Children with early-onset disruptive behavior (DB) who have a parent with a registered mental disorder are at increased risk for poor psychosocial functioning in middle and late adolescence, according to the results of a study published in the Journal of the American Academy of Child & Adolescent Psychiatry. Furthermore, paternal mental disorder is a better predictor than maternal mental disorder.
It is well known that children with early-onset DB are at high risk for poor psychosocial functioning during adolescence and adulthood. They are more likely to drop out of school, engage in criminal activity, and abuse substances, and are more likely to have reduced social skills and mental health problems. This puts stress on families, and it is believed that childhood DB increases the risk for mental disorders in parents. However, it is not known whether parental mental health problems contribute to the risk for poor psychosocial outcomes in children.
To determine the effect of parental mental health on these children, Peter Josse Roetman, MSc, from Leiden University Medical Center in Oegstgeest, The Netherlands, and colleagues used the Child and Adolescent Twin Study in Sweden to identify participants (n=7999) in the study. They administered the Autism-Tics, AD/HD and other Comorbidities inventory by telephone in connection with the twins’ 9th birthday and contacted the families again on the twins’ 15th and 18th birthdays, collecting information using registries and parent- and self-reports. The identification of a parental mental disorder was based on information retrieved from the National Patient Register.
Child DB was positively associated with all outcome measures at both age 15 years (n=6319) and 18 years (n=3068). At age 15 years, paternal MD was positively associated with violent and nonviolent crime, reactive aggression, and the cumulative risk index. Maternal MD was positively related to parent-reported peer problems. Self-reported truancy was associated with a mental disorder in either parent. Three years later, paternal MD was positively associated with self-reported nonviolent crime, aggression, consequences of antisocial behavior, truancy, registered school performance, and the cumulative risk index of poor functioning. Maternal MD was positively related to parent-reported rule-breaking behavior.
In the subsample of 15-year-old children with DB (n=2215), maternal MD was positively associated with peer problems. Paternal MD was not predictive of any of the outcomes. Conversely, at age 18 years (n=1190), paternal MD was prospectively related to self-reported nonviolent crime, consequences of antisocial behavior, truancy, registered poor school performance, and the cumulative risk index, whereas maternal MD was not predictive of any outcomes.
Investigators wrote that fathers must be considered when studying associations between parental mental disorder and offspring psychosocial functioning. They further suggested that treatment as usual of children with DB should include additional screening of parents and, if indicated, treatment of parental mental health problems.
Roetman PJ, Lundstrom S, Finkenauer C, Vermeiren RRJM, Lichtenstein P, Colins OF.. Children with early-onset disruptive behavior: parental mental disorders predict poor psychosocial functioning in adolescence [published online March 12, 2019]. J Am Acad Child Adolesc Psychiatry. doi:10.1016/j.jaac.2018.10.017