Family reactions and coping strategies in response to the physically ill or handicapped child: a review

Reassessing Support Groups for Parents of Visually Impaired Children

This article reports on a qualitative study of the psychosocial adjustment of parents of blind and partially sighted children and youths and their perceptions and experiences in parent support groups. Specifically, the study attempted to clarify the types of parents who participate in support groups and the life conditions associated with their involvement. Organizational issues and professional intervention in parent-to-parent support are also discussed.

Looking Sociologically at Family Coping with Visual Impairment

This article provides an overview of relevant sociological perspectives and knowledge about major social aspects of family coping with visual impairment. Special attention is given to the importance of the social structures and dynamics of families as social networks, the social construction of impairment experiences by families, family social support relations, and the visual impairment of older family members.

A transactional approach to predicting stress experienced when writing dissertations

Although substantial attention has been given to doctoral students, the attention given to master’s students writing dissertations is limited. This article outlines a transactional model of stress that conceptualises dissertation writing as a stressor consisting of a series of phases that tend to increase the risk of negative outcomes. A mixed-method design was used to address the aim of the study. An adapted version of the Stress and Support Questionnaire for University Students was used to measure the stress that master’s students experienced. Open-ended questions were employed to measure students’ evaluations of the stress experienced when writing a dissertation. The model proposed that the phases of dissertation writing moderate the relationship between stressor factors and the stress experienced. In an empirical study making use of the model, the moderation analyses revealed that Phase 1 of dissertation writing significantly moderated the relationship between the stress experienced, stressor factors of relationships, financial and transport problems and health related problems. The qualitative data suggested that stress is evaluated either positively or negatively depending on time-management styles and support systems. The results obtained underscore the importance of support structures in alleviating the stress experienced when writing dissertations in order to improve students’ retention and graduation rates.

Effect of Family Caregiving on Depression in the First 3 Months After Spinal Cord Injury

Objective

To investigate the effect of family caregiving on depression in the first 3 months after spinal cord injury (SCI).

Methods

A retrospective study was carried out on 76 patients diagnosed with an SCI from January 2013 to December 2016 at the Department of Physical Medicine and Rehabilitation of Kyungpook National University Hospital, Korea. Clinical characteristics including age, gender, level of injury, completeness of the injury, time since injury, caregiver information, etiology, and functional data were collected through a retrospective review of medical records. Depression was assessed using the Beck Depression Inventory (BDI). Patients with 14 or more points were classified as depressed and those with scores of 13 or less as non-depressed group.

Results

Of the 76 patients, 33 were in the depressed group with an average BDI of 21.27±6.17 and 43 patients included in the non-depressed group with an average BDI of 4.56±4.20. The BDI score of patients cared by unlicensed assistive personnel (UAP) was significantly higher than that of patients cared by their families (p=0.020). Univariate regression analysis showed that motor complete injury (p=0.027), UAP caregiving (p=0.022), and Ambulatory Motor Index (p=0.019) were associated with depression after SCI. Multivariate binary logistic regression analysis showed that motor completeness (p=0.002) and UAP caregiving (p=0.002) were independent risk factors.

Conclusion

Compared with UAP, family caregivers lowered the prevalence of depression in the first 3 months after SCI.

Chronic non-bacterial osteitis from the patient perspective: a health services research through data collected from patient conferences

OBJECTIVE

Although chronic non-bacterial osteitis (CNO) is an ever-increasingly recognised illness in the paediatric community and the adult healthcare community, a study to assess diagnosing, treatment and the psychosocial aspect of CNO from a large population pool was not available. We aimed to investigate CNO from the patient perspective.

DESIGN

Health services research, patient survey.

SETTING

Ludwig-Maximilians-University (LMU) Pediatric Rheumatology Department CNO Conferences held in June 2013 and June 2015.

PARTICIPANTS

Using a patient survey developed by the LMU Pediatric Rheumatology Department, 105 patients from ages 5 to 63 years were assessed regarding CNO to include epidemiological data, medical history and treatment, initial symptoms, diagnostic procedures, current symptoms, associated diseases, current treating physicians, absences in school and work due to illness and the impact of illness on patient, family and friends.

