Expressed emotion and the outcome of child and adolescent psychiatric disorders

Objective: The review discusses empirical research on the association of "Expressed Emotion" (EE) and the outcome of child and adolescent psychiatric disorders. Method: A comprehensive search in the databases Medline, PsycINFO and PSYNDEX was performed. Moreover, publications cited in the reference sections were taken into consideration. Results: Empirical data suggest that EE is a predictor of the outcome of depressive and eating disorders in childhood and adolescence, but not of behavioural disorders and ADHD. There are no studies on EE and its influence on anxiety disorders and - surprisingly - only two case studies on EE and schizophrenia in childhood and adolescence. Across psychiatric groups there is an association between behavioural disturbances of the child and parental criticism and an association of child anxiety and parental emotional over involvement. Data suggest that EE is not a stable variable. There is some evidence that a high-EE-status of parents transforms from a state into a trait variable. Conclusion: Further studies on the predictive validity of EE for the outcome of child adolescent psychiatric disorders are warranted, as well as studies on variables of the parents and their offspring, which are associated with EE and with the entrenchment of EE with the progress of the disorder. Child and adolescent psychiatrists may contribute to a large research area with studies on the early development of high-EE. The mutual goal is the development of effective early family interventions.