Psychosocial Impact of Predictive Testing for Illness on Children and Families: Challenges for a New Millennium

Predictive testing for adult- and child-onset diseases is becoming widely available. The identification of individuals prone to develop certain illnesses is often medically advantageous in that it may afford opportunities to engage in risk reduction behaviors to detect or delay disease onset. However, sometimes the knowledge gained from these tests can be ambiguous, generate distress, and potentially affect several generations of family members. Overall, these factors create a challenging set of circumstances for persons considering genetic and other forms of predictive testing, particularly parents and children. In this article, we (1) address conceptual issues involved in determining the impact of predictive testing on child and family well-being, (2) review empirical data on this topic, and (3) provide a case example to illustrate these findings. Recommendations are made for additional psychological research on child- and family-focused outcomes associated with participation in testing, highlighting their clinical implications.     

The Influence of Family and Experimental Context on Cognition in Anxious Children

Examined the influence of family on anxious children's cognition. Research by Barrett, Rapee, Dadds, and Ryan (1996) found anxious children reported increased avoidance after interacting with their parents. They labelled this finding the FEAR effect—Family Enhancement of Avoidant Responses. Whilst some subsequent studies have found similar results, others have not. These contradictory findings question whether the direction of parental influence on anxious children is determined by the perceived demands of the experimental context. Anxious children (N = 101) and their parents were asked to interpret seven ambiguous situations and to discuss what their child would do if the scenario actually occurred. Study 1 found that children in the anxious group and an externalizing control group were more likely to interpret ambiguous situations as threatening than nonclinic children were. Study 2 sought to examine changes in the children's responses from pre- to postfamily discussion, and to identify variables associated with the FEAR effect in anxious families. Interestingly, anxious children whose families completed the discussion task after they (children) had been offered treatment were more likely to show a FEAR effect than anxious families who completed the task as part of assessment. Study 3 examined predictors of enhanced avoidance in anxious families. Treatment context and maternal distress were correlated with the child's increased avoidance following family discussion. Limitations of these studies and directions for future research are discussed.     

Examining Partner and Child Abuse: Are We Ready for a More Integrated Approach to Family Violence?

Research and treatment for partner abuse and child abuse are relatively distinct enterprises, yet when the theoretical and research literatures related to these two forms of family violence are examined together, the likelihood of meaningful associations is strikingly apparent. Partner abuse and child abuse co-occur more often than one might expect by chance, and in the context of overlapping theories and risk factors, this suggests that a more integrated conceptualization might be fruitful. We summarize and provide a framework for describing the large number of similar predictors of partner and child abuse, identify some potentially interesting dyadic differences, comment on how our research methodologies could address an integrated area of family violence, and suggest some directions for future research and treatment.     

Clarifying Parent–Child Reciprocities During Early Childhood: The Early Childhood Coercion Model

Consistent with existing theory, the quality of parent-child interactions during early childhood affects children's social relationships and behavioral adjustment during middle childhood and adolescence. Harsh parenting and a propensity toward emotional overarousal interact very early in life to affect risk for later conduct problems. Less empirical work has evaluated the emergence of early childhood coercive parent-child reciprocities. The proposed early childhood coercion model describes the processes by which coercive parent-child reciprocities emerge. Specifically, the interaction between parenting and infants' propensities toward reactivity influences the development of emotion regulation in children and disciplinary styles in parents. Highly reactive children are expected to experience more difficulty learning to regulate emotions and to evoke harsher parenting. Through a process of mutual reinforcement, harsh parenting, negative emotional reactivity, and poor emotion regulation become coercive parent-child reciprocities during early childhood. The emergence of coercive parent-child interactions further diminishes children's emotional regulatory capacities and affects the formation of peer relationships during kindergarten.     

Child abuse and neglect by parents with disabilities: A tale of two families

Two families, in which the children had been placed in foster care due to abuse and neglect by parents who had disabilities, were studied. In the first case, the mother was instructed in skills that our assessment suggested were important for her child's survival. The mother readily acquired and applied these skills, a fact reflected both in changes in her behavior and in changes in the child's well-being. In the second case, the parent's incremental resumption of child custody was made contingent upon completion of relevant parenting tasks. Initially, improvements in the completion of such tasks were evident, but over time and with the onset of militating factors, no further progress was made and all parental rights were terminated. The implications of these cases for behavior analysis and the effort to reunite and preserve families are discussed.     

