Born Unwanted: Psychosocial Consequences for Children Whose Mothers Were Denied Abortion

Abortion is, of course, a vjery controversial but relatively common means of fertity planning. A lot of research has been done on various aspects of it, such as mental health and medical consequences of abortions as compared to completed pregnancies. However, little research has been done on the consequences of completing an unwanted pregnancy for the resulting child. In the American Journal of Orthopsychiatry, april 2011, there is a very interesting study on this topic.

The study compared mental health and developmental outcomes for children whose mothers were denied abortion to those born from accepted pregnancies. In Prague in the 1960s, abortion had to be approved by a local abortion commission, and, if denied, could be approved anyway by a regional commission. Unwantedness was defined for the purposes of this study as an abortion having been denied twice. This is a very strict definition of unwantedness, because, of course, not all unwantedly pregnant women go through the bureaucratic process of twice requesting abortion.

There were 220 unwanted pregnancy children found eligible for the study. Each was pair-matched to a child from an accepted pregnancy (mother’s name did not appear on the abortion record) similar in age, gender, birth order and school, while mothers were matched on age and socio-economic status. Children were followed up at age 9, 14-16, 21-23, 28-31 and 32-35. In addition, a substudy was done on married people at age 26-28.

Children born out of unwanted pregnancies had similar birth weights and lenghts, a similar chance of having congenital abnormalities, and a similar score on signs of minimal brain dysfunction (a condition most like current ADHD) to the accepted pregnancy children. At age 9, the two groups also scored similar on overall IQ. However, the unwanted pregnancy children, particularly boys or only children, were significantly less sociable and well-adjusted than the controls.

In adolescence and young adulthood, problems for the unwanted pregnancy group became more significant as compared to the controls. In adolescence, unwanted pregnancy children had dropped out of school more and had obtained lower scores in school (that is, much fewer scored above-average). Social problems also continued. In young adulthood, fewer unwanted pregnancy people were satisfied with their jobs, relationships and overall mental well-being than accepted pregnancy people. Mothers were also less satsified about their unwanted pregnancy children’s developmental and educational outcomes. More unwanted pregnancy children than accepted pregnancy children had been or were still in treatment for mental health conditions, and also more unwanted pregnancy children had been sent to prison.

By about age 30, there was still a difference in psychosocial adjustment between people born from unwanted pregnancies and accepted pregnancies. However, this gap had narrowed. By this follow up, women’s outcomes were less favorable as compared to controls than men’s. There was a significant difference between unwanted pregnancy women and control women in terms of unemployment, unmarried status, and parenting difficulties that requered authority attention, to the disfavor of the unwanted pregnancy women. Such a difference could not be found among men. Unwanted pregnancy women were also less socially integrated and emotionally stable than controls. These effects were due to unwantedness. This can be seen, because, by this stage in follow up, siblings were used as an additional comparison group, and they did not show these problems.

Lastly, by age 32-35, those unwanted pregnancy and accepted pregnancy people still living in Prague and their siblings were given an extensive face-to-face interview. Mental health outcomes were compared. People born from unwanted pregnancies had significantly more problems, as indicated by nine out of ten measures of mental health – ranging from inpatient treatment to sexual satisfaction – than their siblings. This difference was not found among the accepted pregnancy people. The unwanted pregnancy people were significantly more likely to have received inpatient and outpatient mental health treatment than the accepted pregnancy people. They were also significantly more likely to suffer from anxiety and depression. By this age, however, poor social adjustment was not merely attributable to unwantedness, since siblings of unwanted pregnancy people also had poorer social outcomes than the accepted pregnancy controls’ siblings.

The substudy on married unwanted and accepted pregnancy people found some interesting things. In many ways, the female partners of unwanted pregnancy men and the male partners of unwanted pregnancy women were comparable to unwanted pregnancy women and men, respectively. Female partners of unwanted pregnancy males had more abortions (both one-time and repeat) and were more dissatisfied with their jobs and mental well-being than the famele partners of male controls. Similarly, male partners of female unwanted pregnancy people encountered more relationship difficulties than the male partners of control females. Lastly, unwanted pregnancy women who had at least one child, felt less prepared for and less happy about the pregnancy and parenthood than control females.

This study, the author concludes, shows that unwanted pregnancy and denial of abortion lays the foundation for an environment in which children are poorly reared, which subsequently leads to mental health and psychosocial problems for the unwanted child. An alternative hypothesis, whereby mothers of unwanted pregnancy children are simply emotionally unavailable mothers, is rejected.

The last wave of the Prague study was conducted in 1996/1997. The results of earlier waves of this study, in part, led the Czech government to abolish abortion commissions in 1986. The author of course advocates legal abortion and other means of fertlity regulation. It is interesting that this is argued from the point of view of the unwanted child, who is at significant risk of mental health and psychosocial problems if born. Of course, it remains to be debated, from an anti-abortion standpoint, whether these problems are worse than not to be born.

