Children of Mentally Ill Parents Participating in Preventive Support Groups: Parental Diagnoses and Child Risk

In the Netherlands, preventive support groups are offered to children of mentally ill parents. Given the variety of parental diagnoses it might be questionable if offering a standardized program for all these children is the most effective response. While no overall knowledge exists about the type of parental disorder and varying risk levels and support needs among the participating children, we examined whether there are differences between these children that are related to their parents’ diagnoses. With questionnaires we assessed risk factors in 122 mentally ill parents and their children: high parental illness severity, low perceived parental competence, parent–child interaction problems, poor family functioning, difficult child temperament, and low child competence. We also assessed the children’s psychosocial problems and negative cognitions about their parent’s illness. Results showed that most parents had co-morbidity (multiple diagnoses) and/or personality disorders. Children of parents with either of these conditions were more likely to be exposed to the risk factors: high parental illness severity, low perceived parental competence, problematic parent–child interaction, and low perceived child competence, compared to children of parents without these conditions. They were also faced with more risk factors and had more psychosocial problems and negative cognitions. From these results we may conclude that children of parents with co-morbidity and/or personality disorders require more extensive support than children of parents without these conditions. We suggest strengthening the children’s competence and involving parents as important focuses of preventive interventions for children at high risk. Longitudinal studies should test these assumptions.     

Family psychological factors in relation to children's asthma status and behavioral adjustment at age 4

The objectives of this study were to determine whether family psychosocial factors influenced asthma development by age 4, and whether family factors and early wheezing illness were associated with behavioral adjustment at age 4. Participants were 98 children enrolled in an intervention study at 9-24 months and followed to age 4. Baseline evaluations assessed infants' respiratory illness severity, family psychosocial characteristics, and parental risk factors for asthma development. Active asthma categorization at age 4 utilized both parent report and objective data. Parents completed the Child Behavior Checklist (CBCL). Caregiver single-parent status, a composite of baseline family stresses, and early wheezing illness severity were associated with active asthma at age 4. The contribution of prenatal smoke exposure and early hospitalization to active asthma varied with racial/ethnic group membership. Maternal mental health and family stresses predicted CBCL scores at age 4, whereas early illness severity and hospitalization were unrelated to CBCL scores. CBCL scores were not elevated for children with active asthma at age 4. Family factors consistent with a negative emotional environment were associated with both active asthma and adjustment problems at age 4, suggesting that both outcomes may be influenced by a common factor.     

Parental Migration and Children’s Outcomes in Romania

Although Eastern European migration has increased greatly, the research on its impact on children and families has been limited. In this study I examined the impact of parental economic migration on children psychosocial and academic outcomes in Romania, one of largest Eastern European migrant sending country. Surveys were conducted with 382 children in 5–8th grades. A conceptual model of the impact of parental migration, economic pressure, social support, parenting and children’s outcomes was examined using structural equation modeling. The results indicate that higher economic pressure was associated with higher desire for migration, lower parenting quality and higher child psychological distress. Higher satisfaction with migration was associated with higher quality of parenting, higher child psychosocial functioning and academic achievement. Recommendations for programs and policies targeted to immigrant families are provided.     

Parental Involvement in Primary School Education: its Relationship with Children’s Academic Performance and Psychosocial Competence through Engaging Children with School

The benefits of parental involvement in children’s education have been well established but increasing evidence suggests that overparenting may have adverse effects on children. The question of whether excessive parental involvement hinders children’s academic and psychosocial development warrants further investigations. This study examined the associations of parental educational involvement at home and in school with academic performance and psychological health of 507 Chinese Grade 3 schoolchildren in Hong Kong. Parents reported on their level of involvement in children’s schooling and their children’s psychosocial issues. Children were surveyed to determine their school engagement, and their Chinese language and mathematics attainment was assessed. We also explored the underlying mechanism by testing children’s engagement with school as a mediator of the relationships. Our results showed that home-based parental educational involvement was positively associated with children’s language competence and psychosocial wellbeing, and the associations were linked through engaging children with school. However, the benefits reached a plateau at higher level of parental involvement in children’s learning at home. School-based parental involvement had an indirect effect on children’s prosocial behavior through school engagement. These findings highlight the significance of optimal level of parental involvement in children’s education at home for children’s development.     

Anxiogenic Patterns in Mother-Child Interactions

ABSTRACT

The current study examined psychosocial variables associated with the development of anxiety in children. While previous literature has established parental affectionless control as an important contributor to the development of anxiety in children, few have examined this construct within the dynamic context of parent-child interaction. In the current study, the affect and behavior of anxious mothers and their children (ages 6 to 12 years) were examined during two mildly stressful tasks, with a total of 64 mother-child dyads participating in the study. Analyses supported the hypothesis that maternal affectionless control mediates the relationship between child anxiety and child disengagement/withdrawal from difficult tasks. Results are discussed in terms of implications for psychosocial mechanisms of the familial transmission of anxiety.     

