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J. Indian Assoc. Child Adolesc. Ment. Health 2015; 11(4):279-305

Original Article

Changing social milieu and emotional disorders of childhood

Swapnajeet Sahoo, Adarsh Kohli , Aditi Sharma, Susanta Kumar Padhy

Address for correspondence: Dr. Adarsh Kohli, Department Of Psychiatry, PGIMER,

Chandigarh, Email: doc_adarsh@hotmail.com.

Abstract

Introduction: The Indian society has been undergoing a visible change due to various

reasons resulting in a change in social and family milieu. Children and adolescents being

recipients of the changing family set up, changing relationships and the cumulative stress

face numerous problems. Emotional disorders of children and adolescents are on the rise

among the different psychiatric disorders of children. Parent, child and environmental

factors have been implicated in the development of such disorders.

Aims: To explore the conflicts of children with emotional disorders and to find the

association of the conflicts assessed on Sentence Completion Test and Children’s

Apperception Test with the clinical variables from the case study.

Methodology: Retrospective study of 27 children and adolescents diagnosed as

emotional disorders were taken and conflicts were assessed by Sentence Completion Test

and Children Apperception Test, which were analyzed with clinical variables.

Results: Majority of children, both males and females had disturbed relationship with

parents (48%) and perceived family environment as unhealthy, had poor coping skills

(85%), weak self identification(48%) and were unable to express themselves(74%).

Discussion and Conclusion: Poor parenting and poor inter-parental relationship have

been found to be an important contributing factor in emotional disorders of children and

adolescents.

Keywords: Children, Adolescents, Parenting, Society, Emotional Disorders

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INTRODUCTION

India is known for its rich traditional family values and supportive family culture.

Urbanization and acculturation however have brought about tremendous changes in

Indian society and subsequently in Indian family system. Family is the formative learning

ground for any individual and how an individual grows is the direct impact of its family

system.

Earlier India followed a collectivist society norm that endorsed family integrity, unity, a

sense of support and togetherness [1].It is being seen that the modern day Indian family

setup is undergoing a change with the advent of modernized and globalized values and

norms, resulting in changes in the parenting styles too. The modern family is

characterized by the emotional bonds between husband and wife and this sets it different

from the older generation [2].It is expected to be self- sufficient. Other relatives become

peripheral, while the bonds amongst the nuclear family grow more intense and emotional

[3].The prime value of a modern day family set up is “satisfaction”. The ways in which a

modern family following the current social milieu trains and stimulates its children is also

changing aiming at evolving their children to be more cognitively progressive and hence

better equipped to face the modern day challenges of the society which is based on the

concept of self- sufficiency. However, it has also been observed that the negative effects

of such modern family set up is a corruption in parental love by making it contingent on

whether the child fulfills the parents’ personal expectations. Thus, the changing social

and family milieu has also given rise to many emotional conflicts in the developing mind

of a child and an adolescent.

The 2011 Census of India, reports that 30.9% of Indian population is constituted by

children within the age group of 0–14 years [4].The children of the 21th century are now

being brought up mostly in nuclear family set up rather than joint or extended family set

up. With this change in family set up, there has also been a change in authority figure in

the family. It has been observed that today’s younger generation or adolescents do not

seem to show the same reverence which their parents had for their elders [5].

Along with psychosocial aspects, there are certain material factors also which impact the

child’s healthy mental growth such as socio economic resources, availability of resources

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etc. It has been noticed that children belonging to different socio-economic status

encounter different problems during their formative years of development. Apart from

facing poverty and malnutrition, children belonging to low socio-economic status are

vulnerable to physical abuse, child labor and substance abuse. The children belonging to

middle and upper socio economic status face different set of problems pertaining to either

lack of adequate care or attention from their working parents or to high expectations by

their parents in the growing competitive modern world. In cases of working mothers,

children are placed in an entirely different situation. The demands of urban living are

such that both wife and husband tend to remain outside their home for work even at the

cost of interests of their children and are unable to give proper care and affection to their

children.

