Is expressed emotion a specific risk factor for depression or a nonspecific correlate of psychopathology?

Associations between Computationally Derived Parent Emotional Sentiment Scores and Child ADHD and ODD Over Time

Family emotional climate is often assessed as expressed emotion (EE) using the five-minute speech sample (FMSS). Parent EE is related to child externalizing behavior, but the relationship with ADHD apart from externalizing is unclear. We report the largest ADHD-non-ADHD study of EE to date, introduce computational scoring of the FMSS to assay parent negative sentiment, and use this to evaluate reciprocal parent-child effects over time in ADHD while considering comorbid ODD. Parents of 810 children (nADHD = 509), aged 7-13 years old, completed the FMSS at three points. The FMSS was expert-coded for EE-Criticism at Time 1 and Time 2, negative sentiment was scored at all three time points. Sentiment and EE-Criticism were moderately correlated (r =.39, p <.001, 95% CI [0.32, 0.46]), and each was similarly correlated with baseline ADHD symptoms (r's range 0.31-0.33, p <.001) and ODD symptoms (r(ODD-EE) = 0.35, p <.001; r(ODD-sentiment = 0.28, p <.001). A longitudinal, cross-lagged panel model revealed that increases over time in parental negative sentiment scores led to increased ODD symptoms. Parent sex (namely fathers, but not mothers) showed an interaction effect of sentiment with ADHD. ADHD and ODD are independently and jointly associated with parental EE-Criticism and negative sentiment assessed by the FMSS cross-sectionally. A recursive effects model is supported for ODD, but for ADHD effects depend on which parent is assessed. For fathers, ADHD was related to negative sentiment in complex manners but for mothers, negative sentiment was related primarily to ODD.

A transactional mediation model of risk for the intergenerational transmission of depression: The role of maternal criticism

In this study, we sought to combine two lines of research to better understand risk for the intergenerational transmission of depression. The first focuses on the role of maternal criticism as a potential mechanism of risk for depression in youth while the second builds from interpersonal and stress generation models regarding the potential impact of youth depression on future escalations in maternal criticism. Specifically, we examined the role of maternal criticism within a transactional mediation model using data from a multi-wave study. Participants were 251 mother-offspring pairs consisting of mothers with (n = 129) and without (n = 122) a history of major depressive disorder (MDD) during their child's lifetime who completed assessments every 6 months for 2 years. We found support for the hypothesized transactional mediational model in which maternal expressed emotion-criticism (EE-Crit) mediated the link between maternal history of MDD and residual change in youth's depressive symptoms over the previous 6 months and, reciprocally, youth depressive symptoms mediated the relation between maternal MDD history and residual change in EE-Crit 6 months later. These results indicate that maternal criticism and offspring depressive symptoms may contribute to a vicious cycle of depression risk, which should be considered for interventions targeted toward youth at risk of developing MDD.

Longitudinal change in neurocognitive functioning in children and adolescents at clinical high risk for psychosis: a systematic review

Clinical high risk of psychosis (CHR-P) population has become an attractive area of interest in preventing transitions to psychosis. The consequences of developing a psychotic disorder may be worse in cases of early onset. Thus, childhood and adolescence represent a critical developmental window, where opportunities to gain social and adaptive abilities depend on the individuals' neurocognitive performance. There have been previous syntheses of the evidence regarding neurocognitive functioning in CHR-P individuals and its longitudinal changes. However, there has been less focus on children and adolescents at CHR-P. A multistep literature search was performed from database inception until July 15th, 2022. PRIMSA/MOOSE compliant systematic review and PROSPERO protocol were used to identify studies reporting on longitudinal changes in neurocognitive functioning in children and adolescents (mean age of sample ≤ 18 years) at CHR-P and matched healthy control (HC) group. A systematic review of identified studies was then undertaken. Three articles were included, resulting in a total sample size of 151 CHR-P patients [mean (SD) age, 16.48 (2.41) years; 32.45% female] and 64 HC individuals [mean (SD) age, 16.79 (2.38) years; 42.18% female]. CHR-P individuals had worse outcomes in verbal learning, sustained attention and executive functioning domains compared to HC. Individuals taking antidepressants had better outcomes in verbal learning in contrast with those taking antipsychotics. In children and adolescents, neurocognition may be already impaired before the psychosis onset, and remains stable during the transition to psychosis. Further study should be performed to obtain more robust evidence.

Parental Criticism and Depressive Symptoms: The Contribution of Active Coping Among African American Adolescents : Prairie View A&M University

The present study examined whether parental criticism, active coping, and peer support associated with depressive symptoms. Then using two mediation models, this study explored whether parental criticism related to depressive symptoms through active coping while controlling for peer support among African American Adolescents (N = 883). Results from a multiple regression analysis revealed that maternal and paternal criticism positively associated with depressive symptoms in contrast to active coping and peer support. In the first mediation analysis, active coping explained the relationship between maternal criticism and depressive symptoms. In the second mediation analysis, active coping did not explain the relationship between paternal criticism and depressive symptoms. These results suggest that mental health practitioners should consider incorporating coping techniques in therapy, specifically while treating African American adolescents. Clinical, family, and community implications are discussed.

Parenting Role in the Development of Borderline Personality Disorder

The progressively improving understanding of the borderline personality disorder (BPD) has led to an increased interest in the better clarification of the integrated role of biological and psychosocial factors in the underlying pathophysiology of this condition. The influence of early childhood interactions and stress exposure in shaping our personalities during adulthood cannot be emphasized enough. In this review, we discuss the critical role of parenting-related factors including maladaptive parenting, parenting styles, and parenting psychopathology as early childhood influences in the developmental psychopathology of BPD. Protective factors that may impact the development of this disorder and possible preventive interventions are also briefly reviewed.

Parental criticism and adolescent internalising symptoms: using a Children-of-Twins design with power calculations to account for genetic influence

BACKGROUND

Parental criticism is correlated with internalising symptoms in adolescent offspring. This correlation could in part reflect their genetic relatedness, if the same genes influence behaviours in both parents and offspring. We use a Children-of-Twins design to assess whether parent-reported criticism and offspring internalising symptoms remain associated after controlling for shared genes. To aid interpretation of our results and those of previous Children-of-Twins studies, we examine statistical power for the detection of genetic effects and explore the direction of possible causal effects between generations.

METHODS

Data were drawn from two Swedish twin samples, comprising 876 adult twin pairs with adolescent offspring and 1,030 adolescent twin pairs with parents. Parent reports of criticism towards their offspring were collected concurrently with parent and offspring reports of adolescent internalising symptoms. Children-of-Twins structural equation models were used to control for genetic influence on the intergenerational association between parental criticism and adolescent internalising.

RESULTS

Parental criticism was associated with adolescent internalising symptoms after controlling for genetic influence. No significant role was found for shared genes influencing phenotypes in both generations, although power analyses suggested that some genetic effects may have gone undetected. Models could not distinguish directionality for nongenetic, causal effects between generations.