The Relationship Between Male-Perpetrated Interparental Aggression,Paternal Characteristics,and Child Psychosocial Functioning

It is well established that children in homes where interparental violence is present are at increased risk for psychosocial (i.e., internalizing, externalizing, and attention) difficulties. However, previous studies have provided a limited view on the variety of factors that commonly co-occur in these environments (e.g., other characteristics of the parents and family) and how they may collectively impact children. Knowing this information could have implications for parental interventions aimed at preventing the continuation or initiation of psychosocial problems in children. Thus, the present study simultaneously examined the association between father-perpetrated interparental aggression, father characteristics, and child psychosocial functioning in a sample of 145 men arrested for domestic violence. Results showed that of all the variables examined, paternal antisocial personality traits and interpersonal hostility were uniquely associated with overall child psychosocial impairment, externalizing problems, and attention problems. Implications for intervention programs are discussed.     

PALME

Background

Single mothers and their children are exposed to increased psychosocial burdens and risks. Nevertheless, in Germany offers of help especially designed for the needs of this group are lacking.

Method

An emotion-oriented parental training program (PALME, http://www.palme-elterntraining.de) based on the attachment theory was developed particularly for single mothers with preschool children. The training is guided by trained kindergarten nurses. The effectiveness of the parental training program on the measure of maternal psychological impairment, emotional competence and child problem behavior was investigated within a randomized, controlled study with 61 single mothers suffering from medium grade psychosocial impairment.

Results

Analyses of variance revealed significant group×time interaction effects in favor of the intervention group compared to controls. After the training the mothers showed improvement in their psychological impairment, depression and emotional competence. In addition, evidence suggests that behavioral problems of the children were reduced.

Conclusion

In view of the benefits of this parental training and its low costs it should be recommended as a regular offer of support for single mothers within community settings.     

Parental Responses to School-aged Children’s Sibling Conflict

The goals of this study were: (1) to describe and compare parental responses to school-aged siblings’ conflicts; (2) to explore the sibling relationship structural correlates of the parental responses; and (3) to assess the links between type of parental response and sibling relationship quality and children’s psychosocial and physical well being. One parent from eighty-two families (mothers = 68; fathers = 13; 1 missing) of firstborn (Mage = 9.84 years old) and secondborn (Mage = 7.16 years old) children completed an anonymous survey. Parents employed a child-centered strategy most often and sanctioned sibling aggression least often in response to siblings’ conflicts. Closer age spacing among siblings was related to parents’ sanction of physical aggression. Parental response type was associated with sibling relationship quality and children’s psychosocial and physical well being. The differential associations between parental response type, sibling experiences and children’s mental and physical well being are discussed.     

Psychiatric and psychological aspects of chronic pain

To gain a better understanding and a more complete assessment of chronic pain syndrome, the psychosocial, psychological, psychodynamic, and psychiatric aspects of this condition should be included in patient evaluation. As illustrated in the two case studies presented, this approach leads to clearer recognition of the biological and psychosocial needs of patients, and allows for more effective treatment measures to be taken.     

Resilience and Family Psychosocial Processes Among Children of Parents with Serious Mental Disorders

Resilience involves successful adaptation despite adverse circumstances, and is operationalized in this study as a multidimensional construct which consists of both positive and negative indicators of adaptation. Previous research has emphasized the importance of parental psychopathology in predicting child adaptation among children of parents with serious mental disorders. In contrast, we hypothesized five family psychosocial processes as common sequelae to serious parental mental disorder that are central to child adaptation beyond that predicted by parental psychiatric status. These are diminished family financial resources, social network constriction, impaired performance of parenting tasks, increased familial stress, and disruption of the parent-child bond. We examined the relationship of these processes to child adaptation independently through hierarchical regression analyses after taking into account parental psychiatric symptoms and functioning as well as the child's age and gender. One hundred seventy-seven children of mothers with serious mental disorder, ages 2–17 years old, were assessed on measures of adaptation. Results indicated that family psychosocial processes are a more consistent and powerful predictor of child adaptation than parental psychopathology. Results also indicated that, for these children, adaptation is predicted most consistently by parenting performance, and to lesser extents, by the parent-child bond and familial stress. We discuss our results in terms of their implications for theory and intervention with children of parents with serious mental disorders and for the study of resilience.     

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.     

