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Parental mental health problems and the effects on children

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Title: Parental mental health problems and the effects on children


1
Parental mental health problems and the effects
on children
2
aims
  • You will be able to
  • Briefly describe the main adult mental health
    problems and the pathways through which problems
    may be transmitted within parent child
    relationships
  • Identify specific risk factors relating to
    children with a parent with a mental health
    problem
  • Describe adaptive strategies and resultant
    behaviours in children
  • Practice talking with children about mental
    illness/substance misuse
  • Consider the implications of the above for your
    practice

3
Definitions and classification
4
Mental disorder or health problem?
  • the existence of a clinically recognisable set
    of symptoms or behaviour associated in most cases
    with distress and interference with personal
    function. WHO
  • Mental health problems are more transient, less
    definable and common, but will impact on personal
    functioning

5
Icd 10
  • Mood Disorders
  • Mania
  • Bipolar affective disorder
  • Depression
  • Schizophrenia
  • Organic Disorders
  • Alzheimers
  • Dementia associated with other diseases

6
Icd 10
  • Substance Misuse Disorders
  • Behavioural Syndromes
  • Eating disorders
  • Sexual dysfunction
  • Developmental disorders
  • ASD
  • Behavioural/emotional disorders
  • ADHD
  • Conduct Disorder
  • Tics

7
Icd 10
  • Neuroses
  • Phobias
  • Obsessive compulsive disorders
  • PTSD
  • Disorders of adult personality
  • Personality disorders
  • Learning disabilities

8
depression
  • Reactive depression
  • Endogenous depression
  • Four areas affected
  • Mood misery
  • Cognition-reduce concentration/self esteem
  • Physical poor sleep, diurnal variation poor
    appetite
  • Accumulative interactive impact guilt,
    helplessness, lack of future, ideas about
    death/suicide

9
depression
  • Key symptoms
  • Misery
  • Diurnal variation
  • Poor appetite
  • Lowered self esteem
  • Severe depression include the above plus 3 or 4
    of the others
  • Severe depression with psychosis all ten
    symptoms plus delusional states

10
mania
  • Mood positive to ecstatic
  • Cognition speeding of thoughts and speech
  • Physical symptoms never tires, agitated
  • Accumulative interactive impact ecstatic
    expansion of self
  • Can be associated with psychotic symptoms

11
Bipolar disorder
  • Repeated phases of mania followed by depression
    usually with recovery in between

12
Schizophrenias
  • Disordered thoughts
  • Speeded up thoughts or thoughts blocked
  • Intrusive or broadcasted thoughts
  • Perception and affect disturbed
  • Incongruity of mood
  • Disorder of volition
  • Not in control, stuporised
  • Disorder of senses
  • Hallucinations
  • Primary delusions
  • False beliefs (time and culturally influenced)
  • Can be paranoid

13
Personality Disorders
  • Paranoid other people are interpreted as
    demeaning or threatening
  • Schizoid indifference to social relationships/
    restricted range of emotional experience and
    expression
  • Anti Social callous unconcern for others or
    social norms
  • Emotionally unstable impulsive with affective
    instability

14
Risk
Biological
Psychological
Insecure attachments Learned negative cognitive
distortions Parentification Negative
attributions Chronic trauma
Genetic loading In-utero exposure to toxins Stress
Social
Poverty Stigma Reduced educational role Impaired
social interactions -poor self esteem -parents
not promoting social adaptations
RISK
15
Transmission pathways
  • What gives rise to the risk of parental mental
    health problems also create risks to the
    parent-child relationship
  • E.g. Long standing attachment problems likely to
    lead to increased risk of adult depression and
    impact on the effectiveness of parenting

16
Transmission pathways
  • What gives rise to the risk of parental mental
    health problems also create risks to the
    parent-child relationship
  • PLUS
  • The parental mental health problem also increases
    risk
  • Insensitive parenting arising from risks to the
    parental mental health problems is further
    worsened by the mental health problem

