Adaptation of parents in relation to their 6-month-old infant's type of disability

Psychological wellbeing in parents of children with Down syndrome: A systematic review and meta-analysis

We report a review examining the psychological wellbeing of parents of children with Down syndrome (DS) relative to that of parents of typically developing (TD) children. A systematic search identified 57 relevant studies, which were synthesised meta-analytically. Relative to their counterparts with TD children, mothers and fathers of children with DS reported higher levels of parenting stress (mothers: g = 0.57, 95% CI [0.33, 0.81]; fathers: g = 0.40, [0.24, 0.56]), depressive symptoms (mothers: g = 0.42, [0.23, 0.61]; fathers: g = 0.25, [0.02, 0.48]) and psychological distress (mothers: g = 0.45, [0.30, 0.60]; fathers: g = 0.63, [0.26, 0.99]). Small effects were found for anxiety for mothers (g = 0.16, [0.03, 0.29]), with no differences for fathers (g = 0.03, [-0.25, 0.32]). No group differences were found for positive impact of parenting (mothers: g = -0.09, [-0.25, 0.07]; fathers: g = -0.04, [-0.30, 0.22]), while evidence concerning other positive wellbeing outcomes was limited. No significant moderating effects of child age range, country income level, or group differences in parental education level were identified, but limited subgroup analyses were possible. Raising a child with DS may be associated with elevated stress, depressive symptoms, and psychological distress for mothers and fathers. However, levels of parenting reward appear equivalent to those experienced by parents raising TD children.

Parents of Children Diagnosed with Congenital Anomalies or Cerebral Palsy: Identifying Needs in Interaction with Healthcare Services

The changes deriving from the birth of a child with a congenital anomaly (CA) or cerebral palsy (CP) imply, in many cases, an increased interaction with health services. A cross-sectional descriptive study was conducted with a convenience sample of parents of children diagnosed with four groups of CA (severe heart anomalies, spina bifida, orofacial clefts, and Down syndrome) and/or CP. A semistructured online questionnaire to be answered by parents was sent by web link to focal points of five parent associations and professional institutions. Data were analyzed through thematic content analysis (open-ended questions) and descriptive analysis (closed-ended questions). The results indicate consistency of responses of parents of children diagnosed with different conditions, namely with respect to the perception of health services and professionals. Closed and open-ended responses indicated three main topics in the interaction between health services and parenthood: information, coordinated and integrated responses, and support. The less positive outcomes suggest unmet information needs, while positive aspects include confidence in the care provided and the "training" received from health professionals.

Evaluating caregiver stress in craniosynostosis patients

OBJECTIVE

Caregiver stress from a child's diagnosis can impact a caregiver's ability to participate in treatment decisions, comply, and manage long-term illness. The aim of this study was to compare caregiver stress in children with craniosynostosis at diagnosis and postoperatively.

METHODS

This prospective study included caregivers of pediatric patients with craniosynostosis receiving operative intervention. Demographics and Parenting Stress Index, Short Form (PSI-SF) and Pediatric Inventory for Parents (PIP) surveys at baseline (preoperatively) and 3 and 6 months postoperatively were completed. PSI-SF scores between 15 and 80 are considered normal, with > 85 being clinically significant and requiring follow-up. Higher PIP scores represent increased frequency and difficulty of stressful events due to the child's illness. Pairwise comparisons were performed using the Wilcoxon signed-rank test. Multivariate analysis was performed to assess for PSI-SF and PIP predictors.

RESULTS

Of 106 caregivers (84% Caucasian), there were 62 mothers and 40 fathers. There were 68 and 45 responses at 3 and 6 months postoperatively, respectively. Regarding the baseline group, more than 80% were between 20 and 40 years of age and 58% had less than 2 years of college education. The median household income fell in the $45,001-$60,000 bracket. There was no significant difference between median baseline PSI-SF score (65, IQR 51-80) and those at 3 months (p = 0.45) and 6 months (p = 0.82) postoperatively. Both median PIP frequency (89 vs 74, p < 0.01) and difficulty (79 vs 71, p < 0.01) scores were lower at 3 months, although no significant difference was observed at 6 months (frequency: 95 vs 91, p = 0.67; difficulty: 82 vs 80, p = 0.34). Female sex, uninsured status, and open surgery type were all risk factors for higher parental stress.

CONCLUSIONS

Stress levels ranged from normal to clinically significant in the caregivers, with sex, uninsured status, and open repair predicting higher stress. Stress decreased at 3 months postoperatively before increasing at 6 months. Intervention targeting caregiver stress should be explored to maintain lower stress observed at 3 months after surgery.

Association of child's disability status with father's health outcomes in Japan

Fathers' involvement in childcare has been increasing in recent years. However, very little is known about the health impact on fathers when they are caring for or living with a disabled child. This study aims to understand the psychological distress and subjective health outcomes among fathers living with a disabled child compared to fathers living without a disabled child. Data for this study were obtained from the Comprehensive Survey of the Living Conditions conducted by the Ministry of Health, Labour and Welfare in 2016. Multivariable logistic regression was used among 438 disabled-child and father dyads and 27,682 non-disabled-child and father dyads to analyse the association between a child's disability status with father's health outcomes. Fathers of disabled children had a higher prevalence of psychological distress (17% vs. 12%) and poor subjective health status (13% vs. 8%) than fathers of non-disabled children. A large proportion of disabled children were boys (70%) and had disability level 1 (47%). After adjusting for covariates, the odds ratio (OR) of having psychological distress (OR, 1.53; 95% CI, 1.19–1.97) and poor subjective health status (OR, 1.78; 95% CI, 1.34–2.36) among fathers of disabled children is significantly higher compared to fathers of non-disabled children. Unemployed fathers had a higher odds ratio of psychological distress (OR, 3.07; 95% CI, 2.49–3.79) and poor subjective health status (OR, 4.90; 95% CI, 3.95–6.09) compared to regular working fathers. Fathers of children with disabilities need greater physical and mental health and wellbeing support. They should be provided with additional support not just for their mental but also their subjective wellbeing.

