Parental Incarceration Among Adolescents Receiving Mental Health Services

The Bureau of Justice Statistics estimates that approximately 1 in every 50 youth in the U.S. had a parent in State or Federal prison in 1999. Studies of children of incarcerated parents suggest that these youth are at risk for experiencing emotional and behavioral problems. Using a sample of 258 adolescents receiving routine mental health services, this study explored: (1) differences in demographic characteristics, lifetime exposure to risk factors, recent stressful life experiences, and clinical profiles of adolescents with and without a history of parental incarceration; and (2) the effect of parental incarceration relative to other risk factors on levels of emotional and behavioral problems and treatment outcomes. Nearly half (43%) of the youth studied had experienced the incarceration of one or both parents. Youth who experienced parental incarceration had been exposed to significantly more risk factors during their lifetimes including parental substance abuse, extreme poverty, and abuse or neglect. They were more likely than other treated youth to present with attention-deficit/hyperactivity and conduct disorders and less likely to have major depression. Findings provide preliminary evidence that parental incarceration may have a discrete negative effect on certain outcomes of treatment.     

Family Cohesion and Health-Related Quality of Life of Children with Type 1 Diabetes: The Mediating Role of Parental Adjustment

Despite the increasing number of studies on the health-related quality of life (HRQOL) of children with type 1 diabetes (T1D), little is known about the influence of family and parental factors on this outcome. This study aimed to explore whether family cohesion and children’s HRQOL were connected through three indicators of parental psychological adjustment (parenting stress, depressive symptoms, and anxious symptoms) as well as whether these links varied according to the child’s age. Levels of family cohesion, parenting stress, and depression/anxiety symptoms of parents of children with T1D and parents of healthy children were compared. The sample included 88 child–parent dyads composed of children/adolescents (8–18 years old) with T1D and one of their parents and 121 dyads composed of healthy children/adolescents and one of their parents. The parents completed self-report measures of family cohesion, parenting stress, and emotional adjustment, and the children completed measures of HRQOL. Testing of the hypothesized moderated mediational model showed that higher HRQOL ratings in children were associated with higher levels of cohesion through lower levels of parental stress, regardless of the child’s age. Parents of children with T1D perceived less cohesion and felt more anxiety and stress about parenting tasks compared to parents of healthy children. Our findings suggest that parents of children with T1D are at an increased risk of psychological maladjustment. Moreover, this study highlights the interrelation between family/parental functioning and child adjustment and makes an innovative contribution by identifying a mechanism that may account for the link between family and child variables.     

The Relation Between Parental Mental Illness and Adolescent Mental Health: The Role of Family Factors

Children of parents with a mental illness are often found to be at high risk of developing psychological problems themselves. Little is known about the role of family factors in the relation between parental and adolescent mental health. The current study focused on parent–child interaction and family environment. This cross-sectional questionnaire study included 124 families with a mentally ill parent and 127 families without a mentally ill parent who at the time of the study had children aged 11–16 years old. Parents completed questionnaires about their mental health, parent–child interaction (i.e., parental monitoring and parental support), and family environment (i.e., cohesion, expressiveness, and conflict). Adolescents reported their internalizing and externalizing problems. Path analyses were used to examine the direct associations between parental mental illness and adolescent problems as well as the indirect relations via parent–child interaction and family environment. The results showed that interaction between parents with a mental illness and their child was significantly worse compared to parents without a mental illness. The family environment of parents with mental illness was also more negative. Mentally ill parents monitored their adolescents less, which in turn related to more externalizing problems of the adolescents. No factors mediated the relation between parental mental health and adolescent internalizing problems. Moreover, no direct effects of parental support, family cohesion, and family expressiveness with externalizing problems were found. These findings imply that parental monitoring should get a specific focus of attention in existing interventions designed to prevent adolescents with a mentally ill parent from developing problems.     

