Parental coping following childhood acquired brain injury

Cognitive rehabilitation in paediatric acquired brain injury-A 2-year follow-up of a randomised controlled trial

Background

Goal management training (GMT), a metacognitive rehabilitation method that has been demonstrated to improve executive function (EF) in adults with acquired brain injury (ABI), could potentially be effective for children in the chronic phase of ABI. In a previously published randomised controlled trial (RCT), the efficacy of a paediatric adaptation of GMT (pGMT) compared to a psychoeducative control intervention (paediatric Brain Health Workshop, pBHW) was investigated. Comparable improvements in EF in both groups were found at 6-month follow-up. However, a specific effect of pGMT could not be conclusively proven. The present study reports 2-year follow-up data (T4; T1: baseline, T2: post-intervention, T3: 6-month follow-up, and T4: 2-year follow-up) from this original RCT.

Methods

A total of 38 children and adolescents and also their parents completed questionnaires tapping into daily life EF. Explorative analyses were conducted comparing the 2-year follow-up data (T4) with the baseline (T1) and 6-month follow-up data (T3) for T4-participants in the two intervention groups (pGMT; n = 21, pBHW; n = 17), and we also assessed T4-participants vs. non-responders (n = 38) in the RCT. Primary outcome measures were the Behavioural Regulation Index (BRI) and the Metacognition Index (MI) derived from the Behaviour Rating Inventory of Executive Function (BRIEF) parent report.

Results

No difference between intervention groups was found (BRI, F = 2.25, p = 0.143, MI, F = 1.6, p = 0.213), and no time^*group interaction (BRI, F = 0.07, p = 0.976, MI, F = 0.137, p = 0.937) could be seen at the 2-year follow-up. Nevertheless, both pGMT and the pBHW groups improved daily EF as measured by parental reports over time from the baseline to T4 (p = 0.034). T4 participants and non-responders shared similar baseline characteristics.

Conclusion

Our results extend the findings from the 6-month follow-up previously published. Both pGMT and pBHW groups sustained their improvements in daily life EFs from the baseline, but additional effectiveness of pGMT relative to pBHW was not found.

Coping and wellbeing in families with a child with acquired brain injury compared with families in the community

PURPOSE

Paediatric acquired brain injury (ABI) negatively impacts parental wellbeing and family functioning. Adaptive coping, that is behaviours promoting emotional wellbeing and addressing distressing problems, may support wellbeing and family functioning. This study compared wellbeing, coping, and family functioning between parents of a child with ABI and parents in the community, and examined coping as a predictor of wellbeing and family functioning.

METHODS

Forty parents of a child with ABI and 40 parents in the community participated in this cross-sectional survey using the Personal Wellbeing Index, Coping Scale for Adults Short Form, McMaster Family Assessment Device (General Functioning Subscale).

RESULTS

The ABI group had statistically significantly lower wellbeing, t(68.70) = -4.01, p < 0.001, lower adaptive coping, t(73.95) = -3.27, p = 0.002, and poorer family functioning, t(77) = 4.26, p < 0.001. Family composition (single-parent/couple), having a child with ABI, adaptive coping, and non-productive coping predicted 47.7% of the variance in wellbeing, F(5, 70) = 12.75, p < 0.001. Parental education, having a child with ABI, and non-productive coping predicted 35.9% of the variance in family functioning, F(5, 69) = 7.71, p < 0.001.

CONCLUSIONS

Adaptive coping may contribute to better family outcomes in paediatric ABI.Implications for rehabilitationPaediatric ABI may have a significant impact on the child with ABI and the family, leading to poorer outcomes for some families.This study suggested that parents of a child with ABI use adaptive coping less than parents in the community but do not differ in the use of non-productive coping.Families need long-term targeted support to meet the challenges paediatric ABI presents and may benefit from interventions which actively seek to change parental coping strategies.

Anxiety, meaning in life, self-efficacy and resilience in families with one or more members with special educational needs and disability during COVID-19 pandemic in Greece

BACKGROUND

According to World Health Organization, the COVID-19 pandemic sweeps across the world inducing considerable fear, worry and concern in the population.

AIMS

This study explores anxiety, meaning in life, self-efficacy and resilience in university students belonging to families with one or more members with SEND during the COVID-19 pandemic in Greece, the differences between participants and the regression coefficients.

