Abstract
Theory and research suggest that maternal psychological characteristics are a significant variable in the infant weight gain during childhood, while fewer studies have examined the role of fathers’ psychological profiles. Being the family relationship a core aspect of interpersonal processes during the developmental age, the evaluation of directly and indirectly involved variables in infants and in their parents is a key aim. Both maternal and paternal characteristics can impact on children’s weight faltering and psychological functioning, so that it would be useful to considerate the fathers’ role as risk or protective factor. The present study aimed to evaluate the impact of maternal psychological functioning on the child’s adaptation during childhood, considering the paternal involvement in caregiving. Participants were N=60 parents with their children, recruited through nurseries and primary schools in Central Italy, longitudinally assessed in 6 years, when children were 2 (Time 1), 5 (Time 2) and 8 years old (Time 3). Children with severe feeding difficulties tend to have mothers with similar problems, whereas paternal psychopathology reveals a relevant role in the quality of caregiving modulating the interactional mother-infant patterns. Assessment of maternal and paternal psychopathological risk appears to be crucial to deal with the failure to thrive in their children and for promotion of early intervention in this field. We can say that the involvement of fathers can reduce the impact of important maternal difficulties on infant’s wellbeing, promoting an overall positive balance of the family.
Keywords: Parental psychopathological riskfailure to thrive
1.Introduction
Understanding the emotional-behavioural child’s development is one of the typical issues of
current psychopathology on early childhood. Clinical and researchers agree that the affective and
behavioural expressions of children are particularly vulnerable to parental influence during the
developmental age. Indeed, great attention has recently being paid to explore the association between
child development and parental psychiatric diagnosis (Cerniglia, Cimino, Ballarotto, & Tambelli, 2016;
Herba, Glover, Ramchandani, & Rondon, 2016). More specifically, many empirical findings supported
the role of individual and psychopathological factors related to maladaptive consequences for
psychological and physical offspring’s well-being (Cimino et al., 2016b; Cimino, Cerniglia, & Paciello,
2015).
Being the family relationship a core aspect of interpersonal processes during the developmental
age, the evaluation of directly and indirectly involved variables in infants and in their parents is a key
aim. In this regard, for example, infant feeding in the mother child dyad represents a form of interaction
activity in which some vulnerabilities and psychological distress can be detected from an empirical
standpoint.
As pointed out by recent studies, maternal psychological characteristics should be considered as a
crucial risk factor for the development and maintaining of several emotional behavioural problems in
children (Cimino, Cerniglia, Paciello, Sinesi, 2012; Cox e Barton, 2010). For example, Tambelli, Cimino,
Cerniglia & Ballarotto (2015), argued that early maternal relational traumatic experiences and
psychopathological risk negatively influence the mother infant interactions.
Other authors highlighted the link between maternal severe psychological difficulties and
impairment of offspring’s wellbeing (Alvarez-Segura et al., 2014)
Moreover, recent literature suggests that maternal psychopathology is a significant variable in the
infant weight gain during childhood (Cimino et al., 2016a). In particular, maternal depression has been
founded to be associated with infant weight faltering, such as Organic and Non Organic Failure to Thrive
(NOFTT) (Boursiquot et al., 2014). Similarly, emotional difficulties in mothers, such as emotional
distress, anxiety or somatization, can negatively influence the offspring’s capacity in regulating their
internal states (Bryant-Waugh, Markham, Kreipe & Walsh, 2010; Cerniglia, Cimino, Ballarotto, &
Monniello, 2014).
For these reasons the quality of mother– infant interaction during feeding deserve particular
attention, since mothers’ several difficulties can strongly affect their infant’s psychological welfare
(Ramchandani et al., 2013).
2.Problem Statement
While, as we have seen, several researches have documented the association between maternal
psychopathological risk and offspring’s outcomes on NOFTT, suggesting its generalizability across
different nationalities and social status, fewer studies have examined the role of fathers’ psychological
profiles. Indeed, scientific literature have paid little attention on the possible interconnection between
maternal and paternal characteristics and weight faltering in their children.
