Suicidal ideation and attempts: a longitudinal investigation of children of depressed and well mothers.

OBJECTIVE: This study uses a prospective longitudinal design to examine suicidality (ideation, plans, attempts, and completions) in children and adolescents, to compare suicidality in the offspring of depressed and well mothers, and to identify correlates and predictors of suicidality. METHOD: Two children (n = 192) from each of the families in an ongoing longitudinal study of the offspring of mothers with major depressive disorder (n = 42), with bipolar disorder (n = 26), or without past or current psychiatric diagnosis (n = 30) were studied. Assessment of suicidality, based on diagnostic interviews, was made when the younger of the sibling pairs were approximately 6, 9, and 14 years of age and older siblings were approximately 6, 9, 13, and 18 years of age. RESULTS: Children of depressed mothers were more likely to report suicidal thoughts or behaviors than were children of well mothers (particularly the older sibling cohort). Developmental trajectories of suicidality differed for offspring of mothers with major depressive disorder and bipolar disorder. Links were found between lifetime reports of suicidality and the adolescent's mood problems (e.g., hypomanic behavior), coping strategies, and parental rejection. Also, child's and mother's suicidality were related. CONCLUSIONS: These findings have implications for planning interventions targeted at preventing suicide in youth.

Relation of parental affective illness to family, dyadic, and individual functioning: an observational study of family interaction.

Family, dyadic, and individual functioning were examined in 18 control families and 41 families with a history of maternal affective illness-including 26 in which husbands also had a history of psychiatric illness. Assessments of functioning, based on observed family interactions, indicated that families with a history of affective illness are more likely to have functional problems, and that problems may differ as a function of type of diagnosis and number of ill parents. Findings suggest that clinical program planning should take into account variability within groups, as well as individual competencies.

Caring behavior in children of clinically depressed and well mothers.

Young children's sensitivity and responsiveness to mothers' needs were investigated under conditions of high and low parenting risk (depressed and nondepressed mothers, SADS-L). Child characteristics of gender, affect, and impulse control problems and the mother-child attachment relationship were examined as they related to children's caring actions. Children's caring behavior was observed in an experimental situation in which their mothers simulated sadness and in a naturalistic setting. Attachment alone and child's problems alone were not predictors, and maternal diagnosis alone was not a strong predictor. Girls were significantly more caring than boys. Severe maternal depression was necessary to bring out high levels of responding in boys. Highest frequencies of caring were from children with severely depressed mothers, problems of affect regulation, and secure attachment. The importance of recognizing interacting influences and diverse underlying processes in the development of children's caring behavior is discussed.

Dialogues with preadolescents and adolescents: mother-child interaction patterns in affectively ill and well dyads.

This study examined affective/communicative patterns in the interactions of unipolar, bipolar, and well mothers with their preadolescent and adolescent children. As part of a large longitudinal project, mother-child interaction was assessed for two siblings ages 8 to 11 and 12 to 16. Interactional difficulties were linked to both maternal affective illness and child problem status. Preadolescent children appeared more comfortable/happy with well mothers than with affectively ill mothers. Mothers and their preadolescents were more critical/irritable with each other when the child had a psychiatric disorder. Gender differences were apparent, particularly in regard to mother's current psychiatric status. Interactions in adolescent-daughter dyads were more critical when mothers met criteria for a major depressive episode within the month. The results illuminate interactive processes through which psychopathology may be perpetuated in families.

Affective interactions of depressed and nondepressed mothers and their children.

The expressed affect of clinically depressed and nondepressed mothers as measured by the Schedule for Affective Disorders and Schizophrenia: Lifetime Version (SADS-L) and their children (1 1/2 to 3 1/2 years) was observed in seminatural situations. The objectives were to investigate how maternal depression enters into affective interactions between mother and child and how the affect patterns of mother and child are related. Forty-nine unipolar and 24 bipolar depressed mothers and 45 nondepressed mothers were observed on 2 days, 2 weeks apart, for a total of 5 h. Each minute was coded for the predominant affect of mother and child. Affects relevant to depression (anxious--said, irritable--angry, downcast, pleasant, tender-affectionate) were coded. Depressed mothers expressed significantly more negative affect than did control mothers. Mothers' expressed affect and their self-reports of affect on days of observation were unrelated. Mother's and child's affects, measured on different days, were significantly correlated. Unipolar mothers and mothers severely depressed spent significantly more time in prolonged bouts of negative affect. There was significant synchrony between their bouts and the negative bouts of their daughters. Gender of child was related to mother's and child's affect, and to relations between mother's and child's affect.

