Parental separation and children's behavioral/emotional problems: the impact of parental representations and family conflict

All in the Family? A Systematic Review and Meta-analysis of Parenting and Family Environment as Risk Factors for Attention-Deficit/Hyperactivity Disorder (ADHD) in Children

Parenting and family environment have significant impact on child development, including development of executive function, attention, and self-regulation, and may affect the risk of developmental disorders including attention-deficit/hyperactivity disorder (ADHD). This paper examines the relationship of parenting and family environment factors with ADHD. A systematic review of the literature was conducted in 2014 and identified 52 longitudinal studies. A follow-up search in 2021 identified 7 additional articles, for a total of 59 studies that examined the association of parenting factors with ADHD outcomes: ADHD overall (diagnosis or symptoms), ADHD diagnosis specifically, or presence of the specific ADHD symptoms of inattention and hyperactivity/impulsivity. For parenting factors that were present in three or more studies, pooled effect sizes were calculated separately for dichotomous or continuous ADHD outcomes, accounting for each study's conditional variance. Factors with sufficient information for analysis were parenting interaction quality (sensitivity/warmth, intrusiveness/reactivity, and negativity/harsh discipline), maltreatment (general maltreatment and physical abuse), parental relationship status (divorce, single parenting), parental incarceration, and child media exposure. All factors showed a significant direct association with ADHD outcomes, except sensitivity/warmth which had an inverse association. Parenting factors predicted diagnosis and overall symptoms as well as inattentive and hyperactive symptoms when measured, but multiple factors showed significant heterogeneity across studies. These findings support the possibility that parenting and family environment influences ADHD symptoms and may affect a child's likelihood of being diagnosed with ADHD. Prevention strategies that support parents, such as decreasing parenting challenges and increasing access to parent training in behavior management, may improve children's long-term developmental health.

Selective mutism and the risk of mental and neurodevelopmental disorders among siblings

The siblings of children with mental disorders are more likely to experience mental health issues themselves, but there has been a lack of sibling studies on selective mutism (SM). The aim of this population-based study was to use national registers to examine associations between children with SM and diagnoses of various mental disorder in their siblings. All singleton children born in Finland from 1987 to 2009, and diagnosed with SM from 1998 to 2012, were identified from national health registers and matched with four controls by age and sex. Their biological siblings and parents were identified using national registries and the diagnostic information on the siblings of the subjects and controls was obtained. The final analyses comprised 658 children with SM and their 1661 siblings and 2092 controls with 4120 siblings. The analyses were conducted using generalized estimating equations. Mental disorders were more common among the siblings of the children with SM than among the siblings of the controls. The strongest associations were observed for childhood emotional disorders and autism spectrum disorders after the data were adjusted for covariates and comorbid diagnoses among SM subjects. The final model showed associations between SM and a wide range of disorders in siblings, with strongest associations with disorders that usually have their onset during childhood. Our finding showed that SM clustered with other mental disorders in siblings and this requires further research, especially the association between SM and autism spectrum disorders. Strong associations with childhood onset disorders may indicate shared etiologies.

Prevalence of and factors associated with peer emotional and physical violence among youth ages 13-17 in Cote d'Ivoire

BACKGROUND

Peer violence during childhood is associated with negative outcomes. Data are limited on its associated factors in sub-Saharan Africa.

OBJECTIVE

This study assesses the prevalence and factors associated with peer emotional and physical violence among children and adolescents aged 13-17years in Côte d'Ivoire.

PARTICIPANTS AND SETTING

Data from the 2018 Côte d'Ivoire Violence Against Children and Youth Survey (VACS) were used to examine peer emotional and physical violence victimization. VACS is a national cross-sectional household survey of females and males aged 13-24years.

METHODS

Data included physical, emotional, and sexual violence and socioeconomic, demographic, and relationship factors. We computed the adjusted odds ratios (AOR) and confidence interval (CI) for associated factors adjusted for food insecurity and rural or urban setting.