The needs of children and adolescents have also changed with the advancement of media,

science and technology in the current scenario. Now-a-days, the focus of children has

been found to be shifted to video games, i-pads, laptops, smart phones, mobiles, game

parlors and demand for outdoor unhealthy foods, [6] which was not the case 10-15 years

before. Hence to meet all these needs, both the parents, have to work harder with a view

of attaining economic independence and maintaining a higher standard of living for their

family. In the strive for maintaining a high standard of living, constant work pressures,

deadlines and targets the quality of interpersonal interaction is getting impaired and

hence more of marital disharmony and differences are on the rise which have a direct

impact on children. The modern day family set up is also characterized by changing

parenting values. In the current scenario, parents focus more on particular needs of the

child. In the West, it has been noticed that such type of need based parenting even

though is better for parents has proven to be depriving the children of customized

treatment [7].

Interpersonal parental conflict which has been recently found to be rising day by day, has

been associated with children’s adjustment [8].In a meta-analysis [9], inter-parental

conflict was found to have a more powerful direct effect on children’s wellbeing than

divorce. In such situations the peer group plays a buffer. Research has shown that peer

acceptance-rejection has always played a significant role in the psychological

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development of children and adolescents. Peers are invaluable in providing the support

necessary for a child/adolescent to become independent as a healthy adult. Support can be

physical, social, emotional or intellectual. Children often learn the basic principles of

societal living from their peers. Peer group functions as a major support system after

family in management of stress related problems. In some situations peers take over as

the primary support group in place of parents and family. Changes in the Indian family

structure and corresponding functional modifications are conspicuous by the

mushrooming of modern institutions to substitute the familial functions [10].However,

the peer relationship is also not exempted by the present changing socio-cultural scenario.

Children now days perceive their peers as competitors either in studies or in play. The

type of peer group one belongs to has been linked with various externalizing disorders

and substance abuse [11].

Parenting style

Baumrind has explained four styles of parenting i.e. authoritarian, authoritative,

permissive and uninvolved or neglectful based on the dimensions of demandingness and

responsiveness [12, 13]. Each style has a different effect on the child and the parental-

child relationship. Research has shown that children of authoritarian style parents are

more likely to be aggressive, exhibit conduct problems, impaired peer relationship, less

socially competency, poor self-esteem with probability emotional disorders of childhood

(depression and anxiety).

Needless to say, both parents should be equally involved in the care giving aspects of the

child/adolescent. They should be able to recognize the needs of the growing child and

should modify their parenting skills as the age of the child advances and should be able to

set age appropriate restrictions so as to help them grow in a positive direction in a healthy

social milieu.

Mothering and Fathering: Earlier studies have focused mainly on mother’s role in the

adjustment of children and adolescents and had undermined the role of father [14]. Later

on, it has been established that both maternal and paternal behaviors influence the

adjustment of a growing child [15, 16, 17] . Sex- specific parenting behaviors have also

been found to be related to adjustment difficulties experienced by the child/adolescent

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[17,18].Meta- analysis of parental caregiving and child externalizing behavior among

preadolescents ,both males and females has revealed strong associations among mothers

as compared to fathers [19].Studies in which parent-child/adolescent conflict have been

assessed have shown that usually the conflict between mother and adolescent are more

intense than father-adolescent [20].Studies on families of problem children/adolescents

have shown that usually the mothers act as “crisis manager” leading to more

confrontational behavior from the child [21]. Out of all the stressors usually reported, it

has been seen that problems with authority figure creates a significant distress in children

and more particularly in adolescent age group.

Stress in children and adolescents

During the childhood and adolescence, if they were affected by stress then it can impair

the normal healthy development. In today’s competitive society, the most commonly

encountered stressors encountered by children and adolescents can be categorized into

two main domains [22,23] namely school related (academic difficulties, bullying by

peers, problems with teachers) and related to interpersonal relationships (conflicts with

parents, siblings or peers).

Stress due to studies is one of the most common stressors reported by most of the

children. Nowadays’ children try to compete more and try to excel in studies. Parents

often have high expectations, strictly monitor hours of study and set unrealistic goals for

their children which further increase the stress in them. Modern day parents often

perceive their children’s academics as a matter of prestige resulting in a comparison of

their children’s performance with others thinking it to be motivating for their own

children. However, many children are unable to cope with the increasing burden of

studies and often feel overloaded with stress due to studies.

Children are unable to express their problems and often land into emotional problems. In

addition to these, during adolescence and puberty, girls report more stressors than boys

and these include specific concerns to physical appearance, harassment, sexual abuse,

striving for autonomy and interpersonal conflicts in heterosexual relationships. Seeking

support and managing stress in a healthy manner can lead to adaptive methods of coping

with stress. Usually the adolescents tend to follow unhealthy coping leading to wide

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spectrum of psychological and behavioral problems. The outcome of these stressful

experiences has been linked with emotional problems (depression, anxiety and

dissociative disorders) and behavioral problems (externalizing disorders, aggression) of

childhood and adolescents [24].