Siblings after suicide--"the forgotten bereaved"

There is scarce research on "the forgotten bereaved"--the children and adolescents who lose a sibling by suicide. In this paper we explore their psychosocial situation and needs for assistance through a Norwegian nationwide study. The results show that particularly younger bereaved siblings are suffering from posttraumatic and grief reactions, depression, and anxiety. Most of the difficulties are not individual, but rather relational and social in nature, and largely contextually dependent. Necessary help is impeded due to the extraordinary experience leaving the siblings outside the circle of friends and parental grief community. A systematic outreach help program is presented.     

Association of parental depression with psychiatric course from adolescence to young adulthood among formerly depressed individuals

The authors examined whether parental major depressive disorder (MDD) is associated with course of depression and other psychopathology among formerly depressed adolescents as they enter adulthood. The sample consisted of 244 individuals (age 24) in a longitudinal study who had experienced MDD by 19. Maternal MDD was associated with MDD recurrence, chronicity and severity, anxiety disorders, and (among sons only) lower psychosocial functioning in offspring between the ages of 19 and 24. Paternal MDD was associated with lower functioning. Sons of depressed fathers had elevated suicidal ideation and attempt rates in young adulthood. Recurrent paternal MDD was associated with depression recurrence in daughters but not sons. The impact of parental MDD on offspring could not be attributed to characteristics of the offspring's depression prior to age 19.     

Maternal Expressed Emotion in Relation to Child Behavior Problems: Differential and Mediating Effects

Maternal expressed emotion (EE), including maternal criticism and emotional over-involvement, is considered an index of family emotional climate that is critical for children’s psychological well-being. Limited research investigates how each element of EE differentially contributes to child behavior problems, or explores the mechanisms, such as child emotion dysregulation, through which parental EE influences child psychosocial outcomes. This study examined maternal EE, child emotion dysregulation, and child behavior problems among 60 mother–child dyads from a community sample, utilizing multi-method and multi-reporter assessment. Findings indicated that maternal expressed criticism toward the child was positively associated with child externalizing symptoms through its relation to increased child emotion dysregulation, whereas maternal emotional over-involvement was negatively associated with child externalizing symptoms through its negative relation to child emotion dysregulation. These results provided increased support for a model in which maternal criticism remains negatively associated with child psychosocial outcomes, but the construct of emotional over-involvement is not necessarily associated with youth psychosocial problems. This study also illustrated one pathway through which maternal EE influence child psychosocial functioning, thus placing EE research in the broader context of research on family emotion socialization.     

Parental Health and Children’s Functioning in Immigrant Families: Family Roles and Perceived Treatment at School

Although parents’ health condition is generally thought to be related to their involvement in their children’s functioning, the possible dynamics behind the scenes in school contexts with immigrant children has received little attention. This study examined the association between parents’ health condition and their children’s academic and behavioral functioning, as well as the mediation effects of parents’ school engagement and children’s perceived treatment at school among 607 immigrant families with 10- to 12-year-old children. Using structural equation modeling, the results indicated that parents’ poor health condition was associated with children’s increased behavioral problems. Parents’ school engagement fully mediated the association between parental health condition and children’s academic achievement and partially mediated the association between parental health condition and children’s behavior problems. Notably, higher levels of parents’ school engagement were associated with increased behavior problems, demonstrating a unique feature in these immigrant children’s developmental functioning. Higher levels of perceived harsh treatment by peers at school due to children’s immigrant identity were associated with these children’s greater risks of behavior problems. The results suggested what may lie behind the scenes in these children’s behavioral problems is that many of these children who act out and are brought to the school office for disciplinary issues may suffer from perceived discrimination and bad treatment by their peers. The findings provide important implications for researchers, healthcare practitioners, and educators seeking to understand this subpopulation and to design and implement family support and prevention programs for young adolescents from immigrant backgrounds.     

Parent Satisfaction with Case Managed Systems of Care for Children and Youth with Severe Emotional Disturbance

Case management has emerged as an integral component of current efforts to reform the delivery of mental health services to children and youth with Severe Emotional Disturbance (SED). We examined parental satisfaction with one program's case management system for SED children. In order to validly address parental satisfaction, the program first turned to a group of its parents to develop a satisfaction measure, the Family Satisfaction Survey (FSS). Of the 51 parents who returned an FSS, 74% of the parents were generally satisfied while 26% indicated that they were dissatisfied with their families' case management services. Multivariate regression analyses were employed to examine the role played by client, service, and outcome variables in predicting parental satisfaction. After controlling for child diagnoses, severity of impairment, and levels of psychosocial stress, parent satisfaction with case management services was best predicted by the frequency of monthly contact and fewer days is a psychiatric hospital proportional to length of service. Our results suggest that parent satisfaction is based not only on what case managers do but on how this service impacts SED children's ability to remain at home and in their communities.     

