Parental burden, coping, and family functioning in primary caregivers of children with Joubert syndrome

Caregiver burden in Bardet-Biedl syndrome: findings from the CARE-BBS study

BACKGROUND

Bardet-Biedl syndrome (BBS) is a rare, genetically heterogeneous obesity syndrome associated with hyperphagia. Given the early onset of BBS symptoms in childhood and multifaceted complications, this study aimed to quantify the caregiver burden associated with BBS.

METHODS

A cross-sectional, multi-country survey of caregivers from the United States (US), United Kingdom (UK), Canada, and Germany was designed to quantify the extent of caregiver burden associated with obesity and hyperphagia symptoms (i.e., uncontrollable hunger) among patients with BBS.

RESULTS

A total of 242 caregivers across the four countries met the inclusion criteria and completed the survey. The mean (standard deviation [SD]) age of the caregivers was 41.9 (6.7) years, and the mean (SD) age of individuals with BBS in their care was 12.0 (3.7) years. Hyperphagia contributed to a BBS diagnosis in 230 of 242 individuals (95.0%). On average, caregivers used eight different weight management approaches for those in their care and expressed a strong desire for more effective weight management methods. Based on the Impacts of Hyperphagia: Caregiver version, patients' hyperphagia had a moderate-to-severe impact on caregiver mood (56.6%), sleep (46.6%), and relationships (48.0%). Caregivers reported experiencing a high level of personal strain (mean [SD], 17.1 [2.9]) and family impact (mean [SD] score, 26.0 [3.8]) due to BBS, as measured by the Revised Impact on Family Scale. Among caregivers in the workforce, there also was high impairment in total work productivity (mean [SD], 60.9% [21.4%]) due to caring for patients with BBS according to the Work Productivity and Activity Impairment. More than half (53%) of the caregivers reported spending over 5,000 out-of-pocket in local currency for medical expenses for the patient with BBS in their care.

CONCLUSIONS

Obesity and hyperphagia have negative impacts on the lives of caregivers of patients with BBS. The burden is demonstrated to be multifaceted, with various components that may interact with and confound each other, including intensive weight management efforts, productivity loses, impaired family dynamics and out-of-pocket medical expenses.

Parental stress and adjustment in the context of rare genetic syndromes: A scoping review

Chromosomal abnormalities are now considered a common cause of intellectual disability. With increased genetic testing, phenotyping and technological advancements, many new syndromes have been identified. This review sought to explore parental stress and adjustment in the context of rare genetic syndromes to evaluate their clinical impact. A systematic review of English peer-reviewed literature across three databases (PsycINFO, Medline, CINAHL) was completed and 69 articles were included. Parents of children with rare genetic syndromes experienced greater distress relative to other disabilities. Differences in parental wellbeing were syndrome-specific relative to ASD thus demonstrating the need to consider the contribution of syndrome-specific phenotypes. Child emotional and behavioural difficulties were the most consistent predictor of parental distress. Research reflecting other factors such as physical health, syndrome-specific behaviours, benefit finding and, parental appraisal in the context of a rare genetic aetiology is required in order to support parental adjustment in these conditions.

Psychological Well-Being, Marital Satisfaction, and Parental Burnout in Iranian Parents: The Effect of Home Quarantine During COVID-19 Outbreaks

Coronavirus disease 2019 (COVID-19), as an infectious disease, is now prevalent in many countries around the world, which has recently led many governments to home quarantine and impose penalties for violating quarantine. Concerns and stress caused by lockdown and social isolation led to personal and interactive reactions in some families, which are also culturally important to address. This study was administrated to study the psychological well-being and the effect of home quarantine on marital satisfaction (MS) and parental burnout (PB) from parenting responsibilities during the prevalence of COVID-19 in Iranian parents. A total of 213 parents (140 mothers and 73 fathers) voluntarily participated in the online survey in the period of February to mid-April 2020 and completed the 5-item index of the well-being of the World Health Organization (WHO-5), the Kansas Marital Satisfaction Scale (KMSS), and the Parental Burnout Assessment (PBA). The results showed that the effect of home quarantine on MS and PB was not significant in parents (p > 0.01). The interactive effect of home quarantine and gender was not significant on MS and PB (p > 0.01). In addition, the mothers significantly reported higher PB than the fathers, but the fathers had higher scores in MS and psychological well-being (p < 0.01). The effect of some demographic factors on the studied variables was also significant. Supportive resources in family-based culture may play an essential role to reduce the negative effects of stressful situations on family interactions.

