Research Update Review
Role of the Family in the Onset and Outcome of Childhood Disorders: Selected Research Findings

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ABSTRACT

Objective

Three areas of basic family research were selected for review as being of special importance to the clinically oriented child and adolescent psychiatrist: behavioral genetics, expressed emotion, and the interaction of family dynamics and childhood illness.

Method

Medline and PSYCINFO searches using appropriate keywords were obtained for each of the 3 major areas. All English-language articles published after 1989 that included empirical research pertaining to children or adolescents were reviewed.

Results

Behavioral genetics research indicates that the shared environment, including issues of parental monitoring and discipline, is important in the development and outcome of externalizing disorders. Differential parental treatments of one sibling are critical in internalizing disorders. Criticism (as measured by expressed emotion) is associated with poor outcome of many childhood medical and psychiatric disorders. Chronic illness in a child changes the family dynamics toward being more structured and less emotionally warm and communicative. The family's role in adherence to treatment is critical, and families with high levels of criticism have more difficulty.

Conclusions

Families can cause problems, but many times the problems families have are in response to a child's problems. There is a continued need to empirically assess which family processes are important for specific childhood disorders.

Section snippets

BEHAVIORAL GENETICS

The basic methodology of behavioral genetics is to analyze similarities between relatives of varying genetic relatedness (e.g., between monozygotic [MZ] and dizygotic [DZ] twins or between full siblings, half siblings, step and adopted siblings), so that aspects of the family pertinent to the development of a certain trait or disorder can be parceled into genetic or environmental components (Neale and Cardon, 1992). The environmental components can be further subdivided into those that are

EXPRESSED EMOTION

A clinical research rating called expressed emotion (EE), developed out of studies of young adults with schizophrenia, has been used with increasing frequency to study families with younger children who suffer from both mental and physical illnesses. Ratings of EE are based on a specific set of judgments made concerning the affective climate directed from one person (i.e., the “respondent,” typically a parent or spouse) toward another person (i.e., the “target,” typically the family member with

RECIPROCAL INFLUENCE BETWEEN CHRONIC ILLNESS AND FAMILY PROCESS

Studies examining the role of families in the outcome of childhood medical disorders may inform our understanding of childhood psychiatric disorders. Many recent studies have investigated the interrelationship between family processes and medical illness in children. Most have used longitudinal designs and as such can suggest underlying mechanisms of influence. A number of consistent findings have emerged.

First, there is virtually no evidence that family processes predict onset of illness in

CLINICAL IMPLICATIONS

Being asked to provide a synthesis of how the family affects child psychopathology in the age of the genetic revolution is a daunting task. As seen above, the behavioral genetics literature has shown that much of what makes siblings alike stems from genetic mechanisms, whereas most of the interactions in families tend to make siblings different. In externalizing disorders, there is evidence for shared environmental inputs to development of the disorder, so family interventions focused on

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    This work is supported by federal grants K08-MH01486, RO1-HL45157, RO1-HL53391, and M01-RR00051.

    This series of 10-year updates in child and adolescent psychiatry began in July 1996. Topics are selected in consultation with the AACAP Committee on Recertification, both for the importance of new research and its clinical or developmental significance. The authors have been asked to place an asterisk before the 5 or 6 most seminal references.

    M.K.D.

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    Copyright © 2000 The American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.