Families with Children with Emotional Disorders: A Review of the Literature

Early, Theresa J., Poertner, John, Social Work

Thinking of some children as emotionally disordered or disturbed is a recent phenomenon. Before the 1920s
when children's behavioral and emotional problems first received attention with the establishment of child
guidance clinics, needy children in the United States generally were thought of as dependent or delinquent (Petr
& Spano, 1990). From the 1950s to the 1970s, the number of children in U.S. mental hospitals and residential
treatment centers tripled (Petr & Spano, 1990). This trend went almost unnoticed by the public as the needs of
children with emotional problems were largely ignored (Knitzer, 1982) in spite of federal studies such as the
report of the Joint Commission on the Mental Health of Children (Joint Commission, 1969; Meyers, 1985). It
was not until the publication of Unclaimed Children (Knitzer, 1982) that public attention was drawn to the
needs of children with serious emotional disorders.
As Petr and Spano (1990) pointed out, social work has demonstrated ambivalence about whether to
institutionalize children or keep them with their families. Knowing what to do for or with children with
emotional disorders and designing social work interventions for them is a complex problem. Part of this
complexity is in defining the role of parents in interventions. Knitzer (1982) pointed out that many parents
reported being blamed by the professionals and the public for causing their children's problems: "The
persistence of this attitude is a tragic legacy of early efforts to explain children's problems as resulting from
poor parenting". This blaming of parents is primarily "mother-blaming." In a review of clinical journal articles
from 1970, 1976, and 1982, in which the etiology of someone's emotional problems was discussed, Caplan and
Hall-McCorquodale (1985) concluded that the overwhelming picture in all journals for more than 63 items |
such as whether mother's pathology or father's affected the family; whether only mother or only father was
involved in treatment; number of words used to describe mother compared to number used to describe father~
was one of mother-blaming. This picture was not affected by sex of the author or by the year of publication for
any of the 63 items.
In all, the authors documented more than 70 mental health problems that have been attributed to mothers,
including aggressiveness, anorexia, autism, encopresis, enuresis, schizophrenia, suicidal behavior, tantrums,
and truancy.
Parent-blaming is evident not only in the clinical research literature studied by Caplan and Hall-McCorquodale
(1985) but also in textbooks currently used to train mental health professionals. Wahl (1989) studied nine
abnormal psychology textbooks published in 1986, 1987, and 1988 to determine the treatment of the concept of
"schizophrenogenic parenting," the notion that parental behavior causes schizophrenia. Although research has
failed to establish causal links between parent behavior and schizophrenic development and although a recent
publication of the National Institute of Mental Health states that most researchers now agree parents do not
cause schizophrenia, most of the textbooks did not accurately reflect current thought. In fact, some of the
textbooks implied that parental causation of schizophrenia is likely and as yet has not been proved because of
inadequate research. A recent review of the literature on the parent-professional relationship found that this
literature has focused on parents' perceptions of their relationship with professionals and that parents perceive
they are excluded, alienated, and blamed (Collins & Collins, 1990).
It is evident from the work of Caplan and Hall-McCorquodale (1985) and Wahl (1989) that families, parents in
general and mothers in particular, are "blamed" for their children's mental and emotional disorders. As well,
parents of children with emotional disorders indicate that they experience many practices of and encounters
with professionals as exclusionary and blaming (Collins & Collins, 1990; Knitzer, 1982). In light of the
blaming nature of much research and many practices, and with an eye to designing social work interventions for
families with children with emotional disorders, a review of recent literature (1985 to 1990) was undertaken to
discover empirical knowledge about families with children with emotional disorders that is of use in designing
interventions for these families and their children and to identify ways in which research may be blaming of
parents and families. The authors sought to answer these two questions: (1) What do we empirically know
about families with children with emotional disorders? and (2) How does this information help us design social
policy and social work interventions for families and children?