Correlates of Subjective Caregiver Strain in Caregivers of Youth Evaluated in a Pediatric Psychiatric Emergency Room

BACKGROUND

Although caregiver burden is relevant to the outcome for psychiatrically ill youth, most studies have focused on caregiver burden in the community or research settings. Therefore, we aimed at evaluating the subjective caregiver strain (SCS) at the time of presentation of youth to a pediatric psychiatric emergency room (PPER), assessing potential correlates to provide leads for improvements in formal support systems.

METHODS

In this retrospective cohort study, the internalized, externalized, and total SCS were assessed in caregivers of youth <18 years of age consecutively evaluated at a PPER during a 1 year period using the Caregiver Strain Questionnaire. Sociodemographic and a broad range of clinical data were collected during the PPER visit using a 12-page semistructured institutional evaluation form. The Appropriateness of Pediatric Psychiatric Emergency Room Contact scale, incorporating acuity, severity and harm potential, was used to rate appropriateness of the visit.

RESULTS

In caregivers of 444 youth, the internalized SCS was significantly higher than the externalized SCS (p < 0.001). Multivariable analyses indicated that higher total and externalized SCS were associated with disruptive behavior or substance abuse/dependent disorder diagnosis, presenting complaint of aggression, and discharge plan to the police. Higher total and internalized SCS were associated with lower child functioning, whereas total and internalized SCS were lower in adopted children. In addition, higher externalized SCS was associated with investigator-rated inappropriateness of the emergency visit, presenting complaint of defiance, and a lack of prior psychiatric ER visits.

CONCLUSIONS

High levels of CS in PPER highlight the necessity to adhere to existing guidelines regarding the inclusion of caregivers' perceptions into comprehensive psychiatric assessments. The particularly high strain in caregivers of children with externalizing disorders and in families with low-functioning youth may need to prompt PPER staff to provide efficient information on appropriate treatment options for these children and on support facilities for the parents.

The Impact of Community Paediatric Occupational Therapy on Children with Disabilities and Their Carers

The need to demonstrate ‘best value’ in local authority settings is one of the remits of the white paper Modernising Social Services (Department of Health 1997). This study investigated the effectiveness of paediatric occupational therapy in terms of both increasing the independence of disabled children and reducing the strain of caring on the part of the carers. A before-and-after design was used, in which 33 children with a wide range of disabilities were assessed using two measures — the Community Dependency Index and the Canadian Occupational Performance Measure — prior to receiving and then following occupational therapy. The carers were interviewed separately, using three scales to assess the strain associated with their caring tasks.

The findings show a statistically significant shift in the children's scores indicating that the levels of independence improved for most of the children, although many remained dependent on their carers for a number of daily living tasks. While the carers found the occupational therapy service very satisfactory, the evidence suggests that it did not reduce the strain of caring.

Cognitive rehabilitation in a child with Joubert Syndrome: Developmental trends and adaptive changes in a single case report

We report the clinical and rehabilitative follow up of M, a female child carrying a compound heterozygous pathogenic mutations in the TCTN1 gene and affected by Joubert Syndrome (JS). JS is a congenital cerebellar ataxia characterized by "the molar tooth sign" on axial MRI, a pathognomonic neuroradiological malformation involving the cerebellum and brainstem. JS presents with high phenotypic/cognitive variability, and little is known about cognitive rehabilitation programs. We describe the therapeutic settings, intensive rehabilitation targets and outcome indexes in M's cognitive development. Using a single case evidence-based approach, we attempt to distinguish the effectiveness of the intervention from the overall developmental trend. We assume that an adequate amount of focused, goal directed treatment in a relative short period of time can be at least as effective as one provided in longer time, and much less interfering with the child's everyday life. We conclude by discussing specific issues in cognitive development and rehabilitation in JS and, more broadly, in cerebellar malformations.

Linking caregiver strain to diabetes illness management and health outcomes in a sample of adolescents in chronically poor metabolic control

OBJECTIVE

This study examined a multivariate model of the relationship between caregiver strain and adolescent diabetes illness outcomes in a sample of caregivers of adolescents in chronically poor metabolic control (hemoglobin A1c ≥8.0% at enrollment and for previous 12 mo). Caregiver mental health symptoms were hypothesized to mediate the relationship between caregiver strain and adolescent illness management behavior and metabolic control. Caregivers' perceptions of social support and their level of responsibility for diabetes care tasks were hypothesized to be directly related to caregiver strain and indirectly to caregiver mental health symptoms.

