Family History: An Opportunity to Disrupt Transmission of Behavioral Health Problems

Family history is a traditional clinical approach to identify potential genetic-related disorders within families. Research on brain development and life course health has raised awareness of the impact of childhood social experiences related to parenting behavior leading to subsequent health and mental health problems of children.1 The high and rising rates of mental health disorders, half of which have an onset by age 14 years,2 are now known to be due to genetic and social factors. Family history provides a special opportunity to identify risk and develop strategies to mitigate adverse social factors and experiences associated with parental mental health problems and promote resilience in children. Because some adverse parenting behaviors are related to adverse childhood experience, family history can be a clinical approach to identify such experiences because screening for them lacks reliability and validity.3 The family history is conventionally used to identify risk for genetically loaded physical conditions, such as cardiovascular disease. Yet, too often, behavioral and mental health problems that frequently run in families4–6 are not given comparable attention. Beyond genetic vulnerabilities for mental health problems, parents and grandparents convey multigenerational risk through role modeling and dysfunctional parenting behaviors, including harsh discipline, stress, abuse, and … Address correspondence to Barry Zuckerman, MD, Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, 72 E Concord St, Room 324L, Boston, MA 02118. E-mail: barry.zuckerman{at}bmc.org