Family Management of Pediatric Cancer: Links with Parenting Satisfaction and Psychological Distress

Research has long acknowledged the disruptions posed by pediatric cancer diagnosis and treatment to family life. Nonetheless, the mechanisms through which the family response influences parents’ mental health in this adverse context are not fully understood. The main goal of the present study was to examine the direct and indirect links, via parenting satisfaction, between family condition management and psychological distress of parents of children with cancer. Participants were 201 parents (86.6% mothers) of children/adolescents diagnosed with cancer who completed self‐report questionnaires assessing family condition management (family life difficulty and parental mutuality), parenting satisfaction, and psychological distress (anxiety and depression). Structural equation modeling was used to test the proposed mediation model. The results showed that parenting satisfaction mediated the association between both the family condition management dimensions (family life difficulty and parental mutuality) and depression. Specifically, greater family life difficulties and lower parental mutuality were associated with lower parenting satisfaction, which, in turn, was associated with higher levels of depression. Additionally, greater family life difficulties and lower parental mutuality were directly linked to higher levels of anxiety. Multigroup analyses suggested that the model was valid across patient age groups (children vs. adolescents) and treatment status (on vs. off‐treatment). These findings reinforce the need for family‐ and parent‐based interventions in the pediatric oncology field. Interventions that target families’ difficulties and promote their resources are likely to foster parenting satisfaction and psychological adjustment.     

Family Factors Predicting Categories of Suicide Risk

We compared family risk and protective factors among potential high school dropouts with and without suicide-risk behaviors (SRB) and examined the extent to which these factors predict categories of SRB. Subjects were randomly selected from among potential dropouts in 14 high schools. Based upon suicide-risk status, 1,083 potential high school dropouts were defined as belonging to one of four groups; 573 non-suicide risk, 242 low suicide risk, 137 moderate suicide risk and 131 high suicide risk. Results showed significant group differences in all youth self-reported family risk and protective factors. Increased levels of suicide risk were associated with perceived conflict with parents, unmet family goals, and family depression; decreased levels of risk were associated with perceived parental involvement and family support for school. Perceived conflict with parents, family depression, family support satisfaction, and availability of family support for school were the strongest predictors of adolescent SRB. Our findings suggest that suicide vulnerable youth differ from their non-suicidal peers along the dimensions of family risk and protective factors.     

Depression in Latino adolescents: a cultural discrepancy perspective

Latino adolescents report high levels of depression compared to other youth, yet little is known about how culture-specific factors contribute to risk (Blazer, Kessler, McGonagle, & Swartz, 1994; Roberts, Roberts, & Chen, 1997; Roberts & Sobhan, 1992; Twenge & Nolen-Hoeksema, 2002). In this study we evaluated the link between cultural discrepancy (i.e., perceived acculturation and gender role disparity between children and their parents) and depression among children of Latino immigrants. Compared to boys, Latina adolescents reported greater differences in traditional gender role beliefs between themselves and their parents and higher levels of depression. Gender role discrepancy was associated with higher youth depression, with this relationship mediated by increases in family dysfunction. Moreover, a moderator analysis suggested that gender role discrepancy effects may be most pronounced for Latina adolescents. Gender role discrepancy was associated with poorer family functioning for girls but not for boys, although the interaction effect was only marginally significant. These preliminary results point to the importance of considering cultural discrepancy as a contributing factor to youth depression.     

Expanding the concept of birthparent loss to orphans: Exploratory findings from adolescents in institutional care in South Korea