RESULTS

Active CNO was reported in 90% of patients present, with 73% being women and 27% being men. An overwhelming majority (70%) reported being diagnosed within 18 months of onset of symptoms; however, the initial diagnoses were wide-ranged to include malignancies in 36% to bacterial osteomyelitis in 30%, where the majority were treated with an antibiotic and/or were biopsied. When asked about the psychosocial aspect of this illness, 83% reported that non-bacterial osteitis (NBO) negatively impacted the family, 79% reported that NBO has negatively affected either school or work and 56% reported a negative impact on friendships.

CONCLUSION

Delay of diagnosis, living with differential diagnoses like malignancies and finding specialists for medical care are a few examples of what leads patients into searching for more information. The negative impact on daily life including family relationships, friendships and work/school highlights a need for better psychosocial support such as guidance counselling or psychological support due to three-quarters of patients receiving no such said support.

Coping strategies used by parents of children with traumatic brain injury: A cross-sectional study of Palestinians and Israelis

This study examined the use and helpfulness of coping strategies and patterns among parents of children with traumatic brain injury (TBI). Participants were 122 Arab-Israeli, Jewish-Israeli, and Palestinian parents of 65 children with TBI following their discharge from pediatric rehabilitation hospital. Family-focused strategies were highly prevalent and most helpful among both mothers and fathers. Jewish mothers reported that support coping pattern (but not medical or family) was more helpful than did Arab-Israeli and Palestinian mothers. The findings highlight the need to promote effective coping among mothers of children with TBI with low levels of income and education and underscore the need for continuous long-term professional support to parents of children with TBI after hospital discharge.

Childhood Brain Tumors: Parental Concerns and Stressors by Phase of Illness

The objective of this study is to identify common problems and helpful resources important to parents of children with brain tumors by illness phase and to determine associations with stress. Parents with a child diagnosed within the past 10 years were surveyed regarding healthcare provider interactions, medical information/education, health care utilization and psychosocial concerns. Survey items were rated as problems or helpful, and for importance at each phase of illness. Stress was recorded from 0 to 10 for each phase; associations with demographic characteristics and items were tested statistically. A total of 139 parents from 87 families responded, with 45 mother-father pairs. Half reported unmet informational needs as most important during diagnosis (etiology), recurrence (complementary therapy), end of life (dying process), and remission (long-term effects). Mothers experienced greater stress than fathers during adjuvant treatment (p = .009). Stress increased (p < .05) during diagnosis and hospitalization/surgery with being married, at hospital discharge because of changes in child’s personality/moods, during adjuvant treatment with unmet informational needs regarding stopping treatment, during recurrence regarding employment concerns, and during remission with unmet informational needs regarding life-time expectations. Stressors changed across phases of illness. Married respondents appeared at increased risk for stress. Further work is needed to tailor and evaluate interventions to decrease stress during illness phases.

Stress and Coping Styles in Guangzhou Families with Hepatitis B Virus Children

This study was conducted in Guangzhou, China. The study compared the stress coping styles of three groups of parents: (1) parents of children who are carriers of the hepatitis B virus (HBV) who attend a special health kindergarten; (2) parents of children with HBV who stay at home; and (3) parents of healthy children attending ordinary kindergarten. Parents of HBV children who stayed at home reported greater problems due to stress. The groups did not differ in reports of stress arising from life events other than their child's illness and the fact that their HBV-carrying children were prohibited from the kindergarten. Content analyses of the mothers' reported styles revealed five patterns of coping styles, which are explained with reference to the Chinese cultural context.

Paternal versus maternal coping styles with child diagnosis of developmental delay

Parents of children with disabilities vary in their reaction to their children's diagnosis. The current study focused on fathers in addition to mothers and examined their resolution and coping styles when having children diagnosed with developmental delay (DD). Sixty-five fathers and 71 mothers were interviewed using the reaction to the diagnosis interview (RDI; Pianta & Marvin, 1992a). Results indicated that the majority of parents were unresolved with their child's diagnosis, with no differences found between fathers' and mothers' rates of resolution. Furthermore, both parents of children that were diagnosed at a later age and parents that were less educated tended to be unresolved, as did fathers of a lower socioeconomic status. Older age of both children and mothers was related to maternal lack of resolution. Finally, an in-depth examination revealed significant differences in the manner in which fathers and mothers cope with their children's diagnosis: whereas mothers were more prone to using an emotional coping style, fathers tended to use a cognitive coping style. The clinical implications of paternal versus maternal coping styles are discussed.