Reference

David HP (2011), Born Unwanted: Mental Health Costs and Consequences. American Journal of Orthopsychiatry, 81(2): 184-192. DOI: 10.1111/j.1939-0025.2011.01087.x.

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TDD: Mood Disorder or Personality Trait?

There is an interesting article at Psychiatric Times on the temper dysregulation disorder (TDD) controversy. Particularly, it is noted that TDD is classified as a mood disorder rather than a state of disordered personality development:

In English, that asks whether we should put temper outbursts in with depression and other mood disorders (ie, in the clearly-defined cluster of genetically-determined
chemical imbalances of the brain, or should they be lumped with the personality disorders?). Is an impulsively aggressive person with a long record of assault, drug and alcohol abuse, poor work record, and unstable interpersonal relations suffering a formal mental illness (with all the forensic and social complications that would imply), or is he or she simply choosing to act this way, and is therefore responsible for his/her actions? This is not a trivial question, but it flows directly from the question of whether “such diverse symptoms as irritability, anger, agitation, aggression, distractibility, hyperactivity,
and conduct problems” are or are not of the same ontological nature as depression and hallucinations. For example, in Australia, which has universal welfare
and treatment, if these behavioral factors are held to be mental illness per se, then the “sufferer” is entitled to a pension for life, unlimited (world class) treatment, and an endlessly renewable excuse for all manner of antisocial conduct.

I wonder, actually, why it makes a difference. People who are personality disoredered, should in fact get treatment as much as, or even more than, those with a mental illness. In the Netherlands, in fact, people with personality disorders are entitled to the same welfare and treatment as those with an axis I disorder – which welfare and treatment are by no means universal, by the way.

Also, TDD is a proposed childhood disorder rather than a lifelong disorder, so why should one worry? I think that children with TDD warrant as much treatment as those with oppositional defiant disorder, who at least in the Netherlands do get treatment. Indeed, TDD was at one point proposed as a subtype of ODD, but this idea was thrown out for a reason.

Of course, it is important to decide whether children with TDD are presumed to choose their behaviors, not for the sake of excusing or whether they’re allowed treatment, but because of what treatment is chosen. I, in this light, support the classification of TDD as a mood disorder, especially because dysphoria is part of its currently proposed criteria. Children who are dysphoric (or depressed, as many TDD kids seem to be) need to have this mood recognized and treated with psychotherapy and, in severe cases, medication. Behavior modification alone isn’t going to help.

I have an interest in the matter, of course, in that I would’ve been diagnosed with TDD had it existed in DSM-IV. I was treated with harsh forms of informal behavior modification, and they didn’t work. It could be because I am autistic instead of TDD – and autism needs to be ruled out first before diagnosing TDD -, but it is likely many children currently diagnosed with Asperger’s/PDD and/or ADHD will later be diagnosed with TDD based on observations and the fact that TDD will be the new fashion disease. Now I have little against new fashion diseases – I do not think the children diagnosed with them, are just brats -, but at least these warrant proper, caring treatment.

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Disabled and Childfree: The Default Assumption

I am disabled and childfree, which means I choose not to have children. While the default assumption is that people my age will eventually have children, if they don’t have them already, this does not go for disabled peple: they, especially women, are automatically assumed to be childless, and the reason is supposed to be the disability.

In my case, this is partly true: I do not see myself capable of caring for children responsibly, and my disabilities are a reason for this. But other factors, such as the fact that I simply do not like children, play a role as well.

Besides, it’s simply none of your business. If I’d chosen to have children, that would be up to me. Now that I choose to be childfree, that is up to me, too. The only person whose business the choice of having or not having children is besides my own, is my boyfriend. So stop assuming that disabled women will automatically be childless, and if they choose to be, stop assuming the disability is the reason. It may be or it may not, but it’s simply not for you to know unless we choose to inform you.

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Family Environment Predicts Outcome in Women Physically Abused as Children

I started reading research articles again. In the most recent issue of Child Abuse & Neglect appeared an interesting article on the variables influencing adult outcome for women who experienced childhood physical abuse (CPA). The authors interviewed 290 women living in a community in the northeastern U.S., who had lived for at least ten years of their childhood in a two-parent home. The two-parent home was chosen to increase homogeneity among the women. For the same reason, all women had to be at least second-generation U.S.-born. Blacks and those with an alcoholic parent were oversampled due to their underrepresentation in community settings. However, there was no significant effect of either of these factors on the presence of abuse.

Of the 290 women, 84 met conservative criteria for CPA. CPA was defined as resulting in at least some injury and not merely used as corporal punishment. I wonder how many CPA cases were missed when women perceived their abuse as punishment. However, since the prevalence of CPA was high compared to other studies rather than low, this is likely not considered interesting. What this did show, according to the authors, is that living in a two-parent household is not a protective factor against CPA.

