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  1. 1. Parents with psychiatric problems, addictions and their children risks at both sides L.H.Wenselaar, (child)psychiatrist [email_address] [email_address] 04-06-2009,the Hague
  2. 2. Prevalence of children at risk <ul><li>864.000 parents with psychiatric problems. </li></ul><ul><li>Together they have 1,6 million children </li></ul><ul><li>* 900.000 (<12 years) </li></ul><ul><li>* 400.000 (< 4 years) </li></ul><ul><li>In the Netherlands, all addicted parents combined have 369.000 children </li></ul>
  3. 3. Psychiatric symptoms at the side of the parents <ul><li>Thoughtdisorders, delusions </li></ul><ul><li>Hallucinations </li></ul><ul><li>Paranoid </li></ul><ul><li>Confusion </li></ul><ul><li>Depression </li></ul><ul><li>Agitation </li></ul><ul><li>Apathetic versus sickly activity </li></ul><ul><li>Fears, terror especialy not rea </li></ul>
  4. 4. Psychiatric symptoms at the side of the parents (2) <ul><li>Depersonalisation, derealisation & dissociation </li></ul><ul><li>Apathetic versus sickly activity </li></ul><ul><li>Fears, terror especialy not real </li></ul><ul><li>Sleepingdisorders </li></ul><ul><li>Eatingdisorders </li></ul><ul><li>Odd behaviour </li></ul><ul><li>Suicidal behaviour or attempts towards successful suicide </li></ul>
  5. 5. Psychiatric symptoms at the side of the parents (3) <ul><li>Disturbed agression : self-harm/depression or agression towards the children </li></ul><ul><li>Neglection of oneself or the children </li></ul><ul><li>Somatic expressions without a cause </li></ul><ul><li>Social isolation </li></ul><ul><li>Drugs and alcohol abuse </li></ul>
  6. 6. Psychiatric symptoms at the side of the children <ul><li>E xplanation Total range </li></ul><ul><li>Mild problems: ?? </li></ul>Observed Prevalence Temporary severe problems 33% Long-Term severe problems 33% 1 or 2 parents with psychiatric/addiction problems within a clinic 66% 1 or 2 parents with psychiatric/addiction problems in foster care 25%
  7. 7. Effect of psychiatry/addiction <ul><li>Rise egocentric thoughts and behaviour </li></ul><ul><li>Decreased possibility to imagine oneself in someone else’s situation </li></ul><ul><li>Behaviour evokes strong reactions : rejection versus excessive care </li></ul><ul><li>Deny psychiatry/addiction or blame another (the child) </li></ul><ul><li>Selfsupport diminishes or disappears, offerded help is difficult/ not accepted </li></ul>
  8. 8. Effect of psychiatry/addiction <ul><li>Somatic complaints in the presence of child </li></ul><ul><li>Unreliability in speech and activity </li></ul><ul><li>-> especially when there is graving </li></ul><ul><li>Childcare decreases </li></ul>
  9. 9. Family life and psychiatry/addiction <ul><li>Anxiety/insecurity/uncertainty/traumatic experiences for all family members </li></ul><ul><li>Contact children/parents changes </li></ul><ul><li>W rong attention distribution </li></ul><ul><li>Contact and roles between children changes </li></ul><ul><li>Instability at emotional, behaviour, financial and organizational level </li></ul>
  10. 10. Family life and psychiatry/addiction (2) <ul><li>Mourning because loss of happy familylife </li></ul><ul><li>Hold up development children and parents (individual & family) </li></ul><ul><li>No equal relationship between parents, distortion of balance of power </li></ul><ul><li>Socio-economical fall when family income drops down because of the psychiatry/abuse problem of the parent </li></ul>
  11. 11. Clusters of concern <ul><li>Physically neglect, no medical care when necessary </li></ul><ul><li>Pedagogical neglect </li></ul><ul><li>Material neglect </li></ul><ul><li>Withhold situation of school </li></ul><ul><li>Battering (verbal and non-verbal) </li></ul><ul><li>Sexual abuse </li></ul><ul><li>Social isolation </li></ul>
  12. 12. Style of raising kids in relation with personality traits <ul><li>Not flexible with normal patterns of giving and taking in daily life </li></ul><ul><li>Expectation of adaptation of others </li></ul><ul><li>One way traffic on every area </li></ul><ul><li>Rigid behaviour in relation to others </li></ul><ul><li>Shows no openness (especially for new information) </li></ul><ul><li>Do not endure an answer back </li></ul>
  13. 13. With obsessive-compulsive traits <ul><li>Fix one’s eye upon orderliness, perfection,wants to be in control, is rigid and obstinate </li></ul><ul><li>Wrappes up excessive in one’s own life </li></ul><ul><li>Standards are out of proportion </li></ul><ul><li>Demands discipline </li></ul><ul><li>Finds it difficult te be helped </li></ul>
  14. 14. With paranoid traits <ul><li>Distrust dominates, suspicion about the motives of other people </li></ul><ul><li>Suspects others to take advantage of you or treats you </li></ul><ul><li>Preoccupied by the faithfully or involvement of others </li></ul><ul><li>Does not trust information </li></ul><ul><li>Sees threats in innocent </li></ul><ul><li>remarks or events </li></ul>
