Thomas G. O'Connor

Paternal depression in the postnatal period and child development: a prospective population study

BACKGROUND Depression is common and frequently affects mothers and fathers of young children. Postnatal depression in mothers affects the quality of maternal care, and can lead to disturbances in their childrens social, behavioural, cognitive, and physical development. However, the effect of depression in fathers during the early years of a childs life has received little attention. METHODS As part of a large, population-based study of childhood, we assessed the presence of depressive symptoms in mothers (n=13,351) and fathers (n=12,884) 8 weeks after the birth of their child with the Edinburgh postnatal depression scale (EPDS). Fathers were reassessed at 21 months. We identified any subsequent development of behavioural and emotional problems in their children (n=10,024) at age 3.5 years with maternal reports on the Rutter revised preschool scales. FINDINGS Information was available for 8431 fathers, 11,833 mothers, and 10,024 children. Depression in fathers during the postnatal period was associated with adverse emotional and behavioural outcomes in children aged 3.5 years (adjusted odds ratio 2.09, 95% CI 1.42-3.08), and an increased risk of conduct problems in boys (2.66, 1.67-4.25). These effects remained even after controlling for maternal postnatal depression and later paternal depression. INTERPRETATION Our findings indicate that paternal depression has a specific and persisting detrimental effect on their childrens early behavioural and emotional development.

Maternal antenatal anxiety and behavioural/emotional problems in children: a test of a programming hypothesis

BACKGROUND Previous animal investigations link antenatal stress with a range of persistent behavioural abnormalities in the offspring. The current study examined if the effect was also found in humans through middle childhood. METHODS The current study is based on the Avon Longitudinal Study of Parents and Children (ALSPAC), a prospective, community-based study that has followed a cohort of women from pregnancy. Self-report measures of maternal anxiety and depression were assessed at repeated intervals in pregnancy and the postnatal period. Childrens behavioural/emotional problems were assessed by parent report at age 47 and 81 months. Information on obstetric and psychosocial factors was obtained at several points in pregnancy and the postnatal period. RESULTS Children whose mothers experienced high levels of anxiety in late pregnancy exhibited higher rates of behavioural/emotional problems at 81 months of age after controlling for obstetric risks, psychosocial disadvantage, and postnatal anxiety and depression (for girls, OR = 1.91, 95%CI = 1.26-2.89; for boys, OR = 2.16, 95%CI = 1.41-3.30). Furthermore, the effect at 81 months was comparable to what was previously obtained at 47 months, suggesting the kind of persistent effect proposed in the animal literature. CONCLUSIONS There is evidence that antenatal stress/anxiety has a programming effect on the fetus which lasts at least until middle childhood.

Antenatal Anxiety Predicts Child Behavioral/Emotional Problems Independently of Postnatal Depression

OBJECTIVE To examine the hypothesis that the effects of postnatal depression on childrens behavioral/emotional problems are explained by antenatal maternal mood. METHOD The current study investigated this hypothesis in the Avon Longitudinal Study of Parents and Children, a prospective, community-based study that has followed a cohort of women since pregnancy (n = 7,144) who delivered their baby between April 1, 1991, and December 31, 1992. Self-report measures of maternal anxiety and depression were assessed at repeated intervals in pregnancy and the postnatal period. Childrens behavioral/emotional problems were assessed by parent report at age 4 years. RESULTS After controlling for smoking, alcohol use, birth weight for gestational age, maternal age, child sex, and socioeconomic status, postnatal depression at 8 weeks (OR = 2.27 [1.55-3.31]) and 8 months (OR = 1.68 [1.12-2.54]) was associated with childrens behavioral/emotional problems. Subsequent analyses that included antenatal maternal mood indicated that antenatal anxiety in late pregnancy and not antenatal depression was also independently associated with behavioral/emotional problems at age 4 (OR = 1.72 [1.14-2.59]); 8 week postnatal depression remained a significant predictor after antenatal maternal mood was statistically controlled for (OR = 1.56 [1.04-2.32]). CONCLUSIONS Antenatal anxiety and postnatal depression represent separate risks for behavioral/emotional problems in children and act in an additive manner.

Sleep Problems in Childhood: A Longitudinal Study of Developmental Change and Association With Behavioral Problems

OBJECTIVE The objective of the study was to examine specificity, order of appearance, and developmental changes in the relationships between sleep problems and behavioral problems in children. METHOD Four hundred ninety children were selected from a large-scale longitudinal study of children growing up in adoptive and nonadoptive (biological) families in Colorado. Parental ratings of childrens sleep and behavioral problems on the Child Behavior Checklist were obtained from ages 4 to 15 years. RESULTS Sleep problems decreased from age 4 years to mid-adolescence, but there was modest stability of individual differences across this age range (r = 0.29). Regression analyses indicated that sleep problems at age 4 predicted behavioral/emotional problems in mid-adolescence after accounting for child sex, adoptive status, and stability of behavioral/emotional problems. Finally, the correlation between sleep problems and depression/anxiety increased significantly during this age period from r = 0.39 at age 4 years to r = 0.52 at mid-adolescence. CONCLUSIONS Early sleep problems may forecast behavioral/emotional problems, and there may be important developmental change in the overlap between sleep problems and behavioral/emotional problems.

