Parenting stress and dimensions of parenting behavior: cross-sectional and longitudinal links with adolescents' somatization

Challenges to high-quality care in autism with functional somatic symptoms: A case-inspired narrative review and exploratory biopsychosocial model

BackgroundChildren and adolescents with autism spectrum disorder (ASD) frequently experience functional somatic symptoms (FSS), although the underlying causes often remain unclear. Various biological and psychological factors, both individual and within families, such as alexithymia or health anxiety, can intensify these symptoms, sometimes resulting in excessive and unnecessary medical interventions.MethodsA narrative review of the literature was conducted, alongside the presentation of a case report involving a 13-year-old boy with ASD. The case illustrates how personal and familial factors can influence the presentation of FSS and the risks of inappropriate treatment.DiscussionThe findings suggest that psychological and familial factors play a significant role in the manifestation of FSS in ASD. These factors can increase the risk of unnecessary medicalization, as they often lead to misinterpretation of symptoms by caregivers and healthcare providers. The case report further underscores how the interaction of personal and familial dynamics can complicate the management of FSS. A comprehensive biopsychosocial approach that addresses both the individual and the family is crucial for managing FSS in ASD. Future research should focus on developing targeted interventions that address these psychological and familial influences to enhance the quality of care and reduce unnecessary and potentially harmful healthcare utilization in ASD.

Should pediatric cardiologists refer all patients with unexplained chest pain to a psychiatrist?

OBJECTIVE

The present study aimed to investigate the relationship between unexplained chest pain in children with parents' mental problems, parental attitudes, family functionality, and the child's mental problems.

MATERIAL AND METHOD

A total of 433 children (between 11 and 18 years of age) applied to the Pediatric Cardiology Outpatient Clinic due to chest pain in the last year. A clinical interview was conducted by a child psychiatrist with 43 patients and 33 controls included in the study due to unexplained chest pain.

RESULTS

Family history of physical illness was significantly higher in the chest pain group. When evaluated in terms of psychosocial risk factors, life events causing difficulties, derangement in the family, loss of a close person, and exposure to violence were statistically significantly higher in the group with chest pain. Mental disorders were observed in 67.4% of the children in the chest pain group as a result of the clinical interview. The total score of the DSM-5 somatic symptoms scale, which evaluates other somatic complaints in the chest pain group, was also significantly higher. When the family functions of both groups were evaluated, communication, emotional response, behaviour control, and general functions sub-dimensions were statistically significantly higher in families in the chest pain group.

CONCLUSION

We recommend that psychiatric evaluation be included in diagnostic research to prevent unnecessary medical diagnostic procedures in children describing unexplained chest pain, as well as to prevent the potential for diagnosing mental disorders in both children and adults.

The bidirectional temporal relationship between parenting stress and child maltreatment: A cross-lagged study based on intervention and cohort data

BACKGROUND

Parenting stress has long been proposed as a major risk factor for child maltreatment. However, there is a lack of evidence from existing studies on the temporal sequence to establish a causal relationship. This study aims to examine bidirectional temporal relationships between parenting stress and child maltreatment.

METHODS

Longitudinal data from two different sources were analysed: a pre-post study of an online parenting programme conducted across six countries - the ePLH Evaluation Study, and a prospective cohort study in the United States - LONGSCAN. Cross-lagged panel model on parenting stress and child maltreatment was used in each dataset.

RESULTS

Based on repeatedly measured data of 484 caregivers in the ePLH study across five time points (every two weeks), we found that parenting stress at an earlier time point predicted later child maltreatment (IRR = 1.14, 95 % CI: 1.10,1.18). In addition, the occurrence of child maltreatment was associated with higher subsequent short-term parenting stress (IRR = 1.04, 95 % CI: 1.01,1.08) and thus could form a vicious circle. In the LONGSCAN analysis with 772 caregivers who were followed up from child age of 6 to child age of 16, we also found parenting stress at an earlier time point predicted later child maltreatment (β = 0.11, 95 % CI: 0.01,0.20), but did not observe an association between child maltreatment and subsequent long-term parenting stress.

LIMITATIONS

Potential information bias on the measurements.

CONCLUSIONS

This study provides evidence for a bidirectional temporal relationship between parenting stress and child maltreatment, which should be considered in parenting intervention programmes.

