INFLUENCE OF PSYCHOPATHOLOGICAL
DISORDERS OF CHILDREN IN FAMILY
STRUCTURE AND FUNCTIONING
Adrián Cano Prous
Baras Pastor et al.
Dpto. Psiquiatría y Psicología Medica
University Hospital of Navarra
www.cun.es
CHILD AND ADOLESCENT
PSYCHIATRY
SPECIALIZED NURSERY
PARENTS
SPECIALIZED NURSERY
MARITAL AND FAMILY
THERAPY
SOCIAL WORKERS
CHILDREN
SOCIAL WORKERS
ADULT PSYCHIATRY
MARITAL AND FAMILY THERAPY FRAME
CHILD PSYCHOPATHOLOGY
¿
?
¿
MARITAL
FUNCTIONING
?
FAMILY
FUNCTIONING
MFT
-
ADULT PSYCHOPATHOLOGY
-
CURRENT SITUATION
1. MARITAL FUNCTIONING
2. FAMILY FUNCTIONING
3. ADULT PSYCHOPATHOLOGY
4. CHILDREN PSYCHOPATHOLOGY
Marital breakdown I
More than 1 million annual
divorces
One marital breakdown
every 30 seconds
Over 10 million marital
breakdowns in 10 years,
that have affected over 15
million children
Marital break-down II
Family breakdown has
increased by far the most
in Spain in the last 10
years.
In Spain, family
breakdown has increased
by 268% in 10 years…
Germany, UK, France and
Spain are the UE27 countries
with the highest number of
divorces.
Source: Institute for Family Policies
Marital break-down III
In europe, marriages
that fail last a mean of
13 years.
Italy is the country
where marriage lasts
longest (16.8), and
Austria the one where
it lasts least (10.6).
In Spain, marriage
lasts a mean of 14
years
Source: Institute for Family Policies
CURRENT SITUATION
1. MARITAL FUNCTIONING
2. FAMILY FUNCTIONING
3. ADULT PSYCHOPATHOLOGY
4. CHILDREN PSYCHOPATHOLOGY
European households I
Only 2.4 members per
household
1.5 persons per
household have been
‘lost’ since 1980
Malta, Cyprus, Romania and
Spain are the countries with
the highest number of
members per household
Source: Institute for Family Policies
European households II
Households have fewer
children.
2 out of 3 households
have no children
Only 17% of households
have 2 or more children
Fuente: Instituto de Política Familiar
CURRENT SITUATION
1. MARITAL FUNCTIONING
2. FAMILY FUNCTIONING
3. ADULT PSYCHOPATHOLOGY
4. CHILDREN PSYCHOPATHOLOGY
HOSPITAL ADMISSIONS IN 2007
ADULTS
1200000
Men
Women
Both
1000000
800000
600000
400000
200000
0
25 - 34
35 - 44
45 - 54
55 - 64
35 – 44 years old: 1.037.803 days admitted to hospital
Source: Spanish National Institute of Statistics
HOSPITAL DISCHARGES IN 2007
16000
14000
12000
10000
8000
6000
4000
2000
0
2
Men
Women
Both
2
5-
9
3
3
0-
4
3
3
5-
9
4
4
0-
4
4
4
5-
9
5
5
0-
4
5
5
5-
9
6
6
0-
4
6
6
5-
9
35 – 44 years old: 27.376 mental illness discharges
Source: Spanish National Institute of Statistics
CURRENT SITUATION
1. MARITAL FUNCTIONING
2. FAMILY FUNCTIONING
3. ADULT PSYCHOPATHOLOGY
4. CHILDREN PSYCHOPATHOLOGY
EVOLUTION OF CHILDREN AND ADOLESCENT
PSYCHIATRY CONSULTATIONS
450
400
350
300
250
Patients
200
150
4000
100
50
3500
0
3000
93
19
94
19
95
19
96
19
97
19
98
19
99
19
00
20
01
20
2500
2000
1500
1000
500
Total #
consultations
0
93
19
94
19
95
19
96
19
97
19
98
19
99
19
00
20
01
20
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CHILDREN AND ADOLESCENT PROGRAM
90
80
70
60
50
40
30
20
10
0
This program includes all patients under 17 years attended at Mental Health Centres in our community
