European Child & Adolescent Psychiatry

, Volume 15, Issue 6, pp 309–318 | Cite as

Emotional and behavioural difficulties in children of parents with multiple sclerosis

A controlled study in Greece
  • Stavroula Diareme
  • John Tsiantis
  • Gerasimos Kolaitis
  • Spyros Ferentinos
  • Emmanuel Tsalamanios
  • Elena Paliokosta
  • Sophia Anasontzi
  • Eirini Lympinaki
  • Dimitris C. Anagnostopoulos
  • Costas Voumvourakis
  • Georg Romer


Emotional and behavioural problems were investigated in children who have a parent with multiple sclerosis (MS), in relation to factors such as family dysfunction, parental depression and illness-related characteristics. The participants were 56 MS patients, their spouses and one randomly selected child aged 4–17 years, and a comparison group of 64 children and both their parents, none of whom reported somatic illness. Emotional and behavioural problems in the children were identified by reporting of both parents and self-report using the Achenbach’s Child Behaviour Checklist and Youth Self Report respectively. Parental depression and family dysfunction were explored using the Beck Depression Inventory and Family Assessment Device, respectively. The data were analysed using independent samples t-tests for between-group comparisons, Pearson r correlations between children’s problems and family dysfunction or parental depression, and multiple regression analyses for identifying predictors for children’s problems. Children whose parents, especially mothers, had MS presented greater emotional and behavioural problems than comparison children. Children’s problems were positively associated with maternal depression and family dysfunction. Family dysfunction predicted children’s overall and externalizing problems, while the severity of impairment of the ill mother predicted children’s internalizing problems. Implications of these findings for clinical practice are discussed.


somatically ill parents children’s psychopathology 



This study is part of an international multisite research project, which was supported by a grant from the European Union in its 5th Framework Program “Quality of Life” (QLGT—2001—02378): “Mental Health Prevention in a Target Group at Risk: Children of Somatically Ill Parents (COSIP)”. The following institutions and Principal Investigators collaborated in this project:

1. Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Hamburg–Eppendorf, Germany (Dr. med. Georg Romer).

2. Department of child and Adolescent Neuropsychiatry, University of Vienna, Austria (Prof. Dr. med. M. Friedrich).

3. Department of Psychology, University of Aarhus, Denmark (M. Thastum, Ph.D).

4. Child Psychiatry Clinic, Turku University Hospital, Finland (Prof. Dr. J. Piha).

5. Department of Child Psychiatry, Athens University Medical School, “Aghia Sophia” Children’s Hospital, Greece (Prof. J. Tsiantis).

6. Clinic of Child and Adolescent Psychiatry, University of Medicine and Pharmacy, Bucharest, Romania (Prof. Dr. S. Milea).

