INFLUENCE OF PSYCHOPATHOLOGICAL DISORDERS OF CHILDREN IN FAMILY STRUCTURE AND FUNCTIONING Adrián...

INFLUENCE OF PSYCHOPATHOLOGICAL DISORDERS OF CHILDREN IN FAMILY

STRUCTURE AND FUNCTIONING

Adrián Cano ProusBaras Pastor et al.

Dpto. Psiquiatría y Psicología MedicaUniversity Hospital of Navarra

www.cun.es

SOCIAL WORKERS

SPECIALIZED NURSERY

PARENTS CHILDREN

SOCIAL WORKERS

ADULT PSYCHIATRY

CHILD AND ADOLESCENTPSYCHIATRY

SPECIALIZED NURSERY

MARITAL AND FAMILYTHERAPY

MARITAL AND FAMILY THERAPY FRAME

MARITALFUNCTIONING

¿ ? ?¿

-

- -

-

MFT

ADULT PSYCHOPATHOLOGY

CHILD PSYCHOPATHOLOGY

FAMILYFUNCTIONING

CURRENT SITUATION

1. MARITAL FUNCTIONING

2. FAMILY FUNCTIONING

3. ADULT PSYCHOPATHOLOGY

4. CHILDREN PSYCHOPATHOLOGY

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 breakdown I

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.

Marital break-down II

Source: Institute for Family Policies

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

Marital break-down III

Source: Institute for Family Policies

CURRENT SITUATION

1. MARITAL FUNCTIONING

2. FAMILY FUNCTIONING

3. ADULT PSYCHOPATHOLOGY

4. CHILDREN PSYCHOPATHOLOGY

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

European households I

Source: Institute for Family Policies

Households have fewer children.

2 out of 3 households have no children

Only 17% of households have 2 or more children

European households II

Fuente: Instituto de Política Familiar

CURRENT SITUATION

1. MARITAL FUNCTIONING

2. FAMILY FUNCTIONING

3. ADULT PSYCHOPATHOLOGY

4. CHILDREN PSYCHOPATHOLOGY

HOSPITAL ADMISSIONS IN 2007

0

200000

400000

600000

800000

1000000

1200000

25 - 34 35 - 44 45 - 54 55 - 64

Men

Women

Both

35 – 44 years old: 1.037.803 days admitted to hospital

ADULTS

Source: Spanish National Institute of Statistics

HOSPITAL DISCHARGES IN 2007

35 – 44 years old: 27.376 mental illness discharges

02000400060008000

10000120001400016000

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

Men

Women

Both

Source: Spanish National Institute of Statistics

CURRENT SITUATION

1. MARITAL FUNCTIONING

2. FAMILY FUNCTIONING

3. ADULT PSYCHOPATHOLOGY

4. CHILDREN PSYCHOPATHOLOGY

0

50

100

150

200

250

300

350

400

450

1993

1994

1995

1996

1997

1998

1999

2000

2001

Patients

0

500

1000

1500

2000

2500

3000

3500

4000

1993

1994

1995

1996

1997

1998

1999

2000

2001

Total #consultations

EVOLUTION OF CHILDREN AND ADOLESCENT PSYCHIATRY CONSULTATIONS

010

2030

4050

6070

8090

Psych

otic D

.

Behavio

r D.

Anxiety

D.

Other n

euros

is

Somat

ic s

ympto

ms ED

Genera

l dev

elopm

ent D

.

Specifi

c dev

elopm

ent D.

Perso

nality

D.

Men

tal d

efic

iency

V. fact

ors

Other i

nfant D

.

Addictio

ns

Suicid

e at

tem

pt

Other d

iagnosi

s

With

out dia

gnosis

CHILDREN AND ADOLESCENT PROGRAM

This program includes all patients under 17 years attended at Mental Health Centres in our community

HOSPITAL ADMISSIONS

0

1000

2000

3000

4000

5000

6000

7000

< 1 año 1 a 4 5 a 9 10 a 14 15 a 19 20 a 24

Men

Women

Both

15 - 24 years old: 10.329 mental illness discharges

Source: Spanish National Institute of Statistics

ADHD

HEALTH50% bike accidents 1

33% emergency room visits2

2–4 x other vehicle accidents 3-5

HEALTH50% bike accidents 1

33% emergency room visits2

2–4 x other vehicle accidents 3-5

PATIENTPATIENTFAMILY3–5 x divorce

or separation11,12 2–4 x fights among siblings 13

depression in parents

FAMILY3–5 x divorce

or separation11,12 2–4 x fights among siblings 13

depression in parents

SCHOOL/WORK46% expelled35% leaving 6

Lower occupational level7

SCHOOL/WORK46% expelled35% leaving 6

Lower occupational level7

SOCIETY2x risk of

Substance abuse 8

Early onset 9

More likelihood ofconsumptionin adulthood10

SOCIETY2x risk of

Substance abuse 8

Early onset 9

More likelihood ofconsumptionin adulthood10

WORK (PARENTS) Work absence

Lower productivity14

WORK (PARENTS) Work absence

Lower productivity14

1 DiScala et al, 1998.2 Liebson et al, 2001.3 NHTSA, 1997. 4-5 Barkley et al, 1993, 1996.

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.

