Sholevar G P
Department of Psychiatry, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, Piscataway, New Jersey, USA.
Child Adolesc Psychiatr Clin N Am. 2001 Jul;10(3):501-17.
Low levels of parental skill and cooperation are the prominent roots of arrested socialization, and a lack of appreciation for intimate and gratifying human relationships is evident in children with CD. The relational problems are exaggerated further by the child's observation of chronic parental discord and internalization of a family image constructed around intrafamilial conflict and isolation. Skills deficits in parental and marital communication and problem solving and conflicts in these relationships play significant roles in producing family dysfunction. The low level of parental differentiation and identity formation plays a fundamental role in family dysfunction by interfering with the development of an adequate self-image, self-esteem, and internal codes of behavior in the child. The transmission of parental antisocial tendencies to their children is facilitated by the low level of differentiation between parent and child. Family treatment should focus on enhancing cooperation between parents and children and between parents as co-parents and as a couple. Enhancing parent management skills can undermine the use of coercive, punitive, and impulsive interactions in the families. The higher divorce rate in parents of children with CD should be addressed with parents directly and early in treatment with the hope of mobilizing the rehabilitative and cooperative marital forces. In terms of future directions, family studies should address and incorporate the expanding knowledge of biologic and psychologic characteristics of children with CD and the possible impact of such characteristics in undermining family development and integrity. Such investigations should include the following information: The role of sustained and intense aggression in some children on family functioning and development. The possible role of diminished response to punishment and excessive search for gratification in children with CD. The role of the child with CD in promoting marital and family discord and divorce. The role of neurotransmitters (such as serotonin) in the production of irritability, provocativeness, coercive family processes, and subsequent depression in the caregiver or the child. Effective models of intervention with children with CD in hospitals and residential treatment centers.
父母技能水平低和缺乏合作是社会化停滞的主要根源，患有对立违抗性障碍（CD）的儿童明显缺乏对亲密且令人满足的人际关系的欣赏。孩子对父母长期不和的观察以及围绕家庭内部冲突和孤立构建的家庭形象的内化，进一步加剧了关系问题。父母和婚姻沟通及解决问题的技能缺陷以及这些关系中的冲突在导致家庭功能失调方面起着重要作用。父母分化和身份形成水平低通过干扰孩子适当的自我形象、自尊和内部行为准则的发展，在家庭功能失调中起根本作用。父母与孩子之间低水平的分化促进了父母反社会倾向向孩子的传递。家庭治疗应侧重于加强父母与孩子之间以及作为共同父母和夫妻的父母之间的合作。提高父母管理技能可以减少家庭中强制、惩罚性和冲动性互动的使用。对于患有CD的孩子的父母中较高的离婚率，应在治疗早期直接与父母讨论，以期调动恢复性和合作性的婚姻力量。就未来方向而言，家庭研究应关注并纳入有关患有CD的儿童的生物学和心理学特征的不断扩展的知识，以及这些特征可能对破坏家庭发展和完整性产生的影响。此类调查应包括以下信息：一些孩子持续且强烈的攻击行为对家庭功能和发展的作用。患有CD的孩子对惩罚反应减弱和过度寻求满足的可能作用。患有CD的孩子在促进婚姻和家庭不和及离婚方面的作用。神经递质（如血清素）在产生易怒、挑衅性、强制性家庭过程以及随后照顾者或孩子抑郁方面的作用。医院和住院治疗中心对患有CD的儿童进行有效干预的模式。
