Correlates of psychological distress among mothers of children and adolescents with hemophilia and HIV infection

Psychosocial Challenges Associated with Caregiving in the Context of Pediatric HIV in Rural Eastern Cape

Background

While survival among human immunodeficiency virus (HIV)-infected children has increased due to combination antiretroviral therapy, many children remain vulnerable to the adverse effects of poverty and family disruptions as a result of the loss of one or both biological parents to acquired immunodeficiency syndrome. The aim of this qualitative study was to develop an understanding of the psychosocial challenges experienced by caregivers caring for a child with perinatally acquired HIV.

Method

A series of interviews were conducted with 44 HIV-positive and -negative primary caregivers of HIV+ children. Data were analyzed through interpretative phenomenological analysis using NVivo8 software.

Findings

The findings suggest that caregiving is compromised by inadequate, financial resources and single-headed households where mainly grandparents assume the role of primary caregivers of HIV+ children. HIV remains a stigmatized illness that weakens support networks, as well as timeous and free accessibility to healthcare. This has a negative impact on the mental health of caregivers, with the majority of women in the study displaying symptoms of depression.

Conclusion

The findings highlight the contextual challenges of caregiving in the presence of HIV, which impacts negatively on social ecology of the families. The need for interventions to enhance resilience and coping in families confronted with HIV is indicated.

The evolution of comprehensive haemophilia care in the United States: perspectives from the frontline

The establishment of dedicated comprehensive treatment centres more than a half century ago transformed the management of haemophilia in the United States. Formerly, a disease associated with crippling disability and premature death, today, persons with haemophilia who are treated appropriately from infancy and do not develop inhibitors can expect a normal life expectancy and relatively few bleeding episodes. The evolution of the comprehensive haemophilia care, while chastened by the viral epidemics of the 1980s, has been marked by ongoing advances, including prophylaxis, immune tolerance induction, new drugs and gene therapy research. Current challenges include sustaining the comprehensive care model despite decreased funding and expanding the delivery and affordability of comprehensive haemophilia care.

Factors Related to Depressive Symptoms in Mothers of Technology-Dependent Children

Mothers caring for technology-dependent children at home often suffer clinically significant and unrecognized depressive symptoms. The study aim was to determine factors related to elevated depressive symptoms and provide information to target interventions that assists mothers in self-management of their mental health. Secondary data analysis from a descriptive, correlational study of 75 mothers was performed. Hierarchical multiple regression analysis results indicate that younger, unpartnered mothers with lower normalization efforts and personal resourcefulness, and less care hours, had increased depressive symptoms. The importance of personal resourcefulness and the potential for a resourcefulness training intervention to reduce depressive symptoms are discussed.

Online parent-targeted cognitive-behavioural therapy intervention to improve quality of life in families of young cancer survivors: study protocol for a randomised controlled trial

BACKGROUND

Due to advances in multimodal therapies, most children survive cancer. In addition to the stresses of diagnosis and treatment, many families are now navigating the challenges of survivorship. Without sufficient support, the ongoing distress that parents experience after their child's cancer treatment can negatively impact the quality of life and psychological wellbeing of all family members.

METHODS/DESIGN

The 'Cascade' (Cope, Adapt, Survive: Life after C AncEr) study is a three-arm randomised controlled trial to evaluate the feasibility and efficacy of a new intervention to improve the quality of life of parents of young cancer survivors. Cascade will be compared to a peer-support group control and a 6-month waitlist control. Parents (n = 120) whose child (under 16 years of age) has completed cancer treatment in the past 1 to 12 months will be recruited from hospitals across Australia. Those randomised to receive Cascade will participate in four, weekly, 90-minute online group sessions led live by a psychologist. Cascade involves peer discussion on cognitive-behavioural coping skills, including behavioural activation, thought challenging, mindfulness and acceptance, communication and assertiveness skills training, problem-solving and goal-setting. Participants randomised to peer support will receive four, weekly, 90-minute, live, sessions of non-directive peer support. Participants will complete measures at baseline, directly post-intervention, one month post-intervention, and 6 months post-intervention. The primary outcome will be parents' quality of life. Secondary outcomes include parent depression, anxiety, parenting self-agency, and the quality of life of children in the family. The child cancer survivor and all siblings aged 7 to 15 years will be invited to complete self-report quality of life measures covering physical, emotional, social and school-related domains.