HOSPITAL ADMISSIONS
7000
6000
5000
4000
3000
2000
1000
0
Men
Women
Both
< 1 año
1a4
5a9
10 a 14
15 a 19
20 a 24
15 - 24 years old: 10.329 mental illness discharges
Source: Spanish National Institute of Statistics
ADHD
CONSEQUENCES OF UNTREATED ADHD
PATIENT
HEALTH
50%  bike accidents 1
33%  emergency room visits2
2–4 x other vehicle accidents 3-5
FAMILY
3–5 x  divorce
or separation11,12
2–4 x  fights among siblings 13
depression in parents
SOCIETY
SCHOOL/WORK
46% expelled
35% leaving 6
Lower occupational level7
1 DiScala et al, 1998.
2 Liebson et al, 2001.
3 NHTSA, 1997.
4-5 Barkley et al, 1993, 1996.
2x risk of
Substance abuse 8
Early onset 9
More likelihood of
consumption
in adulthood10
6 Barkley et al, 1990.
7 Mannuzza et al, 1997.
8 Biederman et al, 1997.
9 Pomerleau et al, 1995.
10 Wilens et al, 1995.
11 Barkley et al, 1991.
WORK (PARENTS)
 Work absence
Lower productivity14
12 Brown & Pacini, 1989.
13 Mash & Johnston, 1983.
14 Noe et al, 1999.
IMPACT ON THE FAMILY
•
•
•
•
•
Stress
Self-guilt
Social isolation
Depression
Marital disruption
Mash EJ, Johnston C. J Child Psychol. 1990; 19
PROFESSIONAL IMPACT ON PARENTS OF UNTREATED ADHD CHILDREN
21%
44%
10%
Change work shifts
14%
11%
Give up working
Others
Change type of work
Shorter time at work
Note. American Academy of Family Physicians Annual Scientific Assembly, Dallas, September, 2000
HYPOTHESIS AND OBJECTIVES
MARITAL/FAMILY DYSFUNCTION
¿
DIVORCES/SEPARATIONS
?
CHILDREN PSYCHOPATHOLOGY
PSYCHIATRY CONSULTATION
¿
?
Family of children going for follow-up to
GENERAL PEDIATRICS
Family of children
first-time going to
CHILDREN AND ADOLESCENT PSYCHIATRY
Family of children going to
SPECIALIZED PEDIATRICS
SOCIODEMOGRAPHIC DATA
CHILDREN
Gender
Age
Biologic/adopted
Number of siblings
Position among siblings
Academic year
PARENTS
Civil status
Years of marriage
Socioeconomic level
Place or residence
Educational level
Occupation
Family of children going for
follow-up to
GENERAL PEDIATRICS
Family of children
first-time going to
CHILDREN AND ADOLESCENT PSYCHIATRY
Family of children going to
SPECIALIZED PEDIATRICS
SOCIODEMOGRAPHIC DATA
DAS: Dyadic Adjustment Scale: measures quality
in family relations
FACES III: Family Adaptability and
Cohesion Evalution Scale: measures adaptability
and family cohesion
FAD: McMaster Family Assessment Device:
assesses family functioning
SOCIODEMOGRAPHIC DATA
Ages of family members
50
45,1
45
40
37,4
42,1
34,8
35
30
Fathers
Mothers
Children
25
20
15
10
10,9
4,7
5
0
Families healthy
Families patients
SOCIODEMOGRAPHIC DATA
15,6
16
14
10
9
12
8
9,6
10
7
8
6
Families healthy
6
Families illness
5
4,4
4,3
4
3
4
2
2
1
Household members
0
Years of marriage
Fam
Fam
NATURE OF CHILDREN
Biologic
Adopted
6,6%
93,4%
2,6%
Biologic
Adopted
Patients
97,4%
Healthy
CHILDREN GENDER
37,2%
Male
Female
62,8%
Patients
42,1%
Male
Female
57,9%
Healthy
SOCIOECONOMIC STATUS
31,9%
5,8%
38,0%
2,3%2,3%
63,5%
Healthy
5,8%
50,4%
Medium-Low
Medium
Patients
Medium-High
High
PSYCHIATRIC DIAGNOSIS OF CHILDREN
ADHD
13,0%
Behavior D.
