N = 5877). The effect of sociodemographic variables (age, education, income) was statistically controlled and the effects of six parenting variables (maternal and paternal care, overprotection and authoritarianism) were examined simultaneously. The effects in men and women were examined separately. RESULTS: Lack of care was the parenting variable most consistently associated with adult psychopathology. Parenting experiences with one's mother were more consistently associated with adult mental disorders. In general the impact of parenting was diagnostically non-specific. However, there appeared to be some unique effects for externalizing disorders (substance use disorders and antisocial personality disorder) in males; paternal overprotection and authoritarianism conferred a reduced risk of externalizing disorders in adult males. The overall impact of parenting as assessed by the PBI was modest, accounting for about 1 to 5 % of the variance in the occurrence of adult mental disorders. CONCLUSION: Parenting experiences, particularly lack of care, are potentially causally related in a non-specific manner to a wide variety of forms of adult psychopathology in both men and women. The overall magnitude of the effect is small but statistically significant in a nationally representative US sample.     

Paternal and maternal influences on the psychological well-being, substance abuse, and delinquency of Chinese adolescents experiencing economic disadvantage

On two occasions separated by one year, Chinese adolescents with economic disadvantage in Hong Kong (N = 199) responded to instruments measuring perceived parental parenthood qualities (indexed by perceived parenting styles, support and help from parents, and conflict and relationship with the parents) and psychosocial adjustment (psychological well-being, substance abuse, and delinquency). Results showed that parental parenthood variables were concurrently associated with different measures of adolescent psychological well-being and problem behavior at Time 1 and Time 2. While paternal parenthood qualities at Time 1 predicted changes in existential well-being and delinquency in adolescent boys, but not in adolescent girls, at Time 2, maternal parenthood qualities at Time 1 predicted changes in the mental health and problem behavior in adolescent girls, but not in adolescent boys, at Time 2. There is no strong support for the thesis that adolescent adjustment influences perceived parental parenthood qualities over time. The present study suggests that the influences of fathers and mothers on the adjustment of Chinese adolescents experiencing economic disadvantage vary with the gender of adolescent children.     

Personality characteristics of the mothers of children with disruptive behavior disorders

The biological mothers of 100 outpatient children aged 6-13 years completed the Minnesota Multiphasic Personality Inventory (MMPI). Mothers of children given DSM-III diagnoses of conduct disorder (CD; n = 13) had significantly higher scores on MMPI scales associated with antisocial behavior (Pd and Ma), histrionic behavior (Hs and Hy), and disturbed adjustment (Sc). In contrast, the children's diagnosis of attention deficit disorder with hyperactivity (ADD/H; n = 22) was not significantly associated with any maternal MMPI elevations, and the CD x ADD/H interactions were not significant for any MMPI scale. These results indicate that CD is linked to maternal personality disorder, but ADD/H is not.     

Origins and consequences of child neglect in substance abuse families

The empirical literature pertaining to the prevalence, origins, and consequences of neglectful parenting as it relates to substance abuse is critically reviewed. Available evidence indicates that children who experience parental neglect, with or without parental alcohol or drug abuse, are at high risk for substance use disorder (SUD). The effects of parental substance abuse on substance abuse outcome of their children appear to be partly mediated by their neglectful parenting. The discussion concludes with presentation of a developmental multifactorial model in which neglect, in conjunction with other individual and environmental factors, can be integratively investigated to quantify the child's overall liability across successive stages of development as well as to map the trajectory toward good and poor outcomes.     

Longitudinal relations between parental drinking problems, family functioning, and child adjustment

Relations between maternal and paternal problem drinking symptoms and destructive marital conflict, parenting problems, and children's internalizing and externalizing problems were investigated. Participants were community families with a child in kindergarten who completed questionnaire measures at baseline (N=235), 1 year later (N=227), and 2 years later (N=215). Structural equation modeling revealed that paternal problem drinking at Time 1 was associated with greater destructive marital conflict 1 year later. In turn, destructive marital conflict was related to decreased parental warmth and increased parental psychological control; these parenting problems were associated with greater child internalizing and externalizing problems at the third time point. Further analyses revealed that the indirect effects of paternal drinking on children's adjustment were significant, and that relations remained even after including autoregressive effects. Findings are discussed in terms of family process models for relations between parental drinking and child adjustment problems.     