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Fathers of disabled children have higher odds ratio of psychological distress.

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Fathers of disabled children have higher odds ratio of poor subjective health status.

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70% of disabled children were boys and 47% had mildest severity of disability.

Down syndrome caregivers' support needs: a mixed-method participatory approach

BACKGROUND

The purpose of the study was to explore the support needs of caregivers of children with Down syndrome from their perspective using a mixed-method participatory research approach.

METHODS

Concept mapping methodology was used to obtain caregiver perspectives. Twenty-one caregivers answered the question 'Are parents of individuals with Down syndrome supported, why or why not?' Caregivers were involved in the analysis of the data through concept mapping procedures.

RESULTS

Sorted data were analysed with multidimensional scaling and cluster analysis. Participants generated eight thematic clusters representing the support needs of caregivers of children with Down syndrome. The themes included online and social support, support system gaps, areas where support is lacking, Down syndrome community support, financial support, advocacy needs, educational support and concerns for community programming.

CONCLUSIONS

Themes align with previous research on support needs of parents of children with developmental disabilities. The study highlights the need for more local organisations to offer support that is affordable and accessible for families. Results will support future programme planning for services for individuals caring for those with Down syndrome.

Maternal appraisals of the birth of a child: Portuguese version of the Stress Appraisal Measure

Objective: We assessed (1): the factorial and convergent validity of the Portuguese version of the Stress Appraisal Measure (SAM); (2) maternal primary and secondary appraisals of the birth of a child; and (3) the influence of appraisals on stress.Background: Parental stress is common during transition to parenthood and may be detrimental for parents and infants. Following Lazarus and Folkman's transactional model, the degree of stress is influenced by cognitive appraisals of an event, which are assessed by the SAM.Methods: This was an observational, cross-sectional study. Two hundred and forty-five women with a child of up to 24 months of age filled out several self-report measures, in an online platform.Results: The SAM factorial structure included three primary (Threat, Centrality, and Challenge) and two secondary (Controllable-by-Self and Controllable-by-Others) appraisals. All subscales had adequate internal consistency. The birth of a child was mainly perceived as a challenge, and seldom appraised as a threat. Threat and centrality appraisals positively predicted stress.Conclusion: Assessing maternal appraisals of the birth of a child is relevant to foster adaptation to parenthood. The SAM is an adequate assessment tool. As cognitive appraisals are modifiable, women with higher threat appraisals should be targeted for psychological interventions.

Disabled children's functionality and maternal quality of life and psychological status

BACKGROUND

Physiotherapy is being provided for different disabled groups in pediatric rehabilitation centers. The quality of life (QOL) and psychological status of the mothers of these children is affecting their compliance in the rehabilitation period. The aim of this study was therefore to assess the relationship between disability level of individuals receiving rehabilitation and maternal QOL, psychological status and influencing factors.

METHODS

One hundred and twenty-six disabled children and their mothers were included in this cross-sectional study. Demographic information was noted. Child motor level was assessed using the Gross Motor Function Classification System and the level of independency in activities of daily living (ADL) was assessed with the Katz ADL scale. Maternal QOL was assessed with the 36-item Short Form (SF-36), and psychological status with the Beck Depression Inventory (BDI). SPSS 18.0 was used to analyze data.

RESULTS

Mean maternal age was 36.46 ± 7.2 years. Of the children, 67.5% had physical problems, 16.7% had mental problems, 7.9% had autism, 4.8% had hyperactivity, and 3.2% had hearing and speaking problems. Mild depression was detected in mothers (mean BDI score, 11.27 ± 8.1). There was no correlation between child disability level and maternal QOL and depression (P > 0.05). Maternal BDI score was negatively correlated with all SF-36 subscale scores (P < 0.001 for all parameters).

CONCLUSION

The SF-36 subscale scores of mothers of disabled children were decreased compared with Turkish community norms. Psychological support of mothers of children in the rehabilitation period may positively affect this period.

Depression and anxiety among parents of phenylketonuria children

Objective:

To investigate the existence of depression and/or anxiety with underlying risk factors among parents of children with classical phenylketonuria (PKU).

Methods:

This cross-sectional study was conducted in the Division of Pediatric Metabolism, Ankara Children’s Hospital, Dokuz Eylul University, Kırıkkale University, and Erzurum Local Research Hospital, Turkey, between January and July 2014. Parents of 61 patients and 36 healthy controls completed the self-report questionnaires. We used Beck Depression Inventory (BDI) to assess the parental depression and State-Trait Anxiety Inventory S-T (STAI S-T) to assess parental anxiety.

Results:

Depression and anxiety scores were significantly higher in the case group (BDI 12.3±9.1; STAI-S: 38.2±9.6; STAI-T: 43.2±6.9) than controls (BDI: 5.4±4.1 p=0.000; STAI-S: 31.8±7.6 p=0.001; STAI-T: 37.0±7.2 p=0.000). Mothers of the patients had higher scores than the other parental groups (BDI: p=0.000, STAI-S: p=0.001 and STAI-T: p=0.000). Logistic regression analysis showed that low educational level of the parent was the only independent factor for depression (OR 9.96, 95% CI: 1.89-52.35, p=0.007) and state anxiety (OR: 6.99, 95% CI: 1.22-40.48, p=0.030) in the case group.

Conclusion:

A subset of parents with PKU patients have an anxiety or depressive disorder. Supportive services dealing with the parents of chronically ill children such as PKU are needed in order to reduce the level of anxiety.

Important knowledge for parents of children with heart disease: parent, nurse, and physician views

OBJECTIVES

Parental understanding of their children's heart disease is inadequate, which may contribute to poor health outcomes. The purpose of this study was to determine what parental knowledge is important in the care of children with heart disease from the perspective of parents, nurses, and physicians.

METHODS

Focus groups were formed with parents of children with single ventricle congenital heart disease (CHD), biventricular CHD, and heart transplantation, and with nurses and physicians who provide care for these children. A nominal group technique was used to identify and prioritise important parental knowledge items and themes. The voting data for each theme were reported by participant type--parent, nurse, and physician--and patient diagnosis--single ventricle CHD, biventricular CHD, and heart transplantation.