Conservative estimates of the number of orphaned and abandoned children suggest there are approximately 132 million worldwide, of whom the majority reside in Asia followed by Sub-Saharan Africa. Research on alternative care for children in need of parental protection have largely been siloed by care setting (i.e. institutional care, adoption, foster care) without consideration of risk factors across care types. One factor specific to alternative care that occurs for all children across care settings is disruption and disconnection of birth parents as a consequence of out-of-home placement. Thus, the purpose of this cross-sectional study of 170 adolescents in institutional care in South Korea was to explore whether a common risk factor specific to the experience of family removal and placement in alternative care, cognitive appraisal of birth parent loss, was present and was a risk factor for more mental health and behavior problems. Findings affirmed the majority of adolescents in institutional care had thoughts about birth parents, but most did not express negative emotions towards birth parents. A more negative appraisal of birth parent loss was found to be a significant predictor of more depressive symptoms, PTSD symptoms, and internalizing behavior problems, but not more externalizing behavior problems. Findings suggest cognitive appraisal of birth parent loss may be a risk factor for more mental health and internal behavior problems for youth in institutional care and that systems of alternative care need to assist youth in having information about their birth parents regardless of contact.     

Familial Influences on Dating Violence Victimization Among Latino Youth

Despite theoretical and empirical evidence suggesting that the family environment plays a central role in Latino youth development, relatively little is known about how family processes influence dating violence victimization among Latino adolescents. To address this gap in the literature, we used data from 210 Latino parents and their 13- to 15-year-old adolescents to examine associations between several different family processes, including both parenting practices (parent monitoring, parent–adolescent communication) and aspects of the family relational climate (family cohesion, family conflict, acculturation conflict) and psychological, physical, and sexual dating violence victimization. Consistent with expectations, lower levels of family cohesion and higher levels of family and acculturation conflict were associated with risk for dating violence victimization, although associations varied depending on victimization type. In contrast, neither parental monitoring nor parent–adolescent communication was significantly associated with any type of dating violence victimization. In addition, we found that parent, but not teen, Anglo-American acculturation was associated with higher dating violence victimization risk. Findings suggest that family-based dating abuse prevention programs for Latino youth should seek to increase family cohesion and decrease family conflict, including acculturation-based conflict.     

Family Support and Mental Health Service Use Among Suicidal Adolescents

Despite the fact that multiple evidence-based treatments exist for suicidal adolescents, these youth are unlikely to engage in mental health treatment. While family members can be influential in connecting adolescents to mental health care, suicidal youth are more likely to be exposed to family environments characterized by abuse, neglect, and to have poorer parent–child attachment quality than non-suicidal youth. This study analyzed data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) to examine the relationships between perceived levels of parental support, symptom severity, and mental health service use in a nationally representative sample of suicidal adolescents in the U.S. (n = 1804). Higher levels of parental support were associated with a lower likelihood of mental health service use, lower levels of depression, and lower likelihood of an actual suicide attempt. Additionally, the presence of a suicide attempt and higher levels of depression were associated with a higher likelihood of mental health service use. When mediation effects were tested, the presence of a suicide attempt partially mediated the relationship between parental support and mental health service use. Implications discussed include the protective nature of parental support the need for more family-based interventions for this population.     

The Social Ecology of Parental Monitoring: Parent–Child Dynamics in a High‐Risk Peruvian Neighborhood

While parental monitoring is understood to protect adolescents from engaging in risk behaviors, little is known about how the family dynamics involved in parental monitoring differ across sociocultural contexts. We sought to gain an in‐depth understanding of parent–child relationship dynamics and parental knowledge of adolescents’ activities in an urban Peruvian neighborhood with high levels of crime and adolescent substance use. We conducted 15 in‐depth interviews and two focus groups with adolescents and 12 in‐depth interviews with mothers sampled from a secondary school in Callao, Peru. Our findings emphasize the importance of parent–child confianza (trust) as a foundation for parental awareness of adolescents’ lives and activities. Participants in our sample characterized confianza as encouraging adolescent disclosure and shaping how parental solicitation and rules were interpreted by adolescents. Participants described how confianza was rooted in features of the parent–child relationship, including shared parent–child time, parental affection, adolescent perceptions of parents’ ability to give good advice, and awareness of how parents would react to delicate topics. Participants linked these family dynamics, in turn, to economic hardship, parental feelings of sacrifice and stress, perceptions of neighborhood risk, and gender norms limiting fathers’ involvement in caregiving. Results have implications for the planning and adaptation of family‐based prevention programs for use in high‐risk contexts in Latin America.     

