Childhood cancer: a two-year prospective study of the psychological adjustment of children and parents

OBJECTIVE: To follow prospectively the psychological adjustment of young children, parents, and families during the first 2 years after the children's diagnosis of cancer. METHOD: Children aged 2 to 5 years with cancer diagnoses and their parents and families (n = 38) were assessed immediately after diagnosis, 1 year after diagnosis, and 2 years after diagnosis. At each assessment, the psychological adjustment of the children and their families was compared with the adjustment of a cohort of children and families in the general community (n = 39). RESULTS: Children with cancer and their parents experienced significantly more emotional distress than children and parents in the community during the period immediately after diagnosis. However, the number of problems experienced by the children with cancer and their parents declined during the first year after the children's diagnosis and stabilized at a level comparable with that found among children and parents in the general community. CONCLUSION: Although the results are consistent with reports that suggest that in the longer term the prevalence of psychological problems among children with cancer is similar to that found among children in the general community, they also highlight the considerable distress experienced by children and parents during the period immediately after the children's diagnosis.     

Parent and therapist evaluation of behavior therapy in a child psychological clinic.

Obtained evaluations from the parents of 70 children who were treated by psychological interns being trained in behavior therapy. Therapist ratings of specific problem improvement were obtained at close of therapy. Improvement ratings of the same specific problems were obtained from parents approximately 6 mo later. Classification of an S as improved or unimproved depended on the averages of both the therapist and parent ratings of the presenting problems. This procedure indicated overall improvement in 87 and 90% of the cases, based on therapist and parent averages, respectively. Therapists rated 80% of all specific problems improved at termination, as compared to 77% of problems improved as rated by parents at follow-up. Correlation between the improvement ratings of each problem by parent and therapist was highly significant (r = .51). 96% of the parents liked their therapists, and personal characteristics most frequently noted by the parents were warmth, understanding, and sincere interest in the S. The high improvement rates reported by therapists and parents are discussed in regard to previous therapy outcome studies with children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A new collection method for the evaluation of nasal mucus proteins

BACKGROUND: Although it is generally recognized that poverty and depression can coexist among single parents receiving social assistance, there is insufficient research on this topic. The goals of this study therefore were to investigate the prevalence, correlates and health care expenditures associated with depression among sole-support parents receiving social assistance. METHODS: Sole-support parents who had applied for social assistance in 2 regions of southwestern Ontario were included in the study. Depression was diagnosed with the 1994 University of Michigan Composite International Diagnostic Interview short forms. RESULTS: The 12-month prevalence rate of depressive disorder among the parents interviewed was 45.4% (345/760). A total of 247 (32.5%) had major depressive disorder alone, 19 (2.5%) had dysthymia, and 79 (10.4%) had both major depressive disorder and dysthymia ("double depression"). Those with major depressive disorder, particularly double depression, had significantly higher rates of coexisting psychiatric disorder than those without depressive disorders. Parents with depression reported higher rates of developmental delay and behaviour problems in their children than parents without depression. Expenditures for health care services were higher for parents with depression and for their children than for parents without depressive disorder and their children. INTERPRETATION: Single parents receiving social assistance have high rates of depression. Such parents with depression also have higher rates of other psychiatric disorders and higher expenditures for health care services, and their children have higher rates of developmental delay and behaviour problems.     

Familial aggregation of emotional and behavioral problems of childhood in the general population

OBJECTIVE: This study sought to evaluate the existence and implications of familial aggregation of emotional and behavioral problems of childhood in a general population sample. METHOD: The children included in the study were chosen with the use of a sampling technique that identified households in which there were two or more children aged 4-16 years living at home at the time of the survey. Ratings on checklists of emotional and behavioral problems were obtained from parents, teachers of children in elementary school, and the children themselves if they were adolescents aged 12-16. Children were classified as having problems if their scores on scales of conduct, attention deficit, or emotional problems were in the top 10% of the distribution of scores from any informant. RESULTS: There was evidence for familial aggregation of these problems, particularly conduct and emotional problems. However, this was largely derived from the parents' reports of symptoms, not the teachers' or adolescents' reports. The degree of familial aggregation varied according to certain sibship characteristics and patterns of comorbidity. CONCLUSIONS: Familial aggregation of emotional and behavioral problems does exist in a community population and is not simply an artifact of clinic attendance.     

