Homeostatic interactions: a longitudinal study of biological, psychosocial and family variables in children with cystic fibrosis

A two-Year longitudinal study of thirty-five children used data gathered from pulmonary function tests, clinical measurements and standardized tests of depression, self-esteem and family environment to illustrate homeostatic interactions among biological and psychosocial adaptation to cystic fibrosis. Despite physical deterioration over the course of the study, children with cystic fibrosis reported lower depression and higher self-esteem than population norms, and improvements in psychological functioning. Decline in biological indicators of health was associated with increases on an index based on Family Environmental Scales (FES), subscales of cohesion, expressiveness and organization, and maintenance of high self-esteem and low depression. Presence of additional major life stressors was associated with deterioration in pulmonary function, higher levels of depression and poorer scores on the FES. These findings suggest that homeostatic interactions between children's health status and family functioning may moderate the physical and psychological sequelae of cystic fibrosis.     

Transactional Paths Between Children and Parents in Pediatric Asthma: Associations Between Family Relationships and Adaptation

The particular challenges posed by pediatric asthma may have a negative impact on the adaptation of children and their parents. From a transactional approach it is important to examine how reciprocal links between children and parents contribute to explain their adaptation and under which conditions these associations occur. This cross-sectional study aimed at examining the direct and indirect links between children’s and parents’ perceptions of family relationships and adaptation, separately (within-subjects) and across participants (cross-lagged effects), and the role of asthma severity in moderating these associations. The sample comprised 257 children with asthma, aged between 8 and 18 years-old, and one of their parents. Both family members completed self-reported questionnaires on family relationships (cohesion and expressiveness) and adaptation indicators (quality of life and psychological functioning). Physicians assessed asthma severity. Structural Equation Modeling was used to test within-subjects and cross-lagged paths between children’s and parents’ family relationships and adaptation. The model explained 47 % of children’s and 30 % of parents’ adaptation: family relationships were positively associated with adaptation, directly for children and parents, and indirectly across family members. Asthma severity moderated the association between family relationships and health-related quality of life for children: stronger associations were observed in the presence of persistent asthma. These results highlight the need of including psychological interventions in pediatric healthcare focused on family relationships as potential targets for improving children’s and parents’ quality of life and psychological functioning, and identified the children with persistent asthma as a group that would most benefit from family-based interventions.     

Community violence, family conflict, and preschoolers' socioemotional functioning

This study examined the relations among family conflict, community violence, and young children's socioemotional functioning and explored how children's social cognition and mothers' psychological functioning may mediate the outcomes associated with this exposure. Mothers of 431 Head Start preschoolers completed questionnaires about their family demography, exposure to community violence, family conflict, and children's distress symptoms. Children were administered a social cognition assessment, and teachers rated their behavior. Results showed that mothers' reports of children's co-witnessing of community violence were positively associated with police department crime rates, children's distress symptoms, and teachers' ratings of aggression. A path analysis revealed that children's social awareness and mothers' depressive symptoms partially mediated the effects of community violence and family conflict on outcomes for children.     

An examination of the impact of harsh parenting contexts on children's adaptation within an evolutionary framework

The current study tests whether propositions set forth in an evolutionary model of temperament (Korte, Koolhaas, Wingfield, & McEwen, 2005) may enhance our understanding of children's differential susceptibility to unsupportive and harsh caregiving practices. Guided by this model, we examined whether children's behavioral strategies for coping with threat and challenge cohered into 2 broad, phenotypic dimensions--hawk and dove--that have been maintained by frequency-dependent selection throughout our ancestral history: Hawk-like strategies are characterized by approach, dominant-negative affect, and activity, whereas dove-like strategies are evidenced by avoidance, inhibition, and vulnerable affect. In turn, we examined the moderating effect of hawk or dove profile membership on children's physiological and psychological adaptation to harsh rearing environments. Participants included 201 2-year-old toddlers and their mothers. Consistent with the Korte model, latent profile analyses extracted 2 profiles that cohered into hawk and dove strategies. Children were classified within hawk or dove profiles and separately examined in a process model of harsh caregiving. As predicted, associations between harsh caregiving practices and children's basal cortisol, parasympathetic nervous system, and sympathetic nervous system activity were moderated by profile membership. In turn, basal physiological levels were differentially predictive of children's psychological adaptation over time. Collectively, findings highlight the potential value of translating the study of evolutionary models to understanding developmental outcomes associated with harsh caregiving.     