METHODS

One hundred forty-six caregiver-adolescent dyads completed baseline measures of caregiver strain, responsibility for diabetes care, social support, mental health symptoms, and illness management behavior. Adolescent metabolic control was also assessed.

RESULTS

Findings from structural equation modeling suggested that caregiver strain was directly and positively associated with caregiver mental health symptoms which mediated the relationship to adolescent diabetes management behavior and metabolic control. Caregivers' responsibility for diabetes care tasks was directly related to caregiver strain and indirectly to caregiver mental health, but caregivers' perception of social support was not.

CONCLUSIONS

These findings suggest that caregiver strain is an important dimension of the caregiving context of diabetes. Clinicians and researchers should consider how caregiving strain, responsibility for illness management, and mental health symptoms might be impacting children's diabetes care behavior and diabetes health when working with and designing interventions for adolescents with diabetes.

The daily patterns of time use for parents of children with complex needs: a systematic review

The aim of this systematic review was to critically examine the research that quantifies and describes the daily patterns of time use by parents of children with complex needs. Four electronic databases were searched. A total of 32 studies (30 peer-reviewed journal articles and two theses) met the inclusion criteria. Three key findings emerged from the review: (a) Parents of children with complex needs carry a significant caregiving burden that often does not reduce as the age of the child increases, (b) supervision or 'vigilance' is a category of childcare that carries a particular time requirement for these parents and (c) parents of children with complex needs spend (sometimes considerable) time undertaking health care-related tasks outside the 'normal' parenting role. The time demands placed on parents caring for a child or children with complex needs at home should be considered when health professionals are negotiating essential and/or additional therapies or treatments to be included in a child's home care regime.

The effects of caregiver social connections on caregiver, child, and family well-being

This study examines the degree to which caregiver social connectedness influences the effects of strain associated with caring for a child with severe emotional disturbance (SED) on caregiver well-being. We propose a model describing the relationships among the variables of interest and investigate elements of this model. Caregiver strain and social connections were significantly associated with caregiver well-being. Although, no significant interaction effects of caregiver strain and social connections were detected, study findings suggest that caregiver well-being can affect child progress and adjustment. Implications for child- and family-serving systems are considered.

Psychometric properties of the Caregiver Strain Questionnaire (CGSQ) among caregivers of children with autism

The purpose of this study was to test the psychometric properties of the Caregiver Strain Questionnaire (CGSQ) among caregivers of children with autism. The CGSQ was originally developed to assess burden experienced by parents of children and adolescents with serious emotional and behavioral disorders. Study data was collected from 304 primary caregivers ofchildren with autism using a cross-sectional survey design. We tested the one-, two-, and three-factor CGSQ model. Though the three-factor CGSQ model fit better than the one- and two-factor model, it was still short of an acceptable fit. Minor modifications were made to the three-factor model by correlating error terms. The modified three-factor CGSQ model with correlated error indicated reasonable fit with the data. The 21-item CGSQ had good convergent validity, as indicated by the correlation of its three subscales with constructs including mental health-related quality of life, maladaptive coping, social support, family functioning, and care recipient level of functional impairment and extent of behavioral problems, respectively. The internal consistency reliability of the instrument was also good, and there were no floor and ceiling effects. The CGSQ was found to be a reliable and valid instrument to assess burden among caregivers of children with autism.

When resources get sparse: A longitudinal, qualitative study of emotions, coping and resource-creation when parenting a young child with severe disabilities

Parents who realize that their newborn child is severely disabled often experience severe physical and emotional stress. Parental well-being is essential for the care-taking of the child. It is yet not known why some cope well and others do not. The aim of this study was to explore how parents coped with parenting a disabled child and how they maintained their energy and personal resources. We explored parents’ experiences, coping and resources over a two-year period after their child was diagnosed with a severely disabling condition using a qualitative, longitudinal approach. Findings were interpreted in a theoretical framework of Lazarus and Folkman’s studies on coping and Fredrickson’s broaden-and-build theory of positive emotions, as well as theories of positive illusions and benefit finding during severe adversity. We found that parents continually created and sustained their personal resources through positive cognitive reappraisals of their circumstances, the consequences of those circumstances and their coping possibilities. Nine main coping strategies were identified constituting transformative pathways in resource-creation. A theory of resource-creation is proposed as an addition to the current understanding of coping and the role of positive emotions. Coping and resources were found to be closely interrelated and portals of intervention are discussed.