RESULTS

Thirty-one percent of females and 46.7 % of males experienced lifetime peer physical violence and 36.8 % of females and 40.2 % of males experienced peer emotional violence in the past 12 months. Witnessing violence in the home towards the mother (female AOR 1.2, CI 1.0-1.3); male AOR 1.4, CI 1.2-1.6) and witnessing violence in the home towards a sibling (female AOR 1.2, CI 1.1-1.3; male AOR 1.3, CI 1.12-1.4) increased the odds of ever experiencing peer physical violence. In males, not living with their biological mother (AOR 1.2, CI 1.0, 1.4) or biological father (AOR 1.2, CI 1.1-1.3) was associated with ever experiencing peer physical violence.

CONCLUSION

Interventions for children and adolescents living without parents and programming focused on education and skills-building may help to reduce peer violence against children in Côte d'Ivoire.

Dispute intensity, parent-child relationships and child functioning: Analysis of social workers' reports on families with high-intensity parental disputes

BACKGROUND

High Intensity Parental Dispute (HIPD) is a universal phenomenon that has grave ramifications on the dyadic and familial cells, which are receiving considerable attention in the research, public and professional discourses. However, a significant gap exists between the intensive involvement of systems in this phenomenon, and their ability to characterize and measure cardinal concepts defining it.

OBJECTIVE

The goal of the present study is to examine how indicators that are recognized in literature on HIPD are manifested in the practice of social workers involved in this sphere. More specifically, three dimensions included in evaluations on families involved in HIPD will be examined: dispute intensity, parent-child relationships, and child functioning.

METHOD

The sample included 199 written reports by social workers on families deemed by the court to be involved in HIPD. First, encoding systems for each dimension were developed using deductive content analysis. Second, the frequency of the indicators was examined and qualitatively different subgroups within each dimension were identified using Latent Class Analysis (LCA) or Latent Profile Analysis (LPA).

RESULTS

The findings uncovered two significantly different groups for couples involved in HIPD and revealed the common profiles for parent-child relationships and for child functioning.

CONCLUSIONS

The findings illustrate that there is no single characterization that can accurately describe different dimensions in the lives of families with HIPD, rather that subgroups with different behaviors should be expected to emerge. Thus, the findings emphasize the importance of using systematic measurements for identification and evaluation that could assist in fine tuning interventions and optimized resource allocation.

Impact of Parental Representations and Related Parenting Behavior On Children

Parental representations tend to be formed in the prenatal period and affect the child- parent relationship in the long term. Therefore, in the clinical environment, it is important to define parents’ representations to increase the success of therapeutic interventions and prevent childhood psychopathologies with various intervention programs. With this concern, the aim of this review was to summarize the literature about parental representations and their relationship between parenting behavior, and childhood developmental problems. Related to this purpose, this review includes the definition and categories of parental representations, the factors which contribute to parental representations, and the relations between parenting and childhood developmental problems.

Prescriptions of Psychotropic Medications by Providers Treating Children of Military Service Members

INTRODUCTION

There are approximately 1.5 million U.S. military-dependent children. However, little is known about mental health referrals for these youths. This study sought to examine the type of mental health treatment referrals made by primary care providers for child military-dependent beneficiaries receiving care in the direct (within Military Treatment Facilities) and private care (civilian-fee-for service facilities) sectors of the Military Health System.

MATERIALS AND METHODS

A between-subjects, cross-sectional study was performed on children aged 5-18 years old in fiscal years 2011-2015 and enrolled in TRICARE Prime. Study analyses examined specialty ("talk therapy") mental health care and psychotropic medication referrals from TRICARE Prime (the Defense Health Agency-managed health care program) providers for beneficiary children diagnosed with attention-, mood-, anxiety-, or behavior-related disorders in direct versus private sector care.

RESULTS

Of 1,533,630 children enrolled in TRICARE Prime (50.03% female), 8.6% (n = 131,393) were diagnosed with a psychological disorder during FY 2011-2015. Most were attention-related (5.2%, n = 79,770), followed by mood (1.7%, n = 25,314), anxiety (1.1%, n = 16,155), and conduct-related diagnoses (0.7%, n = 10,154). Adjusting for age, sex, and sponsor rank, children within direct care diagnosed with attention-related disorders were 1.7 times more likely to receive a prescription for psychotropic medication than those in private sector care, odds ratio (OR) = 1.72, 95% confidence interval (CI): [1.66, 1.77]. Children diagnosed with mood-related disorders in direct care were 2.1 times more likely to receive a prescription for psychotropic medication than those in private sector care, OR = 2.08, 95% CI: [1.96, 2.21]. Across disorders, children who received private sector care were more likely to have a referral specialty mental health ("talk therapy") follow-up (ps < 0.0001).