The neuropsychology of antisocial personality disorder

BACKGROUND: The literature on executive function in antisocial populations is unclear due to variation in diagnostic criteria and variation in the inclusion of healthy control comparison groups. Some studies suggest prototypical psychopathy is associated with specific deficits in ventromedial prefrontal (VMPFC) function rather than dorsolateral prefrontal (DLPFC). Meta-analytical studies, however, suggest that antisocial personality disorder may be associated with a broader range of executive deficits. This study assessed DLPFC and VMPFC function in antisocial personality disorder subjects and controls using the Cambridge Neuropsychological Test Automated Battery (CANTAB) and a Go/NoGo task respectively. METHODS: All subjects were screened for Axis I pathology, substance misuse and prescribed medication. The performance of 29 subjects with antisocial personality disorder DSM-IV and 20 male right-handed controls (matched for age and IQ) on the neuropsychological test battery was compared. RESULTS: Subjects with antisocial personality disorder displayed impairments on DLPFC executive function tasks of planning ability and set shifting. Impairments were also seen in VMPFC Go/NoGo tasks and in visual memory tasks. CONCLUSIONS: Antisocial personality disorder is associated with a broad range of deficits in DLPFC and VMPFC function. Future studies need to examine relationships between the interpersonal and behavioural components of antisocial personality disorder and neuropsychological function.     

Heterogeneity of childhood conduct disorder: further evidence of a subtype of conduct disorder linked to bipolar disorder

BACKGROUND: Although a small literature suggests that conduct disorder (CD) co-occurs with bipolar disorder (BPD), little is known about this overlap. Thus, we investigated the familial association of antisocial disorders (CD and/or antisocial personality disorder (ASPD)) and BPD among the first degree relatives of children with CD with and without comorbid BPD. METHODS: We compared relatives of four proband groups defined by the presence or absence of CD and BPD in the proband: (1) CD+BPD (N=26 probands, 92 relatives; (2) BPD without CD (BPD) (N=19 probands, 53 relatives); (3) CD without BPD (CD) (N=16 probands, 58 relatives); and (4) controls without BPD or CD (N=102 probands, 338 relatives). All subjects were evaluated with structured diagnostic interviews. Diagnoses of relatives were made blind to the diagnoses of probands. RESULTS: The results show high rates of antisocial disorders and BPD in relatives of children with CD+BPD. Moreover, antisocial disorders and BPD cosegregated among the relatives of children with CD+BPD. While relatives of both CD proband groups with and without BPD had high rates of CD/ASPD, the combined condition CD/ASPD+BPD was found exclusively among relatives of probands with CD+BPD. Limitations: Since we pooled two datasets, subjects were not all evaluated at the same time. Also, the lack of direct psychiatric interviews with children younger than 12 may have decreased the sensitivity of some diagnoses. CONCLUSIONS: These family-genetic findings suggest that CD and BPD represent separate disorders. Furthermore, they suggest that the comorbid condition of CD+BPD may be a distinct nosological entity. This suggests that clinicians treating CD or BPD children should consider the treatment implications of this comorbid condition.     

Pathways and processes of risk in associations among maternal antisocial personality symptoms, interparental aggression, and preschooler's psychopathology

Two studies examined the nature and processes underlying the joint role of interparental aggression and maternal antisocial personality as predictors of children's disruptive behavior problems. Participants for both studies included a high-risk sample of 201 mothers and their 2-year-old children in a longitudinal, multimethod design. Addressing the form of the interplay between interparental aggression and maternal antisocial personality as risk factors for concurrent and prospective levels of child disruptive problems, the Study 1 findings indicated that maternal antisocial personality was a predictor of the initial levels of preschooler's disruptive problems independent of the effects of interparental violence, comorbid forms of maternal psychopathology, and socioeconomic factors. In attesting to the salience of interparental aggression in the lives of young children, latent difference score analyses further revealed that interparental aggression mediated the link between maternal antisocial personality and subsequent changes in child disruptive problems over a 1-year period. To identify the family mechanisms that account for the two forms of intergenerational transmission of disruptive problems identified in Study 1, Study 2 explored the role of children's difficult temperament, emotional reactivity to interparental conflict, adrenocortical reactivity in a challenging parent-child task, and experiences with maternal parenting as mediating processes. Analyses identified child emotional reactivity to conflict and maternal unresponsiveness as mediators in pathways between interparental aggression and preschooler's disruptive problems. The findings further supported the role of blunted adrenocortical reactivity as an allostatic mediator of the associations between parental unresponsiveness and child disruptive problems.     

