1. INFLUENCE OF PSYCHOPATHOLOGICAL DISORDERS OF CHILDREN IN FAMILY STRUCTURE AND FUNCTIONING
Adrián Cano Prous
Baras Pastor et al.
Dpto. Psiquiatría y Psicología Medica
University Hospital of Navarra

2. MARITAL AND FAMILY THERAPY
CHILD AND ADOLESCENT
PSYCHIATRY
SPECIALIZED NURSERY
SPECIALIZED NURSERY
PARENTS
CHILDREN
MARITAL AND FAMILY
THERAPY
SOCIAL WORKERS
SOCIAL WORKERS
ADULT PSYCHIATRY

3. CHILD PSYCHOPATHOLOGY ADULT PSYCHOPATHOLOGY
MARITAL AND FAMILY THERAPY FRAME
CHILD PSYCHOPATHOLOGY ?
MARITAL
FUNCTIONING
MFT
FAMILY
FUNCTIONING - - - -
ADULT PSYCHOPATHOLOGY

4. CURRENT SITUATION 1. MARITAL FUNCTIONING 2. FAMILY FUNCTIONING
3. ADULT PSYCHOPATHOLOGY
4. CHILDREN PSYCHOPATHOLOGY

5. More than 1 million annual divorces
Marital breakdown I
More than 1 million annual divorces
One marital breakdown every 30 seconds
Over 10 million marital breakdowns in 10 years, that have affected over 15 million children

6. In Spain, family breakdown has increased by 268% in 10 years…
Marital break-down II
Family breakdown has increased by far the most in Spain in the last 10 years.
In Spain, family breakdown has increased by 268% in 10 years…
Germany, UK, France and Spain are the UE27 countries with the highest number of divorces.
Source: Institute for Family Policies

7. In europe, marriages that fail last a mean of 13 years.
Marital break-down III
In europe, marriages that fail last a mean of 13 years.
Italy is the country where marriage lasts longest (16.8), and Austria the one where it lasts least (10.6).
In Spain, marriage lasts a mean of 14 years
Source: Institute for Family Policies

8. CURRENT SITUATION 1. MARITAL FUNCTIONING 2. FAMILY FUNCTIONING
3. ADULT PSYCHOPATHOLOGY
4. CHILDREN PSYCHOPATHOLOGY

9. Only 2.4 members per household
European households I
Only 2.4 members per household
1.5 persons per household have been ‘lost’ since 1980
Malta, Cyprus, Romania and Spain are the countries with the highest number of members per household
Source: Institute for Family Policies

10. Households have fewer children.
European households II
Households have fewer children.
2 out of 3 households have no children
Only 17% of households have 2 or more children
Fuente: Instituto de Política Familiar

11. CURRENT SITUATION 1. MARITAL FUNCTIONING 2. FAMILY FUNCTIONING
3. ADULT PSYCHOPATHOLOGY
4. CHILDREN PSYCHOPATHOLOGY

12. 35 – 44 years old: 1.037.803 days admitted to hospital
HOSPITAL ADMISSIONS IN 2007
ADULTS
35 – 44 years old: days admitted to hospital
Source: Spanish National Institute of Statistics

13. 35 – 44 years old: 27.376 mental illness discharges
HOSPITAL DISCHARGES IN 2007
35 – 44 years old: mental illness discharges
Source: Spanish National Institute of Statistics

14. CURRENT SITUATION 1. MARITAL FUNCTIONING 2. FAMILY FUNCTIONING
3. ADULT PSYCHOPATHOLOGY
4. CHILDREN PSYCHOPATHOLOGY

15. EVOLUTION OF CHILDREN AND ADOLESCENT PSYCHIATRY CONSULTATIONS

16. CHILDREN AND ADOLESCENT PROGRAM
This program includes all patients under 17 years attended at Mental Health Centres in our community

17. 15 - 24 years old: 10.329 mental illness discharges
HOSPITAL ADMISSIONS
years old: mental illness discharges
Source: Spanish National Institute of Statistics