CONCLUSIONS

Parental criticism may be involved in psychosocial family processes in the context of adolescent internalising. Future studies should seek to identify these processes and provide clarity on the direction of potential causal effects.

Maternal criticism and children's neural responses to reward and loss

Parental criticism is linked to a number of detrimental child outcomes. One mechanism by which parental criticism may increase risk for negative outcomes in children is through children's neural responses to valenced information in the environment. The goal of the current study, therefore, was to examine the relation between maternal criticism and children's neural responses to monetary gains and losses. To represent daily environmental experiences of reward and punishment, we focused on reactivity to monetary gains versus losses in a guessing task. Participants were 202 children and their mothers recruited from the community. The average age of the children was 9.71 years (SD = 1.38, range = 7-11), with 52.0% of them male and 72.8% Caucasian. Mothers completed the Five Minute Speech Sample to assess expressed emotion-criticism, and of these dyads 51 mothers were rated as highly critical. In addition, children completed a simple guessing game during which electroencephalography was recorded. Children of critical mothers displayed less neural reactivity to both monetary gain and loss than children without critical mothers. Our results were at least partially independent of children's and mothers' current levels of internalizing psychopathology. These findings suggest that children exposed to maternal criticism may exhibit disruptions in adaptive responses to environmental experiences regardless of valence. Targeted interventions aimed at reducing expressed emotion-criticism may lead to changes in a child's reward responsiveness and risk for psychopathology.

All in the Family: How Parental Criticism Impacts Depressive Symptoms in Youth

Despite a strong connection between family environment and mood symptoms in youth, little research to date has examined potential underlying mechanisms. We propose an etiological model investigating how parenting (i.e., expressed emotion, or EE) affects youth depression by shaping their emotion regulation abilities. Forty-six youth and caregivers participated in this cross-sectional study. Family environment was assessed using the Five-Minute Speech Sample (FMSS) and the Levels of Expressed Emotion Scale (LEE). The Difficulties in Emotion Regulation Scale (DERS) and the Children's Depression Rating Scale-Revised (CDRS-R) were used to assess youth emotion regulation and depressive symptoms, respectively. Analyses demonstrated no significant relationships between type of reporter (i.e., independent rater, parent, youth) of parental EE and criticism. Mediation analyses suggested that youth-reported parental EE predicted greater levels of youth depressive symptoms, and that this association was mediated by emotion regulation. This study has direct clinical implications, elucidating the importance of strengthening positive parent-child communication to support the development of emotion regulation skills and psychological well-being for youth.

Incorporating family factors into treatment planning for adolescent depression: Perceived parental criticism predicts longitudinal symptom trajectory in the Youth Partners in Care trial

BACKGROUND

This study aimed to clarify the predictive significance of youth perceptions of parental criticism assessed using a brief measure designed to enhance clinical utility. We hypothesized that high perceived parental criticism would be associated with more severe depression over 18-months of follow-up.

METHODS

The study involved secondary analyses from the Youth Partners in Care trial, which demonstrated that a quality improvement intervention aimed at increasing access to evidence-based depression treatment in primary care led to improved depression outcomes at post-treatment compared to usual care enhanced by provider education regarding depression evaluation/management. Patients (N = 418; ages 13-21) were assessed at four time points: baseline; post-treatment (six-month follow-up); 12- and 18-month follow-ups. The primary analysis estimated the effect of perceived parental criticism on likelihood of severe depression (i.e., Center for Epidemiological Studies-Depression Scale ≥ 24) over post-intervention follow-ups using a repeated-measures logistic regression model. Secondarily, a linear mixed-effects growth model examined symptom trajectories from baseline through 18-months using the Mental Health Index-5, a measure of emotional distress available at all time-points.

RESULTS

High perceived parental criticism emerged as a robust predictor of clinically-elevated depression (OR=1.66, p=.02) and a more pernicious symptom trajectory over 18-months (β =-1.89, p<.0001).

LIMITATIONS

The association between the self-report perceived criticism and traditional expressed emotion measures derived from verbal and nonverbal parental behaviors was not evaluated.

CONCLUSIONS

Results support perceived parental criticism as a predictor of youth depression outcomes over 18-months. This brief measure can be feasibly integrated within clinical assessment to assist clinicians in optimizing treatment benefits.

When Depression Breeds Rejection Rather Than Compassion: Disagreeableness, Stigma, and Lack of Empathic Concern Among Support Providers

Past research has shown that the close relationships of depressed individuals are often characterised by rejection rather than compassion. The goal of this research was to broaden interpersonal models of depression by investigating the reports of support providers themselves. Individual differences, including disagreeableness, stigmatic beliefs about depression, and empathic concern were measured. These were examined in relation to reported interpersonal behaviours toward a significant other who was currently depressed. A cross-sectional design was used in an undergraduate (N = 312) and community sample (N = 296). Disagreeable individuals reported less compassionate and more rejecting behaviours toward depressed significant others based on an interpersonal circumplex model of social support. Serial mediation models further indicated that the associations between disagreeableness and rejecting behaviours reported by providers were mediated by stigma and lower empathic concern. The current studies shed light on how the personality, attitudes and emotions of support providers influence the level of compassion expressed toward depressed individuals.

Expressed Emotion in the Family: A Meta-Analytic Review of Expressed Emotion as a Mechanism of the Transgenerational Transmission of Mental Disorders

BACKGROUND

High Expressed Emotion (HEE) has been identified as a risk factor for the exacerbation and course of mental illness. EE has been investigated as a caregiver's response to an offspring's problem behavior and pathology. The present meta-analysis regards EE from a transgenerational perspective and as one mechanism that might explain the transgenerational transmission of mental disorders.

METHOD

We identified a total of 13 studies relying on 16 independent samples of parent-child dyads of parents with a mental illness and healthy controls; these were included in our analysis. Results were synthesized into one effect size per sample; meta-regression on additional effects of parental diagnostic category, child mental illness, and child age were also applied.

RESULTS

Parents with a mental illness are classified as HEE significantly more often. Effects were established for high criticism, albeit of small size (OR = 1.45), although they become stronger whenever offspring exhibit mental illness themselves (OR = 2.82).

CONCLUSION

The current study highlights the dearth of studies on EE in families in which a parent has a mental illness and its effects on their children. Our findings highlight EE as a potential mechanism for attributing the transgenerational transmission of mental disorders, especially for the EE-variable criticism, indicating dysfunctional parent-child interactions.

SYSTEMATIC REVIEW REGISTRATION

http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42019117609, identifier: CRD42019117609.

