Disorders In Parents Of Children Research Articles

Prevalence of depression, anxiety, and substance-related disorders in parents of children with cerebral palsy: A systematic review.

Linked Article: https://doi.org/10.1111/dmcn.14321

ChildTalks+: a study protocol of a pre-post controlled, paired design study on the use of preventive intervention for children of parents with a mental illness with focus on eating disorders

BackgroundChildren of parents with a mental illness are at high risk of developing a mental disorder as a result of transgenerational transmission. Without effective intervention, they could form the next generation of psychiatric patients. ChildTalks+ is a preventive intervention involving four structured psychoeducational sessions designed for parents affected by a mental disorder and their children. Its aim is to reduce the risk of mental disorders in children of parents with mental illness. This study draws on our clinical practice and involves a group of patients with eating disorders. The aim of the project, which will run in the Czech Republic, is to evaluate the effectiveness of ChildTalks+ methodology.MethodsChildTalks+ therapists (professionals from health, social, and educational facilities) will recruit 66 families where a parent is treated for a mental disorder and the family includes children aged 6–18. Paired allocation into an intervention group (N = 33) and a control group (N = 33) will be based on the number of risk factors identified in the family. Both groups will complete questionnaires at the baseline, post-test, and follow-up assessments after six and 12 months. The intervention group will receive the ChildTalks+ intervention within 2 months of the baseline assessment; the control group after the last assessment. Questionnaires will be completed by parents and children aged 12+ and, in two cases, 15+ years. Quantitative data will be supplemented with qualitative data from ChildTalks+ therapists working with patients with eating disorders.DiscussionThe ChildTalks+ intervention is expected to strengthen parenting competencies and family protective factors, improve family communication, increase awareness of parental mental health issues, and improve the wellbeing of children of parents with mental illness with long-term sustainable outcomes. The study should contribute to the evidence base for the ChildTalks+ program and help identify key themes in the implementation of similar preventive interventions.Trial registrationClinicalTrials.gov Identifier: NCT05554458. Registered 26 September 2022. Retrospectively registered.

Hospital Contacts for Psychiatric Disorders in Parents of Children With Cancer in Denmark.

BackgroundHaving a child diagnosed with cancer is a devastating experience that may affect parents’ mental health. We aimed to assess the risk of hospital contacts for psychiatric disorders in parents of children with cancer.MethodsWe conducted a nationwide population-based cohort study using Danish registry data. Parents of children diagnosed with cancer between 1982 and 2014 (n = 6689 mothers, n = 5509 fathers) were matched with comparison parents of cancer-free children (n = 67 544 mothers, n = 55 756 fathers). We used Cox proportional hazards models to estimate the risk of hospital contacts for any psychiatric disorder and specific disorders. Cox models were also used to investigate sociodemographic and cancer-related risk factors for psychiatric disorders.ResultsIncidence rates of hospital contacts for any psychiatric disorder were 426 per 100 000 person-years in mothers of children with cancer and 345 per 100 000 person-years in comparison mothers. For fathers, the respective incidence rates were 260 and 262 cases per 100 000 person-years. Compared with parents of cancer-free children, mothers of children with cancer were at an increased risk of hospital contacts for any psychiatric disorder (hazard ratio = 1.23, 95% confidence interval = 1.12 to 1.36), whereas no elevated risk was seen in fathers (hazard ratio = 0.99, 95% confidence interval = 0.87 to 1.13). Among mothers, risks were particularly elevated for affective and stress-related disorders. Parents of deceased children and children diagnosed at a younger age were at particular risk of hospital contacts for psychiatric disorders.ConclusionHospital contacts for psychiatric disorders were overall rare. Health-care professionals should draw attention to subgroups of vulnerable parents to meet their needs of support and adequate treatment.

Shared psychotic disorder in children of parents with untreated schizophrenia: A case series

Shared psychotic disorder (folie à deux) is a unique disorder with varied clinical presentation, posing difficulties in management. Parent–child dyads have been described to be commonly affected by this disorder but very few cases from India are available. Three cases who had parents suffering from untreated schizophrenia and shared their psychotic symptoms presented to the department. Two of these were twins with comorbid attention deficit hyperactivity disorder (ADHD), who required management for the ADHD. Social isolation was a common and the most important risk factor. All three cases showed improvement in psychosis with separation from the primary and none required the use of antipsychotics. Implications and treatment strategies for shared psychotic disorder in children are also discussed.

