Role of the family in the onset and outcome of childhood disorders: selected research findings.

OBJECTIVE: Three areas of basic family research were selected for review as being of special importance to the clinically oriented child and adolescent psychiatrist: behavioral genetics, expressed emotion, and the interaction of family dynamics and childhood illness.
METHOD: Medline and PSYCINFO searches using appropriate keywords were obtained for each of the 3 major areas. All English-language articles published after 1989 that included empirical research pertaining to children or adolescents were reviewed.
RESULTS: Behavioral genetics research indicates that the shared environment, including issues of parental monitoring and discipline, is important in the development and outcome of externalizing disorders. Differential parental treatments of one sibling are critical in internalizing disorders. Criticism (as measured by expressed emotion) is associated with poor outcome of many childhood medical and psychiatric disorders. Chronic illness in a child changes the family dynamics toward being more structured and less emotionally warm and communicative. The family's role in adherence to treatment is critical, and families with high levels of criticism have more difficulty.
CONCLUSIONS: Families can cause problems, but many times the problems families have are in response to a child's problems. There is a continued need to empirically assess which family processes are important for specific childhood disorders.