PatientPlus articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use, so you may find the language more technical than the condition leaflets.
Children's physical and emotional status, as well as their social and cognitive development, greatly depend on their family dynamics. The rising incidence of behavioural problems among children could suggest that some families are struggling to cope with the increasing stresses they are experiencing.
Many characteristics of families have changed during a period of three to five decades.
- In England and Wales, 53% of live births were born within marriage in 2011, compared to 60% in 2001 and 94% in 1961.
- The average age at marriage has increased and more children are born to women older than 30 years.
- Over a period of some 30 years the percentage of children in two-parent families in the USA decreased from 85% to 69%.
- In the UK, there were 2.0 million lone parents with dependent children in 2011. This figure has grown steadily since from 1.7 million in 2001. Lone parents with dependent children represent 26% of all families with dependent children in 2011 - a two percentage point increase since 2001.
- It is estimated that the proportion of marriages ending in divorce is 42%. Nearly half (49%) of couples divorcing in 2011 had at least one child aged under 16 living in the family.
- The percentage of women working has increased and there has been an increase in paternal involvement in childcare.
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- Social problems including withdrawal, loneliness, loss of confidence, school problems, learning disorders, anxiety and depression, alcohol and drug abuse (particularly associated with mental illness), suicide or self-harming, theft and criminal behaviour.
- Discipline problems including selfishness, defiance, unstable behaviour, recklessness, deceitfulness, violent behaviour and disruptive behaviour.
- Educational problems including disruptive behaviour, bullying, decreased learning ability and academic achievements.
According to the Office for National Statistics::
- 10% of children aged 5-16 in Great Britain had a clinically diagnosed mental disorder: 4% had an emotional disorder, 6% had a conduct disorder, 2% had a hyperkinetic disorder, and 1% had a less common disorder such as autism, tics, etc. Some children had more than one type of disorder.
- 16% of children from single-parent families experience a mental health problem compared with 8% from two-parent families.
- Mental disorders are more common in reconstituted families (14%) compared to families containing no stepchildren (9%).
- Mental disorders were also more common in families where neither parent worked (20%), families where someone received disability benefit (24%), and families with lower levels of educational attainment.
Possible risk factors
- Family conflict and discord: lack of structure and discipline, disagreement about child rearing.
- Parental control that is too tight.
- Overprotection is a risk factor for childhood anxiety.
- Marital conflict, divorce or separation: most of the negative effects are caused by disruption of parenting. The parents' ability to cope with the changes may be reflected in the child's ability to cope.
- Involvement of the father; the emotional and social outcomes are significantly improved for children whose fathers play a visible and nurturing role in their upbringing. Father involvement is associated with positive cognitive, developmental and socio-behavioural child outcomes, such as improved weight gain in preterm infants, improved breast-feeding rates, higher receptive language skills and higher academic achievement.
- Maternal depression, including postpartum depression. Young children of depressed mothers have an elevated risk of behavioural, developmental and emotional problems.
- One study found that depressed individuals who are offspring of depressed parents may be at particular risk for the secondary deficits of depression. Such deficits may include physical dysfunction, pain and disability; anxiety, smoking, drinking-related problems and poorer social resources.
- Parental mental illness.
- Parental physical illness.
- Parental alcohol and substance abuse.
- Poverty: mental disorders are more common in households with a low gross weekly income and in families where the parent was in a routine occupational group compared with those in a higher professional group. They were also more common in those living in the social sector (17%) compared with those who owned their accommodation (4%).
- Neglect and/or abandonment; adopted children or children from foster homes.
- Residential instability.
- A chronically ill or disabled child.
- Undiagnosed psychological or developmental problem - eg, attention deficit hyperactivity disorder (ADHD), autism.
- Difficult temperament of a child and a clash in parenting style.
- Fragile emotional temperament of a child.
- Peer pressures.
- Large families.
- Family stress: working parents, job dissatisfaction, fatigue, stress and time, household chores.
- Violence within the home.
- Child sex abuse.
Getting to the bottom of parent-child relationship problems can be difficult because there can be many different underlying issues.
The possible outcomes may also vary depending upon individual families, religion, culture, attitudes, ethnicity and resources available.
- A family-focused approach is helpful in many clinical scenarios - eg, autism, drug dependence.
- Counselling: family counselling and therapy, parental education and training.
- Marriage guidance.
- Social support.
- Medication to treat specific health problems.
- Police/law enforcement.
- Change schooling - eg, different school, boarding or private education.
- Paediatric healthcare.
One study found that a prevention programme implemented through childbirth education programmes enhanced the co-parental relationship, parental mental health, the parent-child relationship and infant emotional and physiological regulation. The programme had a positive effect on co-parental support, maternal depression and anxiety, distress in the parent-child relationship and several indicators of infant regulation. It was particularly helpful to lower-educated parents and families with a father who reported higher levels of insecure attachment in close relationships.