Using SAS PROC CALIS to fit Level-1 error covariance structures of latent growth models

In the present article, we demonstrates the use of SAS PROC CALIS to fit various types of Level-1 error covariance structures of latent growth models (LGM). Advantages of the SEM approach, on which PROC CALIS is based, include the capabilities of modeling the change over time for latent constructs, measured by multiple indicators; embedding LGM into a larger latent variable model; incorporating measurement models for latent predictors; and better assessing model fit and the flexibility in specifying error covariance structures. The strength of PROC CALIS is always accompanied with technical coding work, which needs to be specifically addressed. We provide a tutorial on the SAS syntax for modeling the growth of a manifest variable and the growth of a latent construct, focusing the documentation on the specification of Level-1 error covariance structures. Illustrations are conducted with the data generated from two given latent growth models. The coding provided is helpful when the growth model has been well determined and the Level-1 error covariance structure is to be identified.     

The Relationship Between Social Support and Family Relationships Among Low-Income Couples Attending Relationship Education

Results are mixed for relationship education (RE) interventions with low-income couples. For couples who experienced positive changes, it is not clear what aspects of program models contributed to change. Many low-income couples attend government-funded RE with limited access to social and community resources. Program models often provide related resources complimentary to RE skill-building. We examined the relationship between income, social support, and family functioning for low-income, ethnically diverse couples (N = 856) who attended RE, as well as the mediating effects of social support on family functioning outcomes. Analyses included three separate dyadic models that examined associations among constructs at baseline and immediately following the RE intervention. Results demonstrated relationships between participants’ reported social support and family functioning such that (a) social support was associated with baseline family functioning for both men and women; (b) men’s baseline social support was influenced by women’s baseline family functioning; and (c) men’s and women’s social support change score had a positive influence on their own family functioning change score. However, social support was not a significant mediator of change in family functioning. Implications for RE practice and research are also discussed.     

Asthma severity, child security, and child internalizing: using story stem techniques to assess the meaning children give to family and disease-specific events

Children with persistent asthma are at increased risk for mental health problems. Although mechanisms of effect are not yet known, it may be that children are less trusting of the family as a source of support and security when they have more severe asthma. This study tested whether asthma severity is related to children's perceptions of insecurity in the family, and whether insecurity is in turn associated with child adjustment. Children (N = 168; mean age = 8 years) completed story stems pertaining to routine family events (e.g., mealtimes) and ambiguous but potentially threatening asthma events such as tightness in the chest. Responses were evaluated for the extent to which appraisals portrayed the family as responding in cohesive, security-provoking ways. Asthma severity was assessed by both objective lung function testing and primary caregiver report. Caregivers reported child symptomatology. Beyond medication adherence, caregiver education, and child age and gender, greater asthma severity predicted more internalizing and externalizing symptoms. Greater asthma severity, assessed using spirometry (but not parent report), was related to less secure child narratives of the family, which in turn related to more child internalizing symptoms. Results suggest that asthma can take a considerable toll on children's feelings of security and mental health. Furthermore, given the difficulty in assessing young children's perceptions, this study helps demonstrate the potential of story stem techniques in assessing children's appraisals of illness threat and management in the family.     

Primary and Secondary Caregiver Reports of Quality of Life in Pediatric Asthma: Are they Comparable?

This study aimed to compare primary and secondary caregiver QOL within families of children with asthma and determine the potential importance of including secondary caregiver QOL in clinical and research settings. Participants included 118 families of children with asthma that had primary and secondary caregivers. Families completed measures in a single research session. Caregivers reported on QOL, psychological functioning, and family burden; children completed a measure of QOL. Child lung function was determined from objective spirometry. Adherence to prescribed controller medication was measured for 6 weeks following the research visit. Primary caregiver QOL was significantly lower than secondary caregiver QOL (Mean overall QOL of 5.85 versus 6.17, p < .05). Better medication adherence was associated with higher primary caregiver QOL (ρ = .22, p = .02); secondary caregiver QOL, not primary caregiver QOL, was positively associated with child QOL (ρ = .20, p = .03). Families with discrepant QOL scores between caregivers (difference in scores of at least .50) were characterized by more family burden and primary caregiver psychological symptoms. Differences in QOL scores between caregivers may be a reflection of primary caregivers’ greater investment in daily asthma management. In families reporting low burden and few psychological difficulties in the primary caregiver, QOL assessments from either caregiver may may be informative and representative of how parents are adapting to child asthma. In families experiencing high levels of burden or more primary caregiver psychological difficulties, QOL reports from secondary caregivers may not be as clinically meaningful.     

The development of children's intentions to use alcohol: direct and indirect effects of parent alcohol use and parenting behaviors

The purpose of this study was to explore the effect of parent alcohol use and parenting behavior on the development of children's intentions to use alcohol in Grades 1 through 8. The authors hypothesized that the effect of parent alcohol use on children's intention to use alcohol would be mediated through parenting behavior, specifically monitoring/supervision, positive parenting, and inconsistent discipline. Using cohort-sequential latent growth modeling (LGM), the authors tested 3 models examining the effect of the development of parent alcohol use on the development of children's intentions to use alcohol, as mediated by the development of each of the 3 parenting behaviors. Multiple group analyses were used to explore gender differences. The effect of growth in parent alcohol use on growth in children's intentions was mediated only by parent monitoring/supervision and was significant only for girls. The effect of inconsistent discipline was directly related to growth in intentions for both boys and girls. Although parent alcohol use was related to less positive parenting, positive parenting was unrelated to children's intentions to use alcohol.     