Effects of an adolescent depression prevention program on maternal criticisms and positive remarks

This study examined effects of an adolescent depression prevention program on maternal criticisms and positive remarks, whether the extent of adolescents' depression accounted for effects, and whether effects of the program on maternal criticisms and positive remarks differed by adolescents' gender. Participants were 298 adolescent (M_age = 14.79, SD = 1.36; 59% female) offspring of mothers with histories of depression; youth were randomized to either a cognitive-behavioral prevention (CBP) program or usual care (UC). At baseline and 9-month postintervention evaluations, mothers were administered the Five-Minute Speech Sample to measure number of criticisms and positive remarks made during an open-ended description of their child and their relationship. Adolescents' depression from pre- through postintervention was assessed with interviews. A hierarchical generalized linear model showed a significant condition-by-gender interaction, indicating that, controlling for baseline criticism, at postintervention mothers of girls in CBP made significantly more criticisms than did mothers of girls in UC, whereas mothers of boys in CBP made fewer criticisms than did mothers of boys in UC. The extent of adolescents' depression from pre- through postintervention partially mediated the relation between intervention condition and mothers' criticisms, for boys but not for girls. Second, controlling for preintervention positive remarks, at postintervention, mothers of youth in CBP made significantly more positive remarks about their child than did mothers of youth in UC, regardless of gender; this relation was not mediated by adolescent depression from pre- through postintervention. We suggest possible explanations for the observed effects of CBP on mothers' criticisms and positive remarks. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

A Meta-analytic Review of the Five Minute Speech Sample as a Measure of Family Emotional Climate for Youth: Relations with Internalizing and Externalizing Symptomatology

The Five Minute Speech Sample's (FMSS) measure of parental expressed emotion (EE), defined as criticism (CRIT) and emotional overinvolvement (EOI), has been increasingly used to measure family emotional climate in relation to youth psychopathological development. As CRIT and EOI were defined based on adults, a meta-analysis and systematic review was conducted to analyze the presence and strength of an effect among maternal CRIT and EOI with youth internalizing and externalizing problems. A random effects model was used to analyze the 42 studies on families of youth (aged 1.5 to 19). There was a small, significant relation among maternal CRIT with youth internalizing and externalizing problems and among EOI with youth internalizing problems. EOI was not significantly related to externalizing problems. The current study suggests that the FMSS measure of CRIT is a more robust correlate of youth internalizing and externalizing symptoms than EOI, but EOI does relate to internalizing behaviors. Few moderators emerged, highlighting a continued need to identify factors accounting for heterogeneity. The current results suggest that the FMSS measure of CRIT may be a valuable measure of the family emotional climate in families of youth, but care should be taken when including analyses on EOI.

Burden experienced by caregivers of schizophrenia patients and its related factors

Background: Deinstitutionalization of patients with schizophrenia shifted the primary locus of care from psychiatric hospitals to family and informal caregivers. Family members often play a vital role as caregivers in the lives of individuals with schizophrenia and other serious mental illnesses. This study aimed to assess the burden experienced by the caregivers of patients with schizophrenia and to evaluate its correlation with some demographic characteristics of patients, their caregivers, and the level of expressed emotion in the family.

Methods: This descriptive-analytic study was conducted on 172 schizophrenic patients and their primary caregivers, selected from the outpatient department of a psychiatric hospital in Tehran, Iran, using convenience sampling. Caregivers were evaluated with Zarit Burden Interview and Family Questionnaire to assess the burden experienced by the caregivers and the level of expressed emotion in the family, respectively. Data were analyzed using Spearman correlation coefficient and linear regression method. Data were analyzed using SPSS software (Version 21) and significance level was set at p< 0.05.

Results: The level of burden experienced by most of primary caregivers was higher than moderate. The scores obtained in the subscales of emotional over involvement and critical comments were higher than the cutoff point in 51.7% and 64.5% of caregivers, respectively, and the scores had a significant direct correlation with the burden experienced by the caregivers. The findings of multiple linear regression showed that lower family income (β= -0.33, p< 0.001), higher duration of disorder (β= 0.19, p= 0.006), and younger age at onset of the disorder (β= -0.26, p= 0.001) were predictive of higher burden of disease on caregivers.

Conclusion: Based on the results, some demographic factors of the primary caregivers, patients, and their family significantly affected the burden experienced by the primary caregivers. Most of the caregivers had high expressed emotions and a significant direct association existed between the expressed emotions and the burden experienced.

Relationship between posttraumatic stress symptoms, caregiving response, and parent mental health in youth exposed to single incident trauma

BACKGROUND

Family factors may alter the risk of developing posttraumatic stress disorder (PTSD) or depression in young people after a traumatic event, but it is not clear which modifiable family variables can be addressed in psychological therapies. This study examined the relationships between family factors (Expressed Emotion [EE] and family accommodation) and psychopathology (posttraumatic stress symptoms; PTSS) in young people following a single incident trauma. Potential mediators of these relationships were also investigated.

METHOD

Sixty-six parent-child dyads (aged 8-17 years) were assessed within one month of attending an Emergency Department. Self-reported PTSS and perceived EE were assessed in young people. Parents' own PTSS, mood symptoms, EE, and accommodating behaviours were also assessed.

RESULTS

Cross-sectional analyses revealed that young person-perceived EE, parent-reported emotional over involvement (EOI) and accommodation behaviours significantly predicted higher PTSS in young people. The stress experienced as a consequence of EE mediated the relationship between young person-perceived EOI and PTSS in young people. Parental PTSS and anxiety were positively correlated with EOI and accommodation. Parental PTSS was not significantly associated with symptoms in young people.

CONCLUSIONS

The results support the hypothesis that EE and accommodation are positively associated with PTSS in young people in the month following a potentially traumatic event. Understanding the child in the context of their family environment and relationships offers an important framework for making sense of and facilitating adaptive adjustment following a traumatic event.

Maternal criticism and non-suicidal self-injury in school-aged children

Although non-suicidal self-injury (NSSI) is a significant public health concern in youth, most of the extant research on NSSI has focused on adults and, to a lesser extent, adolescents. Therefore, little is known about the correlates and potential risk factors for NSSI in school-aged children. One factor that may be particularly important to children is their exposure to maternal criticism. Thus, the goal of this study was to examine the association between maternal expressed emotion-criticism (EE-Criticism) and NSSI in children, and to determine whether this relation is similar for girls and boys. Participants were 204 children (ages 7-11; 39.7% female, 81.9% Caucasian) and their mothers. Participants completed interviews assessing the child's history of NSSI. Mothers completed the Five-Minute Speech Sample to determine levels of EE-Criticism toward their child. We found that girls exposed to high levels of EE-Criticism were more likely to have a lifetime history of NSSI than girls of mothers exhibiting low levels of EE-Criticism; however, the relation between EE-Criticism and NSSI was not significant for boys. These results are consistent with interpersonal models of risk for NSSI, but suggest that one interpersonal factor, maternal criticism, is more strongly related to NSSI in girls than in boys.

