Behavioral outcome among survivors of childhood brain tumor: a case control study.
Alias Hamidah,Morthy Sasirekha Krisnan,Zakaria Syed Zulkifli Syed,Muda Zulaiha,Tamil Azmi Mohd
BACKGROUND:Advances in the treatment of childhood brain tumors have significantly improved survival rates. With improved survival rates, long-term treatment-related toxicities have become important, and the resulting complications can affect patients' emotion and behavior. This study aimed to 1) evaluate behavioral outcomes among survivors of childhood brain tumors, 2) compare behavioral outcomes among survivors of childhood brain tumors with survivors of childhood leukemia and healthy children, and 3) determine any demographic, disease, and/or treatment-related factors that could affect the behavioral outcomes of survivors of childhood brain tumors. METHODS:A comparative cross-sectional study was conducted over a period of 1 year (June 1st, 2018-May 31st, 2019) in two tertiary referral centers in Kuala Lumpur, Malaysia. Thirty-eight survivors of childhood brain tumors aged 6 to 18 years old who had been off-treatment for at least 1 year and were in remission, 38 age- and gender-matched survivors of childhood leukemia who had been off-treatment for at least 1 year and were in remission, and 38 age- and gender-matched unrelated healthy children were recruited. The Child Behaviour Checklist (CBCL) parent report and Youth Self-Report (YSR) questionnaires were used to assess behavioral outcomes. RESULTS:Survivors of childhood brain tumors showed statistically significantly worse behavioral outcomes than healthy children for social problems and attention problems (p < 0.05, respectively). A significantly worse outcome was found for "social problems" (p < 0.05) in survivors of childhood brain tumors compared to survivors of childhood leukemia. Significant associations were also found between physical disability, visual impairment, education level of survivors, and father's occupation and behavioral outcomes among survivors of childhood brain tumors. CONCLUSIONS:Survivors of childhood brain tumors in our center showed poor behavioral outcomes for social problems and attention problems. Thus, effective psychosocial support interventions tailored to individual patients as soon as treatment is completed are important to prevent potentially debilitating emotional problems.
Inside the Clockwork of the ECHO Factorial Trial: A Conceptual Model With Proposed Mediators for Prevention of Emotional Problems in Children.
Ingul Jo Magne,Martinsen Kristin,Adolfsen Frode,Sund Anne Mari,Ytreland Kristin,Bania Elisabeth Valmyr,Lisøy Carina,Rasmussen Lene-Mari Potulski,Haug Ida Mari,Patras Joshua,Collins Linda M,Kendall Philip C,Neumer Simon Peter
Frontiers in psychology
Having interventions that are not only evidence-based and effective but also cost-effective and efficient is important for the prevention and treatment of child and adolescent emotional problems. A randomized clinical trial (RCT) tests the total interventions effect but does not address specific components of the intervention. In this article the hypothesis and a conceptual model of the ECHO study are presented and discussed. The ECHO intervention consists of three different components each containing two levels of intervention. By using a cluster randomized factorial design, children aged 8-12 at 40 schools across Norway will be randomized to eight different experimental conditions investigating the optimal balance between effect, cost-effectiveness, and efficiency. The article presents the design and the different components being tested and discusses how optimalization can be reached through this innovative design. The article also discusses how interventions can be improved by investigating and understanding the mechanisms of change within psychological interventions. For each of the three components in the study we consider the mediators that could be active within the intervention and how the study investigates such mediation. The results will contribute to a better understanding of how psychological interventions work and how we intend to optimize the EMOTION intervention.
Child Maltreatment and Neglect.
Alwan Riham Mazen,Atigapramoj Nisa S
Emergency medicine clinics of North America
Emergency medicine clinicians are mandated reporters, legally, which obligates clinicians to report any behavior suspicious for child maltreatment to local authorities. Pediatric patients often present to the emergency department with concern for physical injury and other pervasive complaints. In some cases, these injuries are nonaccidental. To appropriately advocate and protect children from further physical and emotional trauma, it is important for clinicians to recognize the signs and symptoms of child maltreatment and sexual abuse.
Parental reflective function and children's attachment-based mental state talk as predictors of outcome in psychodynamic child psychotherapy.
Halfon Sibel,Besiroglu Burcu
Psychotherapy (Chicago, Ill.)
Mentalization, operationalized as reflective function, is defined as the capacity to understand behavior in terms of mental states. Mentalization can be self-focused (i.e., mentalizing that focuses on one's own thoughts and feelings) or other-focused (i.e., mentalizing that focuses on others' thoughts and feelings). Some studies in adult psychotherapy show the importance of patients' mentalization capacity for treatment outcome; however, this has not yet been investigated in psychodynamic child psychotherapy. This study aimed to investigate whether baseline parental reflective function (PRF) and children's mental state talk (MST) predicted changes in emotional and behavioral problems in psychodynamic child psychotherapy. The sample included 60 Turkish school-age children ( = 7.90, = 1.35, 43.3% girls) with internalizing (18.3%), externalizing (5%), and comorbid (56.7%) problems, and 20% of the children were in the nonclinical range. The mothers were interviewed using the Parent Development Interview, which was coded for PRF (self- and child-focused). Children were administered an attachment-based story stem task, coded for MST (self- and other-focused). The Brief Problem Monitor was administered every month over the course of treatment for a total of 366 sessions. Multilevel modeling analyses indicated that mothers' child-focused PRF and children's self-focused MST predicted changes in problem behaviors. Parents' mentalization about their children and children's mentalization about their own internal states could be predictors of treatment response in psychodynamic child psychotherapy. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Efficacy of the parenting support program on child behavior problems.
Eşkisu Mustafa,Kapçı Emine GÜl
Scandinavian journal of psychology
The study aimed to examine the efficacy of the Parenting Support Program (PSP) for reducing problem behaviors and increasing adaptive behaviors in young children aged 3 to 6. The PSP focuses on effective parenting skills and building positive interactions between parents and their children. Parents of children (n = 18 mothers and 11 fathers) were randomly assigned to an experiment group (EG) and a wait-list (WL) group. The EG attended a total of 12 individually delivered sessions. Data was gathered via parent and teacher report measures, observation and semi-structured interviews. The PSP was effective in increasing adaptive behaviors and decreasing behavior problems in children. The change in the children's score which fulfills the Reliable Change Index criteria in the EG was found to be higher than the WL group. However, fathers reported fewer improvements than mothers in the EG. Qualitative data supported the experimental study results demonstrating the efficacy of the PSP, and met the expectations of parents. Consequently, the PSP could be used as an intervention tool to decrease behavior problems and increase adaptive behaviors in young children.
Early Detection of Temperament Risk Factors: A Comparison of Clinically Referred and General Population Children.
Zentner Marcel,Biedermann Vivienne,Taferner Christina,da Cudan Hannah,Möhler Eva,Strauß Hannah,Sevecke Kathrin
Frontiers in psychiatry
Despite an extensive literature on associations between early childhood temperament and behavior problems, most of this evidence is based on general population samples. Hence, relatively little is known about the temperament characteristics of children who have been referred for in- or outpatient treatment of emotional and/or behavioral problems. Whether temperament-to-behavior problems identified in community samples would also be found in samples of clinically referred children is poorly understood. To redress this limitation, we compared temperament attributes of a predominantly preschool-aged sample of children referred for treatment of emotional and/or behavioral disorders ( = 87) with those from a similarly-aged general population sample ( = 85) by using the Integrative Child Temperament Screener (ICTS)-a new nine-item scale to identify clinically significant temperament attributes. Behavioral symptoms in the clinical sample were assessed through diagnostic interviews in combination with the Child Behavior Checklist (CBCL), which was also administered to the general population children. Compared with general population children, referred children exhibited substantially higher scores on all ICTS subscales except behavioral inhibition. Furthermore, areas under the curve analyses showed that discrimination of both groups based on CBCL scales could be improved by adding the ICTS. Overall, the findings fill a long-standing gap in evidence regarding temperament characteristics of children with serious emotional and/or behavioral symptoms and suggest a useful role for the ICTS in assessment, screening, and prevention.
Unpacking the Impacts of a Universal Parenting Program on Child Behavior.
Altafim Elisa Rachel P,McCoy Dana C,Linhares Maria Beatriz M
This study examined the theory of change of the ACT Raising Safe Kids parenting program, including whether intervention effects on children's behavior problems were explained by improvements in mothers' reported parenting practices, as well as whether baseline child behavior problems moderated these relations. Adult mothers of 3-to 8-year-old Brazilian children were assigned to the intervention (n = 97) or control (n = 46) groups. Results showed that the intervention improved mothers' perceptions of their parenting practices (positive discipline, emotional and behavioral regulation, and communication). Intervention-induced reductions in children's internalizing and externalizing behavior problems were mediated by improvements in mothers' emotional and behavioral regulation. Program effects were strongest for children with high levels of baseline behavior problems.
Impact of parent-child separation on children's social-emotional development: a cross-sectional study of left-behind children in poor rural areas of China.
Shi Huifeng,Wang Yuanyuan,Li Mengshi,Tan Chang,Zhao Chunxia,Huang Xiaona,Dou Yan,Duan Xiaoqian,Du Yufeng,Wu Tianchen,Wang Xiaoli,Zhang Jingxu
BMC public health
BACKGROUND:Parent-child separation is a considerable adversity for left-behind children (LBC), but there is little evidence on the association between detailed characteristics of parent-child separation and social-emotional development among LBC. This study examined the characteristics of parent-child separation and its impacts on developmental delay among under-3 LBC in poor rural China. METHODS:We used data from 811 LBC surveyed in five poor counties in rural China in 2018. Detailed characteristics of their parental migration were recalled by their primary caregivers in face-to-face interviews. The children's social-emotional development was measured by using the Ages and Stages Questionnaire: Social-Emotional. Logistic regression was employed to examine the association of detailed characteristics of parent-child separation with early social-emotional problems after adjusting for the children's and primary caregivers' sociodemographic characteristics. RESULTS:287 (35.4%) children were left behind by fathers and cared for by mothers (FM-MC), while 524 (64.6%) were left behind by both parents and cared for by grandparents (PM-GC). The rate of social-emotional problems among LBC was 36.8% (PM-GC vs FM-MC: 40.6% vs 29.5%; aOR 1.51, 95% CI: 1.06 to 2.16). For paternal migration, the medians of the child's age at the first migration and average duration per migration were 3 months (IQR: 1 to 9 months) and 4.48 months (IQR: 2.38 to 7.54 months), respectively. For maternal migration, the corresponding values were 9 months (IQR: 6 to 13 months) and 4.65 months (IQR: 2.71 to 7.62 months), respectively. On average, LBC had been separated from fathers for 72% of their life due to paternal migration and from mothers for 52% of their life due to maternal migration. No significant association was found between the detailed characteristics of paternal migration and social-emotional development among LBC, while social-emotional problems among LBC were significantly associated with the proportion of cumulative duration of maternal migration in the child's lifetime (aOR 2.83; 95% CI: 1.13 to 7.10). CONCLUSIONS:LBC under 3 years had a high risk of social-emotional problems in poor rural China. Cumulative exposure to maternal migration may be detrimental to LBC's early social-emotional development. Programs are necessary to support these children as well as their families.