Emotional disorders in children and adolescents

A review done in 2006 in USA estimates ranging from 5% to 26% across different

studies [25]. As per ICD 10, emotional disorders of childhood and adolescence include

anxiety disorders ranging from separation anxiety to phobic anxiety and social anxiety,

sibling rivalry, depressive disorders, dissociative disorders and many unspecified

emotional disorders [26]. These disorders are also prevalent in Indian society, however,

the exact prevalence of emotional disorders is not known. An epidemiological study of

child & adolescent psychiatric disorders in urban & rural areas of Bangalore also

revealed a prevalence rate of 4.1 % of emotional disorders in the age group of 4-16 years

(which included specific isolated phobias, Social phobia, Generalized anxiety disorder,

Separation Anxiety Disorder, Agoraphobia, Panic disorder , Social anxiety disorder and

depressive episode) [27]. A study done in Chandigarh which aimed to estimate the

incidence of psychiatric disorders in school children found out that 50 % of the children

diagnosed with psychiatric disorders(i.e.10 out of the total sample of 20 cases of

diagnosed children) fell into the category of neurotic, stress related and affective

disorders.[28]. Usually several family factors, environmental factors and child factors have

been associated with the development emotional problems in children and adolescents.

Brauner has reported poor parent child relationship, low maternal warmth/high maternal

criticism, parental neglect, poor parenting practices, marital disharmony, distress,

dysfunctional families as family factors leading to emotional problems [25]. On the other

side the child factors causing emotional disorders could be temperamental difficulties,

child neglect abuse, stressful life events and traumatic life events. Parent and child factors

interact to influence the development of childhood anxiety and other childhood

internalizing disorders [29]. Low levels of parental acceptance and inconsistent discipline

are associated with depression in children [30].

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AIMS

Keeping all these in background, the aims of the current study is (1) To explore the

conflicts of children with emotional disorders in the current social set up and (2) To find

the association of the conflicts assessed on Sentence Completion Test and Children

Apperception Test with the clinical variables from case history.

MATERIAL AND METHODS

A retrospective study design was followed. The Psychometry reports of the children and

adolescents below 16 years of age in whom projective tests like Sentence Completion

Test and Children Apperception Test applied were retrieved from June 2013 to June

2014. The cases in whom the diagnosis of emotional disorders was made were sorted out

and their detail worked up files were traced from the Child and Adolescent Psychiatry

record section. A total of 27 cases diagnosed to be having emotional disorders of

childhood, registered in Child and Adolescent Clinic of the Department of Psychiatry,

PGIMER whose projective tests reports were available were analyzed.

All these cases were first worked up in the form of a detailed history taking by

Psychiatry trainee resident doctor and later on discussed with a Child and Adolescent

consultant Psychiatrist.The diagnosis had been established after detail workup following

the ICD-10 diagnostic criteria and confirmed by Consultant Psychiatrist. No additional

diagnostic tools were used. After case work up, psychological tests i.e. Sentence

Completion Test (Form S and G) and Children’s Apperception Test were used and

analyzed by a Clinical Psychologist. All the variables in both of these tests were

qualitatively analyzed using SPSS version 16 software.

Tools

Sentence Completion Test (SCT) [Form S and G][31]: It is a projective

technique an indirect, disguised method to explore into the individual’s attitudes,

fears, interpersonal relations, self belief etc. It is based on Rotter’s (1950)

incomplete sentence blank [32].Form G has 35 items and Form S has 20 items

which are partially written sentences which the patients were instructed to

complete.

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Children’s Apperception Test (CAT): It was devised by Leopald Bellak in 1954

for use with young preadolescent children [33]. It is designed to facilitate

understanding of the various childhood problems such as feeding, sibling rivalry,

toilet training etc. The Indian adaptation done by Uma Chaudhary (1960) consists

of 10 cards of pictures of animals in home situations with the underlying

assumption that young children identify more with animals [34].