Parent Emotion Expression and Autonomic-Linked Emotion Dysregulation in Childhood ADHD

Despite evidence that ADHD is associated with disruptions in emotion regulation, few studies have examined the biological correlates of emotion dysregulation among children with this disorder. Prior work has pointed to roles of the parasympathetic and sympathetic nervous system, as indexed via respiratory sinus arrhythmia (RSA) and cardiac pre-ejection period (PEP), respectively. Work in typically developing populations suggests that parenting behavior and parental emotion expression may shape the development of these systems. To date, a single study has examined the independent and interactive roles of autonomic nervous system functioning and parent emotion expression in youth with ADHD. This study seeks to extend that work. 86 children (42 with ADHD), aged 8-12 years, and a parent completed a parent-child interaction task, while electrocardiography and impedance cardiography data were recorded to derive RSA and PEP. Parent and child emotion word use (positive and negative valence) were coded from recordings of the task. Parents of youth with ADHD used fewer positive emotion words throughout the task. Additionally, throughout the task, children with ADHD engaged in excessive RSA withdrawal from baseline. Further, the association between RSA reactivity and ADHD diagnosis was moderated by parent positive emotion word use. Specifically, those with RSA augmentation and parents displaying high positive affect across the task conditions were least likely to have an ADHD diagnosis. If replicated and extended, these results support the use of interventions specifically designed to increase parental modeling of positive emotions, while simultaneously focusing on building emotion regulation skills in youth with ADHD.

Parental Expressed Emotion-Criticism and Neural Markers of Sustained Attention to Emotional Faces in Children

There is growing evidence for the role of environmental influences on children's information-processing biases for affectively salient stimuli. The goal of this study was to extend this research by examining the relation between parental criticism (expressed emotion-criticism, or EE-Crit) and children's processing of facial displays of emotion. Specifically, we examined the relation between EE-Crit and children's sensitivity in detecting facial displays of emotion. We also examined a neural marker of sustained attention, the late positive potential (LPP) event-related potential component (ERP). Participants were 87 children (ages 7-11 years; 53.3% female, 77.8% Caucasian) and their parents (ages 24-71; 90% female, 88.9% Caucasian). Parents completed the Five-Minute Speech Sample to determine levels of EE-Crit toward their child. Children completed a morphed faces task during which behavioral and ERP responses were assessed. Although there were no group differences in sensitivity in detecting facial displays of emotion, we found that children of parents exhibiting high, compared to low, EE-Crit displayed less attention (smaller LPP magnitudes) to all facial displays of emotion (fearful, happy, sad). These results suggest that children of critical parents may exhibit an avoidant pattern of attention to affectively-salient interpersonal stimuli.

The relationship of parental expressed emotion to co-occurring psychopathology in individuals with autism spectrum disorder: A systematic review

Expressed emotion is a construct of the affective relationship between two people, with domains measuring criticism, hostility, warmth, relationship and emotional over-involvement. This review focuses on studies of Expressed Emotion in families of individuals with autism spectrum disorder and its association with co-occurring psychiatric disorders. A systematic search used the Psych-Info and Medline databases to identify articles available at or before September 2016. Eleven studies met the inclusion criteria. The included studies suggest that high levels of expressed emotion, including criticism, are associated with behavioural problems. However, the relationship between expressed emotion and emotional problems is presently unclear because findings were mixed. Also, there is presently little evidence regarding the impact of other components of expressed emotion on co-occurring disorders.

Disrupted physiological reactivity among children with a history of suicidal ideation: Moderation by parental expressed emotion-criticism

OBJECTIVE

The goal of this study was to examine physiological reactivity during parent-child interactions in children with and without a history of suicidal ideation (SI), a group known to be at increased risk for suicidal thoughts and behaviors in the future. We also examined the potential moderating role of parental expressed emotion-criticism (EE-Crit) to determine whether the presence of parental criticism may help to identify a subgroup of children with a history of SI most at risk for physiological dysregulation.

METHOD

Participants were 396 children (age 7-11; 54% male, 71.7% Caucasian) and their biological parent. Children's levels of high frequency heart rate variability (HF-HRV) were assessed during a resting baseline period followed by a positive and negative discussion with their parent. Additionally, parents completed the Five-Minute Speech Sample to determine levels of EE-Crit toward their child, and children completed an interview assessing their history of SI.

RESULTS

Consistent with our hypothesis, we found that exposure to parental criticism moderated the relation between a child's history of SI and their HF-HRV reactivity to the discussions. Specifically, while most children exhibited the typical pattern of HF-HRV suppression from baseline to both interactions, the highest risk children (i.e., children with a history of SI who also had highly critical parents) did not display any change in HF-HRV across the tasks, suggesting a failure to engage a typical psychophysiological response during emotional contexts.

CONCLUSIONS

These results suggest a specific physiological mechanism that may place these children at risk for suicidal thoughts and behaviors in the future.

The Moderating Role of Maternal Depression in the Relation Between Adolescent Behavioral Inhibition and Maternal Critical Expressed Emotion

Behavioral inhibition is associated with a range of negative affective states and behaviors in adolescents which may elicit critical expressed emotion (EE-Crit) among mothers. Whether the relation between adolescent behavioral inhibition and maternal EE-Crit may depend on the presence of maternal depression is unknown. Therefore, a total of N = 81 biological mother/adolescent daughter dyads were recruited: mothers with a history of major depressive disorder (n = 45) and never-depressed mothers (non-depressed: n = 36). Structured clinical interviews were administered, daughters reported their behavioral inhibition and mothers reported daughter-directed maternal EE-Crit. Maternal depression was a moderator such that higher daughter behavioral inhibition was associated with greater EE-Crit among depressed mothers, specifically. There were no group differences for daughter behavioral inhibition or maternal EE-Crit. These findings highlight the significant role that maternal depression may play in relation to adolescent behavioral inhibition, EE-Crit, and risk for the development of adolescent psychopathology.

The Indirect Effect of Perceived Criticism on Suicide Ideation and Attempts

The effect of perceived criticism from others is one potentially important risk factor for suicide that has received scant attention, despite decades of research on the role of criticism in the treatment and course of mental illnesses such as schizophrenia and mood disorders. This study analyzed the effect of perceived criticism's association with suicidal ideation and attempts as well as its connection with the suicide related constructs thwarted belongingness and perceived burdensomeness as described in the Interpersonal Theory of Suicide. Fifty participants (66% female, M_Age = 18.7), 18 of whom had previously made one or more suicide attempts, completed a battery of self-report assessments as well as two in-person, structured clinical interviews. Analyses demonstrated that perceived parental criticism is a significant indicator of suicide ideation (β = .297, p = .003) and attempts (β = .373, p < .001) and that perceived criticism from close friends is a significant indicator of suicide attempts (β = .297, p = .006). Perceived criticism has a strong indirect effect on suicide ideation and attempts through its effect on thwarted belongingness, but not perceived burdensomeness, while controlling for mental illnesses. Some limitations of this study include the cross-sectional design and the use of a relatively small, restricted age sample. Treatment designed to mitigate perceived criticism and thwarted belongingness may be an important component in combatting suicidal ideation and attempts, particularly among young adults.