RESULTS

The following three themes were identified as important by all groups: recognition of and response to clinical deterioration, medications, and prognosis and plan. Additional themes that were unique to specific groups included the following: medical team members and interactions (parents), tests and labs (parents), neurodevelopmental outcomes and interventions (physicians), lifelong disease requiring lifelong follow-up (physicians and nurses), and diagnosis, physiology, and interventions (single ventricle and biventricular CHD).

CONCLUSIONS

Parents, nurses, and physicians have both common and unique views regarding what parents should know to effectively care for their children with single ventricle CHD, biventricular CHD, or heart transplantation. Specific targeted parental education that incorporates these findings should be provided to each group. Further development of questionnaires regarding parental knowledge with appropriate content validity is warranted.

Aconselhamento Genético: Análise e Contribuições a partir do Modelo de Aconselhamento Psicológico

O Aconselhamento Genético (AG) constitui um processo de investigação do diagnóstico de doenças genéticas. Este estudo de caso objetivou a análise de um modelo de AG. A coleta de dados foi realizada por meio de entrevista semiestruturada e da observação de uma sessão de AG. Os participantes foram profissionais biomédicos e a consulente de uma criança com diagnóstico de síndrome do duplo Y. Verificou-se que o AG envolve uma relação intersubjetiva complexa. Percebeu-se, nos dois polos da relação – profissional e consulente-familiar –, os aspectos emocionais (angústia, temor, culpas etc.) e defensivos (identificação, racionalização etc.) referidos na literatura das crises vitais. A análise do processo de AG indicou: 1) dissonância entre a teoria do AG e a ação do profissional; 2) fixação (defensiva) ao protocolo do AG; 3) uso de linguagem técnica dificultando contato e acolhimento do consulente; e, 4) tempo de compreender considerado na dimensão cronológica e não lógico. Infere-se que os fatores afetivos (angústia, temor, culpas etc.) e a defesa psíquica (identificação, racionalização) restringiram a comunicação do diagnóstico comprometendo o acolhimento e esclarecimento do contexto vital do consulente. Conclui-se que o modelo de AG poderia se enriquecer com a experiência do modelo de aconselhamento psicológico no que se refere ao manejo de crises vitais e no trabalho em equipes multidisciplinares.

How are they doing? Listening as fathers of children with autism spectrum disorder compare themselves to fathers of children who are typically developing

The growing prevalence of autism spectrum disorder is accompanied by ongoing efforts to understand and support parents in the face of challenges related to their child's autism spectrum disorder. Although fathers are increasingly hands-on in raising children, research focus on parenting children with autism spectrum disorder continues to be skewed toward experiences of mothers. Our purpose in this article is to contribute understandings of how fathers of children with autism spectrum disorder perceive themselves to be managing, and we undertake this by examining comparisons fathers of children with autism spectrum disorder make between their parenting experiences and experiences of fathers of typically developing children. A purposive sample of 28 fathers of children (aged 2-13 years) with autism spectrum disorder living in an urban center in Western Canada participated in in-depth interviews about their parenting successes and challenges. We found fathers speak of universal fathering experiences yet articulate their own sense of loss and efforts to come to terms with unanticipated demands associated with autism spectrum disorder. Fathers of children with autism spectrum disorder feel "pangs of jealousy" toward fathers of typically developing children, yet they are keenly attentive to their own child's development and convey a sense of gratitude for their child's capabilities and personality amidst an appreciation for trials and triumphs of fathering in general and fathering a child with autism spectrum disorder in particular.

Parental Reports of Stigma Associated with Child's Disorder of Sex Development

Disorders of sex development (DSD) are congenital conditions in which chromosomal, gonadal, or anatomic sex development is atypical. DSD-associated stigma is purported to threaten positive psychosocial adaptation. Parental perceptions of DSD-related stigma were assessed in 154 parents of 107 children (newborn-17 years) questionnaire comprising two scales, child-focused and parent-focused, and three subscales, perceived stigmatization, future worries, and feelings about the child's condition. Medical chart excerpts identified diagnoses and clinical management details. Stigma scale scores were generally low. Parents of children with DSD reported less stigma than parents of children with epilepsy; however, a notable proportion rated individual items in the moderate to high range. Stigma was unrelated to child's age or the number of DSD-related surgeries. Child-focused stigma scores exceeded parent-focused stigma and mothers reported more stigma than fathers, with a moderate level of agreement. Within 46,XY DSD, reported stigma was higher for children reared as girls. In conclusion, in this first quantitative study of ongoing experiences, DSD-related stigma in childhood and adolescence, while limited in the aggregate, is reported at moderate to high levels in specific areas. Because stigma threatens positive psychosocial adaptation, systematic screening for these concerns should be considered and, when reported, targeted for psychoeducational counseling.

Longitudinal Analysis of Parenting Stress in Mothers and Fathers of Infants with and without Single-Suture Craniosynostosis

Objective

To examine longitudinal differences in reported stress between parents of children with and without single-suture craniosynostosis and to compare the stress reports of mothers and fathers.

Design

Multi-site, nonrandomized prospective study.

Setting/Participants

Children with single-suture craniosynostosis (cases) were identified via referral of the treating surgeon or physician at the time of diagnosis, and those without single-suture craniosynostosis (controls) were recruited from pediatric practices, birthing centers, and announcements in print media. When children were aged 6, 18, and 36 months (on average), mothers and fathers of children with and without single-suture craniosynostosis completed the Parenting Stress Index. For cases, 247 mothers and 211 fathers completed the Parenting Stress Index at the first visit; corresponding numbers for controls were 254 and 220, respectively.

Main Outcome Measures

The Parenting Stress Index Parent and Child Domains and subscales scores.

Results

We found few differences between parents of infants with and without single-suture craniosynostosis, regardless of parent gender. Irrespective of case status, mothers consistently reported higher stress than fathers on the Parent Domain. Within the Parent Domain, mothers reported more stress than fathers on the Role Restriction and Spousal Support subscales.