DISCUSSION

This article reviews the empirical rationale for group-based, online cognitive-behavioural therapy in parents of children who have recently finished cancer treatment. The potential challenges of delivering skills-based programs online are highlighted. Cascade's videoconferencing technology has the potential to address the geographic and psychological isolation of families after cancer treatment. Teaching parents coping skills as they resume their normal lives after their child's cancer may see long-term benefits for the quality of life of the family as a whole.

TRIAL REGISTRATION

ACTRN12613000270718 (registered 6 March 2013).

Memory outcomes following cognitive interventions in children with neurological deficits: A review with a focus on under-studied populations

Given the primary role of memory in children's learning and well-being, the aim of this review was to examine the outcomes of memory remediation interventions in children with neurological deficits as a function of the affected memory system and intervention method. Fifty-seven studies that evaluated the outcome of memory interventions in children were identified. Thirty-four studies met the inclusion criteria, and were included in a systematic review. Diverse rehabilitation methods for improving explicit and implicit memory in children were reviewed. The analysis indicates that teaching restoration strategies may improve, and result in the generalisation of, semantic memory and working memory performance in children older than 7 years with mild to moderate memory deficits. Factors such as longer protocols, emotional support, and personal feedback contribute to intervention efficacy. In addition, the use of compensation aids seems to be highly effective in prospective memory tasks. Finally, the review unveiled a lack of studies with young children and the absence of group interventions. These findings point to the importance of future evidence-based intervention protocols in these areas.

Pediatric chronic illness (cancer, cystic fibrosis) effects on well siblings: parents' voices

This study is a secondary analysis of data gathered during baseline data collection prior to a cognitive-psychosocial-respite intervention provided in a randomized controlled trial (RCT). Content analysis was used to identify themes in parents' responses to an open-ended item about their perceptions of the effects on siblings of having a brother or sister who has either cancer or cystic fibrosis (CF). Of 91 themes tallied in the cancer group (n = 29), 74.5% reflected negative manifestations of increased risk in siblings, 1.1% no risk; and 24.2%, positive outcomes. Of 53 themes tallied in the CF group (n = 15), the same three categories had 67.9 %, 0%, and 32.1%, respectively. Contemporary life in these families portrayed in parents' descriptions not only validate the rationale for the RCT done, but also suggest the need in ambulatory pediatrics for intervention research on these vulnerable populations.

A longitudinal study of families with technology-dependent children

Few researchers have longitudinally examined families caring for technology-dependent children at home. We tested a theoretically and empirically based conceptual model by examining family functioning and normalization in 82 mothers (female primary caregivers) twice over 12 months. Time 1 and Time 2 cross-sectional findings were consistent; the only predictor of family functioning was mothers' depressive symptoms. Contrary to the proposed model, normalization, caregiving duration, and home nursing hours were not directly related to family functioning. Baseline family functioning significantly predicted future family functioning. Also, mothers whose children were no longer technology-dependent at Time 2 reported significant improvements in family functioning and normalization. An intervention to address high levels of depressive symptoms of these mothers is essential to optimizing family functioning.

Evaluation of an online peer support network for fathers of a child with a brain tumor

This study explored impacts of an online support network for fathers of a child with a brain tumor. Evaluation comprised pre/post-intervention questionnaires, content analysis of online network postings, and post-intervention qualitative interviews. Findings suggest that this intervention was beneficial to fathers. Positive effects on paternal coping were demonstrated, as were opportunities to grapple with difficult issues related to having a child with a brain tumor. Fathers recommended a combined resource of online and face-to-support, including the development of a support network with a larger participant base. Implications for practice are examined.

Family interaction in pediatric diabetes

Adaptation to type 1 diabetes is optimized in the presence of ongoing family support and supervision. Therefore, it is particularly important to understand how family interactions influence adaptation to the illness. The purpose of this paper is to review the current literature on family interaction in youth with type 1 diabetes. Recent advancements in the literature include greater specificity of types of parental involvement, attention to the role of fathers, acknowledgment of the impact of parental distress, increased use of observational methods, and awareness of the impact of culture. Continued parental involvement-particularly monitoring-in the management of diabetes care is important as children transition into adolescence, and the best outcomes are evident when this involvement occurs in a warm, collaborative manner. Parents need support in managing their own distress to maintain this type of involvement.

