Clinical Assessment of Child and Adolescent Personality and ...

CHAPTER 12 assessing family context295study suggests that an assessment of parents’childhood histories of behavior problemscould aid in the assessment of ADHD inchildren.Parental AnxietyAnother type of problem that appears tohave a familial link is anxiety. Last, Hersen,Kazdin, Francis, and Grubb (1987) reportedthat in their sample of children with an anxietydisorder (n = 58), 83% of the childrenhad a mother with a lifetime history ofanxiety disorders. Furthermore, 57% hada mother experiencing significant levels ofanxiety concurrently with the child. Bothof these proportions were significantlygreater than what was found in parents ofclinically referred children without anxietydisorders.Importantly, Frick et al. (1994) foundsimilar results but also found that the linkbetween mother and child anxiety couldnot solely be attributed to anxious mothersreporting more anxiety in their children.All of the children in the Frick et al.study who self-reported an anxiety disorderhad a mother with a history of an anxietydisorder. Further, there are a number ofstudies suggesting that parental anxietycan influence the attachment between theparent and child (Costa & Weems, 2005)and can lead to parenting behaviors (e.g.,overprotectiveness, failure to encourageindependence) (Dadds, Barrett, Rapee, &Ryan, 1996) that can place a child at riskfor anxiety and other problems in adjustment.Thus, it is clear from these findingsthat parental anxiety is an important area tobe assessed in clinical assessments of anxiouschildren.Parental SchizophreniaAnother type of maladjustment with aclear familial link is schizophrenia. Childrenof one schizophrenic parent appear tohave a 10 to 15% likelihood of developingschizophrenia; the children of two schizophrenicparents have about a 25 to 46%risk (Gottesman, McGuffin, & Farmer,1987). These rates of disorder in offspringsof schizophrenic parents are striking giventhat the prevalence of schizophrenia in thegeneral population is between 1 and 10per 1,000 individuals (Helzer & Pryzbeck,1988). However, parents who have anotherrelative with schizophrenia are often quiteconcerned over the risk for their children,on the basis of the evidence for a familialtransmission. Therefore, it is often importantfor clinical assessors to also view theserisks from the point of view that the vastmajority of children with a schizophrenicrelative, even if that relative is a parent, donot develop schizophrenia.Assessment of Family HistoryFrom this very brief overview of the familiallink to childhood disorders it is evidentthat obtaining a family history is a criticalcomponent of most clinical assessments ofchildren and adolescents. However, likeall aspects of the assessment process, whatareas to be assessed and the depth at whichthey will be assessed depend on the individualcase. In some cases a screening forpsychiatric disorders in a child’s relativescan be conducted as part of an unstructuredinterview followed by a more indepthfamily history assessment only if thisis judged to be warranted from the initialscreening. In other cases a more detailedand structured assessment may be neededfrom the outset.It is beyond the scope of this book tocover assessment of adult psychopathologyin great detail. However, it is importantto note that one can assess a widerange of problems in parents or otherrelatives through omnibus rating scalesor structured interviews. For example, theNEO-Personality Inventory (NEO-PI;Costa & McCrae, 1985) and the Minnesota