CONCLUSIONS

For attention- and mood-related disorders, but not anxiety- or conduct-related disorders, direct care providers were more likely than private sector care providers to prescribe psychotropic medications. Inconsistencies of provider referrals within and outside of the Military Health System should be elucidated to determine the impact on outcomes.

Everyday Conflict in Families at Risk for Violence Exposure: Examining Unique, Bidirectional Associations with Children's Anxious- and Withdrawn-Depressed Symptoms

Exposure to family conflict during childhood increases risk for the development of anxiety and mood problems, though the potential for bidirectionality in this association remains unknown. It is also unclear whether nonviolent family conflict is related to children's anxious- and withdrawn-depressive symptoms within high-risk family contexts, independent of more severe events such as children's exposure to violent victimization. Participants included 1,281 children and their caregivers identified as being at high risk for family violence, interviewed prospectively at ages 6, 8, and 10 about family conflict, children's anxious- and withdrawn-depressive behaviors, and children's victimization experiences. After controlling for cumulative victimization prior to and between each time point, significant cross-lagged, bidirectional associations were identified between family conflict and children's anxious- and withdrawn-depressive symptoms across ages 6 and 8, but not across ages 8 and 10. Invariance testing revealed no differences in model fit between boys and girls and minimal differences depending on whether families were reported for maltreatment prior to recruitment. Findings are partially supportive of a conceptualization of the family-child relationship that is reciprocal, while highlighting the role of daily negative familial interactions, over and above experiences of victimization, in predicting anxious- and withdrawn-depressed symptoms in early and middle childhood.

Children's Maternal Representations Moderate the Efficacy of Parent-Child Interaction Therapy-Emotion Development (PCIT-ED) Treatment For Preschool Depression

A randomized controlled trial (RCT) demonstrated that a novel psychotherapy, Parent-Child Interaction Therapy-Emotion Development (PCIT-ED), effectively treats preschool-onset depression. However, little is known about which children benefit most from PCIT-ED. As positive parent-level factors are associated with lesser depressive symptoms, this study explored the potential moderating role of positive parenting relationships on PCIT-ED efficacy. This study examined mothers and their children aged 3-6 (N = 185) who participated in the PCIT-ED RCT. Children were randomized to immediate PCIT-ED treatment (n = 94) or a waitlist control condition (n = 91) that received treatment after 18 weeks. Prior to treatment, children completed a narrative story completion task that was videotaped and coded for children's positive and negative representations of their mothers. Parent-child interaction tasks were also completed pre-treatment and videotaped and coded to measure observed parenting. Odds of MDD diagnosis post-treatment were predicted by the interaction of children's negative maternal representations and treatment group (Estimate = -.68; SE = .27; [Formula: see text] = 6.45; p = .01) and the interaction of children's relatively more positive than negative maternal representations and treatment group (Estimate = .30; SE = .13; [Formula: see text] = 5.27; p = .02). Observed parenting measures did not significantly predict odds of MDD diagnosis. Thus, PCIT-ED predicted loss of MDD diagnosis for children who displayed maternal representations that were less negative, and relatively more positive than negative. Results suggest that children with relatively more positive maternal representations may be more likely to benefit from PCIT-ED, whereas children with more negative maternal representations may need targeted work to decrease negative maternal perceptions before initiating PCIT-ED in order for treatment to be most effective.