Do chronic conditions increase young children's risk of being maltreated?

OBJECTIVE

To examine whether and to what extent specific chronic health conditions place young children at risk of maltreatment.

METHODS

The study used a sample of Illinois children (born between January 1990 and March 1996) who were through age 3 continuously enrolled in Medicaid, a public health insurance program for low-income families. The study used "paid claims" data and ICD-9-CM health codes to identify children with one or more of three chronic conditions: chronic physical illness, developmental delay/mental retardation (dd/mr), and behavior/mental health conditions (b/mh). The analysis used Cox proportional hazard models to estimate the risk of substantiated child maltreatment that each of these health conditions confer on children under age 6.

RESULTS

Among children under age 6, 24.1% had chronic physical health conditions, 6.1% had b/mh conditions, and 4.2% had dd/mr. Among the children, 11.7% were maltreated (abused or neglected). Children with b/mh conditions were 1.95 times more likely than children without such conditions to be victims of child abuse or neglect. Children with chronic physical health conditions were 1.1 time more likely to be maltreated (p<or=.001). In contrast, children with dd/mr were not at an increased risk of maltreatment. Further, if the child had a prior history of abuse or neglect before age 3 and was also diagnosed with a behavioral health condition, that child was 10 times more likely to be maltreated again (relative risk of 9.2, p<or=.0001).

CONCLUSIONS

Behavioral/mental health conditions placed low-income children under age 6 at the highest risk of abuse or neglect. Developmental delay/mental retardation, however, did not appear to increase the risk of maltreatment, while chronic physical health conditions increased the risk slightly among this group of children. Therefore, identified behavior/mental health in young, low-income children should be considered a risk factor for potential abuse to pediatricians and other health professionals. Child protection agencies should be trained to identify behavioral/mental health conditions of children.

PRACTICE IMPLICATIONS

Chronic behavioral/mental health conditions place young children at heightened risk of abuse or neglect. Early detection of mental or psychosocial health conditions is mandated by the Individuals with Disabilities Education Act (IDEA), a federal law that governs how state and public agencies provide services to children with disabilities. Given the higher risk of abuse and neglect among children with behavioral/mental health conditions, clinicians should give added scrutiny to these children. Child protection agencies should also be trained to identify behavioral/mental health conditions, and more states should record disability status in their abuse records.

Implications of resolving the diagnosis of PKU for parents and children

OBJECTIVE

To examine resolution of the diagnosis among parents of children with phenylketonuria (PKU) as a mechanism of adjustment for parents and children.

METHODS

Reaction to diagnosis interviews were conducted with 52 mothers and 47 fathers of 55 children with PKU aged 2-12 years. The parents also completed questionnaires assessing their personal adjustment (stress symptoms), their child's adjustment (behavior problems), and coping variables (personal hopefulness and coping strategies).

RESULTS

Most mothers (69%) and fathers (77%) were resolved to their child's diagnosis. Lower levels of parent stress were explained by higher personal hopefulness (14% of the variance for mothers and 21% for fathers) and resolution of the diagnosis (15% of the variance for mothers and 6% for fathers) after taking account of demographic variables and severity of the child's PKU. Parent resolution, however, did not contribute independently to the variance explained in child behavior problems after taking account of coping variables and severity of PKU.

CONCLUSIONS

Resolution of the diagnosis of PKU is a strong indicator of parent adjustment, and assessment of parent reactions should be considered an integral component of clinical care. Further research is warranted in relation to the implications of parent resolution for the child's response to PKU through different development stages and the effectiveness of interventions in aiding parent resolution.

Illness through the eyes of the child: the development of children's understanding of the causes of illness

In this study 158 children, 80 children with diabetes mellitus and 78 healthy classmates, were interviewed about their concept of different types of illness (a cold, diabetes, infection, the most and least serious disease) and illness-related concepts (pain, becoming ill and going to the doctor or hospital). Special attention was given to the relationship between development of thinking and the variables anxiety, locus of control and family- and school functioning. The results show that the ideas of the children about the causes of illness follow a sequence of developmental stages, described as 'Through the Eyes of the Child' (TEC) model. Perception seems to be the child's central auto regulative system of cognitive development. The findings suggest that thinking about illness develops relatively independently of other influences. The practical relevance of knowing how children's thinking about illness develops is elaborated in terms of their implications for health education. Immature thoughts of children about illness can be detected and accepted and not dismissed as irrational. With the help of this model, health education of the child can be facilitated.