Psychosocial aspects of haemophilia: a systematic review of methodologies and findings

Psychosocial factors have a significant impact on quality of life for patients with chronic diseases such as haemophilia. Interventions to support the psychosocial needs of patients and their families, such as offering information and assistance, clarifying doubts, and teaching coping strategies to minimize the impact of disabilities, may help to maximize patient outcomes and improve quality of life for their families. The aim of this study was to evaluate the current literature on psychosocial aspects of haemophilia. Literature searches were performed using the PubMed database to identify studies evaluating psychosocial stressors in persons with haemophilia. Articles pertaining to the HIV epidemic were excluded from the analysis, as were those published before 1997. The literature reviews identified 24 studies, covering a range of different populations, generally with small cohorts (n < 100). Most studies were questionnaire based, with almost no overlap in terms of the instruments used. Only one study combined questionnaire techniques with qualitative methods. Except for two European studies, all publications reported data from a single country. Overall, studies tended to show that quality of life is reduced in persons with haemophilia, with a potential impact on education and employment, particularly when prophylactic treatment is not available. Carrier status in women may have a psychosocial impact and affect reproductive choices. Data on psychosocial aspects of the haemophilia life cycle are lacking in the published literature, along with data from developing countries. There is a need for more international, multifaceted research to explore and quantify the social and psychological aspects of life with haemophilia.

Distress at the Dinner Table? Observed Mealtime Interactions among Treatment-Seeking Families of Obese Children

BACKGROUND: Although family-based, behavioral interventions for pediatric obesity require caregivers to make major changes to dietary intake and the family meal, few studies have examined family functioning, and specifically, mealtime behaviors among families of treatment-seeking obese children. The current study compared mealtime family functioning of treatment-seeking obese children and nonobese demographically matched comparisons using a multimethod design. METHODS: Participants included the families of 27 obese children (BMI ≥95(th) percentile; M body mass index (BMI) z-score values [M zBMI] = 2.55) at the time of treatment initiation and 27 families of nonobese children (M zBMI = 0.17). Each family's evening meal was videotaped and coded for observed family functioning using the Mealtime Interaction Coding System (MICS). Caregivers completed a demographics form and a measure of family mealtime climate. RESULTS: Caregivers of obese children self-reported greater mealtime challenges and a less positive meal environment than non-obese comparisons. There were no significant group differences in observed family mealtime interactions. CONCLUSION: Interestingly, although group means on the observational measure of mealtime family functioning were not significantly different, caregivers of obese children reported greater mealtime stress. Accordingly, it is important in the context of treatment to address caregiver perceptions of mealtime challenges and to examine the extent to which these self-reported challenges affect implementation of treatment recommendations and treatment outcomes.

Kidney transplantation in childhood: mental health and quality of life of children and caregivers

Our objective was to assess the mental health and health-related quality of life (HRQOL) in children and their parents after renal transplantation (TX) compared to healthy controls and children with acute lymphoblastic leukemia (ALL) and to identify possible health status variables associated with impaired mental health and HRQOL. Thirty-eight TX children with a median age of 13 (range 3-19) years were investigated. Mental health was assessed by the Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales and the Strength and Difficulties Questionnaire (SDQ-20). Each mother's own mental health and QOL were assessed by the General Health Questionnaire (GHQ-30) and the Quality of Life Scale (QOLS). Forty children with ALL [median age 11 (8.5-15.4) years] and 42 healthy children [median age 11 (8.9- 15) years] served as controls. Treadmill exercise results from 22 of the 38 patients were included in the analysis. TX children showed significantly higher levels of mental health problems and lower HRQOL at 2 to 16 years after transplantation compared to both control groups. Body mass index and maximal oxygen uptake (n = 22/38) were significant predictors of child mental health (SDQ) and child QOL (PedsQL), respectively. Based on these results, we suggest that rehabilitation after TX should include a focus on physical activity and QOL to reduce interconnected physical and psychological morbidity in kidney TX children.