METHODS & PROCEDURES

Study population consisted of 61 participants, aged 20-58 years. A Self-report Questionnaire, the Spielberger State-Trait Anxiety Inventory, the Meaning in Life Questionnaire, the General Self-Efficacy Scale, the Resilience Scale and the Brief Resilience Scale were used for data collection.

OUTCOMES & RESULTS

Participants presented higher levels of anxiety, meaning in life (presence), general self-efficacy and resilience (than average scale). Parents had higher values than university students in state anxiety, state-trait anxiety (total), meaning in life (presence) and resilience. Individuals with higher levels of resilience and meaning in life had lower anxiety levels. A significant correlation was observed for the regression coefficients according to pathway analysis.

CONCLUSIONS AND IMPLICATIONS

Families having members with SEND, although experiencing difficult situations and anxiety due to the unprecedented conditions of the pandemic, activate mechanisms, such as self-efficacy, meaning in life and resilience, to maintain their balance and mental health.

The Caregiving Experiences of Fathers and Mothers of Children With Rare Diseases in Italy: Challenges and Social Support Perceptions

Family caregiving is a growing phenomenon with the increased prevalence of chronic illness and shorter hospitalizations. Rare diseases pose significant challenges not only to patients living with these kinds of pathologies but also to those who care for these patients. The caregiving role has specific characteristics. The present work aims to increase knowledge of the challenges that are common or specific to fathers and mothers of children diagnosed with a rare disease. Moreover, the paper analyses the kinds of social support they experience according to gender. A descriptive study was conducted using grounded theory methodology. A semi-structured interview with open-ended questions was conducted with 15 parents of children with a rare disease. The interview was organized into three main areas: personal experiences in caring for a child with a rare disease, family changes and perceived social support. The transcriptions were analyzed using NVivo 11 software. From data analysis, themes emerged regarding the challenges shared by fathers and mothers, but some aspects also emerged that were gender-specific. The analyses of differences between mothers' and fathers' narratives showed that there is a specific experience of the impact that caregiving has on parents' relationships with their jobs and on their worries. Self-help group is the main source of social support for all respondents. We discuss these findings in relation to possible appropriate specific interventions and support for family caregiving.

Parent experiences and psychosocial support needs 6 months following paediatric critical injury: A qualitative study

INTRODUCTION

Parents of critically injured children can experience high levels of psychological distress post-injury, however little is known about their experiences and needs following injury. This study aimed to explore parent experiences and psychosocial support needs in the six months following child critical injury.

METHODS

An interpretive qualitative design was used. Semi-structured interviews were conducted with 30 parents of 23 critically injured children. Interviews explored parent experiences and psychosocial support needs. Qualitative data were managed using NVIVO 10 and analysed thematically.

RESULTS

Four themes were identified: integrating back into home life; adjusting mentally and emotionally to injury; coping with injury as a family; and navigating resources to meet family needs. Parents and families experienced substantial ongoing emotional impacts at 6 months following child injury. Parents were unprepared for the negative changes in their child's psychological wellbeing and behaviour post injury, and parents' mental health was negatively impacted, with mothers more likely to seek emotional support than fathers. Parents reported receiving no psychosocial follow-up from the hospital and limited information about community services and accessing local community resources on returning home.

CONCLUSIONS

There is a need to include all family members in discharge planning, and to use a family-centred continuity-of-care approach from the time of child injury through to post-discharge recovery. To strengthen parent and family wellbeing, a biopsychosocial holistic approach is recommended, including cognitive-behavioural and other psychological strategies to help reduce distress for parents and all family members and strengthen their coping capacity. A dedicated family support coordinator role to facilitate care over the child recovery trajectory, and development of accessible online and e-psychosocial support resources for parents and families are recommended.

Family appraisal of paediatric acquired brain injury: a social work clinical intervention trial

OBJECTIVE

To compare the efficacy of a new intervention 'Family Forward' with 'Usual Care' social work practice in optimising family appraisal of a child's acquired brain injury to ensure better adaptation during the inpatient rehabilitation phase of care and early transition home.

RESEARCH DESIGN

Single site, prospective, sequential comparison group design.

METHODS AND PROCEDURES

Families were recruited on admission to an inpatient rehabilitation service based at a tertiary paediatric hospital. The 'Usual Care' group (n = 22; 29 parents) recruitment, intervention and data collection were completed first (Phase 1), followed by the 'Family Forward' group (n = 25; 43 parents) (Phase 2). Parents/caregivers completed measures: (Impact of Event Scale- Revised: IES-R; Parents Experience of Childhood Illness and Brief Illness Perception Questionnaire: Brief IPQ) at the time of their child's inpatient rehabilitation admission, inpatient rehabilitation discharge, and 6 weeks post-discharge.