Mothers’ and Adolescents’ Perceptions of Family Environment and Adolescent Social-Emotional Functioning

Research has emphasized the importance of the relationship between family functioning and adolescent behavioral development. The present study examines family environment and social-emotional functioning of primarily minority adolescents, viewed from both adolescents’ and mothers’ perspectives. Participants were a school-based sample of adolescents with and without risk for emotional and behavioral disabilities and their mothers (N = 86 dyads). Results suggested an association between the mothers’ views of their adolescent children’s problem behaviors and the adolescents’ self-ratings of risk-taking behaviors across 5 years. Overall, mothers of the at risk youth receiving special education services reported higher ratings of youth problem behaviors, but results also indicated that mothers of the at risk adolescent boys not receiving special education services perceived greater depressive symptoms in their children and more family conflict in their homes. Mothers of youth at risk but not receiving special education services experienced higher levels of stress associated with being a parent than mothers of the not-at-risk adolescents. The parent measures of adolescent behavior and depressive symptoms, family conflict, and parental stress were not predictive of the social-emotional functioning of these adolescents in the multilevel models. Implications of these findings for early identification and family focused intervention programs are discussed.     

Like parent,like child? Development of prejudice and tolerance towards immigrants

Although intergroup attitudes are assumed to develop due to the influence of parents, there is no longitudinal evidence supporting this claim. In addition, research on socialization of intergroup attitudes has omitted possible effects of adolescents on their parents. We also know little about the conditions under which intergroup attitudes are transmitted. This two‐wave, 2 years apart, study of adolescents (N = 507) and their parents examined the relations between parents and adolescents' prejudice and tolerance from a longitudinal perspective. The study tested whether parental prejudice and tolerance would predict over‐time changes in adolescents' attitudes and whether adolescents' prejudice and tolerance would elicit changes in parental attitudes. Additionally, it explored whether some of the effects would depend on perceived parental support. Results showed significant bidirectional influences between parents and adolescents' attitudes. In addition, adolescents who perceived their parents as supportive showed higher parent–adolescent correspondence in prejudice than youth with low parental support. These findings show that intergroup attitudes develop as a result of mutual influences between parents and adolescents. Hence, the unidirectional transmission model and previous research findings should be revisited. The results also suggest that parents' prejudice influence adolescents' attitudes to the extent that youth perceive their parents as supportive.     

Factors Moderating Children's Adjustment to Parental Separation: Findings From a Community Study in England

Research findings show that there is marked variability in children's response to parental separation, but few studies identify the sources of this variation. This prospective longitudinal study examines the factors modifying children's adjustment to parental separation in a community sample of 5,635 families in England. Children's behavioral/emotional problems were assessed when children were aged 47 and 81 months; marital quality, maternal depression, socioeconomic circumstances, and demographic variables were assessed prior to the separation from maternal report. Results indicated that 346 mothers separated from their partners in the 3-year period. Preseparation differences were found for measures of family process and parent risk factors, with effect sizes ranging from small to trivial. Parental separation was associated with a significant but modest increase in behavioral/emotional problems, independent of marital quality, maternal depression, socioeconomic circumstances, and demographic variables. Moderation analyses showed that children of cohabiting parents had a greater increase in adjustment problems following parental separation than children of married parents. Further research elucidating the factors that moderate children's adjustment to parental separation is needed to improve our understanding of who may most likely benefit from preventive interventions.     