The moderating effect of financial stress and autism severity on development of depression among parents and caregivers of Autistic children in Taif, Saudi Arabia.

Background:Autistic spectrum disorder (ASD) is a common problem in the Kingdom of Saudi Arabia. However, little research explored the extent of anxiety and depressive disorders in parents of children with ASD.Method:Descriptive questionnaire-based cross-sectional survey of a sample of parents of children with ASD who attended Prince Mohammed Bin Salman Autistic Centre, Ministry of defense, Taif city.Results:The study included (n = 50) parents. The prevalence of mild depression was 30%, whereas the prevalence of moderately severe depression was 68%. Increased ASD severity level was associated with a significant impact on the PHQ-9 total score (level II was 1.293 times level I to have an increased PHQ-9 score, and level III was 1.530 times level I to have an increased PHQ-9 score). Economic status did not significantly alter depressive symptoms.Discussion and Conclusion:ASD diagnosis in Saudi children is associated with high parental depressive prevalence. However, this result could be bidirectional. Stigma, future-related worry, and stress could mediate parental depressive symptoms. Our findings in Saudi parents of children with ASD corroborate the established association between parental depressive symptoms and ASD severity. Our results corroborated previous findings that neither parental gender nor child gender exert any substantial effect on predictability of depressive symptoms among parents of children with ASD. Comprehensive therapeutic packages for children with ASD should include treatment of emotional problems arising out of carer burden among their parents. Screening for parental emotional problems should be routine in autism treatment facilities.

Psychiatric Disorders in Children of Parents With Substance Dependence Disorder

Objectives: Children of addicted parents exhibit depression, anxiety, and elevated rates of psychiatric disorders more frequently than do children from nonaddicted families. Hence, we conducted this research to illustrate the psychiatric illness of children of substance-dependent parents. Materials and Methods: The study included 50 children [25 with a parent diagnosed with substance use disorder according Diagnostic and Statistical Manual of Mental Disorders-4th edition criteria (group A), and 25 whose parents had no psychiatric diagnosis according to general health questionnaire (group B)]. The subjects were recruited from the Heliopolis Psychiatric Hospital, which is a Ministry of Health Hospital. They were assessed using the Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI KID) scale. We, furthermore, assessed the relation between the Addiction Severity Index, type of substance used by group A parents, and the MINI KID scale. Results: Group A showed more significant diagnosis than group B (P=0.037) by the MINI KID scale (major depressive disorder, dysthymia, panic disorder, agoraphobia, and separation anxiety disorder) (P=0.018, 0.037, 0.042, 0.021, and 0.004, respectively). Hence, the substance abuse parent has a detrimental effect on their children’s well-being. As regards the relation between addiction severity and result of MINI KID scale in group A, only “employment” was significant (P=0.025). Surprisingly, neither the severity of substance abused nor the type of substance abused by the parent had significant relation with the diagnosed psychiatric disorders in their children. Conclusions: Our study found that the prevalence of psychiatric disorders in children increases when their parents have substance use disorder. Moreover, the variation of the severity of parent addiction does not affect the risk for having psychiatric disorders in their children.

The broad autism phenotype in real-life: clinical and functional correlates of autism spectrum symptoms and rumination among parents of patients with autism spectrum disorder.

Increasing literature reported higher rates of psychiatric disorders in parents of children with autism spectrum disorder (ASD), as well as of autistic-like features in social and cognitive functioning. However, little attention has been paid to the association between autistic traits (AT) and global functioning in this population. The aim of the present work was to investigate clinical and functional correlates of AT among parents of ASD children, with a specific focus on ruminative thinking. One hundred and twenty parents of ASD children were assessed by the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the Adult Autism Subthreshold Spectrum (AdAS Spectrum), the Ruminative Response Scale (RRS), the Social and Occupational Functioning Assessment Scale (SOFAS). Subjects with at least 1 psychiatric disorder (39.2%) showed significantly higher AdAS Spectrum and RRS scores. Subjects with a history of school difficulties and with language development alterations scored significantly higher on specific AdAS Spectrum domains. A significant negative correlation was found between SOFAS and AdAS Spectrum scores, as well as between SOFAS and RRS scores. AdAS Spectrum nonverbal communication domain score was identified has a statistically predictive variable for the presence of psychiatric disorders and lower SOFAS scores. Finally, we found a significant indirect effect of AdAS total score on SOFAS score, which was fully mediated by RRS total score. AT in parents of ASD children seem to be associated with a higher vulnerability toward psychopathology and with a lower global functioning. Ruminative thinking may play a role in the relationship between AT and functional outcome.