MAIN OUTCOMES AND RESULTS

There were more children with traumatic brain injuries in the Family Forward group (n = 13) than Usual Care (n = 6) and the Family Forward group had a longer hospital admission (days, M = 56.4, SD = 46.1 vs. M = 37.5, SD = 16.4, p = 0.019). No significant group differences were found for family appraisal outcomes at any of the three time-points. Both groups reported reductions in trauma and grief responses, emotional experiences and perceptions of their child's injury at post-intervention and follow-up. Both groups continued to have depleted emotional resources (PECI scale) at 6 weeks post-discharge.

CONCLUSIONS

The study contributes important insights into family appraisal experience in the early stages following paediatric acquired brain injury. In this context, 'Family Forward' needs to incorporate interventions that support and promote ongoing family appraisal as issues related to their child's injury arise over time. Future research is needed to focus on whether the Family Forward approach does sustain family system adaptation (a key aim informing the design of the intervention) over the longer term.

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.

Paediatric neurorehabilitation: finding and filling the gaps through the use of the Institute for Manufacturing strategic roadmapping method

Introduction

Acquired brain injury (ABI) is a major cause of morbidity and mortality in childhood. Specialist rehabilitation services are often situated far from families and local services may be non-standardised and fragmented. A strategic level of understanding is needed to improve patient care and outcomes. Roadmapping techniques are commonly used in industry settings to discover and present a systematic understanding of structures; however, they are rarely used in the healthcare setting. With continuing pressures on healthcare systems worldwide, they provide an effective method for examining services.

Methods

The Institute for Manufacturing (IfM) strategic roadmapping method was used to identify areas of difficulty and opportunities in paediatric neurorehabilitation. Participants included stakeholders from a wide range of professions and sectors who have input with children after ABI.

Results

Delegates identified a range of ‘layers’ covering trends, drivers, current experience and unmet needs. From these layers, four priorities were identified and further expanded.These included: ‘access to medical and therapy expertise close(r) to home’, ‘shared understanding across family, school and health’, ‘family and professional awareness of resources and support’ and ‘establishing a centre for rehabilitation technology evaluation, advice and co-ordination of services and research’.

Conclusion

The IfM strategic roadmapping method identified and developed key areas for development in the field of paediatric neurological rehabilitation. Healthcare professionals looking at strategic level difficulties should strongly consider the use of such systematic tools when evaluating areas of practice.

Maternal and Paternal Distress and Coping Over Time Following Pediatric Traumatic Brain Injury

Objective

Examine differences in maternal and paternal coping and distress following traumatic brain injury (TBI) and orthopedic injuries (OI).

Method

Concurrent cohort/prospective design with five assessments between 1 and an average of 7 years after injury of children aged 3-6 years hospitalized for TBI ( n  = 87) or OI ( n  = 119). Mixed models analyses were used to examine hypotheses.

Results

Overall, fathers reported greater depression and general distress than mothers 18 months after injury, but not at long-term follow-up. Active and acceptance coping were unrelated to parental sex, injury factors, or time since injury. A group × rater × time interaction was noted for Denial coping. Following severe TBI, fathers reported greater denial at 18 months, whereas mothers reported greater denial at the long-term follow-up. Denial coping did not differ between mothers and fathers following OI and moderate TBI.

Conclusions

Parental response to early TBI is complex and may warrant clinical intervention even years after injury.

The supportive care needs of parents with a child with a rare disease: results of an online survey

Background

Parents caring for a child affected by a rare disease have unmet needs, the origins of which are complex and varied. Our aim was to determine the supportive care needs of parents caring for a child with a rare disease.

Methods

An online survey was developed consisting of 45 questions (108 items) and separated into six domains. The survey included questions about perceived level of satisfaction with receiving care, experiences and needs of providing daily care, the impacts of disease on relationships, the emotional and psychological burdens of disease, and parents overall satisfaction with the support received.

