Predicting Quality of Life in Caregivers of Children with Cancer Within One Year Post-Diagnosis

Journal of Child and Family Studies - Pediatric cancer diagnosis and treatment can impact the psychological adjustment and quality of life (QOL) of caregivers. We examined: (a) the relationship...     

Parent reports of children’s working memory,coping, and emotional/behavioral adjustment in pediatric brain tumor patients: A pilot study

Neurocognitive problems in childhood survivors of brain tumors are well documented. Further, research has shown that problems in cognitive functioning may be associated with impairment in the use of complex strategies needed to cope with stress, including secondary control coping strategies (e.g., acceptance and cognitive reappraisal) which have been associated with fewer adjustment problems. The present study measured cognitive function, coping strategies, and adjustment in children ages 6–16 years at the time of brain tumor diagnosis and at two follow-up time-points up to 1 year post-diagnosis. In a prospective design, working memory was assessed in a total of 29 pediatric brain tumor patients prior to undergoing surgery, child self-reported coping was assessed at 6 months post-diagnosis, and parent-reported child adjustment was assessed at 12 months post-diagnosis. Significant correlations were found between working memory difficulties and secondary control coping. Secondary control coping was also negatively correlated with child attention and total problems. Regression analyses did not support secondary control coping mediating the association between working memory difficulties and child attention or total problems. These findings represent the first longitudinal assessment of the association between working memory, coping, and adjustment across the first year of a child’s brain tumor diagnosis and suggest a possible role for early interventions addressing both working memory difficulties and coping in children with brain tumors.     

Recommendations from Multi-disciplinary Focus Groups on Cascade Testing and Genetic Counseling for Fragile X-associated Disorders

The purpose of this paper is to report the outcome of a collaborative project between the Fragile X Research and Treatment Center at the Medical Investigation of Neurodevelopmental Disorders (M.I.N.D.) Institute at the University of California at Davis, the National Fragile X Foundation (NFXF), and the Centers for Disease Control and Prevention (CDC). The objective of this collaboration was to develop and disseminate protocols for genetic counseling and cascade testing for the multiple disorders associated with the fragile X mental retardation 1 (FMR1) mutation. Over the last several years, there has been increasing insight into the phenotypic range associated with both the premutation and the full mutation of the FMR1 gene. To help develop recommendations related to screening for fragile X-associated disorders, four, two day advisory focus group meetings were conducted, each with a different theme. The four themes were: (1) fragile X-associated tremor/ataxia syndrome (FXTAS); (2) premature ovarian failure (POF) and reproductive endocrinology; (3) psychiatric, behavioral and psychological issues; and (4) population screening and related ethical issues.     

Lessons in collaboration, four years post-Katrina

Four action researchers present a case study of a project conducted by members of a national family therapy organization and members of a local family therapy institute, which describes their efforts to collaborate with local disaster recovery workers 2 years after Hurricane Katrina. The aim of the collaboration was to create a local action research team to study best practices that strengthen resilience after disaster. The authors discuss choice points and dilemmas faced in finding collaborative partners and in clarifying what constitutes an invitation to work in a community. The case study illuminates tensions and understandings between outsiders and a community still facing the long-term effects of a disaster.     

Learning Emotionally Focused Couple Therapy: Four Clinicians' Perspectives

This study examined the experiences of four clinicians learning emotionally focused couple therapy (EFT). Two group interviews, separated by 6 years, explored topics that included emotion, gender, model differences, personal practitioner impact, and the long-term influence of EFT training on clinical work. Emotion emerged as a major theme, with three subthemes at each phase. Phase 1 results indicated an increase in personal awareness of emotions, a positive impact on close personal relationships, and challenges for males in learning to elicit and use emotion. Phase 2 results, 6 years later, revealed that focusing on emotions remained salient and that EFT continues to influence the work of each clinician to varying degrees. Limitations, future research suggestions, and clinical implications are discussed.     