Some researches, for example, focusing on the psychopathologic symptoms in partners of women
with eating disorders, highlighted how they could prejudice the mother-infant interactions during feeding
(Dietz, Jennings, Kelley, Marshal, 2009). Moreover, other studies revealed a positive and protective
influence of paternal psychological functioning on their children’s emotional and behavioural outcomes
(Cooper, Whelan, Woolgar, Morrell, Murray, 2004).
Despite these contributions, only few researches deeply explored the relationship between child’s
psychological functioning and maternal psychopathologies, considering the role of the father as potential
risk or protective factor (Cerniglia, Cimino, & Ballarotto, 2014; Erriu, Cerniglia, & Cimino, 2017).
3.Research Questions
Assuming a systemic theoretical point of view in the family dynamics evaluation (Minuchin,
1974), mother–infant and father–infant dyads are interconnected. Consequently, also in the case of infant
growth delay, both maternal and paternal characteristics can influence their children’s weight faltering
and psychological functioning. Thus, considering the gap in current literature, it would be useful better
understand the possible fathers’ role as risk or protective factor in predicting psychopathological
problems in offspring (Cicchetti & Rogosh, 1996).
4.Purpose of the Study
The present study aimed to evaluate the impact of maternal psychological functioning on the
child’s adaptation during childhood, considering the paternal involvement in caregiving.
More specifically, this longitudinally research examined a sample of children between the first and
second childhood and their parents, in order to achieve the following specific objectives. First, the study
aimed to analyse the trend of psychological profiles of the mothers and fathers in three different time
points. Moreover, the study had the aim to evaluate the offspring’s malnutrition and emotional profiles,
such as reported by parents in three different assessment sessions.
5.Research Methods
We conducted a longitudinal study on psychopathological outcomes in offspring, assessing parents
and their children during 6 years, at three time-points, when children were 2 years old (T1), 5 years old
(T2) and 8 years old (T3).
5.1.Subjects and procedure
Participants were N=60 parents (aged between 25-45 years) with their children, recruited from an
Italian program for prevention of maladaptive outcomes in offspring, through nurseries and primary
schools in Central Italy (N total = 90).
Ninety-nine percent of participants were Caucasian. Almost all of the couples of parents were
married. Furthermore, all parents came from families with middle socioeconomic status. The majority of
them obtained a secondary school diploma (85%). The gestational age and psychomotor features of all the
children were in the normal range at the first assessment time points.
All parents voluntary took part in the study and did not receive reward. They signed an informed
consent for all the procedures. None of those who accepted dropped the task. All parents completed data
on all study variables without any attrition.
Data collection was carried out by research assistants. Before the start of the study, permission was
obtained from the Ethical Committee of the Medicine and Psychology Faculty at Sapienza, University of
Rome, in accordance with the Declaration of Helsinki.
The sample was divided into two groups, based on nutritional evaluation done by paediatrician.
Group 1 (N = 15), composed by couples of parents whose their children were affected by Non Organic
Failure to Thrive. Group 2 (N= 15), composed by couples of parents with children who presented a
growth consistent with their age. The children’s gender was balanced between males and females in each
group. Moreover, the two groups have been paired by age of the children, age of the mothers and
families’ socio-economic status.
The children’s mean age in the G1 was 2.6 (years, months) at Time 1 (S.D. 0.7), 5.3 (S.D. 0.5) at
Time 2 and 7.6 (S.D. 0.4) at Time 3, whereas the children’s mean age in the G2 was 2.2 (years, months)
at Time 1 (S.D. 0.2), 5.1 (S.D. 0.6) at Time 2 and 7.7 (S.D. 0.5) at Time 3. At Time 1, mothers in the
Group 1 had a mean age of 31.4 (S.D.: 3.6); average age of mothers in the Group 2 was 32 (S.S.: 4.6).
During T1, T2 and T3 the parents were independently administered a set of self-report and report-
form tools, along with children nutritional evaluation made by the paediatrician.
5.2.Measures
To perform our study, we administered the following instruments at three evaluation times (T1,
T2, T3) in the two groups G1 and G2.
