Observations of early triadic family interactions: boundary disturbances in the family predict symptoms of depression, anxiety, and attention-deficit/hyperactivity disorder in middle childhood.

This article argues for the importance of focusing explicitly on the construct of boundary disturbances in families to understand the development of depressive, anxious, and attention-deficit/hyperactivity disorder (ADHD) symptoms in middle childhood. Grounded in family systems theory, this study examined traditional parent-child antecedents of childhood depression and anxiety (hostile, controlling, and disengaged interactions) in the context of the entire family as well as enmeshed patterns, whereby one parent drew in the child by turning to the child for caregiving or intimacy and excluded the spouse, and balanced patterns, whereby all family members expressed vulnerabilities and asserted their needs or desires. Mostly White, middle-class mothers, fathers, and children were observed at home interacting on a series of everyday tasks when the children were 24 months old, and mothers and teachers rated children's symptoms of anxiety, depression, somatic problems, and ADHD at age 7. Regression analyses revealed that, after controlling for maternal depression and the effects of other family patterns, enmeshed family patterns forecast children's depressive symptoms; controlling and disengaged interactions predicted anxious and depressive symptoms; and hostility forecast ADHD and somatic complaints. Intriguing gender differences emerged. As predicted, whereas boys who experienced enmeshed family patterns more often developed symptoms of ADHD, girls who experienced enmeshed family interactions later showed symptoms of depression.