Child and adolescent psychopathology research: problems and prospects for the 1990s.

In November 1990 the National Institute of Mental Health (NIMH) convened a special conference of over 100 scientists and leaders to outline specific strategies and research initiatives that should be developed to implement the recently released National Plan for Research on Child and Adolescent Mental Disorders. Participants included journal editors, educators from psychology and psychiatry, representatives from private foundations, and leaders of research program areas in public funding agencies. Critical knowledge gaps were identified in five areas of child and adolescent psychopathology, including depression, attention deficit hyperactivity disorder, conduct disorder, the anxiety disorders, and the developmental disorders. For each of these areas, special emphasis was placed on developing new ideas and obtaining critical input from other areas of investigation. This report summarizes the identified research gaps and recommends research initiatives to implement the National Plan, as outlined by the conference participants.

Evaluative communications between affectively ill and well mothers and their children.

Earlier research suggests that the natural verbal discourse of mothers with their children can be important in clarifying, verifying, and evaluating the behavior in which a child is engaged, in attributing qualities to the child, and in influencing the child's self-perceptions. We investigated the potential influences of parental affective illness (bipolar affective disorder and unipolar depression in contrast to no history of psychiatric illness) on such "labeling" behavior in a sample of 61 mothers and their older (school-age) and younger (preschool-age) children. It was hypothesized that the dispositions characterizing affective illness (specifically, negativity and disengagement) would be reflected in the labeling statements of mothers with a diagnosis as they interacted with their children. Based on videotaped interactions during a visit to a home-like laboratory apartment, labeling statements were identified in terms of speaker and person being labeled ("addressee") and coded (positive, negative, mixed, or neutral) for judgmental and affective quality of the statement and reaction of the addressee. Data were analyzed (a) by family unit and (b) my mother to child statements. The general pattern of findings indicated, in relative terms, an excess of negativity on the part of family members in the bipolar group and a dearth of negative affect for mothers in the unipolar group. Negativity in the bipolar group appeared to be especially likely when the setting involved mothers and two male children. Additionally, findings are discussed in terms of sex differences in vulnerability to depression.

Inhibition in toddlerhood and the dynamics of the child's interaction with an unfamiliar peer at age five.

Measures of inhibition to social and nonsocial unfamiliar events, obtained in toddlerhood, were studied as predictors of social behaviors during an interaction with an unfamiliar peer in 100 5-year-old children. Social inhibition predicted a highly shy and inhibited behavioral pattern with peer and less frequent expression of affect during fantasy play; nonsocial inhibition predicted decreased involvement in group play. Analysis of the changing dynamics of the ongoing peer interaction revealed that the role of child inhibition as a predictor of social behavior may be mostly evident during the initial encounter with the peer. Children who as toddlers were particularly socially inhibited, during the initial phase of peer interaction showed a significantly stronger pattern of shy and inhibited behavior and proximity to mother. In contrast to existing evidence that maternal depression may be a risk factor for the child's long-term peer relationships, no differences in social behavior were found between children of normal and affectively ill mothers during a brief encounter with unfamiliar peers.

Young children of affectively ill parents: a longitudinal study of psychosocial development.

The course of social-emotional development of young children of affectively ill and well parents was assessed. The families were classified by mother's diagnosis: bipolar illness (N = 22), unipolar depression (N = 41), and normal (N = 37). Father's diagnosis also was obtained. Pairs of siblings were studied; the younger was between 1 1/2 and 3 1/2 years and the older between 5 and 8 years when the study began. They were seen again 3 years later. Psychiatric assessment and mother's report were used to evaluate children's disruptive behavior, anxiety, and depressive characteristics. The frequency of problem-level behavior changed over time in relation to mother's diagnosis. By middle and late childhood, significantly more children of affectively ill than well mothers had depressive and disruptive problems and multiple behavior problems. Offspring of unipolar mothers developed problems earlier and both siblings were more likely to have behavior problems.