5.2.1. Evaluation of parents’ psychopathological profiles
Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), developed by First, Spitzer,
Gibbon, & Williams, 1997 (Italian adaptation by Mazzi et al., 2000). The SCID 1 is a semi-structured
interview that grants to address the DSM-IV Axis I diagnoses. It includes six sections that can be given in
sequence: mood episodes; psychotic symptoms; psychotic disorders; mood disorders; substance use
disorders; anxiety, adjustment, and other disorders.
We administered this tool only at Time 1.
The Symptom Checklist-90-Revised (SCL-90-R) (Derogatis, 1994; Italian version by Prunas,
Sarno, Preti, Madeddu, & Perugini, 2012). It is a self-report questionnaire addressing several
psychological symptoms and psychological distress. It contains 90 items, related to symptom dimensions
such as Somatization, Obsessive-Compulsive, Interpersonal Sensitivity, Depression, Anxiety, Hostility,
Phobic Anxiety, Paranoid Ideation and Psychoticism.
The Eating Attitudes Test (EAT-40), by Garner & Garfinkel (1979; Italian version by Cuzzolaro,
& Petrilli, 1988). It is a self-administered 40 items test, which measures specifically symptoms of
Anorexia Nervosa. It is considered a test with excellent both diagnostic and prognostic quality, showing a
high correlation coefficient with other tools.
5.2.2. Evaluation of children’s emotional and behavioural functioning
Child Behavior Checklist (CBCL 1 ½–5; CBCL/6-18; Achenbach & Rescorla, 2001; Italian
version by Frigerio & Montirosso, 2002). The CBCL 1 ½–5 is a 99 items questionnaire assessing the
child’s behavioural-emotional functioning in different areas of daily functioning (age range: 18–36
months). It measures three symptomatic scales: Internalizing, Externalizing, and Neither Internalizing
Nor Externalizing. The Internalizing scale consists of Emotionally Reactive, Anxious/Depressed,
Withdrawn, Somatic Complaints subscales. The Externalizing scale includes Attention Problems and
Aggressive Behaviour subscales. Finally, the Neither Internalizing Nor Externalizing scale identifies the
syndromes of Sleep Problems and Other Problems. The instrument shows a good internal consistency
(Cronbach’s α, 0.65 to 0.96).
The CBCL/6-18 is a report form questionnaire composed of 113 items. The Internalizing Problem
scale consists of Anxious/Depressed, Withdrawn/Depressed and Somatic Complaints, while the
Externalizing Problem scale includes Rule-Breaking Behaviour and Aggressive Behaviour.
5.3.Statistical analysis
To evaluate the children’s psychopathological problems multivariate analyses of variance
(MANOVA) on the data in the CBCL DSM-oriented scales in all two groups at T1, T2 and T3 were
carried out (considering the effects of age and gender).
To assess parental psychopathological risk in both groups multivariate analyses of variance
(MANOVA) on the data of SCL-90-R subscales and of EAT-40 subscales in all two groups at T1, T2 and
T3 were carried out.
To examine the associations between parental diagnosis and child psychopathology at three point
of assessment, the Pearson’s product-moment correlation coefficient was used.
All data were performed with IBM SPSS software (version 23.0).
6.Findings
6.1.Evaluating parental psychological profiles
With regards to mothers within G1, N=16 subjects were diagnosed with anorexia nervosa, whereas
N=9 mothers received a diagnosis for bulimia nervosa. On the contrary, in Group 2, none of the mothers
has been diagnosed according to SCID-I. Fathers belonging to Group 1 showed a symptomatology related
to a non-specific psychological anxiety diagnosis, while only one father in Group 2 had a diagnosis for a
dysthymia.
Furthermore, no significant differences among maternal and paternal psychological profiles were
found on the SCL-90-R’s scores at the three point times of assessment. Moreover, statistical analysis
revealed a significant effect of SCL-90-R scores X Group interaction (F(4,224)=4.576; p=0.001).
In addition, significant differences have been found between mothers and fathers’ scores in both
Group 1 and Group 2, concerning the following SCL-90-R’s subscales: Somatization (F(1,56) = 16.459;
p<0.001), Depression (F(1,56) = 36.964; p<0.001), Obsessive-compulsive (F(1,56) = 27.042; p<0.001)
and Anxiety (F(1,56) = 14.866; p<0.001).
