Anxiety and Depressive Disorders in Fathers and Mothers of Anxious School-Refusing Children

doi:10.1097/00004583-199907000-00023

Journal of the American Academy of Child & Adolescent Psychiatry

Volume 38, Issue 7, July 1999, Pages 916-922

https://doi.org/10.1097/00004583-199907000-00023 Get rights and content

ABSTRACT

Objective

To examine anxiety and depressive disorders in the mothers and fathers of children with anxious school refusal and to test for the existence of differences in familial aggregation between children suffering from school refusal related to separation anxiety disorder and those suffering from phobic disorder-based school refusal.

Method

Using a blind standardized diagnostic evaluation (Schedule for Affective Disorders and Schizophrenia-Lifetime version, modified for the study of anxiety disorders; Diagnostic Interview for Genetic Studies; and Schedule for Affective Disorders and Schizophrenia for School-Age Children), the authors compared parental lifetime psychiatric illness for the 2 groups of anxious school refusers.

Results

Relationships between specific anxiety disorders in children and their parents revealed increased prevalence of simple phobia and simple and/or social phobia among the fathers and mothers of phobic school refusers, and increased prevalence of panic disorder and panic disorder and/or agoraphobia among the fathers and mothers of school refusers with separation anxiety disorder. Simple and/or social phobia in the father, simple phobia in the mother, and age of the father were associated with the group of phobic school refusers.

Conclusions

The data show the high prevalence of both anxiety and depressive disorders in fathers and mothers of anxious school refusers. Significant differences were observed in familial aggregation considering the subgroups of anxious school-refusing children.

REFERENCES (23)

I Berg
School phobia in the children of agoraphobic women
Br J Psychiatry
(1976)
I Berg et al.
Psychiatric illness in the mothers of school phobic adolescents
Br J Psychiatry
(1974)
GA Bernstein
Comorbidity and severity of anxiety and depressive disorders in a clinic sample
J Am Acad Child Adolesc Psychiatry
(1991)
GA Bernstein et al.
Pedigrees, functioning and psychopathology in families of school phobic children
Am J Psychiatry
(1988)
WJ Chambers et al.
The assessment of affective disorders in children and adolescents by semistructured interview: test-retest reliability of the Schedule for Affective Disorders and Schizophrenia for School-Age Children, Present Episode version
Arch Gen Psychiatry
(1985)
AJ Fyer et al.
A direct interview family study of social phobia
Arch Gen Psychiatry
(1993)
AJ Fyer et al.
Specificity in familial aggregation of phobic disorders
Arch Gen Psychiatry
(1995)
R Gittelman et al.
Relationship between separation anxiety and panic and agoraphobia disorders
Psychopathology
(1984)
R Gittelman-Klein
Psychiatric characteristics of the relatives of school phobic children
JH Kashani et al.
Correlates of anxiety in psychiatrically hospitalized children and their parents
Am J Psychiatry
(1990)

CG Last et al.

Separation anxiety and school phobia: a comparison using DSM-III criteria

Am J Psychiatry

(1987)

Cited by (58)