Influence of parental care on offspring hippocampal volume in young adults varies as a function of overprotection

Parental care results in increased hippocampal volumes through adaptive stress responses in developing animals. However, human studies have not yet provided consistent findings analogous to the animal literature, possibly because parental care in humans is likely intermingled with parental overprotection, as suggested by the optimal parenting theory. Here, we tested the hypothesis that the effect of parental care on offspring hippocampal volume varies as a function of parental overprotection with a large cohort of young adult participants (N = 257). Consistent with some previous human studies, we found that parental care in childhood alone had little association with the hippocampal volume in adulthood. However, when parental overprotection was low, parental care was positively correlated with offspring hippocampal volume, whereas there was no association between parental care and offspring hippocampal volume when parental overprotection was high. Thus, an interaction exists between parental care and overprotection in human’s hippocampal development, which contributes to the elucidation of the complex relationship between brain structure and environmental factors.

Attention-deficit/hyperactivity disorder developmental trajectories related to parental expressed emotion

In the transition from childhood to adolescence, attention-deficit/hyperactivity disorder (ADHD) developmental trajectories diverge. Family environment, as indexed by parental expressed emotion, may moderate these trajectories. 388 children with ADHD and 127 controls were assessed using multi-informant, multimethod diagnostic procedures at up to 3 time points 1 year apart in an accelerated longitudinal design spanning ages 7-13 years. Latent-class growth analysis was used to identify developmental trajectories for parent- and teacher-rated ADHD and oppositional-defiant disorder (ODD) symptoms within the ADHD sample. Parental expressed emotion, criticism, and emotional overinvolvement were coded from a 5-min speech sample at 2 time points, 1 year apart, for 208 of these children and compared among ADHD trajectory groups.

RESULTS

Parent-rated hyperactivity yielded a 4-class trajectory solution in latent-class growth analysis; teacher-rated inattention yielded a 3-trajectory solution. Teacher-rated ODD also yielded 3-trajectory solution. A parent-rated high persistent hyperactive group was more likely than the other ADHD groups to have parents with stable high criticism (34.6%, p < .001), with ODD symptoms controlled. A teacher-identified high ODD-worsening group was more likely to experience high criticism, particularly the initial time point; (87.5%, p < .001), with hyperactivity controlled. Parental criticism, an index of the family environment, is uniquely associated with divergent developmental trajectories among children with ADHD in addition to those associated with ODD symptoms. Lay summary: For many children, ADHD symptoms decrease as they transition to adolescence. Family environmental factors, such as parental criticism, may help explain for whom symptom remission is less likely.

The Mediating Role of Self-Criticism in the Relationship between Parental Expressed Emotion and NSSI

Nonsuicidal self-injury (NSSI) is found at high rates among adolescents and young adults and is associated with many negative consequences, warranting additional research. Two factors that may contribute to NSSI during this time period are one's levels of self-criticism and perceptions of their parental relationships; however, these relationships have received limited attention. The purpose of this current study was to address this gap in the literature. Adolescents and young adults (n=294) completed measures of perceived parental expressed emotion, self-criticism, and NSSI. Participants with a history of NSSI reported perceiving their parents as providing less emotional support, inducing more irritation, being more intrusive, and expressing more criticism compared to those without a history of NSSI. These individuals also endorsed greater self-criticism. Further, self-criticism mediated the relationship between perceived parental expressed emotion and NSSI occurrence, such that those with higher reported self-criticism and greater perceived parental expressed emotion were more likely to engage in NSSI.

Psychoeducation and Expressed Emotion by Parents of Children with Learning Disorders

The present study assessed use of a psychoeducation group program on expressed emotion, family functioning, and child behavior by parents of children with learning disorders. 81 parents of children with learning disorders were randomly assigned to a psychoeducation group program ( n = 46) or to a regular treatment group ( n = 35). A semistructured interview for parental expressed emotion, self-reports of family functioning, and child behavior were utilized at baseline and after an 8-session psychoeducation group program. Parents who attended the program differed significantly from parents in the regular treatment group on measures of criticism, warmth, and positive remarks, and overall expressed emotion, but not on measures of perceived family functioning and child behavior. Findings indicate a psychoeducation group program could be effective in helping parents to establish a more positive emotional climate in their relationships with their children who have learning disorders.

Perceived Expressed Emotion in Adolescents with Binge-Eating Disorder

A sizeable body of research has documented Expressed Emotion (EE) to predict clinical outcomes in various psychiatric disorders, including eating disorders. Patients' perceptions of relative's EE, however, were found to play an important role in the processing of EE. This study aimed to examine the level of perceived EE in adolescent binge-eating disorder (BED) and its impact on eating disorder psychopathology. Adolescents (12-20 years) seeking treatment for BED (n = 40) were compared to adolescents without current or lifetime eating disorder (CG; n = 40). Both groups were stratified according to age, sex, body mass index (BMI, kg/m(2)), and socio-economic status. The Five Minute Speech Sample (FMSS) and the Brief Dyadic Scale of EE were administered to assess patients' perceived maternal EE. Additionally, adolescents and mothers completed questionnaires on eating disorder and general psychopathology. On the FMSS, 37.5 % of patients with BED perceived their mothers as high EE (vs. 12.5 % in the CG). On the Brief Dyadic Scale of EE, patients with BED reported significantly higher levels of perceived maternal criticism, emotional overinvolvement, and lower levels of perceived warmth than controls. After controlling for the diagnosis of BED, perceived criticism and warmth, as assessed by questionnaire, significantly explained adolescents' global eating disorder psychopathology. Negative perceptions of maternal behavior and emotional atmosphere towards the child are characteristic of adolescent BED. As documented for other eating disorders, family factors are likely to have substantial implications for the maintenance and treatment of adolescent BED.

Mother and adolescent expressed emotion and adolescent internalizing and externalizing symptom development: a six-year longitudinal study

In expressed emotion (EE) theory, it is held that high EE household environments enhance adolescent psychopathological distress. However, no longitudinal study has been conducted to examine if either the mother's EE or the adolescent's perception of EE predicts adolescent internalizing and externalizing symptom dimensions (an EE effect model) or vice versa (psychopathological effect model) together in one model. To unravel the reciprocal influences of maternal and adolescent perceived EE to adolescent internalizing and externalizing symptom dimensions, we tested two (i.e., one for internalizing and one for externalizing) cross-lagged panel models. In this study, it was found that both internalizing and externalizing symptom dimensions predicted the adolescent's perception of maternal EE as well as the mother's own rated EE criticism over time. The findings of this study should give both researchers and therapists a reason to reevaluate only using the EE effects model assumption in future EE studies.

