Parent-Child Relationships and Potential Problems
Professional Reference articles are designed for health professionals to use. They are written by UK doctors and based on research evidence, UK and European Guidelines. You may find one of our health articles more useful.
Treatment of almost all medical conditions has been affected by the COVID-19 pandemic. NICE has issued rapid update guidelines in relation to many of these. This guidance is changing frequently. Please visit https://www.nice.org.uk/covid-19 to see if there is temporary guidance issued by NICE in relation to the management of this condition, which may vary from the information given below.
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, 51% of live births were born within marriage in 2020, compared to 59% in 2003 and 93% in 1963.
- The average age at marriage has increased and more children are born to women older than 30 years.
- In the UK, there were 3.0 million lone parents with dependent children in 2021. This figure has grown steadily from 1.9 million in 2005. Lone parents with dependent children represented 15.4% of all families with dependent children in 2021.
- Rates of divorce continue to rise, with an increase of 18.4% from 2018 to 2019.[3, 4]
Potential childhood behavioural problems
- 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 and decreased learning ability and academic achievements.
How common are childhood behavioural problems?
- The 2015 estimated prevalence of conduct disorders in those aged 5 - 16 is 5.6% - they are more common in boys than in girls and the prevalence rises with age.
- Approximately 7.6% of children aged 12 years and older have had moderate to severe depression; those in correctional institutions or who are looked-after have a particularly high prevalence of all mental disorders, including depression.
- The estimated prevalence of autism in children is at least 1% - difficulties associated with autistic spectrum disorders include increased vulnerability to other mental health problems, challenging behaviour, high levels of stress in parents/carers and siblings and a reduced ability to live independently as an adult.
Possible risk factors for problematic parent-child relationships
- 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.
- Depression in pregnancy can affect the development of the infant, including behavioural and emotional issues. This is particularly a problem if the depression is untreated. Postpartum depression can also affect the interaction between a mother and her infant.
- 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 physical illness.
- Parental alcohol and substance abuse.
- People with poor mental health are more likely to live in poverty and to be affected by issues such as homelessness, social isolation, imprisonment and unemployment.
- Neglect and/or abandonment; adopted children or children from foster homes.
- Depression in children is associated with recent negative life events, such as parental separation or job loss and bereavement.
- A chronically ill or disabled child.[7, 15]
- Undiagnosed psychological or developmental problem - eg, attention deficit hyperactivity disorder (ADHD), autistic spectrum disorders.
- 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.
Management of the parent-child relationship
- A family-focused approach is helpful in many clinical scenarios - eg, autistic spectrum disorders, 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 2014 there were over 3,000 children's centres providing integrated services, but unfortunately many of them were closed in subsequent years.[22, 23] All children aged 3-4 years are now offered 30 hours of free childcare, with 15 hours being offered to 2-year-old children if their parents are on certain benefits, or there are issues such as special education needs, adoption or disability.
Further reading and references
Births by parents' characteristics: Datasets up to 2020; Office for National Statistics
Families and households: 2021; Office for National Statistics
Divorces in England and Wales: 2019; Office for National Statistics
Garfield CF, Isacco A; Fathers and the well-child visit. Pediatrics. 2006 Apr117(4):e637-45.
McLeod BD, Wood JJ, Weisz JR; Examining the association between parenting and childhood anxiety: a meta-analysis. Clin Psychol Rev. 2007 Mar27(2):155-72. Epub 2006 Nov 16.
Conduct disorders in children and young people; NICE CKS, April 2018 (UK access only).
Depression in children; NICE CKS, August 2020 (UK access only)
Autism in children; NICE CKS, August 2020 (UK access only)
van Gastel W, Legerstee JS, Ferdinand RF; The role of perceived parenting in familial aggregation of anxiety disorders in children. J Anxiety Disord. 2009 Jan23(1):46-53. Epub 2008 Mar 26.
Depression - antenatal and postnatal; NICE CKS, August 2020 (UK access only)
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 Dec40(4):575-88. Epub 2009 May 20.
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 1115(17):4030-9.
Brown SL; Marriage and Child Well-Being: Research and Policy Perspectives. J Marriage Fam. 2010 Oct 172(5):1059-1077.
Health matters: reducing health inequalities in mental illness; Public Health England, 2018
Raina P, O'Donnell M, Rosenbaum P, et al; The health and well-being of caregivers of children with cerebral palsy. Pediatrics. 2005 Jun115(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-Jun47(Pt 4-5):291-9.
Barlow J, Smailagic N, Huband N, et al; Group-based parent training programmes for improving parental psychosocial health. Cochrane Database Syst Rev. 2014 May 17(5):CD002020. doi: 10.1002/14651858.CD002020.pub4.
Duncan LG, Coatsworth JD, Greenberg MT; Pilot study to gauge acceptability of a mindfulness-based, family-focused preventive intervention. J Prim Prev. 2009 Sep30(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 136:CD002020. doi: 10.1002/14651858.CD002020.pub3.
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 Nov47(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 Apr22(2):253-63.
Sure Start Children's Census Report 2014 - a national overview
Survival, decline or closure? Children’s centres in England, 2018; Sutton Trust, 2018
30 hours free childcare; GOV.UK