Expectant parents’ emotional struggles predict emotional and behavioural problems in 2-year-olds


Expectant parents’ emotional struggles predict emotional and behavioural problems in 2-year-olds, new research shows.

The same study reveals, for the first time, that couple conflict helps explain emotional problems in very young children.

The team of researchers – from the Universities of Cambridge, Birmingham, New York and Leiden – say their findings highlight a pressing need for greater support for couples before, during and after pregnancy to improve outcomes for children.

The study is the first to examine the influence of both mothers’ and fathers’ wellbeing before and after birth on children’s adjustment at 14 and 24 months of age.

Lead author, Professor Claire Hughes from Cambridge’s Centre for Family Research, said: “For too long, the experiences of first-time dads has either been side-lined or treated in isolation from that of mums.

This needs to change because difficulties in children’s early relationships with both mothers and fathers can have long-term effects.

“We have already shared our findings with the NCT (National Childbirth Trust) and we encourage the NHS and other organisations to reconsider the support they offer.”

The study, published today in Development & Psychopathology, drew on the experiences of 438 first-time expectant mothers and fathers who were followed up at 4, 14 and 24 months after birth.

These parents were recruited in the East of England, New York State and the Netherlands.

The researchers found that the prenatal wellbeing of first-time mothers had a direct impact on the behaviour of their children by the time they were two years old.

Mothers who suffered from stress and anxiety in the prenatal period were more likely to see their child display behavioural problems such as temper tantrums, restlessness and spitefulness.

The researchers also found that two-year-olds were more likely to exhibit emotional problems – including being worried, unhappy and tearful; scaring easily; or being clingy in new situations – if their parents had been having early postnatal relationship problems.

These ranged from a general lack of happiness in the relationship to rows and other kinds of conflict.

Hughes says: “Our findings highlight the need for earlier and more effective support for couples to prepare them better for the transition to parenthood.”

Links between child outcomes and parental wellbeing have been shown in other studies, but this is the first to involve couples, track parental wellbeing in both parents over an extended period of time, and focus on child behaviour in the first two years of life.

While there is growing evidence for the importance of mental health support for expectant and new mothers, this study highlights the need to extend this support to expectant fathers and to go beyond individual well-being to consider the quality of new mothers’ and fathers’ couple relationships.

The researchers acknowledge that genetic factors are likely to play a role but they accounted for parents’ mental health difficulties prior to their first pregnancy and after their child’s birth. Co-author Dr. Rory Devine, a developmental psychologist at the University of Birmingham, says “Our data demonstrate that mental health problems during pregnancy have a unique impact on children’s behaviour problems.”

Using standardized questionnaires and in-person interviews, participating mothers and fathers reported on their symptoms of anxiety and depression in the third trimester of pregnancy and when their child was 4, 14 and 24 months old.

At each of these visits, parents also completed standardized questionnaire measures of couple relationship quality and children’s emotions and behaviour.

Hughes says:

“There has been an assumption that it’s really difficult to get dads involved in research like this.

But our study draws on a relatively large sample and is unique because both parents answered the same questions at every stage, which enabled us to make direct comparisons.”

The research is part of an ongoing project examining the wellbeing and influence of new mothers and fathers.

In a closely linked study, published in Archives of Women’s Mental Health in July 2019, the team found that fathers share in traumatic memories of birth with their partners far more than has previously been recognised.

This study compared the wellbeing of parents in the third trimester of pregnancy with that when their child was four months old.

Co-author, Dr. Sarah Foley, also from Cambridge’s Centre for Family Research said: “If mum has a difficult birth, that can be a potentially traumatic experience for dads”.

“What both studies show is that we need to make antenatal support much more inclusive and give first-time mums and dads the tools they need to communicate with each other and better prepare them for this major transition. With resources stretched, parents are missing out on the support they need.”

Mental health disorders (MHD) are very common in childhood and they include emotionalobsessive-compulsive disorder (OCD), anxiety, depression, disruptive (oppositional defiance disorder (ODD), conduct disorder (CD), attention deficit hyperactive disorder (ADHD) or developmental (speech/language delay, intellectual disability) disorders or pervasive (autistic spectrum) disorders[1].

Emotional and behavioural problems (EBP) or disorders (EBD) can also be classified as either “internalizing” (emotional disorders such as depression and anxiety) or “externalizing” (disruptive behaviours such as ADHD and CD).

The terminologies of “problems” and “disorders” are interchangeably used throughout this article.

While low-intensity naughty, defiant and impulsive behaviour from time to time, losing one’s temper, destruction of property, and deceitfulness/stealing in the preschool children are regarded as normal, extremely difficult and challenging behaviours outside the norm for the age and level of development, such as unpredictable, prolonged, and/or destructive tantrums and severe outbursts of temper loss are recognized as behaviour disorders.

