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.     

Attention deficits in children with sickle cell disease

Previous research has suggested that children with sickle cell disease may exhibit cognitive deficits even in the absence of direct cerebrovascular involvement (stroke). This study was designed to assess specific attentional deficits in children with sickle cell disease. 12 children with sickle cell disease (Hb SS) with a prior history of stroke, 14 children with sickle cell disease (Hb SS) without evidence of stroke, and 13 similar aged siblings (Hb AA or Hb AS) were compared on measures of attention, intellectual functioning, achievement, and adaptive functioning. Significant differences were found between children with sickle cell disease (with or without stroke) and healthy controls on a timed test of visual scanning, the Coding subtest of the Wechsler Intelligence Scale for Children-Revised, and subtests of Reading, Arithmetic, and Spelling from the Wide Range Achievement Test-Revised. The differences between children with sickle cell disease and their healthy siblings appear to be the result of strokes rather than sickle cell disease itself as children with sickle cell disease without strokes did not significantly differ from controls. Implications for the effects of sickle cell disease and stroke on academic performance are discussed.     

Predictors of Social Anxiety in Children and Adolescents with Sickle Cell Disease

The aim of this study was to examine the potential moderating effect of age on the child-reported pain–social anxiety relationship in children and adolescents with sickle cell disease (SCD). Participants were children and adolescents (ages 8–17; 33 girls, 25 boys) diagnosed with SCD who completed measures of social anxiety and severity of usual pain. Caregivers provided demographic information, and mean hemoglobin levels were computed as a measure of objective disease severity. Ratings of more severe pain were associated with greater social anxiety, including fear of negative evaluation, for older children and adolescents only, revealing a moderating effect of age. Increased relevancy of peer relationships in adolescence, limited social contacts due to SCD complications, and misreading of social cues (e.g., maladaptive coping response to pain) may explain why older children and adolescents reported greater social anxiety in the presence of a stressor such as pain.     

Sex-related differences in the relationship between sibling status and responsivity to babies

Ninety-six middle-class subjects equally divided by age (4–5, 8–9, and 14–15 years), sex, and the presence or absence of younger siblings in the family were studied in two situations which assessed their interest in babies: responsivity to an unfamiliar baby in a waiting room situation and reactions to pictures of babies. Subjects' birth order does not affect degree of interest, only mode of expression. These findings held for boys, but not girls. Regardless of age, boys without younger siblings expressed their interest in babies in more distal, cautious ways. The results were discussed in terms of the contention that birth order effects are best understood as distinctive for each sex, especially when sex-role-related behavior is being investigated.This project was supported by funds from the Boys Town Center for the Study of Youth at Stanford. We are indebted to Barbara Aschenbrenner for her assistance in all phases of this study.     

Family Coping During Hospitalization of Children with Chronic Illnesses

Information about family coping when a child with a chronic illness is hospitalized for procedures related to his or her illness is needed. The current research presents the results of two pilot studies designed to assess family resilience and coping, during a hospitalization for medical procedures for a child with a chronic condition. Sixty-one parents participated in the first study and reported on their child’s hospital experiences and completed a survey designed to assess family coping. Twelve mothers and one grandmother completed interviews examining their perceptions of their coping, siblings’ coping, and coping of the child with an illness for study two. Results of Study 1 indicated parents’ perceived the family as resilient. Cognitive strategies were used to see the hospital stay as positive for the child or to accept what had to occur as having the possibility of improving the child’s life. Some of the mothers mentioned financial stress as being difficult for the family. Results of Study 2 also supported resilient functioning for mothers, siblings, and children with illnesses. Mothers reported they stayed strong for their child. Siblings could serve as protectors, helpers, and companions and were described as adapting well. Children with illnesses used distraction (e.g., play, art, music) to facilitate their coping. Findings of this study indicated parents perceived the family as coping well and supporting the child with an illness. Future research will need to assess perceptions of siblings and fathers and assess family members’ perspectives at different times over the course of children’s illnesses.     