Differentiation Between School Attendance Problems: Why and How?
2019, Cognitive and Behavioral Practice
Citation Excerpt :
Different strategies can help ascertain the authenticity of parents’ expressed intent for their child to attend school. Martin et al. (1999) suggested that the parents and child need to indicate that they are “convinced of the necessity of school attendance” for classification of SR (p. 916). Evans (2000) recommended interviewing parents to assess their need for the child to be at home, which may elicit information suggestive of SW.
School attendance problems (SAPs) are heterogeneous with respect to etiology and presentation. The long history of conceptualizing SAPs has led to a vast array of terms and definitions as well as different perspectives on the most helpful approach to classification. For educators, practitioners, researchers, and policymakers, this presents a challenge in understanding, assessing, and intervening with SAPs. This paper outlines evolution in the conceptualization of SAPs, focusing on two contemporary approaches to differentiating between them. One approach draws on the longstanding differentiation between SAP types labeled school refusal, truancy, and school withdrawal. A fourth type of SAP, labeled school exclusion, is also considered. The other approach focuses on the function of absenteeism, measured via the School Refusal Assessment Scale (SRAS). Anecdotal and scientific support for the SAP typology is presented, along with the benefits and shortcomings of the SRAS approach to differentiation. The paper offers suggestions for how to differentiate between SAPs and introduces the SNACK, a brief screening measure that permits differentiation by SAP type.
Emerging School Refusal: A School-Based Framework for Identifying Early Signs and Risk Factors
2019, Cognitive and Behavioral Practice
Citation Excerpt :
In cases of established SR, parents were treated for anxiety disorders more often than parents of truant youth and youth without SAPs (Bools et al., 1990). Anxiety disorder occurred in 78% of mothers and 54% of fathers (Martin, Cabrol, Bouvard, Lepine, & Mouren-Simeoni, 1999). Moreover, parents had higher rates of anxiety and depression relative to parents of youth without SR (Bahali, Tahiroglu, Avci, & Seydaoglu, 2011), and mothers of SR youth were more likely to have a history of SR than mothers of control youth (Last & Strauss, 1990).
A student’s academic and social-emotional development is increasingly jeopardized with mounting absence from school. School refusal (SR) is one type of school attendance problem (SAP) that is often associated with absence from school. Once established, it can sometimes be difficult to treat. To prevent established SR and associated problems, indicators of emerging SR and risk for SR should be efficiently identified and acted upon. Risk factors are often discussed in relation to SAPs generally rather than considering risk for specific types of attendance problems. Based on literature review, this paper provides an account of the likely signs and risks for emerging SR. A school-based framework is provided to support school personnel and parents in working together to identify these signs and risks. Several challenges associated with the implementation of the framework are discussed.
The moderating effects of positive psychological strengths on the relationship between parental anxiety and child depression: The significance of father's role in Hong Kong
2017, Children and Youth Services Review
Citation Excerpt :
Epidemiological studies consistently found that parental psychopathology is one of the most influential determinants of the development of offspring depression (Beesdo, Pine, Lieb, & Wittchen, 2010; Knappe et al., 2009). Results of family history studies (Black, Noyes, Goldstein, & Blum, 1992; Fyer, 1993; Martin, Cabrol, Bouvard, Lepine, & Mouren-Simeoni, 1999) have all reported the possible biological/genetic transmission of psychiatric disorders. Furthermore, certain parental attributes, such as modeling, conditioning, and interaction style, have also been considered as latent factors in pathology transmission from parent to child (Muris, Steerneman, Merckelbach, & Meesters, 1996).
This research was conducted in Hong Kong investigating whether parental anxiety increases the risk of children developing depression, and whether positive psychological traits, including optimism, life satisfaction, hope and gratitude, can moderate this association. In a community sample, 439 Chinese primary school children completed questionnaires assessing their levels of depression and positive psychological traits, while parents completed questionnaires assessing their anxiety levels. Results showed that maternal and paternal reports of anxiety symptoms were both positively and significantly associated with child depression. This association was moderated by positive psychological traits, which did not include gratitude, and were only significant in the case of paternal depression. Some evidence emerged that maternal anxiety was related to paternal anxiety. Findings from this study suggest that paternal, as well as maternal, anxiety plays an important role in developing children's depression, and that positive psychological traits are effective buffers in decreasing paternal impact on child depression. Greater attention should be paid in future research, not only to the maternal, but also to the paternal role in child depression, and to positive psychology in child development.
Responses to voluntary hyperventilation in children with separation anxiety disorder: Implications for the link to panic disorder
2013, Journal of Anxiety Disorders
Citation Excerpt :
Klein's work stimulated much research, yielding ambiguous results. Three types of research have tested the separation anxiety hypothesis: retrospective reports of childhood SAD in adults with PD (e.g. Battaglia et al., 1995; Lipsitz et al., 1994); top-down (e.g. Biederman et al., 2001; Unnewehr, Schneider, Florin, & Margraf, 1998; Warner, Mufson, & Weissman, 1995) and bottom-up (Last, Perrin, Hersen, & Kazdin, 1996; Martin, Cabrol, Bouvard, Lepine, & Mouren-Simeoni, 1999) studies of familial aggregation of the two disorders, as well as research on biological correlates of SAD and PD (Pine, Coplan, et al., 1998; Pine et al., 2000). A recent meta-analysis demonstrated that a childhood diagnosis of separation anxiety disorder significantly increases the risk of panic disorder and any anxiety disorder (Kossowsky et al., 2013).
Biological theories on respiratory regulation have linked separation anxiety disorder (SAD) to panic disorder (PD). We tested if SAD children show similarly increased anxious and psychophysiological responding to voluntary hyperventilation and compromised recovery thereafter as has been observed in PD patients.
Participants were 49 children (5–14 years old) with SAD, 21 clinical controls with other anxiety disorders, and 39 healthy controls. We assessed cardiac sympathetic and parasympathetic, respiratory (including pCO₂), electrodermal, electromyographic, and self-report variables during baseline, paced hyperventilation, and recovery.
SAD children did not react with increased anxiety or panic symptoms and did not show signs of slowed recovery. However, during hyperventilation they exhibited elevated reactivity in respiratory variability, heart rate, and musculus corrugator supercilii activity indicating difficulty with respiratory regulation.
Reactions to hyperventilation are much less pronounced in children with SAD than in PD patients. SAD children showed voluntary breathing regulation deficits.
A conceptual review of the comorbidity of attention-deficit/hyperactivity disorder and anxiety: Implications for future research and practice
2008, Clinical Psychology Review
Although approximately 25% of children with attention-deficit/hyperactivity disorder (ADHD) exhibit an anxiety disorder, the comorbidity of ADHD and anxiety has been given less attention than comorbidity of ADHD and oppositional or conduct disorders. While it is true that comorbidity between ADHD and these externalizing disorders is more prevalent (approximately 50%), the comorbidity of ADHD and anxiety deserves careful scrutiny in its own right in as much as this comorbidity may have important implications for etiology, assessment, and treatment. The primary purpose of the current review is to examine the methodological and substantive reasons for the comorbidity of ADHD and anxiety. Methodological areas include definitional issues and informant characteristics, while substantive areas include genetics, temperament, neurobiological and neuropsychological functioning, family influences, and temporal relations between ADHD and anxiety. The study of the comorbidity of ADHD and anxiety will be advanced through a more precise phenotypic classification of ADHD and the integration of research in adjacent fields such as temperament and genetics with current research on the psychopathology of ADHD.
The relationship between maternal and paternal psychological symptoms and ratings of adolescent functioning
2007, Journal of Adolescence
Citation Excerpt :
For example, parents who experience high levels of anxiety may be more likely to have children or adolescents who also experience similar conditions (e.g. Capps, Sigman, Sena, Henker, & Whalen, 1996). In addition, a high prevalence of anxiety and depressive disorders has been observed in fathers and mothers of anxious children who refused to attend school (Martin, Cabrol, Bouvard, Lepine, & Mouren-Siméoni, 1999). Although there is a relationship between the occurrence of anxiety symptoms in both parents and their adolescents, anxious symptoms experienced by parents also may be related uniquely to parental ratings of adolescents’ emotional and behavioral functioning.
Families with an adolescent between the ages of 11 and 18 years participated in a study examining the relationship between parental depressive and anxiety symptomatology and parental ratings of adolescents’ functioning. This study indicated that mothers, fathers, and adolescents exhibited significant cross-informant correspondence (i.e. correlations) and very few significant differences in ratings of adolescents’ functioning. After controlling for demographic variables and the ratings of other informants, mothers’ depressive symptomatology was a significant predictor of mothers’ ratings of adolescents’ internalizing and externalizing behavior problems and competence. With regard to fathers’ ratings, fathers’ depressive symptomatology was a significant predictor of adolescents’ internalizing behavior problems and competence, whereas fathers’ depressive and anxious symptomatology was a significant predictor of adolescents’ externalizing behavior problems. The findings of this study suggested the importance of considering maternal and paternal depressive symptomatology when parents are asked to provide ratings of their adolescents’ functioning.