12 Brown & Pacini, 1989. 13 Mash & Johnston, 1983. 14 Noe et al, 1999.

CONSEQUENCES OF UNTREATED ADHD

Mash EJ, Johnston C. J Child Psychol. 1990; 19

• Stress• Self-guilt• Social isolation• Depression• Marital disruption

IMPACT ON THE FAMILY

Note. American Academy of Family Physicians Annual Scientific Assembly, Dallas, September, 2000

21%

10%

11%14%

44%

Change work shifts

Give up working

Others

Change type of work

Shorter time at work

PROFESSIONAL IMPACT ON PARENTS OF UNTREATED ADHD CHILDREN

HYPOTHESIS AND OBJECTIVES

PSYCHIATRY CONSULTATION

CHILDREN PSYCHOPATHOLOGY ¿ ?

¿ ?MARITAL/FAMILY DYSFUNCTION DIVORCES/SEPARATIONS

Family of children going for follow-up to GENERAL PEDIATRICS

SOCIODEMOGRAPHIC DATA

Family of childrenfirst-time going to

CHILDREN AND ADOLESCENT PSYCHIATRY

Family of children going to SPECIALIZED PEDIATRICS

CHILDRENGenderAgeBiologic/adoptedNumber of siblingsPosition among siblingsAcademic year

PARENTSCivil status

Years of marriageSocioeconomic level

Place or residenceEducational level

Occupation

FAD: McMaster Family Assessment Device:assesses family functioning

DAS: Dyadic Adjustment Scale: measures qualityin family relations

FACES III: Family Adaptability and Cohesion Evalution Scale: measures adaptabilityand family cohesion

Family of children going for follow-up to

GENERAL PEDIATRICS

SOCIODEMOGRAPHIC DATA

Family of childrenfirst-time going to

CHILDREN AND ADOLESCENT PSYCHIATRY

Family of children going to SPECIALIZED PEDIATRICS

SOCIODEMOGRAPHIC DATA

37,434,8

4,7

45,142,1

10,9

0

5

10

15

20

25

30

35

40

45

50

Families healthy Families patients

Fathers

Mothers

Children

Ages of family members

SOCIODEMOGRAPHIC DATA

9,6

15,6

0

2

4

6

8

10

12

14

16

Years of marriage

Families healthy

Families illness4,4 4,3

1

2

3

4

5

6

7

8

9

10

Household members

Families healthy

Families illness

NATURE OF CHILDREN

Patients

97,4%

2,6%Biologic

Adopted93,4%

6,6%Biologic

Adopted

Healthy

37,2%

62,8%

Male

Female

CHILDREN GENDER

42,1%

57,9%

Male

Female

Patients

Healthy

5,8%

50,4%38,0%

5,8%

Medium-Low

Medium

Medium-High

High

SOCIOECONOMIC STATUS

2,3%31,9% 63,5%2,3%

Patients

Healthy

74,0%

5,6%

3,6%

13,0%

3,7%

ADHD

Behavior D.

ED

Development D.

Anxiety

PSYCHIATRIC DIAGNOSIS OF CHILDREN

85,9%

11,6% 2,5%

Matches

Doesn't match

Doesn't answer

AGE – ACADEMIC YEAR

97,4%

2,6%Patients

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)

30

35

40

45

50

55

60

DYADIC CONSENSUS DYADICSATISFACTION

AFFECTIVEEXPRESSION

DYADIC COHESION TOTAL

Fathers

Mothers

DAS - PARENTS OF ILL CHILDREN

30

35

40

45

50

55

60

DYADIC CONSENSUS DYADICSATISFACTION

AFFECTIVEEXPRESSION

DYADIC COHESION TOTAL

Fathers

Mothers

DAS - PARENTS OF HEALTHY CHILDREN

30

35

40

45

50

55

60

DYADIC CONSENSUS DYADICSATISFACTION

AFFECTIVEEXPRESSION

DYADIC COHESION TOTAL

Patients

Healthy

DAS - FATHERS OF BOTH SAMPLES

*

30

35

40

45

50

55

60

DYADIC CONSENSUS DYADICSATISFACTION

AFFECTIVEEXPRESSION

DYADIC COHESION TOTAL

Patients

Healthy

DAS - MOTHERS OF BOTH SAMPLES

*

FAD: McMaster Family Assessment Device:que evalúa el funcionamiento familiar

DAS: Dyadic Adjustment Scale: que mide la calidad de la relación conyugal

FACES III: Family Adaptability and Cohesion Evaluation Scale: que mide la adaptabilidad y la cohesión familiar