Genetic Testing of Children at Risk for Adult Onset Conditions: When is Testing Indicated?

We report a family with an extensive history of colon cancer consistent with hereditary nonpolyposis colorectal cancer (HNPCC). A specific disease causing mutation was identified in affected individuals; p.W714X MLH1 mutation. Given the very young age of onset of cancer in some affected family members, with the youngest affected individual being 19 years of age, genetic counseling was recommended to children as young as 9 years. Ethical issues arose when affected families requested genetic testing for their underage children. Here we describe and debate the value of offering molecular testing for this adult onset disorder to several children in this particular family. We also examine possible molecular causes for the very young age of onset in some family members.     

Parent Perception of Elementary School Aged Children’s Sleep Problems

Wide discrepancies exist concerning the reported occurrence of sleep problems for elementary school children. We describe parental perception of sleep problem behavior in elementary school aged children 5–12 years. Approximately 4% of parents reported their children experienced significant global sleep problems serious enough to adversely affect family functioning. Significant specific sleep problems reported by parents occurred for approximately 9–14% of the children in the sample. These ranges were in the low end of the ranges of sleep problems reported in previous literature for this age group.     

Applying the Transactional Stress and Coping Model to Sickle Cell Disorder and Insulin-Dependent Diabetes Mellitus: Identifying Psychosocial Variables Related to Adjustment and Intervention

This review paper examines the literature on psychosocial factors associated with adjustment to sickle cell disease and insulin-dependent diabetes mellitus in children through the framework of the transactional stress and coping (TSC) model. The transactional stress and coping model views adaptation to a childhood chronic illness as mediated by several psychosocial factors. This review examines the utility of the model in explaining adjustment in two different childhood diseases, identifies needed research and intervention targets, as well as highlights potential changes to the model. The major conclusions of this review suggest that, in addition to child-specific factors, family functioning is an area that interventions should address in sickle cell disease and insulin-dependent diabetes mellitus.     

Perceptions of Hospitalization by Children with Chronic Illnesses and Siblings

Understanding children’s perceptions of their illnesses and functioning when they are undergoing medical procedures remains an important area for research. Further research about siblings’ perceptions will also provide knowledge about how they are coping with a brother or sister’s chronic illness. The current study examined the perceptions of children with illnesses and their siblings using a play interview. Themes in the data indicated resilience in child functioning for both patients and siblings. Children with chronic illnesses could experience pain, which often related to fears and other negative feelings about hospitalization and potentially doctors or nurses, if they were administering painful procedures. Distraction and prayer were coping tools for patients. However, most patients believed their illness and recovery would be a “long journey.” Brothers and sisters of children with chronic illnesses could experience loneliness. A more common report was a strong desire to help and be a support for a brother or sister with an illness. Support from parents was critical for both patients and siblings and both typically enjoyed child life activities. A member-checking process, with a different group of children with illnesses and siblings, was used to audit themes discovered after reviewing play interviews. The audit process supported the positive and negative themes in the data. In the future, examining the impact of magical thinking on outcomes and conducting studies after the children have gained distance from medical trauma will be important. Moreover, increasing a focus on resilience as a hallmark of children’s functioning remains another area for further research.     

The influence of gender,age, Psychological resilience and family interaction factors upon anxiety and depression in non-autism spectrum disorder siblings of children with an autism spectrum disorder

The influence of gender, age, Psychological resilience and family interaction factors upon generalised anxiety disorder (GAD) and major depressive disorder (MDD) was investigated in 75 non-autism spectrum disorder (NASD) siblings who had a brother or sister with an autism spectrum disorder (ASD). GAD and MDD were much more prevalent than in comparable age group samples, and adolescent females had the highest MDD rates. Several Psychological resilience skills were significantly associated with lower GAD and MDD, particularly being able to recognise mistakes in their thinking (for children) and being able to remain in control of their anger (for adolescents). Suggestions are made for ways of encouraging NASD siblings to develop skills that may assist them in avoiding these disorders.     

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.     