Parent-teen interactions as predictors of depressive symptoms in adolescents with headache

This study investigated parent-adolescent conflict, family functioning, and adolescent autonomy as predictors of depressive symptoms in adolescents with primary headache. Frequent headaches during adolescence can have a negative impact on activity levels and psychological functioning. Depression is particularly prevalent in adolescents with headache but little research has examined the role of parent-teen interactions in predicting depressive symptoms. Thirty adolescents diagnosed with migraine or chronic daily headache completed self-report measures of pain intensity, parent-adolescent conflict, family functioning, and depression. Adolescents and their parents also participated in three videotaped interaction tasks, scored by independent raters to assess adolescent autonomy. Regression models revealed that pain intensity, parent-adolescent conflict, and autonomy predicted depressive symptoms. Higher levels of conflict, poorer family functioning and lower levels of autonomy were associated with more depressive symptoms. This study highlights the association between parent-teen interactions and psychological functioning in adolescents with primary headache. Implications for intervention are discussed.

Coping and Psychosocial Adjustment in Mothers of Young Children with Type 1 Diabetes

This study examined symptoms of anxiety and depression in mothers of young children with type 1 diabetes (T1D) in relation to mothers' fears of hypoglycemia, perceptions of coping, and children's metabolic control. Sixty-seven mothers of children less than 8 years of age diagnosed with T1D completed self-report measures, and children's metabolic control was measured with glycosolated hemoglobin (HbA1c). Twenty-one percent of mothers reported clinically significant levels of symptoms of anxiety, and twenty-four percent reported clinically significant levels of depression. Lower income level and finding it more upsetting to cope with diabetes-related stress accounted for higher symptoms of anxiety and depression in mothers. Mothers' symptoms were not related to children's metabolic control. Recommendations are made for screening mothers and providing supportive interventions to alleviate their distress.

Psychosocial problems in families of children with cancer

OBJECTIVE

The aim of this study is to assess the effect of diagnosis of cancer on the parents, to study the coping response adopted by the child and the family and to evolve counseling strategies.

METHODS

Prospective questionnaire based. Thirty-four parents of children suffering from cancer were included, of which 15 belonged to joint families and 19 to nuclear families.

RESULTS

The family support played an important role in giving emotional sustenance, besides shared care of the child, the sibling and the household. Emotional and psychological impact was maximum on the mothers. Siblings of the cancer child were also affected both by way of behaviour problems and school performance. Behaviour problems in the cancer child included temper tantrums, as also verbal and physical abuse of mothers. Group therapy was useful for sharing emotional trauma and exchanging day to day problems of childcare. Positive outlook helped in better care of the cancer child.

CONCLUSION

The family structure was the foundation for emotional and psychological security. Psychological support by professional tumour support group would enhance this.

Epilepsien im Jugendalter

Zusammenfassung: Der Beitrag stellt die Bedeutung chronischer Erkrankungen des Jugendalters im Hinblick auf die Interaktion mit allgemeinen normativen Entwicklungsaufgaben der Adoleszenz dar und spezifiziert dann die besonderen psychosozialen Charakteristika der Epilepsie als häufigste neurologische Erkrankung des Jugendalters. Die besondere Bedeutung der Compliance und Aspekte der Krankheitsbewältigung für Jugendliche mit Epilepsie werden im Hinblick auf wichtige entwicklungspsychologische Themen des Jugendalters diskutiert. Bedeutung und Ziele von Patientenschulung als zentraler Behandlungsbaustein bei chronischen Erkrankungen werden erläutert.

Controlled study of critical parent and family factors in the obesigenic environment

OBJECTIVE

Critical gaps remain in our understanding of the obesigenic family environment. This study examines parent and family characteristics among obese youth presenting for treatment in a clinic setting.

RESEARCH METHODS AND PROCEDURES

Families of 78 obese youth (BMI z-score = 2.4; age, 8 to 16 years; 59% girls; 49% African-American) were compared with 71 non-overweight (BMI z-score = -0.02) demographically matched comparisons. Parents completed measures assessing family demographics, psychological distress (Symptom Checklist 90-Revised), and family functioning both broadly (Family Environment Scale: Conflicted, Support, Control) and at mealtimes (About Your Child's Eating-Revised: Mealtime Challenges, Positive Mealtime Interaction). Height and weight were obtained from all participants.

