Measurement of Health Care Attitudes In Cystic Fibrosis Patients and Their Parents

Previous research indicates that attitudes about information acquisition, and attitudes about behavioral involvement, moderate important health behaviors. These attitudes may play an important role in the management of cystic fibrosis (CF) because of the crucial role that patient knowledge and self-involvement play in maintaining adequate functioning. However, due to the young age of CF onset, and the necessary involvement of parents in CF patients' care, two preliminary questions require attention. First, can health care attitudes be measured reliably in young samples? Second, are parents' attitudes related to their children's attitudes? In this study we examined the measurement of health care attitudes in CF patients and their parents by administering the Health Opinion Survey. Results indicated that health care attitudes could be measured reliably in parents and teens, but that for younger patients (ages 8 to 12 years), reliability was reduced. Results also indicated that parents' attitudes and patients' attitudes were largely unrelated, suggesting that patients do not automatically adopt the health care attitudes of their parents. By implication, educational interventions targeted at parents may have limited effectiveness for their children.     

Intrusive Thoughts as Determinants of Distress in Parents of Children With Cancer1

This study investigated the relationship between frequency of intrusive thoughts and susceptibility to reminiscent stimuli and consequent distress in parents of children with cancer and parents with healthy children. Cancer-related words embedded in the Stroop task (e.g., “chemo” printed in green ink), served as the reminiscent stimuli. Results indicated that frequency of intrusive thoughts reported 2 months before the experimental session was positively correlated with evoked thoughts and associated distress among parents with ill children. Intrusive thoughts predicted 11–17% of the variance in evoked thoughts and in elicited distress, whereas other symptoms of chronic stress did not predict evoked thoughts and elicited distress. Cognitive and affective task reactivity by parents of children with cancer were not accompanied by behavioral or physiological reactivity. Future research should examine the extent to which more acute and naturalistic intrusive thoughts elicit reactivity across cognitive, affective, behavioral, and physiological dimensions, and long-term physical and mental health effects associated with chronic intrusive thoughts.     

Patients' Knowledge of Cystic Fibrosis: Genetic Determinism and Implications for Treatment

This paper uses the self-regulation model of illness perceptions (Leventhal et al. , 1984) to consider the implications of different ways of thinking about the causes of illness. The relationship between anxiety/depression and knowledge or denial of illness is also considered. These issues are explored using adherence to treatment in cystic fibrosis (CF) as an example. Twenty-six CF patients took part in semistructured interviews and completed a standardized anxiety and depression scale (HAD, Zigmond and Snaith, 1983). Interview data were analyzed using Interpretative Phenomenological Analysis (Chapman and Smith, 2002). HAD data were analyzed using SPSS. The respondents displayed widely differing levels of knowledge of their condition. Some deterministic comments were also reported. Findings are discussed in relation to the information that physicians might provide to patients and families in the light of increasing knowledge about genetics in society and the genotyping of individuals with genetic conditions specifically. Any important gaps in patient knowledge could usefully be discussed at transition from pediatric to adult care and issues relating to control and genetic determinism discussed with the patients individually.     

Resilience and Family Psychosocial Processes Among Children of Parents with Serious Mental Disorders

Resilience involves successful adaptation despite adverse circumstances, and is operationalized in this study as a multidimensional construct which consists of both positive and negative indicators of adaptation. Previous research has emphasized the importance of parental psychopathology in predicting child adaptation among children of parents with serious mental disorders. In contrast, we hypothesized five family psychosocial processes as common sequelae to serious parental mental disorder that are central to child adaptation beyond that predicted by parental psychiatric status. These are diminished family financial resources, social network constriction, impaired performance of parenting tasks, increased familial stress, and disruption of the parent-child bond. We examined the relationship of these processes to child adaptation independently through hierarchical regression analyses after taking into account parental psychiatric symptoms and functioning as well as the child's age and gender. One hundred seventy-seven children of mothers with serious mental disorder, ages 2–17 years old, were assessed on measures of adaptation. Results indicated that family psychosocial processes are a more consistent and powerful predictor of child adaptation than parental psychopathology. Results also indicated that, for these children, adaptation is predicted most consistently by parenting performance, and to lesser extents, by the parent-child bond and familial stress. We discuss our results in terms of their implications for theory and intervention with children of parents with serious mental disorders and for the study of resilience.     