Family and childhood adjustment in cystic fibrosis

Family adaptation has been commonly associated with the psychological adjustment of chronically ill children. However, few studies have attempted to systematically evaluate this association and its relationship to illness severity. We studied 44 children ages 7 to 15 and their families at a large cystic fibrosis center and obtained measures of 1) impact of illness on the family; 2) family functioning; 3) behavioral adjustment; 4) social competence; 5) ratings of anxiety, depressive, and eating disorder symptoms; and 6) ratings of illness severity and duration. Impact of illness on the family and overall family dysfunction were significantly correlated with illness severity, but not duration. However, impact of illness on the family was significantly correlated with internalizing behavioral symptoms, while family dysfunction was correlated with depressive symptomatology. These findings suggest that illness-related stress is primarily reflected in general emotional and behavioral symptoms, with familial adaptation either ameliorating or exacerbating their development into depressive symptomatology.     

Distinguishing Caregiver Strain from Psychological Distress: Modeling the Relationships Among Child, Family, and Caregiver Variables

Although both have been used in studies of the impact of mental illness on the family, the constructs of caregiver strain (often referred to as burden of care) and psychological distress have not been clearly distinguished. The vagueness surrounding these constructs, and the lack of a cohesive conceptual framework for understanding how they relate, leads to contradictory interpretations of results. This compromises the building of the knowledge base needed to develop and evaluate interventions to support families as they struggle to meet the needs of their children with emotional and behavioral challenges. We utilized the ABCX Model as a framework for understanding caregiver strain and its relationship to psychological distress. Structural equations modeling was used to test the hypothesized relationship between caregiver strain and psychological distress, as well as the role of key child and family variables. These included child symptoms, stressful life events, social support, family functioning, and material resources. Our findings indicated that caregiver strain and psychological distress, although related, have distinct correlates and different implications in the family context.     

Parental Loss During Childhood and Outcomes on Adolescents’ Psychological Profiles: A Longitudinal Study

The loss of a parent during childhood is a traumatic experience that can bring about several difficulties in adaptation and psychopathological problems over time during the child’s development. The present study assesses the psychological functioning of a sample of non-referred pre-adolescents and adolescents and considers the impact of the loss of a significant caregiver on their current psychological profiles. Three groups of subjects were considered, as follows: Group A experienced loss between birth and 3 years of age; Group B experienced loss between 3 and 10 years of age; and Group C experienced no loss. The results show that there is a significant decrease in psychopathological risk and improvement in subjects’ scores in the transition from pre-adolescence to mid-late adolescence. Adolescents who have suffered the loss of a caregiver within the first three years of life, however, continue to report higher scores than the other two groups, denoting no improvement in their psychological welfare.     

Verbal ability and executive functioning development in preschoolers at head start

Research suggests that executive functioning skills may enhance the school readiness of children from disadvantaged homes. Questions remain, however, concerning both the structure and the stability of executive functioning among preschoolers. In addition, there is a lack of research addressing potential predictors of longitudinal change in executive functioning during early childhood. This study examined the structure of executive functioning from fall to spring of the preschool year using a multimethod battery of measures. Confirmatory factor analyses revealed a unidimensional model fit the data well at both time points, and tests of measurement invariance across time points indicated that children's mean latent executive functioning scores significantly improved over time. Verbal ability was a significant predictor of longitudinal change in executive functioning. Theoretical implications and directions for future research are discussed.     

Mothers' and Fathers' Psychological Symptoms and Marital Functioning: Examination of Direct and Interactive Links with Child Adjustment

A community sample of 51 mother-father dyads with a school-age child rated marital functioning, parental psychological symptoms, and children's adjustment problems. Parents with more psychological symptoms reported lower marital satisfaction levels. Mothers' and fathers' marital functioning and symptomatology individually related to children's adjustment in the expected directions. In addition, interaction tests revealed that, for mothers but not fathers, the combination of poorer marital functioning and higher levels of psychological symptoms amplified the negative effects on children's adjustment problems. These findings support the hypothesis that parental psychopathology and marital adjustment together affect children's functioning in an interactive way, underscoring the need to consider multiple family influences in studies of child development.     

