Family Relationship Influences on Children’s Psychopathology: Revisiting the Developmental Interface between Nature and Nurture Gordon Harold Andrew and Virginia Rudd Professor of Psychology Director, Rudd Centre for Adoption Research and Practice University of Sussex MRC Centre for Neuropsychiatric Genetics and Genomics Cardiff University Kick off Workshop for AU Network of Public Child Mental Health, Aarhus, Denmark, December 12th 2014.
Family relationship influences on children’s mental health A brief review of theory and research A focus on the inter-parental and parent-child relationships Unpacking nature from nurture in examining family relationship influences on children’s mental health Examining the role of the inter-parental and parent-child relationships on childhood psychopathology Study 1: Inter-parental conflict, negative parenting practices and children’s externalising (conduct) problems Study 2: Intergenerational transmission, adoptive mother depression and mother-child hostility and children’s ADHD – conduct problems Study 3: Family process intervention aimed at reducing psychopathology (depression) among a high risk sample Implications for practice and policy Applications of research to practice and policy contexts Overview of Presentation
Children and Mental Health • How are children affected by family factors • Emotional problems • Depression (2020) • Behaviour problems • Conduct Dis (£22B/year) • Social competence • Peer relationships • Academic attainment • Performance, behaviour • Physical health • Substance abuse • What family factors affect children • Economic pressure/poverty • Parent mental health • Parenting behaviour/practices • Inter-parental conflict, domestic violence • Parental separation-divorce
A Process Model of Family Relationship Influences on Children’s Mental Health Paternal Depression Parent-Child Problems Economic or Work pressure Interparental Conflict Child Symptoms Maternal Depression Conger and colleagues 1989-2007
Caveats of Past Research • Salience of the family environment ? • Predominantly conducted with biologically related parents-children • Limited examination of maternal versus paternal parenting influences on children • What if it is all in the genes? • Associations between parental behaviour (e.g. parenting) and child behaviour is BECAUSE children share genes with their parents?? • Passive rGe; Evocative rGE • Disentangling genetic factors from rearing environment factors • Traditional twin, sibling, adoption • Unique research designs (UK, US)
Early Growth and Development Study(Adoption at Birth Design) Sample • 561 sets of adopted children, adoptive parents, and birth parents • Sample retention: Adoptive family = 90% Birth parent = 92% • Families assessed at child age 9-, 18-, 27-months of age; ongoing assessments at 4.5 years, 6 years, 7 years, 8 years, 9 years • Present sample included 341 linked families assessed at 27 months, 4.5 years, and 6 years • Nationally-representative sample of families who made domestic infant adoption placements in the United States between 2003-2009 Method • Videotaped Observation – adoptive families • Child temperament, parent-child interactions, marital interactions video recorded in the home during 3-hour home visits at each wave. Coding for these tasks is on-going • Questionnaire – adoptive parents • Couple relationship, parent-child relationship, symptoms of depression and anxiety, family economic conditions, styles of family interaction, parenting style, children’s emotional and behavioural well-being, child sleep problems • Questionnaire – birth parents • Couple relationship, diagnosis and symptoms of psychopathology, drug use, economic conditions, life stress, temperament
Cardiff In Vitro Fertilization Study(An Adoption at Conception Design) • Children born through in-vitro fertilisation (IVF) • 20 fertility centres within the UK (1 in US) • 888 families • Homologous IVF N = 444 • Sperm donation N = 210 • Egg donation N = 175 • Embryo donation N=36 • Gestational surrogacy N=23 • Families who had a live birth (1994 – 2002) • Children aged between 4 – 10 years (mean = 6.80 yrs, SD=1.23) • Demographics (family income, parent education, ethnicity) • Present sample included children aged 5-8 years old (m = 6.49, sd = .85) • Genetically related versus unrelated groups • Genetically Related • Mothers (N=546):Homologous, sperm donation, surrogacy • Fathers (N=531): Homologous, egg donation, surrogacy • Genetically Unrelated • Mothers (N=160): Egg and embryo donation • Fathers (N=173): Sperm and embryo donation
Inter-Parental Conflict, Hostile Parenting and Children’s Conduct Problems Harold, G. T., Leve, L. D., Elam, K., Thapar, A., Neiderhiser, J., Natsuaki, M., Shaw, D., Reiss, D. (2013). The Nature of Nurture: Disentangling Passive Genotype-Environment Correlation from Family Relationship Influences on Children’s Externalizing Problems. Journal of Family Psychology, 27(1), 12-21.