RESULTS

Compared with mothers and fathers of non-overweight youth, parents of obese youth had significantly higher BMIs (p < 0.001). Mothers of obese youth reported significantly greater psychological distress (p < 0.01), higher family conflict (p < 0.05), and more mealtime challenges (p < 0.01). Less positive family mealtime interactions were reported by both mothers (p < 0.01) and fathers (p < 0.05) of obese youth. These group differences did not vary by child sex or race. Logistic regression analyses indicated that maternal distress and mealtime challenges discriminated between obese and non-overweight youth after controlling for maternal BMI. Family conflict was explained, in part, by maternal distress.

DISCUSSION

Obese youth who present for treatment in a clinic setting are characterized by psychosocial factors at the parent and family level that differ from non-overweight youth. These data are critical because they identify factors that may be serving as barriers to a family's or youth's ability to implement healthy lifestyle behaviors but that are potentially modifiable.

Youth With Epilepsy: Development of a Model of Children's Attitudes Toward Their Condition

A model of children's attitudes toward their epilepsy was tested in 173 children (9-14 years) with epilepsy and their parents. Predictor variables tested were child characteristics, family mastery, child worry, child self-efficacy for seizure management, child psychosocial care needs, and seizure variables. Data were analyzed using structural equation modeling, leading to a revised model in which less child worry, greater family mastery, and greater child seizure self-efficacy were directly related to more child positive attitudes. Discussion focuses on potential targets for psychosocial interventions aimed at improving attitudes toward epilepsy.

The impact of newly diagnosed chronic paediatric conditions on parental quality of life

OBJECTIVE

Parental functioning and well-being are important aspects of a family's adaptation to chronic paediatric conditions. This study investigates the effects of diagnosis (cancer vs. diabetes/epilepsy) and time since diagnosis on parental quality of life (PQL).

METHODS

122 parents (66 mothers, 56 fathers), whose children were diagnosed and treated for one chronic disease, filled in the Ulm Quality of Life Inventory for Parents twice within the first three months after the initial diagnosis. The effects of diagnosis and time (1-2 weeks and 2-3 months after diagnosis) on PQL were analysed separately for mothers and fathers.

RESULTS

Parents of a child with cancer consistently reported lower PQL compared with parents of a child with diabetes/epilepsy. Only the fathers' well-being increased significantly within the first three months after the child was diagnosed for a chronic disease. However, in most of the PQL domains there was a persistent impairment within the time-frame of this study. Parents of children with a chronic disease were more satisfied with their family situation than healthy controls. Age of the child was positively correlated with PQL.

CONCLUSIONS

A diagnosis of cancer, especially in young children, has a strong negative effect on PQL. Measuring PQL in a preventive approach would help to identify vulnerable parents and to provide psychosocial support in time.

Family functioning in children and adolescents with spina bifida: an evidence-based review of research and interventions

Research on the adjustment of families of children with spina bifida is reviewed, with a focus on delineating the impact of spina bifida on family functioning, the strengths and weaknesses of past research, and the needs for future evidence-based research on family interventions with this population. PsychINFO and MEDLINE literature searches were used to identify studies of family functioning and family-based interventions for children with spina bifida. Identified studies were empirically evaluated for the presence or absence of key methodological or analytic criteria. Thirty-two studies of family functioning were identified from 25 separate research groups; most studies displayed significant methodological limitations. No published studies of interventions to promote adaptive family functioning were identified. Methodologically sound, longitudinal, and theory-driven studies of family functioning are needed, as are randomized family-based intervention trials to promote adaptive functioning and better psychosocial outcomes in families of children with spina bifida. Specific recommendations for future work as well as clinical implications are noted.

Direct clinician-delivered versus indirect family-supported rehabilitation of children with traumatic brain injury: a randomized controlled trial

PRIMARY OBJECTIVES

To explore the relative effectiveness of clinician-delivered vs family-supported interventions for children with chronic impairment after TBI.

RESEARCH DESIGN

Randomized controlled clinical trial.

METHODS AND PROCEDURES

Children aged 5-12 years in the chronic phase of their recovery were randomly assigned to the clinician-delivered or to the family-supported intervention group; both samples received intensive services for 1 year; physical outcome was measured by the SARAH scales, cognitive outcome by the WISC-III.