TREATING CHRONIC FOOD REFUSAL IN YOUNG CHILDREN: HOME-BASED PARENT TRAINING

We evaluated the effects of a behavioral parent training program on parent and child feeding-related behaviors in the home. We trained mothers to initiate regular offerings of previously rejected (target) foods and to provide contingent attention (i.e., specific prompts, positive reinforcement) to increase their child's acceptance of nonpreferred foods. For 1 subject, we also directed training at increasing self-eating. Results of a nonconcurrent multiple baseline design across 3 mother-child dyads demonstrated that, with training, all mothers increased offerings of target foods and use of specific prompts, and 2 mothers increased levels of positive attention. In turn, children increased their acceptance of target foods and self-eating, thus demonstrating the functional effects of parent training on in-home mealtimes. Temporary increases in food refusals occurred when treatment was initiated but declined as treatment continued. We discuss the results in terms of the potential benefits and limitations of a home-based treatment model.     

Families of Children With Attention-Deficit/Hyperactivity Disorder: Review and Recommendations for Future Research

This review integrates and critically evaluates what is known about family characteristics associated with childhood Attention-Deficit/Hyperactivity Disorder (ADHD). Evidence suggests that the presence of ADHD in children is associated to varying degrees with disturbances in family and marital functioning, disrupted parent–child relationships, specific patterns of parental cognitions about child behavior and reduced parenting self-efficacy, and increased levels of parenting stress and parental psychopathology, particularly when ADHD is comorbid with conduct problems. However, the review reveals that little is known about the developmental mechanisms that underlie these associations, or the pathways through which child and family characteristics transact to exert their influences over time. In addition, the influence of factors such as gender, culture, and ADHD subtype on the association between ADHD and family factors remains largely unknown. We conclude with recommendations regarding the necessity for research that will inform a developmental psychopathology perspective of ADHD.     

Combining dynamic systems and multivariate analyses to compare the mother-child interactions of externalizing subtypes

A dynamic systems analysis was conducted to distinguish the parent–child interactions of pure externalizing children from children comorbid for externalizing and internalizing problems. Thirty-three parents and clinically referred children (8–12 years old) discussed a problem for 4 min and then tried to wrap up in response to a signal (a perturbation). The perturbation was intended to increase the pressure on the dyad, triggering a reorganization of their behavioral system. We hypothesized that the comorbid group would be distinguished from the externalizing-only group as a result of this reorganization, but not before. The sequential data were analyzed using a combination of case-sensitive (state space grids and chi-square analyses) and group-based, multivariate techniques (log-linear modeling). Results revealed that externalizing dyads engaged in a permissive pattern throughout the problem-solving session, whereas comorbid dyads shifted from a permissive pattern to a mutually hostile pattern after the perturbation. These findings punctuate the need for a dynamic systems approach to the study of relationship processes associated with the development of childhood psychopathology. Theoretical and clinical implications are discussed.     

Parent–Child Interaction Therapy and Chronic Illness: A Case Study

We examined the outcome of parent–child interaction therapy (PCIT) for a child diagnosed with Oppositional Defiant Disorder (ODD) and cancer. Robert, a 4-year-old Caucasian male, showed significant and meaningful changes in his behavior over the course of 13 weeks of PCIT, and Robert no longer met diagnostic criteria for ODD following treatment. His scores on the Eyberg Child Behavior Inventory and the Achenbach Child Behavior Checklist were in the clinical range before treatment and in the normal range at the conclusion of treatment. His mother also reported dramatic improvements in Robert's behavior during medical visits. Physician and social worker reports were consistent with her report. Such anecdotal data may have implications for the generalization of compliance to the medical setting for children with chronic illnesses. The results of this case study should prompt further investigation of parent-training interventions for children with chronic illnesses and disruptive behavior.     