A Process Model of Family Relationship Influences on Children’s Psychopathology Paternal Depression Parent-Child Problems Economic or Work pressure Interparental Conflict Child Symptoms Maternal Depression Conger and colleagues 1989-2007
Inter-parental Conflict Self report of hostility towards spouse IVF & EGDS: Behavior Affect Rating Scale (mothers, =.89/.88; fathers, =.91/.90, Melby et al., 1993) Parent-Child Relations (Hostile Parenting) Mother & Father report of hostility toward child IVF & EGDS: IYFP Ratings Scales (mother, =.70/82; father, =.75/.80, Melby et al., 1993). Child Conduct Problems Mother & Father report of child externalising behavior Cardiff IVF: Strengths and Difficulties Questionnaire (mother, =.80; father, =.78) EGDS: Externalizing subscale, Child Behavior Check List, (mother, =.88; father, =.90) Study Measures (IVF/EGDS)
Theoretical Model (IVF-H/ EGDS) Mother-Child Hostility Mother rated Child Conduct Prob .32**/.31** .23**/.17* .24**/.34** Interparental Conflict .10*/.21** .33**/.19* Father-Child Hostility Father rated Child Conduct Prob .39**/.44** *p <.05, ** p < .01
Mother-Child Hostility Relevance of Genetic Relatedness (IVF Sample) .33**a/.37*b .33**/.37* .31**/.28** Father rated Child Conduct Prob Interparental Conflict Father-Child Hostility .45**/.58** .45***a/.58***b .37**/.38** Mother rated Child Conduct Prob Interparental Conflict *p <.05, ** p < .01
Family relationship influences on children Inter-parental conflict affects children’s conduct problems through disrupted mother-child and father-child relationships Confound of passive rGE controlled Inter-parental conflict as context may have greater disruptive influence on father-child compared to mother-child relationship Implications for intervention (promoting positive maternal and paternal parenting practices in the context of inter-parental conflict) Limitations and considerations Cross-sectional analyses; Rearing (adoptive) parent reports Past longitudinal and experimental evidence; Opposite parent report of child externalizing Role of evocative gene-environment correlation (rGE)?? Genetically informed attributes in the child may evoke disrupted family relationship behaviours/patterns Summary and Considerations
Intergenerational Transmission: Biological versus Adoptive Mother-Child Processes, Children’s ADHD and Conduct Problems Harold, G. T., Leve, L. D., Thapar, A., et al., (in preparation). Adoptive mother-to-child hostility and children's ADHD symptoms and conduct problems: Examining the role of genetically-informed child attributes on pathways to psychopathology.
Direction of effects Parent effects on children Harsh (or positive) family experiences affect children’s psychological development Parental depressive symptoms may affect children’s psychopathology Child effects on parents Child behaviour/disorder/disability may affect parent’s parenting behaviour and family relationship experiences Child behaviour/disorder/disability may affect parent’s mental health (depression) Attention Deficit Hyperactivity Disorder (ADHD) Neurodevelopmental disorder (highly heritable) Families of children with ADHD report higher rates of family conflict and more negative parent-child relationships Role of ADHD on family relationship patterns?? Children’s ADHD symptoms relative to conduct problems?? Intervention/family support programme implications? Contextualising Family RelationshipInfluences on Children
Study Measures EGDS Sample and Maternal Focused Influences • Birth Mother & Adoptive Mother ADHD symptoms: Barkley’s Adult ADHD Scale (Barkley & Murphy, 1998; BM: =.90, AM: 85). • Child Impulsivity: Impulsivity scale of Children’s Behavior Questionnaire (Rothbart, Ahadi, Hershey, & Fisher, 2001)(=.78); Child Activation: Drive, Reward Responsiveness, and Fun Seeking scales of BIS/BAS (Carver & White, 1994; =.81, .71, .70). • Adoptive Mother-to-Child Hostility, Adoptive Mother Depression: Iowa Family Interaction Scales (Melby, 1995; =.91); Beck Depression Inventory (BDI; =.92). • Child ADHD and Conduct Problems: Conner’s Abbreviated Parent Questionnaire(Conners,1997; =.89); CBCL Aggression Subscale (Achenbach, 1991; =.91).
Child ADHD – Conduct Problems Genetically Related Genetically Unrelated Adoptive Mother Hostility Child ADHD Symptoms (Father Report) .12* .19* .14* ..42** .01 Birth Mother ADHD Symptoms .15* Child Impulsivity and Activation .32** .22* .30** .01 Adoptive Mother Depression Child Conduct Problems (Father Report) .02 18 mths – 4.5 yrs 4.5 years 6 years
Primary Summary Points/Findings Passive rGE: Evidence for environmental effects (adoptive mother-to-child hostility) on child ADHD and Conduct problems Evocative rGE: Adoptive mother-to-child hostility evoked by genetically informed child impulsivity which predicts child ADHD and conduct problems Not depression, a focus on parenting Phenotype specificity (ADHD); parenting influences, stronger association with conduct problems (early coercive family process theories; Patterson et al., 1980s) Bottom-Line Take-Home Messages/Implications Evidence-based guidance as to intervention focus Genetic risk for ADHD as risk factor for disrupted family environment (mother-child relationship), mother-child relationship as risk factor for ADHD development AND conduct problems Early child behaviour influences on parenting, not just the other way around Identification of mechanisms, key to early intervention (prevention) Importance of family ‘process’ approach Summary and Implications
Putting Research into Practice: Implementing an Evidence-Based Approach Assessing Children’s Psychological Welfare in the Context of Parental Separation and Divorce Harold, G. T., (2009). Development and Implementation of the CAFCASS Cymru Child and Adolescent Welfare Assessment Checklist (CC-CAWAC). Welsh Government.
