By Dr. Michael Oberschneider, Ashburn Psychological & Psychiatric Services

Dear Dr. Mike,

My family suffers from a history of mental health issues, some minor to some more severe — my husband’s family does not share this same history. That said, we have a toddler and a preschooler and it has occurred to me that they might be at risk for inheriting mental health issues as they get older. Are mental health issues genetic, and, is a specific gender more prone to inheriting one? If so, at what age do symptoms typically present themselves?

Dear Concerned Parent,

Yes, mental illness does sometimes run in families and genetics do play a role. Twin studies and adoption studies have consistently demonstrated the significant role heritability and genetics play for being at risk to develop mental illness and neurodevelopmental conditions within the family. For example, research has shown that the concordance rate for monozygotic twins (identical twins) for Schizophrenia is between 40% and 60%; meaning that if one twin has schizophrenia there is about a 50% likelihood that the other twin will also share the diagnosis. Autism, Bipolar disorder, ADHD, Major Depressive Disorder, and Panic Disorder are some of the other mental health disorders that have a strong genetic reality.

But having a genetic predisposition for a certain mental condition does not mean that the condition will develop; it just means that certain individuals will be more susceptible to the condition due to their genetics. If genes explained everything, then the concordance rate for a condition (e.g., Schizophrenia) for identical twins would be 100%. Several factors in addition to genetics contribute to the development of a mental health condition or disorder — prenatal damage, substance abuse, infections, stress, abuse (emotional, physical, or sexual), poor nutrition, brain damage/defects, exposure to toxins, and other traumas (e.g., early parental loss, divorce, and neglect). Thus, if an individual has a genetic predisposition for a mental illness along with other concerning external or environmental stressors or factors, that individual would then be considered to be at an increased risk for developing a condition.

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Regarding gender, the research has shown that some conditions occur more in females than males and vice versa. When it comes to ADHD and Autism, males are diagnosed with those conditions at much higher rates than females — boys are about 3 times more likely than girls to be diagnosed with ADHD, and boys are 5 more times likely than girls to have an Autism Spectrum Disorder. Men also have higher rates of Alcohol Dependence and Substance Abuse and Antisocial Personality Disorder, while Major Depressive Disorder is twice as common in women. Women are also shown to have higher rates of certain types of Anxiety Disorders than men. The research has not shown significant gender differences for several other disorders, such as Bipolar Disorder or Schizophrenia.

Regarding the age of onset, some conditions develop early in life and others not until much later. For example, children with Autism Spectrum Disorders have been diagnosed as young as 2 years old, and most are diagnosed between 4- and 5 years old. The average age for ADHD is 7 years old. This is because problems associated with Autism and ADHD become more apparent with the increasing demands and challenges of life (e.g., attending school). Schizophrenia is typically diagnosed in the early 20s with signs sometimes being apparent in adolescence. Adolescents tend to have higher rates for Depression, but Depression and Anxiety can occur at any stage of life.

You write that you have a toddler and preschooler who have a history of unspecified mental illness on your side of the family. While you are a good mother to wonder about your children with your history, again, remember that genes alone do not determine whether or not one will develop a mental health condition. Rather than worrying about what could happen, I would instead recommend that you focus your energy on what you can do to help your children develop a strong psychological core and foundation. By providing a loving and secure home environment for your little ones with exposure to various social, physical and learning/enrichment concentrated activities; you will be doing what you can to ensure their future well-being.

And also remember that the occurrence of social, emotional, learning, or behavioral problems does not necessarily mean that a condition or disorder is present, so please do not panic if your child experiences some struggles. Early intervention is advised should any problems arise. In my opinion, your pediatrician or family physician is the best professional to turn to for initial assessment and direction. Those professionals are well-trained to identify problems in development and then direct intervention and treatment to a child psychologist or child psychiatrist if needed.

By Dr. Michael Oberschneider, Ashburn Psychological & Psychiatric Services

Dear Dr. Mike,

What are the effects of fighting in front of your children?

