influence of psychopathological disorders of children in family structure and functioning
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INFLUENCE OF PSYCHOPATHOLOGICAL DISORDERS OF CHILDREN IN FAMILY STRUCTURE AND FUNCTIONING. Adrián Cano Prous Baras Pastor et al. Dpto. Psiquiatría y Psicología Medica University Hospital of Navarra www.cun.es. CHILD AND ADOLESCENT PSYCHIATRY. SPECIALIZED NURSERY. SPECIALIZED NURSERY. - PowerPoint PPT PresentationTRANSCRIPT
INFLUENCE OF PSYCHOPATHOLOGICAL DISORDERS OF CHILDREN IN FAMILY
STRUCTURE AND FUNCTIONING
Adrián Cano ProusBaras Pastor et al.
Dpto. Psiquiatría y Psicología MedicaUniversity Hospital of Navarra
www.cun.es
SOCIAL WORKERS
SPECIALIZED NURSERY
PARENTS CHILDREN
SOCIAL WORKERS
ADULT PSYCHIATRY
CHILD AND ADOLESCENTPSYCHIATRY
SPECIALIZED NURSERY
MARITAL AND FAMILYTHERAPY
MARITAL AND FAMILY THERAPY FRAME
MARITALFUNCTIONING
¿ ? ?¿
-
- -
-
MFT
ADULT PSYCHOPATHOLOGY
CHILD PSYCHOPATHOLOGY
FAMILYFUNCTIONING
CURRENT SITUATION
1. MARITAL FUNCTIONING
2. FAMILY FUNCTIONING
3. ADULT PSYCHOPATHOLOGY
4. CHILDREN PSYCHOPATHOLOGY
More than 1 million annual divorces
One marital breakdown every 30 seconds
Over 10 million marital breakdowns in 10 years, that have affected over 15 million children
Marital breakdown I
Family breakdown has increased by far the most in Spain in the last 10 years.
In Spain, family breakdown has increased by 268% in 10 years…
Germany, UK, France and Spain are the UE27 countries with the highest number of divorces.
Marital break-down II
Source: Institute for Family Policies
In europe, marriages that fail last a mean of 13 years.
Italy is the country where marriage lasts longest (16.8), and Austria the one where it lasts least (10.6).
In Spain, marriage lasts a mean of 14 years
Marital break-down III
Source: Institute for Family Policies
CURRENT SITUATION
1. MARITAL FUNCTIONING
2. FAMILY FUNCTIONING
3. ADULT PSYCHOPATHOLOGY
4. CHILDREN PSYCHOPATHOLOGY
Only 2.4 members per household
1.5 persons per household have been ‘lost’ since 1980
Malta, Cyprus, Romania and Spain are the countries with the highest number of members per household
European households I
Source: Institute for Family Policies
Households have fewer children.
2 out of 3 households have no children
Only 17% of households have 2 or more children
European households II
Fuente: Instituto de Política Familiar
CURRENT SITUATION
1. MARITAL FUNCTIONING
2. FAMILY FUNCTIONING
3. ADULT PSYCHOPATHOLOGY
4. CHILDREN PSYCHOPATHOLOGY
HOSPITAL ADMISSIONS IN 2007
0
200000
400000
600000
800000
1000000
1200000
25 - 34 35 - 44 45 - 54 55 - 64
Men
Women
Both
35 – 44 years old: 1.037.803 days admitted to hospital
ADULTS
Source: Spanish National Institute of Statistics
HOSPITAL DISCHARGES IN 2007
35 – 44 years old: 27.376 mental illness discharges
02000400060008000
10000120001400016000
25 - 29
30 - 34
35 - 39
40 - 44
45 - 49
50 - 54
55 - 59
60 - 64
65 - 69
Men
Women
Both
Source: Spanish National Institute of Statistics
CURRENT SITUATION
1. MARITAL FUNCTIONING
2. FAMILY FUNCTIONING
3. ADULT PSYCHOPATHOLOGY
4. CHILDREN PSYCHOPATHOLOGY
0
50
100
150
200
250
300
350
400
450
1993
1994
1995
1996
1997
1998
1999
2000
2001
Patients
0
500
1000
1500
2000
2500
3000
3500
4000
1993
1994
1995
1996
1997
1998
1999
2000
2001
Total #consultations
EVOLUTION OF CHILDREN AND ADOLESCENT PSYCHIATRY CONSULTATIONS
010
2030
4050
6070
8090
Psych
otic D
.