18. ADHD

19. CONSEQUENCES OF UNTREATED ADHD
PATIENT
HEALTH
50%  bike accidents 1
33%  emergency room visits2
2–4 x other vehicle accidents 3-5
FAMILY
3–5 x  divorce
or separation11,12
2–4 x  fights among siblings 13
depression in parents
SOCIETY
2x risk of
Substance abuse 8
Early onset 9
More likelihood of
consumption
in adulthood10
WORK (PARENTS)
 Work absence
Lower productivity14
SCHOOL/WORK
46% expelled
35% leaving 6
Lower occupational level7
The DSM-IV and ICD-10 criteria recognise the same problem behaviours as the basis for a diagnosis of ADHD and HKD with almost identical sets of symptoms.
There are however three important differences in the decision rules:
1. A diagnosis using ICD-10 (HKD) requires symptoms in all three symptom domains, whereas a diagnosis using DSM-IV (ADHD) does not. DSM-IV specifies a subtype if symptoms are from only one domain.
2. ICD-10 aims for a single diagnosis and does not recommend a diagnosis in the presence of internalising disorders, such as anxiety and mood disorders, whereas DSM-IV allows the presence of comorbid conditions.
3. ICD-10 makes special provision for a diagnosis of conduct disorder whereas no provision is made by DSM-IV.
1 DiScala et al, 1998.
2 Liebson et al, 2001.
3 NHTSA, 1997.
4-5 Barkley et al, 1993, 1996.
6 Barkley et al, 1990.
7 Mannuzza et al, 1997.
8 Biederman et al, 1997.
9 Pomerleau et al, 1995.
10 Wilens et al, 1995.
11 Barkley et al, 1991.
12 Brown & Pacini, 1989.
13 Mash & Johnston, 1983.
14 Noe et al, 1999.

20. Stress Self-guilt Social isolation Depression Marital disruption
IMPACT ON THE FAMILY
Stress
Self-guilt
Social isolation
Depression
Marital disruption
Mash EJ, Johnston C. J Child Psychol. 1990; 19

21. PROFESSIONAL IMPACT ON PARENTS OF UNTREATED ADHD CHILDREN
The DSM-IV and ICD-10 criteria recognise the same problem behaviours as the basis for a diagnosis of ADHD and HKD with almost identical sets of symptoms.
There are however three important differences in the decision rules:
1. A diagnosis using ICD-10 (HKD) requires symptoms in all three symptom domains, whereas a diagnosis using DSM-IV (ADHD) does not. DSM-IV specifies a subtype if symptoms are from only one domain.
2. ICD-10 aims for a single diagnosis and does not recommend a diagnosis in the presence of internalising disorders, such as anxiety and mood disorders, whereas DSM-IV allows the presence of comorbid conditions.
3. ICD-10 makes special provision for a diagnosis of conduct disorder whereas no provision is made by DSM-IV.
Note. American Academy of Family Physicians Annual Scientific Assembly, Dallas, September, 2000

22. CHILDREN PSYCHOPATHOLOGY
HYPOTHESIS AND OBJECTIVES
¿ ?
MARITAL/FAMILY DYSFUNCTION
DIVORCES/SEPARATIONS
PSYCHIATRY CONSULTATION
CHILDREN PSYCHOPATHOLOGY
¿ ?

23. SOCIODEMOGRAPHIC DATA
Family of children going for follow-up to
GENERAL PEDIATRICS
Family of children
first-time going to
CHILDREN AND ADOLESCENT PSYCHIATRY
Family of children going to
SPECIALIZED PEDIATRICS
SOCIODEMOGRAPHIC DATA
CHILDREN
Gender
Age
Biologic/adopted
Number of siblings
Position among siblings
Academic year
PARENTS
Civil status
Years of marriage
Socioeconomic level
Place or residence
Educational level
Occupation

24. SOCIODEMOGRAPHIC DATA
Family of children going for
follow-up to
GENERAL PEDIATRICS
Family of children
first-time going to
CHILDREN AND ADOLESCENT PSYCHIATRY
Family of children going to
SPECIALIZED PEDIATRICS
SOCIODEMOGRAPHIC DATA
DAS: Dyadic Adjustment Scale: measures quality
in family relations
FACES III: Family Adaptability and
Cohesion Evalution Scale: measures adaptability
and family cohesion
FAD: McMaster Family Assessment Device:
assesses family functioning

25. DATOS SOCIODEMOGRÁFICOS
FAMILIES
PATIENT
(N 121)
FAMILY
HEALTHY
(N 44)
Age of father
45,1
37,4
Age of mother
42,1
34,8
Age of child
10,9
4,7
Years of marriage
15,6
9,6
Household members
4,3
4,4