Efficacy of a self-help manual in increasing resilience in carers of adults with depression in Thailand

Caring for a person with a mental illness can have adverse effects on caregivers; however, little is known about how best to help such caregivers. The aim of the present study was to examine the efficacy of a cognitive behaviour therapy-guided self-help manual in increasing resilience in caregivers of individuals with depression, in comparison to caregivers who receive routine support only. A randomized, controlled trial was conducted, following CONSORT guidelines, with 54 caregivers allocated to parallel intervention (self-help manual) (n = 27) or control (standard support) (n = 27) groups. Resilience was assessed at baseline, post-test (week 8), and follow up (week 12). Intention-to-treat analyses were undertaken. Repeated-measures ANOVA indicated a significant difference in resilience scores between the three time points, showing a large effect. Pairwise comparisons between intervention and control groups indicated resilience to be significantly different between baseline and post-test, and between baseline and follow up, but not between post-test and follow up. Overall, the intervention group showed a slightly greater increase in resilience over time than the control group; however, the time-group interaction was not significant. Guided self-help is helpful in improving caregivers' resilience and could be used as an adjunct to the limited support provided to carers by mental health nurses and other clinicians.

Parental Expressed Emotion and Youth Psychopathology: New Directions for an Old Construct

Levels of parental expressed emotion (EE) are prospectively associated with the symptomatic course of a range of childhood psychiatric disorders. This article reviews the literature linking parental EE to youth psychopathology and proposes a novel framework for understanding its mechanisms of action. We find that, despite noteworthy methodological limitations, parental EE is linked consistently to a more deleterious course of mood, anxiety, and psychotic disorders in youth. Its mechanism of action is unknown. Models of "toxic family stress" (referring to frequent, sustained, and uncontrollable stress without protective influences) provide one framework for understanding how high EE environments interact with individual biological vulnerabilities to promote illness onset and recurrence. Research aimed at understanding biological responses (e.g., stress reactivity, arousal) to familial EE is needed. Such work may inform efforts to understand how EE affects the course of psychiatric disorders and may guide the development of novel interventions emphasizing emotion regulation strategies.

The Meaning of Emotional Overinvolvement in Early Development: Prospective Relations With Child Behavior Problems

Emotional overinvolvement (EOI) in parents’ Five Minute Speech Samples (FMSSs; Magaña-Amato, 1993) is thought to measure overconcern and enmeshment with one’s child. Although related to maladaptive outcomes in studies of adult children, FMSS EOI evidences varied relations with behavior problems in studies with young children. These mixed findings may indicate that certain FMSS EOI criteria reflect inappropriate and excessive involvement with adult children, but do not indicate maladaptive processes when parenting younger children. Thus, this study evaluated relations of each FMSS EOI criterion with changes in child behavior problems from preschool to first grade in a community sample of 223 child–mother dyads (47.98% female; Wave 1 M(age) 49.08 months; 56.50% Hispanic/Latina). Maternal FMSS EOI ratings were obtained at Wave 1, and independent examiners rated child externalizing and internalizing behavior problems at Wave 1 and again 2 years later. Path analyses indicated that both the self-sacrifice/overprotection (SSOP) and statements of attitude (SOAs) FMSS EOI criteria predicted increased externalizing problems. In contrast, excessive detail and exaggerated praise were not related to child externalizing behavior problems, and Emotional Display was not evident in this sample. None of the FMSS EOI criteria evidenced significant relations with internalizing behavior problems. Multigroup comparisons indicated that the effect of SOAs on externalizing behavior problems was significant for boys but not for girls, and there were no significant group differences by race/ethnicity. These findings point to the salience of SSOP and SOAs for understanding the developmental significance of EOI in early development.

Maternal criticism and adolescent depressive and generalized anxiety disorder symptoms: a 6-year longitudinal community study

This 6-year longitudinal study examined the direction of effects (i.e., parent effects, child effects, or reciprocal effects) between maternal criticism and adolescent depressive and Generalized Anxiety Disorder (GAD) symptoms, including adolescents' perceptions of criticism as a potential mediator. Consistent with recent empirical findings on associations between parenting and adolescent internalizing symptoms, we hypothesized stronger child effects than parent effects. A community sample of 497 adolescents (M age = 13.03 at T1, 57 % boys) reported annually on their depressive and GAD symptoms as well as their perceptions of parental criticism. Their mothers (M age = 44.41 at T1) also reported annually on their own critical behavior toward their adolescent. As expected, cross-lagged panel models demonstrated stronger child effects (i.e., adolescent psychopathology predicting maternal criticism) than parent effects (i.e., maternal criticism predicting adolescent psychopathology) for both adolescent depressive and GAD symptoms, including adolescent perceived criticism as a significant mediator. Our results emphasize the importance of considering (1) potential bidirectional influences over time, contrary to a focus on parent effects on adolescent mental health, as well as (2) adolescent perceptions of parenting as an important potential mediator in associations between aspects of the parent-adolescent relationship and adolescent internalizing psychopathological symptoms.

'Living with Teenagers': feasibility study of a peer-led parenting intervention for socially disadvantaged families with adolescent children

OBJECTIVE

To develop and test the feasibility of a peer-led parenting intervention for parents of adolescent children.

DESIGN

Formative evaluation using a mixed-method cohort design.

SETTING

Socially deprived community sites in London, UK.

PARTICIPANTS

Parents seeking help with managing behavioural difficulties of an index adolescent child (aged 11-17 years).

INTERVENTION

A structured, group-based intervention ('Living with Teenagers') delivered by trained peer facilitators.

MAIN OUTCOME MEASURES

We assessed feasibility in terms of uptake and completion rates (% parents completing ≥5 sessions); social validity (assessed by service satisfaction measure and participant interviews); and potential for impact (assessed by parent-reported measures of adolescent behaviour and mental health, parenting satisfaction, expressed emotion, and disciplinary practices).

RESULTS

Participants (n=41) were predominately (79%) from minority ethnic backgrounds and nearly half were lone parents. Most had not previously accessed a structured parenting programme. The completion rate was 71%. Significant changes (p<0.05) were observed in reduced parental concern about adolescent problems, increased parenting satisfaction and less negative expressed emotion. There were non-significant changes in disciplinary practices and adolescent mental health. Participants were highly satisfied with their service experience and endorsed the acceptability of the intervention's content, materials and peer-led format, while suggesting an expanded number of sessions and more skills practice and demonstrations.

CONCLUSIONS

Peer-led parenting groups are feasible and potentially effective for supporting parents of adolescents living in socially disadvantaged communities. These findings warrant more rigorous testing under controlled conditions.

Expressed emotion as an assessment of family environment with mothers and fathers of 1-year-old children

BACKGROUND

High levels of expressed emotion (EE) in parents have been found to put children at risk for emotional and behavioural problems. However, the majority of existing studies have focused on mothers of school-aged children and adolescents rather than younger children, and have only rarely included fathers.