Behavio
r D.
Anxiety
D.
Other n
euros
is
Somat
ic s
ympto
ms ED
Genera
l dev
elopm
ent D
.
Specifi
c dev
elopm
ent D.
Perso
nality
D.
Men
tal d
efic
iency
V. fact
ors
Other i
nfant D
.
Addictio
ns
Suicid
e at
tem
pt
Other d
iagnosi
s
With
out dia
gnosis
CHILDREN AND ADOLESCENT PROGRAM
This program includes all patients under 17 years attended at Mental Health Centres in our community
HOSPITAL ADMISSIONS
0
1000
2000
3000
4000
5000
6000
7000
< 1 año 1 a 4 5 a 9 10 a 14 15 a 19 20 a 24
Men
Women
Both
15 - 24 years old: 10.329 mental illness discharges
Source: Spanish National Institute of Statistics
ADHD
HEALTH50% bike accidents 1
33% emergency room visits2
2–4 x other vehicle accidents 3-5
HEALTH50% bike accidents 1
33% emergency room visits2
2–4 x other vehicle accidents 3-5
PATIENTPATIENTFAMILY3–5 x divorce
or separation11,12 2–4 x fights among siblings 13
depression in parents
FAMILY3–5 x divorce
or separation11,12 2–4 x fights among siblings 13
depression in parents
SCHOOL/WORK46% expelled35% leaving 6
Lower occupational level7
SCHOOL/WORK46% expelled35% leaving 6
Lower occupational level7
SOCIETY2x risk of
Substance abuse 8
Early onset 9
More likelihood ofconsumptionin adulthood10
SOCIETY2x risk of
Substance abuse 8
Early onset 9
More likelihood ofconsumptionin adulthood10
WORK (PARENTS) Work absence
Lower productivity14
WORK (PARENTS) Work absence
Lower productivity14
1 DiScala et al, 1998.2 Liebson et al, 2001.3 NHTSA, 1997. 4-5 Barkley et al, 1993, 1996.
6 Barkley et al, 1990.7 Mannuzza et al, 1997.8 Biederman et al, 1997.
9 Pomerleau et al, 1995.10 Wilens et al, 1995.11 Barkley et al, 1991.
12 Brown & Pacini, 1989. 13 Mash & Johnston, 1983. 14 Noe et al, 1999.
CONSEQUENCES OF UNTREATED ADHD
Mash EJ, Johnston C. J Child Psychol. 1990; 19
• Stress• Self-guilt• Social isolation• Depression• Marital disruption
IMPACT ON THE FAMILY
Note. American Academy of Family Physicians Annual Scientific Assembly, Dallas, September, 2000
21%
10%
11%14%
44%
Change work shifts
Give up working
Others
Change type of work
Shorter time at work
PROFESSIONAL IMPACT ON PARENTS OF UNTREATED ADHD CHILDREN
HYPOTHESIS AND OBJECTIVES
PSYCHIATRY CONSULTATION
CHILDREN PSYCHOPATHOLOGY ¿ ?