Malins Intelligence Scale for Indian Children(MISIC)[35]: It is the Indian

adaptation of Wechsler’s Intelligence Scale for Indian children by A.J Malin. It is

designed for children within the age group of 6 to 15 years. It has 11 scales out of

which 6 are verbal scales namely Information, General comprehension,

Arithmetic, similarities, Vocabulary and Digit Span. 5are performance scales

namely picture completion, Block design, Object assembly, coding and Mazes. In

our study 4 verbal scales (Information, General comprehension, Arithmetic and

Digit Span) and 2 performance scales (picture Completion and Block design)

were applied.

PROCEDURE

Every patient was made to sit in a quite atmosphere in the Psychology section of the

department. After the detailed work up every subject was given the Sentence Completion

Test (SCT) form which was filed by them. After that the patient was given Children’s

Apperception Test(CAT)on which each child was asked to formulate a story including

what was happening in the past, who are the characters, what led to this scene and what

will happen in the future. The choice of CAT cards was done on the basis of conflicts

emerging in SCT. After the patients had filled the SCT forms and had written the CAT

stories all the children were interviewed based on the responses on SCT and CAT and

they were asked to read the sentences and the stories written by them. Intelligence

Quotient (IQ) of all the children was assessed using Malins Intelligence Scale for Indian

Children (MISIC). IQ was done to exclude those cases with subnormal or low

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intelligence presenting with emotional and behavioural problems to avoid bias due to

cognitive inflexibility in such children and adolescents.

Ethical considerations: Strict confidentiality was maintained and non-willingness to

participate in the study did not result in any change in treatment. Parents were informed

regarding the details of the procedure.

RESULTS

Table I: Socio –demographic profile of children with Emotional disorders

(N=27)

Table II:Clinical profile of children with Emotional disorders (N=27)

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Table III: Intellectual functioning of children (N=27)

Table IV: Conflicts on Relationship Issues revealed on analysis of Sentence

Completion Test (N=27)

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Table V: Conflicts related to Self revealed on Sentence Completion Test (N=27)

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Table VI: Themes on Relationship Issues emerging on stories of Children’s

Apperception Test (N=27)

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Table VII: Themes related to Self emerging on stories of Children’s Apperception

Test (N=27)

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Table VIII: Relationship of parenting variables with child variables.

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Summary of results

Profile of children with emotional disorders as obtained:

Demographic and Clinical Variables:

In our study, the mean age of presentation was 13 years (standard deviation -

2.32), and most of the patients were more than 12 years (77.7%) and the mean

years of schooling were 7.74. Females outnumbered males by 33.4 % (18 out of

27 cases). Majority of the patients (88.9%) belonged to middle and low socio-

economic status and about 60 % were residents of urban set up. Dissociative

disorder was found to be the most common (44.4%) diagnosis in this sample

which was closely followed by depression (40.7%). The mean IQ of the sample

group was 96 (standard deviation –8.68) with a mean scatter of 20.69 which is

significant and suggestive of psychopathology.

Relationship Issues:

Majority (77.8%) of the children both males and females report having an

insecure relationship with the mother and a need for affection. Majority of

children (29.6%) both males and females seek support from a source outside the

family. Majority (59.3%) both males and females have a fear of abandonment by

the parents and report disturbed relationship with both the parents (44.4% with

father and 48.1% with mother). Mostly female children (61.1%) had disturbed

relationship with mother whereas most of the male children (66.6%) had disturbed

relationship with father. Insecure relationship with the mother is leading to a

yearning for affection in about 74% of children in both males and females.

Parental inconsistency is more commonly found in children with depression in

our sample and more specifically mother’s inconsistent parenting has been found

to lead to weak self- identification in 48% children of both genders. 88.9%

children of both the genders have reported grudges related to family. Non cordial

relations between the parents have been reported by about 37% of the

patients.40% of children perceive non cordial relations with friends perceiving

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friends as competitors and are in a constant struggle to maintain relationships with

them

Variables related to Self:

There is a strong feeling (77.8%) of being ‘isolated’ in the family constellation by

children both males and females.59.3% children (both males and females) have a

feeling of running away, escapism i.e. flight reaction. Majority resort to using

poor or unhealthy coping mechanisms (85.2%).There is a dire need for autonomy

(85.2%) and conflict with authority (77.8%) reported in the sample. Majority

(63%) perceive themselves as weak and timid in the face of authority. Lacking in

ability to express (74.1%) and poor self confidence (70.4) are reported in most of

these children in this study. Most of the children both males and females (55.6%)

perceive studies as favorable and around 25% children report failure in exams as

the greatest fear in their lives. In addition to all these, around 48% of these

children report studies to be the most important part of their lives.