MAIN OUTCOMES AND RESULTS

Parents in the family-supported intervention sample efficiently acquired the skills needed to deliver physical and cognitive interventions within the context of everyday routines of the child's life at home; family education level was not a factor. Although both groups demonstrated improvements, only the children in the family-supported intervention group demonstrated statistically significant--and clinically important--improvements on both outcome measures.

CONCLUSIONS

This RCT provides compelling evidence for organizing cognitive and physical interventions and supports for children with TBI around the everyday routines of their lives, with intensive supports for their families.

Entwicklung eines Fragebogens zur familienbezogenen Lebensqualität (FLQ) für Mütter mit chronisch kranken Kindern

Zusammenfassung. Zur Entwicklung eines Fragebogens zur familienbezogenen Lebensqualität von Müttern mit chronisch kranken Kindern wurden Aussagen zusammengestellt, die bedeutsame Aspekte des persönlichen Wohlbefindens von Müttern, die durch die Betreuung und Versorgung ihres Kindes in die Familie eingebunden sind, beinhalten. Die Überprüfung der Faktorenstruktur des Fragebogens zur familienbezogenen Lebensqualität (FLQ) an zwei Stichproben von Müttern mit epilepsiekranken Kindern ergab drei gut interpretierbare Faktoren, auf deren Grundlage drei Subskalen gebildet wurden (Entlastung und Selbstverwirklichung, Energie und Aktivität, Sozialer Rückhalt in der Familie). Zur Überprüfung der Validität des FLQ wurden Zusammenhänge mit familiären Stressoren (kritische Lebensereignisse, krankheitsbedingte Anforderungen, Funktionsbeeinträchtigungen und Verhaltensauffälligkeiten des Kindes), der mütterlichen Belastung (psychovegetative Stresssymptome, PSI), dem mütterlichen Coping und der Funktionsfähigkeit der Familie ermittelt. Der FLQ war weitgehend unabhängig von den objektiven Anforderungen, die sich für die Mütter aus den familiären Stressoren ergeben. Substanzielle Zusammenhänge ergaben sich mit der mütterlichen Belastung, der familiären Funktionsfähigkeit und der Adaptivität des mütterlichen Copings.

Chronische Krankheiten

Zusammenfassung. Zur Übersicht über Anforderungen und Belastungen in Familien mit chronisch kranken Kindern und Jugendlichen wird ein allgemeines Rahmenkonzept vorgestellt, das der Familienstresstheorie entlehnt ist. Es beschreibt den Zusammenhang zwischen den potenziellen Stressoren, mit denen Familien mit chronisch kranken Kindern und Jugendlichen konfrontiert sind, den moderierenden und vermittelnden Prozessen, die verantwortlich dafür sind, wie sich die Stressoren auswirken und der psychosozialen Anpassung, die Aufschluss darüber gibt, wie gut es der Familie und den betroffenen Kindern und Jugendlichen gelingt, die Anforderungen und Belastungen zu bewältigen.

Conversational strategies with parents of newly diagnosed leukaemic children: an analysis of 4880 conversational turns

GOALS OF WORK

Communication with parents of children newly diagnosed with cancer poses a number of problems, mostly due to the psychological effects of parental trauma. This study was designed to answer the following questions: How can we sustain the flow of communication with parents of children newly diagnosed with leukaemia so that it may become easier and more effective? What should we say to gather more reliable information from parents? How can we help empower their coping strategies?

PATIENTS AND METHODS

We analysed 4880 conversational turns in individual conversations carried out between psychologists and 21 parents of children with leukaemia. The conversations were aimed at gathering information of the families' daily routines. Dialogues were audiotaped and fully transcribed. The type and frequency of speech acts present in each turn were coded along 18 categories by two independent judges (inter-rater agreement, Cohen Kappa =0.73).

MAIN RESULTS

The parental speech acts expressing emotion in various ways go up to 58% of the total number of their speech acts. The lag-sequential analysis showed that such expressions are not associated with any of the interviewer's speech act. The same analysis showed that, by contrast, the interviewer's style has an effect upon the cognitive aspects of parents' conversation. Support of hope favoured parental ability to identify their coping strategies. Explicit requests, confirmations such as "sure" and key words summarizing parents' viewpoints are followed by parental factual and objective narratives.

CONCLUSIONS

Based on these results, a few practical recommendations for health care professionals are given in order to better communicate with parents of children newly diagnosed with cancer.