Because both the literature and public policy lack clear definition of what constitutes a serious emotional
disorder (Knitzer, 1982), drawing boundaries around the literature is difficult. Studies were included in the
present review if they met two criteria: (1) The research focused on families with children under the age of 18,
or at least provided between-group comparisons of some aspect of family structure or interaction in families
with children under the age of 18, and (2) the children who were subjects were identified as having a serious
emotional or behavioral disorder (that is, by psychiatric diagnosis or scoring in the clinical range of a
classification measure). Studies that described an intervention or compared interventions were specifically
excluded. Searches of Social Work Research & Abstracts, Psychological Abstracts, and Educational Resources
Information Center (ERIC) and indexes of selected journals for the years January 1985 through August 1990
yielded 44 articles that met these criteria.
Four types of study emerged in the literature. One body of studies examined the rates of identifiable mental or
emotional disorder in close relatives of children or adolescents diagnosed with particular disorders. The second
category concerns the use of behavior checklists or other evaluation instruments. Another group has the general
format of correlating some aspect of family structure or interaction with a child's emotional, mental, or
behavioral problems. The final group of studies may be categorized as ecological in nature because they
consider the wider context of the behavioral or emotional problems, examining such issues as factors
discriminating which children are referred for psychiatric services; what parents hope to gain from seeking help
for their children; and family perspectives on their problems, needs, and experiences in relation to their child
with an emotional disorder.
Because the volume of the literature is large and because of our interest in information useful to frontline social
workers intervening with families and children, this review is limited to research that studies correlations of the
child's disorder with family structure or interaction and ecological factors.
Correlations of Child's Disorder with Family Structure or Interaction
The majority of the literature identified for this review (28 of 32 articles) concerns the correlation of a child's
emotional, mental, or behavioral problem with particular actions (or inaction) of the parent or with a more
generalized measure of family interaction (nine studies), some aspect of the child's perception of the family or
the parents' perception of the child (seven studies), or characteristics of the child's parents (12 studies). The
following sections summarize findings of each of these categories of correlational studies.
Parental Action or Family Interaction
Nine studies may be categorized as correlating some measure of parents' functioning (Johnson & O'Leary,
1987; Webster-Stratton, 1985), mothers' functioning (Field et al., 1987; Gardner, 1989; McFarlane, 1987;
Sanders, Dadds, & Bor, 1989; Webster-Stratton, 1985), or family functioning (Bernstein, Svingen, & Garfinkel,
1990; Cunningham, Benness, & Siegel, 1988; Huffington & Sevitt, 1989; McFarlane, 1987) with the emotional
or behavioral problems of a child in the family. Table 1 lists authors, sample characteristics, family-related
variables studied, and major results of these studies. (Tables 1 to 4 follow the reference list.)
Several studies found significant relationships between measures of mothers' functioning and the presence of
behavioral or emotional problems in their children. Space does not allow for indepth reporting here of all
results. Selected examples follow.
Gardner (1989) found a relationship between mothers' inconsistency and episodes of angry conflict with their
children with conduct problems. Field et al. (1987) found mothers of normal children and children who are
depressed reported themselves to be significantly more nurturant than mothers of children with conduct
disorders. Also, mothers of normal children and children who are depressed were observed to express more
approval toward their children than mothers of children with conduct disorder, and mothers of children who are
depressed and children with conduct disorders expressed more disapproval toward their children than did
mothers of normal children. Finally, mothers of children with conduct disorders were found to engage in
significantly more aversive behavior than mothers of normal children during observations of usual parenting
practices in the home (Sanders et al., 1989).

Other studies revealed no relationship between children's behavioral or emotional problems and measures of
mothers' functioning. Specifically, no significant differences were found between abusive families and
nonabusive families in mothers' reports of use of forceful and nonforceful methods of discipline (WebsterStratton, 1985). Factors that were found to discriminate abusive families from nonabusive families were
mothers being significantly more depressed in abusive families, abusive families reporting significantly more
abuse as children and partner abuse, significantly more abusive families headed by a single mother, and
significantly lower income in abusive families.