Effects of an episode of specialist care on the impact of childhood atopic dermatitis on the child's family

INTRODUCTION

Although some preliminary work has examined the impact of atopic dermatitis (AD) on families, no empirical work has examined changes in the impact on families dealing with AD over time. An exploratory analysis of change in impact on families dealing with AD before and after an episode of medical care in a physician office setting was conducted.

METHOD

Baseline and follow-up surveys were completed by 35 parent caregivers before and 1 month after a dermatologist visit for the child at an academic medical center.

RESULTS

In the postcare survey, there was a 43% reduction in the Dermatitis Family Impact Questionnaire (DFI) scores (P <.01) compared with baseline. Significant differences were also observed in other parent caregiver-reported characteristics. The significant change in parent caregiver characteristic associated with the decreased DFI score was the increased satisfaction with the medical care related to the child's treatment (P <.01).

DISCUSSION

These data reveal that there is a strong decrease in impact on a family associated with an episode of specialist care for children with AD. The importance of pediatric health care professionals in decreasing the impact of AD on families needs further exploration.

Disease severity and associated family impact in childhood atopic dermatitis

AIM

To examine the association between childhood atopic dermatitis (AD) severity and family impact at baseline and after an intervention by a physician specialist, using validated measures of both severity and family impact.

METHODS

Cross sectional self administered survey of parent-caregivers of 49 randomly selected children with AD; 35 parents were available for follow up. Family impact was measured using a modified AD Family Impact Scale completed by the parent-caregiver. The child's disease severity was measured using both the investigator's assessment via the Eczema Area and Severity Index (EASI) and the caregiver's assessment via the recently validated Self Assessment Eczema Area and Severity Index (SA-EASI).

RESULTS

The parent-caregiver's assessment of severity of the child was the most significant correlate of the family impact of the child's AD (p = 0.65 at baseline and p = 0.38 at follow up). In multivariate regression models, the parent-caregiver's estimate of severity remained the single strongest predictor of family impact before and after receipt of dermatologist care, as well as the difference in impact between pre and post-dermatologist care.

CONCLUSIONS

There is evidence to support the ability of parent-caregivers of children with AD to accurately determine severity of their child's AD; perceived severity is the driver of the family impact of this condition. Treatment of a child by a physician specialist is associated with reductions in both perceived severity, as well as family impact of this condition.

Reduction of chronic sorrow: a health promotion role for children's community nurses?

Families who have a child with a chronic illness face losses in their lives and react in a variety of ways. The theory of constuctivism is used to examine these losses. The ongoing nature of these losses can lead to ongoing grief rather than acceptance. This is discussed within the themes of time-limited grief and chronic sorrow. The role of children's community nurses in assisting families with resolving this sorrow is discussed, the main suggestions being the provision of an empathetic presence, time and the provision of accurate and specific information regarding the illness and the ways of managing it within the familys life.

Origins and consequences of child neglect in substance abuse families

The empirical literature pertaining to the prevalence, origins, and consequences of neglectful parenting as it relates to substance abuse is critically reviewed. Available evidence indicates that children who experience parental neglect, with or without parental alcohol or drug abuse, are at high risk for substance use disorder (SUD). The effects of parental substance abuse on substance abuse outcome of their children appear to be partly mediated by their neglectful parenting. The discussion concludes with presentation of a developmental multifactorial model in which neglect, in conjunction with other individual and environmental factors, can be integratively investigated to quantify the child's overall liability across successive stages of development as well as to map the trajectory toward good and poor outcomes.

