Children of Parents With Affective and Nonaffective Psychoses: A Longitudinal Study of Behavior Problems

Abstract

Objective It is generally accepted that children of parents with schizophrenia or other forms of psychosis are at heightened risk for a range of behavioral problems. However, it remains unclear whether offspring of parents with different forms of psychosis (e.g., schizophrenia, other non-affective psychoses, and affective psychoses) have distinct forms of behavioral problems (i.e., internalizing and externalizing). Method Behavioral observations at ages 4 and 7 years of children of parents with psychosis (n = 281) and parents without psychosis (n=188) were examined. Results There were no significant differences between groups in behavior observed at age 4. At age 7, compared to children of unaffected parents, children of parents with psychosis had an adjusted odds ratio of 2.8 (95% CI = 1.5, 5.6) for externalizing problems, in particular for children of parents with schizophrenia (adjusted OR = 4.4; 95% CI = 1.7, 12.5). This increase in risk for externalizing problems was observed for females only (adjusted OR = 8.1; 95% CI = 2.5, 26.3). In contrast, male children were at increased risk for internalizing problems (adjusted OR = 3.6; 95% CI = 1.6, 8.3). Conclusions Children of parents with various forms of psychosis are at risk for internalizing and externalizing problems by age 7; this risk varies by gender of the offspring. Implications for treatment of parents with psychotic disorders and high-risk children are discussed.

The interplay of childhood behavior problems and IQ in the development of later schizophrenia and affective psychoses

“…As described in previous reports (Donatelli et al, 2010; Seidman et al, 2013; Agnew-Blais et al, 2015), cohort members with a history of psychiatric hospitalization and/or possible psychotic illness were identified from: 1) nested follow-up and case-control studies, including interviews with approximately 20% of the cohort; 2) record linkages with public hospitals, mental health clinics, and the MA and RI Departments of Mental Health; and 3) reports from participants in follow-up studies of a family member with a history of psychotic symptoms or diagnosis. Participants who consented to a follow-up interview were given the Structured Clinical Interview for DSM-IV (First et al, 1996).…”

“…Childhood behavior was assessed by clinicians during neurological and cognitive tests and a period of free play at study visits as described in Donatelli et al (2010), who used the same behavior measures. At age 4 behaviors assessed included emotional reactivity, irritability, dependency, duration of attention span, degree of cooperation, goal orientation, response to directions, level of activity, nature of activity, nature of communication, fearfulness and level of frustration tolerance.…”

“…For example, for emotional reactivity, one endpoint reflected “flat affect” and the other “unstable emotional response.” Therefore, to define problem behaviors we created two variables from each original item, each with a three-point scale (0=not true; 1=somewhat true; 2=very true); for example, from the original item of emotional reactivity we created two new variables: “flat affect” and “unstable emotional response.” An individual who was rated as “extremely flat” (score=1) on the original emotional reactivity item was scored as “very true” (score=2) on the new “flat affect” item and “none” (score=0) on the new “unstable emotional response” item. In our previous study focusing on children at genetic risk for psychosis, externalizing and internalizing behavior factors were derived from these same variables (Donatelli et al, 2010). In that paper, these items were entered into principal components analyses (PCA) (separately at age 4 and age 7) with varimax rotation.…”

“…However, whether the finding of less premorbid impairment for affective psychoses compared with schizophrenia extends to childhood behavior problems is uncertain, nor is it clear whether the age of onset, severity and type of behavior problems differ between those who develop schizophrenia and affective psychoses. We have previously found that children of individuals with schizophrenia and affective psychoses showed elevated risk for behavior problems, including internalizing and externalizing behaviors at age 7 (Donatelli et al, 2010); however we have not investigated behavior problems among children who later develop these disorders themselves in later life.…”

Behavioral Problems in Offspring of Bipolar Mothers

“…Various hypotheses have been proposed with respect to behavioral disorders and it appears plausible that holding on to one hypothesis will not justify the occurrence of this spectrum of disorders (10). Different hypotheses have discussed varied modalities of abnormal behavior among children and adolescents such as: Critical period of adolescence, substance abuse, job-related stress of parents, passive parents, psychotic parents, smoking habits of parents, parents addiction, cannabis abuse, chaotic family dynamic, mother's depression, life stressful events, antisocial personality disorder (11)(12)(13)(14)(15)(16)(17)(18)(19)(20). In another sense, in assessing the correlation between mother's psychiatric disorders and children emotional/behavioral problems, genetic factor and neurobiological changes have been noted (21).…”