26. SOCIODEMOGRAPHIC DATA
Ages of family members

27. SOCIODEMOGRAPHIC DATA

28. NATURE OF CHILDREN
Patients
Healthy

29. CHILDREN GENDER
Patients
Healthy

30. SOCIOECONOMIC STATUS
Healthy
Patients

31. PSYCHIATRIC DIAGNOSIS OF CHILDREN

32. AGE – ACADEMIC YEAR
Patients
Healthy

33. DAS: Dyadic Adjustment Scale: measures the quality of dyadic relationships
FORMAT:
32 items.
Different response formats (Likert scales from 2 to 7 points)
SCALES:
Dyadic Consensus
Dyadic Satisfaction
Affectional Expression
Dyadic Cohesion
Dyadic Adjustment (global scale)

34. DAS - PARENTS OF ILL CHILDREN

35. DAS - PARENTS OF HEALTHY CHILDREN

36. DAS - FATHERS OF BOTH SAMPLES*

37. DAS - MOTHERS OF BOTH SAMPLES*

38. FAD: McMaster Family Assessment Device: measures family functioning
Familia de niños que
acuden a revisión de
PEDIATRÍA GENERAL
FAD: McMaster Family Assessment Device: measures family functioning
Familia de niños que acuden
por primera vez a
PSIQUIATRÍA INFANTO-JUVENIL
Familia de niños que acude a
PEDIATRÍA ESPECIALIZADA
FORMAT: 60 items.
SCALES:
Problem solving
Communication
Roles
Affective responsiveness
Affective involvement
Behaviour control
DATOS SOCIODEMOGRÁFICOS
DAS: Dyadic Adjustment Scale: que mide
la calidad de la relación conyugal
FACES III: Family Adaptability and
Cohesion Evaluation Scale: que mide la
adaptabilidad y la cohesión familiar
FAD: McMaster Family Assessment Device:
que evalúa el funcionamiento familiar

39. FAD - PARENTS OF PATIENTS
Functional
Dysfunctional

40. FAD - PARENTS OF HEALTHY CHILDREN
Functional
Dysfunctional

41. FAD - FATHERS OF BOTH SAMPLES
Functional
Dysfunctional * *

42. FAD - MOTHERS OF BOTH SAMPLES
Functional
Dysfunctional * *

43. Familia de niños que
acuden a revisión de
PEDIATRÍA GENERAL
FACES III: Family Adaptability and Cohesion Evaluation Scale: measures adaptability and family cohesion
Familia de niños que acuden
por primera vez a
PSIQUIATRÍA INFANTO-JUVENIL
Familia de niños que acude a
PEDIATRÍA ESPECIALIZADA
FORMAT: 20 items.
SCALES:
Cohesion: assesses emotional bonds betwen family members
Adaptability: assesses family ability to vary its structure when needed
Both scales are represented with the Olson Circumplex Model
DATOS SOCIODEMOGRÁFICOS
DAS: Dyadic Adjustment Scale: que mide
la calidad de la relación conyugal
FACES III: Family Adaptability and
Cohesion Evaluation Scale: que mide la
adaptabilidad y la cohesión familiar
FAD: McMaster Family Assessment Device:
que evalúa el funcionamiento familiar

44. FACES - PARENTS OF PATIENTS
Baja
COHESION
Alta
DISENGAGED SEPARATED CONNECTED ENMESHED 8
High
CHAOTIC 7 F L E X I B T Y
Father patients 6
FLEXI-BLE
Mother patients 5 4
STRUCTU-
RED 3 2
RIGID
Low 1
EXTREME
MEDIUM
BALANCED

45. FACES – PARENTS OF HEALTHY CHILDREN
Low
COHESION
High
DISENGAGED SEPARATED CONNECTED ENMESHED 8
High
CHAOTIC 7 F L E X I B T Y
Father healthy 6
FLEXI-BLE
Mother healthy 5 4
STRUCTU-
RED 3 2
RIGID
Low 1
EXTREME
MEDIUM
BALANCED

46. FACES III PADRES Father healthy Father patient High COHESION Low 8
DISENGAGED SEPARATED CONNECTED ENMESHED 8
High
CHAOTIC 7 F L E X I B TY
Father healthy 6
FLEXI-BLE 5 4
Father patient
STRUC-TURED 3 2
RIGID
Low 1
EXTREME
MEDIUM
BALANCED

47. FACES III MADRES * Mother healthy Mother patient Low COHESION High 8
DISENGAGED SEPARATED CONNECTED ENMESHED 8
High
CHAOTIC 7 F L E X I B TY
Mother healthy 6
FLEXI-BLE 5 4
Mother patient
STRUC-TURED 3 2
RIGID
Low 1
EXTREME
MEDIUM
BALANCED

48. THANKS FOR YOUR ATTENTION
Adrián Cano Prous
Baras Pastor et al.
Dpto. Psiquiatría y Psicología Medica
University Hospital of Navarra