. "4 Using a Developmental Framework to Guide Prevention and Promotion." Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities. Washington, DC: The National Academies Press, 2009.
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Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities
Family Dysfunction and Disruption. With the family as the primary setting for child development from birth through childhood and adolescence, it is not surprising that dysfunction in family relations, particularly parent–child relations, is associated with multiple mental, emotional, and behavioral problems, including those described above. Many risk factors (e.g., poverty, parental mental illness) influence mental, emotional, and behavioral problems and disorders through their effects on parent–child relations (Grant, Compas, et al., 2003; Riley, Valdez, et al., 2008). The discussion here focuses on two broad categories of risk factors that are related to dysfunctional family relations and that provide opportunities for preventive intervention: child maltreatment, which represents the extreme manifestation of family dysfunction, and disruptions in family structure, which create serious challenges to healthy family functioning.
Child Maltreatment. Maltreatment of children by primary caregivers is one of the most potent risk factors for mental, emotional, and behavioral problems, and it has been found to be associated with other serious risk factors, such as poverty and parental mental illness. Protective factors include children’s positive relationship with an alternative caregiver, positive and reciprocal friendships, and higher internal control beliefs (Bolger and Patterson, 2003).
The prevalence of child maltreatment in the United States is unclear. One estimate places it at 1.2 percent of children in 2004 (National Child Abuse Data System). Hussey, Chang, and Kotch (2006) report that 11.8 percent of adolescents report physical neglect, 28.4 percent report physical assault by a parent or caregiver, and 4.5 percent report sexual abuse by a parent or caregiver sometime before they reached the sixth grade. In the National Longitudinal Study of Adolescent Health (Add Health), which includes a nationally representative sample of adolescents, each form of maltreatment was associated with multiple health problems, including depression, substance use, violence, obesity, and poor physical health (Hussey, Chang, and Kotch, 2006). The majority of these associations remained significant after controlling for such demographic variables as family income, age, gender, ethnicity, parent education, region, and immigrant generation (Hussey, Chang, and Kotch, 2006).
In a recent empirical examination in the National Comorbidity Study (Molnar, Buka, and Kessler, 2001), one of the largest and most methodologically sound studies, childhood sexual abuse was reported by 13.5 percent of the women and 2.5 percent of the men. Significant associations were found with 14 mood, anxiety, and substance abuse disorders among women and 5 disorders among men. The analysis controlled for other adversities, including divorced parents, parental psychopathology,