Trauma-Focused CBT in the Context of Parental Chronic Medical Conditions: A Case Report

Parental chronic medical conditions (CMCs) are relatively common and have been shown to impact children’s psychosocial functioning. Previous research suggests that, for some youth, parental CMCs may be conceptualized as a form of traumatic stress. Trauma-focused cognitive behavioral therapy (TF-CBT) is a multicomponent, evidence-based intervention that is designed to reduce symptoms of posttraumatic stress, depression, and anxiety, as well as behavioral problems, among children and adolescents. Despite its robust empirical support, however, no known studies have utilized this treatment approach to address the mental health needs of youth affected by parental CMCs. The purpose of this article is to describe the application of TF-CBT to treat an adolescent male whose mother was diagnosed with a CMC, which had resulted in continuous family stressors since his birth. Results suggest that TF-CBT offers a promising approach for treating symptoms of posttraumatic stress, anxiety, and depression among children of parents with CMCs, and clinical trials to investigate its effectiveness among this population may be warranted.     

The Use of Empirically Supported Strategies for Building a Therapeutic Relationship With an Adolescent With Oppositional-Defiant Disorder

Manualized evidence-based treatments, particularly behavioral and cognitive-behavioral interventions, have been found efficacious for the treatment of adolescents with oppositional-defiant disorder (ODD). However, despite research that underscores the importance of the therapeutic relationship for the success of treatment, manuals do not adequately address how a therapist should engage an adolescent and his/her family in treatment. This paper demonstrates how to utilize findings from the empirical literature on youth and parent engagement when delivering evidence-based treatment to an adolescent diagnosed with ODD. Examples of strategies for engaging adolescents and parents in treatment are provided.     

The Role of Family Functioning in Bipolar Disorder in Families

Investigated the association between family functioning and conflict and their links with mood disorder in parents and with children's risk for bipolar disorder. Participants were 272 families with a child between the ages of 5-17 years. Parents' history of psychiatric diagnoses and children's current diagnoses were obtained via semi-structured interviews. Parent report on the Family Assessment Device and the Conflict Behavior Questionnaire measured family functioning and conflict, respectively. Results revealed a small but significant indirect pathway from parental diagnosis of mood disorder to child bipolar disorder through impaired family functioning, via increased family conflict. Parental mood disorders were also significantly related to other negative outcomes in children, including unipolar depression and oppositional defiant disorder. Associations between parent diagnoses and family functioning changed depending on youth age, but not youth sex.     

Depressive Symptoms among Children with ODD: Contributions of Parent and Child Risk Factors in a Chinese Sample

Oppositional Defiant Disorder (ODD) is a developmental disorder characterized by serious and persistent social impairment, especially stressful interactions with parents. Although previous studies demonstrated associations between parent mental health and children’s ODD symptoms, less attention has been paid to integrating both parent and child risk factors. The purpose of the current study was to investigate the associations among parent emotion regulation, child emotion regulation, parental depression, and child depression in Chinese children with ODD. A total of 234 children with ODD ranging in age from 6 to 13 years, along with their fathers or mothers, completed questionnaires. Results indicated that: (1) Parent emotion regulation, parental depression and child emotion regulation were significantly correlated with children’s depressive symptoms. (2) Parent emotion regulation was related to children’s depression indirectly through parental depression and child emotion regulation. (3) Child emotion regulation fully mediated the relationship between parent emotion regulation and child depression, and also fully mediated the relationship between parental and child depression. These findings highlight the need to improve parent emotion regulation and pay attention to parental mental health, because both risk factors may exacerbate their children’s emotion regulation difficulties and further associate the high level of depressive symptoms among children with ODD.     

Effects of marital discord on the school behavior of children of schizophrenic,affectively disordered,and normal parents

An association between children's school behavior and two family variables, marital discord and parental psychopathology, has been consistently reported in the literature. However, the joint effects of each of these two familial factors has not been closely examined. The present report provides a further examination of the interrelationships among these three variables with particular emphasis on the effects of marital discord on children's school behavior in families with behaviorally disturbed parents. Marital discord was found to account for much of the association between having a parent with bipolar disorder or unipolar depression and problematic school behavior, but the same variable did not explain the relationship between having a schizophrenic parent and problems in school. The implications of these findings for interventions with the children of disturbed parents and for high-risk research are discussed.This research was supported by Grant MH21145 from the National Institute of Mental Health.