¿ ?MARITAL/FAMILY DYSFUNCTION DIVORCES/SEPARATIONS
Family of children going for follow-up to GENERAL PEDIATRICS
SOCIODEMOGRAPHIC DATA
Family of childrenfirst-time going to
CHILDREN AND ADOLESCENT PSYCHIATRY
Family of children going to SPECIALIZED PEDIATRICS
CHILDRENGenderAgeBiologic/adoptedNumber of siblingsPosition among siblingsAcademic year
PARENTSCivil status
Years of marriageSocioeconomic level
Place or residenceEducational level
Occupation
FAD: McMaster Family Assessment Device:assesses family functioning
DAS: Dyadic Adjustment Scale: measures qualityin family relations
FACES III: Family Adaptability and Cohesion Evalution Scale: measures adaptabilityand family cohesion
Family of children going for follow-up to
GENERAL PEDIATRICS
SOCIODEMOGRAPHIC DATA
Family of childrenfirst-time going to
CHILDREN AND ADOLESCENT PSYCHIATRY
Family of children going to SPECIALIZED PEDIATRICS
SOCIODEMOGRAPHIC DATA
37,434,8
4,7
45,142,1
10,9
0
5
10
15
20
25
30
35
40
45
50
Families healthy Families patients
Fathers
Mothers
Children
Ages of family members
SOCIODEMOGRAPHIC DATA
9,6
15,6
0
2
4
6
8
10
12
14
16
Years of marriage
Families healthy
Families illness4,4 4,3
1
2
3
4
5
6
7
8
9
10
Household members
Families healthy
Families illness
NATURE OF CHILDREN
Patients
97,4%
2,6%Biologic
Adopted93,4%
6,6%Biologic
Adopted
Healthy
37,2%
62,8%
Male
Female
CHILDREN GENDER
42,1%
57,9%
Male
Female
Patients
Healthy
5,8%
50,4%38,0%
5,8%
Medium-Low
Medium
Medium-High
High
SOCIOECONOMIC STATUS
2,3%31,9% 63,5%2,3%
Patients
Healthy
74,0%
5,6%
3,6%
13,0%
3,7%
ADHD
Behavior D.
ED
Development D.
Anxiety
PSYCHIATRIC DIAGNOSIS OF CHILDREN
85,9%
11,6% 2,5%
Matches
Doesn't match
Doesn't answer
AGE – ACADEMIC YEAR
97,4%
2,6%Patients
Healthy
DAS: Dyadic Adjustment Scale: measures the quality of dyadic relationships
• FORMAT:– 32 items.
– Different response formats (Likert scales from 2 to 7 points)
• SCALES:– Dyadic Consensus
– Dyadic Satisfaction
– Affectional Expression
– Dyadic Cohesion
– Dyadic Adjustment (global scale)
30
35
40
45
50
55
60
DYADIC CONSENSUS DYADICSATISFACTION
AFFECTIVEEXPRESSION
DYADIC COHESION TOTAL
Fathers
Mothers
DAS - PARENTS OF ILL CHILDREN
30
35
40
45
50
55
60
DYADIC CONSENSUS DYADICSATISFACTION
AFFECTIVEEXPRESSION
DYADIC COHESION TOTAL
Fathers
Mothers
DAS - PARENTS OF HEALTHY CHILDREN
30
35
40
45
50
55
60
DYADIC CONSENSUS DYADICSATISFACTION
AFFECTIVEEXPRESSION
DYADIC COHESION TOTAL
Patients
Healthy
DAS - FATHERS OF BOTH SAMPLES
*
30
35
40
45
50
55
60
DYADIC CONSENSUS DYADICSATISFACTION
AFFECTIVEEXPRESSION
DYADIC COHESION TOTAL
Patients
Healthy
DAS - MOTHERS OF BOTH SAMPLES
*
FAD: McMaster Family Assessment Device:que evalúa el funcionamiento familiar
DAS: Dyadic Adjustment Scale: que mide la calidad de la relación conyugal
FACES III: Family Adaptability and Cohesion Evaluation Scale: que mide la adaptabilidad y la cohesión familiar
Familia de niños que acuden a revisión de
PEDIATRÍA GENERAL
DATOS SOCIODEMOGRÁFICOS
Familia de niños que acudenpor primera vez a
PSIQUIATRÍA INFANTO-JUVENIL
Familia de niños que acude a PEDIATRÍA ESPECIALIZADA
FAD: McMaster Family Assessment Device: measures family functioning
• FORMAT: 60 items.• SCALES:
– Problem solving
– Communication
– Roles
– Affective responsiveness
– Affective involvement
– Behaviour control
FAD - PARENTS OF PATIENTS
30
35
40
45
50
55
60
Proble
m s
olvin
g
Comm
unicat
ion
Roles
Affect
ive
resp
onse
Affect
ive
invo
lvem
ent
Behav.