Weak self identification is associated with weak relationship with mother in 48%

of children of both genders. Need for autonomy has been more associated with

mother’s inconsistency(62.9%) than father’s inconsistency(40%) in children both

males and females.25.9% children of both genders have reported oral frustration

needs in terms of feeding problems. Need for affection has been found to be

associated with an insecure relationship with mother in 66.6% children of both

genders.44.4% children of both genders have reported a negative attitude towards

heterosexual relationships.37% of the children have reported sibling rivalry.

Positive findings from our study sample are that around 63% of the children, both

males and females reported positive attitude towards life, 85% children reported

constructive wish and 55 % children perceived studies to be favorable. These

findings suggest that proper intervention should be taken early in these areas too

or else these findings can also change into negative if the problems persists.

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Discussion

Children are influenced by their perceptions of parental behaviors, rather than by actual

parental behaviors or those reported by the parents [36]. Thus it seems necessary to

explore how children perceive the parental behaviors and that could be helpful in

explaining the mechanisms of development of childhood emotional problems. The

various factors could be divided into self variables and parental and family variables.

There are two well established predictors of internalizing behavior problems: child

temperament and family environment both of which act independently or in interaction

[37].Literature indicates that children’s negative perception of the relationship with their

mothers’ clearly predicts internalizing problems [38]. Consistent with the existing

literature our study also shows that a majority (77.8%) of our sample of internalizing

emotional disorders have an insecure relationship with the mother.

Parent and child factors often interact to influence the development of childhood anxiety

and various other internalizing disorders [29]. Parental involvement further improves the

child’s active use of coping strategies and overall emotional functioning. The results of

the index study also show that majority of the children (85.2%) in the sample under study

had poor and unhealthy coping mechanisms and also had a perceived feeling of

abandonment by the parents. Low level of parental acceptance is also found to be

associated with depression in children [30]. Earlier Davies and Cummings (1994) also

showed that emotional security mediates the relationship between parental behaviors

(availability and control) and adjustment [39]. They showed that when a sense of security

is lost, as a consequence of problems with parental availability or negative control the

efforts of recovering emotional security can lead to long lasting maladjustment which

may lead to the development of various internalizing and externalizing disorders.

Davies further tried to explore what mediated the relationship between emotional security

and child’s adjustment and they found that inter-parental conflict was linked to a child’s

subsequent psychological symptoms through its association with the child’s emotional

insecurity [40].

The changing social milieu also has some underpinnings in the modern day family set up

and thus probably adding onto the mediating variables responsible for emotional

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disorders. In recent years due to social changes more mothers have come out the house

and work and research has shown that maternal work conditions was expected to affect

children’s development directly through its effect on parenting styles or other aspects of

family processes [41]. Berkien reported that children have more internalizing and

externalizing problems when they perceive their parents as more dissimilar in parenting

styles [42].Similar findings were reported by Jaursch who found that parental

dissimilarity in emotional warmth and rejection were correlated with children’s

internalizing and externalizing disorders [43]. Unpredictability of the parents’ behavior

constitutes a risk for children to develop learnt helplessness and is associated with

various emotional problems [44].

Further, Creemers reported that damaged self esteem is associated with internalizing

disorders [45]. They also provided evidence that defensive or fragile self esteem was

solely associated with loneliness. Earlier it has been established self esteem plays a

crucial in the onset and maintenance of internalizing problems [46]. Creemers similarly

reported that when there is a discrepancy between both the components of self esteem i.e.

implicit and explicit, then this discrepancy is positively associated with depressive

symptoms and feelings of loneliness in patients with internalizing disorders [47].Similar

findings are endorsed by our study wherein we found a negative self esteem in about 70%

children of both the genders.