Case vignette: genetic secrets

Mrs. Thomas, age 50, became concerned after experiencing intermittent uncontrollable jerky body movements. She contacted her family physician and, following a full diagnostic evaluation, learned that she is experiencing early symptons of Huntington's disease. This illness is a degenerative disease of the central nervous system, which will ultimately lead-to physical incapacity, dementia, and death. The disease is known to be transmitted genetically as an autosomal dominant trait, with the first onset of symptoms usually occurring in middle age. For example, the child of an affected person has a 50% chance of inheriting the gene, and thus the illness, and a 50% chance of passing it on to their children. Mrs. Thomas is unaware of any history of the disease among others in her family; however, her father was an adopted child, who died in an automobile accident at the age of 37 and may well have been a carrier of the gene. It is highly likely that other members of her family, including her siblings and children, may be carriers of the gene and ultimately transmit it to their children before clinical symptoms of the disease develop. Her own son married last year, and her two brothers have children of childbearing age. Genetic screening and counseling are available for those at risk for Huntington's disease; however, Mrs. Thomas does not want to discuss her diagnosis with family members, fearing that they may blame her and that she may lose her job and friends if the information becomes public knowledge. What advice would you give to the health-care providers caring for Mrs. Thomas regarding the assorted rights, duties, and obligations surrounding this situation?     

Parents’ Communication with Siblings of Children Affected by an Inherited Genetic Condition

The objective of this study was to explore parents’ communication about risk with siblings of children affected by an inherited genetic condition, and to ascertain what level of support, if any, is required from health professionals. Semi-structured interviews were conducted with affected and unaffected children and their parents. Families were affected by one of six genetic conditions representing different patterns of inheritance and variations in age of onset, life expectancy and impact on families. Interviews were analysed using constructivist grounded theory and informed by models which focused on three different aspects of family communication. Interviews with 33 families showed that siblings’ information and support needs go largely unrecognized by health professionals and sometimes by parents. Some siblings were actively informed about the genetic condition by parents, others were left to find out and assimilate information by themselves. Siblings were given information about the current symptoms and management of the genetic condition but were less likely to know about its hereditary nature and their own potential risk. When siblings were fully informed about the condition and included in family discussion, they had a better understanding of their role within their family, and family relationships were reported to be more harmonious. The information and support needs of siblings can be overlooked. Parents with the responsibility for caring for a child affected by a genetic condition may require support from health professionals to understand and respond to their unaffected children’s need for more information about the genetic condition and its implications for the children’s own future health and reproductive decision-making.     

Knowledge of sex-role stereotypes in children aged 3 to 5

When do children begin acquiring adult sex-role stereotypes? This study examined the sex-stereotypic knowledge of four groups of young children: 3.0–3.5, 3.5–4.0, 4.0–4.5, and 4.5–5.0 years old. To assess the development of their knowledge, the same children were retested six months later. Evidence of sex-stereotyping appeared at 3.5 years and increased both across the different age groups and within the same children as they aged. The children's knowledge encompassed both feminine and masculine traits, and was related to general intellectual development. These results are interpreted as supporting cognitive-developmental theories that children learn sex-role stereotypes as structural rules for organizing and understanding behaviors present in their social environment.Thanks are due to Diane Bulow, Grace Horsman, Barbara Kutner, Joan Strutts, and the other teachers for aiding our access to children enrolled in their centers. Moira Davidson, Beth Kaplan, Keith Miller, Suzanna Nam, Dan Birecree, Sara Corse, Jim Gilbert, Jean Merenda, Anna Steiner, and Steve Tannenbaum served graciously as testers.     

Siblings' adjustment in middle childhood: Links with mother-child relationships

Associations between siblings' behavior problems and mother-child relationships were examined when older siblings were approximately 7 years old and 3 years later when younger siblings reached the same age. Children's behavior problems were positively associated with mothers' controlling behavior and negatively associated with mothers' affectionate behavior. Both different-age differential maternal behavior—differences in mother's behavior to siblings assessed at the same point in time when siblings were different ages-and same-age differential maternal behavior—differences in mothers' behavior to siblings assessed across a 3-year interval when siblings were the same age—were associated with children's adjustment. Children who received more maternal control and less maternal affection than their siblings had more behavior problems than other children. The magnitude of difference between siblings in behavior problems was correlated with the extent of maternal differential treatment but was not significantly associated with age or gender differences between siblings.     