Community studies have identified that more than 80% of pre-schoolers have mild tantrums sometimes but a smaller proportion, less than 10% will have daily tantrums, regarded as normative misbehaviours at this age[2,3].

Challenging behaviours and emotional difficulties are more likely to be recognized as “problems” rather than “disorders” during the first 2 years of life[4].

Emotional problems, such as anxiety, depression and post-traumatic stress disorder (PTSD) tend to occur in later childhood.

They are often difficult to be recognised early by the parents or other carers as many children have not developed appropriate vocabulary and comprehension to express their emotions intelligibly[5].

Many clinicians and carers also find it difficult to distinguish between developmentally normal emotions (e.g., fears, crying) from the severe and prolonged emotional distresses that should be regarded as disorders[6].

Emotional problems including disordered eating behaviour and low self-image are often associated with chronic medical disorders such as atopic dermatitis, obesity, diabetes and asthma, which lead to poor quality of life[79].

Identification and management of mental health problems in primary care settings such as routine Paediatric clinic or Family Medicine/General Practitioner surgery are cost-effective because of their several desirable characteristics that make it acceptable to children and young people (CYP) (e.g., no stigma, in local setting, and familiar providers). Several models to improve the delivery of mental health services in the Paediatric/Primary care settings have been recommended and evaluated recently, including coordination with external specialists, joint consultations, improved Mental Health training and more integrated on-site intervention with specialist collaboration[10,11].

A review of relevant published literature was conducted, including published meta-analyses and national guidelines. We searched for articles indexed by Ovid, PubMed, PubMed Medical Central, CINAHL, the Cochrane Database of Systematic reviews and other online sources. The searches were conducted using a combination of search expressions including “childhood”, “behaviour”, “disorders” or “problems”.


Various definitions for a wide range of childhood behavioural disorders are being used. The DSM-5[12] offers the commonest universally accepted standard criteria for the classification of mental and behaviour disorders. The ICD-10 is the alternative classification standard[13].

Challenging behaviours

Any abnormal pattern of behaviour which is above the expected norm for age and level of development can be described as “challenging behaviour”.

It has been defined as: “Culturally abnormal behaviour (s) of such an intensity, frequency or duration that the physical safety of the person or others is likely to be placed in serious jeopardy or behaviour which is likely to seriously limit or deny access to and use of ordinary community facilities”[14].

They can include self-injury, physical or verbal aggression, non-compliance, disruption of the environment, inappropriate vocalizations, and various stereotypies.

These behaviours can impede learning, restrict access to normal activities and social opportunities, and require a considerable amount of both manpower and financial resources to manage effectively.

Many instances of challenging behaviour can be interpreted as ineffective coping strategies for a young person, with or without learning disability (LD) or impaired social and communication skills, trying to control what is going on around them. Young people with various disabilities, including LD, Autism, and other acquired neuro-behavioural disorders such as brain damage and post-infectious phenomena, may also use challenging behaviour for specific purposes, for example, for sensory stimulation, gaining attention of carers, avoiding demands or to express their limited communication skills[15]. People who have a diverse range of neurodevelopmental disorders are more likely to develop challenging behaviours[16].

Some environmental factors have been identified which are likely to increase the risk of challenging behaviour, including places offering limited opportunities for making choices, social interaction or meaningful occupation.

Other adverse environments are characterized by limited sensory input or excessive noise, unresponsive or unpredictable carers, predisposition to neglect and abuse, and where physical health needs and pain are not promptly identified.

For example, the rates of challenging behaviour in teenagers and people in their early 20s is 30%-40% in hospital settings, compared to 5% to 15% among children attending schools for those with severe LD[15].

Aggression is a common, yet complex, challenging behaviour, and a frequent indication for referral to child and adolescent Psychiatrists.

It commonly begins in childhood, with more than 58% of preschool children demonstrating some aggressive behaviour[17].

Aggression has been linked to several risk factors, including individual temperaments; the effects of disturbed family dynamics; poor parenting practices; exposure to violence and the influence of attachment disorders.

No single factor is sufficient to explain the development of aggressive behaviour[18]. Aggression is commonly diagnosed in association with other mental health problems including ADHD, CD, ODD, depression, head injury, mental retardation, autism, bipolar disorder, PTSD, or dyslexia[19].

More information: Claire Hughes et al, Parental well-being, couple relationship quality, and children’s behavioral problems in the first 2 years of life, Development and Psychopathology (2019). DOI: 10.1017/S0954579419000804

undefined undefined et al. Worrying in the wings? Negative emotional birth memories in mothers and fathers show similar associations with perinatal mood disturbance and delivery mode, Archives of Women’s Mental Health (2019). DOI: 10.1007/s00737-019-00973-5

Journal information: Development and Psychopathology
Provided by University of Cambridge


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