Two studies in this group measure fathers' behavior separately from generic parental behavior. One found that
fathers of girls with conduct disorders used a more aggressive response style than fathers of control subjects
(Johnson & O'Leary, 1987); the other found that fathers reported significantly poorer affective responsiveness
than their wives (Cunningham et al., 1988).
Perceptions of the Child or the Parents
The research reporting on perceptions of the child or parents (seven articles) examined relationships between
children's perceptions of their families or parents' perceptions of their children with serious emotional disorders.
Table 2 lists authors, sample characteristics, family-related variables studied, and major results of these studies.
Two articles explored parents' perceptions of their children (Brody & Forehand, 1986; Grotevant, McRoy, &
Jenkins, 1988). Specifically, Brody and Forehand measured mothers' perceptions of their children's behavior as
maladjusted, along with depression of the mother and child's compliance; Grotevant et al. examined parents'
perceptions of compatibility between child's personality and parents' behavioral style. The remaining five
articles explored children's perceptions of family members' conflict resolution styles (Kashani, Burbach, &
Rosenberg, 1988), family environment (Asarnow, Carlson, & Guthrie, 1987; Margalit, Weisel, Heiman, &
Shulman, 1988), and parental bonding (Burbach, Kashani, & Rosenberg, 1989; Kashani et al., 1987).
A few results from these studies illustrate the content of these works. The majority of these studies considered
the family as the unit of analysis, not separating mothers' perceptions from fathers' or children's perceptions of
their mothers from perceptions of their fathers. Exceptions to this considered mothers' and fathers' conflict
resolution tactics separately (Kashani et al., 1988) and only mothers' perceptions of their children's behavior
(Brody & Forehand, 1986).
Mothers' higher scores of perception of child maladjustment were associated with high maternal depression and
with low child compliance, especially in interaction with high maternal depression (Brody & Forehand, 1986).
Significant relationships were found between children's perceptions of different aspects of their family
environments and their emotional problems. Children classified as suicide attempters saw their families as less
cohesive and higher in conflict than did nonsuicidal subjects (Asarnow et al., 1987).
Significant relationships also were found between children's perceptions of parental bonding and children's
disorders. Adolescents determined to be "in need of treatment" reported their parents as significantly less caring
than did adolescents not in need of treatment (Kashani et al., 1987); adolescents who were nondepressed
psychiatric subjects reported significantly less parental care and more parental overprotection than adolescents
with no diagnosis (Burbach et al., 1989).
Characteristics of the Parents
Studies reported in this section (12 articles) measured characteristics of mothers only (four articles: Frick,
Lahey, Hartdagen, & Hynd, 1989; Goodyer, Wright, & Altham, 1988; Lahey, Russo, Walker, & Piacentini,
1989; Mouton & Tuma, 1988), both parents separately (six articles: Brown, Borden, Clingerman, & Jenkins,
1988; Clark & Bolton, 1985; Hamdan-Allen, Stewart, & Beeghly, 1989; Hodges, Kline, Barbero, & Woodruff,
1985; Kaslow, Rehm, Pollack, & Siegel, 1988; Webster-Stratton, 1989), or parents in the generic sense (two
articles: Aarkrog, 1985; Tompson, Asarnow, Goldstein, & Miklowitz, 1990). No articles concerned the
characteristics of fathers only. Table 3 lists authors, sample characteristics, parent- and family-related variables
studied, and major results of these studies. Examples of results from the studies follow.

Not surprisingly, because 10 of the studies measured something about mothers and only six measured
something about fathers, the greatest number of significant results concerned characteristics of mothers. In
studies that concerned only mothers, children's anxious or depressive emotional disorders were found to be
associated with mothers' poor confiding relationships, maternal distress, and recent stressful life events
(Goodyer et al., 1988).
Studies that measured characteristics of both mothers and fathers found significant results for fathers'
characteristics as well as mothers' characteristics. Hamdan-Allen et al. (1989) found the greatest number of
significant relationships between boys with pervasive aggressive conduct disorder (PACD) and their parents'
characteristics: Mothers had higher rates of alcoholism and drug abuse than mothers of boys with a situational
aggressive conduct disorder (SACD) or mothers of boys in the comparison group; antisocial behavior was more
prevalent for fathers. Also, fathers of boys with both PACD and SACD abused alcohol at rates significantly
higher than fathers of boys in the comparison group.