Attachment Disorder Behavior Following Early Severe Deprivation: Extension and Longitudinal Follow-up

OBJECTIVE To examine attachment disturbances and disorder in a sample of children adopted into the U.K. following severe early privation and in a comparison sample of nondeprived, within-country, early-placed adoptees. METHOD The subjects, 165 children adopted from Romania and 52 adoptees from the U.K., were assessed at age 6 years; longitudinal data (at ages 4 and 6 years) were available on the 111 Romanian adoptees placed in U.K. homes before 24 months of age and on all U.K. adoptees. Information on attachment disorder was derived from a semistructured interview with the parent; in addition, data on childrens cognitive and social development were assessed using standardized assessments. RESULTS Analyses revealed a close association between duration of deprivation and severity of attachment disorder behaviors. In addition, attachment disorder behaviors were correlated with attentional and conduct problems and cognitive level but nonetheless appeared to index a distinct set of symptoms/behaviors. Finally, there was marked stability in individual differences in attachment disorder behaviors and little evidence of a mean decrease over this 2-year period. CONCLUSIONS The findings offer construct validation for the attachment disorder construct and highlight clinical and conceptual questions that require further research.

Are there biological programming effects for psychological development?: Findings from a study of Romanian adoptees

Associations between experiences and outcomes could be due to (a) continuation of adversity or (b) organismic changes, including experience-expectant and experience-adaptive developmental programming. The adoption into British families of children who had been reared in profoundly depriving institutions in Romania presented an opportunity to test mechanisms. Romanian children reared from infancy in very depriving institutions for periods up to 42 months were compared with 52 nondeprived UK-born children placed into adoptive families before the age of 6 months. The results at 6 years of age showed substantial normal cognitive and social functioning after the provision of family rearing but also major persistent deficits in a substantial minority. The pattern of findings suggests some form of early biological programming or neural damage stemming from institutional deprivation, but the heterogeneity in outcome indicates that the effects are not deterministic.

The Effects of Global Severe Privation on Cognitive Competence: Extension and Longitudinal Follow-Up.

The current study extends previous research on a sample of children adopted into the United Kingdom following severe early deprivation and a comparison sample of nondeprived, within-country, early adoptees. We assessed 165 children adopted from Romania and 52 U.K. adoptees at age 6 years. Longitudinal data (at age 4 and 6 years) were available on 111 Romanian adoptees placed into U.K. homes before 24 months of age and on all U.K. adoptees. Results indicated that there was considerable catch-up among late-placed Romanian children from entry into the United Kingdom to age 6, but as a group they exhibited lower cognitive scores and general developmental impairment compared with earlier adopted Romanian children. In addition, the resilience suggested at the assessment at age 4 years was maintained longitudinally, but there was no further evidence of catch-up or recovery.

Genetics and Child Psychiatry: II Empirical Research Findings

Key substantive findings from quantitative and molecular genetic research are reviewed in relation to affective disorder, schizophrenia, autism, hyperkinetic/attention deficit disorder, oppositional and conduct disorders, drug/alcohol problems, and Tourettes syndrome/chronic tics.

Depression in men in the postnatal period and later child psychopathology: a population cohort study

OBJECTIVE Postnatal depression in women is associated with adverse effects on both maternal health and childrens development. It is unclear whether depression in men at this time poses comparable risks. The present study set out to assess the association between depression in men in the postnatal period and later psychiatric disorders in their children and to investigate predisposing factors for depression in men following childbirth. METHOD A population-based cohort of 10,975 fathers and their children from the Avon Longitudinal Study of Parents and Children (ALSPAC) was recruited in the prenatal period and followed for 7 years. Paternal depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale and later child psychiatric disorder (DSM-IV) with the Development and Well-Being Assessment. RESULTS Depression in fathers in the postnatal period was significantly associated with psychiatric disorder in their children 7 years later (adjusted OR 1.72, 95% CI 1.07-2.77), most notably oppositional defiant/conduct disorders (adjusted OR 1.94, 95% CI 1.04-3.61), after adjusting for maternal depression and paternal educational level. A history of severe depression and high prenatal symptom scores for depression and anxiety were the strongest predictors of paternal depression in the postnatal period. CONCLUSIONS Depression in fathers in the postnatal period is associated with later psychiatric disorders in their children, independently of maternal postnatal depression. Further research into the risks associated with paternal psychopathology is required because this could represent an important opportunity for public health intervention.

Can Inattention/Overactivity Be an Institutional Deprivation Syndrome?

Elevated rates of attention deficit and overactivity have been noted previously in samples of institution-reared children. This study examined the hypothesis that inattention/overactivity(I/O) might constitute a specific deprivation syndrome. One hundred and sixty five children adopted at varying ages (e.g., 0–42 months of age) into the UK following severe early deprivation were compared with 52 within-UK adoptees who did not suffer deprivation. The children were rated by teachers and parents on levels of I/O, conduct difficulties, and emotional difficulties using the Revised Rutter Scales. Data were collected at age 6 for the entire sample and at age 4 for the UK adoptees and for the subsample of Romanian children who entered the UK before the age of 2 years. Mean level analyses suggested a significant effect of duration of deprivation on I/O, but not on conduct or emotional difficulties. The effects of duration of deprivation were specific to I/O and were not accounted for by low birth weight, malnutrition, or cognitive impairment. Levels of I/O correlated with attachment disturbances. Furthermore, the effects of duration of deprivation on I/O did not attenuate over time. We conclude that I/O may well constitute an institutional deprivation syndrome, but that the type of attention deficit and overactivity exhibited by these children may present a different clinical picture from that of “ordinary” varieties of attention deficit disorder or hyperkinetic syndrome.