Correspondence between mothers' self-reported and observed child-rearing practices.

The correspondence between self-reported child-rearing attitudes and practices and actual child management was examined among 68 mothers of young children. Data on mothers' verbal and physical control techniques along with children's responses (cooperation vs. resistance) were obtained during 90 min of spontaneous interaction in a naturalistic setting. Self-report data (the Block Q-Sort) were obtained 1-2 weeks later. The Block Q-Sort factors were combined to represent authoritarian and authoritative patterns of attitudes. The authoritarian pattern was positively associated with the use of direct commands, physical enforcements, reprimands, and prohibitive interventions, and negatively associated with the use of suggestions. The authoritative pattern was positively related to the use of suggestions and positive incentives, and negatively related to the use of physical enforcements, prohibitive interventions, and direct commands. Mothers' enjoyment of the parental role and their negative affect toward the child, as expressed in the Block Q-Sort, were more a result of the child's cooperation/resistance during the interaction than predictors of maternal control strategies.

A follow-up investigation of offspring of parents with bipolar disorder.

Seven male children who each had a manic-depressive parent (five alos had a parent with unipolar depression) and 12 control children were studied. The proband children had shown a range of adjustment problems as infants and toddlers. Four years later, they continued to have substantial behavior problems, including ones that could be classified as DSM-III psychiatric diagnoses. On the basis of psychiatric interviews and psychological assessments, the proband children received more DSM-III diagnoses than the control children. Proband children reported internalizing symptoms; this pattern was corroborated by their mothers, who also characterized these children as showing antisocial behavior patterns.

Resolutions of control episodes between well and affectively ill mothers and their young children.

Control interactions between 87 well and affectively ill mothers and their 15- to 51-month-old children were studied. Spontaneously occurring control interventions (conceptualized as episodes of interaction between mother and child) were coded from 90 minutes of videotaped interactions in a naturalistic laboratory apartment setting. The results suggest developmental changes in mother-child interaction in the 2nd to 4th years of life: the increase of the rate of immediate maternal success (p less than .05) and compromise (p less than .05), on the decrease in maternal use of power (ultimate success by enforcement, p less than .01). Well mothers achieved compromise with their children, particularly daughters, more often than did affectively ill mothers (p less than .05). Affectively ill mothers more often than well mothers avoided confrontation with their children (p less than .05). The impairments in control interventions of affectively ill mothers were exacerbated by the severity of the disorder.

Patterns of attachment in two- and three-year-olds in normal families and families with parental depression.

Patterns of attachment were examined in normal and depressed mothers. Mother's diagnosis (bipolar, major unipolar, or minor depression, or no psychiatric disorder), self-reported current mood states, and affective behavior in interaction with the child were considered. A modified version of Ainsworth and Wittig's Strange Situation was used to assess attachment. Insecure (A, C, and A/C patterns) attachments were more common among children of mothers with a major depression (bipolar or unipolar) than among children of mothers with minor depression or among children of normal mothers. Insecure attachment was more frequent in children of mothers with bipolar depression than in children of mothers with unipolar depression. A/C attachments were associated with histories of most severe depression in the mother. In families in which mothers were depressed, depression in the father did not increase the likelihood of anxious attachment between mother and child. However, if mothers with a major affective disorder were without a husband in the household, risk of an insecure mother-child attachment was significantly increased. The mothers' expressed emotions (positive vs. negative) in interaction with their children in situations other than the Strange Situation, and independent of diagnosis, predicted patterns of attachment: mothers of insecurely attached children expressed more negative and less positive emotion. Mothers' self-reports of moods on the days they were observed were unrelated to attachment. Results are discussed in terms of the transmission of social and emotional disorders in relation to mothers' affective functioning.

Effects of nutritional supplementation on children's responses to novel, frustrating, and competitive situations.

