Stress and resolution in mothers of children with cerebral palsy

Vulnerability to depression and resolution in mothers of children with cerebral palsy

BACKGROUND

This study investigated associations between Self-Criticism and Dependency as factors of vulnerability to depression and maternal resolution. Resolution entails parental cognitive and emotional acceptance of the child's developmental disability.

METHODS

Our sample included 100 mothers whose children had a diagnosis of cerebral palsy. The Reaction to Diagnosis Interview, the Depressive Experiences Questionnaire and the Depression Scale were administered.

RESULTS

The results showed that unresolved mothers scored higher on the dimensions of Self-Criticism and Dependency compared to their resolved counterparts. The hierarchical cluster analysis yielded three maternal profiles based on the scores obtained on the dimensions of vulnerability to depression, regardless of maternal resolution status. The first profile was labeled Low Vulnerability and was characterized by low scores on Self-Criticism and Dependency. The second profile was labeled Dependent and it included mothers with higher scores on Dependency and lower scores on Self-Criticism. The third profile comprised mothers with higher scores on both Self-Criticism and Dependency. The smallest proportion of unresolved mothers belonged to the third, most vulnerable profile labeled Double Vulnerability.

DISCUSSION

We discussed the implications of the obtained results in light of a need for psychotherapeutic interventions that would focus on individual differences when providing support to parental resolution.

Diving into the Resolution Process: Parent's Reactions to Child's Diagnosis

This research presents an in-depth observation of parental resolution regarding a child's diagnosis with special needs to help counsellors understand the complexities of parental coping. Sixty-two parents of children with Autism Spectrum Disorder/Intellectual Developmental Delay participated in a Reaction to the Diagnosis Interview and a semi-structured interview. Categorical analysis revealed that 59.7% of the parents had reached resolution, with approximately 40% emotional orientation, 40% cognitive orientation, and 20% proactive orientation. Content analysis revealed three themes: emotions-feelings of guilt, shame, and emotional breakdown; thoughts-fear of stigma and concern for the child's future; actions-concealment, seeking support, and attempts to reject the results of the diagnosis. Whereas most parents were diagnosed as having reached resolution, the content analysis still found complex subject matter suggesting lack of resolution. Research findings show that counsellors should identify the intricate emotional dynamics of parents coping while being cautious of premature coping categorization.

Parents' resolution of their child's diagnosis: A scoping review

This scoping review focused on parents' resolution of their reactions to receiving a diagnosis for their child, based on Marvin and Pianta's model and Reaction to Diagnosis Interview (RDI). We aimed to map the populations examined, the prevalence of parents' narrated resolution, and what is known about its outcomes and determinants. A structured search identified 47 peer-reviewed papers published between 1992-2021. All employed the RDI and most had a cross-sectional design. Studies focused on a wide range of children's health and mental health diagnoses. Days to years after receiving the diagnosis, RDI narratives of 18.43% to 72.49% of the parents (44% on average) indicated lack of resolution. Studies reported associations between unresolved narratives and children's insecure attachment, higher parenting stress, and poorer parental health. However, findings on the associations of narrated resolution with parents' representations of their child, sensitivity, and psychological symptoms were equivocal, and findings on factors that may shape narrated resolution were limited. To advance the understanding of parents' narrated resolution and its effects, we recommend researchers employ prospective and longitudinal designs, evaluate narrated resolution as a continuous phenomenon, focus on outcomes derived from attachment theory, and systematically sample families from heterogenous cultures.

Physicians' Ineffective Communication Leading to Cerebral Injuries in Children With Cerebral Palsy

Inspirational enlightenment has guided me to write this review article while encountering, during my practice as a pediatrician, referred cases of previously stable, positively progressing cerebral palsy (CP) children who had not yet celebrated their first teen birthday but ended up being in a deep coma and mechanical ventilation-dependent post a cardiac arrest outside the hospital. The dramatic end was believed to be probably caused by food aspiration, which could have been prevented by effective counseling to the in-denial, struggling parents about their children’s condition. This report tries to emphasize the importance of effective communication between physicians and caregivers of children who were diagnosed with CP. The importance is elaborated by linking the level of the provided communication/education to the caregivers with cerebral injuries, such as intracranial hemorrhage (ICH), which potentially could have been prevented among CP children. The sequence of the injury is believed to be initiated by aspiration of food, which resulted in apnea/asphyxia, followed by a cardiopulmonary arrest outside hospital settings. Such a life-threatening event is hypothesized to be the leading cause of non-reversible intracranial injuries to the CP child of misinformed/unaware parents. Data on unsolved parental status, parent-provider miscommunications, and aspiration pneumonia leading to cerebral injuries and their permanent neurological insult in CP children were reviewed.

