This article provides an overview of what we know about families where a parent has a mental illness, in order to situate the following papers for the special edition. An extensive search during No...

What do we know about families where parents have a mental illness? A systematic review

Objectives: Despite substantial evidence supporting the efficacy of stimulant medication for children with attention-deficit/hyperactivity disorder (ADHD), adherence to stimulant treatment is often suboptimal. Applying social/cognitive theories to understanding and assessing parent attitudes toward initiating medication may provide insight into factors influencing parent decisions to follow ADHD treatment recommendations. This report describes results from formative research that used focus groups to obtain parent input to guide development of a provider-delivered intervention to improve adherence to stimulants. Methods: Participants were caregivers of children with ADHD who were given a stimulant treatment recommendation. Focus groups were recorded and transcribed verbatim. Data were analyzed by inductive, grounded theory methods as well as a deductive analytic strategy using an adapted version of the Unified Theory of Behavior Change to organize and understand parent accounts. Results: Five gro...

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Parent perspectives on the decision to initiate medication treatment of attention-deficit/hyperactivity disorder.

Purpose of reviewHaving a parent with a mental illness is a major risk to children's wellbeing. The first step in developing policies and procedures that could assist these children is to determine the numbers of parents attending adult psychiatric services. This is the first systematic examination

The number of parents who are patients attending adult psychiatric services.

Attention-deficit/hyperactivity disorder (ADHD) is a common, early-onset and enduring neuropsychiatric disorder characterized by developmentally inappropriate deficits in attention, hyperactivity, increased impulsivity and emotional dysregulation, resulting in impairments in multiple domains of personal and professional life. ADHD has long been considered a disorder of childhood that resolves gradually with maturation during adolescence; however, this view was contested by systematic follow-up studies documenting the persistence of ADHD across the lifespan. In this article, we present converging evidence from clinical and genetic studies arguing for a remarkable perseverance of ADHD-related symptomatology, taking into account the disorder's variable and changing phenotype moderated by a high rate of comorbidity throughout the lifecycle. We also cover findings highlighting alterations in structural and functional neuroanatomy based on neuropsychological, psychophysiological and brain imaging approaches, and discuss options for deficit-focused pharmacological and psychotherapeutic interventions at different stages of life. In addition, we develop a fusion model of disease risk underlying the pathway to ADHD etiology. Finally, we argue for large-scale, systematic studies to explore factors predicting the long-term outcome of the disease and the possibilities to exploit those predictors with more personalized treatment strategies to enhance remittance and/or coping.

A lifetime of attention-deficit/hyperactivity disorder: diagnostic challenges, treatment and neurobiological mechanisms

Research on children of persons with a severe mental illness focuses predominantly on parents' and others' perceptions. Children of mentally ill parents form a vulnerable group that has not been adequately paid attention to in psychiatric care institutions. Comparatively little is known about the children's recognition of their parents and the everyday situation of these families. The aim of the study was to investigate experiences of their life situation in children 10-18 years of age in a family with a parent with a severe mental illness. Eight children were interviewed concerning their everyday life situation. The interviews were analysed inspired from using thematic analysis. From the analysis of the material emerged aspects concerning the following themes: need for conversation, love for their family, maturity, experience of fear and blame, feelings of loneliness, responsibility and associated stigma. This study highlights the situation experienced by children of severely mentally ill persons who also are parents. The study may be found to be a basis for inspiring structured interventions and treatments programmes including children of the adult patients seeking psychiatric treatment.

Interviews with children of persons with a severe mental illness: investigating their everyday situation.

This study reports the possibility of accomplishing a survey in an ordinary psychiatric service organization to identify the children and the adolescents in families with a parent with mental illness and to highlight the number of patients in psychiatric treatment with little or virtually no contact with their minor children. The prevalence of patients being parents to minor children was 36% in the total sample consisting of 137 patients, from both inpatient and outpatient services, participating in the survey. Three of four patients were living together with the children. A higher proportion of patients in the outpatient unit were parents to minor children, and more often lived together with them. There were no differences in prevalence of patients with minor children according to sex or diagnostic subgroup. However, female patients more often and patients with a psychosis diagnosis more seldom had the custody of the children. A majority of the patients had communicated with their children about their own situation, showing that psychiatric patients care a lot about the situation of their children, although, according to the patients, the psychiatric services only take an active part in this information in a minority of the cases. The study may be found to be a basis for inspiring structured interventions and treatments programmes, including the minor children of the adult patients seeking psychiatric treatment. Prevention of mental disorders in the oncoming generation is an important issue for all psychiatric professionals, especially in co-operation between adult and child/adolescent psychiatric services.

Illuminating patients with children up to 18 years of age - A 1-day-inventory study in a psychiatric service

Objective: This research seeks to study the impact on family function after 3 months of treatment with amphetamine. Method: A total of 43 children, 6 to 11 years of age, with ADHD were treated with amphetamine for 3 months. Family function was studied before and after treatment by parent self-rating and independent observer ratings of videotaped parent—child interactions. Results: The families with a child with ADHD were found to be more dysfunctional than control families. Families with children with severe ADHD behavior showed evidence of more family dysfunction compared to families with children with less severe ADHD behavior. After 3 months of treatment with amphetamine, the children's behavior and the mother's well-being and some aspects of parent-reported and observer-rated family functioning improved. Conclusion: This study gives support to the notion that some aspects of family dysfunction may be related to the child's ADHD behavior.

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Lena Eidevall

Papers

Illuminating patients with children up to 18 years of age - A 1-day-inventory study in a psychiatric service

Treatment of Attention Deficit/Hyperactivity Disorder With Amphetamine: Short-Term Effects on Family Interaction.

Treatment of Attention Deficit Hyperactivity Disorder with Amphetamine.