Conclusions

The parents of children with single-suture craniosynostosis reported levels of stress similar to those reported by parents of same-aged, unaffected children. Mothers reported greater stress than fathers, and these differences remained remarkably stable over time. This may reflect widely held perceptions of gender differences in parenting roles.

Educational paper: parenting a child with a disfiguring condition-how (well) do parents adapt?

Studies indicate serious levels of stress among parents of children with a medical condition. Moreover, adaptation seems to be a specific challenge for parents of children with a disfiguring condition because of the visible nature of the condition. In the present overview, we performed a literature search in PubMed, Embase, and PsycINFO to identify both qualitative and quantitative studies concerning psychological distress among parents of children with a disfiguring condition. Two of the authors critically appraised the retrieved citations. A total of 1,459 publications were identified, of which 21 qualitative and 22 quantitative studies met our inclusion criteria. Most qualitative studies infer that the birth of a child with a disfiguring condition starts an adaptation process in which parents experience a range of negative emotions and have concerns related to the visible nature of the condition. The results of quantitative studies are mixed and contradictory, and together suggest that some, but not all parents of a child with a disfiguring condition experience stress. Methodological limitations of the quantitative studies and potential stressors are discussed, and recommendations for future research are made.

CONCLUSION

The present overview neither shows that the existing literature is conclusive about the perceived strain among the parents of children with a disfiguring condition nor does it provide evidence for a relationship between visibility and parental strain.

The clinical profile of mentally retarded children in India and prevalence of depression in mothers of the mentally retarded

BACKGROUND

Mental retardation (MR) has a varied phenomenology in different parts of the world. While studying MR, psychological issues of caretakers are equally relevant. A study to investigate the phenomenology of MR in Indian children and the prevalence of depression in their mothers was planned in a teaching institute in Madhya Pradesh with an attached tertiary care hospital.

OBJECTIVES

The objective of the following study is to study the clinical profile of mentally retarded children in the study sample, prevalence of depression in the mothers and investigate various factors affecting it.

STUDY DESIGN

A cross-sectional study.

MATERIALS AND METHODS

A total of 60 patients diagnosed as MR were included in the study. Objective data was collected in a special proforma and mothers of these individuals were subjected to evaluation with Beck's Anxiety Inventory and the 17 item Hamilton Rating Scale for Depression.

RESULTS

The mean age of patients in the sample was 11.6 years, had received an average of 2.42 years of schooling, mean age at diagnosis of MR was 6.5 years and their mean IQ was 53. Out of the total 60 patients, 88% of the patients had significant co-morbidities. The prevalence of depression in mothers was 85% and it was more in mothers of, the ones with significant co-morbidities (OR = 2.67), severer forms of retardation and with higher levels of anxiety in the mother.

CONCLUSIONS

Prevalence of depression in mothers of mentally retarded children in India seems to be much greater than those reported from studies around the world. Medical services offered to the mentally retarded should move from an individual level to the family level, especially toward the mothers, who are the main caretakers. Counseling services, treatment if required and regular screening of mothers of the mentally retarded should be included in the protocol for management of mental retardation.

Examination of mental health status and aggravation level among mothers of children with isolated oral clefts

OBJECTIVE

To examine self-reported mental health status and aggravation level in mothers of children with isolated oral clefts.

METHODS

Population-based sample of children (aged 4 to 9 years) with isolated oral clefts was enumerated from births from 1998 through 2003 in Arkansas, Iowa, and New York State. Mothers of 294 children completed the Mental Health Inventory 5-item questionnaire and Aggravation in Parenting Scale. The Mental Health Inventory and Aggravation in Parenting Scale scores, stratified by poor (Mental Health Inventory ≤ 67) and better (Mental Health Inventory > 67) mental health status or high (Aggravation in Parenting Scale ≤ 11), moderate (Aggravation in Parenting Scale = 12 to 15) and low (Aggravation in Parenting Scale = 16) aggravation, were compared by selected maternal and child characteristics. Mean scores for each instrument and proportion of mothers with poor mental health or high aggravation were compared with those reported in the National Survey of American Families.

RESULTS

Mean scores for each instrument and proportion of mothers with poor mental health or high aggravation differed little from published data. Mothers with poor mental health tended to be less educated, to have lower household incomes, and to rate their health and their child's health lower than those in better mental health. Mothers with high aggravation tended to have lower household incomes, to have more children, and to rate their health and their child's health lower than those with moderate or low aggravation.

CONCLUSIONS

Mothers of affected children were not more likely to experience poor mental health or high aggravation compared with published data; however, sociodemographic characteristics were associated with maternal psychosocial adaptation. Brief screeners for mental health and parenting administered during routine appointments may facilitate identifying at-risk caregivers.

Trauma reactions in mothers and fathers after their infant's cardiac surgery

OBJECTIVE

To investigate the prevalence and nature of trauma symptoms in mothers and fathers of infants who had cardiac surgery.

METHOD

Parents of infants who underwent cardiac surgery before 3 months of age were recruited at the time of surgery. 77 mothers and 55 fathers completed the Acute Stress Disorder Scale 1 month after their infant was discharged from hospital.

RESULTS

26 of 77 (33.8%) mothers and 10 of 55 (18.2%) fathers satisfied criteria for acute stress disorder. For all symptom clusters, except dissociation, mothers had significantly higher mean scores (and therefore higher levels of symptoms) than did fathers, ps = .01, -.02. 83 percent of parents endorsed at least 1 trauma symptom and 11.4% endorsed only 1 symptom at a clinical level. Symptoms of dissociation were the most commonly endorsed by both parents, with each symptom in that cluster being endorsed at a clinical level by at least 26% of parents.

CONCLUSIONS

Consistent with our hypotheses, approximately one-third of parents overall, as well as one-third of mothers and close to one-fifth of fathers, experienced trauma symptoms consistent with a diagnosis of acute stress disorder. Most parents experienced at least one symptom at a clinical level, with symptoms of dissociation being the most commonly endorsed symptom cluster. These findings highlight the need for clinical supports for parents.