Effects of respite care for children with developmental disabilities: evaluation of an intervention for at risk families

Respite child care programs that provide temporary child care, support, and referral services to families of children with developmental disabilities are thought to be a critical component of formal social support interventions deemed necessary to promote healthy family functioning and prevent child maltreatment. This study describes sociodemographic characteristics, parenting stress levels, foster care placement, and founded child maltreatment rates in families of children with developmental disabilities who were using respite care services in a rural Midwestern state. Comparison of matched pre- and post-test Parenting Stress Index scores indicated significant decreases in Total Stress scores (t=3.27, df=86, p=0.0016), Parent Domain scores (t=3.55, df=86, p=0.0006), and Child Domain scores (t=2.2, df=86, p=0.02) following provision of respite care. Through logistic regression, it was determined that life stress, social support, and service level were significantly related to the occurrence of child maltreatment during enrollment ( p < 0.05). The investigator suggests that public health nurses can enhance their case management strategies when working with the parents of children with developmental disabilities by monitoring for caregiver burnout in addition to ensuring that the child is receiving care appropriate for his or her level of need.

Dinâmica familiar de crianças autistas

Avaliamos 15 famílias de autistas, 15 de portadores da síndrome de Down e 15 de filhos saudáveis, com indivíduos na faixa etária de 5 a 15 anos. Os pais (ambos os genitores) desses três grupos familiares foram avaliados quanto ao à dinâmica familiar, visando relacionar tais sintomas com o funcionamento de famílias de autistas, em estudo comparativo. Detalhou-se a família, o quadro autístico, a família do autista, a família e a saúde mental, suas limitações e dificuldades ao longo do ciclo vital. A pesquisa de campo foi realizada mediante o uso dos instrumentos de dinâmica familiar da Entrevista Familiar Estruturada, (Carneiro,1983). Os dados coletados foram comparados estatisticamente. Considerando a população estudada (n = 45 famílias) constatou-se que as famílias dos autistas e portadores da síndrome de Down são dificultadoras da saúde emocional dos elementos do grupo, constituindo as dos autistas maior porcentagem. Concluimos que a dinâmica familiar do autista é dificultadora da saúde emocional dos membros do grupo, seus pais apresentam estresse, sendo as mães com scores mais significativos mas semelhantes nos outros dois grupos.

Predictors of delayed social maturation and mental health disorders in young adults chronically ill since childhood

To ascertain the influence of juvenile-onset chronic physical diseases and associating factors of social environment on delayed social maturation and mental health disorders in young adults, we analysed a group of 407 (184 female, 223 male) subjects with these conditions and compared the results with those of 123 (63 female, 60 male) healthy controls studied at the age of 19-25 years. The social maturation index was formed on the basis of a demographic interview, which also reviewed the state of social development and the family situation during childhood. Mental health disorders were assessed with a Present State Examination (PSE) interview analysed with the CATEGO program. With regard to social maturation at least half of the patients and controls were doing well, whereas for 29% (CI(95), 25%-33%) of the patients and 17% (CI(95), 10%-24%) of the controls the index showed delayed maturation. Subjects with poor social maturation were found most often among the disabled patients but also among the patients without severe diseases. The prevalence of PSE-CATEGO-identified psychiatric syndromes was equal in the patients and the controls (22% versus 20%). However, the patients with severe or disabling diseases had more severe psychiatric syndromes. The prevalences of depressive syndromes were also equal, but the depression of the patients was more often a profound affective disorder. Male sex, poor scholastic and vocational success, and social problems in the family during childhood were significantly associated with poor social maturation. On the other hand, the most significant predictors of mental health problems in young adults were female sex, family distress during childhood, and a severe disease. Juvenile-onset physical disease was considered to delay social maturation in some subjects and to deepen or modulate the clinical picture of mental health disorders. It is concluded that juvenile-onset physical diseases combined with family-related factors affect in different ways the social growth and psychiatric well-being. The results suggest that the subjects with chronic diseases during childhood should be thoroughly assessed by a child psychiatrist to evaluate the orientation of psychological development and the impact of the child's disease on the family and to ensure balanced psychological and social growth.