7. Clinic of Child and Adolescent Psychiatry, Basle University Hospital, Switzerland (PD Dr. B. Steck).

8. Department of Psychological Medicine, Royal Marsden Hospital, Sutton, United Kingdom (M. Watson, Ph.D.).


  1. 1.
    Achenbach TM (1991a) Manual for the child behaviour checklist and 1991 child behaviour profile. University of Vermont, Department of Psychiatry, Burlington, VTGoogle Scholar
  2. 2.
    Achenbach TM (1991b) Integrative guide to the 1991 CBCL/4-18, YSR and TRF profiles. University of Vermont, Department of Psychiatry, Burlington, VTGoogle Scholar
  3. 3.
    Armistead L, Klein K, Forehand R (1995) Parental physical illness and child functioning. Special issue: the impact of the family on child adjustment and psychopathology. Clin Psychol Rev 15(5):409–422CrossRefGoogle Scholar
  4. 4.
    Armsden G, Lewis FM (1993) The child’s adaptation to parental medical illness: theory and clinical implications. Patient Educ Couns 22(3):153–165PubMedCrossRefGoogle Scholar
  5. 5.
    Armsden GC, Greenberg MT (1987) The inventory of parent and peer attachment: relationships to well-being in adolescence. J Youth Adolescence 16(5):427–454CrossRefGoogle Scholar
  6. 6.
    Armstrong J (1988) Emotional functioning of Multiple Sclerosis patients from a family life cycle stage perspective. Dissertation Abstracts International: 48/10bGoogle Scholar
  7. 7.
    Arnaud (1992) Some psychological characteristics of children of Multiple Sclerosis. Psychosom Med 21(1):8–22Google Scholar
  8. 8.
    Beck AT, Ward C, Mendelson M, Mock J, Erbaugh J (1961) An inventory for measuring depression. Arch Gen Psychiat 4:53–63Google Scholar
  9. 9.
    Blackford KA (1992) Strategies for intervention and research with children or adolescents who have a parent with Multiple Sclerosis. Axon: 50–54Google Scholar
  10. 10.
    Brennan PA, Brocque RL, Hammen C (2003) Maternal depression, parent-child relationships, and resilient outcomes in adolescence. J Am Acad Child Adol Psychiat 42:1469–1477CrossRefGoogle Scholar
  11. 11.
    Brennan PA, Hammen C, Andersen MJ, Bor W, Najman JM, Williams GM (2000) Chronicity, severity and timing or maternal depressive symptoms: Relationships with child outcomes at age 5. Developmental Psychopathology 36: 759–766Google Scholar
  12. 12.
    Deatrick JA, Brennan D, Cameron ME, (1998). Mothers with multiple sclerosis and their children-effects of fatigue and exacerbations on maternal. support Nurs Res 47(4):205–210PubMedCrossRefGoogle Scholar
  13. 13.
    Diareme S, Tsalamanios E, Paliokosta H, Anasontzi S, Kolaitis G, Voumvourakis C, Tsiantis A, Tsiantis J (2005) Implementing a preventive counselling service for children of parents with Multiple Sclerosis in a Southern European country. In: Romer G, Kenbacher C, Milea S, Piha J, Steck B, Thastum M, Tsiantis J, Watson M (eds) Children of somatically ill parents. International perspectives of family-oriented mental health prevention. Final Report of a European Project (RTD Project: QLG4-CT-2001-02378) within the frame of Quality of Life and Management of Living Resources Programme, Public Health and Health Services Research of the European Union, pp. 297–314Google Scholar
  14. 14.
    Ebers G (2001) Natural history of Multiple Sclerosis. J Neur Neurosurg Psychiat 71(suppl II):ii16–ii19Google Scholar
  15. 15.
    Epstein NB, Baldwin LM, Bishop DS (1983) The McMaster family assessment device. J Marriage Fam Therapy 9:171–180Google Scholar
  16. 16.
    Fuller G, Manford M (2000) An illustrated colour text neurology. Xxxx, Harcourt Publishers LimitedGoogle Scholar
  17. 17.
    Kalb R (1998) Multiple Sclerosis. A guide for families. New York, DemosGoogle Scholar
  18. 18.
    Karnofsky DA, Burchenal JH (1949) The clinical evaluation of chemotherapeutic agents in cancer. In: McLead CM (ed) Evaluation of chemotherapeutic agents. Columbia University Press, New YorkGoogle Scholar
  19. 19.
    Lindsay K, Bone I, Callander B (1991) Neurology and neurosurgery illustrated, 2nd edn. Churchill Livingstone Google Scholar
  20. 20.
    McCubbin HI, Patterson JM (1981) Systematic assessment of family stress, resources and coping: tools for research, education and clinical intervention. St. Paul, MN, University of MinnesotaGoogle Scholar
  21. 21.
    Power PW (1985) Family coping behaviours in chronic illness: a rehabilitation perspective. Rehabilitation Literature 46:3–4, 78–83Google Scholar
  22. 22.
    Ravens-Sieberer U, Bullinger M (2000) Manual: KINDL questionnaire for measuring health-related quality of life in children and adolescents. Hamburg University, Hamburg, GermanyGoogle Scholar
  23. 23.
    Romer G, Bakmann C, Schulte-Markwort, Thomalla G, Riedesser P (2002) Children of somatically ill parents: a methodological review. Clin Child Psychol Psychiat 7(1):17–38CrossRefGoogle Scholar