In the present study, we also found an ‘inability to express’ in 70%of the children in both

males and females. Empirically it has been shown that social competence includes

inability to express and predicts internalizing symptoms across longer periods in

childhood and adolescence with lower social competence early forecasting more

symptoms later [48].Relationships with peers also is a part of social competence skills

and it is reported that peer rejection and anxious solitude in kindergarten predict teacher

reported depressive symptoms in children across a four year interval [49]. Anxiety,

depression and other internalizing symptoms have predictive significance for a spectrum

of emotional disorders and problems and also show signs of reciprocal linkages over time

with poor peer social adjustment [50].Similarly in our index study also about 41% of the

children report negative or non cordial relations with the friends indicating that along

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with family disturbances , an unhealthy relationship with peers could attribute to the

maintenance of an internalizing emotional disorder in children. Social isolation and

incompetence in second grade students were found to be linked with the onset of

internalizing behaviors in children 3 years later [51]. Similarly Larson reported increased

social isolation to be associated with depressed mood in boys aged 12 to 15 years [52]. In

the sample of the present study (comprising of children with depression, dissociative

disorder, somatoform disorder and anxiety spectrum) we also found 77.8% children to

have a feeling of ‘isolation’ in family constellation.

As found in our study 37% of the patients have reported non-cordial relations between

the parents. Literature suggests that marital negativity is associated with increased

hostility towards the child [53] and decreased warmth [54]and engagement [55].Parents

negative thoughts and emotions during marital conflict subsequently affect parent child

interactions [56]. It has been found that stressful family interactions during the day,

including marital hostility and hostile parenting could interfere with children feeling safe

at bed time and throughout the night. Thus, marital hostility may be perceived by the

child as a potential source of threat to the family system [39].This threat as perceived by

children could also function indirectly via its impact on parenting as understood [57,58].

As the social milieu is changing and along with it, the emotional disorders in children and

adolescents are also on the rise. Hence, the implication of the index study is that we need

to focus on the various socio-cultural, relationship and parenting issues while dealing

with children with emotional problems so that early interventions can be done. This study

highlights some of the important areas as evident from the conflicts assessment where

one need to explore and intervene while managing such children/adolescents.

To conclude, our results are indicative of strong pointers towards few mediating factors

between adequate parenting and childhood emotional problems in the context of

changing social milieu. Not only is adequate parenting crucial and contributing but also

the child’s perception of the parenting is important. Similarly, to foster healthy general

well being in the child the interparental relationship also plays an important role as it has

a two way impact on the child’s psyche i.e. directly through the child’s feelings of threat

and secondly indirectly through the hostile parenting that arises due to inter-parental

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conflict. Results also suggest the role of inadequate peer relationships in the maintenance

internalizing emotional disorders.

Limitations of the study: A small sample size is a major limitation of the study.

References

1. Chekki D. Family Values and Family Change. Indian J Soc Work.1996; 69:338–

348.

2. Stone L. The Family, Sex and Marriage in England, 1500-1800. New York:

Harper and Row; 1977.

3. Dizard JE, Gadlin H. The Minimal Family. Amherst, Mass. University of

Amherst Press; 1990.

4. Figures at a glance, India 2010. Available at

www.censusindia.gov.in/vital_statistics/srs/At_a_glance__2010.xls, last accessed

on 11/11/2012

5. EstévezE ,Góngora JN. Adolescent aggression towards parents: factors associated

and intervention proposals: Handbook of Aggressive Behavior Research.

CaitrionaQuin and Scott Tawse; 2009. Chapter 6; pp. 143-164

6. Rideout JV, Foehr UG, Roberts DF. Generation M2 media in the lives of 8 to 18

year olds. A Kaiser Family Foundation Study. Henry J. Kaiser Family

Foundation, Menlo Park, California; Jan 2010

7. Elkind D. The Post-modern Family, A New Imbalance. New York: Knopf;1992

8. Riggio HR. Parental marital conflict and divorce, parent– child relationships,

social support, and relationship anxiety in young adulthood. Personal

Relationships.2004; 11: 99–114.

9. Amato PR, Keith B. Parental divorce and the wellbeing of children: A meta-

analysis. Psychol Bull, 1991 Jul;110(1):26-46

300

10. Nalini B. Structural functional changes and the need for grand parental support in

Indian families. Department of Sociology, Madurai Kamraj University,

Madurai.1997.

11. D’Amico EJ, McCarthy DM. Escalation and initiation of younger adolescents’

substance use: The impact of perceived peer use. J Adolesc Health, 2006; 39:481–

7.

12. Baumrind D. Current patterns of parental authority. Developmental Psychology.

Jan 1971; Vol 4(1, Pt.2) : 1-103.

13. Baumrind D. Effective parenting during the early adolescent transition. In P.A.

Cowan & E. M. Hetherington (Eds.), Advances in family research. Vol 2.