Boundary regulation in family and personal systems: Perceptions of late adolescents

Examination of boundary regulation can provide family therapists with a framework to describe both the functioning of family systems and personal systems (i.e., the intrapsychic functioning of individual family members). In the present study, late adolescents' perceptions of boundary regulation within their family systems (i.e., ratings of family health, communication, leadership, expressiveness, cohesion, and family conflict) were related to regulation of their personal boundaries (i.e., self-reported personal competence, distress, and patterns of defense mechanism use). In addition, personal system variables reliably discriminated between adolescents who described their families as psychologically healthy versus psychologically unhealthy.     

Family Relationships as a Predictor of Post-Treatment Drug Abuse Relapse: A Follow-Up Study of Drug Addicts and Their Spouses

This study examined family-of-origin (FO) characteristics of drug addicts and their spouses, who participated in an in-home drug treatment program. Discriminant analysis revealed a set of FO characteristics that differentiated between 25 men who remained drug-free for six months after detoxification and 25 men who suffered a relapse. This set of FO characteristics successfully predicted relapse 30 months later. Men who remained drug-free for the entire period maintained closer relationships with healthy than with unhealthy families, whereas those who relapsed maintained closer relationships with unhealthy families. Compared with those who relapsed, men who remained drug-free also maintained closer relationships with their spouses' families. The findings are discussed in terms of the family system's view of drug abuse, as well as their implications for family-based intervention.     

Parent–child interaction: Does parental language matter?

Although parental language and behaviour have been widely investigated, few studies have examined their unique and interactive contribution to the parent–child relationship. The current study explores how parental behaviour (sensitivity and non‐intrusiveness) and the use of parental language (exploring and control languages) correlate with parent–child dyadic mutuality. Specifically, we investigated the following questions: (1) ‘Is parental language associated with parent–child dyadic mutuality above and beyond parental behaviour?’ (2) ‘Does parental language moderate the links between parental behaviour and the parent–child dyadic mutuality?’ (3) ‘Do these differences vary between mothers and fathers?’ The sample included 65 children (M_age = 1.97 years, SD = 0.86) and their parents. We observed parental behaviour, parent–child dyadic mutuality, and the type of parental language used during videotaped in‐home observations. The results indicated that parental language and behaviours are distinct components of the parent–child interaction. Parents who used higher levels of exploring language showed higher levels of parent–child dyadic mutuality, even when accounting for parental behaviour. Use of controlling language, however, was not found to be related to the parent–child dyadic mutuality. Different moderation models were found for mothers and fathers. These results highlight the need to distinguish parental language and behaviour when assessing their contribution to the parent–child relationship.     

Comparing the Family Environments of Adolescents with Conduct Disorder or Depression

We attempted to differentiate the family environments of youth with Conduct Disorder (CD) compared to youth with a depressive disorder. Participants were 34 adolescents from a residential treatment facility. The K-SADS-P was used to determine the youth's diagnosis, while their family environment was assessed by the Self Report Measure of Family Functioning Child Version. A MANOVA was used to compare the two diagnostic groups on seven family environment variables. Results indicate that adolescents with CD described their parents as having a permissive and ambiguous discipline style, while adolescents with a depressive disorder described their relationship with their parents as enmeshed. A discriminant function analysis, using the two family environment variables of enmeshment and laissez-faire family style as predictors, correctly classified 82% of the participants. Implications for treatment of youth with both types of diagnoses and their families are discussed.     

Two‐year‐olds’ understanding of self‐symbols

This study investigated 48 2.5‐year‐olds’ ability to map from their own body to a two‐dimensional self‐representation and also examined relations between parents’ talk about body representations and their children's understanding of self‐symbols. Children participated in two dual‐representation tasks in which they were asked to match body parts between a symbol and its referent. In one task, they used a self‐symbol and in the other they used a symbol for a doll. Participants were also read a book about body parts by a parent. As a group, children found the self‐symbol task more difficult than the doll‐task; however, those whose parents explicitly pointed out the relation between their children's bodies and the symbols in the book performed better on the self‐symbol task. The findings demonstrate that 2‐year‐old children have difficulty comprehending a self‐symbol, even when it is two‐dimensional and approximately the same size as them, and suggest that parents’ talk about self‐symbols may facilitate their understanding.