The effects of caloric supplementation for pregnant women and children from an endemically malnourished population on children's school age behavior were examined. The child's abilities to respond to routinely stressful problem-solving situations and to interact appropriately with peers were the dependent variables. Seventy-eight boys and 60 girls in rural Guatemala received different amounts of food supplementation, pre- and postnatally, as part of the INCAP Longitudinal Study. Children were classified as High or Low Supplementation, based on supplemental caloric intake prenatally and from birth to four years. When measured at 6 to 8 yr, High Supplementation children showed more interest in and exploration of a novel environment, more involvement in a competitive game, greater persistence on a frustrating task, better motor impulse control, and greater initiative across several group tasks than did Low Supplementation children. In free play with peers, the High Supplementation children showed more frequent happy affect, social involvement, and moderate activity level, and were less frequently timid or anxious. Results are consistent with findings from studies on the effects of early undernutrition on infant behavior, and suggest that behavior impairments associated with early undernutrition have long-term consequences for the child's development.

Altruism, aggression, and social interactions in young children with a manic-depressive parent.

This is an exploratory study of the emotional and social functioning of young children with a manic-depressive parent. Seminaturalistic observations and experimental manipulations of the affective environment were used to assess 2-year-old children's regulation of emotion, as well as their aggression, altruism, and affiliative interactions. Children with a bipolar parent sometimes showed heightened distress and preoccupation with the conflicts and suffering of others, especially disturbances in adults. These children had difficulty in maintaining friendly social interactions, in sharing, and in helping their playmates. They also had difficulty modulating hostile impulses; they showed more maladaptive patterns of aggression toward peers and adults. These interpersonal and emotional problems of offspring of manic-depressives were often similar to those problems of manic-depressives that have been implicated in the clinical literature as possibly associated with the transmission of the disorder. This apparent congruence of findings obtained from different disciplines employing very different research strategies and studying people of different ages, attests to the utility of an explicit interdisciplinary approach in the area of developmental psychopathology.

Problem behaviors and peer interactions of young children with a manic-depressive parent.

By the age of 2 years, children with a manic-depressive parent were already found to be experiencing substantial psychiatric problems. The authors examined the ways in which these early problems then become embedded in social relationships. Naturalistic observations and experimental manipulations of the emotional environment were used to measure 2-year-old children's regulation of emotion, aggression, and altruism during peer interactions. Children with a manic-depressive parent had difficulty in sharing with their friends and in handling hostility, showing maladaptive patterns of aggression. The social and emotional problems of these children were similar to the interpersonal problems of their manic-depressive parents.

A developmental view of affective disturbances in the children of affectively ill parents.

The authors review the various clinical and experimental studies of children of parents with affective illness, spanning infancy, childhood, and early adolescence and including their own and the studies reported in this Special Section of the Journal. They find a clear tendency to early disturbances in these children that seems related to adult affective illness in the areas of affect regulation and social interaction. Although these findings suggest a developmental line of affective illness linking child and adult forms, many issues need further clarification.

Developmental changes in children's reactions to anger in the home.

Developmental trends in children's reactions to anger and affection between others in the home were examined. School-age children evidenced greater emotional self-control and more effective and planful strategies for attempting to alter the course of others' conflicts. Children's responses to anger appeared to be mediated by individual differences in emotionality, which evidenced continuity across settings and between age periods. However, there was evidence that experience could modify reaction patterns to anger. Boys become less likely than girls to react emotionally to affection as they got older, but otherwise there were no developmental changes in responding to affection. Continuity across settings in reacting to affection was also apparent, but there was no relationship between patterns of responding to anger and affection.

Child rearing and children's prosocial initiations toward victims of distress.

Maternal rearing behavior was examined in relation to children's reparation for transgressions and altruism as bystanders to distress in others. The children were 1 1/2-2 1/2 years old. Mothers were trained in techniques of observing. They recorded their child's reactions and their own behaviors in everyday encounters with expressions of distress in others (sorrow, discomfort, pain). Distress was also simulated by mothers and investigators. Mothers' empathic caregiving was rated during home visits. Mothers' affectively delivered explanations regarding the distresses their children had caused to others were associated with children's reparations for transgressions. Such explanations were also associated with children's altruism when they were bystanders to another's distress. Empathic caregiving by mothers was positively associated with children's reparation and altruism. Findings are discussed in relation to theories of altruism, conscience, and child rearing.