The Influence of Early Childhood Temperament on Later Social-Emotional Functioning in Youth with Cancer.
Willard Victoria W,Tillery Rachel,Harman Jennifer L,Long Alanna,Phipps Sean
Journal of pediatric psychology
OBJECTIVE:One of the peak incidences of childhood cancer is during the early childhood years. This is also an important time for psychosocial and personality development, and it is well known that early childhood temperament influences later psychosocial functioning. However, this association has not been examined in young children with cancer. METHODS:Parents of children with cancer (N = 39) and healthy comparisons (N = 35) completed an indicator of temperament (Children's Behavior Questionnaire) when children were young (Mage=4.99 ± 1.05 years). Five years later, parents and youth completed measures of psychosocial functioning (Mage=10.15 ± 1.10 years; Behavior Assessment Scale for Children, 2nd edition and Social Emotional Assets and Resilience Scale). RESULTS:Parents of healthy comparisons reported that their children demonstrated greater surgency than youth with cancer; there were no differences in negative affect or effortful control. Children with cancer and healthy comparisons were rated similarly on measures of psychosocial functioning. Health status was not a significant predictor of later functioning, but socioeconomic status and temperament were. The influence of temperament was stronger for strengths-based functioning (e.g., social competence, adaptive functioning) versus distress (internalizing and externalizing problems). CONCLUSIONS:Early childhood temperament is a strong predictor of later psychosocial functioning, regardless of health status. Findings highlight the need to consider temperament in the clinical assessment of psychosocial functioning in children with cancer. Additional research is needed to specifically assess how a diagnosis of cancer in early childhood influences temperament over time.
Effectiveness of Group vs. Individual Therapy to Decrease Peer Problems and Increase Prosociality in Children.
Melero Silvia,Morales Alexandra,Espada José P,Méndez Xavier,Orgilés Mireia
International journal of environmental research and public health
Emotional difficulties in children are often shown to be associated with peer problems and low prosocial behaviors. Super Skills for Life (SSL) is a transdiagnostic protocol for the prevention of emotional problems in children and has also obtained improvements of other comorbid symptoms. This study aimed at comparing the effects of SSL in reducing peer problems and increasing prosocial behaviors in children aged 8 to 12 years between the group and the individual modalities. For this purpose, 140 children (35% girls) received the program, 70 in group format and 70 in individual format, and were evaluated at the baseline, posttest, and after one year. Both modalities were effective in enhancing social relationships in children, although the individual modality showed more promising results. Children belonging to the individual modality group presented fewer peer problems (less social isolation and rejection, greater social acceptance, more friends) and greater prosocial behaviors (helping, empathy, kindness, and sharing) compared to children receiving the therapy in group modality, both in the short and in the long term. In conclusion, this study provides evidence of SSL protocol efficacy for improving children's peer relationships and prosocial behaviors and encourages the implementation of transdiagnostic interventions in both clinical and educational settings.
[Relationship between parental stress and psychological distress and emotional and behavioural problems in pre-school children with autistic spectrum disorder].
Romero-González Marina,Marín Ester,Guzmán-Parra Jose,Navas Patricia,Aguilar Juan Manuel,Lara J Pablo,Barbancho Miguel Ángel
Anales de pediatria
INTRODUCTION:The Autistic Spectrum Disorders (ASD) are characterised by general deficits in social communication, stereotypes, and restricted interests. The ASD have a high prevalence of additional psychiatric disorders that make their daily functioning worse, and reduces the quality of life of them and their families. MATERIAL AND METHODS:In an effort to identify family environmental characteristics that may influence in the course of additional psychiatric disorders, this study has focused on the symptoms of parental stress and psychological distress as possible risk factors. A cross-section study was carried out on the relationship between the stress and psychological distress of the parents and its relationship with co-existing psychopathology in a population of pre-school children with ASD (2-6 years). RESULTS AND CONCLUSIONS:High levels of stress and psychological distress of the parents arealready associated, since early childhood, with co-existing psychiatric symptoms, specifically with emotional and behavioural problems (p < 0.05). However, further longitudinal studies are needed for a better understanding of the causal relationship between these variables and their possible bidirectional relationship.
Does parent management training reduce behavioural and emotional problems in children with intellectual disability? A randomised controlled trial.
Kostulski Michael,Breuer Dieter,Döpfner Manfred
Research in developmental disabilities
BACKGROUND:Children with intellectual disability (ID) are more likely to develop behavioural and emotional problems. However, specific interventions for the treatment of these problems in children with ID have rarely been evaluated. Parent management training (PMT) has been shown to be effective in reducing behavioural and emotional problems for other mental disorders. Therefore, we developed and evaluated a special PMT intervention for parents of children with ID. METHODS:The PMT was developed based on existing programs for children with other mental disorders. The effects of the PMT were analysed in a randomised controlled trial (intervention group: n = 21; waitlist control group: n = 21). The primary outcome was behavioural and emotional problems of children as rated by parents. Additionally, effects on parent-rated family burden and positive and negative parenting were assessed. OUTCOME:For the primary outcome, a statistically significant reduction of behavioural and emotional problems of the children emerged, with moderate effects for disruptive/ antisocial behaviour and anxiety. Family burden was reduced as a trend, with a small effect size. There was a significant increase in positive parenting and no effect on negative parenting.
The Effects of TIME-IN on Emotion Regulation, Externalizing, and Internalizing Problems in Promoting School Readiness.
Weymeis Henk,Van Leeuwen Karla,Braet Caroline
Frontiers in psychology
Children's readiness for school is often threatened by the occurrence of both externalizing and internalizing problems. Previous research has shown that Positive Behavioral Interventions and Supports (PBIS) is particularly effective for fostering children's behavioral skills and reducing externalizing problems. However, whether PBIS can enhance children's emotional skills and reduce internalizing problems is less clear. Therefore, TIME-IN was developed, which extends PBIS by also including emotional support systems. It was tested whether TIME-IN was effective for (a) improving emotion regulation and (b) reducing depressive symptoms. Furthermore, it was tentatively explored whether TIME-IN is accompanied by more than natural fluctuations in both children's externalizing and internalizing problems. The effectiveness of TIME-IN was evaluated in a non-randomized study, in which an intervention group was compared with a matched control group. Both research questions were addressed in a sample consisting of 81 children between 8 and 12 years of age with special educational needs. Questionnaires for teachers (i.e., TRF), children (i.e., FEEL-KJ and CDI), and their parents (i.e., CBCL) were administered at the beginning (T0) and the end of the school year (T1) using multi-informant assessment. Only indicative evidence was found for the hypothesis that TIME-IN improved children's emotion regulation. Practical implications, strengths, and limitations were discussed. This work was retrospectively registered at International Standard Registered Clinical/soCial sTudy Number (ISRCTN) registry ISRCTN54456609 (Weymeis, 2017). Registered 28 March 2017.
Age-related effects of the COVID-19 pandemic on mental health of children and adolescents.
Schmidt Stefanie J,Barblan Lara P,Lory Irina,Landolt Markus A
European journal of psychotraumatology
: Children and adolescents are affected in various ways by the lockdown measures due to the COVID-19 pandemic. Therefore, it is crucial to better understand the effects of the COVID-19 pandemic on mental health in this age-group. : The objective was to investigate and compare the effects of the COVID-19 pandemic on mental health in three age groups (1-6 years, 7-10 years, 11-19 years) and to examine the associations with psychological factors. : An anonymous online survey was conducted from 9 April to 11 May 2020 during the acute phase of major lockdown measures. In this cross-sectional study, children and adolescents aged between 1 and 19 years were recruited as a population-based sample. They were eligible if they were residents in Austria, Germany, Liechtenstein or Switzerland, were parents/caregivers of a child aged between 1 and 10 years or adolescents ≥11 years, had sufficient German language skills and provided informed consent. : Among 5823 participants, between 2.2% and 9.9% reported emotional and behavioural problems above the clinical cut-off and between 15.3% and 43.0% reported an increase in these problems during the pandemic. Significant age-related effects were found regarding the type and frequency of problems (χ ≥50.2, ≤ 0.001). While preschoolers (1-6 years) had the largest increase in oppositional-defiant behaviours, adolescents reported the largest increase in emotional problems. Adolescents experienced a significantly larger decrease in emotional and behavioural problems than both preschoolers and school-children. Sociodemographic variables, exposure to and appraisal of COVID-19, psychotherapy before COVID-19 and parental mental health significantly predicted change in problem-scores (F ≥ 3.69, ≤ 0.001). : A substantial proportion of children and adolescents experience age-related mental health problems during the COVID-19 pandemic. These problems should be monitored, and support should be offered to risk-groups to improve communication, emotion regulation and appraisal style.
Reducing Adolescent Psychopathology in Socioeconomically Disadvantaged Children With a Preschool Intervention: A Randomized Controlled Trial.
Bierman Karen L,Heinrichs Brenda S,Welsh Janet A,Nix Robert L
The American journal of psychiatry
OBJECTIVE:Living in poverty increases exposure to adversities that undermine healthy development, impeding growth in the social-emotional and language skills that support adaptive coping and promote mental health. Evidence-based programs have the potential to improve current preschool practice and strengthen these early skills, potentially reducing risk for later psychopathology. The authors tested the hypothesis that an enrichment program in preschool would be associated with reduced levels of psychopathology symptoms at the transition from middle to secondary school. METHODS:The Head Start REDI (Research-Based, Developmentally Informed) intervention was used to enrich preschool classrooms serving children from low-income families with an evidence-based social-emotional learning (SEL) program and a coordinated interactive reading program. Centers were randomly assigned to the intervention or usual practice, and 356 4-year-olds (58% White, 25% Black, 17% Latino; 54% female) were followed into early adolescence. Hierarchical linear models were used to evaluate intervention effects on teacher-rated psychopathology symptoms using the Strengths and Difficulties Questionnaire in grade 7 (ages 12-13) and grade 9 (ages 14-15), 8-10 years after the end of the intervention. RESULTS:Statistically significant intervention-related reductions were observed in conduct problems and emotional symptoms in the intervention group. In addition, the proportion of youths with clinically significant levels of conduct problems, emotional symptoms, and peer problems was reduced in the intervention group, with rates one-third of those in the control group. CONCLUSIONS:The study findings indicate that enriching preschool programs serving at-risk children with a relatively inexpensive evidence-based SEL program with interactive reading substantially improved the later benefits for adolescent emotional and behavioral health. This kind of SEL enrichment represents an approach that can leverage public investments in preschool programs to enhance public health.
Hyperactivation of Posterior Default Mode Network During Self-Referential Processing in Children at Familial High-Risk for Psychosis.