17
Transmission pathways
  • Mental health problem alone
  • E.g. Lack of affect is disturbing to a child.

18
Parenting and the Impact on parenting
19
Being a parent depends on ...
  • Our personality and temperament
  • Whether we have the support of a partner
  • Whether we have the support of family and friends
  • How many children we have and what ages and
    developmental stages they are at
  • Whether our children are physically and mentally
    healthy or whether they are coping with
    significant health or developmental problems
  • Whether we are combining child care with the
    demands of paid employment
  • Whether we have enough money to bring up our
    family or are finding it hard to make ends meet
  • Whether we live in comfortable housing or are
    struggling with poor accommodation
  • Whether we are coping with stressful events in
    our lives such as a separation, a bereavement or
    unemployment
  • The experiences we had in our own childhood, and
    whether or not we have been able to come to terms
    with any problems that we faced when we were
    young
  • Youngminds (2004) Looking After Ourselves

20
Negative emotions generated through being a parent
  • Anger
  • Resentment
  • Exhaustion
  • Envy
  • Boredom
  • Guilt
  • Sadness
  • Disappointment
  • Despair
  • Youngminds (2004) Looking After Ourselves

21
Problems in parenting
  • Physical exhaustion
  • Feeling tearful
  • Feeling depressed
  • Feeling agitated
  • Feeling angry more often than is usual for you
  • Difficulty sleeping
  • Mood swings
  • Feelings of panic
  • Difficulty concentrating
  • Youngminds (2004) Looking After Ourselves
  • Difficulty making decisions
  • Losing interest in life
  • Avoiding other people
  • Negative thoughts
  • Suicidal thoughts
  • Not eating or over-eating
  • Smoking or drinking more than is usual for you

22
Impact on parenting
  • Parental mental health problems are highly
    correlated with poverty and deprivation, poor
    housing and social adversity.
  • For some the stigma of mental health problems and
    racism further exacerbate risk to children

23
Impact on parenting
  • Attachment relationships
  • Emotionally attuned engagement
  • Communication
  • Children need information
  • Adult Conflict
  • Combination of discord and mental health problems
    is very dangerous to children
  • Separation and Change
  • Children fear parental separation. Also fear
    being removed from the family and fear parents
    admission to hospital
  • Peer Friendships and Support
  • Friendships change for the worse

24
Impact on parenting
  • Parental Behaviour
  • Most parents with mental health problems do not
    pose a risk to children. For those that do they
    are more likely to have been psychotic, co-morbid
    and socially deprived.
  • Childrens behaviour
  • Some evidence that the severity of parental
    mental health problems increases likelihood of
    childrens behaviour problems
  • Coping
  • Non productive coping styles/avoidance in parents
    are adopted by children

25
Impact on parenting
  • Parents may
  • be unable to ensure the basic (physical) care and
    safety of children
  • readily attend to a childs physical needs (such
    as maintaining a spotless home environment) but
    struggle with the provision of warmth and praise
  • not appreciate their child as an autonomous
    individual with his or her own separate,
    age-dependent needs
  • expect their child to behave as an adult and to
    undertake a variety of adult tasks and
    responsibilities (for example, role reversal with
    developmentally inappropriate expectations)

26
Impact on parenting
  • Parents may
  • be unable to play with and provide adequate
    stimulation for their child
  • struggle to provide appropriate guidance,
    boundaries and necessary stability for their
    children
  • become frustrated when efforts to discipline
    their children are unsuccessful (escalating
    cycles of coercive exchange have been well
    described criticism and hostile responses may
    occur and physical punishments ensue, which may
    in turn result in physical harm)
  • be unaware of the nature and extent of their
    childrens emotional needs.

27
Specific risk factors
  • Persistent negative views expressed about a
    child, including rejection
  • Ongoing emotional unavailability,
    unresponsiveness and neglect, including lack of
    praise and encouragement, lack of comfort and
    love and lack of age appropriate stimulation
  • An inability to recognise a childs needs and to
    maintain appropriate parent child boundaries
  • Ongoing use of a child to meet a parents own
    needs

28
Specific risk factors
  • Distorted, confusing or misleading communications
    with a child including
  • involvement of the child in the parents symptoms
    or abnormal thinking, including, for example,
    delusions targeting the child
  • incorporation of the child into a parents
    obsessional cleaning/contamination rituals, or
    keeping a child at home because of excessive
    parental anxiety or agoraphobia
  • Ongoing hostility, irritability and criticism of
    the child
  • Inconsistent and/or inappropriate expectations of
    the child.