The epidemiology and experience of atopic eczema during childhood: a discussion paper on the implications of current knowledge for health care, public health policy and research

Atopic eczema is a chronic skin condition affecting between 5% and 20% of children aged up to 11 years at one time or other. Research suggests that prevalence is increasing and various environmental factors have been implicated in the aetiology. While often seen to be a minor problem, research suggests that it can cause considerable disruption to the lives of children and their carers and involves significant cost for the family and health care systems. The current consensus is that the majority of cases of atopic eczema are most appropriately managed within primary care. However, management of the condition is problematic because diagnosis is often difficult. Consultations tend to focus on the physical aspects of the problems neglecting the psychosocial, while treatment remains mainly palliative and can be as diverse as the condition itself. More appropriate and effective primary care management and support for children with atopic eczema and their carers will only be developed if health professionals become more aware of the social context of the disease and the impact on the lives of those affected. Public health responses focusing on primary prevention are also needed. This paper reviews a diverse literature on the epidemiology of the condition, the way in which it affects the lives of children and their carers and the factors that shape their help seeking decisions. The aim is to contribute to a more substantial knowledge base for public health and primary care developments and to point to areas for future research

First-stroke recovery process: the role of family social support

OBJECTIVE

To determine the role of family social support in three stroke rehabilitation variables (functional status, depression, social status) during a 6-month recovery period.

DESIGN

Assessment of first-stroke patients' functional status, depression, and social status before discharge and at 1, 3, and 6 months after stroke onset, in comparison with the amount of family social support received. The family social support scale--compliance, instrumental, and emotional support--was employed in the first month.

SETTING

A university hospital and patients' residences.

PATIENTS

A consecutive sample of 43 first-stroke patients meeting the inclusion criteria.

MAIN OUTCOME MEASURES

Changes of patients' rehabilitation variables over the 6-month period were tested by use of repeated multivariate analysis of variance measures.

RESULTS

Observers of functional, depression, and social status changes were blind to patient grouping according to levels of family support. These three variables were significantly affected by higher levels of support (p = .001, p = .001, p = .020, respectively), but a significant interaction was found only with regard to functional status adjusted for initial stroke severity (p = .019). Patients with moderate/severe stroke and high levels of social support attained a significantly better and progressively improving functional status than those with less support.

CONCLUSIONS

High levels of family support--instrumental and emotional--are associated with progressive improvement of functional status, mainly in severely impaired patients, while the psychosocial status is also affected.

The impact of eating disorders on family relationships

Having a child in crisis with an eating disorder impacts the entire family as well as the child. The family's emotional involvement, as well as such changes in routine involving appointments with thera-pists and support groups, all cause disruption to normal patterns and to family relationships. The purpose of this study was to investigate the challenges that parents face and the changes that occur, particularly in relationships, when a child is diagnosed with an eating disorder, and how parents cope with these changes. A detailed questionnaire using both quantitative and qualitative questions was completed by 52 mothers in Ontario. The findings indicated that there is a significant impact on relationships correlated with age of child, personal leisure, and level of confusion in the family. The findings also showed contrasts in the way families cope with having a child in crisis, either very negatively or very positively. The qualitative anecdotes describe the tremendous strains and changes in patterns within families particularly during the initial period of diagnosis. The parents provide helpful recommendations for researchers, practitioners, and service providers.

Parenting of at-risk infants in the face of uncertainty: home apnea monitoring of subsibs

This article describes the experiences of a group of parents in New Zealand who lost infants to sudden infant death syndrome (SIDS) and who monitored their subsequent infants or subsibs (infants born after the death of an infant due to SIDS) at home for signs of apnea. Their caregiving experiences are explored within the framework of the substantive theory developed by Cohen (1993) that describes how another group of parents, those caring for children with chronic life-threatening illnesses, copes with living under conditions of sustained uncertainty. Attention is drawn to the similarities in both the grieving processes and coping strategies used by both groups of parents in these parallel situations.

Psychosocial impact of chronic illness in children

Chronic illness is common in childhood and is associated with an increased risk of psychological difficulties in the child. Current research is focused on the identification of specific risk and protective factors that may predict psychological and health outcomes. The challenges faced by physicians caring for a child with chronic illness are described and contrasted with the medical role in treating acute illness. The child's adaptation to illness is discussed in a developmental framework and positive and maladaptive family responses are identified. It is suggested that chronic illness and/or its treatment may compromise intellectual development and academic progress.

Childhood cancer--a family crisis 2: coping with diagnosis

A diagnosis of cancer in a child requires families to mobilize their coping strategies in response to an extremely stressful life event. In the second article of this two-part series, the nature of coping, the strategies employed, and the factors that influence the family's choice of strategy are examined. The findings indicate that personality traits may constitute internal factors that affect the coping response, while concurrently stressful events and chronic uncertainty may be considered external influences on the family's ability to cope with a diagnosis of cancer in a child. In the first article of this series, the nature, purpose and functioning of the family were explored in an attempt to explain the impact of a childhood cancer diagnosis on the family. Overall, family reaction appears to be directed by several factors: communication and information; stage and prognosis, and as attitude to the nature of the disease itself.