Paternal and maternal influences on family functioning among Hong Kong Chinese families

The linkages between dyadic relationships in the family and family functioning were examined in 378 Chinese families on two occasions. The following dyadic relationships were investigated: (a) parent-child relationship qualities reported by adolescent children (questionnaire and interview measures of parenting style, parent-adolescent conflict, parent-adolescent communication, and parent-adolescent relationship) and by their parents (questionnaire measures of parent-child relationship quality and demand); and (b) marital quality reported by the parents via questionnaire measures. Results showed that parents' and children's views of family functioning were longitudinally related to dyadic relationships in the family. Relative to mother-adolescent relationship and mothers' report of marital quality, father-adolescent relationship and fathers' report of marital quality were generally found to have a stronger association with perception of family functioning and its change over time.     

Family interaction and child outcome in a high-risk sample

This study hypothesized that the quality of family interaction would predict longitudinally children's follow-up functioning. The subjects were 97 boys, functioning on the average within the normal range but considered to be at risk for psychopathology because one parent had previously been hospitalized for psychiatric illness. Family measures of deviant and healthy communication and of activity, balance, and warmth related significantly to children's competent social/emotional/cognitive functioning at a 3-yr. follow-up. The findings suggest the importance of considering multiple predictors of outcome for children and of employing clinical interventions that attend to more than one aspect of family functioning.     

母亲元情绪理念与学前儿童社会适应的相互作用关系

采用追踪设计对438名学前儿童母亲进行问卷调查研究,主要探讨了母亲元情绪理念与学前儿童社会适应的相互作用关系。交叉滞后分析结果表明：（1）相邻两次测量的母亲各元情绪理念之间,社会适应各指标之间均具有中等程度的稳定性;（2）同一时间点的母亲各元情绪理念与儿童社会适应各指标之间均显著相关;（3）母亲元情绪理念与儿童社会适应之间部分存在着相互作用关系：控制了变量自身的连续性后,前测的母亲情绪教导显著正向预测后测的儿童敏感合作;前测的母亲情绪不干涉显著正向预测后测的儿童愤怒攻击、焦虑退缩行为;反过来,前测的儿童敏感合作能正向预测后测的母亲情绪教导,显著负向预测情绪不干涉、情绪摒除和情绪紊乱;前测的焦虑退缩能显著正向预测后测的母亲情绪摒除和情绪紊乱。     

Preschoolers with Asthma: Narratives of Family Functioning Predict Behavior Problems

This study tested a model predicting behavior symptoms in preschoolers with asthma. Specifically, it examined the role that asthma severity and children's representations of family functioning may play in the development of child behavior problems in a sample of 53 low-income preschoolers. The study included parent report of asthma severity and a narrative story-stem method to assess children's representations of both general and disease-specific family processes. A regression model tested the inclusion of both types of family processes in predicting child internalizing and externalizing behavior. Disease severity and children's family narratives independently predicted children's behavior over and above the combined effects of demographic variables including child age, socioeconomic status, and family structure. Although children's narratives about general family functioning predicted children's behavior, narratives about family response to asthma symptoms did not. Findings support that both disease severity and family functioning are important considerations in understanding children's behavior problems in the context of asthma. Clinical applications of findings may include: (1) Informing family based-assessments to incorporate children's narratives, and (2) A focus on reducing asthma symptoms and strengthening family functioning to prevent or address child behavior problems.     

Provider Perspectives on Outcome Goals for Children's Day Treatment

I describe service provider perspectives regarding outcome goals of children's day treatment and their ideas for how to make day treatment programs successful in achieving stated outcomes. Respondents were direct service staff from ten day treatment programs in one county in Washington state. Data were obtained through nominal group process methods. The primary outcome goals of day treatment reported were: community re-integration, improved adaptive functioning skills, psychological growth, and improved family functioning. Aspects of day treatment that may help achieve outcome targets included: team quality; comprehensive programming; a consistent, safe, accepting program environment; an individualized, developmental approach; linkages with other services; family involvement, and a low staff-to-client ratio. Outcome goals are discussed relative to those described within the research literature on children's mental health services. Implications for the use of outcome goals for quality improvement are described.     

Chaotic-Enmeshment and Anxiety: The Mediating Role of Psychological Flexibility and Self-Compassion

With anxiety becoming the most prevalent mental health issue among the college student population, it is important to understand the factors that are associated with symptomology. This study aims to expand the research on the interrelationship between family functioning, intrapsychic factors, and anxiety. Guided by the circumplex model of family systems, the current study explores the link between college student (N?=?500) chaotically-enmeshed family functioning and anxiety, and whether psychological flexibility and self-compassion mediate this relationship. Multiple-sample latent structural equation modeling results revealed that higher levels of chaotically-enmeshed family functioning was significantly associated with lower levels of psychological flexibility and self-compassion levels, and that psychological flexibility and self-compassion mediated the relationship between chaotic-enmeshment and anxiety. Implications for family therapists who provide services to this population are discussed.