Collin Guusje,Bauer Clemens C C,Anteraper Sheeba Arnold,Gabrieli John D E,Molokotos Elena,Mesholam-Gately Raquelle,Thermenos Heidi W,Seidman Larry J,Keshavan Matcheri S,Shenton Martha E,Whitfield-Gabrieli Susan
Frontiers in psychiatry
Patients with schizophrenia spectrum disorders show disturbances in self-referential processing and associated neural circuits including the default mode network (DMN). These disturbances may precede the onset of psychosis and may underlie early social and emotional problems. In this study, we examined self-referential processing in a group of children (7-12 years) at familial high risk (FHR) for psychosis ( = 17), compared to an age and sex-matched group of healthy control (HC) children ( = 20). The participants were presented with a list of adjectives and asked to indicate whether or not the adjectives described them (self-reference condition) and whether the adjectives described a good or bad trait (semantic condition). Three participants were excluded due to chance-level performance on the semantic task, leaving = 15 FHR and = 19 HC for final analysis. Functional MRI (fMRI) was used to measure brain activation during self-referential vs. semantic processing. Internalizing and externalizing problems were assessed with the Child Behavior Checklist (CBCL). Evaluating main effects of task (self > semantic) showed activation of medial prefrontal cortex in HC and precuneus/posterior cingulate cortex (PCC) in FHR. Group-comparison yielded significant results for the FHR > HC contrast, showing two clusters of hyperactivation in precuneus/ PCC ( = 0.004) and anterior cerebellum / temporo-occipital cortex ( = 0.009). Greater precuneus/PCC activation was found to correlate with greater CBCL internalizing ( = 0.60, = 0.032) and total ( = 0.69, = 0.009) problems. In all, this study shows hyperactivity of posterior DMN during self-referential processing in pre-adolescent FHR children. This finding posits DMN-related disturbances in self-processing as a developmental brain abnormality associated with familial risk factors that predates not just psychosis, but also the prodromal stage. Moreover, our results suggest that early disturbances in self-referential processing may be related to internalizing problems in at-risk children.
Childhood Resilient Personality Trajectories and Associations with Developmental Trajectories of Behavioral, Social-emotional, and Academic Outcomes across Childhood and Adolescence: A Longitudinal Study Across 12 Years.
Shi Qinxin,Liew Jeffrey,Ettekal Idean,Woltering Steven
Personality and individual differences
This study examined the continuity and change of childhood resilient personality (first three years in grade school), and how differential trajectories in resilient personality were dynamically associated with behavioral problems, social-emotional functioning and academic performance across the primary and secondary school years (Grade 1-12). Participants were 784 academically at-risk students predominantly from low SES families (47% girls, 37.4% Latino or Hispanic, 34.1% European American, and 23.2% African American) who were recruited in grade 1 (Mean age = 6.57) and followed annually through the final year of high school (Grade 12). Results revealed three distinct trajectories of childhood resilient personality, including an ego-resilient or flexible group (26.8%), an ego-brittle or inflexible group (21.9%), and an ordinary or common group (49.9%). Children in the ego-brittle group were at a greater risk for sustaining high levels of behavioral problems, low socio-emotional functioning (based on parent and teacher report), and poor academic performance across formal schooling. In contrast, the resilient children exhibited persistently low behavioral problems, high social-emotional functioning, and better academic performance across formal schooling. Findings also indicated that the protective effect of childhood resiliency was sustained even after the transition from childhood to adolescence.
School-aged children with sexual behavior problems: Untangling the relationship between externalizing behavior problems and non-sexual victimization on the variety and severity of sexual behaviors.
Tremblay Marie-Jeanne,Daignault Isabelle V,Fontaine Nathalie M G,Boisvert Isabelle,Tourigny Marc
Child abuse & neglect
BACKGROUND:Sexual behavior problems (SBP) in school-aged children is a social concern that draws increased attention amongst child protection services and practitioners. Past research that highlighted the variety in profiles and in behavioral manifestations of children with SBP emphasizes the importance of a well-informed and sensitive approach for appropriate intervention. However, studies validating the theoretically hypothesized vulnerability of children with SBP remains scarce. OBJECTIVE:This study aimed to further our understanding of the risk factors that influence the variety and severity of SBP. PARTICIPANTS AND SETTING:Eighty-eight child-adult dyads (35.2% girls, M = 9.1 years; SD = 2.2 years) referred for SBP by child protection services or public services between 2006 and 2010 participated in the study. Participants completed a series of questionnaires as part of their assessment in a specialized therapeutic center for SBP. METHODS:A theoretical model of risk factors was examined using multiple linear regression analysis. RESULTS:Amongst the factors identified, externalizing behavior problems were the most strongly associated with the variety (β = .50; p < 0.001) and severity of SBP (β = .40; p < .001). Non-sexual victimization experiences (e.g., exposure to family violence) were also associated with a greater variety (β = .30; p < .001) and severity of SBP (β = .36; p < .001), while sexual abuse alone was not. CONCLUSIONS:This study outlines the high co-occurrence of SBP, externalizing behaviors and non-sexual victimization, which should raise concern for the assessment of the children and to further adapt treatment strategies and goals.
Parent-child attachment security is associated with preschoolers' memory accuracy for emotional life events through sensitive parental reminiscing.
Lawson Monica,Chae Yoojin,Noriega Ivette,Valentino Kristin
Journal of experimental child psychology
There is considerable controversy regarding the accuracy and suggestibility of children's autobiographical memory for emotionally salient life events. Attachment perspectives of autobiographical memory development identify the attachment security of parent-child dyads and parents' emotional support and coherence during reminiscing with their children as critical mechanisms underlying children's memory accuracy and suggestibility. In the current investigation, 72 preschool-aged children (M = 4.01 years, SD = 0.85; 44 female) reminisced with their parents about times they felt happy, sad, scared, and angry. Children were then independently interviewed about these experiences by an unfamiliar researcher using free recall, specific questions (i.e., questions about factual details), and misleading questions (i.e., questions suggesting false details). Parents completed an assessment of their children's attachment security within the parent-child relationship. Results revealed significant indirect effects of parent-child attachment security on children's memory accuracy through parental sensitive guidance during reminiscing when cognitive (i.e., intelligence) and behavioral (i.e., temperament, behavior problems) covariates were statistically controlled. Parent-child attachment security was positively associated with parental sensitive guidance during reminiscing, which, in turn, was positively associated with the accuracy of children's independent reports. The findings support attachment perspectives of autobiographical memory by identifying emotionally sensitive and coherent reminiscing as a parenting behavior that explains in part associations between parent-child attachment security and children's independent memory accuracy for emotional life events.
The effects of self-efficacy and social support on behavior problems in 8~18 years old children with malignant tumors.
Liu Qian,Mo Lin,Huang Xianqiao,Yu Lu,Liu Yang
OBJECTIVE:To explore the influence factors of behavior problems of 8~18 years old children with malignant tumors in the treatment period, as well as the mediating effects of social support self-efficacy and post-traumatic growth. METHODS:From May 2019 to October 2019, 160 children with malignant tumors during the treatment were selected through convenience sampling method, and were investigated via the General Self-Efficacy Scale, Social Support Questionnaire, Post-Traumatic Growth Scale and Conners' Parent Symptom Questionnaire. Structural equation model was established on the basis of survey results. RESULTS:The total detection rate of behavior problems in 8~18 years old children with malignant tumors was 10.6%. The structural equation models indicated that boys had more behavior problems than girls, self-efficacy, social support and post-traumatic growth can directly affect the behavior problems of 8~18 years old children with malignant tumors in the treatment period, and the standardized total effect of self-efficacy in both of the first model and the second model was the largest. Self-efficacy is also able to indirectly and negatively predict the behavior problems based on social support or post-traumatic growth. Social support can directly affect behavior problems or indirectly predict behavior problems through self-efficacy and post-traumatic growth. After 2000 bootstrap tests, the mediating effects of social support self-efficacy and post-traumatic growth were confirmed. CONCLUSION:Reduced total detection rate of behavior problems suggests that targeted interventions in recent years may be effective. Interventions focused on improving self-efficacy, social support and post-traumatic growth may lessen behavior problems of children with malignant tumors in the treatment period.
Parent-Teacher Disagreement on Ratings of Behavior Problems in Children with ASD: Associations with Parental School Involvement Over Time.
Levinson Sarah,Neuspiel Juliana,Eisenhower Abbey,Blacher Jan
Journal of autism and developmental disorders
ASD symptomology and behavioral problems pose challenges for children with ASD in school. Disagreement between parents and teachers in ratings of children's behavior problems may provide clinically relevant information. We examined parent-teacher disagreement on ratings of behavior problems among children with ASD during the fall and spring of the school year. When child, teacher, and class characteristics were considered simultaneously, only ASD symptom severity predicted informant disagreement on internalizing and externalizing behavior problems. We also examined associations between informant disagreement and parent school involvement. Cross-lagged panel analyses revealed that higher informant disagreement on children's behavior problems in the fall predicted lower parent school involvement in the spring, suggesting that greater informant agreement may foster parental school involvement over time.
Trajectories of peer relationship problems and emotional symptoms in children 5 years after a nuclear disaster: Fukushima Health Management Survey.
Itagaki Shuntaro,Takebayashi Yoshitake,Murakami Michio,Harigane Mayumi,Maeda Masaharu,Mizuki Rie,Oikawa Yuichi,Goto Saori,Momoi Maho,Miura Itaru,Ohira Tetsuya,Oe Misari,Yabe Hirooki,Yasumura Seiji,Kamiya Kenji
Journal of radiation research
The Fukushima Daiichi Nuclear Power Station (NPS) accident, which occurred in March 2011, is having long-term effects on children. About 3 years after the accident, we identified three patterns of peer relationship problems and four patterns of emotional symptoms using group-based trajectory modeling. As a result, we reported that different factors might be related to very severe trajectories of peer relationship problems and emotional symptoms. In this study, we used five waves of data from fiscal year (FY) 2011 to FY2015 from the Mental Health and Lifestyle Survey, a detailed survey of the Fukushima Health Management Survey started in FY2011. We analyzed 7013 residents within the government-designated evacuation zone (aged 6-12 years old as of 11 March 2011) with responses to all items of psychological distress in at least one wave from FY2011 and FY2015. We planned this study to describe the trajectories of peer relationship problems and emotional symptoms in children and to examine potential risks and protective factors over the 5 years following the NPS accident. We identified four patterns of peer relationship problems and five patterns of emotional symptoms using latent class growth analysis. For peer relationship problems, male sex, experiencing the NPS explosion and lack of exercise habits were associated with the severe trajectory group. For emotional symptoms, experiencing the NPS explosion, experiencing the tsunami disaster and lack of exercise habits were associated with the severe trajectory group. Exercise habits are very important for the mental health of evacuees after a nuclear disaster.
Emotional and behavioural problems of children and adolescents who stutter: Comparison with typically developing peers.