Familia de niños que acuden a revisión de

PEDIATRÍA GENERAL

DATOS SOCIODEMOGRÁFICOS

Familia de niños que acudenpor primera vez a

PSIQUIATRÍA INFANTO-JUVENIL

Familia de niños que acude a PEDIATRÍA ESPECIALIZADA

FAD: McMaster Family Assessment Device: measures family functioning

• FORMAT: 60 items.• SCALES:

– Problem solving

– Communication

– Roles

– Affective responsiveness

– Affective involvement

– Behaviour control

FAD - PARENTS OF PATIENTS

30

35

40

45

50

55

60

Proble

m s

olvin

g

Comm

unicat

ion

Roles

Affect

ive

resp

onse

Affect

ive

invo

lvem

ent

Behav.

Contro

l

Total

Mothers

Fathers

Functional

Dysfunctional

FAD - PARENTS OF HEALTHY CHILDREN

30

35

40

45

50

55

60

Proble

m s

olvin

g

Comm

unicat

ion

Roles

Affect

ive

resp

onse

Affect

ive

invo

lvem

ent

Behav.

Contro

l

Total

Fathers

Mothers

Functional

Dysfunctional

FAD - FATHERS OF BOTH SAMPLES

30

35

40

45

50

55

60

Proble

m s

olvin

g

Comm

unicat

ion

Roles

Affect

ive

resp

onse

Affect

ive

invo

lvem

ent

Behav.

Contro

l

Total

Patients

Healthy* *

Functional

Dysfunctional

FAD - MOTHERS OF BOTH SAMPLES

30

35

40

45

50

55

60

Proble

m s

olvin

g

Comm

unicat

ion

Roles

Affect

ive

resp

onse

Affect

ive

invo

lvem

ent

Behav.

Contro

l

Total

Patients

Healthy* *

Functional

Dysfunctional

FAD: McMaster Family Assessment Device:que evalúa el funcionamiento familiar

DAS: Dyadic Adjustment Scale: que mide la calidad de la relación conyugal

FACES III: Family Adaptability and Cohesion Evaluation Scale: que mide la adaptabilidad y la cohesión familiar

Familia de niños que acuden a revisión de

PEDIATRÍA GENERAL

DATOS SOCIODEMOGRÁFICOS

Familia de niños que acudenpor primera vez a

PSIQUIATRÍA INFANTO-JUVENIL

Familia de niños que acude a PEDIATRÍA ESPECIALIZADA

FACES III: Family Adaptability and Cohesion Evaluation Scale: measures adaptability and family cohesion

• FORMAT: 20 items.• SCALES:

– Cohesion: assesses emotional bonds betwen family members

– Adaptability: assesses family ability to vary its structure when needed

– Both scales are represented with the Olson Circumplex Model

EXTREME MEDIUM BALANCED

4

FLEXI-BLE

CHAOTIC

COHESION AltaBaja

FLEXIBILITY

High

LowRIGID

STRUCTU-RED

8

7

6

5

3

2

1

DISENGAGED SEPARATED CONNECTED ENMESHED

Father patients

Mother patients

FACES - PARENTS OF PATIENTS

EXTREME MEDIUM BALANCED

4

FLEXI-BLE

CHAOTIC

COHESION HighLow

FLEXIBILITY

High

LowRIGID

STRUCTU-RED

8

7

6

5

3

2

1

DISENGAGED SEPARATED CONNECTED ENMESHED

Father healthy

Mother healthy

FACES – PARENTS OF HEALTHY CHILDREN

FACES III PADRES

EXTREME MEDIUM BALANCED

4

FLEXI-BLE

CHAOTIC

COHESION LowHigh

FLEXIBILITY

High

LowRIGID

STRUC-TURED

8

7

6

5

3

2

1

DISENGAGED SEPARATED CONNECTED ENMESHED

Father healthy

Father patient

FACES III MADRES

EXTREME MEDIUM BALANCED

4

FLEXI-BLE

CHAOTIC

COHESION HighLow

FLEXIBILITY

High

LowRIGID

STRUC-TURED

8

7

6

5

3

2

1

DISENGAGED SEPARATED CONNECTED ENMESHED

Mother healthy

Mother patient

*

THANKS FOR YOUR ATTENTION

Adrián Cano ProusBaras Pastor et al.

Dpto. Psiquiatría y Psicología MedicaUniversity Hospital of Navarra

www.cun.es