Illness appraisals in paediatric patients and their parents: A short scale

Seven illness appraisals (situation and resource appraisals) were examined in paediatric patients with cancer, diabetes, or accidental injuries and their parents. It was hypothesized that situation appraisals but not resource appraisals would co-vary with the diagnosis and other medical variables. It was also expected that corresponding appraisals in children and their parents would be associated. 244 newly hospitalised paediatric patients (aged 6-16 years) with cancer, diabetes or an accidental injury were interviewed regarding illness appraisals. Corresponding parent illness appraisals were assessed by means of a questionnaire. Situation appraisals co-varied with medical diagnosis and other medical variables in both patients and their parents. There were also associations between corresponding parents’ appraisals and paediatric patients’ appraisals. Findings encourage measurement of distinct categories of illness appraisals.

Development and preliminary validation of a self-efficacy measure for use among parents of children with juvenile idiopathic arthritis

OBJECTIVE

To develop a valid and reliable measure to assess parents' perceived ability to control, or manage, aspects of their children's juvenile idiopathic arthritis (JIA).

METHODS

Construction of the Parent's Arthritis Self-Efficacy Scale (PASE) was based on existing knowledge and the results of focus groups with parents of children with JIA, children with JIA, and health professionals. Data for validation of the PASE were collected by self-administered questionnaires completed by 178 parents and 89 children with JIA.

RESULTS

Analyses revealed a 2-factor structure for both mothers and fathers. These factors related to parents' self-efficacy for managing children's arthritis-related symptoms and psychosocial health. Taken together, the two factors explained 75.5% and 65.8% of the total variance (mothers' and fathers,' respectively). The PASE demonstrated high internal consistency, concurrent validity, and construct validity, particularly among mothers.

CONCLUSION

Preliminary findings suggest that the PASE is worthy of further psychometric testing and may have the potential to help delineate variations in adjustment among parents of children with JIA.

Psychopathology and familial stress - comparison of boys with Fragile X syndrome and spinal muscular atrophy

BACKGROUND

Chronic illness and mental retardation are both associated with an increased rate of behavioural problems in children and with considerable emotional strain in families. The aim of the study was to analyse and compare the specific effects of two exemplary conditions on familial stress and coping.

METHODS

Forty-nine boys with Fragile X syndrome (FXS) were compared with 46 boys with Spinal Muscular Atrophy (SMA) and 32 male controls. Intelligence was measured with the RAVEN or K-ABC tests. Psychopathology was assessed with the CBCL questionnaire and a structured psychiatric interview (Kinder-DIPS), parental stress with the QRS, coping with the F-COPES and social support with the F-SOZU questionnaires.

RESULTS

The mean age of the FXS boys was 8.6, of the SMA boys 12.7 and of the controls 11.2 years. The mean IQ was 47 for the FXS, 112 for the SMA and 103 for the control groups. According to the CBCL, 89.8% of the FXS boys, 21.7% of the SMA and 15.7% of the controls had a total score in the borderline or clinical range. The rates were 63.3%, 34.8% and 21.9% for internalising and 67.3%, 10.9% and 18.8% for externalising behaviour, respectively. 81.6% of the FXS and 10.9% of the SMA patients had a DSM-IV or ICD-10 psychiatric diagnosis. The most common were ADHD (FXS: 36) and Separation Anxiety Disorder (SMA: 4). In total, parental stress was significantly higher in the FXS than in the SMA families (and in both compared to controls). There were no major inter-group differences regarding social support and familial coping.

CONCLUSIONS

Children with FXS are severely mentally retarded and have a high rate of mainly externalising disorders. Despite good coping abilities and social support, this is associated with high familial stress. The SMA boys, with an intelligence in the upper normal range, are no more deviant than their healthy controls. Parental stress is lower in the SMA families with good coping abilities. In conclusion, families with mentally retarded children are in even greater need of help than those of children with severe chronic illness/physical handicap.