Karahan Tığrak Tuğçe,Kulak Kayıkcı Maviş Emel,Kirazlı Meltem Çiğdem,Tığrak Arcan
Logopedics, phoniatrics, vocology
PURPOSE:There are several studies showing contradictory results on concurrent emotional and behavioural problems of children and adolescents who stutter (CAWS). This study aimed to identify whether there is a difference between Turkish-speaking CAWS and their typically developing peers (TDP) in emotional and behavioural problems. METHODS:The study group consisted of 45 CAWS, aged between 3.40 and 15.92 years, and the control group consisted of 45 TDP, aged between 3.15 and 16.80 years. Participants were divided into three age groups: early childhood (0-6 years), middle childhood (7-11 years) and adolescence (12-18 years). CAWS and TDP were compared separately in each age group with Mann-Whitney U tests. Assessments of emotional and behavioural problems were conducted with the Child Behaviour Checklist (CBCL) for Ages 1.5-5 and the CBCL for Ages 6-18. RESULTS:In early childhood, CAWS had significantly higher emotional reactivity, anxiety/depression, somatic complaints, withdrawal, sleep problems, attention problems and aggressive behaviour scores than TDP. In middle childhood and adolescence, CAWS had significantly higher anxiety/depression, withdrawal/depression, social problems, attention problems, rule-breaking behaviour and aggressive behaviour scores compared to TDP. In adolescence, somatic problems and thought problems scores were also significantly higher in AWS than TDP. CONCLUSIONS:We concluded that emotional and behavioural problems associated with stuttering are noticeable from early childhood to adolescence. Cooperation with mental health professionals may be needed to improve the quality of speech therapy in CAWS.
Life Satisfaction and Subsequent Physical, Behavioral, and Psychosocial Health in Older Adults.
Kim Eric S,Delaney Scott W,Tay Louis,Chen Ying,Diener E D,Vanderweele Tyler J
The Milbank quarterly
Policy Points Several intergovernmental organizations (Organisation for Economic Co-operation and Development, World Health Organization, United Nations) are urging countries to use well-being indicators (e.g., life satisfaction) in addition to traditional economic indicators when making important policy decisions. As the number of governments implementing this new approach grows, so does the need to continue evaluating the health and well-being outcomes we might observe from policies aimed at improving life satisfaction. The results of this study suggest that life satisfaction is a valuable target for policies aiming to enhance several indicators of psychosocial well-being, health behaviors, and physical health outcomes. CONTEXT:Several intergovernmental organizations (Organisation for Economic Co-operation and Development, World Health Organization, United Nations) are urging countries to use well-being indicators (e.g., life satisfaction) in addition to traditional economic indicators when making important policy decisions. As the number of governments implementing this new approach grows, so does the need to continue evaluating the health and well-being outcomes we might observe from policies aimed at improving life satisfaction. METHODS:We evaluated whether positive change in life satisfaction (between t ;2006/2008 and t ;2010/2012) was associated with better outcomes on 35 indicators of physical, behavioral, and psychosocial health and well-being (in t ;2014/2016). Data were from 12,998 participants in the University of Michigan's Health and Retirement Study-a prospective and nationally representative cohort of US adults over age 50. FINDINGS:Participants with the highest (versus lowest) life satisfaction had better subsequent outcomes on some physical health indicators (lower risk of pain, physical functioning limitations, and mortality; lower number of chronic conditions; and higher self-rated health) and health behaviors (lower risk of sleep problems and more frequent physical activity), and nearly all psychosocial indicators (higher positive affect, optimism, purpose in life, mastery, health mastery, financial mastery, and likelihood of living with spouse/partner; and lower depression, depressive symptoms, hopelessness, negative affect, perceived constraints, and loneliness) over the 4-year follow-up period. However, life satisfaction was not subsequently associated with many specific health conditions (i.e., diabetes, hypertension, stroke, cancer, heart disease, lung disease, arthritis, overweight/obesity, or cognitive impairment), other health behaviors (i.e., binge drinking or smoking), or frequency of contact with children, family, or friends. CONCLUSIONS:These results suggest that life satisfaction is a valuable target for policies aiming to enhance several indicators of psychosocial well-being, health behaviors, and physical health outcomes.
Outcomes of Childhood Preventive Intervention Across 2 Generations: A Nonrandomized Controlled Trial.
Hill Karl G,Bailey Jennifer A,Steeger Christine M,Hawkins J David,Catalano Richard F,Kosterman Rick,Epstein Marina,Abbott Robert D
Importance:Trials of preventive interventions for children that were implemented in the 1980s have reported sustained positive outcomes on behavioral and health outcomes into adulthood, years after the end of the intervention. This present study examines whether intervention in childhood may show sustained benefits across generations. Objective:To examine possible intervention outcomes on the offspring of individuals (now parents) who participated in the Raising Healthy Children preventive intervention as children in the elementary grades. Design, Setting, and Participants:This nonrandomized controlled trial was conducted in public elementary schools serving high-crime areas in Seattle, Washington. The panel originated in Seattle but was followed up locally and in out-of-state locations over time. Data analyzed in this study were collected from September 1980 to June 2011, with follow-up of the firstborn offspring (aged 1 through 22 years) of 182 parents who had been in the full intervention vs control conditions in childhood. Their children were assessed across 7 waves in 2 blocks (2002-2006 and 2009-2011). Data were analyzed for this article from September 2018 through January 2019. Interventions:In grades 1 through 6, the Raising Healthy Children intervention provided elementary school teachers with methods of classroom management and instruction, first-generation (G1) parents with skills to promote opportunities for children's active involvement in the classroom and family, and second-generation (G2) child with social and emotional skills training. Main Outcomes and Measures:Outcomes examined in the third-generation (G3) offspring were self-regulation (emotion, attention, and behavioral regulation), cognitive capabilities, and social capabilities. Risk behaviors, including substance use and delinquency, were examined from age 6 years to study completion. Early onset of sexual activity was examined from age 13 years to study completion. Intent-to-treat analyses controlled for potential confounding factors. Results:A total of 182 G3 children were included in this analysis (72 in the full intervention and 110 in the control condition; mean age at first wave of data collection, 7 [range, 1-13] years). Significant differences in the offspring of intervention parents were observed across 4 domains: improved early child developmental functioning (ages 1-5 years; significant standardized β range, 0.45-0.56), lower teacher-rated behavioral problems (ages 6-18 years; significant standardized β range, -0.39 to -0.46), higher teacher-rated academic skills and performance (ages 6-18 years; significant standardized β range, 0.34-0.49), and lower child-reported risk behavior (ages 6-18 years; odds ratio for any drug use [alcohol, cigarettes, or marijuana], 0.27 [95% CI, 0.10-0.73]). Conclusions and Relevance:To our knowledge, this is the first study to report significant intervention differences in the offspring of participants in a universal childhood preventive intervention. Cost-benefit analyses have examined the benefits of childhood intervention in the target generation. The present study suggests that additional benefits can be realized in the next generation as well. Trial Registration:ClinicalTrials.gov Identifier: NCT04075019.
Managing precocious puberty: A necessity for psychiatric evaluation.
Temelturk Rahime Duygu,Ilcioglu Ekici Gokcen,Beberoglu Merih,Siklar Zeynep,Kilic Birim Gunay
Asian journal of psychiatry
OBJECTIVE:Precocious puberty (PP) is one of the most common endocrine disorders in school-age girls. It has been reported that there is an increased tendency for psychiatric disorders for early maturing girls. The aim of this study was to determine the prevalence of psychiatric problems and to investigate depression and anxiety levels, and self-concept characteristics in girls with PP. METHODS:Girls with PP (n = 41) and controls (n = 45) aged 7-11 years participated in this study. Psychiatric evaluations were conducted with semi-structured interviews. Behavioral and emotional problems were assessed using Child Behavior Check List and Teacher Report Form. Children's Depression Inventory, State-Trait Anxiety Inventory for Children and Piers-Harris Children's Self Concept Scale were administered, respectively. RESULTS:Girls with PP had significantly more psychiatric diagnosis than controls (68.3 % vs 20 %, p < 0.001). PP group had significantly higher anxious-depressed, somatic complaints, social problems, aggresive behaviors and interestingly autistic traits. Increased symptom levels of depression and anxiety, and lower self-concept scores were also obtained from PP subjects. CONCLUSIONS:PP is an independent predictor of psychiatric disorders. It is also associated with poorer psychiatric status, lower self esteem characteristics, and autistic traits. A multidisciplinary approach combining endocrinologic and psychiatric evaluations seem to be beneficial for the management of girls with PP.
Association between perceived social support of parents and emotional/behavioral problems in children with ASD: A chain mediation model.
Lu Minghui,Chen Jiawei,He Wanting,Pang Feifan,Zou Yuqing
Research in developmental disabilities
BACKGROUND:Parental psychosocial factors are associated with emotional/behavioral problems in children with Autism Spectrum Disorder (ASD), but studies investigating their relationships are limited. AIMS:To explore the relationships between parents' perceived social support, parental resilience, parenting self-efficacy, and emotional/behavioral problems in children with ASD, and the mechanism underlying these relationships. METHOD:The participants were 289 parents of children with ASD (including fathers and mothers) in China. A survey comprising the Multidimensional Scale of Perceived Social Support, Resilience Scale, Parenting Sense of Competence Scale, and Strengths and Difficulties Questionnaire was administered. RESULTS:(1) Parents' perceived social support, parental resilience, and parenting self-efficacy were significantly associated with emotional/behavioral problems in children with ASD; (2) parental resilience and parenting self-efficacy were found to play a chain-mediating role in the association between perceived social support of parents and emotional/behavioral problems in children with ASD. CONCLUSION:It is crucial to improve parents' perceived social support, parental resilience, and parenting self-efficacy to reduce emotional/behavioral problems in children with ASD.
Salivary cytokine cluster moderates the association between caregivers perceived stress and emotional functioning in youth.
Parent Carine,Pokhvisneva Irina,de Mendonça Filho Euclides José,O'Donnell Kieran J,Meaney Michael J,Kee Michelle Z L,Thng Gladi,Wing Holly,Adler Nancy E,Keeton Victoria,Pantell Matthew S,Hessler Danielle,Gottlieb Laura M,Silveira Patricia P
Brain, behavior, and immunity
Some individuals exposed to early life stress show evidence of enhanced systemic inflammation and are at greater risk for psychopathology. In the current study, caregivers and their offspring (0-17 years) were recruited at a pediatric clinic visit at the University of California, San Francisco (UCSF). Mothers and seven-year-old children from the Growing Up inSingaporeTowards healthy Outcomes (GUSTO) prospective birth cohort were used as a replication cohort. Caregivers perceived stress was measured to determine potential intergenerational effects on the children's functioning and inflammation levels. Children's emotional functioning in the UCSF cohort was evaluated using the Pediatric Quality of Life (PedsQL) inventory. Child emotional and behavioral functioning was measured using the Child Behavior Checklist (CBCL) in GUSTO. Saliva was collected from the children and salivary levels of IL-6, IL-1β, IL-8 and TNF-α were measured using an electrochemiluminescent cytokine multiplex panel. Child IL-6, IL-1β, IL-8 cytokine levels were clustered into low, average, and high cytokine cluster groups using hierarchical cluster analysis. We did not find that salivary cytokine clusters were significantly associated with children's emotional or behavioral function. However, cytokine clusters did significantly moderate the association between increased caregiver perceived stress and reduced child emotional functioning (UCSF cohort) and increased Attention-Deficit-Hyperactivity (ADH) problems (GUSTO cohort, uncorrected Cohen's F2 = 0.02). Using a cytokine clustering technique may be useful in identifying those children exposed to increased caregiver perceived stress that are at risk of emotional and attention deficit hyperactivity problems.