The impact of participation in support groups on mental health of parents having children with autism

Abstract Introduction Whilst there is accumulated evidence about the high prevalence of stress and mood disorders in parents of children with autism, few studies have shown that participating in parental support groups was associated with less mental health problems. This study was aimed to explore the association of participation in support groups with stress and mood disorders in parents of children with autism in Kazakhstan. Methods Participants (n = 146) were recruited to this cross-sectional survey from autism non-governmental organizations and Republican Children’s Rehabilitation Center in Nur-Sultan city during April-December 2018. A 59 item survey consisted of questions on parental socio-demographics, needs, participation in support groups, depression, anxiety and stress (DASS), and Multidimensional Scale of Perceived Social Support (MSPSS). Descriptive, bivariate and multivariate logistic regression analyses were performed in STATA 15. Results 44.4% of parents reported experiencing stress, and almost half of the sample had elevated depressive (53.7%) and anxiety symptoms (47.4%). 45.3% of participants were members of parental organizations; there were no significant differences in the prevalence of stress and mood disorders among members and non-members of parental support groups. Results of the multivariate logistic regression showed that parents with older autistic children (OR 1.37, p-value 0.001), less family support (OR 0.894, p-value 0.044) and higher income (OR 3.01, p-value 0.025) were more likely to be members of support groups. Conclusions These findings indicate the need to increase support groups to under-served populations of Kazakhstan’s families with autistic children. Additional efforts are needed to strengthen the role of support groups in meeting the emotional needs of the parents. Key messages Parents of children with autism spectrum disorder experience elevated level of stress and mood disorders; however participation in support groups was not beneficial for relieving parental distress. Further research is warranted to explore the benefits of participation in support groups, and interventions are needed to strengthen the role of support groups in meeting the needs of parents.

Prevalence of depression, anxiety, and substance-related disorders in parents of children with cerebral palsy: a systematic review.

To estimate the prevalence of mental illness in parents of children with cerebral palsy (CP). This is a systematic review that follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols in the search for observational studies determining the prevalence of depression, anxiety, and substance abuse in parents of individuals with CP. The information sources used for this study were: PubMed, SciELO, Cochrane Library, Clinical Trials, and Biblioteca Virtual de Saúde. Fourteen articles were selected and included, investigating 1264 mothers and 105 fathers of children with CP. Data extracted for analysis were divided into three categories: study data, data about participants with CP, and data about parents. All studies included volunteer parents, of whom 95 per cent were female. CP is related to a higher prevalence of symptoms of depression and anxiety in parents. Factors such as a child's degree of functionality and socioeconomic level may influence the frequency of mental disorders in parents. However, these studies have heterogeneous samples and applied different criteria to characterize their populations. Depression and anxiety are more prevalent for parents of children with cerebral palsy (CP) than parents of typically developing children. The child's illness severity is a risk factor for mental illness in parents of children with CP. The more time spent on child care, the higher the risk of mental illness among mothers of children with CP. There is a lack of reliable data in the literature on substance abuse in parents of children with CP.

Psychopathology in parents of children with autism spectrum disorder: A systematic review and meta-analysis of prevalence.

Parents of children with autism spectrum disorder appear to experience high levels of psychological distress, yet little is known about the prevalence of psychological disorders in this population. The aim of this systematic review and meta-analysis was to estimate the proportion of these parents who experience clinically significant psychopathology. Articles reporting proportions of psychological disorders in a sample of parents of children with autism spectrum disorder were located. The initial search returned 25,988 articles. Thirty-one studies with a total sample of 9208 parents were included in the final review. The median meta-analytic proportions were 31% (95% confidence interval = [24%, 38%]) for depressive disorders, 33% (95% confidence interval = [20%, 48%]) for anxiety disorders, 10% (95% confidence interval = [1%, 41%]) for obsessive-compulsive disorder, 4% (95% confidence interval = [0%, 22%]) for personality disorders, 2% (95% confidence interval = [1%, 4%]) for alcohol and substance use disorders and 1% (95% confidence interval = [0%, 5%]) for schizophrenia spectrum disorders. Significant heterogeneity was detected in these categories. Further research is needed to gain more insight into variables that may moderate parental psychopathology. This review and meta-analysis is the first to provide prevalence estimates of psychological disorders in parents of children with autism spectrum disorder.

