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Chapter 31: Child Psychiatry
Stepparents.
Although there are many different scenarios
that may occur after a divorce and remarriage, several poten-
tial scenarios have been outlined in Table 31.1-10. These
include: (1) Neo-traditional, (2) Romantic, and (3) Matriar-
chal. When remarriage occurs, children must learn to adapt to
the stepparent and to the “blended” family. Adaptation is often
challenging, especially when a child feels that a stepparent is
nonsupportive, resents the stepchild, or favors his or her own
natural children. Of step-families, 25 percent tend to dissolve
within the first 2 years, whereas 75 percent grow to find a new
balance in their blended family. A biological child born to a
new couple with a stepchild already in the home may receive
more attention than the stepchild, leading to of sibling rivalry.
After 5 years, about 20 percent of adolescents in step-families
suggest that they move out and try living with their other bio-
logical parent.
Family Factors in Child Development
Family Stability.
Parents and children living under the
same roof in harmonious interaction is the expected cultural
norm in Western society. Within this framework, childhood
development presumably proceeds most expeditiously. Devia-
tions from the norm, such as divorced- and single-parent fami-
lies, are associated with a broad range of problems in children,
including low self-esteem, increased risk of child abuse, and
increased incidence of divorce when they eventually marry, and
increased incidence of mental disorders, particularly depres-
sive disorders and antisocial personality disorder as adults.
Why some children from unstable homes are less affected
than others (or even immune to these deleterious effects) is of
great interest. Michael Rutter has postulated that vulnerability
is influenced by sex (boys are more affected than girls), age
(older children are less vulnerable than younger ones), and
inborn personality characteristics. For example, children who
have a placid temperament are less likely to be victims of abuse
within a family than are hyperactive children; by virtue of their
placidity, they may be less affected by the emotional turmoil
surrounding them.
Adverse Events.
It is now well known that significant
adverse events, especially in early childhood such as sexual and
physical abuse, neglect, or loss of a parent, interact with genetic
background in a given child and influences the trajectory of
development. For example, as mentioned earlier early severe
maltreatment such as sexual abuse increases the risk of mul-
tiple psychosocial difficulties and emergence of many psychi-
atric disorders. Among young maltreated children, those with
particular genetics, that is, who have the “short” variant of the
serotonin transporter gene (short 5-HTTLPR polymorphism)
are significantly more vulnerable to chronic depression in adult-
hood. This example of specific gene–environment interaction
plays an important role in a child’s development as well as in the
risk for future psychopathology. Current investigations are also
seeking insight into what factors lead to resilience in youth who
have been exposed to adverse events, yet maintain allostasis,
that is, stability in the face of stressful events. Hormones of the
adrenal glands, thyroid, gonads, as well as metabolic hormones
play a role on the brain’s ability to maintain stability upon
exposure to stress, and the prefrontal cortex, hippocampus, and
amygdala play critical roles in regulating emotionality, aggres-
sion, and resilience.
Day Care Centers.
The role of day care centers for chil-
dren is under continuous investigation, and various studies
have produced different results. One study found that children
Table 31.1-9
Effects of Divorce on Children
Children in homes with absent fathers are more likely to suffer
from antisocial personality disorder, child conduct disorder,
and attention-deficit hyperactivity disorder.
The divorce rate of children of divorced parents doubles that
of children from stable families.
Children of divorce are far more likely to be delinquent,
engage in premarital sex, and bear children out of wedlock
during adolescence and young adulthood.
Children from divorced homes function more poorly than
children from continuously married parents across a variety of
domains, including academic achievement, social relations,
and conduct problems.
Children fromdivorced homes have more psychological problems
than those from homes disrupted by the death of a parent.
Children from disrupted marriages experience greater risk of
injury, asthma, headaches, and speech defects than children
from intact families.
Children of divorce tend to be impulsive, irritable, socially
withdrawn, lonely, unhappy, anxious, and insecure.
Children of divorce, especially boys, are more aggressive than
children whose parents stayed married.
Suicide rates for children of divorce are much higher than for
children from intact families.
Twenty to 25 percent have significant adjustment problems as
teenagers
(Data adapted from Americans for Divorce Reform, Arlington, Virginia.
Table by Nitza Jones.)
Table 31.1-10
Types of Step-Families
Neo-Traditional
Families
Resembles “traditional” families
Absent biological parent is included at times.
Discipline, boundaries and limits, and
expectations are discussed openly.
Family coalitions and “side-taking” are
better avoided.
Romantic
Families
Expect to be a “traditional family”
immediately
The absent biological parent is expected to
disappear and is often criticized.
Stepparent/stepchild difficulties are common.
Stress is unbearable.
Few open and frank discussions about
problems
Matriarchal
Families
Run by a highly competent mom and her
companion follows
Companion is a “buddy” to the children, not
to the parent.
Birth of a step-sibling causes problems.