Stressful life events and associations with child and family emotional and behavioral well-being in diverse immigrant and refugee populations.
Berge Jerica M,Mountain Samaria,Telke Susan,Trofholz Amanda,Lingras Katie,Dwivedi Roli,Zak-Hunter Lisa
Families, systems & health : the journal of collaborative family healthcare
Although stressful life events (SLEs) have been suggested to be associated with child well-being, few studies have examined SLEs with child and family behavioral and emotional well-being, especially within diverse populations. The current study examined the associations between SLEs and child behavioral and emotional outcomes, in addition to family-level measures of well-being. Children 5-7 years old and their families ( = 150) from 6 racial and ethnic groups ( = 25 each for African American, Hispanic, Hmong, Native American, Somali, White families) participated in this mixed-methods study. Participants were recruited through primary care clinics. Results showed that all racially and ethnically diverse immigrant and refugee families were experiencing SLEs. The majority of diverse children were experiencing emotional and behavioral problems (i.e., hyperactivity, emotional) in the face of SLEs (i.e., combined SLE score, health-related events), with Somali children being at highest risk. Additionally, the majority of diverse families did not experience lower family functioning in response the SLEs, except regarding certain SLEs (i.e., health-related, legal). However, specific families (i.e., Somali) experienced lower family functioning in the face of multiple SLEs. Health care practitioners should consider screening and providing extra resources for reducing stress in children, given all children in the study had some emotional and behavioral problems in the face of SLEs. Additionally, it would be important for practitioners to know which families are at greatest risk for experiencing SLEs (i.e., African American, Native American, Somali families) to ensure they are provided with the resources necessary to mitigate the impact of SLEs. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Attachments: The Pediatric Symptom Checklist: A Bridge to Child and Adolescent Psychiatry From Pediatrics.
Jellinek Michael S
Journal of the American Academy of Child and Adolescent Psychiatry
During my residency training in pediatrics and child/adolescent psychiatry (1973-1979), I wondered how pediatricians would identify children with psychosocial problems. Some behavioral problems were obvious because the school or parent had raised a concern. Most pediatricians would ask 1 or 2 psychosocial questions, and some, attuned to emotional issues, would identify children based on their clinical impressions. However, the few studies that had been done at the time indicated that the rates of psychosocial problems identified in pediatric primary care were far lower than predicted by epidemiological studies. Therefore, I began the work to create a screening questionnaire.
Parenting styles for children with oppositional defiant disorder: Scope review.
Fooladvand Maryam,Nadi Mohammad Ali,Abedi Ahmad,Sajjadian Ilnaz
Journal of education and health promotion
Behavioral and emotional problems are the most common form of child psychiatric pathology. Parenting styles are one of the factors affecting the formation of children's personality and the use of inefficient styles can lead to several negative consequences such as behavioral problems. The aim of the present article is to describe a variety of parenting styles and their relationship with children behavioral problems. The present study reviews a variety of parenting styles including Kazdin's Parent Management Education Model, Barclay's Parent Training Program, Adler and Dreikurs Approach, and Positive Parenting Program. Finally, based on reality theory, parenting is neglected to be one of those styles. Therefore, it is imperative to do a research based on reality theory with existential psychotherapy and with the view that everyone chooses to behave, external pressure is always an imposition, the children learn from their mistakes, and everyone is responsible for his own happiness.
Impaired Self-Awareness after Pediatric Traumatic Brain Injury: Protective Factor or Liability?
Lloyd Owen,Ownsworth Tamara,Fleming Jennifer,Jackson Megan,Zimmer-Gembeck Melanie
Journal of neurotrauma
Children and adolescents with traumatic brain injury (TBI) can experience impaired self-awareness, or difficulty in accurately perceiving their personal abilities. This study aimed to identify the neuro-developmental and socio-environmental factors associated with self-awareness impairment and determine how self-awareness is associated with psychosocial functioning. Parents and their children age 8-16 years with TBI ( = 107, 65.4% male, mean [M] age = 12.66 years, standard deviation [SD] = 2.6 years) were consecutively recruited from an outpatient clinic over a 4-year period. Children completed the Paediatric Awareness Questionnaire (PAQ) to report their functional abilities, and the Beck Youth Inventories to report their self-concept, and anxiety and depression symptoms. Parents completed the PAQ and measures of family functioning, parenting style, and children's emotional and behavioral problems. Self-awareness impairments were defined as more negative parent-child discrepancy scores on the PAQ. Younger age at injury, more severe injury, and more family dysfunction were significantly associated with poorer self-awareness. Poorer self-awareness was associated with worse parent-rated child adaptive functioning and emotional and behavioral problems. However, poorer self-awareness was also significantly associated with more positive self-concept and fewer symptoms of depression and anxiety as rated by children. Overall, impaired self-awareness seems to be both a liability and a benefit depending on the reporter (parent or child) and outcome of interest (adaptive function/behavior or self-concept/mood).
Migration as a Determinant in the Development of Children Emotional and Behavior Problems: A Quantitative Study for Lisbon Region, Portugal.
Muggli Zélia,Mertens Thierry,-Sá Silva,Amado Regina,Teixeira Ana L,Vaz Dora,O Martins Maria Rosário
International journal of environmental research and public health
The role of migration as a determinant in child mental health has been demonstrated in a number of studies. However, results are not always consistent, and the research continues to be scarce, especially in Portugal. We examined the association between sociodemographic profiles and the chance for the development of emotional and behavioral difficulties in a group of 420 children, immigrant ( = 217) and born in Portugal to Portuguese born parents ( = 203). We used a structured questionnaire to obtain sociodemographic information and the Strength and Difficulties Questionnaire (SDQ). Descriptive statistics were used to characterize children and their families; variables were compared between groups using the Chi-squared, Fisher's Exact Test, or the Mann-Whitney U test and logistic regression was used to analyze the association between socio-demographic factors and emotional and behavioral difficulties. Results showed a pattern of social and mental health inequalities with immigrant children at a disadvantage: they are more often part of families with low income and where parents had low skilled jobs. Internalizing behaviors are more frequent in immigrants than in children born in Portugal to Portuguese-born parents ( = 0.001) whereas a high total SDQ difficulties score ( = 0.039) and externalizing behaviors were more frequent in 1st generation immigrant children ( = 0.009). A low family income (aOR 4.5; 95% CI: 1.43-13.95), low parental education level (aOR 2.5; 95% CI: 1.11-5.16), and being a first-generation immigrant child (aOR 2.2; 95% CI: 1.06-4.76) increased significantly the chance of developing emotional and behavioral difficulties. This study contributes to the identification of children vulnerable to mental health problems who can benefit from monitoring, early detection and preventive interventions in order to mitigate possible negative outcomes in the future.
Effects of the Family Check-Up 4 Health on Parenting and Child Behavioral Health: A Randomized Clinical Trial in Primary Care.
Berkel Cady,Fu Emily,Carroll Allison J,Wilson Charlton,Tovar-Huffman Angelica,Mauricio Anne,Rudo-Stern Jenna,Grimm Kevin J,Dishion Thomas J,Smith Justin D
Prevention science : the official journal of the Society for Prevention Research
The Family Check-Up 4 Health (FCU4Health) is an adaptation of the Family Check-Up (FCU) for delivery in primary care settings. While maintaining the original FCU's focus on parenting and child behavioral health, we added content targeting health behaviors. This study evaluated whether the adapted FCU maintained positive effects on parenting (positive behavior support, limit setting, parental warmth) and child behavioral health (self-regulation, conduct problems, emotional problems). Pediatric (6-12 years) primary care patients with a BMI ≥ 85%ile (n = 240) were recruited from primary care clinics in Phoenix. Children were 75% Latino, 49% female, and 73% Medicaid recipients. This type 2 effectiveness-implementation hybrid trial compared families randomized to FCU4Health (n = 141) or usual care (n = 99). FCU4Health was delivered over a period of 6 months. This study focuses on a priori secondary outcomes included parenting and child behavioral health targets of the original FCU, assessed at baseline and 3, 6, and 12 months. Significant improvements were found for the FCU4Health condition, compared to usual care, in parenting from baseline to the 3-month assessment [β = .17 (.01; .32)]. Parenting predicted improvements in child self-regulation at 6-months [β = .17 (.03; .30)], which in turn predicted reductions in conduct problems [β = - .38 (- .51; - .23)] and emotional problems [β = - .24 (- .38; - .09)] at 12 months. Ethnicity and language of delivery (English or Spanish) did not moderate these effects. The FCU4Health can improve parenting and child behavioral health outcomes when delivered in primary care.Trial Registration Trial registration number: NCT03013309 ClinicalTrials.gov.
Emotional distress and burden among caregivers of children with oncological/hematological disorders.
Edmond Sara N,Graves Patricia E,Whiting Sara E,Karlson Cynthia W
Families, systems & health : the journal of collaborative family healthcare
INTRODUCTION:Caring for children with oncological and hematological disorders may lead to caregiver emotional distress and caregiver burden; however, little work has examined the relationship between children's symptoms and caregiver's distress and burden. METHOD:This study used self-report survey data from caregivers (N = 96) and a cross-sectional design to examine correlates of caregiver emotional distress and burden. Data collected included caregiver and child demographic data, child symptoms (i.e., sleep problems, pain, and emotional/behavioral problems), caregiver emotional distress, and caregiver burden. RESULTS:Multiple linear regression found that parent reported financial difficulty (β = 0.29, t = 3.13, p = .003), greater child sleep problems (β = 0.29 t = 2.81, p = .007), greater child pain (β = 0.33 t = 3.48, p = .001), and greater child emotional/behavioral problems (β = 0.27, t = 2.71, p = .009) were all related to higher levels of caregiver emotional distress. Only financial difficulties (β = -0.35, t = -2.03, p = .04) and child pain (β = -0.30, t = -2.33, p = .02) were related to caregiver burden. DISCUSSION:Child symptoms may play an important role in the development of caregiver distress and caregiver burden; future research should utilize longitudinal designs to examine temporal and casual relationships. (PsycINFO Database Record
Supporting the Decision Making of Children With Cancer: A Meta-synthesis.