Several studies failed to show significant results. Kaslow et al. (1988) rebutted the notion that cognitive
distortions of parents lead to cognitive deficits and depression in their children. Although significantly more
mothers of children who were depressed were themselves depressed, no between-group differences were
detected in parents' attributional style and self-control behavior (the cognitive functioning dimensions studied),
and no relationship was found between children's and parents' cognitive functioning. Tompson et al. (1990)
found no significant differences in disordered communication or thought disorder between parents of children
with schizophrenia spectrum disorders and children with major depression.
Ecological Factors
The remainder of the empirical literature reviewed (four articles) moves in a different direction from the efforts
described earlier. Instead of seeking to identify aspects of the family that may be correlated with children's
disorders, this literature has identified needs of parents and families in regard to their children with emotional
disorders (Bailey & Garralda, 1989; Friesen, 1989) and identified factors that were related to children being
referred for mental health services (Dulcan et al., 1990; Garralda & Bailey, 1988). Table 4 lists authors, sample
characteristics, family and ecological variables studied, and major results of these studies.
Both studies of factors affecting referral for mental health services involved researchers' completing diagnostic
interviews for all children with their parents. Although both studies found pediatricians had identified and
referred fewer children than were determined by researchers to receive Diagnostic and Statistical Manual of
Mental Disorders-Third Edition (DSM-III) (American Psychiatric Association, 1980) diagnoses (labeled
"disturbed" by researchers), 60 percent of disturbed children had been referred in the Garralda and Bailey
(1988) study and only 17 percent had been referred in the Dulcan et al. (1990) study. There was greater
agreement between the two studies in the percentages of children referred but determined not to be disturbed:
20 percent (Garralda & Bailey, 1988) and 16 percent (Dulcan et al., 1990).
Factors found to be associated with referral in the Garralda and Bailey (1988) study included high total
antisocial scores on the child behavior questionnaire filled out by parents, high parental concern about their
ability to control their child, and disadvantaged social class. Further results from the same study reported in a
different article (Bailey & Garralda, 1989) examined doctors' statements of their reasons for referral of children
in the referred sample. In more than half the cases, doctors gave as a main referral reason parental anxiety or
parental request; the severity of the child's problem was a main reason for referral in slightly less than half the
cases; and family disturbance was a main reason in about one-third of the cases. Parental concern about the
child's problems also was associated with referral in the Dulcan et al. (1990) study. For children determined to
be disturbed, identification by the pediatrician was 13 times more likely when the parent had consulted the
pediatrician about the child's emotional and behavioral problems and was not significantly increased for
children determined not to be disturbed.
Parents were hesitant to discuss emotional and behavioral problems with pediatric staff. Dulcan et al. (1990)
reported that more than half of the parents in their study expressed a concern about their child's emotional and
behavioral problems to the researchers, but only 23 percent reported having discussed their concerns with the

health maintenance organization pediatric staff. Often, parents' concerns about their children's emotional and
behavioral problems were supported by the diagnostic process of the research: 85 percent of parents whose
child met DSM-III criteria for diagnosis expressed concern about the child's problems to the researchers and
only 45 percent of parents whose child did not meet diagnostic criteria did so. Controlling for the presence of
diagnosis, factors that significantly predicted parents' expressing concern about their child's problems to the
researchers were distress in the mother and a family history of mental problems. These same factors had the
greatest effect on parents' reporting having consulted the pediatrician about the child's problems.
When their child was referred for psychiatric services, parents reported expecting to obtain help for the child,
desiring to have an explanation for the child's behavior and problems, and expecting to receive advice on how
to deal with the child's difficulties (Bailey & Garralda, 1989).
In Friesen's (1989) study, services parents indicated they received included support groups (38 percent),
advocacy services (20 percent), and financial assistance (36 percent). All respondents reported currently using
one or more services for their children with emotional disorders. Services being used for children included
special education (67 percent), psychiatric hospitalization (11 percent), and residential treatment (25 percent).