Hillsdale, NJ: Erlbaum;1991

14. Phares V. Fathers and developmental psychopathology. New York: John Wiley;

1996.

15. Laible DJ, Carlo G .The differential relations of maternal and paternal support and

control to adolescent social competence, self-worth, and sympathy. J Adolesc

Res.2004;19:759-782

16. Steinberg L. We know some things: Adolescent-parent relationships in retrospect

and prospect. J Res Adolesc.2001; 11:1-19.

17. McKinney C, Renk K. Differential Parenting Between Mothers and Fathers :

Implications for Late Adolescents. J Fam Issues.2008;29(6): 806-827

18. Bosco GL, Renk K, Dinger TM, Epstein MK, Phares V. The connections

between adolescents’ perceptions of parents, parental psychological symptoms,

and adolescent functioning. J Applied Dev Psychol.2003;24,179-200

19. Rothbaum F, Weisz JR. Parenting caregiving and child externalizing behaviour in

nonclinical samples: a meta-analysis. Psychol Bull. 1994 Jul;116(1):55-74.

301

20. Laursen B, Collins WA. Interpersonal conflict during adolescence. Psychol Bull.

1994 Mar; 115(2):197-209.

21. Patterson GR. Mothers: the unacknowledged victims. MonogrSoc Res Child

Dev.1980; 45 (5):186

22. Donaldson D, Prinstein MJ, DanovskyM ,Spirito A. Patterns of Children's Coping

With Life Stress: Implications for Clinicians. Am J Orthopsychiatry.2000;70(3):

351–359

23. Williamson DE, Birmaher B, Ryan DN, Shiffrin TP, Lusky JA, Protopapa J, et al.

The Stressful Life Events Schedule for children and adolescents: Development

and validation. Psychiatry Res. 2003; 119:225–241

24. Kovacs M, Devlin B. Internalizing Disorders in Childhood. J Child Psychol

Psychiatry.1998 Jan;39(1): 47–63.

25. Brauner CB, Stephens CB. Estimating the Prevalence of Early Childhood Serious

Emotional/Behavioral Disorders: Challenges and Recommendations. Public

Health Rep. 2006 May-Jun; 121(3): 303–310.

26. International statistical classification of diseases and related health problems.

World Health Organization.10th Rev. 2nd ed. Geneva.2004; 1208 p

27. Srinath S, Girimaji SG, Gururaj G, Seshadri S, Subbakrishna DK , Bhola P et al.

Epidemiological study of child & adolescent psychiatric disorders in urban &

rural areas of Bangalore, India. Indian J Med Res.July 2005;122: pp 67-79

28. Malhotra S, Kohli A, Kapoor M, Pradhan B. Incidence of childhood

psychiatric disorders in India. Indian J Psychiatry 2009;51:101-7

29. Chase RM, Eyberg SM. Clinical presentation and treatment outcome for children

with comorbid externalizing and internalizing symptoms. J Anxiety disord. 2008;

22:273-282

302

30. Gonzales NA, Pitts SC, Hill NE, Roosa MW. A meditational model of the impact

of interparental conflict on child adjustment in a multiethnic, low-income sample.

J Fam Psychol.2000; 14: 365–379

31. Verma SK, KhannaBC ,Wig NN. Construction of PGI Sentence Completion

Tests(in Hindi).Mind.1985;11:,7-14.

32. Rotter JB, Rafferty JE. The Rotter Incomplete Sentence Blank. San Antonio, TX

:Psychological Corporation,1950.

33. Bellak, L. The Thematic Apperception Test and the Children’s Apperception test

in clinical use. Grune and Stratton, New York,1954.

34. Chowdhury , U. An Indian Modification of the Children’s Apperception Test.

New Delhi.Manasayan, 1960.

35. Malin, AJ. Manual for Malin’s Intelligence Scale for Indian Children. Nagpur

Child Guidance Centre, 1969.

36. Demo DH, Small SA,Savin-Williams RC. Family relations and the self-esteem of

adolescents and their parents. J Marriage Fam. 1987; 49: 705–715.

37. Leve LD, Kim HK, Pears KC. Childhood temperament and family environment as

predictors of internalizing and externalizing trajectories from ages 5 to 17. J

Abnorm Child Psychol.2005; 33(5): 505-520.

