Kaplan + Sadock's Synopsis of Psychiatry, 11e

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Chapter 31: Child Psychiatry

Table 31.1-9 Effects of Divorce on Children

challenging, especially when a child feels that a stepparent is nonsupportive, resents the stepchild, or favors his or her own natural children. Of step-families, 25 percent tend to dissolve within the first 2 years, whereas 75 percent grow to find a new balance in their blended family. A biological child born to a new couple with a stepchild already in the home may receive more attention than the stepchild, leading to of sibling rivalry. After 5 years, about 20 percent of adolescents in step-families suggest that they move out and try living with their other bio- logical parent. Family Factors in Child Development Family Stability.  Parents and children living under the same roof in harmonious interaction is the expected cultural norm in Western society. Within this framework, childhood development presumably proceeds most expeditiously. Devia- tions from the norm, such as divorced- and single-parent fami- lies, are associated with a broad range of problems in children, including low self-esteem, increased risk of child abuse, and increased incidence of divorce when they eventually marry, and increased incidence of mental disorders, particularly depres- sive disorders and antisocial personality disorder as adults. Why some children from unstable homes are less affected than others (or even immune to these deleterious effects) is of great interest. Michael Rutter has postulated that vulnerability is influenced by sex (boys are more affected than girls), age (older children are less vulnerable than younger ones), and inborn personality characteristics. For example, children who have a placid temperament are less likely to be victims of abuse within a family than are hyperactive children; by virtue of their placidity, they may be less affected by the emotional turmoil surrounding them. Adverse Events.  It is now well known that significant adverse events, especially in early childhood such as sexual and physical abuse, neglect, or loss of a parent, interact with genetic background in a given child and influences the trajectory of development. For example, as mentioned earlier early severe maltreatment such as sexual abuse increases the risk of mul- tiple psychosocial difficulties and emergence of many psychi- atric disorders. Among young maltreated children, those with particular genetics, that is, who have the “short” variant of the serotonin transporter gene (short 5-HTTLPR polymorphism) are significantly more vulnerable to chronic depression in adult- hood. This example of specific gene–environment interaction plays an important role in a child’s development as well as in the risk for future psychopathology. Current investigations are also seeking insight into what factors lead to resilience in youth who have been exposed to adverse events, yet maintain allostasis, that is, stability in the face of stressful events. Hormones of the adrenal glands, thyroid, gonads, as well as metabolic hormones play a role on the brain’s ability to maintain stability upon exposure to stress, and the prefrontal cortex, hippocampus, and amygdala play critical roles in regulating emotionality, aggres- sion, and resilience. Day Care Centers.  The role of day care centers for chil- dren is under continuous investigation, and various studies have produced different results. One study found that children

 Children in homes with absent fathers are more likely to suffer from antisocial personality disorder, child conduct disorder, and attention-deficit hyperactivity disorder.  The divorce rate of children of divorced parents doubles that of children from stable families.  Children of divorce are far more likely to be delinquent, engage in premarital sex, and bear children out of wedlock during adolescence and young adulthood.  Children from divorced homes function more poorly than children from continuously married parents across a variety of domains, including academic achievement, social relations, and conduct problems.  Children fromdivorced homes have more psychological problems than those from homes disrupted by the death of a parent.  Children from disrupted marriages experience greater risk of injury, asthma, headaches, and speech defects than children from intact families.  Children of divorce tend to be impulsive, irritable, socially withdrawn, lonely, unhappy, anxious, and insecure.  Children of divorce, especially boys, are more aggressive than children whose parents stayed married.  Suicide rates for children of divorce are much higher than for children from intact families.  Twenty to 25 percent have significant adjustment problems as teenagers (Data adapted from Americans for Divorce Reform, Arlington, Virginia. Table by Nitza Jones.)

Stepparents.  Although there are many different scenarios that may occur after a divorce and remarriage, several poten- tial scenarios have been outlined in Table 31.1-10. These include: (1) Neo-traditional, (2) Romantic, and (3) Matriar- chal. When remarriage occurs, children must learn to adapt to the stepparent and to the “blended” family. Adaptation is often

Table 31.1-10 Types of Step-Families

Neo-Traditional Families

 Resembles “traditional” families

 Absent biological parent is included at times.  Discipline, boundaries and limits, and expectations are discussed openly.  Family coalitions and “side-taking” are better avoided.  The absent biological parent is expected to disappear and is often criticized.  Stepparent/stepchild difficulties are common.  Few open and frank discussions about problems  Run by a highly competent mom and her companion follows  Companion is a “buddy” to the children, not to the parent.  Birth of a step-sibling causes problems.  Stress is unbearable.  Expect to be a “traditional family” immediately

Romantic Families

Matriarchal Families