Sources of support included formal and informal sources such as spouses, other relatives, and friends.
Emotional support was listed by more than 70 percent of respondents as the most helpful type of help to receive
from informal sources. Nearly half the respondents affirmed involvement with religion and involvement with
other parents as helpful to them in coping with raising their children with emotional disorders; these were the
activities chosen first or second across parents from all income categories except the over-$50,000 category
(Friesen, 1989).
Although very small percentages of parents reported positive effects of their children's emotional problems on
the family's relationships with others, relationships among family members, effects on other children, and
health of the parents, one-quarter of the parents did report a positive effect of the child's problems on
involvement by both parents in the care of the child (Friesen, 1989). More than 50 percent of respondents
reported a negative effect of the child's problems on family life in areas such as parents' opportunity to have
time away from their children; effects on other children in the family; amount of attention parents provide to
other children; the ability to plan and participate in social activities as a family; and the family's relationships
with other family members, friends, and neighbors.
Social Work Use of What Is Known
The major questions this review seeks to answer are what social workers know about families with children
with emotional disorders and how this helps social workers respond to the needs of these families and children
on policy, program, and practice levels. The summary of this research presents a substantial challenge in
answering these questions.
Many of the studies are aimed at investigating factors associated with various emotional disorders in children
and adolescents, presumably to understand something about the causes of such disorders. Given that the
primary methodology is one of correlation, there is the danger of confusing cause and effect. The temporal
order of the variables studied remains uninvestigated. Thus, for the significant relationship demonstrated
between mothers' anxiety and their children's recurrent abdominal pain or behavior disorders, it is not possible
to know whether mothers' anxiety preceded their children's problems or is a response to parenting children with
such difficulties, or whether both factors are related to some other, unidentified variable.
If one takes this view of the findings, it may make more sense and be more helpful to keep in mind that anxiety,
depression, and a number of other affective responses may be expected and not dysfunction on the part of
parents. This makes a difference in the ways social workers engage with families and in the focus of their
interventions. If family factors or parent characteristics are thought to cause children's emotional problems, then
social workers' work with families with children with emotional disabilities may overtly or covertly blame these
families for their children's problems.

When families are assumed to be at fault for their children's problems, families are not considered to be a
resource for their children; rather, they are something to be "fixed" or removed from their children's lives
through placing the children out of their homes. On the other hand, if social workers accept that parenting a
child with an emotional disorder is stressful for the family, they are in a better position to create policies and
practices that relieve some of the stress to enable families to better care for their children and that emphasize a
preference for serving children and their families.
If mothers' distress and family history of mental problems predict parents' expressing concern about their child's
emotional problems and if these factors also predict parents' having consulted a medical doctor about such
problems (Dulcan et al., 1990), it may be that the referred or treatment samples of parents studied are not
representative of the general population of parents of children with emotional and behavioral disorders. If social
workers base policy and programs on information collected from biased samples, then these policies and
programs may not be useful to the wider population of families and their children with emotional disorders.
Another way in which the correlational literature fails to be useful is in the extent to which, consistent with the
mother-blaming identified by Caplan and Hall-McCorquodale (1985), the majority of conclusions focus on
mothers' emotional states, actions, or inaction at rates far greater than those with which fathers' contributions
are examined. As Caplan and Hall-McCorquodale observed,
Child rearing is still primarily considered the mother's responsibility. The increasing number of single
mothers ... means that, above all, mothers are there. They are there for the professionals who assess and treat
their children; they are there to be identified, studied, and questioned by these professionals; and they are there
for the general public to see, raising their children. Thus, they, more than the absent fathers, are easy targets for
blame.
Research that singles out the relationship between an action or trait of mothers and their children's disorders
that fails to consider the influence of fathers perpetuates mothers being held solely responsible for their
children's development.