Emotional and Behavior Difficulties and the Mental Health of Caregivers of Adolescents Living with HIV

This study examined the relationship between child emotional and behavioral difficulties, parenting stress and the mental health of caregivers of adolescents living with HIV. Caregiver data from a two-year pilot study for adolescents and their caregivers (N = 89 dyads) in Uganda, were analyzed. Ordinary Least Square regression models were conducted to examine the association between child difficulties reported by caregivers using the Strengths and Difficulties Questionnaire on parenting stress (measured by Parenting Stress Index) and caregiver mental health (measured by the Brief Symptoms Inventory). Results indicate that 12.36% of caregivers reported child difficulty scores within the borderline range and 8.99% reported scores within the abnormal range. Child difficulties (b = 0.52, 95% CI: 0.18, 0.85) were associated with parenting stress. Similarly, the perceived impact of child difficulties was associated with both parenting stress (b = 0.89, 95% CI: 0.24, 1.54) and caregiver mental health (b = 1.73, 95% CI: 1.09, 2.37). Study findings have important implications for developing effective psychosocial interventions targeting children and adolescents living with HIV and their caregivers.

Stress in Egyptian parents of children with developmental disabilities. The moderating effect of social support

BACKGROUND

Research shows that parents of children with developmental disabilities (DDs) are at increased risk for elevated stress. Child adaptive functioning as well as social supports are key factors influencing stress in parents. However, few studies have examined the interaction between these variables and their contribution to perceived stress especially in Egyptian parents.

AIMS

The present study investigated the relationship between parenting stress, child adaptive functioning, and social supports. It also examined the moderating role of social support in the relationship between child adaptive functioning and stress in Egyptian parents of children with DDs.

METHOD

Sixty-four Egyptian parents of children with DDs completed assessment measures of parenting stress, child adaptive functioning, and social supports.

RESULTS

Parenting stress was negatively associated with child adaptive functioning and informal social supports. However, there was no association between parenting stress and formal social supports. In addition, level of informal social support had a moderating effect on the relationship between child adaptive functioning and level of parenting stress.

CONCLUSIONS

The findings highlight the importance of interventions that reduce child-related stressors, particularly low adaptive functioning. Programs that address parenting stress and promote effective informal and formal social supports are crucial to help parents cope with stress.

Discrimination and Internalizing Symptoms in Rural Latinx Adolescents: The Protective Role of Family Resilience

Objective: There is a well-documented relationship between discrimination and increases in internalizing symptoms among rural Latinx youth. Among numerous assets in these adolescents' lives, family resilience emerges as a culturally relevant and robust protective factor. However, it is still unclear whether family resilience is equally protective across different internalizing symptom clusters and whether this buffering effect is independent of other interconnected resilience sources.Method: Latinx adolescents from an underserved rural community (n = 444; M_age = 15.74, SD_age = 1.22; 51% male) reported on their internalizing symptoms, experiences of discrimination, and sources of resilience. We examined whether perceived family resilience moderated the association between perceived discrimination and self-reported depressive, somatic, and anxiety symptoms over and above adolescents' sex, self-reported level of acculturation, as well as perceived individual and contextual resilience.Results: Analyses showed that perceived discrimination experiences were robustly associated with higher levels of self-reported internalizing symptoms, while perceived family resilience was related to lower self-reported symptomatology. Closer examination revealed that perceived family resilience buffered the negative effects of perceived discrimination on self-reported depression and somatic symptoms, but not anxiety symptoms.Conclusions: This study addresses a gap in the literature by identifying differential protective effects of family resilience that might be explained by cultural values and practices in rural Latinx families. Findings suggest that interventions that incorporate family members and promote supportive family environments may benefit rural Latinx youth with a broad range of internalizing symptoms.

Effect of socioeconomic conditions on frequent complaints of pain in children: findings from the UK Millennium Cohort Study

BACKGROUND

Frequent complaints of pain (FCP) are common in high-income countries, affecting about 25% of children, and may have significant adverse consequences including prolonged school absence and disability. Most FCP are unexplained, and the aetiology is poorly understood. This study aimed to identify risk factors for FCP and explore how risk factors explain variation in pain reporting by childhood socioeconomic conditions (SECs).

METHODS

Analysis of the UK Millennium Cohort Study, including 8463 singleton children whose parents provided data throughout the study. At 11 years, mothers were asked whether their child frequently complains of pain. Risk ratios (RR) and 95% CIs for FCP were estimated using Poisson regression, according to maternal education. Other risk factors were explored to assess if they attenuated any association between FCP and SECs.

RESULTS

32.3% of children frequently complained of pain. Children of mothers with no educational qualifications were more likely to have FCP than children of mothers with higher degrees (RR 2.06, 95% CI 1.64 to 2.59) and there was a clear gradient across the socioeconomic spectrum. Female sex, fruit consumption, childhood mental health and maternal health measures were associated with childhood FCP in univariable and multivariable analyses. Inclusion of these factors within the model attenuated the RR by 17% to 1.70 (95% CI 1.36 to 2.13).