My husband and I are going through a rough patch, and I am finding it hard for me to control my temper and end up yelling at him in front of the kids. I guess I’m just nervous I have done irreversible damage.

Dear Concerned Parent,

Disagreements and arguments are a normal part of any marriage and family. However, research in this area has shown that the quality of one’s relationship and the ways in which spouses fight are the main factors that determine how exactly a child is impacted by conflict. When spouses are able to find respectful and loving resolutions to arguments, children can actually benefit from the conflict. Compassion and compromise can be experienced as advantageously learned outcomes for children after high-conflict moments.

In contrast, arguments that escalate to yelling, threats, or physical force can be very damaging to a child’s emotional stability and well-being. With repeated exposure to this sort of toxic fighting, a child can become vulnerable to experiencing depression, anxiety, aggression, and hostility.

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Results from a recent, large-scale study support the finding that high-stress/conflict fighting can be harmful to children; when children feel threatened on an emotional level, they have an increased potential to either turn inward (where their struggles may go unnoticed) or act out aggressively. These researchers found that some children even act out to distract their parents from fighting and will repeat this behavior again and again in a distorted attempt to normalize things.

Other recent research in this area has shown that angry parents and fighting, as a chronic stressor for a child, can actually impact a child’s neurology and learning/problem-solving.

Developmental research on this topic has even shown that infants as young as 6 months of age can pick up on distress among their parents (e.g., the infant’s blood pressure rises in response to the stressor). And longitudinal studies have shown that children who are raised in high-conflict homes tend to have higher rates of physical, emotional, and social problems when compared to children who were not raised in highly stressful homes.

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Regarding your situation, rather than focusing on any permanent damage you might have caused your children by fighting with your husband in their presence, I recommend that you work on improving the way you have disagreements. Children can be pretty resilient, and it is what you do now and in moving forward that is what matters most.

I think you first need to acknowledge that you are human and are thus not perfect; that while you might feel bad about your fighting in the presence of your children, your “rough patch” does not make you a bad person or parent. Most husbands and wives go through difficult times at some point over the course of a long relationship, so remember to be good to yourself as you begin to correct things.

Here are a few tips on calming things down with your husband:

Be Aware of Your Emotional Thermometer
Address your concerns with your husband at the start of a problem and not after things have upset you too much to deal with your feelings or him effectively. If you are too hot to have a rational discussion, walk away and return when cool heads prevail.

Do Not Win the Battle to Lose the War
Make deals or compromises whenever you can. Even if you feel that you are right and he is wrong, most marital problems involve perception, and, as the old saying goes, “one’s perception is one’s reality. So work toward finding a respectful and shared perspective or perception of a problem. Be careful not to right yourself right out of your marriage!

Focus on the Behavior & Not the Person
You want to both like your husband and love your husband. So, try to remember the things you like and love about him and focus your negative feelings on the behavior that is upsetting you so much.

“The Eagle Has Landed”
Use a code word or code phrase that works for you and your husband when your children are present and if things are becoming too upsetting for you as a couple. You or your husband could code the moment when needed, disengage to calm down and return to the issue when you are ready.

Conflict…with a Resolution as the New Normal for Your Children
Yelling at your husband is a conflict without a resolution; it is likely harmful to your husband and children, especially if it has become a pattern and is chronic. Instead, when having an argument or disagreement with your husband, use those moments, as age-appropriate teachable moments for your children. You might explain to your children (in basic terms) what the issue was about that was upsetting to you so much and how you and your husband came to an agreement that worked for you both as loving parents. This approach should serve to increase understanding, compromise, and compassion both in your marriage and for your children in their relationships with you and important others.

Lastly, you do not offer any information on what has upset you so much in relation to your husband. You may have every right to be upset, but yelling in front of your children is not a good solution. Perhaps you and your husband should consider couples therapy, especially if your efforts do not improve within a reasonable period of time.