  15. 15. With anti-social traits <ul><li>Does things continuously that have the risk of social exclusion </li></ul><ul><li>Reckless, indifferent for the safety of oneself or others </li></ul><ul><li>Thinks that other people do not have rights </li></ul><ul><li>Feels completly justified about own acts </li></ul><ul><li>Tells lies and cheats </li></ul><ul><li>Shows no regret </li></ul>
  16. 16. With dependent traits <ul><li>Needs to be taken care of </li></ul><ul><li>Submissive </li></ul><ul><li>Desire to cling to other people </li></ul><ul><li>Always looks for advice and the need for comfort by others </li></ul><ul><li>Not comfortable while being alone </li></ul><ul><li>Worries about everything </li></ul>
  17. 17. With borderline traits <ul><li>No stable relations with a lot of ups and downs </li></ul><ul><li>Moodswings </li></ul><ul><li>Problems with self-control </li></ul><ul><li>Unpredictability </li></ul><ul><li>Difficulties to control self-destructive impulses </li></ul><ul><li>Threat with almost everything </li></ul><ul><li>Emptiness inside </li></ul><ul><li>Suspicion and distrust when there is stress </li></ul>
  18. 18. With narcistic traits <ul><li>Desire/need for excessive admiration, angry when not enough ( and it is never enough) </li></ul><ul><li>Lack of intuitive power off the feelings and needs of other people </li></ul><ul><li>Almighty thoughts </li></ul><ul><li>Convinced of a special right for a special treatment </li></ul>
  19. 19. With narcistic traits (2) <ul><li>Others automaticly have to give satisfaction to their needs and demands </li></ul><ul><li>They exploit others for their own purposes </li></ul><ul><li>Constantly jealous of the performances and properties of others </li></ul><ul><li>Arrogant </li></ul>
  20. 20. With theatrical traits <ul><li>Excessive in expression of emotions, but emotions are superficial and seem unreal </li></ul><ul><li>Angling for attention </li></ul><ul><li>E asily influenced </li></ul><ul><li>Wants to be the centre/ if not : claims it </li></ul><ul><li>No correct judgement concerning relations </li></ul><ul><li>Talking is exaggerated and dramatical </li></ul>
  21. 21. With avoidant traits <ul><li>Clumsy, vulnerable, insecure and inhibited in social situations </li></ul><ul><li>Avoid interpersonal contact </li></ul><ul><li>No observed involvement in the life of other people </li></ul><ul><li>Detached while experiencing intimacy </li></ul>
  22. 22. What we can do <ul><li>Acknowledgement that there are conflicting interests </li></ul><ul><li>Restore the parental rol, show and teach the parents responsibility </li></ul><ul><li>Stimulate the protective factors </li></ul><ul><li>Diminish risk-factors </li></ul><ul><li>O ptional: Seek advice </li></ul><ul><li>And especially : realize that you as the professional have a responsibility for the well-being of the child </li></ul>
  23. 23. Risk factors at the parent level <ul><li>Reverences and duration of symptoms </li></ul><ul><li>The care-giving parent is the sick one </li></ul><ul><li>Level of functioning </li></ul><ul><li>Temper </li></ul><ul><li>Pedagogically problems </li></ul><ul><li>Not stable and chaotic familylife (level: emotional, organizational & financial ) </li></ul>
  24. 24. Risk factors at the parent level (2) <ul><li>Relationship problems </li></ul><ul><li>Personality problems </li></ul><ul><li>No appreciation for the child </li></ul><ul><li>The healthy parent becomes </li></ul><ul><li>also sick </li></ul>
  25. 25. Riskfactors at the family level <ul><li>Shifting roles in the family (parentification) </li></ul><ul><li>Low socio-economical level of the family with care avoiding behaviour </li></ul><ul><li>Socially isolated family </li></ul><ul><li>No awareness of outsiders </li></ul><ul><li>No experienced support </li></ul>
  26. 26. Riskfactors at the child level <ul><li>Emotional-, behavioural-,social- and schoolproblems,restricted speech </li></ul><ul><li>If there is more than one child : struggle instead aligning powers between them </li></ul><ul><li>Low competence and low self-esteem of the child </li></ul><ul><li>No confidant outside the family </li></ul><ul><li>No activities outside the family </li></ul>
  27. 27. Riskfactors at the child level (2) <ul><li>Nobody near to go to </li></ul><ul><li>No confidant outside the family </li></ul><ul><li>Wrong school </li></ul><ul><li>Wrong friends or no friends </li></ul>
  28. 28. How to accomplish good care <ul><li>Cooperation in stead off walls </li></ul><ul><li>F amily in stead off individual view </li></ul><ul><li>Be open </li></ul><ul><li>Make clear agreements with everyone about the progress and the failures </li></ul>
  29. 29. Results <ul><li>a successtory for the whole family! </li></ul>