Factors associated with positive adjustment in siblings of children with severe emotional disturbance: the role of family resources and community life

This study builds on the scant research involving siblings of children with severe emotional disturbances (SED) and examines: associations between adversity experiences and adjustment among 5- to 10-year-old siblings, and relations among family resources, community life, and sibling adjustment. Caregivers from 100 families completed standardized indicators of sibling adjustment and scales reflecting multiple contextual variables. Results document negative associations between stress exposure and sibling adjustment. Regression models also indicate positive associations between the caregiver-child relationship and broader family resources on sibling behavioral and emotional strengths, even after accounting for adversity experiences; adversity exposure was the prime correlate in regression models involving sibling oppositional behavior. Analyses also suggest that strain related to parenting a child with SED is associated with sibling adjustment. This work documents the needs of these siblings and their family systems and highlights the relevance of not only core proximal influences (e.g., child-caregiver relationship) but also elements of their broader contexts. Implications and recommendations are described, including the need to support plans of care that involve services, supports, or preventive strategies for these siblings.

Responding to the needs of children and families after a disaster: linkages between unmet needs and caregiver functioning

Disasters may negatively influence caregivers' ability to respond to the needs of their families. In this context, service organizations' response to families' needs may affect caregivers' symptoms and parenting. Interviews were conducted with caregivers affected by Hurricane Katrina approximately 1 year (T(1); N = 68) and 2 years posthurricane (T(2); N = 52). Caregivers reported high levels of service needs and unmet needs for themselves and their child(ren) and family at both time points. Regression analyses indicated that after accounting for hurricane exposure: (a) child unmet service needs significantly contributed to T(1) caregiver distress, (b) caregiver service needs and child unmet needs were associated with higher levels of posttraumatic stress symptoms, and (c) caregiver unmet needs related to greater strain at T(1). At T(2), after accounting for T(1) scores, service need variables did not contribute to distress or posttraumatic stress symptoms. Caregiver strain at T(1) and T(1) child service needs were associated with greater T(2) strain. These findings highlight the importance of extending the availability of services beyond the initial postdisaster recovery period to better meet the needs of caregivers and families.

Siblings of children with severe emotional disturbances: risks, resources, and adaptation

This study examines risks, resources, and adjustment among siblings of children with severe emotional disturbances (SED) involved in an initiative to develop family centered Systems of Care in North Carolina. These siblings experience many of the same risks as the children who have been diagnosed with SED (i.e., "targets"), but have received relatively little attention from the system or researchers. This first systematic study of these siblings describes an early sample (n = 56), compares them to their system-identified brothers and sisters, and explores contextual factors related to sibling resources and adjustment. Findings suggest the siblings, much like the targets: (a) have been exposed to extremely high levels of adversity, and (b) evidence substantial variability in behavioral and emotional strengths and social-emotional adjustment. Although many siblings exhibit significant strengths and positive adjustment, a substantial proportion displays levels of competencies or problem behaviors on par with those targeted to receive services. Factors associated with positive sibling adjustment are consistent with those identified in prior risk and resilience work. Additional systematic study of these children could have implications for service delivery and preventive interventions.

Validation of the Subjective and Objective Family Burden Interview (SOFBI/ECFOS) in primary caregivers to adults with intellectual disabilities living in the community

BACKGROUND

There is little information on the psychometric properties of instruments for assessing family care burden in adults with intellectual disabilities (ID). The aim of this study is therefore to analyse the usefulness of the 'Subjective and Objective Family Burden Interview' (SOFBI) in the assessment of principal caregivers in Spain.

METHODS

The SOFBI was administered to 166 principal caregivers of adults with ID in a vocational centre. The psychometric analysis included: internal consistency, inter-rater and test-retest reliability, construct validity, convergent validity with the World Health Organization's Disability Assessment Schedule II, and feasibility.

RESULTS

The Cronbach's alpha was 0.88 for the overall interview and always above 0.7 in the quantitative subdomains. The Kappa coefficients for test-retest were between 0.5 and 0.8, whereas inter-rater agreement was nearly perfect. Maximum-likelihood factor analysis showed four well-defined factors, which fitted the previously designed domains. Feasibility was also good.

CONCLUSIONS

The SOFBI is a multi-domain, modular instrument which is feasible, reliable and valid for measuring the burden of family caregivers to adults with ID living in the community.

The specifics of coping: parents of daughters with anorexia nervosa

In this article, the authors report on an interview study in which parents described the coping strategies they used to deal with the demands of having a daughter diagnosed with anorexia nervosa. They compare parents' accounts with commonly used categorizations in quantitative studies of parental coping and adjustment. The study indicates that parents attribute multiple, complex, and unique motives to their actions that problematize quantitative constructions of types of coping. Parents often defined their actions differently and reported using coping strategies that were not considered or measured by the most widely used quantitative coping instruments. The analysis indicates that when the focus is on understanding and assisting parental coping in particular circumstances, situated, context-specific analyses are necessary to design measures that accurately reflect parents' coping efforts.

