Helping Children and Teens Living With Mentally Ill Parents

Originally published in the Brown University Child and Adolescent Behavior Letter 18(7):1, 3-4, 2002

Introduction

Children living with a mentally ill parent are faced with challenges their peers will probably never be able to relate to. Research has shown that children of affectively ill parents have a 40 percent chance of experiencing an episode of major depression by age 20, and by the age of 25 this rate increases to 60 percent.

In addition, the meta-analytic indications are that 61 percent of children whose parents had major depressive disorder will develop a psychiatric disorder during childhood or adolescence, and are four times more likely to develop an affective disorder than children with non-ill parents. These problems include general difficulties in functioning, signs of increased guilt, interpersonal difficulties and problems with attachment.¹

A recent longitudinal study confirms that the effects persist when these children mature into adults.²

Therefore, the important question becomes, what can we do to prevent, offset, or counteract these challenges while children are growing and developing in homes where one or both parents have an affective illness, such as depression, obsessive-compulsive disorder (OCD), or anxiety?

Ronald Seifer, Ph.D., professor of Psychiatry and Human Behavior at Brown University and Research Director at Bradley Hospital, says that in families where one or both parents have psychopathology the jobs of daily life don't get accomplished smoothly; family members don't communicate with each other as well as in homes without illness; goals aren't defined as well, they don't problems solve as well, and the family as a unit doesn't seem to work as well.

Role allocation is an example of the kind of dysfunctional parental modeling from which the children are learning. In many families, Seifer says, it's clear who's going to the grocery store to get food for dinner, or who is responsible for making sure the appliances in the house are working. In families that don't function as well, sometimes there isn't food in the house for dinner because there wasn't any clear allocation as to whose role it was to go to the grocery store. Perhaps the washing machine hasn't been working for 3 weeks because there is no assignment as to who is responsible for making sure it gets fixed.

"It's those everyday activities that families have to engage in to make sure their lives go smoothly. That kind of stuff doesn't seem to work as well when there are mental health problems in the family,"says Seifer."That will be a disorganizing influence for children."

These children don't have the models for organizing their lives that children whose families function better are going to have. They may not develop organizational skills in terms of interacting with their social peers, solving complex problems, engaging in things that require long-term plans and organization, such as writing a book report. This requires that a child set out a period of time to read the book, organize their thoughts, write the paper and have it done in an organized way.

What Can Be Done to Help?

"We know a fair amount about how these families differ and about the psychological and behavioral functioning of the kids, but when you ask what do the kids need, there is an implication that it's a simple step from identifying what's different to identifying how you might ameliorate any problems," Seifer says. "There is very little research that has systematically examined whether these common sense solutions would work or whether other things that maybe aren't quite as apparent would work." One recent study by William Beardslee's group at the Judge Baker Children's Center in Boston, led by Gregory N. Clarke, Ph.D., found that a brief, group therapy prevention program can reduce the risk for depression in the adolescent offspring of parents with a history of depression.³

A review of the literature of the past 10 years, also by Beardslee, discusses their research on promoting resilient traits in non-ill children and modifying risk factors through two protocols—clinician facilitated and lecture—in an effort to prevent psychopathology from developing in this high-risk group of children.¹

Seifer says his suggestions are a mix of common sense extended to what we know about the characteristics of these families and "basically speculation, at this point." He feels that efforts should focus on making the family environment work better.

"That would take a lot of different paths, one of which is treating the parents depression. That's a no-brainer," he says. "Parents who are less symptomatic are more likely to be able to participate fully in their roles as parent and their roles as family members."

Marital dissatisfaction goes hand-in-hand with depression, Seifer says, and research confirms this. When adult partners living together in a family are dissatisfied with one another they tend to behave less well, are less tolerant of the others shortcomings, they don't communicate as well and the affective tone of the family is more negative, says Seifer. "I think also dealing with parent-child interaction issues will help."

Once children are older and are out with peers, there will probably be more individual issues to work out. They begin seeing that 'things don't get done in my family,' or 'my Mom is different from all the other Moms down the street.' At that point, an individual intervention modality would be important for those children.

Unfortunately, Seifer says, the bottom line is that despite the fact that we know that these children are more likely to have mental health problems later in life and we know some of the behavioral differences that occur within families, we're not close to putting all the pieces together.

"The answer to the question of 'what do we do to help the children' is not going to be anything dramatic and it's not going to be something like, 'you do these eight things over the course of six weeks and everything is going to be fine,' " says Seifer.

References

Beardslee WR, Versage E, Gladstone T: Children of Affectively Ill Parents: A Review of the Past 10 Years. Journal of the American Academy of Child and Adolescent Psychiatry, 1998; 37:1134-1141.
Nomura Y, Wickramaratne PJ, Warner V, et al.: Family Discord, parental Depression and Psychopathology in Offspring: Ten-Year Follow-Up. Journal of the American Academy of Child and Adolescent Psychiatry, 2002; 41:402-409.
Clarke GN, Hornbrook M, Lynch F, et al.: A Randomized Trial of a Group Cognitive Intervention for Preventing Depression in Adolescent Offspring of Depressed Parents. Archives of General Psychiatry, 2001; 58:1127-1134.

Sidebar: Parental Psychiatric Illness: Decreasing the Risk to Children

Children of parents with mental illness are at increased risk for developing mental illnesses, particularly if both parents are mentally ill, according to the American Academy of Child and Adolescent Psychiatry. The risk for developing a psychiatric illness may be even greater if a parent has bipolar disorder, an anxiety disorder, ADHD, schizophrenia, substance use disorder, or depression, or if the child's family environment is inconsistent and unpredictable.

Some protective factors that may decrease the risk to children include:

Knowledge that their parent(s) is ill and that they are not to blame.
Help and support from family members.
A stable home environment.
Psychotherapy for the child and the parent(s).
A sense of being loved by the ill parent.
A naturally stable and happy personality in the child.
Positive self esteem.
Inner strength and good coping skills in the child.
A strong relationship with a healthy adult.
Friendships, positive peer relationships.
Interest and success at school.
Healthy interests outside the home for the child.
Help from outside the family to improve the family environment (e.g., marital psychotherapy or parenting classes).