Results

Three-hundred and one parents from Australia and New Zealand completed the survey; 91 % (n = 275/301) were mothers, with 132 distinct rare diseases being reported. Fifty-four percent (n = 140/259) of parents were dissatisfied with health professionals’ level of knowledge and awareness of disease; 71 % (n = 130/183) of parents felt they received less support compared to other parents. Information regarding present (60 %, n = 146/240) and future services (72 %, n = 174/240) available for their child were considered important. Almost half of parents (45 %, n = 106/236) struggled financially, 38 % (n = 99/236) reduced their working hours and 34 % (n = 79/236) ceased paid employment. Forty-two percent (n = 99/223) of parents had no access to a disease specific support group, and 58 % (n = 134/230) stated that their number of friends had reduced since the birth of their child; 75 % (n = 173/230) had no contact with other parents with a child with a similar disease, and 46 % (n = 106/230) reported feeling socially isolated and desperately lonely. Most frequent emotions expressed by parents in the week prior to completing the survey were anxiety and fear (53 %, n = 119/223), anger and frustration (46 %, n = 103/223) and uncertainty (39 %, n = 88/223).

Conclusion

This study is the first to develop an online survey specifically for use with parents to investigate their supportive care needs across a large and diverse group of rare diseases. The findings highlight that parents with a child with a rare disease have common unmet needs regardless of what disease their child has. Such information may allow health providers to improve child outcomes through improving parental supportive care.

The Supportive Care Needs of Parents With a Child With a Rare Disease: A Qualitative Descriptive Study

There are few studies that exist which focus specifically on parents with a child with a rare disease. The purpose of this study was to better understand the lived experiences and supportive care needs (SCN) of parents caring for a child across a spectrum of rare diseases. A qualitative descriptive approach was used to guide the research, and four semi-structured focus group interviews were conducted with 23 parents (17 mothers and 6 fathers). Participants described 'feeling boxed-in outside the box' due to a number of limitations unique to their child's disease, daily practical challenges in providing care and the various relational impacts of caring for a child with a rare disease were discussed. The results from this study help to give clearer direction for health professionals on where to focus future efforts in better meeting the supportive care needs of parents and their child with a rare disease.

Determinants of Effective Caregiver Communication After Adolescent Traumatic Brain Injury

OBJECTIVE

To characterize the effects of caregiver mental health and coping strategies on interactions with an injured adolescent acutely after traumatic brain injury (TBI).

DESIGN

Multi-site, cross-sectional study.

SETTING

Outpatient setting of 3 tertiary pediatric hospitals and 2 tertiary general medical centers.

PARTICIPANTS

Adolescents (N = 125) aged 12-17 years, 1-6 months after being hospitalized with complicated mild to severe TBI.

METHODS

Data were collected as part of a multi-site clinical trial of family problem-solving therapy after TBI. Multiple regression analyses were used to examine the relationship of caregiver and environmental characteristics to the dimensions of effective communication, warmth, and negativity during caregiver-adolescent problem-solving discussions.

MAIN OUTCOMES MEASURES

Adolescent and caregiver interactions, as measured by the Iowa Family Interaction Rating Scales.

RESULTS

Caregivers who utilized problem-focused coping strategies were rated as having higher levels of effective communication (P < .01), as were those with higher socioeconomic status (P < .01). Problem-focused coping style and higher socioeconomic status were also associated lower levels of negative interactions (P < .01 and P < .05, respectively). Female gender of the adolescent and fewer children in the home were associated with increased parental warmth during the interaction (P < .01 and P < .05, respectively). Neither adolescent TBI severity nor caregiver depression significantly influenced caregiver-teen interactions.

CONCLUSIONS

Problem-focused coping strategies are associated with higher levels of effective communication and lower levels of caregiver negativity during the initial months after adolescent TBI, suggesting that effective caregiver coping may facilitate better caregiver-adolescent interactions after TBI.

Mothers report more child-rearing disagreements following early brain injury than do fathers

OBJECTIVE

To investigate differences between mother's and father's perceptions of marital relationship quality, child rearing disagreements, and family functioning over the initial 18 months following traumatic brain injury (TBI) in early childhood relative to an orthopedic-injury comparison group.

METHODS

Participants included 147 parent-dyads of children with TBI (n = 53) and orthopedic injuries (OI; n = 94) who were between the ages of 3 and 7 years at injury. Family functioning, marital quality, and child-rearing disagreements were assessed shortly after injury and at 6, 12, and 18-month follow-ups, with ratings at the initial assessment completed to reflect preinjury functioning. Mixed model analyses were used to examine mother and father's reports of family functioning, marital quality, and child-rearing disagreements over time as a function of injury severity and parent gender.

RESULTS

We found a significant Group x Gender interaction for ratings of love and parenting disagreements. As hypothesized, mothers of children with severe TBI rated the relationship as significantly less loving than did their partners, and mothers of children with both moderate and severe TBI endorsed more parenting disagreements than did their partners. However, fathers reported higher levels of family dysfunction than their partners, regardless of injury type or severity.

