Parental depression and offspring psychopathology: a children of twins study.

BACKGROUND: Associations between parental depression and offspring affective and disruptive disorders are well documented. Few genetically informed studies have explored the processes underlying intergenerational associations. METHOD: A semi-structured interview assessing DSM-III-R psychiatric disorders was administered to twins (n=1296) from the Australian Twin Register (ATR), their spouses (n=1046) and offspring (n=2555). We used the Children of Twins (CoT) design to delineate the extent to which intergenerational associations were consistent with a causal influence or due to genetic confounds. RESULTS: In between-family analyses, parental depression was associated significantly with offspring depression [hazard ratio (HR) 1.52, 95% confidence interval (CI) 1.20-1.93] and conduct disorder (CD; HR 2.27, CI 1.31-3.93). Survival analysis indicated that the intergenerational transmission of depression is consistent with a causal (environmental) inference, with a significant intergenerational association in offspring of discordant monozygotic (MZ) twin pairs (HR 1.39, CI 1.00-1.94). Logistic regression analysis suggested that the parental depression-offspring CD association was due to shared genetic liability in the parents and offspring. No intergenerational association was found when comparing the offspring of discordant MZ twins [odds ratio (OR) 1.41, CI 0.63-3.14], but offspring of discordant dizygotic (DZ) twins differed in their rates of CD (OR 2.53, CI 0.95-6.76). All findings remained after controlling for several measured covariates, including history of depression and CD in the twins' spouses. CONCLUSIONS: The mechanisms underlying associations between parental depression and offspring psychopathology seem to differ depending on the outcome. The results are consistent with a causal environmental role of parental depression in offspring depression whereas common genetic factors account for the association of parental depression and offspring CD.

The roles of ethnicity and culture in the development of eating disturbance and body dissatisfaction: a meta-analytic review.

This meta-analysis involved 35 studies examining eating disturbance and body dissatisfaction in white and non-white populations and the role of acculturation in the development of eating-related psychopathology. While the role of acculturation in predisposing non-whites to eating disorders remains to be determined, mean effect sizes indicate that whites report more eating disturbance than non-whites. Differences are greatest when studies compare black and white college samples on measures of subclinical eating pathology, like dietary restraint, ideal body shape, and body dissatisfaction. They are weakest when non-clinic populations and clinical forms of eating disturbance, like bulimia nervosa, are examined. These findings suggest that the current literature may be incorrect in its view that subclinical and clinical forms of eating disturbance represent the poles of a single continuum. In addition, they call into question the belief that SES influences the development of eating pathology.

Child custody mediation and litigation: custody, contact, and coparenting 12 years after initial dispute resolution.

Long-term follow-up data were obtained on families who had been randomly assigned to mediate or litigate their child custody disputes. In comparison with families who litigated custody, nonresidential parents who mediated were more involved in multiple areas of their children's lives, maintained more contact with their children, and had a greater influence in coparenting 12 years after the resolution of their custody disputes. The increased involvement of nonresidential parents who mediated did not lead to an associated increase in coparenting conflict. Parents who mediated also made more changes in their children's living arrangements over the years. For the most part, the changes apparently reflect increased cooperation and flexibility. Satisfaction declined for parents (especially fathers) in both groups over time, but fathers remained much more satisfied if they mediated rather than litigated custody. Few differences in satisfaction were found between mothers in the 2 groups. The 12-year follow-up data indicate that, even in contested cases. mediation encourages both parents to remain involved in their children's lives after divorce without increasing coparenting conflict.

Distress among young adults from divorced families.

Researchers find that most children from divorced families function normally, but some clinicians assert that young people are disturbed even many years after a divorce. These accounts may be less discrepant than they appear, because research typically focuses on notably problematic behavior (disorder), whereas case studies emphasize more subtle inner turmoil (distress). In Study 1 college students reported painful feelings, beliefs, and memories about their parents divorce on a reliable new measure, but they also reported accepting the divorce and having few psychological symptoms. Distress about family life was greater among students from divorced than from married families. Study 2 replicated these findings in a community sample of young people from low-income divorced families. In both studies, greater distress was associated with children's residence, frequency of contact with fathers, interparental conflict, and psychological symptoms.

Posttraumatic stress in children following acute physical injury.

OBJECTIVE: To prospectively assess the presence of posttraumatic stress disorder (PTSD) in children hospitalized following acute physical injury. The focus was identification of the incidence of PTSD, PTSD symptoms, and exploration of factors associated with development of PTSD symptoms and disorder. METHOD: Forty children ages 8-17 were interviewed approximately 1 month following a serious injury and assessed for PTSD, pretrauma behavior problems, levels of peritraumatic fear, and posttraumatic thought suppression. RESULTS: Twenty-two and a half percent of participants met DSM-IV diagnostic criteria for PTSD; 47.5% met criteria for at least two of the three PTSD symptom clusters. Greater thought suppression was associated with increased symptoms of PTSD, as were the child's peritraumatic fear response and pretrauma internalizing behaviors. CONCLUSIONS: Results suggest that many children who have been hospitalized for physical trauma may be experiencing clinically significant PTSD symptomatology and may benefit from psychological as well as medical intervention.