  24. 24.
    Romer G, Saha R, Haagen M, Pott, M, Baldus, C (in press) Differential family functioning, family coping and children’s psychological adjustment when a parent is physically ill—a multi perspective study. Family ProcessGoogle Scholar
  25. 25.
    Romer G, Stock M, Baldus C, Diareme S, Grether A, Gubba L, Kienbacher C, Manninen H, Oancea C, Schmitt F, Stancescu D, Steck B, Thastum M, Tsalamanios E, Haagen M (2005) Lessons learned from implementing preventive mental health services for children of somatically ill parents in various medical settings: a transnational multicentre perspective. In: Romer G, Kenbacher C, Milea S, Piha J, Steck B, Thastum M, Tsiantis J, Watson M (eds) Children of somatically ill parents. International perspectives of family-oriented mental health prevention. Final Report of a European Project (RTD Project: QLG4-CT-2001-02378) within the frame of Quality of Life and Management of Living Resources Programme, Public Health and Health Services Research of the European Union, pp 297–314Google Scholar
  26. 26.
    Roussos A, Francis K, Zoubou V, Kiprianos S, Prokopiou A, Richardson C (2001) The standardization of Achenbach’s Youth Self-Report in Greece in a national sample of high school students. Eur Child Adoles Psychiat 10: 47–53 CrossRefGoogle Scholar
  27. 27.
    Roussos A, Karantanos G, Richardson C, Hartman C, Karajiannis D, Kyprianos S, Lazaratou H, Mahaira O, Tassi M, Zoubou V (1999). Achenbach’s child behaviour checklist and Teacher’s report form in a normative sample of Greek children 6–12 years old. Eur Child Adoles Psychiat 8(3):165–172CrossRefGoogle Scholar
  28. 28.
    Rutter M (1966) Children of sick parents. An environmental and psychiatric study. Oxford University Press, LondonGoogle Scholar
  29. 29.
    Schag CC, Heinrich RL, Ganz PA (1984) Karnofsky performance status revisited: reliability, validity, and guidelines. J Clin Oncol 2:187–193PubMedGoogle Scholar
  30. 30.
    Sheeber L, Hops H, Alpert A, Davis B, Andrews J (1997) Family support and conflict: prospective relations to adolescent depression. J Abnorm Child Psych 25:333–344CrossRefGoogle Scholar
  31. 31.
    Spirito A (2004) Personal Communication and Correspondence with the author of KIDCOPE. Child and Family Psychiatry, Rhode Island Hospital, Providence, RI, USAGoogle Scholar
  32. 32.
    Steck B, Amsler F, Kappos L, Burgin D (2001) Gender-specific differences in the process of coping in families with a parent affected by a chronic somatic disease (e.g. Multiple Sclerosis). Psychopathology 34:236–244PubMedCrossRefGoogle Scholar
  33. 33.
    Tsalamanios E, Paliokosta E, Anasontzi S, Kolaitis G, Diareme S, Tsiantis J (2003) When the parent is ill: the psychosocial impact of Multiple Sclerosis on children and families: literature overview child and adolescent: mental health and psychopathology (in Greek) 6 (1): 43–56Google Scholar
  34. 34.
    Tzemos J (1984) The standardization of the Beck Questionnaire for the Greek population (in Greek). Doctoral Dissertation, Athens University Medical SchoolGoogle Scholar
  35. 35.
    Watson M, St James-Roberts I, Ashley S, Tilney C, Brougham B, Edwards L, Boldus C, Romer G. (2006) Factors associated with emotional and behavioural problems among school age children of breast cancer patients. Brit J Cancer 94(1):43–50PubMedCrossRefGoogle Scholar
  36. 36.
    Weinert C, Catanzaro ML (1994) Challenging assumption about Multiple Sclerosis. Rehabil Nurs Res 3:122–129Google Scholar
  37. 37.
    Wineman NM (1990) Adaptation to Multiple Sclerosis: the role of social support, functional disability, and perceived uncertainty. Nurs Res 39(5):294–299PubMedGoogle Scholar
  38. 38.
    Worsham N, Compas B, Sydney E (1997) Children’s coping with parental illness. In: Wolichik, Sandler (eds) Handbook of children’s coping: linking theory and intervention. New York Plenum Press, pp 195–213Google Scholar

Copyright information

© Steinkopff Verlag Darmstadt 2006

Authors and Affiliations

  • Stavroula Diareme
    • 1
  • John Tsiantis
    • 1
  • Gerasimos Kolaitis
    • 1
  • Spyros Ferentinos
    • 1
  • Emmanuel Tsalamanios
    • 1
  • Elena Paliokosta
    • 1
  • Sophia Anasontzi
    • 1
  • Eirini Lympinaki
    • 1
  • Dimitris C. Anagnostopoulos
    • 1
  • Costas Voumvourakis
    • 2
  • Georg Romer
    • 3
  1. 1.Child and Adolescent Mental Health Unit Dept. of PsychiatryMedical School University of AthensAthensGreece
  2. 2.Neurological University ClinicAthens University Medical School “Attikon” General HospitalAthensGreece
  3. 3.Dept. of Child and Adolescent Psychiatry and PsychotherapyUniversity Hospital Eppendorf University of HamburgHamburgGermany

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