Sure Start is a government-led initiative which encompasses a number of different projects aimed at giving every child the best possible start. In 2012-13, there will be around 3,500 children's centres providing integrated services. These have been put on a legal footing and are subject to regular Ofsted inspection. The Early Education initiative guarantees all 3- to 4-year-olds a free, part-time, early-education place. Registered childcare places are being increased: At the end of March 2009, the stock of places recorded by Ofsted stood at over 1.5 million (more than double the 1997 level).
Further reading & references
- Live Births in England and Wales by Characteristics of Mother 1, 2011; Office for National Statistics, January 2013
- Schor EL; Family pediatrics: report of the Task Force on the Family. Pediatrics. 2003 Jun;111(6 Pt 2):1541-71.
- Families and households, 2001 to 2011; Office for National Statistics, January 2012
- Divorces in England and Wales - 2011; Office for National Statistics, December 2012
- Garfield CF, Isacco A; Fathers and the well-child visit. Pediatrics. 2006 Apr;117(4):e637-45.
- McLeod BD, Wood JJ, Weisz JR; Examining the association between parenting and childhood anxiety: a meta-analysis. Clin Psychol Rev. 2007 Mar;27(2):155-72. Epub 2006 Nov 16.
- McLeod BD, Weisz JR, Wood JJ; Examining the association between parenting and childhood depression: A meta-analysis. Clin Psychol Rev. 2007 Mar 12;.
- Mental health of children and young people in Great Britain, 2004; Office for National Statistics
- van Gastel W, Legerstee JS, Ferdinand RF; The role of perceived parenting in familial aggregation of anxiety disorders in children. J Anxiety Disord. 2009 Jan;23(1):46-53. Epub 2008 Mar 26.
- Family Dynamics after Divorce: A meta-analysis; Economic and Social Research Council
- Forman DR, O'Hara MW, Stuart S, et al; Effective treatment for postpartum depression is not sufficient to improve the developing mother-child relationship. Dev Psychopathol. 2007 Spring;19(2):585-602.
- Timko C, Cronkite RC, Swindle R, et al; Parental depression as a moderator of secondary deficits of depression in adult offspring. Child Psychiatry Hum Dev. 2009 Dec;40(4):575-88. Epub 2009 May 20.
- Elgar FJ, Mills RS, McGrath PJ, et al; Maternal and Paternal Depressive Symptoms and Child Maladjustment: The Mediating Role of Parental Behavior. J Abnorm Child Psychol. 2007 Jun 19;.
- Thastum M, Watson M, Kienbacher C, et al; Prevalence and predictors of emotional and behavioural functioning of children where a parent has cancer: a multinational study. Cancer. 2009 Sep 1;115(17):4030-9.
- O'Connor TG, Dunn J, Jenkins JM, et al; Family settings and children's adjustment: differential adjustment within and across families. Br J Psychiatry. 2001 Aug;179:110-5.
- Raina P, O'Donnell M, Rosenbaum P, et al; The health and well-being of caregivers of children with cerebral palsy. Pediatrics. 2005 Jun;115(6):e626-36.
- Williams KR, Wishart JG; The Son-Rise Program intervention for autism: an investigation into family experiences. J Intellect Disabil Res. 2003 May-Jun;47(Pt 4-5):291-9.
- Davis K, Gavidia-Payne S; The impact of child, family, and professional support characteristics on the quality of life in families of young children with disabilities. J Intellect Dev Disabil. 2009 Jun;34(2):153-62.
- Duncan LG, Coatsworth JD, Greenberg MT; Pilot study to gauge acceptability of a mindfulness-based, family-focused preventive intervention. J Prim Prev. 2009 Sep;30(5):605-18. Epub 2009 Aug 13.
- Barlow J, Smailagic N, Huband N, et al; Group-based parent training programmes for improving parental psychosocial health. Cochrane Database Syst Rev. 2012 Jun 13;6:CD002020. doi: 10.1002/14651858.CD002020.pub3.
- Thomas R, Zimmer-Gembeck MJ; Behavioral outcomes of parent-child interaction therapy and triple p-positive parenting program: a review and meta-analysis. J Abnorm Child Psychol. 2007 Jun;35(3):475-95. Epub 2007 Feb 27.
- Gardner F, Burton J, Klimes I; Randomised controlled trial of a parenting intervention in the voluntary sector for reducing child conduct problems: outcomes and mechanisms of change. J Child Psychol Psychiatry. 2006 Nov;47(11):1123-32.
- Feinberg ME, Kan ML; Establishing family foundations: intervention effects on coparenting, parent/infant well-being, and parent-child relations. J Fam Psychol. 2008 Apr;22(2):253-63.
- Sure Start Children's Centres; Department for Education
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Dr Hayley Willacy
Dr Euan Lawson
Dr Helen Huins