Posttraumatic Stress Symptoms and Disorders in Parents of Children and Adolescents With Chronic Physical Illnesses: A Meta-Analysis.

The present meta-analysis analyzed whether parents of young people with pediatric chronic physical illnesses experience higher levels of posttraumatic stress symptoms (PTSS) and higher rates of posttraumatic stress disorder (PTSD) than other adults and searched for correlates of PTSS in these parents. Based on a systematic search in electronic databases, 184 studies were included in the meta-analysis. On average, 18.9% of the parents fulfilled the criteria for PTSD, and PTSS were more common among parents of young people with pediatric chronic physical illnesses than in other adults, with Hedges' g showing a 0.85 increase in standard deviation units. Parental PTSS were most prevalent among parents of children with epilepsy, g = 1.25, and diabetes, g = 1.16, and were positively associated with being the mother, r = .19; illness severity, r = .18; treatment duration/intensity, r = .21; and PTSS of the child, r = .34. In contrast, longer illness duration, r = -.19; longer time since active treatment, r = -.10; and better social resources, rs = -.17 to -.07, were associated with lower parental PTSS. The findings indicate that parents who have faced traumatic events in the context of their child's chronic illnesses should be screened for PTSS and PTSD and receive psychological interventions when needed.

Parenting Styles and Psychiatric Disorders in Children of Bipolar Parents.

Background:Bipolar disorders (BD) in parents can have different effects on children and perhaps as a reason of the incidence of various psychiatric disorders in them and they may show a particular parenting style due to features of their disease. Given a crucial role of parenting style in upbringing children, this study aimed to evaluate different styles of parenting and its relationship with psychiatric disorders in children of parents with bipolar disorder (PBD) compared with controls.Materials and Methods:In this case–control study, 500 parents with children aged 6–17 years were included that 250 of them with BD were selected as the case group and 250 of them were healthy as control group. The parents were selected according to the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) by a physician. Psychiatric disorders in children were assessed by The Kiddie Schedule for Affective Disorders and Schizophrenia for school-age children (KSADS). The collected data were analyzed with SPSS (version 20).Results:According to KSADS, there was significant difference between two groups of children in depression, mania, attention-deficit hyperactivity disorder, and posttraumatic stress disorder (P < 0.05). In authoritative dimension, parenting styles were effective in the incidence of psychosis (odds ratio [OR] [95% confidence interval (CI)]: 0.775 [0.63–0.95]) and led to a decrease of 0.320 times in the chance of oppositional defiant disorder incidence (OR [95% CI]: 0.320 [0.21–0.74]; P = 0.043) but an increase of 1.129 times in the chance of cigarette/tobacco use (OR [95% CI]: 1.129 [1.02–1.25]; P = 0.016).Conclusion:The chance of psychiatric disorder's incidence in children of PBD was so far more than children of healthy parents. Hence, the incidence of some psychiatric disorders in children can be associated with parenting styles.

Estimation of the psychoemotional state of parents of babies with a heavy craniocerebral trauma as a basis of the system of medical-psychological support in child's neuro-surgery

Aim: The complex study of features of emotional disorders in parents of children of the first year of life with a heavy craniocerebral trauma. Materials and methods. 137 families (mother and father) of children of the first year of life with craniocerebral trauma, examined and treated in a child’s neurosurgical department. The mean age of parents was 27,0±3,0 years.Methods of examination: anamnestic, psychodiagnostic with questionnaires of neuropsychic tension (T.A. Nemchyn, 1984), clinical scales of anxiety and depression (M. Hamіlton, 1967),adapted to ICD-10 (G. P. Panteleev, 1988), scale of situational and personal anxiety by D. Spilberg (adapted by Y.L. Hanin, 1981).Results of research. A child’s disease is a psychotraumatic situation for all parents and leads to the development of anxious-depressive reactions and statuses. The anxious-depressive, astheno-depressive, depressive-adaptive and dysphoric variants of emotional disorders in parents of babies with a heavy craniocerebral trauma were separated and their clinical features were described.The high level of emotional tension, abrupt intensification of negative emotions, effect of sorrow and anxiety, depressive manifestations are typical for parents of babies with a craniocerebral trauma. According to the data of the psychodiagnostic examination in parents were observed a light moderate depressive and anxious episodes by Hamilton scale; high levels of situational and personal anxiety by C.D. Spilberg’s method, high level of expressiveness of nervous-psychic tension by T.A. Nemchyn scale.Conclusions. The high level of emotional tension, abrupt intensification of negative emotions, anxious-depressive manifestations were typical for parents after a baby’s craniocerebral heavy trauma