29
Attachment and child development
30
Attachment Theory
  • Attachment behaviour is defined as
  • the seeking of protection when anxious which is
    triggered by external threats or behaviours.
  • The person to whom a child is attached provides a
    secure base, a place of safety, warmth and
    comfort.

31
Attachment Theory
  • A securely attached child feels confident that
    should they feel anxious, their parents will
    respond. Such security is brought on by
    interactions which are
  • sensitivity
  • regularly available and reliable
  • warm
  • responsive, and
  • consistent

32
Way attachment develops
33
Insecure avoidant attachments
  • Children who anxiously avoid contact have been
    rejected.
  • This avoidant attachment behaviour is a way of
    coping with distress.
  • The distress itself is turned inwards and the
    view of self which emerges is an unworthy one.
  • Adults are experienced as unavailable,
    untrustworthy and rejecting.

34
Representational Model (Avoidant)
  • Caregiver subtly or overtly reject childs
    attachment needs at time of stress
  • Bids for comfort will be rebuffed
  • Child keeps his/her attention directed away from
    their caregivers in an effort not to arouse
    anxiety and frustration
  • In control because of the need for self reliance
  • Comfort self rather than accept it from others

35
Representational Model (Avoidant)
  • The infant cannot approach because of the
    parents rejection and cannot withdraw because of
    its own attachment needs. Rebuff heightens alarm
    and hence heightens attachment, leading to
    increased rebuff. By repelling the infant the
    mother simultaneously attracts him.

36
Insecure ambivalent attachments
  • Children who show an ambivalence in their
    attachments have experienced inconsistent or
    chaotic care.
  • Their attachment behaviour is intensified to
    attract the parent.
  • Relationship meets mothers needs rather than
    those of the infant
  • Such children are often angry and resent their
    carers.

37
Representational Model (Ambivalent)
  • Caregiver will be inadequate at meeting child
    attachment needs (caregiver is passive,
    unresponsive and ineffective)
  • Childs strategy is to amplify attachment needs
    and signals in an effort to arouse a response
    (verbal and behavioural bubbly affection to
    rage, anger, panic and despair. All experienced
    as controlling)
  • Unlovable and helpless selves unpredictable and
    withholding others.

38
Antecedents of disorganised attachment
  • The antecedents of this behaviour can be
  • The secure base has not been available so
    attachment behaviour has failed to achieve its
    goal of proximity to the secure base
  • Prolonged separation in adverse conditions
  • Strong rejection by the parent with threats to
    send the child away
  • Depression, alcohol and/or drug misuse
  • Intense marital conflict
  • Actual abuse, physical, emotional, sexual
  • Absence of reparation
  • Abdication of care giving
  • At the core of this experience is a frightening
    or frightened attachment figure

39
Disorganised attachment
  • Care givers are both unpredictable and rejecting
  • Child finds it difficult to organise attachment
    behaviour to increase care and safety when the
    care giver is the source of distress
  • Children feel vulnerable and out of control they
    become listless or coercive

40
Characteristics of disorganised attachment
  • Absence of a secure base and unrelieved anxiety
  • Mistrust of adult authority
  • Hyper-vigilance
  • Sensitivity to denigration and humiliation
  • Need to be in control to cope with helplessness
    in the face of overwhelming and uncontained
    anxiety in the presence of adults who may be
    frightening and unreliable

41
Representational Model (Disorganized)
  • Child experiences the carer giver as the source
    of alarm and its only solution.
  • Child in these circumstances is unable to be
    guided by their mental model of the world because
    it offers few directions.
  • Frightened, helpless, fragile and sad
  • At risk of mental health problems or anti-social
    behaviour

42
Effects on the child
  • Implications for attachment styles (meta
    analyses)
  • Martins and Gaffan (2000) found a reduced
    likelihood of secure attachments, increased
    likelihood of avoidant disorganised styles in
    children of depressed mothers.
  • Atkinson, et al (2000) found a link between
    maternal social/marital support, maternal stress
    and maternal depression and attachment security

43
Effects on the child
  • Implications for attachment styles (single
    studies)
  • Teti et al (1995) found that maternal depression
    is linked to an increase in attachment
    insecurity. Those children with disorganised
    styles were more likely to have chronically
    impaired mothers
  • Bifulco et al (2002) studied 276 mother-offspring
    pairs half of which were vulnerable in terms of
    interpersonal functioning and low self esteem.
    Offspring of vulnerable group 4x more likely to
    be psychiatrically disordered and 2x more likely
    to experience severe neglect, physical or sexual
    abuse before age 17. Vulnerability and not
    maternal depression accounted for these
    differences.

