Clinical Assessment of Child and Adolescent Personality and ...

CHAPTER 12 assessing family context293Parental AdjustmentIn the introduction to this chapter, wediscussed several ways in which assessingparental psychiatric adjustment is criticalto the clinical assessment of children. Wediscussed two areas of research, one onparental depression and another on parentalanxiety, that suggest that informationobtained from a parent must be interpretedin light of the parent’s level of emotionaldistress. We also discussed the importanceof obtaining a family psychiatric history formaking differential diagnoses and treatmentrecommendations. In this section, weprovide a brief overview of basic researchshowing the link between parent and childadjustment difficulties that can aid theclinical assessor in structuring assessmentsand making appropriate interpretationsfrom the assessment information.Parental DepressionOne type of parental adjustment that has awell-documented link to child developmentis parental depression. Studies have foundthat between 40% (Orvaschel, Walsh-Allis,& Ye, 1988) and 74% (Hammen et al.,1987) of the children of depressed parentsexhibit significant adjustment problems.Depression in parents places children atrisk for a number of problems spanningacademic, social, emotional, and behavioraldomains (Downey & Coyne, 1990).Therefore, it seems that parental depressionis a nonspecific risk factor for problemsin children. That is, it is not specificallyrelated to the development of a single typeof child behavior problem.There are two possible exceptions tothis non-specific relationship, both relatedto subtypes within affective disorders.First, Weissman, Warner, Wickramaratne,& Prusoff (1988) found some preliminaryevidence that early-onset recurrent depression(depression that has its initial onsetbefore adulthood) might have a more specificlink with childhood depression. Second,family histories of bipolar disordersin parents predict a risk for subsequentbipolar disorder in adolescents with achildhood-onset of depressive symptoms(Geller et al., 1993).Goodman and Gotlib (1999) reviewedthe literature on the risk for problems inadjustment in children of depressed mothers.They outline four possible mechanismsto explain this risk: (a) an inherited predispositiontransmitted from parent to child;(b) failure of the child to develop appropriateemotional regulation strategies;(c) exposure to negative maternal moods,thoughts, and behaviors; and (d) exposureto a high rate of stressors associated withmother’s depression (e.g., higher rates ofmarital conflict). These links clearly illustratethe need to assess parental depressionto understand several potential causal factorsthat could help to explain a child’s oradolescent’s problems in adjustment.Parental Substance AbuseA comprehensive review of the literaturefound that, like parental depression, parentalalcoholism is associated with a numberof child adjustment problems. West andPrinz (1987) reported studies finding anassociation between parental alcohol abuseand the following problems in their children:hyperactivity, conduct problems,delinquency, substance abuse, intellectualimpairment, somatic problems, anxiety,depression, and social deficits. Like depression,some of the lack of specificity in itseffect on child adjustment may be due to afailure to define subgroups within parentswho abuse substances (Frick, 1993). Alternatively,West and Prinz reviewed severalstudies suggesting that the effects of havinga substance-abusing parent on a child’sadjustment may be mediated through the