The presence of a subthreshold autism spectrum is associated with greater prevalence of mental disorders in parents of children with autism spectrum disorders

IntroductionAutism spectrum disorders (ASD) are highly heritable and first degree relatives (especially fathers) of autistic probands have been shown to often manifest a set of subthreshold autistic features. It is not known, however, the clinical significance of this subthreshold autism spectrum.Objectives– to evaluate the prevalence of a subthreshold autism spectrum respectively in fathers and mothers of children with ASD;– to describe clinical correlates of parents with and without a subthreshold autism spectrum respectively.Methods36 fathers and 39 mothers of preschoolers with ASD were administered the autism-spectrum quotient (AQ), the adult autism subthreshold spectrum (AdAS spectrum), the trauma and loss spectrum (TALS), the SCID-5 and the social and occupational functioning assessment scale (SOFAS).ResultsFathers and mothers did not differ for both AQ and AdAS spectrum total and subscale scores. Overall, 13 parents (17.3%) scored higher than 45 on the AdAS spectrum, as indicative of the presence of a subthreshold autism spectrum. This group showed greater prevalence of mood, anxiety and feeding/eating disorders, greater utilization of antidepressants and higher scores on the TALS and the SOFAS than the group scoring lower than 45 (all P &lt; 0.05).ConclusionsFathers and mothers of children with ASD show autistic traits in equal measure. The presence of a subthreshold autism spectrum is associated to greater prevalence of mood, anxiety and feeding/eating disorders, to greater susceptibility to traumatic events and to lower levels of functioning.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Evaluation of the Prevalence of Drug Abuse and Smoking in Parents of Children with Attention Deficit Hyperactivity Disorder.

Attention deficit hyperactivity disorder (ADHD) affects 5% of children. In addition to pharmacotherapy, non-drug treatments such as appropriate parenting are also very important in the treatment of these children. Diagnosis and treatment of parents with psychiatric disorders and substance abuse and evaluation of the frequency of these disorders in parents is critical. In this case-control study, 200 parents were studied. The target population included parents of 7 to 12 year-old children who referred to child and adolescent psychiatric clinics. The control group included parents of children who referred to child non-psychiatric clinics. The parents were evaluated via a demographic information form, and structured interviews based on the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) for nicotine and drug addiction. Then, the Hamilton Anxiety Rating Scale (HAM-A) and Hamilton Depression Rating Scale (HDRS) was used to assess their anxiety and depression. Among the studied parents, the comparison of drug abuse, smoking, and stress showed significant differences between the two groups. In terms of depression and ADHD, the difference between the case and control groups was not statistically significant. The higher prevalence of these disorders in parents of children with ADHD may indicate the possible role of this disorder in the etiology.

The lived experience of US parents of children with autism spectrum disorders: a systematic review and meta-synthesis.

Current US statistics indicate that 1 in 68 children is diagnosed with an autistic spectrum disorder (Centers for Disease Control (2014) Prevalence of autism spectrum disorder among children aged 8 years-autism and developmental disabilities monitoring network, 11 Sites, United States, 2010. Morbidity and Mortality Weekly Report (MMWR)). The lived experience of parents with children diagnosed with autism spectrum disorder is important to know since quantitative studies have indicated that higher rates of mental disorders exist in this population as compared to parents of typically developing children (Yirmiya and Shaked (2005) Psychiatric disorders in parents of children with autism: a meta-analysis. Journal of Child Psychology and Psychiatry 46: 69-83). This study was a meta-synthesis of the qualitative literature in this area embedded within a systematic review. A comprehensive search and review yielded 14 studies. A total of six major themes were identified: (a) emotional stress and strain; (b) adaptation; (c) impact on the family; (d) services; (e) stigmatization; and (f) appreciating the little things. Implications of these results are discussed.

Autism spectrum disorders in children of parents with inflammatory bowel disease - a nationwide cohort study in Denmark.