Severity of abuse was assessed using a seven-point scale that assesed whether abuse occurred at all, whether it occurred at least weekly, whether the mother was the perpetrator or there were multiple perpetrators, whether the abuse lasted for more than one year, and whether injury was severe. When predicting adult outcome, however, severity was not more useful than a dichotomous measure of whether CPA had occurred or not. This is not saying that severity is not important. Rather, they may be the specific dimensions of severity measured that were not significant. This finding needs to be replicated.

Other variables that were assessed where the quality of the family environment and childhood stresses. The quality of a family environment was measured using nine items for each of the following four dimensions: conflict, cohesion, expressiveness, and organization. I could not make out how childhood stresses were measured.

Adult outcomes were measured with a variety of scales, measuring self-esteem, depressed mood, life satisfaction, satisfaction with social support, social adjustment, and the presence or absence of a psychiatric disorder or alcohol problem.

As I said, severity of abuse did not predict adult outcome better than whether abuse occurred at all, so when adding family environment and childhood stress into the model, the authors used the dichotomous measure of CPA. As the authors expected, family environment contributed significantly to adult outcome. Particularly, conflict, cohesion and expressiveness were correlated with all seven measures of mental health. When childhood stress was added as a variable, family environment remained a significant predictor of the women’s outcome. Childhood stress alone was not a significant outcome predictor.

Reference

Griffin ML, Amodeo M (2010), Predicting Long-Term Outcomes for Women Physically Abused in Childhood: Contribution of Abuse Severity versus Family Environment. Child Abuse & Neglect, 34(10):724-733. DOI: 10.1016/j.chiabu.2010.03.005.

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Comments on Young Children and Antipsychotics

John M. Grohol of World of Psychology has a very interesting article about prescribing atypical antipsychotics to children under age six. The take-home message from the article is:

After carefully reviewing the limited amount of research in this area, Psych Central recommends that parents should never accept an atypical antipsychotic medication prescription for a child age 5 or younger. If your doctor makes such a prescription, you should (a) look for another doctor and (b) consider filing a complaint with your state’s medical board against the doctor.

Grohol explains about the lack of research on antipsychotics for young children. What research has been done on children under age thirteen, is usually not longitudinal. I find it astonishing, in fact, that drugs get approved by the FDA after very short-term trials. Abilify was approved for autistic irritability in children age six to seventeen after two brief (8- to 12-week) trials found it beat placebo. The reality is that these children will not take Abilify for two or three momths, but probably for several years, unless serious side effects develop. Since drugs are regularly a substitute for proper behavioral and supportive intervention, they remain the only “solution” to the problem.

In the case of the child discussed in this blog post, there wasn’t even a brain disorder – or only a relatively mild one that shouldn’t be treated with antipsychotics, ie. attention deficit disorder – prior to the prescription of Risperdal. This child did not have bipolar disorder or autism. This child was having tantrums due to his stressful family situation, and it took involvement from a supporitive professional to find that out. (Of course, as I have said a million times, autistics and people with bipolar disorder can also have meltdowns due to unsuitable circumstances, and meds are not the solution then, either.) Young Kyle was medicated for all the wrong reasons, and who knows what brain damage Risperdal may’ve done?

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Increasing Numbers of Children Take Antipsychotics

In the Netherlands, between 2008 and 2009, the number of children taking antipsychotics increased by 14%, according to a Dutch news report. The main reason children take antipsychotics, particularly Risperdal, is autistic irritability.

The problem, according to a child psychiatrist cited in the article, is not that these children are put on these drugs in the first place. Usually, this happens during crisis situations, when the only alternative would be admission to a psychiatric hospital. However, when these children are stabilized on Risperdal or a similar drug, behavioral intervention and parent support should start to enhance the family’s and child’s coping strategies. Then, children should be taken off antipsythocis as soon as possible to prevent serious side effects such as weight gain.

As a person who takes an antipsychotic, I agree to some extent. I agree that antipsychotics are no substitute for proper support, but I have had enough experience of long-term insufficient support to know that I, for one, would not quit my medication anytime soon. For children, perhaps better services are available. If this is the case, indeed, families should be steered towards services rather than having their kids on antipsychotics long-term. But I still wonder whether the current services will suffice for the most challenging autistic children and adults. This is not advocating more medicating, but even better services.

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CNN: Stress Excuses Murdering of Autistics

CNN last Friday tried to raise awareness of the high stress experienced by parents of autistic children. Unfortunately, they chose a bad reason for their awareness raising: in Texas, a mother had just killed her two autistic children a few days earlier, telling the 911 operator that she’d strangled them because they were autistic. “I want normal children.” As if those don’t cause stress.