Parenting Styles, Coparenting, and Early Child Adjustment in Separated Families with Child Physical Custody Processes Ongoing in Family Court

Coparenting conflict and triangulation after separation or divorce are associated with poorer child adjustment when parenting gatekeeping and conflict occur. Fewer studies reported psychosocial adjustment of children under three. We explored the effects of authoritarian and permissive parenting styles and negative coparenting on child adjustment in a purpose sample of 207 Portuguese newly separated/divorced parents (50.2% mothers/49.8% fathers) with sole or joint (49.8%/50.2%) physical custody processes ongoing in court. Parents filled out the Parenting Styles Questionnaire-Parents' report, the Coparenting Questionnaire, and the Strengths and Difficulties Questionnaire. Parenting and coparenting moderations path analysis to predict child adjustment were tested for two groups (2/3-year-old child/>3-year-old-child) and showed a good fit, followed by multigroup path analysis with similarities. Findings suggest harsh parenting and interparental conflict and triangulation as predictors for poor early child adjustment. The ongoing custody process could contribute to increased interparental conflict. The families' unique functioning, parenting, and conflict should be considered in young children custody decisions made in a particularly stressful period when the parental responsibilities' process is still ongoing and conflict may increase to serve the best interest of the child and promote healthy development. Future directions and practical implications are discussed.

The whole is greater than the sum of its parts: profiles of multiple mental health risk factors using Latent class analysis

BACKGROUND

The exposure to an accumulation of various risk factors during childhood and adolescence relative to a single risk is associated with poorer mental health. Identification of distinct constellations of risk factors is an essential step towards the development of effective prevention strategies of mental disorders. A Latent class analysis (LCA) extracts different combinations of risk factors or subgroups and examines the association between profiles of multiple risk and mental health outcomes.

METHODS

The current study used longitudinal survey data (KiGGS) of 10,853 German children, adolescents and young adults. The LCA included 27 robust risk and protective factors across multiple domains for mental health.

RESULTS

The LCA identified four subgroups of individuals with different risk profiles: a basic-risk (51.4%), high-risk (23.4%), parental-risk (11.8%) and social-risk class (13.4%). Multiple risk factors of the family domain, in particular family instability were associated with negative mental health outcomes (e.g. mental health problems, depression, ADHD) and predominately comprised late adolescent girls. The social environment represented a more common risk domain for young males.

CONCLUSION

The understanding of multiple risk and different risk "profiles" helps to understand and adjust targeted interventions with a focus on vulnerable groups.

Multiple risk factors affecting childhood psychosocial dysfunction in primary school Egyptian children

Background

Childhood psychosocial dysfunction (CPD) is an important cause of morbidity among children, and its frequency in primary care is growing. The information about its prevalence and risk factors is weak in many developing countries. The study aims to determine the prevalence of psychosocial problems among primary school children and identify the risk factors associated with childhood psychosocial dysfunction.

Results

A cross-sectional study was conducted on 368 primary school children aged 6–12 years. About (19.0%) of the studied sample had probable CPD according to Strengths and Difficulties Questionnaire (SDQ). CPD was statistically associated with older age group, male sex, and low social class.

The association between biological and medical risk factors of the studied group and CPD showed statistical significant relations between CPD and low body weight (n = 35, 50.7%), maternal history of problems with pregnancy (n = 26, 66.47%), history of receiving medications during pregnancy (n = 13, 86.7%), abnormal general condition of baby at birth (n = 57, 16.2%), family history of mental disorders (n = 2, 100%), medical history of congenital diseases (n = 9, 90%), acute medical disorders (n = 29, 90.6%), chronic diseases, receiving medications (n = 22, 91.7%), and exposure to trauma (n = 27, 84.4%).

Also, The association between psychosocial risk factors and CPD revealed high statistical significant relation between CPD among the studied children and presence of family problems (n = 33, 62.3%), living with single parent (n = 15, 71.4%), parent(s) death (n = 12, 63.2%), major changes in the family (n = 39, 79.6%), parent(s) smoking status (n = 22, 51.2%), and parent(s) addiction (n = 4, 100%).

Moreover, there was statistical significant relation between CPD among the studied children and poor academic achievement (n = 19, 27.5%), problems with teachers (n = 25, 33.3%), problems with peers (n = 22, 51.2%), and exposure to violence (n = 56, 22.4%).

Conclusions

Psychosocial dysfunction is common among Egyptian school children. It is associated with many risk factors. Hence, mental health services should be incorporated into primary health care facilities and school health program. Also, training of family physicians and primary health care providers is crucial.