METHODS

The present study examined the reliability of EE in mothers and fathers of 1-year old children. It also investigated whether depression and marital problems in the postnatal period predicted EE toward the child at 12 months. EE was assessed with the Preschool Five Minute Speech Sample in 163 families.

RESULTS

The rater-interrater and code-recode reliability was high for most EE dimensions. Mothers and fathers were found to display quite similar EE scores. Regression analyses showed that depression and couple relationship significantly predicted EE in mothers, but not fathers.

CONCLUSIONS

The findings suggest that EE provides a reliable and useful assessment of the family environment in families of young children.

The significance of at-risk symptoms for psychosis in children and adolescents

The early detection and treatment of people at risk for psychosis is currently regarded as a promising strategy in fighting the devastating consequences of psychotic disorders. Currently, the 2 most broadly used sets of at-risk criteria, that is, ultra-high risk (UHR) and basic symptom criteria, were developed mainly in adult samples. We review the data regarding the presence and relevance of at-risk symptoms for psychosis in children and adolescents. The few existing studies suggest that attenuated psychotic symptoms (APS) and brief limited intermittent psychotic symptoms (BLIPS) do have some clinical relevance in young adolescents from the general population. Nevertheless, their differentiation from atypical psychotic symptoms or an emerging schizotypal personality disorder, as well as their stability and predictive accuracy for psychosis, are still unclear. Further, standard interviews for UHR criteria do not define a minimum age for the assessment of APS and BLIPS or guidelines as to when and how to include information from parents. APS and basic symptoms may be predictive of conversion to psychosis in help-seeking young adolescents. Nevertheless, the rate and timing, and thus the required observation time, need further study. Moreover, no study has yet addressed the issue of how to treat children and adolescents presenting with at-risk symptoms and criteria. Further research is urgently needed to examine if current at-risk criteria and approaches have to be tailored to the special needs of children and adolescents. A preliminary rationale for how to deal with at-risk symptoms for psychosis in clinical practice is provided.

Family functioning and the course of adolescent bipolar disorder

The symptoms of bipolar disorder affect and are affected by the functioning of family environments. Little is known, however, about the stability of family functioning among youth with bipolar disorder as they cycle in and out of mood episodes. This study examined family functioning and its relationship to symptoms of adolescent bipolar disorder, using longitudinal measures of family cohesion, adaptability, and conflict. Parent- and adolescent-reported symptom and family functioning data were collected from 58 families of adolescents with bipolar disorder (mean age =14.48±1.60; 33 female, 25 male) who participated in a 2-year randomized trial of family-focused treatment for adolescents (FFT-A). Cohesion and adaptability scores did not significantly change over the course of the study. Parent-reported conflict prior to psychosocial treatment moderated the treatment responses of families, such that high-conflict families participating in FFT-A demonstrated greater reductions in conflict over time than low-conflict families. Moreover, adolescent mania symptoms improved more rapidly in low-conflict than in high-conflict families. For all respondents, cohesion, adaptability, and conflict were longitudinally correlated with adolescents' depression scores. Finally, decreases in parent-reported conflict also predicted decreases in adolescents' manic symptoms over the 2-year study. Findings suggest that family cohesion, adaptability, and conflict may be useful predictors of the course of adolescent mood symptoms. Family conflict may be an important target for family intervention in early onset bipolar disorder.

Views of young people with depression about family and significant other support: interpretative phenomenological analysis study

Families and significant others have an important role in helping young people cope with depression, but lack of support undermines coping. In this paper, we present the views of young people with depression about the role of family and significant others in assisting them to cope with their illness. An interpretative phenomenological analysis study was undertaken using semistructured, audio-recorded interviews with 26 young people diagnosed with depression. The findings present two contrasting themes in the data, which reflect the young people's views about the influence of families and significant others in helping them cope with depression. The first, being supportive, highlighted how families and significant others helped through patience, tolerance, understanding, and encouragement; all of which strengthened young people's resilience as they attempted to cope with depression. The second theme, being unsupportive, showed how, in the young people's view, family conflict and change, and living in an unsupportive environment, compromised their ability to cope with depression. The findings suggest that mental health nurses, other clinicians, and primary care practitioners need to increase families' and significant others' understandings of depression and their capacity to support young people in these circumstances.

Toward an integration of cognitive and genetic models of risk for depression

There is growing interest in integrating cognitive and genetic models of depression risk. We review two ways in which these models can be meaningfully integrated. First, information-processing biases may represent intermediate phenotypes for specific genetic influences. These genetic influences may represent main effects on specific cognitive processes or may moderate the impact of environmental influences on information-processing biases. Second, cognitive and genetic influences may combine to increase reactivity to environmental stressors, increasing risk for depression in a gene×cognition×environment model of risk. There is now growing support for both of these ways of integrating cognitive and genetic models of depression risk. Specifically, there is support for genetic influences on information-processing biases, particularly the link between 5-HTTLPR and attentional biases, from both genetic association and gene×environment (G×E) studies. There is also initial support for gene×cognition×environment models of risk in which specific genetic influences contribute to increased reactivity to environmental influences. We review this research and discuss important areas of future research, particularly the need for larger samples that allow for a broader examination of genetic and epigenetic influences as well as the combined influence of variability across a number of genes.

Expressed emotion-criticism and risk of depression onset in children

The primary goal of the current study was to examine the impact of maternal criticism (expressed emotion-criticism; EE-Crit) on the prospective development of depressive episodes in children. In addition to examining baseline levels of EE-Crit, we also sought to determine whether distinct subgroups (latent classes) of mothers could be identified based on the levels of EE-Crit they exhibited over a multiwave assessment and whether that latent class membership would predict depression onset in children. Finally, we examined whether EE-Crit and maternal depression would independently predict children's depression risk or whether EE-Crit would moderate the link between maternal depression and children's depression onset. Children of mothers with or without a history of major depression (N = 100) were assessed 5 times over 20 months. Children completed the Children's Depression Inventory and mothers completed the Five Minute Speech Sample and the Beck Depression Inventory at the baseline assessment, and at 2-, 4-, and 6-month follow-up assessments. Children and mothers completed diagnostic interviews assessing children's onsets of depressive episodes at the 20-month follow-up. Latent class analysis of the 4 waves of EE-Crit assessments revealed two distinct groups, exhibiting relatively lower versus higher levels of EE-Crit across the first 6 months of follow-up. EE-Crit latent class membership predicted children's depression onset over the subsequent 14 months. This finding was maintained after controlling for mother's and children's depressive symptoms during the initial 6 months of follow-up. Finally, maternal depression did not moderate the link between EE-Crit and childhood depression onset. Continued exposure to maternal criticism appears to be an important risk factor for depression in children, risk that is at least partially independent of the risk conveyed by maternal depression. These results highlight the importance of a modifiable risk factor for depression-repeated exposure to maternal criticism.