A fugue in four voices: sounding themes and variations on the reflecting team

In this account of an on-going reflecting team, a group of 4 therapists describe how they preserve multiple perspectives, yet join their voices to create coherent, meaningful reflections. This reflecting approach emphasizes developing a theme and creating variations on this theme, in a manner resembling a musical fugue. In addition, the practicalities of creating and sustaining a reflecting team in a private practice context are described.     

Cognitive,affective and social mechanisms in depression risk: Cognition,hostility, and coping style

Although some research has assessed cognitive variables in individuals at risk for depression, few studies have specifically assessed the role of automatic thinking, and virtually no studies have assessed anger and coping in this group. The current study compared measures of these variables in a high-risk group that was defined on the basis of a previous episode of depression, and a control group comprised of low-risk/never depressed individuals. Even though neither group evidenced depressive symptoms at the time of assessment, group comparisons and regression analyses indicated that high-risk individuals reported more negative automatic thoughts than did low-risk participants and that social support seeking, self-blame, and avoidance emerged as coping predictors of risk as did higher levels of anger and hostility. These data thus suggest patterns of interpersonal, behavioural, and cognitive variables that may characterise depression risk.     

A vigilance task sensitive to the effects of stimulants, hypnotics, and environmental stress: The Scanning Visual Vigilance Test

The Scanning Visual Vigilance Test is a variable-length detection test designed to assess the ability of individuals to maintain visual alertness for sustained periods of time. The test was designed to be sensitive to changes in vigilance produced by subtle variations in performance, such as those produced by low doses of centrally acting food constituents, drugs, or environmental stress. The test has been shown to be sensitive to the effects of stimulants and sedatives, as well as cold stress and sleep loss. It requires the subject to continuously scan a video monitor to detect the occurrence of infrequent stimuli that are difficult to detect. The number of stimuli correctly detected, false alarms, and reaction times are recorded. The stimulus is a small rectangle displayed for 2 sec at random locations on a darker region of a video monitor at random or pseudo-random times. The brightness of the stimulus can be adjusted for each subject individually on an automated threshold detection test. Training and test session length are defined by the experimenter. Hardware requirements are an IBM-compatible personal computer (286 or higher) with a color or grayscale VGA monitor.     

Anger in response to challenge: children’s emotion socialization predicts approach versus avoidance

Negative emotion is typically associated with avoidance behavior; however, recent advances in the adult literature show that unlike some emotions (sadness, shame), anger predicts both approach and avoidance. Here we propose that socialization to suppress anger will play a role in whether children who express anger respond to a performance challenge with approach or avoidance. Children (N = 79; M _age  = 11.4 years) reported perceptions of parental use of positive conditional regard (PCR) to socialize anger suppression and worked on four unsolvable puzzles. We measured change in verbalized puzzle-solving strategies during failure, and coded emotion expression on the final puzzle. We examined whether negative emotion type (shame/sadness vs. anger) and PCR for anger predicted change in strategy use, and whether the association between level of PCR for anger and approach-avoidance (change in strategy use) depended on type of negative emotion expressed. Neither emotion expression nor level of PCR anger predicted strategy use; however, type of negative emotion moderated the association between PCR anger and change in strategy use, controlling for NCR anger. For children who displayed anger, low PCR was associated with increased strategy use, and high PCR was associated with decreased strategy use. We discuss the role of emotion socialization in shaping approach and avoidance motivation.     

Behavioral Health Integration in Health Care Settings: Lessons Learned from a Pediatric Hospital Primary Care System

Behavioral health integration within primary care has been evolving, but literature traditionally focuses on smaller scale efforts. We detail how behavioral health has been integrated across a large, urban pediatric hospital system’s six primary care clinics (serving over 35,000 children annually and insured predominately through Medicaid) and discuss strategies for success in sustaining and expanding efforts to achieve effective integration of behavioral health into primary care. In a time span of 3 years, the clinics have implemented routine, universal behavioral health screening at well child visits, participated in a 15-month behavioral health screening quality improvement learning collaborative, and integrated the work of psychologists and psychiatrists. Additional work remains to be done in improving family engagement, further expanding services, and ensuring sustainability.