Parenting stress in the infant aphakia treatment study

OBJECTIVE

To evaluate parenting stress following infants' cataract extraction surgery, and to determine if levels of stress differ between 2 treatments for unilateral congenital cataract in a randomized clinical trial.

METHODS

At surgery, an intraocular lens (IOL) was implanted or children were left aphakic, treated with contact lens (CL). Stress measures were administered 3 months after surgery and at the first visit after the visual acuity (VA) assessment done at 12 months of age.

RESULTS

Caregivers in the IOL group reported higher levels of stress than those in the CL group 3 months after surgery, but there were no group differences in stress scores at the post-VA assessment. Stress scores did not change differentially for participants assigned to IOL versus CL treatments.

CONCLUSIONS

Treatment assignment did not have a significant impact on caregiver stress during infancy or on the change in stress during the child's first 2 years of life.

Psychosocial functioning in children with and without orofacial clefts and their parents

OBJECTIVE

To determine whether psychosocial functioning in children with orofacial clefts and their parents differs from that in unaffected controls.

DESIGN

The study used a nonrandomized, case-control design.

PARTICIPANTS

Outcomes were evaluated in 93 cases with orofacial clefts and 124 controls, aged 5 to 9 years, who were part of the Massachusetts Center for Birth Defects Research and Prevention registry.

MAIN OUTCOME MEASURES

Measures included the Child Behavior Checklist, the PedsQL 4.0, the Social Competence Scale, and the Parenting Stress Inventory.

RESULTS

Group differences were negligible for all measures, and findings changed little with the application of inverse probability weighting to adjust for response bias. Stratified analyses revealed differences according to both sex and age, with worse outcomes observed in male cases and cases aged 7 to 9 years.

CONCLUSIONS

In contrast to previous studies, we found minimal differences in psychosocial functioning among children with orofacial clefts and their parents compared with unaffected controls. This may reflect ascertainment factors, and psychosocial differences may be less apparent in population-based versus clinic-based samples. Alternatively, social-emotional deficits may become apparent in older school-aged children, making the preschool and early elementary school years an optimal time for preventive interventions.

Facets of parenting a child with hypoplastic left heart syndrome

The purpose of the study was to conceptualize the needs of parents of young children with hypoplastic left heart syndrome (HLHS) to provide a theoretical framework to inform the development of future parent interventions. Participants were parents and grandparents (n = 53) of 15 young children who had undergone the Sano surgical approach for HLHS. Analysis of recorded and transcribed single interviews with each participant was done as directed by interpretive description methodology. A model of five facets of parenting was conceptualized. These included survival parenting, “hands-off” parenting, expert parenting, uncertain parenting, and supported parenting. The facets of parenting delineated through this study provide a theoretical framework that can be used to guide the development and evaluation of interventions for parents of children with complex congenital heart disease and potentially other life-threatening conditions. Each facet constitutes a critical component for educational or psychosocial intervention for parents.

Transição para a parentalidade no contexto de cardiopatia congênita do bebê

O estudo objetivou investigar o processo de transição para a parentalidade no contexto de cardiopatia congênita do bebê. Participaram do estudo quatro casais, cujos filhos nasceram com malformação cardíaca. Utilizou-se delineamento de estudo de caso coletivo. Mãe e pai foram entrevistados sobre os primeiros momentos após o nascimento do bebê e a experiência da maternidade e da paternidade, respectivamente. Análise de conteúdo indicou que o diagnóstico de cardiopatia do bebê interfere no processo de parentalização. Destacou-se a intensa preocupação das mães com a sobrevivência dos bebês, evidenciada por meio da dedicação exclusiva a eles. Os pais demonstram-se envolvidos com seus filhos, assumindo também a tarefa de proteger as mães. Conclui-se que os sentimentos relativos à parentalidade focalizaram-se na sobrevivência do bebê.

Patients with univentricular heart in early childhood: parenting stress and child behaviour

AIMS

To assess perceptions of child behaviour and parenting stress among the parents of young children with hypoplastic left heart syndrome (HLHS) and other forms of functionally univentricular heart defects (UVH).

METHODS

As part of our prospective nation-wide neurodevelopmental follow-up study, the parents of 23 patients with HLHS, 14 with UVH and 46 healthy controls at the mean age of 18 months received the questionnaires Child Behavior Checklist and Parenting Stress Index.

RESULTS

The reported level of total parenting stress was significantly higher among the mothers (mean score 241 vs 205, p < 0.001) and fathers (235 vs 202, p = 0.003) of patients with HLHS compared with those of controls. The parents of patients with HLHS reported significantly more total (mean T score 52 vs 45, p = 0.005) and internalizing (51 vs 41, p < 0.001) behaviour problems than the controls, but among the syndrome scales, a significant difference was only found in somatic complaints. The parents of patients with UVH did not report more parenting stress or emotional problems than the controls.

CONCLUSION

Hypoplastic left heart syndrome, a severe congenital heart defect, increases parenting stress. The reported emotional maladjustment in affected children might in part be owing to somatic complaints.

Maternal role attainment with medically fragile infants: Part 2. relationship to the quality of parenting

We examined which components of maternal role attainment (identity, presence, competence) influenced quality of parenting for 72 medically fragile infants, controlling for maternal education and infant illness severity. Maternal competence was related to responsiveness. Maternal presence and technology dependence were inversely related to participation. Greater competence and maternal education were associated with better normal caregiving. Presence was negatively related although competence was positively related to illness-related caregiving. Mothers with lower competence and more technology dependent children perceived their children as more vulnerable and child cues as more difficult to read. Maternal role attainment influenced parenting quality for these infants more than did child illness severity; thus interventions are needed to help mothers develop their maternal role during hospitalization and after discharge. © 2010 Wiley Periodicals, Inc. Res Nurs Health 34:35-48, 2011.

Antenatal depression and anxiety affect postpartum parenting stress: a longitudinal, prospective study

OBJECTIVE

Postpartum depression has been associated with parenting stress, impacting attachment and child development. However, the relation between antenatal depression or anxiety and postpartum parenting stress has not been investigated. We studied the effect of antenatal depression and anxiety and treatment with selective serotonin reuptake inhibitors and selective norepinephrine reuptake inhibitors (antidepressants [ADs]) on postpartum parenting stress.