Maternal prenatal smoking, parental antisocial behavior, and early childhood physical aggression

This study investigated joint effects of maternal prenatal smoking and parental history of antisocial behavior on physical aggression between ages 17 and 42 months in a population sample of children born in Québec (N = 1,745). An analysis of variance (ANOVA) showed significant main effects of maternal prenatal smoking and a significant interaction between maternal prenatal smoking and mother's history of antisocial behavior in the prediction of children's probability to display high and rising physical aggression. The interaction indicated that the effects of heavy smoking during pregnancy (> or =10 cigarettes/day) were greater when the mother also had a serious history of antisocial behavior. The effects remained significant after the introduction of control variables (e.g., hostile-reactive parenting, family functioning, parental separation/divorce, family income, and maternal education). Another significant interaction not accounted for by control variables was observed for maternal prenatal smoking and family income, indicating more serious effects of maternal prenatal smoking under relatively low-income, conditions. Both interactions indicate critical adversities that, in combination with maternal prenatal smoking, have supra-additive effects on (the development of) physical aggression during early childhood. These findings may have implications for the selection of intervention targets and strategies.     

Childhood adversities as risk factors for alexithymia and other aspects of affect dysregulation in adulthood

BACKGROUND: Affect regulation is assumed to be a biologically based function that can become disrupted by inadequate parenting and by traumatic experiences. We studied the relation between the perceived parental parenting style, and sexual and physical abuse, with alexithymia, dissociation, anxiety and depression. METHODS: In a cross-sectional study psychiatric outpatients were administered a structured interview on childhood physical and sexual abuse and they completed a number of questionnaires about the parenting styles of their parents, and about alexithymia, dissociation and mood pathology. RESULTS: Maternal and paternal parenting styles were moderately correlated with alexithymia and depression. The paternal parenting style was also correlated with dissociation. Optimal parenting of one of the parents had a buffering effect on the degree of alexithymia, but not on the severity of other forms of affect dysregulation. The effect of sexual or physical abuse did not add to that of parental parenting style in terms of predicting affect dysregulation. However, a positively perceived maternal parenting style was found to have a buffering effect in terms of the degree of alexithymia, if sexual abuse had also taken place. CONCLUSIONS: Perceived parenting does appear to be of some significance in the development of alexithymia. Optimal parenting of one of the parents may protect against the development of alexithymia when the parenting of the other parent is perceived as non-optimal. However, it is likely that other factors besides parental care and sexual or physical abuse play an important role in the development of an adequate affect regulation.     

Antisocial behaviors moderate the deviant peer pathway to substance use in children with ADHD.

This study evaluated the interplay of attention deficit hyperactivity disorder (ADHD) symptom severity, deviant peer group affiliation, oppositional defiant disorder (ODD), and conduct disorder (CD) as risk factors among 142 adolescents with childhood ADHD. Deviant peer affiliation mediated the relation between childhood ADHD symptoms and 6 substance use and abuse variables. Moreover, moderated mediation analyses found that for children with high levels of ODD and CD symptoms, the mediated effect of ADHD through deviant peer affiliation was significant; however, for children with low levels of ODD and CD symptoms, this mediated effect was weak and nonsignificant. Results suggest that children with severe ADHD symptomatology and comorbid antisocial behavior are at highest risk for peer-mediated substance use in adolescence.     