Childhood cancer--a family crisis 1: the impact of diagnosis

There have been substantial improvements in both treatment and survival of childhood cancer in recent decades. However, the diagnosis of cancer in a child still poses a threat to the whole family unit. In this article, the first of a two-part series, the nature, purpose and functioning of the family are explored to suggest how families may perceive a cancer diagnosis in a child. Review of the literature indicates that the level of threat correlates with indicators such as overall family reaction, information and communication, position within the disease continuum, prognosis and the presence of metastatic disease.

Transplant allograft loss in the adolescent patient

The case of an adolescent transplant recipient who lost her allograft as a result of medication noncompliance serves as the focus of this multidisciplinary review. The discussion that follows includes (1) a review of current graft survival data for adolescent renal transplant recipients with particular attention to the occurrence of medication noncompliance in this patient population, (2) an overview of normal growth and development as it applies to the adolescent patient with chronic disease, and (3) proven treatment strategies with emphasis on the needs of the adolescent transplant patient. The discussion is intended to provide the reader with a greater understanding and appreciation of developmental issues that influence adolescent behavior and, in turn, impact medical care. It is also hoped that the information provided will be used by health care providers to promote adherence to a chronic medical regimen on behalf of the adolescent transplant recipient.

A child with chronic illness and the process of family adaptation

This article analyzes the concept of family adaptation to a child with chronic illness according to the Wilson method. This concept is viewed developmentally as a continual process of adjustment and change by a family system with a resultant response found across a continuum from optimal to ineffective adaptation. In a developmental context, the family system is viewed from a health-oriented rather than a pathological perspective. The focus is on the family's ability to address the stressful chronic illness situation rather than centering on maladaptation of the family and subsequent treatment.

Caregiver mental health and family health outcomes following critical hospitalization of a child

Changes in caregiver and family health and in family health behavior patterns were examined 9 weeks after the hospitalization of a child for an acute, first-time illness in a pediatric intensive care unit (PICU). Family and caregiver health included reports of physical, mental, role, and social functioning as well as perceptions of health, pain, and changes in health behavior patterns at 3-7 days after admission to PICU and 9 weeks later. A convenience sample of 20 primary caregivers (all mothers) of children aged 2 days to 17 years served as subjects for the study. Results showed a decrease in mental health scores of all subjects over the 9-week period. Further, those caregivers whose child was rated as having a greater potential for chronicity had a significantly greater decline and were in the range of poor mental health at the 9-week posttest. Seventy percent of subjects reported new health problems in the family posthospitalization, and 43% reported at least one change in family health behavior patterns. Implications for testing the efficacy of mental health nursing consultation and case management during and after critical childhood illness are discussed.

Compensatory parenting: how mothers describe parenting their 3-year-old, prematurely born children

Premature infants and their mothers experience difficulties in establishing their relationships. The effect of these early problems on later parenting is not known. This study explored whether mothers' recollections surrounding the birth and hospitalization of a preterm infant affected their perceptions and their parenting of these children at 3 years of age. Twenty-seven primary caregivers of 30 prematurely born children completed three questionnaires on their perceptions of their children and were interviewed about parenting experiences. The core concept identified in analysis was compensatory parenting, a parenting style in which mothers provided special experiences and avoided others in an attempt to compensate the children for their neonatal experiences. Compensatory parenting was influenced by the view of these prematurely born children as both special and normal and by salient prenatal, labor, and delivery experiences; memories of the neonatal intensive care unit experience; the sequelae of emotional responses to these experiences; and subsequent health problems after discharge. Prospective research is needed to further study compensatory parenting and to develop interventions.

Hearing impaired families: the social ecology of hearing loss

The services available to parents of children with hearing losses, and the options concerning the modes of communication and the educational programs for their children, have significant effects on family relations and the family's understanding of hearing impairment and deafness. This is particularly true in rural areas of British Columbia, Canada, where the range of programs is limited. This paper examines the programs available, parents' understandings of their options, the decisions they make, and the impact on the family of the selection and availability of programs.