I am fine with it that the high stress levels experienced by parents of autistic children are covered in the media. I advocate for more supports to families, so that they can more easily navigate the complex system they will have to work with. But please, can we pay attention to these issues outside of the scope of terrible homicide cases? First of all, many more parents are in need of help than those who will eventually kill their children. Do we wait until someone kills their child before we advocate for support? Secondly, many people who kill their children, have other reasons to do so. Lastly, stress is simply no excuse for murder, period.

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This Is News?: Antipsychotics Cause Weight Gain In Children

For the sake of eliciting an “Oh, duh!” with most of my readers, research just found that antipsychotics cause weight gain in children. In fact, all four drugs tested – Risperdal, Seroquel, Zyprexa and Abilify – cause significant weight gain within the first three months of use, sometimes up to 15% of the child’s former weight.

This is quite a disturbing finding, because unhealthful weight gain is at least as dangerous for children as it is for adults. You don’t want to put children at significantly increased risk of diabetes and heart disease.

Of course, however, I am not opposed to the use of antipsychotics. I’m also not opposed by definition to their use in children. However, extreme caution should be taken when prescribing these powerful drugs, and I’m a little worried that too many children are prescribed antipsychotics for convenience rather than as genuine treatment for their mental illness.

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Father to Plead Guilty to Shaking Baby

This is horrible. A father shook his baby at least 50 times in the first three months of his life, thereby causing what will likely be lifelong disabilities from so-called Shaken Baby Syndrome. Go figure, there’s even a specific name for the damage caused by a very specific, horrible kind of abuse. That is sad, because it indicates babies are shaken at least regularly enough for doctors to invent a separate syndrome for the resulting disabilities. Think of that for a moment.

The father, Brett Walsh, agreed to give up his parential rights to his son Viktor. Mr. Walsh is scheduled to plead guilty to first and second-degree child abuse tomorrow. Viktor is in foster care, where he continues to get worse neurologically. My heart goes out to him and to all the people who love him dearly.

Now on to the tiny detail they had to throw in, without which this story would never have caught my eye: Viktor’s mother, Suzanne Fox, who is also charged with child abuse, has Asperger’s Syndrome and is in therapy to improve her parenting skills. It is not said whether Fox was involved in the shaking of Viktor – the child abuse charges suggest that she was -, but she most likely knew. I do not know what improper parenting skills or Asperger’s have to do with child abuse, since obviously it doesn’t take parenting skills or social skills to know that there is no good reason to shake a baby. However, if a connection to Ms. Fox’s disability is found to the point where Ms. Fox had limited capacity for responsibility, I hope she will get the proper help. If, more likely, no connection is found, I see no reason to mention this at all other than for the media to perpetuate the myth that only parents with mental health problems would abuse their children.

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Thirty Months in Prison for Mother with Bipolar Who Killed Autistic Child

Six years ago, a mother who suffers from bipolar disorder drowned her autistic child. Now, she was sentenced to five years in prison. Because she had already served thirty months in pre-trial custody, she was given two-for-one credit for time served and released immediately. Five years is, in Canada, at the low end of the spectrum of sentences for manslaughter.

This is a complicated case, in the sense that we do not know to what extent each factor in the mother’s circumstances was exactly discounted towards this low sentence. If, for example, she committed the crime during an episode of her bipolar disorder, and if it can be established that it was the bipolar disorder that “made” her do it, treatment, especially medication, can alleviate the risk of her committing a similar crime again. It would then be understandable that she’d be given a low sentence because of insanity with a low risk of recidivism. There is, however, no indication as far as the media report goes that Ms. Peng suffered from a bipolar episode at the time of her crime. Furthermore, if I’m correct, the McNaughton test is used in the Canadian justice system, so it would be very unlikely for someone to be considered insane even if they committed a crime during an episode of mental illness. Mental illness, after all, doesn’t mean automatic insanity.

I fail to understand how the child’s autism contributes to the mother being given a lower sentence. Of course, having your child diagnosed as autistic is a stressor, but everyone experiences stress at some point. Unless the stressor exacerbated the mother’s mental illness to such an extent that she had diminished capacity for responsibility, there is no reason to consider this factor in a diminished sentence. To me, it almost sounds like: “If Ms. Peng just doesn’t get another defective child, she won’t do it again.” I am even afraid that the mother’s bipolar disorder was insignificant in the crime, but just used to give her case more of the pity factor. Everyone can see how parenting a disabled child – oh wait, being alone with a disabled child for three hours – would turn a crazy woman into a murderer. Even I find myself being compelled to have sympathy for Ms. Peng, and this is as I try to write a balanced, anti-ableist post on the case. Isn’t it wonderful the way the media reinforces stereotypes of mental illness and the burden of caring for disabled people?

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