Yamaji Noyuri,Suto Maiko,Takemoto Yo,Suzuki Daichi,Lopes Katharina da Silva,Ota Erika
Journal of pediatric oncology nursing : official journal of the Association of Pediatric Oncology Nurses
Recently, awareness of children's decision making has increased in an effort to enhance palliative care. However, the conceptual framework for decision making among children with cancer remains unclear. We clarified the decision-making process of children with cancer regarding their care, treatment, and support from family and health care professionals, and identified their needs and preferences. We used metaethnography to conduct a metasynthesis of relevant studies. We searched PubMed, EMBASE, PsycINFO, MEDLINE, and CINAHL. This report was prepared in accordance with the PRISMA statement. Of the 7,237 retrieved studies, 27 met our inclusion criteria. Four themes emerged that reflected the decision-making process of children with cancer: (a) facing changes brought about by a health threat, (b) preparing for action, (c) asserting one's choice, and (d) internal and external influences. Children with cancer initially undergo a decision-making process. Respecting children's preferences, values, and emotions may help build trusting relationships and promote their decision-making capability. Future research should focus on children's emotions, cognition, development, and interactions with parents and health care professionals.
Parents' acceptance and regret about end of life care for children who died due to malignancy.
Das Kunal,Khanna Tanvi,Arora Anshika,Agrawal Nitika
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
PURPOSE:To analyse the preference of end of life care place in paediatric oncology patients, and to understand the end of life care needs and regrets among the care givers. METHOD:This was an observational qualitative study. Parents of in-curable paediatric malignancy patients who died during the years 2016-2018 were interviewed using a pre-formed open-ended questionnaire. Fears during the last phase of child's life, most disturbing symptoms, choice of end of life care plan, regret of care givers and reasons for such choices were noted and analysed. RESULT:Twenty six families were interviewed. A median of 3 months of discordance was noted between declaration of in-curability and acceptance of the same by the family. During terminal months, pain (84.62%) was described as the most bothersome symptom followed by respiratory distress (73.08%). Eighteen families (69%) opted for home-based terminal care, 8 (31%) for hospital-based terminal care. Regret of choice was noted in 62.5% families of the hospital-based care group (separation from home environment being the main reason) and 38.89% of the home-based care group (lack of access to health care personnel and pain medication being the main reasons). CONCLUSION:Home-based care is the preferred option for end of life care by the care givers. Lack of community-based terminal care support system and availability of analgesics are the main areas to work on in India.
Effects of Art Intervention Program for Siblings of Children With Cancer: A Pilot Study.
Jo Myoung-Ju,Hong Sungsil,Park Ho Ran
Journal of pediatric oncology nursing : official journal of the Association of Pediatric Oncology Nurses
Siblings of children with cancer often experience negative feelings, and art intervention can help them express their feelings and overcome hardships. This study aimed to develop an Art Intervention Program to improve the psychological adaptation of siblings of children with cancer and to evaluate its effects. Participants were seventeen 7- to 10-year-old siblings of children with cancer. The program comprised 12 sessions conducted once a week. The effects of the intervention were assessed in terms of self-esteem, anxiety, depression, and problem behavior. Self-esteem significantly improved after intervention compared with pretest. Children showed improved scores in externalizing problems and total behavior problems; however, anxiety and depression did not change. The study results indicated that the art intervention program helped improve the self-esteem and helped reduce somatic symptoms, aggressiveness, externalizing problems, and emotional instability among problem behaviors of siblings of children with cancer. However, the study was limited by its small sample size and the lack of a control group. Therefore, the study design allows no firm conclusions, and a randomized controlled trial is needed to investigate the effectiveness of the program.
Fronto-limbic white matter microstructure, behavior, and emotion regulation in survivors of pediatric brain tumor.
Wier Ryan,Aleksonis Holly A,Pearson Matthew M,Cannistraci Christopher J,Anderson Adam W,Kuttesch John F,Compas Bruce E,Hoskinson Kristen R
Journal of neuro-oncology
PURPOSE:After treatment, pediatric brain tumor survivors (PBTS) face emotional and behavioral challenges, perhaps due to tumor or treatment-related changes in brain structures involved in emotion regulation, including those with fronto-limbic connections. We hypothesized that relative to healthy controls (HCs), PBTS would exhibit greater difficulties with behavior and emotional functioning, and display reduced mean fractional anisotropy (mFA) in white matter tracts with fronto-limbic connections including the cingulum bundle (CB), inferior fronto-occipital fasciculus (IFOF), and uncinate fasciculus (UF). We further predicted that mFA would account for variance in the relationship between group and emotional/behavioral outcome. METHODS:Eleven 8-16 year old PBTS and 14 HCs underwent MRI, including diffusion tensor imaging to assess white matter microstructure. Tractography quantified mFA of selected tracts. Parents rated children's emotional and behavioral functioning. RESULTS:Compared to HCs, caregivers of PBTS reported poorer behavioral regulation and greater internalizing and externalizing symptoms. Relative to HCs, PBTS had lower mFA within the bilateral CB, IFOF, and UF (ds = 0.59-1.15). Across groups, several medium-to-large correlations linked tract mFA and increased internalizing, externalizing, and poor behavioral regulation. Tract mFA also accounted for significant variance in the group-outcome association. CONCLUSIONS:Reduced mFA in fronto-limbic associated tracts may be associated with reduced behavioral regulation following pediatric brain tumor. PBTS with treatment known to impact white matter may be most susceptible. Research with larger, longitudinal samples should clarify this relationship, allow for multiple mediators across time, and consider factors like tumor and treatment type.
The Emotional Experience and Perceived Changes in Siblings of Children With Cancer Reported During a Group Intervention.
Neville Alexandra,Simard Melissa,Hancock Kelly,Rokeach Alan,Saleh Amani,Barrera Maru
Oncology nursing forum
PURPOSE/OBJECTIVES:To examine the experiences and perceived changes in siblings of children with cancer while participating in a group intervention program.
. RESEARCH APPROACH:Repeated observations during group participation and content analysis.
. SETTING:A tertiary pediatric health center in Ontario, Canada.
. PARTICIPANTS:Twenty-two siblings (aged 7-18 years) of children with cancer.
. METHODOLOGIC APPROACH:Siblings participated in the Siblings Coping Together program, an eight-week group intervention designed for this population. Data consisted of materials completed by siblings (49 homework sheets, 33 pieces of artwork), and 31 logs recording events within group sessions.
. FINDINGS:Three categories emerged from the data. CONCLUSIONS:These findings provide rich insight into siblings' own views of changes in themselves and within the family, as well as the perceived benefits of group participation.
. INTERPRETATION:Methodologically, this study demonstrated that the inclusion of visual materials as data is a valid methodology for future research. Clinically, these findings can help nurses in their daily care of children with cancer and their families.
Somatic symptoms in children who have a parent with cancer: A systematic review.
Hauskov Graungaard Anette,Roested Bendixen Christina,Haavet Ole Rikard,Smith-Sivertsen Tone,Mäkelä Marjukka
Child: care, health and development
BACKGROUND:This systematic review explored the occurrence and types of somatic symptoms in children (0-20 years) who have experienced parental cancer. METHODS:We complemented a systematic literature search from PubMed and PsycInfo with a reference search. We identified 1,694 articles, which were independently screened by two authors; they further evaluated potentially relevant papers for quality and extracted the data. We found nine relevant studies (10 publications) on altogether 672 children with a parent who had cancer; four studies included a control group. RESULTS:The studies typically focused on children's psychosocial reactions on parental cancer rather than somatic complaints, so symptom prevalence cannot be reliably summarized. Several studies were small, and the types of somatic symptoms were only specified in five studies. Somatic symptoms were reported as a measure of emotional reactions in the remaining four studies. Three studies provided longitudinal data. The main types of specific symptoms reported were eating problems, pain, sleeping troubles, and bed-wetting. Children of cancer patients tended to show an increase of unspecified somatic symptoms and pain, but evidence was inconsistent. There was a tendency that somatic complaints were associated with increased emotional distress in the children. The material did not allow for separate analysis by age group or bereavement status. CONCLUSIONS:Children in families with parental cancer may present with somatic complaints, but the prevalence and significance is not possible to estimate due to very sparse research in this area. Health professionals or counselling providers should not overlook this possible sign of distress. Qualitative studies report significant health anxiety in these children; this may represent a specific topic for counselling in this population. Targeted studies are needed to evaluate the prevalence and significance of somatic symptoms, and especially vulnerable groups need to be identified.
Posttraumatic stress in young children with cancer: Risk factors and comparison with healthy peers.
Tillery Rachel,Willard Victoria W,Long Alanna,Phipps Sean
Pediatric blood & cancer
OBJECTIVE:The most commonly occurring childhood cancers are diagnosed during the preschool years; yet limited psycho-oncology research has focused on this developmental time period. The primary objective was to examine rates of posttraumatic stress symptoms (PTSS) in young children with cancer and compare these findings with those of children without a history of serious illness (comparisons). The secondary aim was to examine risk and modifiable factors associated with PTSS. METHOD:Ninety-seven caregivers of patients (n = 50) and comparisons (n = 47) aged three to six years completed diagnostic interviews for the assessment of PTSD. They also completed a survey measure of PTSS adapted from the Child Behavior Checklist (CBCL-PTSD), along with measures of their child's temperament and their own current psychological functioning. RESULTS:On the CBCL-PTSD, no differences in PTSS were observed between children with cancer and comparisons, although many in both groups appeared at risk, with approximately 34% of children with cancer and 27% of comparisons meeting threshold scores for probable PTSD. However, using a "gold-standard" clinical-interview assessment, only three children in the patient group and no children in the comparison group met diagnostic criteria for PTSD. Parental distress and child temperament were significantly associated with PTSS scores. CONCLUSION:Findings indicate PTSD is relatively infrequent in children with cancer, and survey measures may overestimate rates of PTSD in young children. However, other emotional or behavioral issues may be present. Ultimately, screening for potential emotional/behavioral concerns in young children with cancer is indicated, and interventions should continue to target caregiver distress.
Behavioral symptoms and psychiatric disorders in child and adolescent long-term survivors of childhood acute lymphoblastic leukemia treated with chemotherapy only.
Liu Wei,Cheung Yin Ting,Brinkman Tara M,Banerjee Pia,Srivastava Deokumar,Nolan Vikki G,Zhang Hongmei,Gurney James G,Pui Ching-Hon,Robison Leslie L,Hudson Melissa M,Krull Kevin R
BACKGROUND:Prevalence of emotional, behavioral, and psychiatric outcomes in child and adolescent survivors of childhood acute lymphoblastic leukemia treated on a chemotherapy-only protocol were not well defined. METHODS:Self- and parent-reported emotional and behavioral symptoms were assessed for 161 survivors of childhood acute lymphoblastic leukemia (51.0% female; mean [SD] age 12.1[2.6] years; 7.5[1.6] years post-diagnosis). Age- and sex-adjusted scores were calculated for standardized measures and compared with 90th percentile of norms. Frequencies of survivor psychiatric disorders from structured diagnostic interviews with parents were compared with the general population. Parent emotional distress and post-traumatic stress symptoms were assessed. Associations between child symptoms/disorders and parent distress were examined with log-binomial models, adjusting for highest parent education. RESULTS:Compared with population expectations (10%), more survivors self-reported symptoms of inattention (27.9; 95% CI, 21.0%-35.7%), hyperactivity/impulsivity (26.0%; CI, 19.2%-33.6%), and oppositional-defiant behavior (20.1%; CI, 14.1%-27.3%). Parents reported survivors with more symptoms of inattention (23.6%; CI, 17.2%-31.0%), higher frequencies of obsessive-compulsive disorder (10.3% vs 2%) and oppositional defiant disorder (16.0% vs 9.5%), but not attention-deficit/hyperactivity disorder (7.1% vs 7.8%) or generalized anxiety disorder (3.2% vs 4.1%), compared with national norms. Parent-report of child anxiety disorders was associated with parent self-reported emotional distress but not survivor self-report of anxiety. CONCLUSION:A significant minority of survivors have long-term psychiatric morbidity, multi-informant assessment is important to understand these symptom profiles and to inform selection of appropriate interventions. Interventions targeting inattention and oppositional behavior in children and emotional distress in parents are warranted in families with survivors who display behavioral problems.