An overview of the nature, causes, and consequences of abusive family relationships. Toward differentiating maltreatment and violence.

Despite gaps in research, this review argues for distinguishing family maltreatment from family violence, a differentiation between minimal or moderate abuse and serious endangerment, physical injury, or sexual violation. Most acts now defined as violent or abusive are moderate, and stressful life circumstances contribute to their development. Research suggests that abuse may develop through multiple pathways. The consequences of abuse appear to be general, but more commonalities may be found by examining more subtle and complex effects. Many interventions have attempted to prevent or treat family violence and its consequences, and several show promise. More systematic research is needed, but several changes in intervention seem warranted now. For instance, (a) mental health professionals should not be required to report maltreatment while a family is engaged in therapy; (b) the social service system needs to rediscover its roots in supporting families under stress, including in cases of moderate maltreatment; and (c) swift and decisive legal intervention is needed in cases of serious family violence.

Do marriage problems affect fathering more than mothering? A quantitative and qualitative review.

The important question of whether marital problems disrupt fathering more than mothering is addressed in (a) a quantitative review of evidence on marital conflict and parenting in intact families, and (b) a qualitative review of research on mother and father involvement with their children following divorce. We conclude that (a) there is limited evidence that, relative to mothering, fathering is more likely to be affected by marital conflict, but suggest that (b) marital status (i.e., divorce) affects fathering notably more than it affects mothering. We further suggest that marital problems may disrupt father involvement which, in turn, weakens the quality of father-child relationships; there likely are multiple alternative pathways through which marriage problems affect parenting, including both "spillover" and "compensation"; researchers need to examine more carefully how marital problems disrupt coparenting; child age and gender may moderate linkages between the parental and marital subsystems; and coparenting, marital happiness, and the institution of marriage itself may be essential first avenues of intervention for those who wish to improve or maintain fathers' involvement with their children.

Practical and emotional consequences of parental divorce.

This review explores divorce as a risk factor for psychological problems among children and adolescents and the difficult emotional and practical transitions it creates for them. The authors provide helpful suggestions for primary care pediatricians on how best to assist their adolescent patients and their families in dealing with the transition.

Divorce mediation and resolution of child custody disputes: long-term effects.

Separated parents randomly assigned to either mediation or traditional adversarial methods for resolving child custody disputes were surveyed nine years postsettlement. Noncustodial parents assigned to mediation reported more frequent current contact with their children and greater involvement in current decisions about them. Parents in the mediation group also reported more frequent communication about their children during the period since dispute resolution.

Parent-child relationships and the management of insulin-dependent diabetes mellitus.

Several dimensions of parent-child relationships were examined as predictors of adherence to treatment and metabolic control in a multi-informant study of 88 children and adolescents with insulin-dependent diabetes mellitus who were recruited from 2 endocrinology clinics. Ratings of parent-child discipline, warmth, and behavioral support were not significantly associated with diabetes outcome, but parent-child conflict was a consistent correlate of both adherence and metabolic control. Within a public hospital subsample, conflict was related to parent, child, and nurse ratings of adherence and to a physiological index of metabolic control. These results were partially replicated in a private practice sample where conflict was significantly related to parents' ratings of adherence and to metabolic control. Conflict accounted for unique variance in diabetes outcome beyond that associated with other measures of the parent-child relationship, but the relation between conflict and metabolic control was no longer significant when adherence ratings were entered into regression equations first.

Child custody mediation and litigation: parents' satisfaction and functioning one year after settlement.

A 1-year follow-up study was conducted on families randomly assigned to settle custody disputes either in mediation or through adversary procedures. Consistent with Time 1 reports, at Time 2 fathers who mediated were substantially more satisfied than were fathers who litigated. Fathers who mediated also complied more with child support orders. Contrary to prediction, the greater satisfaction and compliance of fathers did not lead to increased satisfaction among mothers who mediated. In contrast to Time 1, at follow-up mothers who mediated were significantly less satisfied than were mothers who litigated, but selective attrition may account for these differences. The psychological adjustment of mothers and fathers was not significantly different between settlement groups at Time 2, but mothers in both groups reported less satisfaction with dispute settlement and less dysphoria at Time 2 than they had reported at Time 1.

Parental functioning and children's adjustment in families of divorce: a prospective study.

This paper prospectively examined relations between marital status, predivorce parenting practices, and children's adjustment, using data from the New York Longitudinal Study (NYLS). Prospective analyses of children's predivorce adjustment indicated that neither boys nor girls showed more problematic behavior prior to parental separation, and only boys had more difficulties after divorce. However, parents of to-be-divorced families reported more difficulties in childcare practices before divorce than did parents of always-married families. Parenting difficulties in to-be-divorced families were found consistently for boys but not for girls. Results suggest that the difficulties found among boys after divorce may be linked with parenting problems that begin before divorce.

Parenting in context: systemic thinking about parental conflict and its influence on children.