[Differences in Conflict-Based Play Behavior, Socio-Emotional and Cognitive Development of Preterm Children Compared to Full-Term Children at Preschool Age]

Differences in Conflict-Based Play Behavior, Socio-Emotional and Cognitive Development of Preterm Children Compared to Full-Term Children at Preschool Age Preterm children are at increased risk for socio-emotional and cognitive developmental difficulties at preschool age. This study investigates whether preterm children (n = 50) at the age of five years show different socio-emotional competencies in conflict situations and in the corresponding conflict resolution capacity in comparison to full-term children (n = 50). For this purpose, the MacArthur Story Stem Battery was used as the central examination method. In addition, parents completed the Strengths and Difficulties Questionnaire to obtain information about the children's behavior; moreover, the Wechsler Preschool and Primary Scale of Intelligence - Third Edition was applied to examine cognitive development. The parental reports did not reveal any behavioral differences between preterm and term children. However, significant group differences regarding their play behavior were detected. In their narratives, preterm children included content themes of interpersonal conflict and dysregulation more frequently compared to term born controls. Concerning empathic and moral themes and narrative coherence, no group difference could be detected. This could indicate that preterm children show no clinically manifest behavioral disorders at preschool age, but differences concerning intrapsychic experience compared to controls. In addition, preterm children had significantly lower IQ scores than term-born controls. Gestational age was a significant predictor of IQ and hyperactivity and attention problems. The results clarify the need for long term clinical follow up of preterm children and should be used to provide more specific care and support.

The Complex Role of Parental Separation in the Association between Family Conflict and Child Problem Behavior

Parental separation is a major adverse childhood experience. Parental separation is generally preceded by conflict, which is itself a risk factor for child problem behavior. Whether parental separation independent of conflict has negative effects on child problem behavior is unclear. This study was embedded in Generation R, a population-based cohort followed from fetal life until age 9 years. Information on family conflict was obtained from 5,808 mothers and fathers. The 4-way decomposition method was used to apportion the effects of prenatal family conflict and parental separation on child problem behavior into 4 nonoverlapping components. Structural equation modeling was used to test bidirectional effects of child problem behavior and family conflict over time. Family conflict from pregnancy onward and parental separation each strongly predicted child problem behavior up to preadolescence according to maternal and paternal ratings. Using the 4-way decomposition method, we found evidence for a strong direct effect of prenatal family conflict on child problem behavior, for reference interaction, and for mediated interaction. The evidence for interaction implies that prenatal family conflict increased the children's vulnerability to the harmful effect of parental separation. There was no evidence of a pure indirect effect of parental separation on child problem behavior. Overall, results indicated that if parental separation occurs in families with low levels of conflict, parental separation does not predict more child problem behavior. Moreover, the bidirectional pattern suggested that child problem behavior influences the persistence of family conflict.

The voice of the child in parental divorce: implications for clinical practice and mental health practitioners

OBJECTIVE

Research on parental divorce suggests that the nature of the divorce process, as experienced by the child, is the most important factor in his or her post-divorce adjustment. Research regarding children's experiences of the divorce process has been limited and the adult perspective has dominated the discourse on divorce; only recently has research started to consider children's viewpoint. This article describes a narrative inquiry into the experiences and perceptions of parental divorce, of 9- to 10-year-old children. Its aim is to use children's stories of parental divorce to inform the practice of professionals working with such children.

METHOD

The research adopted a narrative paradigm. Unstructured interviews were conducted with five children whose parents were divorced. Data were analysed thematically.

FINDINGS

Seven themes were identified. The first theme explored children's endeavours to describe and explain parental divorce. An additional six themes were developed around the types of stories children told of the divorce process. The seven themes were: (i) What is a divorcement; (ii) Stories of loss; (iii) Stories of gain; (iv) Stories of change; (v) Stories of stability; (vi) Healing stories; and (vii) Complicating stories.

CONCLUSION

On the basis of the narratives elicited from children on parental divorce, this article proposes several guidelines for professionals such as psychologists, registered counsellors, social workers, and teachers as well as parents in their possible interventions with children. Some guidelines may also be of use to family and maintenance courts, and the government departments of health and education.

Psychiatric disorders among adolescents from Lebanon: prevalence, correlates, and treatment gap

PURPOSE

Adolescence is a critical age for the development of psychiatric disorders. Although Lebanon, a low-to-middle income country, has suffered from decades of war and political instability, the burden of psychiatric disorders among adolescents in Lebanon remains unclear. This study aims to estimate the prevalence of psychiatric disorders among adolescents in the Lebanese capital, Beirut, and to study the correlates and treatment seeking behavior associated with these disorders.