A significant effect of the Group x EAT-40 scores interaction has been found (F(4,224) = 4.576;
p=0.001), with G1 showing significantly higher scores on all the EAT-40 dimensions over the three
times of evaluation compared with Group 2 (p<0.05).
6.2.Evaluating children’s psychological profiles
The two groups of children showed statistical difference with regards to malnutrition. None of the
children within Group 2 showed a malnutrition over the three evaluation moments.
Moreover, a statistical interaction has been identified between time, children’s emotional-
behavioural functioning and the group (F(8,448)=15.374; p<0.001), with all the CBCL subscales’ scores
reducing in the last evaluation session (p<0.05). Finally, the children within the G2 show significantly
higher scores than peers in Group 1 as regards to all the CBCL subscales (p<0.05), over the three session
of assessment.
7.Conclusion
The overall purpose of the current study was to investigate children’s emotional and psychological
functioning and parental psychopathologic risk across infancy, focusing on children growth delay.
The present study confirmed that children with feeding problems are more prone to have mothers
with similar problems
(Cooper et al., 2004). Indeed, the association between maternal eating disorders and offspring’s
feeding disorders has been well documented by research (Ammaniti, Lucarelli, Cimino, D’Olimpio, &
Chatoor, 2010; Micali, Simonoff, Stahl, Treasure, 2011). Particularly, our findings highlighted the link
between maternal psychopathological risk and child’s NOFTT, as well as it was confirmed by other
studies (Watkins, Cooper, & Lask, 2011).
Moreover, children diagnosed with NOFTT showed to have parents with stable
psychopathological profiles. Both mothers and fathers of these children, indeed, reported high
psychopathological risk, such as somatization and depression (mothers) and obsessive-compulsive
behaviours and anxiety (fathers).
In this scenario, paternal psychopathology showed to have a relevant role in the quality of
caregiving, modulating the interactional mother-infant patterns. In fact, according to Elgar et al. (2007),
fathers with psychopathologic symptoms may represent a risk factor for the onset of child’s dysfunctional
behaviour. Furthermore, the maternal psychopathology associated to a paternal psychopathological
profile may lead to a “maladaptive” co-parenting characterized by unfavourable interactive cycles with
the children (Teubert, Pinquart, 2010).
Our current study offers important information and suggestions for future research in the area of
feeding parent-infant interaction and psychopathological risk. Given that the children of parents with
psychopathological profiles were more prone to manifest emotional and behavioural difficulties, research
should paid more attention in understanding family relationship. Indeed, only a deepen investigation of
the mechanisms by which the parental psychiatric diagnoses can impair psychological well-being across
the development allows us to realize effective mental health prevention programs (Cimino, Cerniglia,
Paciello, & Sinesi, 2013).
Assessment of both maternal and paternal psychopathological risk appears to be crucial to face up
to children growth delay. Our study tried to clarify the role of fathers in promoting or modulating the
onset of problems in their offspring, considering the evolution of the psychological and/or
psychopathological profile of parents and children in the course of time. In conclusion, we can say that
the involvement of fathers can reduce the impact of important maternal difficulties on infant’s wellbeing,
promoting an overall positive balance of the family.
A limitation of the present study is the use of different report form instruments to assess the
psychopathological problems in offspring (described by parents) and the psychopathological profiles in
parents. Second, we did not assess the family functioning in general.
Nevertheless, despite the aforementioned limitations, a longitudinal study seems to be a valid tool
to explain the evolution of problems in all family members, recognizing signs of psychopathological
outcomes.
Considering that child’s emotional and behavioural difficulties during developmental age can be
explained only through a relational assessment, we strongly think that fathers’ role deserve even more
attention. This is certainly a future aim of our studies.
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Cite this article as:
Erriu, M. (2017). Longitudinal Study On Parental Psychopathological Risk And Offspring’s Growth Delay. In Z. Bekirogullari, M. Y. Minas, & R. X. Thambusamy (Eds.), Clinical & Counselling Psychology - CPSYC 2017, vol 22. European Proceedings of Social and Behavioural Sciences (pp. 57-65). Future Academy. https://doi.org/10.15405/epsbs.2017.05.8