View all citing articles on Scopus

View full text

ARTICLESAnxiety and Depressive Disorders in Fathers and Mothers of Anxious School-Refusing Children

ABSTRACT

Objective

Method

Results

Conclusions

School phobia in the children of agoraphobic women

Br J Psychiatry

Psychiatric illness in the mothers of school phobic adolescents

Br J Psychiatry

Comorbidity and severity of anxiety and depressive disorders in a clinic sample

J Am Acad Child Adolesc Psychiatry

Pedigrees, functioning and psychopathology in families of school phobic children

Am J Psychiatry

The assessment of affective disorders in children and adolescents by semistructured interview: test-retest reliability of the Schedule for Affective Disorders and Schizophrenia for School-Age Children, Present Episode version

Arch Gen Psychiatry

A direct interview family study of social phobia

Arch Gen Psychiatry

Specificity in familial aggregation of phobic disorders

Arch Gen Psychiatry

Relationship between separation anxiety and panic and agoraphobia disorders

Psychopathology

Psychiatric characteristics of the relatives of school phobic children

Correlates of anxiety in psychiatrically hospitalized children and their parents

Am J Psychiatry

Separation anxiety and school phobia: a comparison using DSM-III criteria

Am J Psychiatry

ARTICLES
Anxiety and Depressive Disorders in Fathers and Mothers of Anxious School-Refusing Children