METHODS

Through a multistage cluster sampling design, 510 adolescents, aged 11-17 years were recruited from a household sample in Beirut in 2012. Parents and adolescents completed a battery of self-reported questionnaires and interviews including the Development and Well-being Assessment (DAWBA), the Peer-Relations Questionnaire (PRQ), and a demographic/clinical information questionnaire. Logistic regression models were used to study the correlates of psychiatric disorders.

RESULTS

The 30-day prevalence of psychiatric disorders was 26.1 %, with anxiety disorders (13.1 %) and ADHD (10.2 %) being the most prevalent disorders. Only 6 % of those with disorders reported seeking professional help. Parental marital status, not attending school, having a chronic medical condition, having a family history of psychiatric disorders, as well as propensity to bullying and to being victimized by peers emerged as correlates of having psychiatric disorders.

CONCLUSIONS

A clear treatment gap is evident with a high 30-day prevalence of psychiatric disorders among adolescents in Beirut coupled with a very low percentage seeking treatment. Scaling up mental health services and addressing potential barriers to seeking care would be important to close this gap.

New approaches to divorce with children: A problem of public health

This broad review elaborates on the most up-to-date knowledge on biochemical and psychobiological aspects of parental loss and other childhood adversities during divorce involving minor children. So far, divorce involving minor children was unfortunately considered by authorities only as a purely juridical problem, and this approach has often allowed a completely different approach according to the Courts. Now, scientific research, also making use of animal models, is demonstrating the biological basis of the problem and the indisputable consequences on the well-being and health of children. The innovative conclusion of this review is that this argument (because of its frequency and gravity) is primarily a question of public health and that it is necessary to further harmonize practices in this area.

Analyzing pathways from childhood maltreatment to internalizing symptoms and disorders in children and adolescents (AMIS): a study protocol

BACKGROUND

Effective interventions for maltreated children are impeded by gaps in our knowledge of the etiopathogenic mechanisms leading from maltreatment to mental disorders. Although some studies have already identified individual risk factors, there is a lack of large-scale multilevel research on how psychosocial, neurobiological, and genetic factors act in concert to modulate risk of internalizing psychopathology in childhood following maltreatment. To help close this gap, we aim to delineate gender-specific pathways from maltreatment to psychological disorder/resilience. To this end, we examine the interplay of specific maltreatment characteristics and psychological, endocrine, metabolomic, and (epi-)genomic stress response patterns as well as cognitive-emotional/social processes as determinants of developmental outcome. Specifically, we will explore endocrine, metabolomic, and epigenetic mechanisms leading from maltreatment to a higher risk of depression and anxiety disorders.

METHODS/DESIGN

Four large samples amounting to a total of N = 920 children aged 4-16 years will be assessed: Two cohorts with prior internalizing psychopathology and controls will be checked for maltreatment and two cohorts with substantiated maltreatment will be checked for internalizing (and externalizing) psychopathology. We will apply a multi-source (interview, questionnaires, official records), multi-informant strategy (parents, children, teachers) to assess maltreatment characteristics (e.g., subtypes, developmental timing, chronicity) and psychopathological symptoms, supplemented with multiple measurements of risk and protective factors and cutting-edge laboratory analyses of endocrine, steroid metabolomic and epigenetic factors. As previous assessments in the two largest samples are already available, longitudinal data will be generated within the three year study period.

DISCUSSION

Our results will lay the empirical foundation for (a) detection of early biopsychosocial markers, (b) development of screening measures, and

Stress levels experienced by parents of children with and without attention-deficit/hyperactivity disorder during the back-to-school period: results of a European and Canadian survey

OBJECTIVE

The back-to-school stress survey was designed to compare stress in parents of children/ adolescents with/without attention-deficit/hyperactivity disorder (ADHD) in six European countries and Canada when children prepare to return to school.

METHODS

Parents of children/adolescents (6-17 years) with/without ADHD were recruited and interviewed by a consumer research organization. Parents rated potentially stress-causing situations (both standard and specifically related to the return to school) on a scale from 1 (low stress) to 10 (high stress). Mean scores were compared using Student's t-test.