Neurorehabilitation outcome in moyamoya disease

OBJECTIVE: To assess the contribution of emotional health problems to the burden of disability affecting people of working age. DESIGN: Analysis of data collected in a postal questionnaire survey of a random sample of people aged 18-64 years. SETTING: The four counties of the old Oxford region in 1991. SUBJECTS: 9332 people who responded to a questionnaire survey mailed to 14,000 people randomly selected from the Family Health Service Authority registers of the four counties of Berkshire, Buckinghamshire, Oxfordshire, and Northamptonshire. OUTCOMES MEASURES: Interference with work or other regular daily activity as reported in questions 4 and 5 of the health status measure SF-36. RESULTS: In this population the prevalence of disability attributable to emotional health problems was greater than that attributable to all physical health problems combined. People reporting that their work or other regular daily activity was affected by their emotional health were much less likely to report a long-standing illness, consultation with a GP or consultation with a hospital doctor than people reporting a physical health problem. CONCLUSIONS: Emotional health problems are a more important cause of disability in adults of working age than all physical health problems put together. Their importance is underestimated in health needs assessment exercises, which are based on NHS consultation rates or reporting of chronic illness. Research into the causes, prevention, and management of emotional health problems should be a national priority for the health service.     

Cochlear implants in children: an analysis of use over a three-year period

OBJECTIVE: This study aimed to determine whether children continue to wear their cochlear implant systems 1 and 3 years after implantation. STUDY DESIGN: The design was a prospective study based on the analysis of forced-choice questionnaires on implant use completed independently by parents and teachers. SETTING: The study was performed at a dedicated pediatric cochlear implant program in a tertiary referral center in the United Kingdom. PATIENTS: All 85 consecutively implanted children who had reached the 1-year interval after implantation and 37 children who had reached the 3-year assessment interval after implantation participated. The patients represented all socioeconomic status groups, the entire range of educational settings, and often lived at a considerable distance from the implant center. MAIN OUTCOME MEASURES: Parents and local teachers were asked to describe implant use in the following categories: 1) all of the time; 2) most of the time; 3) some of the time; and 4) none of the time. RESULTS: One year after implantation, parents and teachers, respectively, rated 79 (93%) and 82 (96%) children as full-time users (category 1). Parents rated six children (7%) as users most of the time (category 2), and teachers rated three children (4%) as users most of the time. No child was rated as an occasional or nonuser (category 3 or 4). At 3 years after implantation, 33 (89%) and 34 (95%) children were rated as full-time users (category 1) by parents and teachers, respectively. Parents judged four children (11%) and teachers rated two children (5%) to be users most of the time (category 2). Again, no child was rated in category 3 or 4 as an occasional or nonuser. CONCLUSIONS: The majority of implanted children use their implant systems all of the time over a 3-year period after implantation when selected appropriately and given appropriate follow-up.     

Cancer chemotherapy in patients of advanced age (over 75)

The changes occurring within Korean society provide an opportunity for studying the influence of family structure on children's emotional and behavioural problems. Children aged 7-13 years from two Korean cities were assessed for emotional and behavioural problems in school by their teachers, using the Children's Behaviour Questionnaire. In Study 1, 326 children from extended families were compared with demographically matched nuclear family children in the same school classes. In Study 2, a further sample of 204 extended family children was compared with pair-matched nuclear family children, in order to replicate the findings. Children from Study 1 were followed up 2.5 years later. Children from extended families had lower behaviour problems scores and the prevalence of serious problems was lower in extended family children. These differences were most marked in relation to externalising behaviour problems and were stable over the studies and time. Grandparents in extended families may increase children's resiliency by providing sources of attachment, affection, and knowledge, as well as having indirect effects through their support of parents. Consistent with recent ideas about the cognitive bases for behaviour problems, it may be that rules for behaviour derived from traditional cultural beliefs and values are internalised by children from extended families and generalise to prevent behaviour problems in school.     

Interhemispheric asymmetry exists in female in the N100m source position of the auditory evoked magnetic fields