44
Effects on the child
  • Implications for attachment styles (single
    studies)
  • Walsh et al (2009) found differences in coping
    strategies for middle aged children of mother
    with a mental health problem.

45
Walsh et als study
  • Multiple strategies following social conventions
  • Its the boy/girls first day and s/he is saying
    goodbye to Mum at the school gatehow would you
    feel in this situation? Same as he probably
    would scared and excited? These were generated
    in response to an earlier question Yeah. Why?
    Well because it would be a new school and I would
    have to make new friends and some people might
    take the mick or something, but, um, Id look
    forward to it because it would be a new
    experience. Id be looking forward to making new
    friends with teachers and things, new work and
    things. What would you do? Do what I was told
    to do by the teacher, do what Im supposed to do,
    what everyone else was doingtry to chat to some
    people there and chat to the teachers and things

46
Walsh et als study
  • Little adaptive coping strategy
  • Its the boy/girlss first day and s/he is
    saying goodbye to Mum at the school gatehow
    would you feel? A bit upset cause a new school
    would be a bit scary What would you do? Uh,
    cant think of anything. What might you do? Sit
    down

47
Effects on the child
  • Lynne Murrays longitudinal work
  • Women with post natal depression often had
    further occurrences of depression later in life
  • Analysis of total months of maternal depression
    predicted offspring depression p 0.008
  • Total months of maternal depression a more
    significant predictor of childrens depression
    (p0.018) than post natal depression status
    (p0.11)

48
Traumatic stress
  • The automatic response to trauma, involving the
    production of toxic amounts of stress hormones
    which affect
  • Brain function
  • All major body systems
  • Social functioning

49
Impact of trauma/stress
  • The ultimate endpoint of experiencing
    catastrophic states of relational-induced trauma
    in early life is a progressive impairment of the
    ability to adjust, take defensive action, or act
    on ones own behalf, and, most importantly, a
    blocking of the capacity to register affect and
    pain.
  • Schore, A (2001) The effects of early relational
    trauma on right brain development, affect
    regulation and infant mental health. Infant
    Mental Health Journal 22(1-2), 201-69

50
Implications for practice
51
Adaptive strategies
  • Helpless and preoccupied parent child likely to
    be attention-seeking. If these provoke a response
    then the attention-seeking is adaptive.
  • Ambivalent styles
  • Parent likely to make inaccurately minded
    comments

52
Adaptive strategies
  • Irritable and hostile parents- present children
    with difficulties in adapting. The inadequate
    source of comfort is also the cause of alarm.
  • Disorganised styles of punitive controlling and
    compulsive self reliance

53
Adaptive strategies
  • Helpless parents who are consumed by their own
    despair children adapt by taking control of the
    relationship by being attentive and solicitous.
  • Avoidant style helps with feeling insecure but
    child struggles to understand own emotions.
    Parent like to make few minded comments. Child
    may display moody behaviour outside the home.

54
Resilience
  • Compensatory
  • Challenge
  • Protection
  • Change childs appraisal and cognitive processing
    of events
  • Reduce exposure to risk

55
Implications
  • Effects are mediated by the interaction between
    the biological, psychological and social.
  • The mind is constructed through a combination
    of genetics, constitution and the environment.
  • More specifically ones identity is formed
    through interactions with other peoples minds
    (subjective states), typically parents.
  • The mind is made up of thoughts, feelings,
    perceptions, memories, interpretations and
    beliefs and these mediate the way the other
    person is experienced and reacted to.

56
implications
  • Parental behaviour is likely to be influenced by
    how the child is perceived, evaluated and
    integrated into the parents mind which will be
    influenced by both current and previous
    experiences

57
practice
  • Preoccupation with the states of children and
    parents minds and the interaction between these.
  • Interagency practice which elevates mindful
    discussion.
  • Acceptance that there are other psychological
    views.
  • Organisations which are minded.
  • Adaptable responses
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