RESULTS

In Europe, 613/693 (mean [SD] age: 40.7 [7.0]/40.1 [6.9] years) and in Canada, 102/150 (mean [SD] age: 44.4 [8.1]/44.1 [7.2] years) parents of children with/without ADHD, respectively, participated in the survey. Children with ADHD (mean [SD] age: 11.2 [3.2]/12.6 [3.2] years in Europe/Canada) had generally similar characteristics in both samples. Parents in the ADHD group showed higher stress levels than parents in the non-ADHD group in all situations (p < 0.001 for Europe). The return to school was considered one of the most stressful events during the year.

CONCLUSIONS

In Europe and Canada, ADHD has a significant impact on parental stress, particularly during the back-to-school period. This can have important implications as parental stress can affect presentation of ADHD symptoms.

Well-being and suicidal ideation of secondary school students from military families

BACKGROUND

The mental health of children is a primary public health concern; adolescents of military personnel may be at increased risk of experiencing poorer well-being overall and depressive symptoms specifically. These adolescents experience individual and intrafamilial stressors of parental deployment and reintegration, which are directly and indirectly associated with internalizing behaviors.

PURPOSE

The present study sought to better understand the influence of parental military connectedness and parental deployment on adolescent mental health.

METHODS

Data from the 2011 California Healthy Kids Survey examined feeling sad or hopeless, suicidal ideation, well-being, and depressive symptoms by military connectedness in a subsample (n = 14,299) of seventh-, ninth-, and 11th-grade California adolescents. Cross-classification tables and multiple logistic regression analyses were used.

RESULTS

More than 13% of the sample had a parent or sibling in the military. Those with military connections were more likely to report depressive symptoms and suicidal ideation. Controlling for grade, gender, and race/ethnicity, reporting any familial deployment compared with no deployments was associated with increasing odds of experiencing sadness or hopelessness, depressive symptoms, and suicidal ideation.

CONCLUSIONS

Findings emphasize the increased risk of mental health issues among youth with parents (and siblings) in the military. Although deployment-related mental health stressors are less likely during peace, during times of war there is a need for increased screening in primary care and school settings. Systematic referral systems and collaboration with community-based mental health centers will bolster screening and services.

Wartime military deployment and increased pediatric mental and behavioral health complaints

BACKGROUND

Children of military personnel face stress when a parent deploys.

OBJECTIVE

Our goal was to determine the effect of parental military deployment on the relative rate of outpatient visits for mental and behavioral health disorders in children aged 3 to 8 years.

METHODS

This was a retrospective cohort study. Records of children of active-duty personnel during fiscal years 2006 and 2007 were linked with their parent's deployment records. Mental and behavioral health visits were identified by using International Classification of Diseases, Ninth Revision, codes. The incidence rate ratio (IRR) of visits per year according to parental deployment status was determined with random-effects negative binomial regression modeling with longitudinal data analysis.

RESULTS

A total of 642,397 children aged 3 to 8 years and 442,722 military parents were included. Mean child age was 5.0 years (SD: 1.9 years); 50.6% were male, and 68.0% were white. Ninety percent of the parents were male, and 90.5% were married; 32.0% of the parents were deployed during the study. There were 1,049,081 person-years with 611,115 mental and behavioral health visits (0.6 visit per year). The IRR of mental and behavioral health visits for children with a deployed parent compared with when a parent was home was 1.11 (95% confidence interval [CI]: 1.07-1.14; P < .001). IRRs of pediatric anxiety, behavioral, and stress disorders when a parent deployed were 1.14 (95% CI: 0.98-1.32; P = .095), 1.19 (95% CI: 1.07-1.32; P < .001), and 1.18 (95% CI: 1.10-1.26; P < .001), respectively. Older children and children with military fathers and married parents had larger increases in rates of mental and behavioral health visits during parental deployments. In contrast, the overall outpatient rate and rates of visits for other diagnoses decreased when a parent was deployed.

CONCLUSIONS

Mental and behavioral health visits increased by 11% in these children when a military parent deployed; behavioral disorders increased 19% and stress disorders increased 18%. Rates especially increased in older children and children of married and male military parents.