OBJECTIVE: To evaluate the affect of families' attitudes about the appropriateness of discussing psychosocial concerns on pediatric providers' identification of psychosocial problems. DESIGN: These data were collected as part of the Greater New Haven Child Health Study, New Haven, Conn. The study design was a prospective cohort. SETTING: Families were recruited from a stratified random sample of all primary care practices in the greater New Haven area. Nineteen of 23 invited practices agreed to participate including 2 prepaid practices, 2 neighborhood health centers, and 7 fee-for-service group and 8 fee-for-service solo practices. PARTICIPANTS: All families of children aged 4 to 8 years who attended these practices during 2 separate 3-week periods (1 in fall 1987 and 1 in spring 1988) were invited to participate in the study. Families were invited to participate only once, on the first contact with any eligible child, using approved procedures. Of 2006 eligible families, 1886 (94%) chose to participate. MAIN OUTCOME MEASURE: The outcome variable for these analyses is the identification of any behavioral, emotional, or developmental problem by the pediatrician on the 13-category checklist. Overall, pediatric clinicians identified 27.5% of children with 1 or more psychosocial problems. RESULTS: Our data suggest that there is a great deal of discrepancy between what parents report is appropriate to do when their children have psychosocial problems and what they actually do when they recognize such problems in their children. Most (81.1%) believed it was appropriate to discuss 4 or more of the 6 hypothetical situations with their children's physician, while only 40.9% actually did discuss any of these problems with a physician when a problem occurred. Given the correlates of parents who intended to discuss such problems (higher education, older age, Euro-American ethnicity, higher income, married, availability of medical insurance) the possibility that parents are providing socially acceptable responses to such questions seems likely. Further, our data indicate that parents' actual reports of discussions of psychosocial problems is unrelated to whether physicians identified those problems in children. CONCLUSIONS: Pediatricians'judgments about the presence of psychosocial problems in their young patients seem to be based on their own observations rather than on what parents report. Physician-parent communication about psychosocial problems will be increasingly important as primary care physicians assume their role as gatekeepers to more expensive services such as mental health interventions.     

Diet and humoral responsiveness of lines of chickens divergently selected for antibody response to sheep red blood cells

OBJECTIVE: To assess everyday life stress and emotional adjustment in patients with rheumatoid arthritis (RA) and their children. METHODS: We conducted a 6 month study of 14 patients with RA with children aged 4-16 years (25 children) and 24 control families (53 children). Life event stress and functional capacity were assessed at the beginning and end of the study, and minor stressors (hassles), positive events (uplifts), and salivary cortisol were recorded weekly. Emotional adjustment was measured monthly in adults by self-report, and bimonthly in children using the Child Behavior Checklist (completed by parents). Social support and psychological coping responses were also measured. RESULTS: Patients with RA experienced fewer positive events than did controls, and they tended to have smaller support networks. Daily hassle levels correlated with severity of disability, and differences in psychological coping were also observed. Children from RA families reported nearly 50% more hassles per week than did controls, and their social networks were significantly smaller. They were rated as having greater problems of social adjustment than controls. Cortisol concentration was greater among children who experienced more life event stress over the study period, but did not differ between groups. CONCLUSION: The patients with RA in this study showed good adaptation, but experienced less pleasure in their daily lives. The children of patients with RA may have heightened vulnerability to stress related problems, with fewer social resources and difficulties in behavioral adjustment.     

A comparison of federal definitions of severe mental illness among children and adolescents in four communities

OBJECTIVE: Using data from an epidemiological survey, the study compared existing definitions of severe mental illness and serious emotional disturbance among children and adolescents to demonstrate the range of prevalence rates resulting from application of different definitions to the same population. METHODS: Three definitions of severe mental illness and serious emotional disturbance were applied to data from the Methods for the Epidemiology of Child and Adolescent Mental Disorders survey, with a sample of 1,285, conducted in 1991-1992 by the National Institute of Mental Health. The resulting proportions of cases identified, demographic characteristics, service use, and perceived need for services were compared. RESULTS: From 3 to 23 percent of the sampled youth met criteria for severe mental illness or serious emotional disturbance. From 40 percent to as many as 78 percent of the defined youth used a mental health service in the year before the survey. School and ambulatory specialty settings were used most frequently. Generally, more than half of the parents of children with severe mental illness or serious emotional disturbance thought that their child needed services. CONCLUSIONS: The prevalence and characteristics of severe mental illness and serious emotional disturbance among children are sensitive to the definition used and its operationalization. Care should be taken by policy makers and service planners to avoid either over- or underestimating the prevalence of impaired youth in need of intensive interventions.     

Triple P-Positive Parenting Program as a public health approach to strengthening parenting.