Perhaps some of the most useful information one may glean from the correlational studies is unrelated to the
questions being studied. For instance, it is known that children with conduct disorders are from families that are
nonabusive as well as from families that are abusive and that both adoptive and nonadoptive families have
children with emotional disturbances. This is useful information for social workers and other professionals, as it
challenges stereotypes and myths: One must not assume the presence of one trait based on the existence of
another trait.
A limitation of the majority of the studies identified in all categories is the lack of race and socioeconomic
status (SES) information on the samples of families and children. In all, only 12 studies reported the races and
eight studies discussed the SESs of subjects. Even the studies that describe sample racial and socioeconomic
characteristics usually fail to consider the effect of race or SES on the other variables under study or have
sample sizes insufficient for such comparisons to be meaningful.
Information that is most useful to practitioners, policymakers, and planners primarily is found in the ecological
studies. From the studies of factors associated with referrals of children for mental health services, one finds
that general medical practitioners make errors of 40 percent to 83 percent in underreferral and 16 percent to 20
percent in overreferral.
Assuming that the researchers in these studies accurately identified children in need of mental health services,
attention needs to be focused on reaching the 40 percent to 83 percent of disturbed children not identified by
community professionals. Some policy and research issues are raised: Do current mental health systems have
the capacity to find and serve these children? What about the 20 percent of children referred but found not to be
disturbed? How are these children different? What do they need rather than mental health services? How may
their parents get the assistance they are seeking? Are some children receiving mental health services who do not
need them? Although the research presented in this review does not answer these questions, it brings up lines of
inquiry that may lead human services professionals in useful directions.

Given possible difficulties of accurate assessment and the stigma of a mental illness label, we suggest that
social workers take a normalization approach. If they work toward normal living and educational arrangements
for the child, it may be possible to reduce stigma, divert children from the mental health system, and hasten the
exit from the system of children inaccurately identified.
The ecological literature also yields useful information about the parent perspective. Parents want an
explanation of the behavior or problem; advice on how to handle the problem; special education services that
meet their children's needs; emotional support from spouses, relatives, and friends; time to get away; and
normal relationships with other children in the family as well as with friends. From a practice point of view, it is
clear that social workers can and should focus their efforts on meeting these self-expressed needs. Most of these
needs are well within the realm of usual social work practice. Policy implications are clear as well. Families
require supportive services to care for their children with emotional disorders and to maintain their family unit.
Providing explanations for children's problems or behavior may be problematic because it is likely that one
cannot reliably identify the cause. Yet even this information is useful to parents. The drive for an explanation
may be related to blame placed by family, friends, and professionals, as well as self-blame. A parent may ask
himself or herself, "Did I do something as a parent to cause this?" Given professionals' inability to answer this
question in a valid and reliable manner, the most useful approach might be to recognize the complexity of and
lack of knowledge of the cause of emotional problems. Practitioners' attention then shifts to helping families
focus their resources on the current solution. In our view, the most appropriate role for social work is to counter
some of the forces that have blamed families in general and mothers in particular. Social workers enable
mothers and families to be released from self-blame when they identify their strengths and build on them to
meet the needs of caring for their child. It must be social work's role to ask the question, "Given your child's
behavior, what is it you need to provide care?" Social work can then join with parents to get these needs met.
It is our position that the research literature reported as ecological studies is the hope for the future for social
work policy, practice, and research. The profession is just beginning to realize that a different approach to
families of children with emotional disturbances is needed. Research on referral and parents' expressed
caregiving needs is not a sufficient research agenda, however. In addition, researchers need to examine areas
and outcomes of intervention that assist families in meeting their caregiving needs. Research is needed on how
caregivers cope and on the consequences of caring for a child with an emotional disturbance. Research of this
type holds promise for developing social work practice and policy to address this difficult problem.
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References
Aarkrog, T. (1985). Borderline and psychotic adolescents' relationship to their parents: A therapeutic point of
view. Adolescence, 20, 681-687.
American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.).
Washington, DC: Author.
Asarnow, J. R., Carlson, G. A., & Guthrie, D. (1987). Coping strategies, self-perceptions, hopelessness, and
perceived family environments in depressed and suicidal children. Journal of Consulting and Clinical
Psychology, 55, 361-366.