Contro
l
Total
Mothers
Fathers
Functional
Dysfunctional
FAD - PARENTS OF HEALTHY CHILDREN
30
35
40
45
50
55
60
Proble
m s
olvin
g
Comm
unicat
ion
Roles
Affect
ive
resp
onse
Affect
ive
invo
lvem
ent
Behav.
Contro
l
Total
Fathers
Mothers
Functional
Dysfunctional
FAD - FATHERS OF BOTH SAMPLES
30
35
40
45
50
55
60
Proble
m s
olvin
g
Comm
unicat
ion
Roles
Affect
ive
resp
onse
Affect
ive
invo
lvem
ent
Behav.
Contro
l
Total
Patients
Healthy* *
Functional
Dysfunctional
FAD - MOTHERS OF BOTH SAMPLES
30
35
40
45
50
55
60
Proble
m s
olvin
g
Comm
unicat
ion
Roles
Affect
ive
resp
onse
Affect
ive
invo
lvem
ent
Behav.
Contro
l
Total
Patients
Healthy* *
Functional
Dysfunctional
FAD: McMaster Family Assessment Device:que evalúa el funcionamiento familiar
DAS: Dyadic Adjustment Scale: que mide la calidad de la relación conyugal
FACES III: Family Adaptability and Cohesion Evaluation Scale: que mide la adaptabilidad y la cohesión familiar
Familia de niños que acuden a revisión de
PEDIATRÍA GENERAL
DATOS SOCIODEMOGRÁFICOS
Familia de niños que acudenpor primera vez a
PSIQUIATRÍA INFANTO-JUVENIL
Familia de niños que acude a PEDIATRÍA ESPECIALIZADA
FACES III: Family Adaptability and Cohesion Evaluation Scale: measures adaptability and family cohesion
• FORMAT: 20 items.• SCALES:
– Cohesion: assesses emotional bonds betwen family members
– Adaptability: assesses family ability to vary its structure when needed
– Both scales are represented with the Olson Circumplex Model
EXTREME MEDIUM BALANCED
4
FLEXI-BLE
CHAOTIC
COHESION AltaBaja
FLEXIBILITY
High
LowRIGID
STRUCTU-RED
8
7
6
5
3
2
1
DISENGAGED SEPARATED CONNECTED ENMESHED
Father patients
Mother patients
FACES - PARENTS OF PATIENTS
EXTREME MEDIUM BALANCED
4
FLEXI-BLE
CHAOTIC
COHESION HighLow
FLEXIBILITY
High
LowRIGID
STRUCTU-RED
8
7
6
5
3
2
1
DISENGAGED SEPARATED CONNECTED ENMESHED
Father healthy
Mother healthy
FACES – PARENTS OF HEALTHY CHILDREN
FACES III PADRES
EXTREME MEDIUM BALANCED
4
FLEXI-BLE
CHAOTIC
COHESION LowHigh
FLEXIBILITY
High
LowRIGID
STRUC-TURED
8
7
6
5
3
2
1
DISENGAGED SEPARATED CONNECTED ENMESHED
Father healthy
Father patient
FACES III MADRES
EXTREME MEDIUM BALANCED
4
FLEXI-BLE
CHAOTIC
COHESION HighLow
FLEXIBILITY
High
LowRIGID
STRUC-TURED
8
7
6
5
3
2
1
DISENGAGED SEPARATED CONNECTED ENMESHED
Mother healthy
Mother patient
*
THANKS FOR YOUR ATTENTION
Adrián Cano ProusBaras Pastor et al.
Dpto. Psiquiatría y Psicología MedicaUniversity Hospital of Navarra
www.cun.es