Change in the Psychological Adjustment of Children with Cystic Fibrosis or Sickle Cell Disease and Their Mothers

Objectives: This study has three interrelated objectives: (1) to track the adjustment of children and adolescents with sickle cell disease (SCD) or cystic fibrosis (CF) and their mothers through a third assessment point 2 years after the initial assessment; (2) to determine whether the adaptational processes of the transactional stress and coping model associated with adjustment at the initial assessment continue to be associated with adjustment 2 years later; and (3) to determine whether the pattern of association of adaptational processes with adjustments differs by illness subgroup. Methods: The study samples included 59 children with CF and 50 children with SCD and their mothers. Measures were obtained on maternal adjustment and appraisals of daily and illness stress, coping methods, and family functioning. Child measures included child-reported and mother-reported child adjustment and child perceptions of self-worth and health locus of control and pain coping methods. Results: Consistency in adjustment classification was only 31–32% for child self-report, 66% for mother-reported child behavior problems, and 56–77% for mother self-reported adjustment for the CF and SCD groups, respectively. Support was provided for the association of adaptational processes with maternal adjustment and with the adjustment of children with SCD but not for children with CF. Conclusion: The stability of adjustment has implications for prevention and treatment intervention and subsequent research steps. Intervention efforts should be focused on the relatively small subgroups of children with chronic illnesses and their mothers with consistently poor adjustment.     

Understanding the Quality of Life for Parents and Their Children Who have Asthma: Family Resources and Challenges

In this study we investigated the links between caregiver burden, family environment, and quality of life in 97 pairs of children with asthma and the one who was determined to be the primary family caregiver. Using structural equation modeling, within-participant analyses showed that family environment was positively linked to quality of life for both children and parents. Across-participant analyses demonstrated that parents’ positive perceptions of family environment were associated with parents’ and children’s improved quality of life. In addition, parents’ perceptions of family environment mediated the link between caregiver burden and parents’ and children’s quality of life. Implications for intervention with families are discussed in light of this study’s important results.     

Patterns of Aggression in Parents and their Children

In this research, we examined children's awareness of inconsistencies in messages that are meaningful for children, instructions for games. In the first experiment, kindergarten (n = 25) and second- (n = 25) and fourth-grade (n = 26) children were individually read the instructions for two games, each of which included two inconsistent statements. Chi-square analyses yielded a significant effect for grade for one game (p < .05) and a marginally significant effect for a second game (p < .10). In a second experiment, second- (n = 40), fourth- (n = 40), and sixth-grade (n = 40) children were read the instructions for two games, each of which included two statements that were inconsistent. An analysis of variance demonstrated that with an increase in grade, there was a significant increase (p < .001) in awareness that a message contained an inconsistency. The analysis also indicated that the subjects were more willing (p < .08) to question an adult than they were to question a child about an inconsistency. Moreover, a regression analysis indicated that awareness of inconsistencies in the rules for games was significantly related to memory (p < .001) and to one's ability to note inconsistencies in shorter, simpler messages (p < .001).     

Psychosocial Predictors of Psychological Distress in Taiwanese Secondary School Boys and Girls

This study was designed to investigate predictors of psychological distress in secondary school boys (n =779) and girls (n = 893) in Taiwan. Participants completed anxiety and depression scales as part of a larger study. Gender, GPA, parenting practices, self-esteem, and personality/satisfaction were significantly correlated with psychological distress. Significant gender differences were found in students' psychological distress, GPA, stereotyped thinking, academic self-expectations, parental expectations, parenting practices, and mother's education level. Stepwise regressions revealed that self-esteem was the only significant predictor for boys; it accounted for 40.9% of the variance in their psychological distress. GPA, family income, self-esteem, and parenting practices were significant predictors for girls; they accounted for 42.6% of the variance in girls' psychological distress. Research recommendations and educational implications are discussed.     