Siblings in family therapy

The participation of siblings in family therapy was studied from case records in 76 consecutive cases attending a child and adolescent psychiatric outpatient clinic. Siblings took part in family therapy in two thirds of the cases. Of these, 76 per cent attended only one or two sessions. A sub-sample of nine families with children below 13 years of age was interviewed. Seven out of 10 evaluated siblings had psychiatric symptoms of some severity at the onset of therapy compared to two after, and all had fewer symptoms after therapy compared to before (p<0.01). Most families thought it relevant for both parents and siblings to take discussing their children's behaviour in front of them and wanted the opportunity of also talking to the therapist without the children being present.     

Regrets and Subjective Well-Being: A Life Course Approach

The aim of the study was to examine age and gender differences in the contents of regrets, and the association between regrets and subjective well-being. The sample consisted of 176 participants ranging in age from 19 to 82 years. The results showed that young adults (19–29 years) named regrets related to relationships and leisure more often than middle-aged (30–54 years) and older adults (55–82 years), whereas regrets related to work and family were more salient among middle-aged and older adults. Furthermore, gender comparison revealed that regrets concerning relationships and family were more frequent among women than among men. Related to subjective well-being, results showed that regrets concerning education and work were negatively associated with life satisfaction, and depressive symptoms associated with self-related regrets.     

Family Stress and Children's Rejection by Peers: Do Siblings Provide a Buffer?

We present two studies examining the role of siblings as possible buffers against the negative impact of family stress on children's peer relations. In Study 1, we examined associations between stress, sibling status, and peer rejection in a sample of 206 children in grades 3–5 in a majority African-American, rural, lower SES sample. In this low-income sample, higher stress was associated with more peer rejection, but having a sibling did not appear to buffer children against rejection by peers. In Study 1, we examined associations between stress, sibling status, and multiple dimensions of peer relations in a sample of 47 children in grades 3–6 in a majority Caucasian, urban, middle SES sample. In this middle-class sample, stress was unrelated to peer rejection but was associated with higher aggression, which often leads to rejection. In addition, the results from the middle class sample suggested that having a sibling may act as a buffer under high-stress conditions. The results are discussed in terms of current conceptualizations of buffering, contextual influences on family–peer links, and the need to assess multiple dimensions of children's peer-related functioning.     

My Mother: My Best Friend? Adults’ Relationships with Significant Others Across the Lifespan

In order to investigate the significance of adults’ relationship to their parents, this relationship is compared to relationships with siblings, friends, partners, and children. German adults (N = 902) between the ages of 20 and 86 completed the Network of Relationships Inventory (Furman and Buhrmester 1992). Participants felt most supported by their partners, followed by their children, mothers, friends, fathers, and siblings. Conflicts were more frequently found within the family (especially with the partner, followed by children, mothers, fathers, and siblings) than with friends. Except for partner relationships, both conflict and support decreased with age. Concerning relative power within their relationships, partners, mothers, and siblings are seen as equals, friends and especially fathers are perceived as more powerful, and children as less, yet increasingly powerful. Regarding all relationship types and relationship qualities, the differences between women and men were small.     

The Development of Family Loyalty and Relational Ethics in Children

Despite little research investigating how family loyalty and relational ethics develop in children, theorists suggest that children's early family loyalty experiences play a significant role in their future relationships. Twenty-four children, ages 5–10 years, were interviewed to examine developmental trends in children's conceptualizations of family and family loyalty and their reasoning through parent-child ethical dilemmas. Results indicate (a) younger children possess a simpler, more concrete schema for family and family loyalty than do older children and (b) younger children are less able than older children to adopt their parents' perspectives in reasoning through ethical dilemmas.A psychotherapist with T. W. Ponessa & Associates