Maternal and child expressed emotion as predictors of treatment response in pediatric obsessive-compulsive disorder

Expressed emotion (EE) is associated with symptoms and treatment outcome in various disorders. Few studies have examined EE in pediatric OCD and none of these has assessed the child's perspective. This study examined the relationship among maternal and child EE, child OCD severity, and OCD-related functioning pre- and post-treatment. At pre-treatment, mothers completed speech samples about the child with OCD and an unaffected sibling. Children with OCD completed speech samples about parents. There were low rates of high maternal EE (child with OCD: 16.1%; sibling: 2.6%) and high child EE about parents (mothers: 11.9%; fathers: 10.2%). High EE was primarily characterized by high criticism, not high overinvolvement. High maternal EE and child EE regarding fathers were associated with pre-treatment child OCD severity but not post-treatment severity. High child and maternal EE were predictive of post-treatment OCD-related functioning. EE may be an important child and maternal trait associated with pre-treatment OCD severity and generalization of treatment gains.

Relational stressors and depressive symptoms in late adolescence: rejection sensitivity as a vulnerability

The role of rejection sensitivity as a critical diathesis moderating the link between adolescent relational stressors and depressive symptoms was examined using multi-method, multi-reporter data from a diverse community sample of 173 adolescents, followed from age 16 to 18. Relational stressors examined included emotional abuse, maternal behavior undermining adolescents' autonomy and relatedness, and lack of support from close peers. As hypothesized, multiple relational stressors were found to predict the future development of depressive symptoms, but as hypothesized predictions existed primarily for adolescents who were highly rejection sensitive. Results are discussed in terms of a diathesis-stress model of depression and suggest that though relational stressors have previously shown consistent modest links to depressive symptoms, understanding pre-existing intrapsychic vulnerabilities of the adolescent may be critical to identifying the processes by which such stressors lead to depressive symptoms.

Family environment, expressed emotion and adolescent self-harm: a review of conceptual, empirical, cross-cultural and clinical perspectives

Self-harm in young people is a complex and pervasive problem with a number of co-existing risk factors. Although research has implicated a range of family variables in understanding the onset, maintenance and prevention of adolescent self-harm, relatively little attention has been given to the expressed emotion (EE) construct. Based on a narrative review and synthesis of peer-reviewed literature up to and including 2011, this paper considers the conceptual background and empirical evidence for the role of family environment in the expression of adolescent self-harm, with a particular focus on EE. The clinical implications of this literature for working with young people and families from different cultures are also addressed. In summary, the surveyed research provides insufficient evidence for a direct causal link between family environment and adolescent self-harm, with questions raised about the temporal sequencing of measured variables, specificity of implicated family risk factors, and the nature and role of protective factors in families. Emerging evidence for an association between high EE and adolescent self-harm requires replication in well-controlled, prospective studies. There is also a lack of empirically-supported, family-based treatment modalities for adolescents who self-harm. Intervention strategies should be guided by personalised formulation, taking into account individual vulnerabilities, strengths and social contexts, as well as cultural norms for family environment.

How does longitudinally measured maternal expressed emotion affect internalizing and externalizing symptoms of adolescents from the general community?

BACKGROUND

In previous studies, maternal expressed emotion (EE) has been found to be a good predictor of the course of adolescent internalizing and externalizing symptoms. However, these studies have been cross-section as opposed to longitudinal. The goal of this study is to examine longitudinal data of perceived maternal EE and adolescent internalizing and externalizing symptoms to determine if maternal EE affected the course of adolescent symptoms (a parent effect model), or if the course of adolescent symptoms affected maternal EE (a child effect model), or if maternal EE and adolescent symptoms affected one another bidirectionally.

METHODS

Dutch adolescents (N = 497; 57% boys; M = 13 years) from the general community and their mothers were prospectively studied annually for three years. At all waves the mothers completed the Level of Expressed Emotion (LEE) questionnaire and the adolescents completed self-rated measures of internalizing and externalizing symptoms. Structural equation modeling (SEM) was used to analyze the longitudinal data.

RESULTS

The results of the SEM analyses clearly demonstrate that a child effect model best describes the relationship between maternal EE and the course of adolescent internalizing and externalizing symptoms.

CONCLUSIONS

This longitudinal study of the mothers' EE perceptions suggests that it is the course of the internalizing and externalizing symptoms of adolescents from the general community that affects maternal EE, and not the mothers' perceived EE influencing the course of the adolescents' symptoms. Since this study was based on adolescents from the general community, it is suggested that these findings should also be replicated in clinical samples of adolescents.

Disentangling child and family influences on maternal expressed emotion toward children with attention-deficit/hyperactivity disorder

OBJECTIVE

We used multi-level modelling of sibling-pair data to disentangle the influence of proband-specific and more general family influences on maternal expressed emotion (MEE) toward children and adolescents with attention-deficit/hyperactivity disorder (ADHD).

METHOD

MEE was measured using the Five Minute Speech Sample (FMSS) for 60 sibling pairs (aged 5 through 17 years) each comprising one proband with ADHD and one child without ADHD. Questionnaire measures were used to assess child and adolescent conduct and emotional problems and maternal depression and ADHD. Multi-level models partitioned the effects of five MEE components (initial statement [IS], relationship [REL], warmth [WAR], critical comments [CC], and positive comments [PC]) into proband-specific and general family effects.

RESULTS

Significant proband-specific effects were confirmed for all MEE components, with higher levels of MEE expressed toward probands with ADHD than siblings without ADHD. For REL, PC, and CC, this effect was explained by comorbid child conduct problems rather than ADHD. Only low WAR was associated with child ADHD itself. Furthermore, only low WAR was related to variations in more general family characteristics, especially levels of maternal depression.

CONCLUSIONS

MEE toward children with ADHD was influenced by proband-specific factors. For most components, these were driven by comorbid symptoms of conduct problems rather than ADHD itself. WAR was different; it was influenced by both child-specific and more general characteristics of the family. Further studies utilising a longitudinal design are required to establish the direction of causation and extend our understanding of the relationship between EE components and ADHD.

Predictors of parental locus of control in mothers of pre- and early adolescents

Parental locus of control refers to parents' perceived power and efficacy in child-rearing situations. This study explored parental locus of control and its correlates in 160 mothers of children ages 8 to 14 cross-sectionally and 1 year later. Maternal depression, maternal expressed emotion, and child internalizing and externalizing behavior were examined, along with a number of sociodemographic factors. Cross-sectional analyses indicated that external parental locus of control was associated with child externalizing behavior, maternal depression, less maternal education, lower income, and older maternal age. Longitudinal analyses showed that child age and externalizing behavior also predicted increases in external parental locus of control 1 year later. Finally, lower income and less parental perceived control predicted increases in child externalizing behavior over time.