METHOD

Ninety-four pregnant women (part of a larger study examining prenatal AD exposure on infants) were prospectively monitored for depression and anxiety during the third trimester and 3- and 6-months postpartum using the Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating Scale. Parenting stress was assessed using the Parenting Stress Index-Short Form at 3- and 6-months postpartum.

RESULTS

Both antenatal third trimester depression and anxiety were significant predictors of 3- and 6-month postpartum parenting stress, after controlling for maternal age, number of children, and exposure to prenatal ADs (all Ps < 0.001). Third trimester depression accounted for 13% to 22% of the variance in postpartum stress at 3 and 6 months. Prenatal AD use was not a significant predictor in any of the models (all Ps > 0.2). Twenty of 41 mothers on ADs achieved remission (HDRS = 7) in pregnancy and had average parenting stress scores of about 1 standard deviation lower than those who did not at 3- and 6-months postpartum (t = 3.32, df = 32, P = 0.002 and t = 2.52, df = 32, P = 0.02, respectively).

CONCLUSIONS

Our findings indicate that antenatal depression and anxiety directly impact postpartum parenting stress, regardless of antenatal AD treatment. Ongoing maternal mental illness in pregnancy is an important predictor of postpartum parenting stress. Early recognition and treatment to remission is key.

A gender perspective on the extent to which mothers and fathers each take responsibility for care of a child with high and intermediate imperforate anus

Imperforate anus is a malformation of the child's anus. Parents' experiences of responsibility for care of the child may differ. The aim of this study was to evaluate a gender perspective on the extent to which mothers and fathers each take responsibility for the care of a child with high and intermediate imperforate anus. Parents of children with imperforate anus and two control groups of children and parents participated. Data collection with questionnaires focusing on responsibility was performed. In conclusion, our study revealed additional evidence of unevenly divided parental responsibility for care of a child with a chronic condition. The mothers in this study were shown to be the primary caregiver.

A developmental approach to mental health for children and adolescents with orofacial clefts

The mental health of children, adolescents, and adults with orofacial clefts has been studied extensively. Outcomes of interest have included parental adaptation, parent-child attachment, child development, intellectual and academic outcomes, behavioral adaptation, and quality of life. The literature sheds light on mental health needs and opportunities in each of these domains at various stages of development. However, this research has been limited in several respects and methodologically rigorous studies are needed to clarify the role of mental health in craniofacial team care. In particular, randomized controlled trials investigating the efficacy of psychosocial interventions tailored for this population are long overdue. Such studies have the potential to advance routine mental health care for individuals with orofacial clefts to the level of 'evidence-based care.'

Psychosocial outcomes for preschool children and families after surgery for complex congenital heart disease

The purpose of the current study was to assess the psychosocial outcomes of preschool-aged survivors (ages 3-6 years) of hypoplastic left heart syndrome (HLHS; n=13) and transposition of the great arteries (TGA; n=13). Parents completed the following measures: Pediatric Quality of Life Inventory, Impact on the Family Scale, Parenting Stress Index, Parent Behavior Checklist, and Child Behavior Checklist. Quality of life scores did not differ from those of healthy controls. Parents of children with HLHS reported more negative impact of the child's illness on the family and more parenting stress than parents of children with TGA. Parents of both groups of children were more permissive in their parenting style than parents of healthy controls. Children with HLHS had higher rates of attention and externalizing behavior problems than children with TGA. The results highlight the need for practitioners working with these children and families to ask about parental stress, family functioning, and behavioral expectations for the child in the context of routine medical/cardiac follow-up.

Gender differences and similarities in the experience of parenting a child with a health problem: current state of knowledge

The birth of a child is a transitional situation that triggers stress in the family and each person has to use adjustment strategies allowing them to reposition gradually in relation to themselves and other members of the family, and to make space for the new arrival. When the child has a health problem, the stress on the parents is correspondingly greater. Research shows that fathers and mothers of a child with a health problem experience this ordeal differently. This article reports on the current state of knowledge about the experience of fathers and mothers of a child with a health problem, and suggests new directions for research to provide a fuller understanding of their experience.

Psychologic Impact of Deafness on the Child and Adolescent

The purpose of this article is to provide a brief overview of the psychologic impact (stimuli and events that influence cognitive, social, and emotional development) of deafness on children and adolescents. In addition, methods for connecting with families to provide information, support, and resources to enhance deaf children's development are described.

Factors influencing satisfaction and well-being among parents of congenital heart disease children: development of a conceptual model based on the literature review

AIM AND METHOD

The treatment and management of congenital heart disease (CHD) has improved dramatically over the past 25 years, necessitating re-evaluation of satisfaction with care and well-being among CHD children and their parents (PCCHD). The present study reviews the published literature over the past 25 years on parental satisfaction with the paediatric care of CHD and well-being among the parents, with the specific aim of: (a) assessing the extent of psychosocial problems and grade of satisfaction with care and (b) modelling factors associated with satisfaction and well-being among the parents.

RESULTS

There is general agreement in the literature that PCCHD experience psychosocial morbidity to a higher degree than parents of children with other paediatric conditions and parents of healthy children. The research on satisfaction with care among PCCHD is not conclusive, though there is considerable agreement that a substantial proportion of PCCHD may not be receiving adequate information regarding the ill-child's condition, treatment and medical prognosis. Finally, based on the review of factors affecting satisfaction and well-being, a model is generated indicating that interactions between parental perception of CHD, psychosocial resources and social vulnerability may account for differences in well-being among PCCHD, which in turn may explain differences in satisfaction with care among them.

CONCLUSION

A holistic approach to the care of CHD that acknowledges the role of parents' perception of CHD, need for psychosocial resources and social vulnerability in the adaptation process is recommended to improve parental satisfaction with the care of CHD.