PurposeInflammatory bowel disease (IBD) and autism spectrum disorders (ASD) may share genetic and environmental risk factors. We examined whether parental IBD is associated with an increased risk of ASD in offspring.MethodsWe conducted a registry-based nationwide cohort study including children born alive in Denmark from January 1, 1994 to December 31, 2009, with follow-up throughout 2010. IBD in parents and ASD in offspring were identified using inpatient and outpatient hospital diagnoses. We computed risk of ASD and crude and adjusted incidence rate ratios (aIRRs) with 95% confidence intervals (CI) using Cox proportional-hazards regression. We evaluated the risk of ASD according to maternal and paternal IBD, and separately for maternal and paternal Crohn’s disease (CD) and ulcerative colitis (UC). Children with parents free of IBD were the comparison cohort.ResultsWe identified 1,005,330 children during the study period. Among them, 11,888 (1.2%) had a parent with IBD and 8,087 (0.8%) had a diagnosis of ASD during up to 17 years of follow-up. The 10-year risks of ASD were 0.7% among children of parents with IBD and 0.9% among children of parents without IBD. The aIRR for ASD among children with parental IBD was 0.8 (95% CI: 0.6–1.0), and results were similar regardless of parent of IBD origin or whether a parent had CD or UC. The estimates were similar for different ASD subtypes.ConclusionWe found no evidence of an increased risk of ASD among children born to parents with IBD.

Parents psychopathology of children with Attention Deficit Hyperactivity Disorder

Attention Deficit Hyperactivity Disorder (ADHD) is a disorder with extremely complex etiology, not yet well defined but certainly multi-factorial. This study investigated the possible etiopathogenetic role of ADHD symptoms and psychopathology disorders in parents of children with ADHD. We present a case-control study of parents of 50 children affected by ADHD and of 45 healthy children, matched to age and gender. Parents of ADHD children reported higher levels of ADHD symptoms, depressive disorders and Depressive Personality Disorders than parents of healthy children. Mothers displayed greater presence of depression, while fathers showed problems concerning alcohol use. The occurrence of ADHD symptoms, psychopathology and personality disorders in parents highlights the importance to integrate the treatment programs in the ADHD children with the screening and treatment for psychopathological symptoms of the parents.

P.4.e.004 The frequency of anxiety disorders in parents of children with attention deficit hyperactivity disorder

The aim of this study was to establish an accumulated strain pattern in different parts of rapid maxillary expansion appliances and relate them to different vertical growth patterns. A clinical study was conducted of 40 patients with posterior crossbite who required rapid palatal expansion.Patients (mean age, 8.48 years) were recruited and treated at the Dental Hospital of Bellvitge, Hospitalet de Llobregat, Barcelona, Spain. Strain gauges were placed on the arms of the RME hyrax screw appliance to record deformation (strain) during the expansion and the retention phases for 75 days. A finite element model was used to place the gauge at the point where the strain was most expressed. The vertical coefficient of variation was used to classify the patients by their vertical growth pattern. P = 0.05 was considered to be statistically significant.During the expansion phase, the highest values of accumulated strain were measured in the posterior part of the appliance for all facial biotypes, but these values passed to the anterior area at the end of the retention phase of the mesocephalic and brachycephalic patients. There was statistically significant difference in the strain of the posterior arms in accordance with the vertical growth pattern (P = 0.05) during the retention phase. At 75 days of retention, 61.25% of the arms had already begun to have strain dissipation.The accumulated strain pattern in the rapid maxillary expansion appliance can vary depending on the facial biotype. In the future, orthodontists should try to tailor the activation and retention protocol based on each patient's characteristics.

Missed opportunities: mental disorder in children of parents with depression.

Emerging evidence suggests that early intervention and prevention programmes for mental health problems in the offspring of parents with depression are important. Such programmes are difficult to implement if children with psychiatric disorder are not identified and are not accessing services, even if their parents are known to primary care. To investigate service use in children of parents who have recurrent depression, and factors that influence such contact. A total of 333 families were recruited, mainly through primary health care, in which at least one parent had received treatment for recurrent depression and had a child aged 9-17 years. Psychiatric assessments of parents and children were completed using research diagnostic interviews. The service-use interview recorded current (in the 3 months prior to interview) and lifetime contact with health, educational, and social services due to concerns about the child's emotions or behaviour. Only 37% of children who met criteria for psychiatric disorder were in contact with any service at the time of interview. A third, who were suicidal or self-harming and had a psychiatric disorder at that time, were not in contact with any service. Lack of parental worry predicted lower service use, with higher rates in children with comorbidity and suicidality. Most children with a psychiatric disorder in this high-risk sample were not in contact with services. Improving ease of access to services, increasing parental and professional awareness that mental health problems can cluster in families, and improving links between adult and child services may help early detection and intervention strategies for the offspring of parents with depression.