Bailey, D., & Garralda, M. E. (1989). Referral to child psychiatry: Parent and doctor motives and expectations.
Journal of Child Psychology and Psychiatry, 30, 449-458.

Bernstein, G. A., Svingen, P. H., & Garfinkel, B. D. (1990). School phobia: Patterns of family functioning.
Journal of the American Academy of Child and Adolescent Psychiatry, 29, 24-30.
Brody, G. H., & Forehand, R. (1986). Maternal perceptions of child maladjustment as a function of the
combined influence of child behavior and maternal depression. Journal of Consulting and Clinical Psychology,
54, 237-240.
Brown, R. T., Borden, K. A., Clingerman, S. R., & Jenkins, P. (1988). Depression in attention deficit-disordered
and normal children and their parents. Child Psychiatry and Human Development, 18, 119-132.
Burbach, D. J., Kashani, J. H., & Rosenberg, T. K. (1989). Parental bonding and depressive disorders in
adolescents. Journal of Child Psychology and Psychiatry, 30, 417-429.
Caplan, P. J., & Hall-McCorquodale, I. H. (1985). Mother-blaming in major clinical journals. American Journal
of Orthopsychiatry, 53, 345-353.
Clark, D. A., & Bolton, D. (1985). Obsessive-compulsive adolescents and their parents: A psychometric study.
Journal of Child Psychology and Psychiatry, 26, 267-276.
Collins, B., & Collins, T. (1990). Parent-professional relationships in the treatment of seriously emotionally
disturbed children and adolescents. Social Work, 35, 522-527.
Cunningham, C. E., Benness, B. B., & Siegel, L. S. (1988). Family functioning, time allocation, and parental
depression in the families of normal and ADDH children. Journal of Clinical Child Psychology, 17, 169-177.
Dulcan, M. K., Costello, E. J. Costello, A. J., Edelbrock, C., Brent, D., & Janiszewski, S. (1990). The
pediatrician as gatekeeper to mental health care for children: Do parents' concerns open the gate? Journal of the
American Academy of Child and Adolescent Psychiatry, 29, 453-458.
Field, T. M., Sandberg, D., Goldstein, S., Garcia, R., Vega-Lahr, N., Porter, K., & Dowling, M. (1987). Play
interactions and interviews of depressed and conduct disorder children and their mothers. Child Psychiatry and
Human Development, 17, 213-234.
Frick, P. J., Lahey, B. B., Hartdagen, S., & Hynd, G. W. (1989). Conduct problems in boys: Relations to
maternal personality, marital satisfaction, and socioeconomic status. Journal of Clinical Child Psychology, 18,
114-120.
Friesen, B. J. (1989). National study of parents whose children have serious emotional disorders: Preliminary
findings. In A. Algarin, R. M. Friedman, A. J. Duchnowski, K. M. Kutash, S. E. Silver, & M. K. Johnson (Eds.),
2nd annual conference proceedings, children's mental health services and policy: Building a research base (pp.
36-52). Tampa: Research and Training Center for Children's Mental Health, Florida Mental Health Institute,
University of South Florida.
Gardner, F.E.M. (1989). Inconsistent parenting: Is there evidence for a link with children's conduct problems?
Journal of Abnormal Child Psychology 17, 223-233.
Garralda, M. E., & Bailey, D. (1988). Child and family factors associated with referral to child psychiatrists.
British Journal of Psychiatry, 153, 81-89.
Goodyer, I. M., Wright, C., & Altham, P.M.E. (1988). Maternal adversity and recent stressful life events in
anxious and depressed children. Journal of Child Psychology and Psychiatry, 29, 651-667.
Grotevant, H. D., McRoy, R. G., & Jenkins, V. Y. (1988). Emotionally disturbed, adopted adolescents: Early
patterns of family adaptation. Family Process, 27, 437-457.

Hamdan-Allen, G., Stewart, M. A. & Beeghly, J. H. (1989). Subgrouping conduct disorder by psychiatric
family history. Journal of Child Psychology and Psychiatry, 30, 889-897.