Fauber and Long's (1991) overview of research on family therapy with children is a valuable integration of the literatures on the family correlates of and treatments for childhood disorders. Several concerns apply to some of the inferences they draw from risk research, however. Their assertion that various sources of family distress have effects that are mediated primarily through parenting is questionable, as is their suggestion that parenting therefore is the appropriate focus of family treatment. The conceptual issues of reductionism, linearity, holism, and change in defining causality are discussed in questioning these conclusions about etiology and treatment. Other empirical and methodological issues are raised briefly, particularly as they relate to statistical models of direct and indirect influences and to the body of correlational and analogue research on how parental conflict influences children.

Mediational screening in theory and in practice.

Pillow et al.'s (1991) argument for mediational selection omits discussion of what may be the strategy's greatest advantage, the early identification of risk. The theoretical benefits to prevention of identifying developmental processes are briefly noted here. At the same time, practical limitations of mediational selection are noted, particularly in relation to establishing and interpreting the correlation found between mediational and outcome variables. It is concluded that mediational selection is one, but only one, selection strategy worthy of consideration in prevention research.

Child custody mediation and litigation: further evidence on the differing views of mothers and fathers.

An earlier study was replicated in which parents were randomly assigned to negotiate child custody disputes either in mediation or through the adversary system. In both the initial study (Emery & Wyer, 1987a) and the present replication, mediation greatly reduced the frequency of custody hearings, allowed settlements to be reached in half the time, and substantially improved the satisfaction reported by fathers. Considerably fewer differences were found for mothers who used the alternative forms of dispute resolution, however. Some differences found in both studies favored the women who litigated. No consistent differences in the psychological adjustment of mothers or fathers who mediated or litigated emerged across the two studies. Although careful consideration of findings argues against the conclusion that mediation is "good" for fathers and "bad" for mothers, findings point to the conflicting perspectives of men and women who contest child custody.

The role of behavior therapists in child custody cases.

Given awareness of research, a focus on the present, sensitivity to multiple life events, and preference for active interventions that characterize the social learning tradition, behavior therapists are well equipped to expand their work into the child custody context. However, therapists need to be aware of the multiple potential roles they may be asked to play in child custody cases. All therapists must make clear whether they are functioning as an evaluator, a mediator, or a therapist. These roles overlap somewhat in function, and on occasion the same psychologist may successfully fulfill more than one role. However, the wise course of action is for the therapist to define a single role from the outset of the case and to remain in that one role throughout. Although a social learning background is an excellent starting point, therapy with child custody cases requires specialized knowledge about the emotional, practical, and legal aspects of divorce. Self-education is an especially important precursor to working in the child custody context, because perhaps the single most important intervention with divorcing and divorced families is to educate them. Given the lack of institutionalized guidance on how to handle both the emotional and the practical aspects of divorce, families often turn to therapists for direction. To provide such direction, therapists must educate themselves about the various emotional, social, practical, and legal aspects of divorce. We hope that this chapter is but an initial step that the reader will take toward that goal.

Family violence.

Researchers and policymakers have begun to recognize the extent and severity of family violence in recent years, particularly its effects on children. Despite a flurry of research, however, there is much disagreement about the definition of violence, its development, the consequences for victims, and the most effective avenues for intervention. Similar conceptual, methodological, and practical problems are faced by those working in the areas of physical child abuse, child sex abuse, and child witnesses to spouse abuse. In further research on these complex problems, researchers are encouraged to use operational definitions that avoid terms like abuse and violence, to focus new efforts on emotional mediators of violent actions, to evaluate the effects of violence on the entire family system, and to redouble efforts to conduct systematic outcome research. Those professionals who are currently responsible for intervention are encouraged to use definitions of and responses to family violence that match those used for assaults between strangers.

Methodological issues in child sexual abuse research.

The amount of research concerning the prevalence and consequences of child sexual abuse has increased dramatically during the past decade. Too little attention has been paid to possible methodological influences on this research. This investigation reports on the influences of response rate, ordering of questions, and definition of child sexual abuse on the results of a survey of college students' childhood and adolescent sexual experiences. Response rates affected prevalence rate estimates, and the use of varying definitions of child sexual abuse affected estimates of both prevalence and consequences. The importance of the awareness of these methodological issue in future research efforts is discussed.

Family members as third parties in dyadic family conflict: strategies, alliances, and outcomes.

Systems theorists have argued that triads rather than dyads need to be considered as a basic interaction unit, particularly in regard to episodes of conflict. While theoretically appealing, the description of the strategies used and alliances formed when third parties intervene in dyadic conflict presents a number of conceptual and empirical challenges. In the present report, a reliable system for coding such third-party participation in verbal conflicts is described and is used to analyze routine family conflicts that were observed during dinner. A number of specific findings of interest are reported, including that girls were more likely than boys to intervene in all family disputes except marital conflicts, that mothers and fathers rarely sided against each other when intervening as third parties, and that the third-party strategies most commonly used corresponded with family roles: fathers used authority strategies, mothers used mediational tactics, and children used distraction. Of greater importance, however, are the general findings that document the influence of third parties on dyadic conflict. Additional family members frequently joined dyadic family conflicts, they were about equally likely to attempt to end or to continue the conflict, they formed alliances about half of the time, and their intervention strategies were related to the outcome of the conflict as well as its patterning.