Exploring Correlates and Predictors of Stress in Parents of Children Who are Deaf: Implications of Perceived Social Support and Mode of Communication

Parenting stress has been linked to negative outcomes for both parents and children, including poor attachment, behavior problems, less positive parent–child interactions, and marital dissatisfaction. Given that parents of special needs children often experience excess stress, they may be susceptible to negative outcomes, thus investigations of protective factors are needed. We explored relationships among parenting stress, social support, mode of communication, and child cochlear implant status in parents rearing a deaf child or child with hearing loss. Findings of our exploratory study indicated that parents of children who use sign language only reported more support, while parents of children who use total communication exhibited less self-reported stress. Also, parents with children who use implants did not differ on any of the measures compared to parents of children without implants. Additional findings suggested that higher levels of perceived social support corresponded with lower stress among parents, however, receipt of supportive behaviors did not correlate significantly with parenting stress. In an overall model, perceived social support and mode of communication were significant predictors of parenting stress. Finally, enacted support predicted significantly life satisfaction in parents. Implications and limitations, as well as suggestions for future research, will also be offered.     

The Role of Social and Cognitive Processes in the Relationship Between Fear Network and Psychological Distress Among Parents of Children Undergoing Hematopoietic Stem Cell Transplantation

The current study examined whether cognitive and social processing variables mediated the relationship between fear network and depression among parents of children undergoing hematopoietic stem cell transplant (HSCT). Parents whose children were initiating HSCT (N = 179) completed survey measures including fear network, Beck Depression Inventory, cognitive processing variables (positive reappraisal and self-blame) and social processing variables (emotional support and holding back from sharing concerns). Fear network was positively correlated with depression (p < .001). Self-blame and holding back emerged as individual partial mediators in the relationship between fear network and depression. Together they accounted for 34.3 % of the variance in the relationship between fear network and depression. Positive reappraisal and emotional support did not have significant mediating effects. Social and cognitive processes, specifically self-blame and holding back from sharing concerns, play a negative role in parents’ psychological adaptation to fears surrounding a child’s HSCT.     

A Systematic Review of Sleep Associations in Parents and Children

This systematic review aimed to examine sleep associations in a) typically developing children and their parents, and b) children with neurodevelopmental disorders and their parents. Literature search was conducted on PubMed, PsycINFO, EMBASE and Scopus databases for articles examining sleep associations between parents and children. Thirty studies were included in the final review. Based on the first aim, sleep associations between parents and typically developing children were observed for sleep quality, sleep duration and sleep efficiency. However, evidence for associations between sleepiness levels in parents and children and sleep schedules related to bedtime or waketime was limited. Based on the second aim, children with neurodevelopmental disorders and their parents reported greater sleep disturbances in comparison to typically developing children and their parents. The review concluded that sleep in parents and children is interrelated across a number of sleep parameters. It also revealed some preliminary evidence on bidirectionality in parent-child sleep, which warrants further examination. The review highlights the need to examine the mediating role of environmental factors on the interactions between parent-child sleep. Rigorous, longitudinal designs should be employed to explore the pathways through which parents may impact their children’s sleep and functioning and vice-versa.

     

Family Functioning and Coping Behaviors in Parents of Children with Autism

We analyzed family dynamics and coping behaviors of parents with a child with an autistic spectrum disorder. Previous research suggests that moderate levels of cohesion and adaptability are associated with higher levels of positive coping, and that the more coping strategies a family implements, the greater their satisfaction with family functioning. Using a family systems approach, the relationships among the familial variables of cohesion, adaptability, and social support were evaluated for their contributions to coping in the family unit. We also compared the responses of mothers and fathers. Surprisingly, for these parents of children with autism, those who rated their family as enmeshed implemented more positive coping strategies than did those from other cohesion styles. This finding suggests that the enmeshed style may be more adaptive for a family that encounters extreme challenges. Notably, mothers and fathers agreed on all variables except for perception of social support from family and friends. Mothers perceived more social support from family and friends. The results lead to several interesting suggestions for future research.     

Self-Esteem and Its Relationship to Mental Health and Quality of Life in Adults with Cystic Fibrosis

Research from the general population indicates an important role for self-esteem in mental health, but limited research in this area exists in the cystic fibrosis (CF) literature. This study aimed to explore the predictive value of self-esteem and health-related quality of life (HRQoL) in mental health symptoms in adults with CF. Seventy-four participants, recruited online, completed the Clinical Outcomes in Routine Evaluation-Outcome Measure 34 (CORE-OM), Rosenberg Self-esteem Scale and Cystic Fibrosis Questionnaire-Revised (CFQ-R). Comparably high levels of self-esteem were found, but HRQoL was lower than previous research. Thirty percent of participants scored within the clinical range for mental health difficulty. Hierarchical regression, controlling for gender, explored the value of four CFQ-R subscales (physical, social, emotional and role functioning) and self-esteem in predicting CORE-OM total score. Gender accounted for 8.2 % of the variance in mental health scores while the five independent variables accounted for a further 73.0 % of variance. Of the five variables, CFQ-R emotional functioning and self-esteem were significant predictors of mental health symptoms. Results are discussed in relation to clinical implications and potential uses for internet technologies to promote socialisation.     

