Role of the family in the onset and outcome of childhood disorders: Selected research findings

Objective: Three areas of basic family research were selected for review as being of special importance to the clinically oriented child and adolescen t psychiatrist: behavioral genetics, expressed emotion, and the interaction of family dynamics and childhood illness. Method: Medline and PSYCINFO sea rches using appropriate keywords were obtained for each of the 3 major area s. All English-language articles published after 1989 that included empiric al research pertaining to children or adolescents were reviewed. Results: B ehavioral genetics research indicates that the shared environment, includin g issues of parental monitoring and discipline, is important in the develop ment and outcome of externalizing disorders. Differential parental treatmen ts of one sibling are critical in internalizing disorders. Criticism las me asured by expressed emotion) is associated with poor outcome of many childh ood medical and psychiatric disorders. Chronic illness in a child changes t he family dynamics toward being more structured and less emotionally warm a nd communicative. The family's role in adherence to treatment is critical, and families with high levels of criticism have more difficulty. Conclusion s: Families can cause problems, but many times the problems families have a re in response to a child's problems. There is a continued need to empirica lly assess which family processes are important for specific childhood diso rders.