Disability and the transition to adulthood: issues for the disabled child, the family, and the pediatrician

The pediatrician treating a child with a disability must focus not only on the physical needs of the child but also on the emotional and social issues associated with being disabled in our society. This dual focus becomes increasingly important as the child matures through adolescence and transitions into adulthood. In addition, the pediatrician must understand the complex interrelationships between the family and their maturing, disabled child during the vital process of separation from the family. This transition is particularly difficult for an adolescent who is dependent on others for physical care and other independent living skills. Many of the transitional problems faced by disabled adolescents and their parents have roots in early childhood. With an awareness of the specific stressors on the parent caregivers and an understanding of the influence of disability on the developmental processes, the pediatrician can play a major role in easing the transition of a disabled adolescent into adulthood. By guiding the parents of a young child through the important tasks of childhood and adolescence, the pediatrician can set the stage for both the parents and their disabled child to have independent, yet supportive lives--lives that are focused not on the disability but on mutual respect and life satisfaction. It is recommended that disabled teens and young adults be given more help in independence skills, personal counseling services should be made available, and physicians should give teens age-appropriate information about disabilities. There are needs for sex education, preparation for parenthood, and genetic counseling. Other issues that should be addressed are early vocational awareness, alternatives to work, and leisure time use. Just because an adolescent is disabled, we cannot assume that he or she will have self-esteem and self-concept difficulties. To adjust to being devalued by society, the disabled person must challenge societal beliefs that strength, independence, and appearance are the essential aspects of a quality life. The importance of being kind, intelligent, and productive to one's capacity must become more important. (See Table 3 for additional resource information.)

Psychological problems in siblings of children and adolescents with inflammatory bowel disease

The mental health of twenty siblings of children and adolescents with inflammatory bowel disease (IBD) was compared with a matched group of siblings of healthy children and adolescents. No significant differences were found as regards general psychopathology or behaviour problems. However, significant differences were found in certain areas, especially with regard to peer relations, mood and reliance. Self-esteem was also lower among the siblings of such IBD patients and they tended towards depression and physiological anxiety symptoms. There was no significant correlation between the degree of severity or the duration of the disease and psychopathology in the siblings. The results show that the mental health of siblings of children and adolescents with IBD may merit the attention of paediatricians.

Coping strategies of chronically ill adolescents and their parents

The purpose of this exploratory pilot study was to determine the coping strategies used by adolescents with chronic illnesses and compare those strategies with the strategies used by their parents. Adolescent coping strategies were measured by the Jaloweic Coping Scale, while parental perceptions of their coping strategies were assessed using the Hymovich Chronicity Impact and Coping Instruments: Parent Questionnaire (CICI:PQ). Fifteen chronically ill adolescents and their parents were administered the tools. Analysis revealed that there were significant differences between the parent coping strategies and those of the adolescents in the sample. Adolescent responses on the three subscales of the Jaloweic Coping Scale were analysed using ANOVA, resulting in no significant differences in responses on the three subscales.

Analysed interaction in a children's oncology clinic: the child's view and parent's opinion of the effect of medical encounters

Every effort is made to provide children affected by cancer-related illness with advanced medical care. This theory-developing, hypotheses-generating study focused on the child's view of the service provided in an oncology clinic. The methodology included interviews, observations of medical consultations and children's drawings. It also sought the parents' opinion of the effect of an impending appointment on the child's behaviour. The population for this ideographic research consisted of a convenience sample of 10 children over the age of 5 years, attending an oncology clinic which served a medium-sized city and its surrounding area. Quantitative and qualitative data were collected from semi-structured interviews, participant observations, transcribed audio-tape recordings and gaze interaction charts. Data were analysed using grounded theory. The medical interview was not acknowledged as being very significant by the children: their conscious attention centred on peers and play activities. The data also suggest that clinic visits are more acceptable for children when staff invest personal attention, give appropriate adequate explanations and handle children sensitively. Behaviour changes before appointments were reported by parents to be more prevalent in children who received less positive regard from the health team. Clinic observations and transcripts demonstrated the doctor's 'dominant role' during consultations. Interaction with the child centred around the examination and was frequently interrupted. A more extensive study would confirm or refute these provisional findings.