Predictors of Psychosocial and Cognitive Adaptation in Children with Sickle Cell Syndromes

Examined the role of socioecological factors (family functioning and socioeconomic variables) in predicting behavioral and cognitive adaptation in children with sickle cell syndromes (SCD). Participants included 74 African American children and adolescents with SCD and their primary caretakers. Outcomes included internalizing and externalizing behavior symptoms, as rated by caretakers, as well as intellectual abilities and academic achievement, as assessed by individually administered standardized instruments. Family functioning consisted of both caretaker adjustment and family environment (i.e., family adaptability and cohesion). Hierarchical multiple regression analyses revealed that caretaker psychological adjustment predicted externalizing behaviors, while family environment (i.e., adaptability and cohesion) predicted neither behavioral nor cognitive functioning. Socioeconomic variables alone predicted intellectual abilities and academic achievement and also contributed to the prediction of child behavioral adaptation. Results are discussed in terms of relevant sociocultural issues and implications for family-level prevention and intervention.     

Perceptions of Self and Relationship with Parents in Aggressive and Nonaggressive Rejected Children

This study examined the perceptions of self and the attachment relationship to parents in aggressive and nonaggressive rejected children, as compared to children with an average or popular sociometric status. Participants were 216 children from grades 3 and 4. They completed peer nomination measures, the Self-Perception Profile for Children (SPPC), and the Security Scale (mother and father form). Results generally confirmed the assumption that only the nonaggressive rejected children perceive themselves as less competent and worthy as a person than the more popular children. Aggressive rejected children did not report lower feelings of global self-worth or competence, although they did report lower levels of social acceptance. Furthermore, rejected-nonaggressive children perceived the relationship with their father (but not with their mother) as less secure than did the more popular children. Logistic regression analyses suggested that the linkage between felt security with father and rejected-nonaggressive status was mediated by children's self-worth. Implications for attachment theory and for the hypothesized heterogeneity among rejected children are discussed.     

Psychosocial Characterization of Physically Abused Children from Low Socioeconomic Households in Comparison to Neglected and Nonmaltreated Children

Research reports on the long-term sequelae of physically abused children have not produced a coherent profile that can be used to identify this population as a distinct diagnostic group. To define the specific combination of symptomatology and personality characteristics of this group, 41 physically abused children, referred by the state Child Protection Officers were interviewed using the Attachment Style Classification Questionnaire, the Children's Depression Inventory, the Trait Anxiety Inventory, and the Child Suicidal Potential Scales. The results were compared with those of 38 neglected children and 35 nonabused, nonneglected children. The physically abused children showed an avoidant attachment style, specific depressive and suicidal symptomatology, high anxiety level, high aggression level, and primitive defense mechanisms. A discriminant data analysis identified 92.8% of the participants in terms of their diagnostic status. Our study suggests that an emotional and behavioural cluster of characteristics may differentiate physically abused children from neglected and nonmaltreated children. This cluster highlights the severity of induced developmental damages in the short and long-term.     

Cognitive and Interpersonal Predictors of Stress Generation in Children of Affectively Ill Parents

Stress generation is a process in which individuals, through their depressive symptoms, personal characteristics, and/or behaviors, contribute to the occurrence of stressful life events. While this process has been well documented in adults, few studies have examined it in children. The present study examines whether cognitive and interpersonal vulnerability factors to depression contribute to stress generation in children, independent of their current depressive symptoms. Participants included 140 children (ages 6 to 14) and one of their parents. During an initial assessment, children completed self-report measures assessing cognitive and interpersonal vulnerability factors to depression. Children and their parents also completed measures assessing depressive symptoms. One year later, children and their parents participated in a semi-structured interview assessing the occurrence of stressful life events in the past year. Multi-level modeling results provided strong support for the stress generation process in children of affectively ill parents and highlight the importance of considering gender and age moderation effects.