Posterior fossa syndrome: Review of the behavioral and emotional aspects in pediatric cancer patients.
Lanier Jane C,Abrams Annah N
Medulloblastoma, the most common malignant brain tumor of childhood, occurs in the posterior fossa, the part of the intracranial cavity that contains the brainstem and the cerebellum. The cerebellum is involved in many complex aspects of human behavior and function, and when it is disrupted or insulted, this can lead to significant sequelae in children with posterior fossa tumors. A constellation of impairing and distressing symptoms, including mutism, ataxia/hypotonia, and emotional lability, develops in approximately 25% of children after the surgical resection of posterior fossa tumors. These symptoms may impede treatment and frequently require intervention in order for children to be able to participate in their care. The eventual recovery of speech occurs for most, but with slowly improving dysarthria over many months. Behavioral changes and emotional lability also occur. This phenomenon has been classified differently by different investigators over the past 35 years. For the purposes of this article, the term posterior fossa syndrome is used to refer to the neuropsychiatric and behavioral features that compose this condition. The current review summarizes the development of the clinical understanding of this phenomenon with a focus on near- and long-term psychosocial and psychiatric implications. Also, clinical examples of the presentation, management, and lasting implications of this syndrome are provided. This review is intended to be a resource for clinicians who treat affected children. Cancer 2017;123:551-559. © 2016 American Cancer Society.
The Divorced Family-Focused Care Model: A Nursing Model to Enhance Child and Family Mental Health and Well-Being of Doubly Bereaved Children Following Parental Divorce and Subsequent Parental Cancer and Death.
Marcussen Jette,Hounsgaard Lise,Bruun Poul,Laursen Merete Golles,Thuen Frode,Wilson Rhonda
Journal of family nursing
The experience of parental death concomitant with parental divorce occurs for 46% of Danish children and 50% of American children who lose a parent to death. This experience of loss and double bereavement compounds increased risk of mental health problems. The aim of this study was to explore nursing interventions for double bereaved children that promoted their well-being. A phenomenological-hermeneutic approach was used to conduct 20 interviews with nurses in family cancer care. Ricoeur's theoretical framework was followed with naïve reading, structural analysis, and critical interpretation, resulting in the formulation of a new model of nursing care for these children: the Divorced Family-Focused Care Model. Four themes were apparent: (a) collection of information about family structure, (b) assessment of support needs, (c) initiation of well-being support, and (d) coordination and follow-up focused on the child's well-being. The new intervention model has implications for health care education and implementation of health care policies.
Supporting children facing a parent's cancer diagnosis: a systematic review of children's psychosocial needs and existing interventions.
Ellis S J,Wakefield C E,Antill G,Burns M,Patterson P
European journal of cancer care
This review aimed to (1) summarise the psychosocial needs of children/adolescents (0-18 years) with a parent with cancer across the illness trajectory (diagnosis to bereavement) and (2) evaluate existing interventions for this population. Medline, CINAHL, PsychInfo, EMBASE and Social Work Abstracts were systematically searched for articles published from 1985 to 2015. Of 98 full text articles retrieved, 12 reported on children's psychosocial needs, and 12 intervention studies were identified. Each article was appraised in accordance with the Mixed Method Appraisal Tool. Three factors emerged as critical to consider in future intervention development: (1) Children need age-appropriate information about their parent's cancer; (2) Children require support communicating with parents, family members and health professionals and (3) Children need an environment where they feel comfortable sharing positive/negative emotions and can have their experiences normalised among peers. All intervention studies reported at least one positive outcome, however, only five reported significant improvements in child/family functioning based on validated quantitative measure/s. Variability in study design and quality, combined with considerable heterogeneity in intervention characteristics and outcome variables limited the conclusions, which could be drawn. Therefore, further carefully designed and scientifically evaluated interventions for children facing a parent's cancer diagnosis are clearly warranted.
Emotion regulation and positive affect in the context of salivary alpha-amylase response to pain in children with cancer.
Jenkins Brooke N,Granger Douglas A,Roemer Ryan J,Martinez Ariana,Torres Tara K,Fortier Michelle A
Pediatric blood & cancer
BACKGROUND:Children with cancer routinely undergo painful medical procedures invoking strong physiological stress responses. Resilience to this pain may be conferred through resources such as emotion regulation strategies and positive affect. PROCEDURE:This study measured dispositional positive affect in children with cancer (N = 73) and randomly assigned participants to one of three emotion regulation strategy conditions (distraction, reappraisal, or reassurance). Children applied their assigned strategy during an experimental pain procedure (the cold pressor task [CPT]) and provided saliva samples before, immediately after, and 15 min after the CPT. Saliva samples were later assayed for salivary alpha amylase (sAA)-a surrogate marker for autonomic/sympathetic nervous system activity and regulation. RESULTS:Children in the reassurance group had sAA levels that continued to rise after completion of the CPT compared to children in the distraction (b = -1.68, P = 0.021) and reappraisal conditions (b = -1.24, P = 0.084). Furthermore, dispositional positive affect moderated the effect of condition such that children in the reassurance group with lower levels of positive affect had sAA levels that continued to rise after completion of the CPT (dy/dx = 1.56, P = 0.027), whereas children in the reassurance condition with higher levels of positive affect did not exhibit this rise (P > 0.05). CONCLUSIONS:Specific emotion regulation strategies, such as distraction and reappraisal, may attenuate the stress response to pain in pediatric patients with cancer, and positive affect may confer resilience in response to pain even with use of less effective coping strategies such as reassurance.
Children Navigating Parental Cancer: Outcomes of a Psychosocial Intervention.
O'Neill Carla,O'Neill Catherine S,Semple Cherith
Comprehensive child and adolescent nursing
Research has evidenced a marked increase in the prevalence of cancer among younger people with up to one in five, parenting children under the age of 18 years of age. When a parent is diagnosed with cancer they experience fears and anxieties as they attempt to simultaneously manage their role as a parent, with the illness experience. Parents have expressed difficulties in knowing how to communicate appropriately with their children throughout the illness trajectory as they are primarily focused on protecting or shielding their children from knowledge of the illness. Understandably parents may become overwhelmed with significant parental stress impacting on their psychological well-being. This subsequently affects the well-being of the entire family unit, coupled with changes to routines, roles, and responsibilities. This study was carried out to examine how a group psychosocial intervention Children's Lives Include Moments of Bravery (CLIMB®) helped young children to navigate parental cancer. A qualitative research design utilizing focus group methodology, artwork and individual interviews was used to generate data from 19 participants (parents, children, and health-care professionals). Three key themes emerged from the data, navigating the diagnosis, navigating emotions and changed routines, creating spaces to talk about cancer. The findings evidenced that attending CLIMB® was a positive experience for both children and parents. It gave the children the language and opportunity to express their fears and worries. CLIMB® equipped them with tools and skills to both express and manage their negative emotions, life skills that could be transferred to other challenging life events. All techniques that created spaces to talk and appeared to have a reassuring effect on the children. The parents appreciated the professional support that the structured intervention offered to them and helped them communicate more openly with their children. Creating spaces to talk about cancer reduces mistrust and tension between parents and children, when parental cancer occurs, and hopefully minimizes future psychological and social problems.
Parent reports of children's working memory, coping, and emotional/behavioral adjustment in pediatric brain tumor patients: A pilot study.
Desjardins Leandra,Thigpen Jennifer C,Kobritz Molly,Bettis Alexandra H,Gruhn Meredith A,Ichinose Megan,Hoskinson Kristen,Fraley Claire,Vreeland Allison,McNally Colleen,Compas Bruce E
Child neuropsychology : a journal on normal and abnormal development in childhood and adolescence
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.
Parenting stress as a mediator of parents' negative mood state and behavior problems in children with newly diagnosed cancer.
van der Geest Ivana M,van den Heuvel-Eibrink Marry M,Passchier Jan,van den Hoed-Heerschop Corry,Pieters Rob,Darlington Anne-Sophie E
OBJECTIVE:The aim was to investigate the influence of parents' negative mood state and parenting stress on behavior in children with newly diagnosed cancer. METHODS:A total of 123 parents (n=58 fathers, n=65 mothers) of 67 children with newly diagnosed cancer completed three questionnaires separately at the same time measuring parents' negative mood state, parenting stress, and child behavior problems. RESULTS:Parents' negative mood state was weakly correlated to more child behavior problems (r=0.31, p<0.01), and higher levels of parenting stress were strongly correlated to more child behavior problems (r=0.61, p<0.01). Mediation analyses indicated that the relationship between parents' negative mood state and child behavior problems (c=0.29, p=0.02 (fathers); c=0.25, p=0.04 (mothers)) became non-significant after mediating for parenting stress (c'=0.003, p=0.98 (fathers); c'=0.10, p=0.42 (mothers)). The indirect effect of parents' negative mood state and child behavior problems was only significant for fathers (95% CI [0.12; 0.51]), indicating that parenting stress mediates the effect between fathers' negative mood state and child behavior problems. CONCLUSIONS:This is the first study to demonstrate the mediational role of parenting stress in fathers of a child with newly diagnosed cancer.
Behavioral, Social, and Emotional Symptom Comorbidities and Profiles in Adolescent Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study.