38. Frampton KL, Jenkins JM, Dunn J. Within-family differences in internalizing

behaviors: the role of children’s perspectives of the mother-child relationship. J

Abnorm Child Psychol. 2010; 38: 557–568.

39. Davies PT, Cummings ME. Marital conflict and child adjustment: An emotional

security hypothesis. Psychol Bull.1994; 116: 387-411.

40. Davies PT, Harold GT, Goeke-Morey MC, Cummings EM. Child emotional

security and interparental conflict. MonogrSoc Res Child Dev.2002; 67: 1-113.

303

41. Foster EM ,Kalil A. Developmental Psychology and public policy : progress and

prospects. Dev Psychol.2005; 41: 827-932.

42. BerkienM ,Louwerse A , Verhulst F, Ende J. Children’s perception of

dissimilarity in parenting styles are associated with internalizing and externalizing

behavior. Eur Child Adolesc Psychiatry. 2012; 21(2):79-85.

43. Jaursch S, Losel F, Beelmann A, Stemmler M. Inconsistency in parenting

between mothers and fathers and children’s behavior

problems. PsycholErziehUnterr. 2009 ;56:172–186

44. Tiggemann M, Winefield AH. Predictability and timing of self-report in learned

helplessness experiments. PersSocPsychol Bull. 1987; 13:253–264.

45. Creemers DHM, Scholte RHJ, Engels RCME, PrinsteinMJ,WiersRW. Front

Psychology.2013; 4: 152

46. Evans E, Hawton K, Rodham K. Factors associated with suicidal phenomena in

adolescents: a systematic review of population-based studies. ClinPsychol

Rev.2004; 24(8) : 957–979.

47. Creemers DHM, Scholte RHJ, Engels RCME, Prinstein MJ, Wiers RW. Implicit

and explicit self-esteem as concurrent predictors of suicidal ideation, depressive

symptoms and loneliness. J BehavTherExp Psychiatry.2012; 43(1), 638–646.

48. Kiesner J. Depressive symptoms in early adolescence: Their relations with

classroom problem behavior and peer status. J Res Adolesc. 2002;12:463–478.

49. Gazelle H, Ladd GW. Anxious solitude and peer exclusion: A diathesis-stress

model of internalizing trajectories in childhood. Child Dev. 2003;74:257–278.

50. Lewinsohn PM, Rohde P, Klein DN, Seeley JR. Natural course of adolescent

major depressive disorder: I. Continuity into young adulthood. J Am Acad Child

Adolesc Psychiatry. 1999;38:56–63.

304

51. Hymel S, Rubin KH, Rowden L, LeMare L. Children’s peer relationships:

Longitudinal prediction of internalizing and externalizing problems from middle

to late childhood. Child Dev.1990;61:2004–2021

52. Larson RW, Raffaelli M, Richards MH, Ham M, Jewell L. Ecology of depression

in late childhood and early adolescence: A profile of daily states and activities. J

Abnorm Psychol.1990;99:92–102.

53. Harold GT, Osborne LN, Conger R. Mom and dad are at it again: Adolescent

perceptions of marital conflict and adolescent psychological distress. Dev

Psychol. 1997;33:333–350.

54. Vandewater EA, Lansford JE. Influences of family structure and parental conflict

on children’s well-being. Family Relations. 1998;47:323–330

55. Kitzmann KM. Effects of marital conflict on subsequent triadic family

interactions and parenting. Dev Psychol. 2000;36:3–13.

56. Erel O, Burman B. Interrelatedness of marital relations and parent-child relations:

A meta-analytic review. Psychol Bull. 1995; 118:108–132.

57. Kaczynski KJ, Lindahl KM, Malik NM, Laurenceau J. Marital conflict, maternal

and paternal parenting, and child adjustment: A test of mediation and

moderation. J Fam Psychol. 2006; 20:199–208.

58. Rhoades KA, Leve LD, Harold GT, Neiderhiser JM, Shaw DS, Reiss D.

Longitudinal pathways from marital hostility to child anger during toddlerhood:

Genetic susceptibility and indirect effects via harsh parenting. J Fam

Psychol. 2011; 25:282–291.

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Dr. Swapnajeet Sahoo, Junior Resident; Dr. Adarsh Kohli, Professor in Clinical

Psychology; Dr. Aditi Sharma, Assistant Clinical Psychologist; Dr. Susanta Kumar

Padhy, Assistant Professor, Dept. Of Psychiatry, PGIMER, Chandigarh.