3,6%
3,7%
ED
Developm ent D.
5,6%
Anxiety
74,0%
AGE – ACADEMIC YEAR
11,6%
2,5%
Matches
Doesn't match
85,9%
Doesn't answer
2,6%
Patients
97,4%
Healthy
DAS: Dyadic Adjustment Scale: measures the
quality of dyadic relationships
• FORMAT:
– 32 items.
– Different response formats (Likert scales from 2 to
7 points)
• SCALES:
–
–
–
–
–
Dyadic Consensus
Dyadic Satisfaction
Affectional Expression
Dyadic Cohesion
Dyadic Adjustment (global scale)
DAS - PARENTS OF ILL CHILDREN
60
55
50
Fathers
Mothers
45
40
35
30
DYADIC CONSENSUS
DYADIC
SATISFACTION
AFFECTIVE
EXPRESSION
DYADIC COHESION
TOTAL
DAS - PARENTS OF HEALTHY CHILDREN
60
55
50
Fathers
Mothers
45
40
35
30
DYADIC CONSENSUS
DYADIC
SATISFACTION
AFFECTIVE
EXPRESSION
DYADIC COHESION
TOTAL
DAS - FATHERS OF BOTH SAMPLES
60
55
*
50
Patients
Healthy
45
40
35
30
DYADIC CONSENSUS
DYADIC
SATISFACTION
AFFECTIVE
EXPRESSION
DYADIC COHESION
TOTAL
DAS - MOTHERS OF BOTH SAMPLES
60
55
*
50
Patients
Healthy
45
40
35
30
DYADIC CONSENSUS
DYADIC
SATISFACTION
AFFECTIVE
EXPRESSION
DYADIC COHESION
TOTAL
Familia de niños que
acuden a revisión de
PEDIATRÍA GENERAL
FAD: McMaster Family Assessment Device:
measures family functioning
Familia de niños que acuden
por primera vez a
PSIQUIATRÍA INFANTO-JUVENIL
• FORMAT: 60 items.
• SCALES:
Familia de niños que acude a
PEDIATRÍA ESPECIALIZADA
– Problem solving
DATOS SOCIODEMOGRÁFICOS
– Communication
– Roles
Affective
responsiveness
FACES III: Family Adaptability and
DAS:–Dyadic
Adjustment
Scale: que mide
Cohesion Evaluation Scale: que mide la
la calidad de la relación conyugal
– Affective involvement
adaptabilidad y la cohesión familiar
– Behaviour control
FAD: McMaster Family Assessment Device:
que evalúa el funcionamiento familiar
A
ffe
ct
iv
e
so
lv
in
g
To
ta
l
in
vo
lv
em
en
B
t
eh
av
.C
on
tro
l
e
ol
es
sp
on
s
R
un
ic
at
io
n
re
om
m
ffe
ct
iv
e
A
C
ob
le
m
Functional
Pr
FAD - PARENTS OF PATIENTS
Dysfunctional60
55
50
45
40
Mothers
Fathers
35
30
A
ffe
ct
iv
e
so
lv
in
g
ol
es
To
ta
l
e
in
vo
lv
em
en
B
t
eh
av
.C
on
tro
l
sp
on
s
R
un
ic
at
io
n
re
om
m
ffe
ct
iv
e
A
C
ob
le
m
Functional
Pr
FAD - PARENTS OF HEALTHY CHILDREN
Dysfunctional 60
55
50
45
40
Fathers
Mothers
35
30
re
ol
es
sp
on
s
R
l
*
To
ta
e
in
vo
lv
em
en
B
t
eh
