CLINICAL HANDBOOK OF SCHIZOPHRENIA

472 VI. SPECIAL POPULATIONS AND PROBLEMSsexually transmitted diseases, may decrease energy for parenting and is especially difficultwhen limited child care alternatives allow ill parents no respite.For many parents with schizophrenia, intermittent parenting is the norm. Their childrenmay live with others in informal caregiving arrangements or in legal custody situations.The relationship between a parent with schizophrenia and other child caregivers isa key factor in the well-being of the ill parent and the children. In the worst case scenario,custody may be awarded to relatives who were abusive to the parent; the resultant anxietyabout the children’s safety and well-being may undermine the parent’s treatment andrecovery. In the best case scenario, alternative caregivers are supportive coparents, possiblyliving close by or in the same home. Coparents provide respite, support the parent–child relationship, provide guidance and advice, and serve as role models of effectiveparenting behavior for the parent with SMI.THE IMPACT OF SCHIZOPHRENIA ON PARENTINGParenting capability in individuals with schizophrenia can range from highly attuned andcompetent to adequate, to abusive and/or neglectful. Mental illnesses, including schizophrenia,are more prevalent in samples of parents who are known to abuse their children;however, there are no systematic data on prevalence of child abuse by parents withschizophrenia. Some studies have demonstrated that when schizophrenia does impairparenting capability, it can do so in specific ways. Understanding these disease-linkedfunctional impairments can help clinicians plan parenting rehabilitation interventions.Negative SymptomsParent–infant interactions that are synchronous and contingent promote healthy development.Difficulty in reading nonverbal cues especially limits parenting of babies and toddlers.Blunted affect, apathy, and withdrawal can reduce a parent’s capacity to conveymoods clearly and to respond appropriately to children. Prolonged lack of stimulationcan impair children’s cognitive and social development. Compromised executive functioningcan impair day-to-day family functioning (e.g., meal planning and preparation)and child behavior management.Positive SymptomsThought disorder can interfere with a parent’s ability to recognize antecedents and to anticipateconsequences of children’s behavior. Parents with schizophrenia may have delusionalfears regarding potential harm to their children, may misinterpret their children’sbehavior, or may erroneously believe their children are causing problems or have problems.Hallucinations involving children, particularly command hallucinations, may contributeto a parent injuring a child. However, although command hallucinations havebeen linked to violence, there are no systematic data on the likelihood that parents withschizophrenia will act upon command hallucinations to harm their children.Impaired InsightA parent’s level of insight into his or her illness has been found to correlate with responsiveparenting behavior, and to be inversely correlated with risk of child maltreatment inparents with SMI.