Development of antisocial personality disorder in detained youths: the predictive value of mental disorders

Antisocial personality disorder (APD) is a serious public and mental health concern. Understanding how well conduct disorder (CD) and other mental disorders predict the development of APD among youths involved in the juvenile justice system is critical for prevention. The authors used a stratified random sample of 1,112 detained youths to examine the development of APD at a 3-year follow-up interview. Nearly one fifth of male juvenile detainees later developed APD; approximately one quarter of male juvenile detainees with CD at baseline later developed APD. Significantly more males than females developed APD; no differences were found by race/ethnicity. Having 5 or more symptoms of CD, dysthymia, alcohol use disorder, or generalized anxiety disorder was significantly associated with developing modified APD (M-APD; APD without the CD requirement). Some disorders were strong predictors of APD; however, none were adequate screeners for identifying which detainees would later develop M-APD. The findings of this study have implications for interventions and further research in developmental psychopathology.     

History of Childhood Behavior Problems in Biological Relatives of Boys With Attention-Deficit Hyperactivity Disorder and Conduct Disorder

Assessed the history of childhood behavior problems in the biological relatives of 177 outpatient boys aged 7 to 12 years with attention-deficit hyperactivity disorder (ADHD) or conduct disorder (CD). The mothers, fathers, and other biological relatives of children with ADHD were significantly more likely to have a history of childhood ADHD but not problems of antisocial behavior or substance use in childhood Attention deficit disorder with or without hyperactivity was similarly associated with a family history of ADHD. In contrast, fathers of children with CD were more likely to have a childhood history of either CD or substance abuse, although these results did not remain significant with the effects of race and socioeconomic status controlled. These results provide further support for the independence of ADHD and CD as clinical syndromes, in spite of their high degree of comorbidity.     

Serious conduct problems in the children of adolescent mothers: disentangling confounded correlations

Early motherhood (less than 20 years of age) was found to be significantly correlated (r = .33) with the number of DSM-III symptoms of conduct disorder in a sample of 253 boys aged 6-13 years who had been referred to outpatient clinics. The following models were compared using path analysis: (a) Teenage motherhood, parental antisocial personality, and SES each contribute uniquely to the prediction of childhood conduct problems; (b) teenage motherhood mediates the association of SES and parental antisocial personality with child conduct problems; and (c) teenage motherhood is spuriously related with child conduct problems because of common associations with SES and parental antisocial personality. Model (c) best fit our data. Similar results were obtained whether maternal age at the birth of the firstborn child or the proband child was used to define maternal age and when teenage motherhood was defined as giving birth at less than 18 years.     

Parenting and adult mood, anxiety and substance use disorders in female twins: an epidemiological, multi-informant, retrospective study

BACKGROUND: Although parenting has long been considered an important risk factor for subsequent psychopathology, most investigations of this question have studied a single informant, clinical populations, one or a few disorders and did not consider relevant covariates. METHODS: Three dimensions of parenting (coldness, protectiveness and authoritarianism) were measured by combining the retrospective reports from adult female twins, their co-twins, and their mothers and fathers. We assessed by personal interview, lifetime history in the twins of eight common psychiatric and substance abuse disorders and a range of predictors of parenting. Analyses were performed using logistic regression. RESULTS: Examined individually, high levels of coldness and authoritarianism were modestly but significantly associated with increased risk for nearly all disorders, while the impact of protectiveness was more variable. These associations declined modestly when putative predictors of parenting were added as covariates. Maternal and paternal parenting were equally associated with outcomes in adult daughters. When coldness, protectiveness and authoritarianism were examined together, nearly all significant associations were seen solely with coldness. Few significant interactions were found between maternal and paternal parenting or between coldness, protectiveness and authoritarianism. The shared experience of these three dimensions of parenting predicts a quite small correlation in liability to these disorders in dizygotic twin pairs (e.g. r < 0.04). CONCLUSION: In women, parenting behaviour, especially levels of coldness, is probably causally related to risk for a broad range of adult psychiatric disorders. The impact of parenting on substance use disorders may be largely mediated through their co-morbidity with major depression, phobias and generalized anxiety disorder. In general population samples, the association of poor parenting with psychiatric illness is modest, largely non-specific and explains little of the observed aggregation of these disorders in families.     

