CLINICAL HANDBOOK OF SCHIZOPHRENIA

45. Parenting 473THE IMPACT OF PARENTAL SCHIZOPHRENIA ON CHILDRENOffspring of mothers with schizophrenia are more likely to have developmental, emotional,social, behavioral, and cognitive problems. This is due in part to genetics and inpart to adverse childhood experiences, perhaps exacerbated by common correlates of seriousmental illness (e.g., unemployment, poverty, family conflict and disruption, andhomelessness). Children born to women with schizophrenia spectrum disorders are athigher risk for emotional symptoms during early childhood than children born to womenwithout psychiatric illness, and are more prone to social inhibition during their schoolyears. Children with unmet special needs or those who pose behavior management difficultiesmay contribute to greater stress for parents with schizophrenia, and provide additionalchallenges to their parenting capabilities. Screening during early childhood canlead to timely implementation of prevention and intervention strategies for children.Children whose parents have schizophrenia may be pressed into service as caretakersof ill parents, or of siblings. Some children whose parents have schizophrenia suggest thatthis role reversal enhanced their coping and caregiving skills; others report having sufferedfrom age-inappropriate family burdens.Children whose parents have schizophrenia may be at greater risk of family disruption,through the increased likelihood of parental divorce and/or being removed fromtheir parental home. Although children’s safety is a priority, the disruption of family relationshipshas costs. Children may be extremely loyal to the most disturbed of parents andhave difficulty forming what they view as competing attachments. They may worry thattheir parents will suffer if they are separated from them. Children placed in different fosterhomes may lose contact with siblings. Multiple placements over time may seriouslyimpair children’s capacity to form healthy relationships.THE EXPERIENCES OF PARENTS WITH SCHIZOPHRENIAMany mothers with SMI describe motherhood as rewarding and central to their lives,and feel pride in fulfilling the maternal role. Mothers with schizophrenia, like manymothers, may also be stressed by the demands of parenting, particularly if supports areinsufficient; such stress may precipitate illness relapse. Hospitalizations and resultant separationsfrom children can also be stressful, particularly if mothers are forced to placechildren with strangers in foster care. Mothers may prioritize their children’s needs, jeopardizingtheir own health and well-being by not keeping treatment appointments or nottaking medications if these conflict with parenting responsibilities. Many mothers withSMI fear that their children will be adversely affected by their illnesses, and may becomeoverly concerned when their children express normal, age-appropriate, though “difficult”behavior (e.g., temper tantrums in a 2-year-old).INCREASED VULNERABILITY TO LOSSParenthood is somewhat less prevalent among women with nonaffective psychoses thanamong women with other mental illnesses. Women with SMI have more unplanned andunwanted pregnancies than do women without psychiatric disorders. This relative lack ofplanning may decrease the chance for successful parenting. Other women with schizophreniamay not define motherhood as an option; consequently, they may need to grievethe loss of this life role.