Child-rearing practices of primary caregivers of HIV-infected children: An integrative review of the literature

The number of human immunodeficiency virus (HIV)-infected children has increased because of the HIV and acquired immunodeficiency syndrome epidemic. Yet little is known about the child-rearing practices of these children's primary caregivers. The purpose of this article is to describe what is known about the child-rearing practices of primary caregivers of HIV-infected children. The review covers a 10-year period from 1990 to 2000. Three electronic bibliographic databases (MEDLINE, CINAHL, and AIDSLINE) were explored. Key words used were HIV-positive children, caregivers, and child-rearing. A total of 50 papers were examined. Using the Matrix Method, each paper was evaluated according to five frames of reference: journal, purpose, sample, method, and findings. Content analysis was used to identity salient themes. Themes that emerged were: caregiver, child, and interactions or child-rearing practices. These findings affirm the parent-child interaction model generated by Kathryn E. Barnard and support this framework as a tool for investigating the relationships between these children and their caregivers.

Parental coping with the diagnosis of childhood cancer: gender effects, dissimilarity within couples, and quality of life

OBJECTIVE

Considering coping as dynamic process within the family, effects of gender and diagnosis are investigated. Dissimilarity within couples in coping with childhood cancer is studied longitudinally in its effects on quality of life of mothers, fathers, and the sick children.

METHODS

A total of 108 parents out of 54 complete families participated in a prospective study. Twenty-five families had a child newly diagnosed with cancer, 29 families had a child newly diagnosed with juvenile diabetes or epilepsy. The Coping Health Inventory for Parents, the Trier Coping Scales, and the Ulm Quality-of-Life Inventory for Parents were employed 1-2 weeks after diagnosis and again 10-12 weeks after diagnosis.

RESULTS

In face of childhood cancer, parents develop more rumination, defense, and information seeking, and less social support seeking strategies compared to the control group. Mothers report more frequent and more effective coping compared with fathers, but mothers and fathers do not differ in their self-reported quality of life. No convergence within couples could be demonstrated in most of the corresponding coping styles. The strongest correlation between mothers and fathers appeared in the religious coping style (r=0.60, p<0.001). Coping dissimilarity within couples in social support seeking and religion is correlated with an improvement of parental quality of life. Parental dissimilarity in information seeking is correlated with a decrease in the child's quality of life.

CONCLUSION

Coping dissimilarities between fathers and mothers have differential effects on the family members. For this reason, psychosocial interventions should support dis-synchrony when it appears adaptive, and they should help parents to overcome those differences that negatively affect their child.

Developing psychosocial aftercare for children surviving cancer and their families

More children than ever are surviving childhood cancer. However, the medical and psychosocial consequences of their longer survival are becoming clear for former patients and their families, underlining the need for aftercare. Whereas the need for medical follow-up programs is widely recognized, psychosocial aftercare is still in its infancy. This paper presents a systematic approach to developing psychosocial aftercare based on evidence from research studies. First, the family member most in need of aftercare is identified. Research findings indicate that the child surviving cancer is most seriously affected by the cancer experience, followed by mothers and fathers, whereas siblings are least affected. Accordingly, former patients and parents should be the primary target groups. Second, different types of interventions need to be developed based on the nature of the problems of the target groups and the individual's level of adjustment. Finally, psychosocial aftercare programs need to demonstrate their effectiveness in reducing late effects and improving the quality of life after treatment ends. If our aim is to cure the child truly of cancer, than the development of psychosocial aftercare, its clinical application, and evaluation of its effectiveness will be the challenge for paediatric psycho-oncology in years to come.

Childhood cancer: a 4-year prospective study of the psychological adjustment of children and parents

PURPOSE

The objective of this 4-year prospective study was to assess the psychological adjustment of children treated for cancer and their parents.

PATIENTS AND METHODS

Children aged 2 to 12 years with cancer diagnosed and their parents and families (n = 39) were assessed immediately after their diagnosis and then annually for the next 4 years. At each assessment, the psychological adjustment of the children and their families was compared with the adjustment of a cohort of children and families in the general community (n = 49).

RESULTS

Immediately after the diagnosis of cancer in the children, the children and their parents had significantly more psychological problems than children and parents in the community. However, at subsequent assessments, there was no difference in the number of psychological problems experienced by children and parents in the two groups.

CONCLUSIONS

In the longer term, the prevalence of psychological problems experienced by children treated for cancer and their parents does not differ from that found in children and parents in the general community. Future research should give greater attention to other aspects of the lives of children treated for cancer and their parents, including their broader health-related quality of life.