CONCLUSION

In this representative UK cohort, there was a significant excess of FCP reported in less advantaged children that was partially attenuated when accounting for indicators of parental and childhood mental health. Addressing these factors may partially reduce inequalities in childhood FCP.

When somatization is not the only thing you suffer from: Examining comorbid syndromes using latent profile analysis, parenting practices and adolescent functioning

Understanding somatization presents a challenge to clinicians because it is often associated with other syndromes. We addressed somatization's comorbidity with other internalizing syndromes (anxiety, depression, withdrawal) using latent profile analysis. A representative sample of 3496 Israeli middle and high-school youths reported their internalizing symptoms, perceived parenting practices, psychosocial functioning, and health behaviors. Four profiles, similar across age and gender, were identified: overall-low (65.4%), moderately-high anxiety/depression/withdrawal (24.4%), high somatization (4.8%), and overall-high (5.4%). MANOVAs and follow-up ANOVAs revealed that for the most part the overall-high profile evinced the worst parenting, psychosocial functioning, and health behaviors (smoking and drinking), while the overall-low group evinced the best. For most variables the high somatization and moderately high profiles displayed midway results. However, the moderately-high profile reported higher levels of harsh parenting than the high somatization profile. The high somatization profile reported similar or higher levels of smoking, risk taking, vandalism, and rule violation than the overall-high group. High somatization, either alone or alongside anxiety, depression, and withdrawal, was associated with disruptive and risk-taking behaviors. This link might reflect problems in emotion and anger regulation and become stronger in adolescence because of dysregulation processes characterizing this period. Implications for practice are discussed.

A qualitative study of adolescents with medically unexplained symptoms and their parents. Part 1: Experiences and impact on daily life

Medically unexplained symptoms (MUS) are common among adolescents and are frequently encountered in primary care. Our aim was to explore how these adolescents and their parents experience the condition and its impact on their daily lives and to provide recommendations for health professionals. Using a qualitative approach, six focus groups and two individual interviews were conducted. These involved a total of ten adolescents with different types of MUS and sixteen parents. The respondents were recruited in a university hospital in Switzerland. A thematic analysis was conducted according to the Grounded Theory. The analysis of the data highlighted four core themes: disbelief, being different, concealing symptoms, and priority to adolescent's health. Transcending these themes was a core issue regarding the discrepancy between the strategies that adolescents and their parents use to cope with the symptoms. Health professionals should be made aware of the emotional needs of these patients and their families.

Parenting stress and child behavior problems within families of children with developmental disabilities: Transactional relations across 15 years

Parents of children with developmental disabilities (DD) are at increased risk of experiencing psychological stress compared to other parents. Children's high levels of internalizing and externalizing problems have been found to contribute to this elevated level of stress. Few studies have considered the reverse direction of effects, however, in families where a child has a DD. The present study investigated transactional relations between child behavior problems and maternal stress within 176 families raising a child with early diagnosed DD. There was evidence of both child-driven and parent-driven effects over the 15-year study period, spanning from early childhood (age 3) to adolescence (age 18), consistent with transactional models of development. Parent-child transactions were found to vary across different life phases and with different domains of behavior problems.

The relation between parenting stress and adolescents' somatisation trajectories: a growth mixture analysis

OBJECTIVE

The impact of somatisation in adolescence is substantial. Knowledge on (predictors of) individual-level development of somatisation is necessary to develop tailored treatment. The current study assessed individual-level development of somatisation by means of latent mixed modelling. Parenting stress was included as a predictor of somatisation trajectory membership and within-trajectory variation.

METHODS

A total of 1499 adolescents and one of their parents (mostly the mother) agreed to participate. Questionnaires were administered when the adolescents were respectively 12-13 (T1), 13-14 (T2), and 14-15 (T3) years old. Adolescents reported on their somatisation, parents on their parenting stress.

RESULTS

Four individual somatisation trajectories were found: increased, long-term low, long-term high, and decreased. Higher early parenting stress (T1) significantly predicted less favourable trajectory membership (increased and long-term high). The relation between later parenting stress (T2 and T3) and somatisation depended on trajectory membership. For adolescents in the long-term high and decreased somatisation trajectories, lower T2 and T3 parenting stress was related to higher somatisation, while for adolescents in the long-term low and increased trajectories, higher T2 and T3 parenting stress was related to higher somatisation.

CONCLUSIONS

The results support a general recommendation to prevent the onset of high levels of parenting stress. In addition, for families in which high levels of parenting stress already exist, clinicians should be aware of natural fluctuations in parenting stress, its associated features (e.g., aspects of overall care, like looking for professional help) and of the consequences this might have for the adolescent.