Newborns with an impairment: discourses of hospital staff

The birth of a baby with an impairment goes against dominant cultural ideals about a happy event. Therefore, the interaction between professionals and parents is particularly important, from the hospital maternity ward to the home. In this article, the author examines both the representations of neonatal impairments constructed by professionals and the consequent subject positions for these babies with impairments. The study is based on interview data collected among 19 staff members of one Finnish county hospital. The author analyzed the data by means of qualitative discourse analysis and concludes that it would be important for health care professionals to provide many-sided elements for parents to consider in the construction of the image of their baby other than traditional tragically and negatively biased cultural interpretations.

Factors affecting parenting stress among biologically vulnerable toddlers

Parenting a child with, or at risk for, a developmental delay or disability can be stressful. Abidin's parenting stress model was used as a framework to examine how several maternal, child, and family factors predict parent stress outcomes. Stepwise regression models revealed that maternal and child factors were significant contributors to parenting stress. However, family factors (income and family functioning) were not retained. Parenting stress was lower when child (cognitive and adaptive ability) and maternal (depression and child care competence) characteristics were more positive. Child cognitive ability was a strong contributor to total parenting stress and two parenting stress subscales. Findings suggest that these parents need stress lowering interventions such as supportive child care, respite relief, and a child behaviour-focused program.

Mothers' adaptation to antenatal diagnosis of surgically correctable anomalies

OBJECTIVE

To assess the applicability of Drotar model when the diagnosis of congenital malformation is made antenatally.

METHODS

In a 3-year period (2000-2003) fifty mothers, counselled for fetal malformations amenable to surgical correction at birth, were interviewed. Statistical associations were sought between each stage of the adaptation process and type of anomaly, gestational age at diagnosis, maternal age, educational background and previous miscarriage. Emotional experience at each stage was studied as dichotomous variables.

RESULTS

Fetuses were affected by the following anomalies: abdominal wall defects (11), intestinal atresia (14) and diaphragmatic hernia (25). All mothers experienced stage one, two and three. No association was found between anger, type of anomaly, maternal age, educational background, and age at diagnosis. On the contrary, such association was statistically significant for previous miscarriage. Thirty-nine mothers reached the adaptation stage while none of them experienced that of reorganization.

CONCLUSION

Despite significant differences, the adaptation process proposed by Drotar to describe parents reactions is applicable in prenatal age.

Psychosocial morbidity among parents of children with congenital heart disease: A prospective longitudinal study

OBJECTIVE

The study objectives were to assess long-term psychosocial morbidity and its determinants among parents of children with congenital heart disease (PCCHD), and to compare mothers with fathers on psychosocial variables.

METHOD

The study design was longitudinal. Data comprising PCCHD (n = 632, 58% were women) were collected on two occasions 1 year apart.

RESULTS

Many PCCHD reported psychosocial problems manifested in depression (18%), anxiety (16%-18%), somatization (31%-38%), and hopelessness (16%) during both measurement points. In addition, 7% to 22% reported psychosocial problems persisting over a 1-year period. Consistently over time, mothers reported more severe symptoms of depression, anxiety, somatization, and hopelessness than fathers. Children's clinical severity did not significantly explain parent's psychosocial morbidity over time. Instead, parental caregiving burden, dissatisfaction with care, social isolation, and financial instability were associated with an increased risk of long-standing psychosocial morbidity.

CONCLUSIONS

An important proportion of PCCHD are at risk of long-standing psychosocial morbidity, suggesting that psychosocial intervention may be beneficial. Feasible interventions are discussed.

L’expérience des pères et mères ayant un enfant atteint d’un problème de santé : état actuel des connaissances*

La naissance d’un enfant est une situation transitionnelle qui suscite un stress au sein de la famille et implique la mise en oeuvre de stratégies adaptatives qui permettront graduellement à chacun de se resituer face à lui-même et face à l’autre et de faire une place à ce nouvel être. Lorsque l’enfant présente un problème de santé, le stress ressenti par les parents est d’autant plus important. Les recherches montrent que les pères et les mères d’enfant atteint d’un problème de santé vivent différemment cette expérience. Cet article vise à faire le point sur l’état actuel des connaissances de l’expérience des pères et des mères d’enfant atteint d’une problématique de santé et à proposer de nouvelles avenues de recherche permettant une meilleure compréhension de leur expérience.

Parents' informational needs at the birth of a baby with a surgically correctable anomaly

Previous studies have assessed informational needs of parents of sick fetuses, neonates and children to identify favourable patterns of physician-parent interaction. The aim of this paper was to assess parents' informational needs before and after the operation when the one affected by a surgically correctable anomaly is a newborn. In the period ranging from 1997 to 2000 all couples with newborns undergoing major surgical procedures at birth, at the Newborn Surgery Unit of the Hospital Bambino Gesù, were surveyed by means of a questionnaire. Thirty couples form the object of the study. The two genders did not show significant difference in any of the considered items. All 30/30 mothers (M; 100%) and 29/30 fathers (F; 97%) had never heard about the anomaly before the diagnosis was established in their baby. All parents (100%) stated that it would be better if the surgeon informed them with written educational material. Principal informational needs before operation regard: the description of the anomaly (M = 10; F = 11) and the prognosis in terms of survival chances of the baby (M = 17; F = 15); after surgery the cause of the anomaly (M = 5; F = 3); the steps of the recovery process (M = 10; F = 12) as well as the quality of their baby's life (M = 9; F = 9). In the immediate perioperative period the surgeon should well address parents' informational needs, which may significantly differ from his communication plan.

The impact of the severity of disease and social disadvantage on quality of life in families with congenital cardiac disease

OBJECTIVE

Increasing rates of survival have raised the question of medical and psychosocial factors contributing to quality of life of patients with congenital cardiac disease. We investigated the impact of the severity of disease, and social disadvantage, on the quality of life of patients and their primary caregivers.

METHODS

One hundred and thirty two families participated in a computer-assisted evaluation of their quality of life in a German outpatient centre for paediatric cardiac diseases. Quality of life for the patients was evaluated by a multi-dimensional proxy-measure. The quality of life of the caregivers was evaluated by a multi-dimensional self-reporting measure. Severity of the disease was evaluated by the responsible paediatrician. Social disadvantage was defined as single-parent status, ethnic minority status, unfinished parental education or professional training, and/or unemployment. Analyses of variance were calculated with mild, moderate, or severe forms of disease, and risk as opposed to no risk for social status, both factors being treated independently, and the quality of life of the patients and their caregivers as dependent variables.