av
.C
on
tro
l
ffe
ct
iv
e
ffe
ct
iv
e
g
un
ic
at
io
n
so
lv
in
50
A
A
om
m
ob
le
m
Functional
C
Pr
FAD - FATHERS OF BOTH SAMPLES
Dysfunctional60
55
*
45
Patients
Healthy
40
35
30
A
re
ol
es
sp
on
s
R
un
ic
at
io
n
g
l
*
To
ta
e
in
vo
lv
em
en
B
t
eh
av
.C
on
tro
l
ffe
ct
iv
e
ffe
ct
iv
e
om
m
50
A
C
so
lv
in
Functional
ob
le
m
Dysfunctional
Pr
FAD - MOTHERS OF BOTH SAMPLES
60
55
*
45
Patients
Healthy
40
35
30
Familia de niños que
acuden a revisión de
PEDIATRÍA GENERAL
FACES III: Family Adaptability and
Cohesion Evaluation Scale: measures
Familia
de niños que acuden
adaptability
and family cohesionFamilia de niños que acude a
por primera vez a
PSIQUIATRÍA INFANTO-JUVENIL
• FORMAT: 20 items.
• SCALES:
PEDIATRÍA ESPECIALIZADA
DATOS
SOCIODEMOGRÁFICOS
– Cohesion:
assesses
emotional bonds betwen family
members
– Adaptability: assesses family ability to vary its
FACES III: Family Adaptability and
DAS: Dyadic Adjustment Scale: que mide
structure
when
needed
Cohesion Evaluation Scale: que mide la
la calidad de la relación conyugal
adaptabilidad
y la cohesión
familiar
– Both scales are represented with
the Olson
Circumplex
Model
FAD: McMaster Family Assessment Device:
que evalúa el funcionamiento familiar
FACES - PARENTS OF PATIENTS
Baja
DISENGAGED
COHESION
SEPARATED
CONNECTED
Alta
ENMESHED
8
High
CHAOTIC
7
F
L
E
6
X
I FLEXIBLE
B
I
5
L
I
T
4
Y
Father patients
Mother patients
STRUCTURED
3
2
RIGID
Low
1
EXTREME
MEDIUM
BALANCED
FACES – PARENTS OF HEALTHY CHILDREN
Low
DISENGAGED
COHESION
SEPARATED
CONNECTED
High
ENMESHED
8
High
CHAOTIC
7
F
L
E
6
X
I FLEXIBLE
B
I
5
L
I
T
4
Y
Father healthy
Mother healthy
STRUCTURED
3
2
RIGID
Low
1
EXTREME
MEDIUM
BALANCED
FACES III PADRES
High
DISENGAGED
COHESION
SEPARATED
CONNECTED
Low
ENMESHED
8
High
CHAOTIC
7
F
L
E
6
X
I FLEXIBLE
B
I
5
L
I
T
4
Y
Father healthy
Father patient
STRUCTURED
3
2
RIGID
Low
1
EXTREME
MEDIUM
BALANCED
FACES III MADRES
Low
DISENGAGED
*
COHESION
SEPARATED
CONNECTED
High
ENMESHED
8
High
CHAOTIC
7
F
L
E
6
X
I FLEXIBLE
B
I
5
L
I
T
4
Y
Mother healthy
Mother patient
STRUCTURED
3
2
RIGID
Low
1
EXTREME
MEDIUM
BALANCED
THANKS FOR YOUR ATTENTION
Adrián Cano Prous
Baras Pastor et al.
Dpto. Psiquiatría y Psicología Medica
University Hospital of Navarra
www.cun.es