Parenting programs have considerable potential to improve the mental health and well-being of children, improve family relationships, and benefit the community at large. However, traditional clinical models of service delivery reach relatively few parents. A public health approach is needed to ensure that more parents benefit and that a societal-level impact is achieved. The Triple P-Positive Parenting Program is a comprehensive, multilevel system of parenting intervention that combines within a single intervention universal and more targeted interventions for high-risk children and their parents. With Triple P, the overarching goal is to enhance the knowledge, skills, and confidence of parents at a whole-of-population level and, in turn, to reduce the prevalence rates of behavioral and emotional problems in children and adolescents. The distinguishing features of the intervention and variables that influence its effective implementation are discussed. Self-regulation is a unifying concept that is applied throughout the entire system (e.g., to interactions between children, parents, service providers, and agencies involved in delivering the intervention). Challenges and future directions for the development of public health approaches to parenting are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Parents with human immunodeficiency virus infection: perceptions of their children's emotional needs

OBJECTIVE: To investigate the likelihood of patients who have human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) being parents and to identify concerns of these parents about their children. DESIGN: A survey was conducted of parental status, demographics, perceptions of social/emotional needs of self and one's children. Responses were analyzed for demographic differences. PARTICIPANTS: A total of 242 patients from the university HIV/AIDS clinics completed the survey. MAIN OUTCOME MEASURES: Parental status, number, and ages of children, parental concerns about their children related to their own HIV/AIDS: RESULTS: Nearly one third (31.8%) of the sample of HIV/AIDS patients were parents, and three fourths (76%) of the female patients were mothers. Slightly more than one third of these were married, and these were not predominantly families who also had infected children. The percentage of women in the parent subsample (40.8%) was higher than the percentage of women in the overall patient sample (16.7%). Only half of the parents reported that their children > 4 years of age knew of their diagnosis. Two thirds of the parents reported they believed their children did not need to talk to someone about their parent's health, and nearly half of the parents reported that they did not need help dealing with their children concerning issues related to AIDS. CONCLUSION: The percentage of HIV/AIDS patients who are parents is high, and parental status and emotional needs of parents and their children will likely become an increasingly important issue. Many questions are raised by our findings. Should we be concerned that many parents have been unable to talk to their children about their own health? Should we help parents acknowledge that their children may need some outside help to cope?     

Interparental agreement on child behavior problems.

Interparental agreement (IA) on child behavior problems was studied by having parents in 137 families complete the Child Behavior Checklist (CBC) for their children (aged 3–13 yrs). IA on specific behavior problems was low. Mothers consistently reported more problem behavior than fathers, but parents did not show different levels of agreement for boys and girls. Discrepancies between parental reports of problem behavior, but not kappa scores, increased as the distress level of the family increased. CBC items rated high for objectivity, observability, molecularity, disturbance, and social undesirability generally obtained higher levels of parental agreement than items rated low for these qualities. Some evidence indicated that items on the externalizing scale of the checklist achieve higher agreement and are more objective, observable, and socially undesirable than items on the internalizing scale. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Triangles in the family circle: Effects of family structure on marriage, parenting, and child adjustment.

Mothers, fathers, and 6- to 10-year-old children used the Family Cohesion Index to type their family system as cohesive (all close), separate (all distant), triangulated (cross-generational coalitions), or detouring (child excluded from the parental sub-system). Family members agreed modestly with one another. Multivariate analyses of variance showed that parents in triangulated families were higher in marital conflict and dissatisfaction than were cohesive and detouring parents. Children in triangulated families reported more interparental conflict and more negative affect in the family. Children in detouring families rated themselves higher in self-blame for their parents' conflicts, and their parents rated them highest in internalizing problems. Parents in separate families rated their children highest in externalizing problems. Implications for the integration of family systems perspectives with research on marriage and parenting are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavior problems among young children in low-income urban day care centers

The purposes of this study were to describe: (a) the frequency and correlates of behavior problems among a sample of 2- and 3-year-old children from low-income families as seen by their parents and day care teachers, (b) the degree to which parents and teachers agree about the children's behavior problems in their respective contexts, and (c) family characteristics that distinguish toddlers with behavior problems both at home and at day care from the rest of the sample. Parents of 133 toddlers from 10 Chicago day care centers completed measures of child behavior problems, child behavioral intensity, parenting self-efficacy, discipline strategies, and stress. Children's day care teachers also completed a measure of child behavior problems. Parent-reported behavior problems were associated with higher child behavioral intensity, greater parent stress, lower self-efficacy, and discipline strategies characterized by irritability, coercion, and inconsistency. Parent and teacher ratings on child behavior were correlated for boys' behavior problems only. Parents reported more child behavior problems than teachers. Approximately 8% of the children were rated as having behavior problems at home and at day care. Although most of the children are functioning well, many of these parents and toddlers are engaged in highly stressful and coercive relationships.     

An attachment and school satisfaction framework for helping children raised by grandparents.