Antisocial personality disorder,childhood delinquency,and frontal brain functioning: EEG and neuropsychological findings

This experiment examined the ability of EEG activity and neuropsychological testing to predict both antisocial personality disorder (ASP) and retrospective self-ratings of early childhood problem behaviors (CPB). Regression analyses found that increased frontal left-hemisphere EEG activation was associated with a decreased likelihood of the diagnosis of ASP or CPB. An association was also found between several motor tests of the Luria-Nebraska and Porteus Maze Test scores and CPB/ASP. The current findings suggest that ASP and CPB are associated with variations in frontal lobe functioning. They further suggest that disturbances in prefrontal functioning may be a common biological ground that links ASP, substance abuse, and biological mechanisms of reinforcement. © 1996 John Wiley & Sons, Inc.     

Separation of DSM-III attention deficit disorder and conduct disorder: evidence from a family-genetic study of American child psychiatric patients

Using family study methodology and assessments by blind raters, this study tested hypotheses about patterns of familial association between DSM-III attention deficit disorder (ADD) and antisocial disorders (childhood conduct (CD) and oppositional disorder (OPD) and adult antisocial personality disorder) among 457 first-degree relatives of clinically referred children and adolescents with ADD (73 probands, 264 relatives), psychiatric (26 probands, 101 relatives) and normal controls (26 probands, 92 relatives). Among the 73 ADD probands, 33 (45%) met criteria for OPD, 24 (33%) met criteria for CD, and 16 (22%) had no antisocial diagnosis. After stratifying the ADD sample into those with CD (ADD + CD), those with OPD (ADD + OPD) and those with neither (ADD) familial risk analysis revealed the following: (1) relatives of each ADD proband subgroup were at significantly greater risk for ADD than relatives of both psychiatric and normal controls: (2) the morbidity risk for ADD was highest among relatives of ADD + CD probands (38%), moderate among relatives of ADD + OPD (17%) and ADD probands (24%) and lowest among relatives of psychiatric and normal controls (5% for both); (3) the risk for any antisocial disorder was highest among relatives of ADD + CD (34%) and ADD + OPD (24%) which were significantly greater than the risk to relatives of ADD probands (11%), psychiatric (7%) and normal controls (4%); and (4) both ADD and antisocial disorders occurred in the same relatives more often than expected by chance alone. Although these findings suggest that ADD with and without antisocial disorders may be aetiologically distinct disorders, they are also consistent with a multifactorial hypothesis in which ADD, ADD + OPD and ADD + CD fall along a continuum of increasing levels of familial aetiological factors and, correspondingly, severity of illness.     

Predictors, clinical characteristics, and outcome of conduct disorder in girls with attention-deficit/hyperactivity disorder: a longitudinal study

BACKGROUND: Research on the overlap between attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) in males has provided useful information on the etiology, correlates, course, and nosology of this co-morbid condition. However, it is unclear how these results extend to females. Our aim was to examine the predictors, clinical characteristics, and functional outcome of CD in a sample of female youth with and without ADHD. METHOD: We conducted a blind, 5-year prospective longitudinal study of girls with (n=140) and without (n=122) ADHD, aged 6-18 years at baseline. At the 5-year follow-up, 123 (88%) and 112 (92%) of the ADHD and control children respectively were reassessed at a mean age of 16.7 years. Psychiatric disorders were assessed using blind structured diagnostic interviews. RESULTS: Baseline ADHD was a significant risk factor for lifetime CD throughout childhood and adolescence [hazard ratio (HR) 5.8, 95% confidence interval (CI) 2.9-11.5, p<0.001]. Among ADHD girls, childhood-onset (<12 years) CD was predicted by paternal antisocial personality disorder (ASPD), while adolescent-onset CD (12 years) was predicted by family conflict. In addition, lifetime CD significantly predicted academic, psychiatric and sexual behavior problems in girls with ADHD at follow-up. CONCLUSIONS: ADHD is a significant risk factor for CD in girls. CD is associated with increased risk for academic, psychiatric and sexual behavior problems compared to ADHD girls without CD. Given that the therapeutic approaches indicated by ADHD and CD differ, these findings highlight the importance of improved efforts aimed at early identification and treatment of CD in girls with ADHD.