CONCLUSIONS

Implications for treatment based on differences in mothers' and fathers' perceptions of family and marital functioning, and future directions for research, are discussed.

Parents' experiences following children's moderate to severe traumatic brain injury: a clash of cultures

Little is understood about parents' experiences following children's moderate to severe traumatic brain injury (TBI). Using descriptive phenomenology, we explored common experiences of parents whose children were diagnosed with moderate to severe TBI. Parents from across the United States (N = 42, from 37 families) participated in two semistructured interviews (~ 90 minutes in length and 12 to 15 months apart) in the first 5 years following children's TBI. First interviews were in person. Second interviews, done in person or by phone, facilitated updating parents' experiences and garnering their critique of the descriptive model. Parent themes were (a) grateful to still have my child, (b) grieving for the child I knew, (c) running on nerves, and (d) grappling to get what my child and family need. Parents reported cultural barriers because of others' misunderstandings. More qualitative inquiry is needed to understand how the knowledge, attitudes, beliefs, and culture-based expectations of others influence parents' interactions and the family's adjustment and well-being.

Caregiver functioning following early childhood TBI: do moms and dads respond differently?

INTRODUCTION

Research suggests that pediatric TBI results in injury-related stress and burden and psychological distress for parents. However, existing studies have focused almost exclusively on mothers, so that we know relatively little about the impact of childhood TBI on fathers.

SPECIFIC AIMS

The aims were to prospectively examine differences in maternal and paternal response to early childhood TBI over time relative to a comparison cohort of mothers and fathers of children with orthopedic injuries (OI).

METHODS

The concurrent cohort/prospective research design involved repeated assessments of children aged 3-6 years with TBI or OI requiring hospitalization and their families. Shortly after injury and at 6, 12, and 18 months post injury, parents of 48 children with TBI (11 severe and 37 moderate) and 89 with OI completed standardized assessments of injury-related stress and burden, parental distress, and coping strategies. Mixed models analyses and Generalized Estimating Equations examined differences in maternal versus paternal burden, distress, and coping over time. The analyses included interactions of parent sex with group (severe TBI, moderate TBI, OI) and time since injury, to examine the moderating effects of injury severity on parental response to injury over time.

RESULTS

Fathers were more likely than mothers to use denial to cope following moderate and severe TBI, but not OI. Conversely, mothers were more likely to prefer acceptance and emotion-focused strategies than fathers regardless of the type of injury. The use of active coping strategies varied as a function of injury type, parent sex, and time since injury. Fathers reported greater injury-related stress and distress than mothers over time, with pronounced differences in the severe TBI and OI groups.

CONCLUSIONS

Mothers and fathers appear to respond differently following TBI. The different types of responses may serve to exacerbate emerging family dysfunction.

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.

An exploration of the experience of mothers whose children sustain traumatic brain injury (TBI) and their families

This study aims to describe and explore the lived experience of mothers whose children, aged 0-16 years, have sustained a traumatic brain injury (TBI). Mothers were interviewed between 2 and 10 years following the TBI. The study employed a qualitative method, interpretative phenomenological analysis (IPA), following semi-structured interviews with 10 mothers. Validity measures included independent audit of the analysis. The analysis generated themes of ;changes to and loss of the past child', ;effects on mother's health', ;mother's process of coping and support', ;changed roles', ;effects on the whole family' and ;contact with services'. Discussion of the links between participants' accounts and grief and attachment theories is provided, with a view to informing assessment and rehabilitative practice with children and families. The clinical implications of mothers' descriptions for psychological intervention and service delivery are explored.

Encephalitis in children: a clinical neuropsychology perspective

Encephalitis is an inflammation of brain tissue that can result from a number of viruses and can be contracted at any age, with prevalence in children exceeding adult incidence. In order to illustrate specific cognitive, behavioural and service provision issues related to post-encephalitis rehabilitation of children, this paper examines the pattern of referrals to a specialist regional paediatric neuropsychology service in the United Kingdom. Three case vignettes are presented to demonstrate the wide range of presentations encountered in our service ranging from mild (10%) to moderate (65%) and severe (25%) impairment with 80% of referrals relating to behaviour and educational concerns. On average 13 new referrals are received annually resulting in a cumulative case-load due to the need for serial assessment. The implications for patient care are discussed.

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.

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.