The numbers of children raised by their grandparents are increasing. Although placement with their grandparents may be the best setting for children whose parents can no longer care for them, research suggests the children may experience difficult school functioning such as behavioral, emotional, and academic problems. Additionally, the grandparents often are subject to high levels of stress that adversely affects their physical and emotional well-being. The aforementioned problems frequently occur secondary to relational issues. Attachment and school satisfaction constructs include human relational factors that are important to understanding the school-related functioning of children raised by grandparents. In this article, the implications of attachment and school satisfaction on the children's functioning are described. The constructs offer relational strategies to improve the educational and developmental trajectories of children raised by their grandparents. An attachment model and framework, based on the constructs, is described to guide prevention and intervention with these families. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Positive and negative emotionality: Trajectories across six years and relations with social competence.

The goals of the present study were to examine (1) the mean-level stability and differential stability of children's positive emotional intensity, negative emotional intensity, expressivity, and social competence from early elementary school-aged to early adolescence, and (2) the associations between the trajectories of children's emotionality and social functioning. Using four waves of longitudinal data (with assessments 2 years apart), parents and teachers of children (199 kindergarten through third grade children at the first assessment) rated children's emotion-related responding and social competence. For all constructs, there was evidence of mean-level decline with age and stability in individual differences in rank ordering. Based on age-centered growth-to-growth curve analyses, the results indicated that children who had a higher initial status on positive emotional intensity, negative emotional intensity, and expressivity had a steeper decline in their social skills across time. These findings provide insight into the stability and association of emotion-related constructs to social competence across the elementary and middle school years. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Epidemiological study of wheeze, doctor diagnosed asthma, and cough in preschool children in Leicestershire

OBJECTIVE: To determine the cumulative prevalences of wheeze and doctor diagnosed asthma and the point prevalences of recurrent cough and wheeze in children aged 5 years and under. DESIGN: Questionnaire survey of population based random sample of children registered on regional authority's child health index for immunisation; questionnaire completed by parents. SETTING: Leicestershire. SUBJECTS: 1650 white children born in 1985-9 who were surveyed in 1990. MAIN OUTCOME MEASURES: Cumulative prevalences of wheeze and doctor diagnosed asthma and point prevalences of recurrent cough and wheeze by age and sex. RESULTS: There were 1422 replies (86.2%; 726 for boys, 696 for girls). Overall, 11.0% (95% confidence interval 9.4% to 12.6%) of children had formally been diagnosed as having asthma, the cumulative prevalence in boys (12.7%) being somewhat higher than in girls (9.2%) (age adjusted odds ratio 1.47, p = 0.03). As expected, the cumulative prevalence of asthma increased significantly with age (7.5% (13/173) in children under 1 year, 15.9% (61/383) in children of 4 years and over; p < 0.001). The cumulative prevalence of wheeze overall was 15.6% (13.7% to 17.5%), being higher in boys (17.6%) than in girls (13.5%) (odds ratio 1.38, p = 0.03). The overall prevalence of recurrent cough without colds was 21.8% (19.6% to 23.9%), with a non-significant excess in boys (23.1% v 20.4%). The overall prevalence of wheezing attacks during the previous 12 months was 13.0% (11.3% to 14.8%) with a non-significant excess in boys (14.5% v 11.5%). CONCLUSIONS: These findings are baseline results and emphasise the importance of studying the age group of interest rather than relying on the recall of parents of school age children.     

Follow-up of a cohort of 422 children aged 6 to 13 years conceived by in vitro fertilization

OBJECTIVE: To contact the total cohort of children conceived by IVF-ET consecutively in our center between June 1981 and December 1988. DESIGN: Retrospective study. SETTING: Infertility unit of the department of Obstetrics and Gynecology, Antoine Béclère Hospital, Clamart, France. PATIENT(S): Complete information was obtained on 370 children. The percentage lost for follow-up was 9%. INTERVENTION(S): To assess the children's well-being, telephone interviews of the parents and questionnaires sent to the parents and/or pediatrician were used. MAIN OUTCOME MEASURE(S): Surgical procedures, malformation, height and weight, school performance. RESULT(S): The physical growth of these children showed no major pathological features, with only 2.2% of them being below 2 SD for weight and 0.3% for height. The rates of malformation were not significantly different between these children and the general population. School performance was good, with 92.2% presenting encouraging outcome. Fifty-eight percent of the parents of children aged 6 to 10 years old did not inform their children about the IVF nor did 34% of the parents of children aged 11 to 13. Subsequent to the birth of the IVF child, 30 patients (8.9%) had a spontaneous pregnancy. However, five of them (15.1%) were ectopic. CONCLUSION(S): This study reports, for the first time, reassuring data on the long-term assessment of a large group of older IVF-ET children conceived consecutively, with a low percentage of subjects lost for follow-up.