Brinkman Tara M,Li Chenghong,Vannatta Kathryn,Marchak Jordan G,Lai Jin-Shei,Prasad Pinki K,Kimberg Cara,Vuotto Stefanie,Di Chongzhi,Srivastava Deokumar,Robison Leslie L,Armstrong Gregory T,Krull Kevin R
Journal of clinical oncology : official journal of the American Society of Clinical Oncology
PURPOSE:In the general population, psychological symptoms frequently co-occur; however, profiles of symptom comorbidities have not been examined among adolescent survivors of childhood cancer. PATIENTS AND METHODS:Parents of 3,893 5-year survivors of childhood cancer who were treated between 1970 and 1999 and who were assessed in adolescence (age 12 to 17 years) completed the Behavior Problems Index. Age- and sex-standardized z scores were calculated for symptom domains by using the Childhood Cancer Survivor Study sibling cohort. Latent profile analysis identified profiles of comorbid symptoms, and multivariable multinomial logistic regression modeling examined associations between cancer treatment exposures and physical late effects and identified symptom profiles. Odds ratios (ORs) and 95% CIs for latent class membership were estimated and analyses were stratified by cranial radiation therapy (CRT; CRT or no CRT). RESULTS:Four symptoms profiles were identified: no significant symptoms (CRT, 63%; no CRT, 70%); elevated anxiety and/or depression, social withdrawal, and attention problems (internalizing; CRT, 31%; no CRT, 16%); elevated headstrong behavior and attention problems (externalizing; CRT, no observed; no CRT, 9%); and elevated internalizing and externalizing symptoms (global symptoms; CRT, 6%; no CRT, 5%). Treatment with ≥ 30 Gy CRT conferred greater risk of internalizing (OR, 1.7; 95% CI, 1.0 to 2.8) and global symptoms (OR, 3.2; 95% CI, 1.2 to 8.4). Among the no CRT group, corticosteroid treatment was associated with externalizing symptoms (OR, 1.9; 95% CI, 1.2 to 2.8) and ≥ 4.3 g/m(2) intravenous methotrexate exposure was associated with global symptoms (OR, 1.5; 95% CI, 0.9 to 2.4). Treatment late effects, including obesity, cancer-related pain, and sensory impairments, were significantly associated with increased risk of comorbid symptoms. CONCLUSION:Behavioral, emotional, and social symptoms frequently co-occur in adolescent survivors of childhood cancer and are associated with treatment exposures and physical late effects. Assessment and consideration of symptom profiles are essential for directing appropriate mental health treatment for adolescent survivors.
Parent-Child Communication and Adjustment Among Children With Advanced and Non-Advanced Cancer in the First Year Following Diagnosis or Relapse.
Keim Madelaine C,Lehmann Vicky,Shultz Emily L,Winning Adrien M,Rausch Joseph R,Barrera Maru,Gilmer Mary Jo,Murphy Lexa K,Vannatta Kathryn A,Compas Bruce E,Gerhardt Cynthia A
Journal of pediatric psychology
Objectives:To examine parent-child communication (i.e., openness, problems) and child adjustment among youth with advanced or non-advanced cancer and comparison children. Methods:Families (n = 125) were recruited after a child's diagnosis/relapse and stratified by advanced (n = 55) or non-advanced (n = 70) disease. Comparison children (n = 60) were recruited from local schools. Children (ages 10-17) reported on communication (Parent-Adolescent Communication Scale) with both parents, while mothers reported on child adjustment (Child Behavior Checklist) at enrollment (T1) and one year (T2). Results:Openness/problems in communication did not differ across groups at T1, but problems with fathers were higher among children with non-advanced cancer versus comparisons at T2. Openness declined for all fathers, while changes in problems varied by group for both parents. T1 communication predicted later adjustment only for children with advanced cancer. Conclusions:Communication plays an important role, particularly for children with advanced cancer. Additional research with families affected by life-limiting conditions is needed.
Measuring behavioral and emotional changes in children following hospitalization: Limitations and future directions.
Uhl Kristen,Cravero Joseph P
Psychological and behavioral changes have been observed and documented in children following medical interventions/hospitalizations. The Posthospital Behavior Questionnaire (PHBQ) was created to assess for such changes in youth. Over the past several decades, researchers have used this measure to examine rates and duration of behavior changes as well as relevant risk factors. However, certain limitations to the PHBQ exist that may interfere with its utility. This article advocates for creating an optimized measure with an underlying theoretical framework, clinical cutoffs, and developmental sensitivity in order to better identify and track significant emotional and behavioral changes in youth following hospitalization and surgery.
Emotional and behavioral problems in children and adolescents with neurofibromatosis type 1.
Rietman André B,van der Vaart Thijs,Plasschaert Ellen,Nicholson Bethany A,Oostenbrink Rianne,Krab Lianne C,Descheemaeker Mie-Jef,Wit Marie-Claire Y de,Moll Henriëtte A,Legius Eric,Nijs Pieter F A de
American journal of medical genetics. Part B, Neuropsychiatric genetics : the official publication of the International Society of Psychiatric Genetics
To assess emotional and behavioral problems in children and adolescents with neurofibromatosis type 1,parents of 183 individuals aged 10.8 ± 3.1 years (range 6-17) completed the Child Behavior Checklist (CBCL). Also, 173 teachers completed the Teacher's Report Form (TRF), and 88 adolescents (children from 11 to 17 years) completed the Youth Self-Report (YSR). According to parental ratings, 32% scored in the clinical range (above the 90th percentile). This percentage was much lower when rated by teachers or adolescents themselves. Scores from all informants on scales for Somatic complaints, Social problems, and Attention problems were significantly different from normative scores. Attentional problems were associated with lower verbal IQ, male gender, younger age, and ADHD-symptoms. Disease-related factors did not predict behavioral problems scores. Substantial emotional and behavioral problems were reported by parents, teachers, and to a lesser extent by adolescents with NF1 themselves. Possibly, a positive illusory bias affects the observation of behavioral problems by adolescents with NF1.
Understanding the Relationship Between Child Health-Related Quality of Life and Parent Emotional Functioning in Pediatric Hematopoietic Stem Cell Transplant.
Rodday Angie Mae,Terrin Norma,Leslie Laurel K,Graham Robert J,Parsons Susan K
Journal of pediatric psychology
Objective:Explore interrelationships between domains of child health-related quality of life (HRQL) and parent emotional functioning using parent-proxy and child report in the context of hematopoietic stem cell transplant (HSCT). Methods:Data on 258 parent-child dyads were used from two longitudinal studies. Domains of HRQL included physical, emotional, and role functioning, and HSCT-related worry. We used structural equation modeling to model the outcome of parent emotional functioning using primary and alternative conceptual models. Results:Parent-proxy raters reported lower child HRQL than child raters. Structural equation models demonstrated relationships between child emotional functioning, child HSCT-related worry, and parent emotional functioning, with some differences by raters. Conclusions:Relationships between child HRQL and parent emotional functioning within the context of HSCT are complex. To optimize the child's health outcomes, providing psychosocial support for children and their families may be necessary, especially for those experiencing distress or facing treatment complications.
Measuring cancer-specific child adjustment difficulties: Development and validation of the Children's Oncology Child Adjustment Scale (ChOCs).
Burke Kylie,McCarthy Maria,Lowe Cherie,Sanders Matthew R,Lloyd Erin,Bowden Madeleine,Williams Lauren
Pediatric blood & cancer
BACKGROUND:Childhood cancer is associated with child adjustment difficulties including, eating and sleep disturbance, and emotional and other behavioral difficulties. However, there is a lack of validated instruments to measure the specific child adjustment issues associated with pediatric cancer treatments. The aim of this study was to develop and evaluate the reliability and validity of a parent-reported, child adjustment scale. PROCEDURE:One hundred thirty-two parents from two pediatric oncology centers who had children (aged 2-10 years) diagnosed with cancer completed the newly developed measure and additional measures of child behavior, sleep, diet, and quality of life. Children were more than 4 weeks postdiagnosis and less than 12 months postactive treatment. Factor structure, internal consistency, and construct (convergent) validity analyses were conducted. RESULTS:Principal component analysis revealed five distinct and theoretically coherent factors: Sleep Difficulties, Impact of Child's Illness, Eating Difficulties, Hospital-Related Behavior Difficulties, and General Behavior Difficulties. The final 25-item measure, the Children's Oncology Child Adjustment Scale (ChOCs), demonstrated good internal consistency (α = 0.79-0.91). Validity of the ChOCs was demonstrated by significant correlations between the subscales and measures of corresponding constructs. CONCLUSION:The ChOCs provides a new measure of child adjustment difficulties designed specifically for pediatric oncology. Preliminary analyses indicate strong theoretical and psychometric properties. Future studies are required to further examine reliability and validity of the scale, including test-retest reliability, discriminant validity, as well as change sensitivity and generalizability across different oncology samples and ages of children. The ChOCs shows promise as a measure of child adjustment relevant for oncology clinical settings and research purposes.
Factors Associated with Emotional Distress in Children and Adolescents during Early Treatment for Cancer.
Sohn In Jung,Han Jung Woo,Hahn Seung Min,Song Dong Ho,Lyu Chuhl Joo,Cheon Keun Ah
Yonsei medical journal
PURPOSE:Children and adolescents diagnosed with cancer experience emotional distress, such as sadness, worrying, and irritability. However, there is little information about the psychological well-being of parents at the time of their child's diagnosis. We sought to identify factors that were associated with emotional distress in cancer patients as a basis for developing innovative psychological interventions. MATERIALS AND METHODS:A retrospective chart review was performed on patients newly diagnosed with cancer at a single center in Korea from 2014 to 2016. Eighty-five patients and their mothers completed psychological inventories. To determine factors associated with emotional distress in patients, we assessed the psychological inventory results using multiple linear regression after performing correlation analysis. RESULTS:The maternal Beck Depression Inventory-II (BDI-II) score was positively correlated with total problem scores and externalizing scores in patients aged less than 7 years. In patients aged 7-12 years, there was no significant association between the patient's emotional distress and other variables. In contrast, the maternal BDI-II score was the strongest factor associated with patient depression in adolescents. CONCLUSION:We suggest that the most important factor affecting emotional distress in children and adolescents with cancer is maternal depression, especially in patients aged 1-6 years and aged 13-17 years. Understanding the factors associated with emotional distress of cancer patients allows us to develop early psychiatric interventions for patients and their parents at the initial psychological crisis.
Children of cancer patients: prevalence and predictors of emotional and behavioral problems.
Möller Birgit,Barkmann Claus,Krattenmacher Thomas,Kühne Franziska,Bergelt Corinna,Beierlein Volker,Ernst Johanna,Brähler Elmar,Flechtner Hans-Henning,Herzog Wolfgang,von Klitzing Kai,Führer Daniel,Resch Franz,Romer Georg
BACKGROUND:Children of patients with cancer are at increased risk for developing emotional and behavioral problems. This study explored the prevalence and predictors of emotional and behavioral problems in Children of cancer patients in a multisite research project. METHODS:A cross-sectional sample of N = 235 families was recruited simultaneously in 5 university medical centers. The participants, including parents (N = 402) and children (N = 324; ages 11-21 years) completed standardized questionnaires. Emotional and behavioral problems in children were measured by the Strengths and Difficulties Questionnaire (SDQ). On the basis of previous research and using a mixed-model approach, child-, parent-, family- and cancer-related variables were examined in addition to socioeconomic status as potential predictors. Descriptive statistics and a multiple random coefficient model were used in the analyses. RESULTS:Compared to norms, Children of cancer patients show increased mean levels of emotional and behavioral symptoms. The best predictor of emotional and behavioral problems from the perspectives of the child, the healthy parent, and the ill parent was general family dysfunction. Although family dysfunction was identified as the main predictor, the analysis revealed that the main part of variance was related to the individual child's level. CONCLUSIONS:The results indicate that screening for child mental health problems and family dysfunction in oncological and psychosocial treatment units can identify the families most in need of psychosocial support. Psychological services need to be both family-oriented and child-centered and focus on family dysfunction to prevent mental health problems in children.