Neuropsychological functioning in preschool-age children with sickle cell disease: the role of illness-related and psychosocial factors.

Cognitive and academic deficits have been identified in school-aged children with sickle cell disease (SCD). However, there have been very few identified studies that examine neuropsychological functioning in preschool-age children with SCD. It is important to understand effects of SCD from a developmental perspective and to consider the contribution of environmental factors in this at-risk population. Neuropsychological functioning of preschool-age children with SCD and no history of overt stroke (n = 26) was examined across several domains (language, immediate memory/brief attention, visuospatial/visuoconstructional, motor/visuomotor). The mean Full Scale IQ for the sample was 89.0. Performance on the Immediate Memory/ Brief Attention domain was significantly higher than the other domains, although the pattern of performance was relatively consistent, with mean standard scores ranging from 88.0 to 95.0. Disease severity was not significantly related to cognitive functioning in this group of young children with SCD. Socioeconomic status (SES) was significantly correlated with most domain scores and, based on regression analyses, accounted for 18% to 47% of the variance in functioning. Psychosocial factors, such as number of children living in the home and parental stress levels, were negatively associated with Motor/Visuomotor skills, and weekly hours in school/day care was positively associated with language-related skills. Results suggest that, at this young age, psychosocial risk factors appear to be appropriate targets for intervention, with the goal of improving long-term outcome in children with SCD. Further investigations should include comparison to a matched control group.     

Anxious-Irritable Children: A Distinct Subtype of Childhood Anxiety?

Children with anxiety disorders often present with other co-occurring symptom clusters, of which irritability is among the most highly co-occurring. Despite compelling clinical and pathophysiological evidence linking anxiety and irritability, little is known regarding the clinical presentation and associated impairment of children with both anxiety and irritability. In this study, our aims were to confirm the preponderance of irritability in clinically anxious children and compare clinically anxious children with irritability to those without irritability across sociodemographic, clinical, psychosocial, and family domains. Participants were 230 children with anxiety disorders (ages 6–14 years) and their mothers, and 91 healthy controls (ages 6–17 years) and their mothers. Of the clinically anxious children, 121 were anxious and irritable; 109 were anxious but not irritable. Irritability levels were significantly higher in the clinically anxious children compared with the healthy controls. Children with anxiety disorders and irritability presented with greater severity and impairment across clinical phenomenology, psychosocial, and family domains relative to anxious children without irritability. Regression analysis findings were convergent in that greater severity and impairment across these same domains predicted higher irritability levels in the children with anxiety disorders. Results support the meaningful distinction between anxious children with and without irritability. Implications of the findings are discussed particularly in regard to assessment and treatment and future research directions are delineated.     

Neuropsychological Functioning in Preschool-age Children with Sickle Cell Disease: The Role of Illness-related and Psychosocial Factors

Cognitive and academic deficits have been identified in school-aged children with sickle cell disease (SCD). However, there have been very few identified studies that examine neuropsychological functioning in preschool-age children with SCD. It is important to understand effects of SCD from a developmental perspective and to consider the contribution of environmental factors in this at-risk population. Neuropsychological functioning of preschool-age children with SCD and no history of overt stroke (n = 26) was examined across several domains (language, immediate memory/brief attention, visuospatial/visuoconstructional, motor/visuomotor). The mean Full Scale IQ for the sample was 89.0. Performance on the Immediate Memory/ Brief Attention domain was significantly higher than the other domains, although the pattern of performance was relatively consistent, with mean standard scores ranging from 88.0 to 95.0. Disease severity was not significantly related to cognitive functioning in this group of young children with SCD. Socioeconomic status (SES) was significantly correlated with most domain scores and, based on regression analyses, accounted for 18% to 47% of the variance in functioning. Psychosocial factors, such as number of children living in the home and parental stress levels, were negatively associated with Motor/Visuomotor skills, and weekly hours in school/day care was positively associated with language-related skills. Results suggest that, at this young age, psychosocial risk factors appear to be appropriate targets for intervention, with the goal of improving long-term outcome in children with SCD. Further investigations should include comparison to a matched control group.     

A Review of Psychosocial Factors in Complex Regional Pain Syndrome

Complex regional pain syndrome (CRPS) is a disabling pain condition poorly understood by medical professionals. Because CRPS is particularly enigmatic, and has significant impact on patient function, researchers have examined psychological processes present among patients with this diagnosis. This systematic review examines psychosocial factors associated with CRPS, both predictors and sequelae. Our conclusions are that CRPS is associated with negative outcomes, both psychological (e.g., increased depression and anxiety) and psychosocial (e.g., reduced quality of life, impaired occupational function) in nature. However, research does not reveal support for specific personality or psychopathology predictors of the condition.