Parenting stress and its relationship to the behavior of children with Joubert syndrome

This study describes the relationship between parenting stress and behavior in children with Joubert syndrome, a rare genetic neurodevelopmental disorder. Parents (N = 43) reported severely impaired child adaptive behaviors. Most children did not show maladaptive behaviors, but a subset of approximately 20% displayed significant problems in areas such as inattention, overactivity, social withdrawal, and atypical behaviors. Mothers (59%) and fathers (40%) reported elevated levels of parenting stress. A hierarchical regression, including demographics, adaptive behavior, and maladaptive behavior, predicted 67% of the variance in mothers' stress and 40% of the variance in fathers' stress. Maladaptive behaviors uniquely contributed to maternal and paternal stress. The child's adaptive behavior level contributed significantly to parenting stress for mothers but not for fathers. Findings provide a better understanding of the impact of child behavior on parents caring for a child with Joubert syndrome.

RECOGNITION OF THE CLINICAL SIGNS AND SYMPTOMS OF JOUBERT SYNDROME

Joubert Syndrome is a rare, autosomal recessive disorder that affects the cerebellum and brain stem. It presents with a distinct respiratory pattern and profound tachypnea in the newborn period. This article provides an overview of the condition and discusses the embryologic origins of this syndrome. A focused history and systematic physical assessment provide a step-by-step guide to enhance the early recognition of clinical signs and symptoms of this disorder. A series of clinical photographs and a brief case report offer insight into the classic presentation of this uncommon disorder. The diagnosis of Joubert syndrome is confirmed with magnetic resonance imaging, which reveals a classic neuroradiologic finding, characterized as the molar tooth sign. A discussion of the range of developmental outcomes and complex multispecialty care and intensive support that these infants and their families require is also provided.

The care of my child with cancer: parents' perceptions of caregiving demands

Parents are actively involved in the direct care of their ill child receiving cancer treatment by providing and monitoring therapy and by managing symptoms related to the therapy or to the disease itself. Little is known about parents' perception of what helps or hinders them with their caregiving responsibilities or what effect the caregiving role has on the parent. In this descriptive, exploratory study, 151 parents responded to one or more of six open-ended questions that were part of the newly developed instrument, Care of My Child with Cancer. The 1,280 responses were analyzed using a semantic content analysis technique. The most frequently reported effect on parental caregiving involved negative physical and emotional health. One parent responded, "You feel like you lose all control over your life. It's no longer your own." The most desired forms of assistance with the caregiving role were periodic relief from direct caregiving, ongoing assistance with household responsibilities, and different forms of conveniences that could save time and energy. Two types of actual assistance found to be most helpful by parental caregivers included timely education about their child's health status from health care providers and emotional support from family members, friends, and others. These study findings provide the basis for future interventions that may diminish the effect that caregiving demands place on parents of children with cancer.

Factors influencing maternal mental health and family functioning during the low birthweight infant's first year of life

The care of the low birthweight (LBW) infant poses a considerable challenge to the entire family, especially to the infant's mother, who is typically the primary caregiver. The purpose of this study was to determine the effects of the infant's medical vulnerability and the psychosocial context of caregiving on the mental health of mothers who care for these infants and the functioning of their families. Results indicate that the degree to which an infant was unresponsive and the severity of the baby's physical health problems during the first year were associated with more mental health problems for the mother. Lack of infant responsiveness was also related to less cohesion and adaptability for the family as a whole. Family cohesion, presence of a partner, emotional support, and a mother's satisfaction with her family all contributed to her better mental health. In contrast, her life stress and the family's use of internally focused coping strategies contributed to worse mental health outcomes. Findings indicate the need for nursing interventions to support the mother and family in developing effective approaches to care for their LBW infant and for one another.

Development of a child with Joubert syndrome

The article describes the development of a child with Joubert Syndrome who, since the age of 16 months, has received personalized stimulation therapy at home and in the Early Intervention Unit (EIU) of the Faculty, in each of the five areas considered by the Portage Guide to Early Education: socialization, language, self-help, cognition, and motoricity. Repeated evaluations during the treatment (up to age 40 months) showed show progress in all developmental areas, as well as in general attitude to and capacity for learning. During treatment, greatest progress was made in the areas of cognition and communication.