RESULTS

We demonstrated significant effects of the severity of disease on the quality of life of the children, and of social disadvantage on the quality of life of both the children and their parents. A significant interactive effect indicated a cumulative negative impact of the severity of the disease and social disadvantage on the quality of life of the patients.

CONCLUSION

Programmes providing psychosocial support for children with cardiac disease and their caregivers should consider risk factors which are both medical and social.

Living with congenital or acquired cardiac disease in childhood: maternal perceptions of the impact on the child and family

AIMS

Firstly to assess maternal perceptions of the impact of congenital or acquired cardiac disease on the child, parents, and siblings, and secondly to determine whether there were differences between different diagnostic groups, or between those with and without other health problems, with a view to informing the development of a cardiac liaison nursing service for children.

METHODS

A postal survey of 447 families of children with congenital or acquired cardiac disease.

RESULTS

Completed questionnaires were received from 209 (46.8 percent) families. The cardiac lesion was perceived to have a negative impact on many areas of family life for about one fifth of the sample, particularly in those families where the child was perceived to be more ill. Family relationships, however, were affected in a very different way, with 43 percent reporting that family members had become closer, and only 8 percent that they had been "pulled apart" by the condition of their child. There were a number of differences in the perceived impact of the cardiac malformation on school and family life between children with different diagnoses, with this being particularly evident for families of the patients who had undergone transplantation. When the sample was divided according to the presence or absence of other problems with health, however, many of these differences between the diagnostic groups disappeared.

CONCLUSIONS

Irrespective of the severity of the disease, the presence of a cardiac malformation has an impact on everyday life for a significant number of children and families, particularly if associated with other problems with health. Implications for targeting resources to reduce morbidity in these children and families are discussed.

Anxiety, Depression, and Quality of Life in Mothers of Children with Cleft Lip/Palate

Multidisciplinary care for patients with cleft lip and palate (CLP) includes the surgical correction of the facial disfigurement and the rehabilitation of functional deficits to optimize the communicational competence of the affected patient. Although the well-being of the mother of a CLP child is an important protective factor for the child, up to now literature has paid only little attention to this topic. In this study, 50 mothers of CLP children aged 1-10 years were examined using the 36-item Short-Form Health Survey and the Hospital Anxiety and Depression Scale (HADS) to screen for quality of life, anxiety and depression. Surprisingly, the data obtained indicate no group-specific alterations of these items when compared with normal controls. In cases with a deteriorated quality of life, the results of the HADS were pathologic as well. In general, mothers of CLP children aged more than 12 months do not require psychological screening. In individual cases, screening for relevant emotional aspects may be restricted to using the HADS.

Effect of an early intervention programme on low birthweight infants with cerebral injuries

OBJECTIVE

To determine the effect of an early intervention programme (EIP) on low birthweight infants with cerebral injuries.

METHODS

Subjects were 23 high-risk low birthweight infants (periventricular leukomalacia 15, intraventricular haemorrhage 5, both 3) receiving care in the neonatal intensive care unit (NICU) at Nagasaki University Hospital. Subjects were randomly assigned to the EIP group (n = 12) or the control group (n = 11). Participants in the EIP group received a Neonatal Behavioral Assessment scale (NBAS)-based intervention combined with developmental support designed to enhance the infants' development and the quality of the parent-infant relationship. The control group received routine medical nursing care without the EIP. The EIP began prior to discharge from the NICU and lasted until 6 months of corrected age. All children were examined on the NBAS preintervention and again at 44 weeks postconceptional age. Maternal anxiety status (STAI) and maternal feelings of confidence in dealing with her baby (LCC) were measured pre and postintervention. Mental and motor development was assessed postintervention using the Bayley Scale of Infant Development.

RESULTS

Orientation and State Regulation of infant behavioural profiles, the STAI and LCC scores significantly improved in the EIP group (mean difference (95% CI): Orientation 0.7 (0.4, 1.1), State Regulation 0.9 (0.3, 1.5), STAI -5.5 (- 9.1, -1.9, LCC 5.3 (4.2, 6.5)), but not in the control group. Bayley mental developmental index (MDI) score in the EIP group was higher than in the control group, but there was no significant difference between the two groups (mean difference (95% CI): MDI 8.5 (- 0.8, 17.8), PDI 6.7 (- 1.9, 15.4)).

CONCLUSION

The EIP has beneficial effects on neonatal neurobehavioural development and maternal mental health of low birthweight infants with cerebral injuries. This evidence suggests that short-term changes in maternal mental health and infant neurobehaviour promoted by an EIP may serve to initiate a positive interaction between parents and infants.

Follow-up survey of parents of children with major birth defects in New York State

BACKGROUND

One of the objectives of the New York State birth defect surveillance system, the New York State Congenital Malformations Registry (CMR), is to identify children in need of special programs and assist prevention/intervention programs and services with evaluation. In 1999, the CMR started a statewide mass-mailing program to inform parents of children with major birth defects about programs and support groups that might be helpful to them. A follow-up survey by mail was conducted in 2002 to evaluate the usefulness of the mailing program.

METHODS

The survey was mailed between September and December of 2001 to parents of children born in 2001 and reported to the CMR with selected major birth defects. Non-respondents were followed-up by telephone.

RESULTS

Of the 226 eligible families, 54% (122) responded to the survey. Approximately 66% of responding parents stated that the information provided by the mailing program was helpful, and 48% had contacted and/or used the programs and services listed in the information sheets. Parents with children younger than 6 months of age at the time of mailing were more likely to find the information helpful, compared to parents with children 6 months of age or older. The majority of responding parents had contacted and/or used the Early Intervention Program.

CONCLUSION

The findings from the current survey show that the statewide information-mailing program administered by CMR is helpful and useful to the families of children with major birth defects in New York State.