Hodges, K., Kline, J. J., Barbero, G., & Woodruff, C. (1985). Anxiety in children with recurrent abdominal pain
and their parents. Psychosomatics, 26, 859-866.
Huffington, C. M., & Sevitt, M. A. (1989). Family interaction in adolescent school phobia. Journal of Family
Therapy, 11, 353-375.
Johnson, P. L., & O'Leary, K. D. (1987). Parental behavior patterns and conduct disorders in girls. Journal of
Abnormal Child Psychology, 15, 573-581.
Joint Commission on the Mental Health of Children. (1969). Crisis in child mental health: Challenge for the
1970s. New York: Harper & Row.
Kashani, J. H., Burbach, D. J., & Rosenberg, T. K. (1988). Perception of family conflict resolution and
depressive symptomatology in adolescents. Journal of the American Academy of Child and Adolescent
Psychiatry, 27, 42-48.
Kashani, J. H., Hoeper, E. W., Beck, N. C., Corcoran, C. M., Fallahi, C., McAllister, J., Rosenberg, T.J.K., &
Reid, J. C. (1987). Personality, psychiatric disorders, and parental attitude among a community sample of
adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 26, 879-885.
Kaslow, N. J., Rehm, L. P., Pollack, S. L., & Siegel, A. W. (1988). Attributional style and self-control behavior
in depressed and nondepressed children and their parents. Journal of Abnormal Child Psychology, 16, 163-175.
Knitzer, J. (1982). Unclaimed children. Washington, DC: Children's Defense Fund.
Lahey, B. B., Russo, M. F., Walker, J. L., & Piacentini, J. C. (1989). Personality characteristics of the mothers
of children with disruptive behavior disorders. Journal of Consulting and Clinical Psychology, 57, 512-515.
Margalit, M., Weisel, A., Heiman, T., & Shulman, S. (1988). Social skills and family climate of behaviorally
disordered adolescents. Behavioral Disorders, 13, 253-262.
McFarlane, A. C. (1987). The relationship between patterns of family interaction and psychiatric disorder in
children. Australian and New Zealand Journal of Psychiatry, 21, 383-390.
Mouton, P. Y., & Tuma, J. M. (1988). Stress, locus of control, and role satisfaction in clinic and control mothers.
Journal of Clinical Child Psychology, 17, 217-224.
Petr, C. G., & Spano, R. N. (1990). Evolution of social services for children with emotional disorders. Social
Work, 35, 228-234.
Sanders, M. R., Dadds, M. R., & Bor, W. (1989). Contextual analysis of child oppositional and maternal
aversive behaviors in families of conduct-disordered and nonproblem children. Journal of Clinical Child
Psychology, 18, 72-83.
Tompson, M. C., Asarnow, J. R., Goldstein, M. J., & Miklowitz, D. J. (1990). Thought disorder and
communication problems in children with schizophrenia spectrum and depressive disorders and their parents.
Journal of Clinical Child Psychology, 19, 159-168.
Wahl, O. F. (1989). Schizophrenogenic parenting in abnormal psychology textbooks. Teaching of Psychology,
16, 3-33.

Webster-Stratton, C. (1985). Comparison of abusive and nonabusive families with conduct-disordered children.
American Journal of Orthopsychiatry, 55, 59-69.
Webster-Stratton, C. (1989). The relationship of marital support, conflict, and divorce to parent perceptions,
behaviors and childhood conduct problems. Journal of Marriage and the Family, 51, 417-430.
Theresa J. Early, MSW, is a doctoral candidate and research assistant, and John Poetner, DSW, is professor,
University of Kansas School of Social Welfare, Twente Hall, Lawrence, KS 66045. This paper was supported
paper was supported in part by the Research and Training Center on Family Support and Children's Mental
Health, NIDRR Grant No. H122B90007-90. This article does not necessarily reflect the views or policies of
these organizations. The authors thank Beth Thompson for her contribution of library research, which was
critical to the completion of this article.