Development and Validation of a Nomogram for Predicting the Unresolved Risk of Parents of Adolescents With Psychiatric Diagnoses

Evaluating the resolution of parents of ill children can help in taking measures to alleviate their distress in a timely manner and promote children's rehabilitation. This study aims to develop and validate a nomogram for predicting the unresolved risk of parents of adolescents with psychiatric diagnoses. The data for 130 parents (modeling dataset = 90; validation dataset = 40) were collected. A nomogram was first developed to predict the unresolved risk for parents based on the logistic regression analysis in the modeling dataset. The internal and external validation then were conducted through quantifying the performance of the nomogram with respect to discrimination and calibration, respectively, in the modeling and validation datasets. Finally, the clinical use was evaluated through decision curve analyses (DCA) in the overall dataset. In the results, the nomogram consisted of six risk factors and provided a good discrimination with areas under the curve of 0.920 (95% CI, 0.862-0.978) in internal validation and 0.886 (95% CI, 0.786-0.986) in external validation. The calibration with good consistency between the observed probability and predicted probability was also found in both internal and external validation. DCA showed that the nomogram had a good clinical utility. In conclusion, the proposed nomogram exhibited a favorable performance with regard to its predictive accuracy, discrimination capability, and clinical utility, and, thus, can be used as a convenient and reliable tool for predicting the unresolved risk of parents of children with psychiatric diagnoses.

Parental Attunement, Insightfulness, and Acceptance of Child Diagnosis in Parents of Children With Autism: Clinical Implications

Early parent-child relationships are an important factor influencing many domains of child development, even in the presence of autism. In this study, we investigated the associations between parent-child attunement during play, parental insightfulness, and parental acceptance of their child's diagnosis of an autism spectrum disorder. A sample of 50 parents (26 mothers and 24 fathers) of 26 children aged between 24 and 58 months were videotaped during parent-child play interactions and then interviewed about what they thought had gone through their child's head during the play interaction, and about their feelings and thoughts about their child's diagnosis. Play interactions were evaluated using a coding protocol to assess parental attunement. The results showed that parents who were more able to accept their child's diagnosis and to see things from their child's perspective were more likely to also be attuned during play interactions with their children. These findings highlight the importance of studying the parental ability of insightfulness and acceptance of their child diagnosis of ASD for the implementation of intervention programs for supporting parental attunement and improving the interactions between the parents and the children with autism spectrum disorders.

Prevalence of depression, anxiety, and substance-related disorders in parents of children with cerebral palsy: a systematic review

AIM

To estimate the prevalence of mental illness in parents of children with cerebral palsy (CP).

METHOD

This is a systematic review that follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols in the search for observational studies determining the prevalence of depression, anxiety, and substance abuse in parents of individuals with CP. The information sources used for this study were: PubMed, SciELO, Cochrane Library, Clinical Trials, and Biblioteca Virtual de Saúde.

RESULTS

Fourteen articles were selected and included, investigating 1264 mothers and 105 fathers of children with CP. Data extracted for analysis were divided into three categories: study data, data about participants with CP, and data about parents. All studies included volunteer parents, of whom 95 per cent were female.

INTERPRETATION

CP is related to a higher prevalence of symptoms of depression and anxiety in parents. Factors such as a child's degree of functionality and socioeconomic level may influence the frequency of mental disorders in parents. However, these studies have heterogeneous samples and applied different criteria to characterize their populations.

WHAT THIS PAPER ADDS

Depression and anxiety are more prevalent for parents of children with cerebral palsy (CP) than parents of typically developing children. The child's illness severity is a risk factor for mental illness in parents of children with CP. The more time spent on child care, the higher the risk of mental illness among mothers of children with CP. There is a lack of reliable data in the literature on substance abuse in parents of children with CP.

The reaction to diagnosis questionnaire: a preliminary validation of a new self-report measure to assess parents' resolution of their child's diagnosis

Parents' resolution of their child's diagnosis is associated with parental sensitivity and secure child attachment. The Reaction to Diagnosis Interview (RDI) is the accepted measure for assessing resolution, but its administration and coding are time and labor intensive. This study examined the psychometric properties of the Reaction to Diagnosis Questionnaire (RDQ), a new self-report measure that assesses resolution. 75 mothers of children diagnosed with Cerebral Palsy or Developmental Delay completed the RDI and the RDQ and reported on family characteristics. The RDQ showed good internal consistency. Mothers who were classified as resolved using the RDI had higher RDQ scores compared with mothers who were classified as unresolved. The networks of associations of the RDI and the RDQ with family characteristics were similar, although formal equivalence testing could not be performed. The RDQ may be a promising time- and cost-effective tool. Nevertheless, more research is needed to further establish its validity.

Maternal resolution of preterm birth from 1 to 18 months

Preterm birth can be traumatic for some mothers, involving feelings of grief over the hoped-for full-term pregnancy. In this longitudinal study, we interviewed 50 mothers of preterm infants, using the reaction to diagnosis interview when their child was 1 month and 18 months old. We examined change and stability in resolution status over time. Additionally, we explored possible predictors of resolution trajectories between 1 and 18 months. Findings indicated that resolution at 1 month was not yet common. The rate of resolution at 18 months was 62.6%, compared with 38.2% at 1 month. Prenatal precursors of preterm birth, lower medical neonatal risk, and lower maternal stress at 1 month significantly differentiated mothers who attained resolution as early as at 1 month from those who were unresolved at 1 and 18 months. Lower maternal stress at 1 month was the only predictor that significantly differentiated initially unresolved mothers who later attained resolution from those who remained unresolved at 18 months. Discussion focuses on maternal stress, which may mark a subgroup of mothers of preterm infants who are at risk of being unresolved through the first 18 months, and who may benefit from resolution-focused intervention.