A Practice and Policy Context Parental separation and divorce Over 50% of new marriages end in divorce (UK, USA) 28% of children (>1 in 4) will have lived through their parents divorce before the school leaving age of 16 years 68% under the age of 10 yrs Divorce as cause?? Conflict that occurs before, during and after divorce may explain more about children’s adaptation than actual divorce (Kelly, 2000) Legislative context Adoption and Children Act (2002) Definition of significant harm emanating from exposure to domestic violence has been extended to include ‘impairment suffered from seeing or hearing the ill treatment of another Supporting children in the context of parental separation and divorce in the UK Children and Family Court Advisory Support Service in Wales (CAFCASS CYMRU) How do practitioners assess “psychological risk” to children
Assessing the psychological effects of witnessing inter-parental conflict on children • Child and Adolescent Welfare Assessment Pack (CAWAC) • Psychological impacts of family process assessment pack • A questionnaire and short answer instrument aimed at allowing assessment of psychological risk/impacts to children who witness inter-parental conflict and violence for application within the family justice system • Comprehensive research review relating to the effects of inter-parental conflict on children • Practitioner friendly summary of bottom line findings and implications derived from comprehensive research review • Accessible summary and practice guidelines • Context of Use • Private and Public Law applications • CAFCASS (Wales) 7,812 cases involving children (2009-10)
Children’s psychological symptoms, experiences of inter-parental conflict and parenting practices (Sections 1, 2, 3) Psychological symptoms (e.g. SDQ) Perceptions of inter-parental relations (e.g. CPIC) Perceptions of parent-child relations (e.g. CRPBI) Children’s perceptions of community, family and caregiver relationships and court expectations (Sections 4, 5 ,6) Profiling children’s family ‘connectedness’, kinship and support systems (peers, school, extended family) Implications of court request for children’s perceptions of inter-parental, parent child, sibling relations, kinship relations/connectedness and individual well being Primary Assessment Domains
Assessment to Recommendation • Format of Assessment • Questionnaire and interview format (parent, carer, practitioner, child, teacher) • Child (age 6-11 years); Adolescent (age 12-16 years) versions • Aimed at equipping practitioners with objective assessment materials so as to complement existing practice guidelines and individual expertise in making court based recommendations • Identifying “at risk” children (population comparison) • Applying population norms to calibrate the welfare of children relative to children of similar age and gender in the general population • Practitioner orientated report format for application in the court context • Guidelines and report writing template • Improving objective assessment of psychological impacts of “seeing or hearing the ill treatment of another” in the context of parental separation-divorce
Practitioner Training and Accreditation Practitioner accreditation process Formal training (day long); Six-month practice based accreditation Self and software generated comprehensive report Equipping (training) practitioners for cross-examination challenge Results to date CAWAC has been used in over 600 cases since April 2009 (Private Law)JUDGE: Processed application to court (request for increased access/contact by parent) in 15 mins that would have ordinarily taken six months”) Standardized assessment of mental health impacts of parental separation and divorce on children Review (North and South Wales): 60% - 80% showing significant to severe symptoms (age 5 to 16 years) Future Application Common assessment strategy for use by health workers, social workers, court officials, other practitioners/educators Developing context specific intervention (support) programmes (Court, School, Health, adoption, foster-care)
Highlighting the role of family relationship influences on children ‘s mental health Inter-parental relationship; Parent-child relationships Implications for practice and policy Evidence-based guidance as to intervention focus When do we target, who do we target, what do we target? Salience of family relationship influences on children Irrespective of genetic relatedness Practice and policy implications Importance of utilising a complement of research designs Informing intervention targets through carefully designed research Supporting parents (adoption, IVF, step-parent, carer, biological) Emphasising the importance of the rearing environment Promoting resilient children by promoting and supporting resilient parents (helping children by helping parents) Early prevention versus late intervention (cost benefits) Bringing it All Together
Acknowledgements EGDS and MTFCCardiff IVF Study Leslie Leve Anita Thapar JenaeNeiderhiser Frances Rice MisakiNatsuaki Gemma Lewis Daniel Shaw Alyson Lewis David Reiss Dale Hay Laura Scaramella Jacky Boivin Rand Conger XiaoJiaGe Jody Ganiban XiaojiaGe Phil Fisher Patti Chamberlain John Reid David DeGarmo The Wellcome Trust The Nuffield Foundation The National Institutes of Health (USA)