Psychological adjustment of children with cystic fibrosis: the role of child cognitive processes and maternal adjustment.

Found 60% of children 7-12 years old with cystic fibrosis to have a parent-reported behavior problem and 62% met the criteria for a DSM-III diagnosis based on a structured clinical interview with the child. Mixed internal and external behavior problem patterns and diagnoses of anxiety and oppositional disorder were most frequent. Support was provided for the hypothesized psycho-social/mediational roles of child perception of self-worth and maternal anxiety in child adjustment. Together, the variables of the transactional stress and coping model accounted for 39 and 43% of the variance in mother-reported internalizing and externalizing behavior problems and for 68% of the variance in child-reported problems.     

The role of parent stress and coping and family functioning in parent and child adjustment to Duchenne muscular dystrophy.

This study found 57% of parents of 35 children with Duchenne Muscular Dystrophy (4 to 14 years of age) to have self-reported poor psychological adjustment. The hypothesized mediational variables of parent appraisal of stress, relative use of palliative coping methods, and level of family conflict accounted for 58% of the variance in general distress, 50% in depressive symptoms, and 31% in anxiety symptoms. In terms of parent-reported child adjustment, 89% of the children were classified by parent report as having a behavior problem pattern. The internalizing profile pattern was most frequent (37%). The parent mediational variables accounted for 26% of the variance in parent-reported internalizing behavior problems and 29% in externalizing behavior problems.     

Psychological Adjustment of Mothers of Children and Adolescents with Sickle Cell Disease: The Role of Stress, Coping Methods, and Family Functioning

Assessed the psychological adjustment of 78 mothers of childrenand adolescents (7–17 years of age) with sickle cell disease.Support was provided for a transactional stress and coping modelin delineating the processes associated with maternal adjustment.In particular, poor maternal adjustment was associated withuse of palliative coping methods and high levels of stress relatedto daily hassles. Variables of the model accounted for 55% ofthe variance in maternal psychological distress.     

Psychological Adaptation and Adjustment of Mothers of Children With Congenital Heart Disease: Stress, Coping, and Family Functioning

Objective: Investigate support for the transactional stressand coping model for mothers of children with congenital heartdefects, in accounting for the variance in maternal adjustment. Methods: Participants were 52 mothers of children recruitedfrom a university medical center. Measures included illnessvariables, cognitive processes (i.e., appraisals of stress,expectations, methods of coping, family functioning, and maternalpsychological adjustment). Results: Maternal adjustment was associated with high levelsof daily stress and palliative coping techniques and was notsignificantly associated with severity of the cardiac defect.Together, the variables of the model accounted for approximately38% of the variance in maternal adjustment. Conclusions: The findings are in accord with previous researchamong other chronically ill populations in suggesting an associationbetween stress, coping, and maternal adjustment. Within thelimitations of the study, the data were interpreted to supportthe utility of theoretical models in identifying areas in needof intervention across chronic illness groups.     

Stress, coping, and psychological adjustment of adults with sickle cell disease.

A transactional model of psychological adjustment to chronic illness was examined with 109 African-American adults with sickle cell disease (SCD). Good psychological adjustment was associated with lower levels of perceived daily stress and stress regarding SCD illness tasks, higher efficacy expectations, less use of palliative coping methods, less use of negative thinking/passive adherence pain-coping strategies, and family functioning characterized by high levels of support and low levels of conflict and control. Overall the underlying stress and coping conceptual model accounted for 44-50% of the variance in psychological adjustment.     

Behavioral Adjustment of Pediatric Burn Victims

Investigated the relationship of a variety of biopsychosocialvariables to maternal ratings of children's psychosocial adjustmentin a sample of 68 child burn survivors. Results indicated that(a) the mean maternal ratings of behavioral adjustment for pediatricburn patients did not differ from those reported for nonburned,nonclinic children, (b) a relatively small but statisticallysignificant percentage of children had overall adjustment scoresin the deviant range, and (c) little variance in the behavioraloutcome measures was accounted for on the basis of three setsof predictor variables (demographic, burn severity, injury visibility)hypothesized to influence children's adjustment. Results suggestthat the prevalence of behavioral disturbance in long-term pediatricburn survivors may be lower than previous reports have indicated.Implications of the results for consultation and future researchare discussed.     

The impact of maternal perceptions and medical severity on the adjustment of children with congenital heart disease

Hypothesized that maternal perceptions would be more significant predictors of emotional adjustment than medical severity. Mothers of 99 children, between the ages 4-10 years, completed the Child Behavior Checklist, Parenting Stress Index, Parental Locus of Control Scale, and a measure of perception of medical severity. Assessed medical severity by number of hospitalizations, operations, catheterizations, hospital days, outpatient visits, and a cardiologist's rating of illness severity. Maternal perceptions were potent predictors of emotional adjustment. Approximately 33% of the variability in adjustment was accounted for by maternal perceptions, while the medical severity accounted for less than 3% of the variability. Severity of illness appears less critical to successful adaptation than the quality of the mother-child relationship.     

Congenital gastrointestinal anomalies: psychosocial functioning of children with imperforate anus, gastroschisis, and omphalocele.

This study assessed the psychosocial status of 56 children aged 6-16 years with imperforate anus, gastroschisis, or omphalocele. Results indicate that (a) children were of average intellectual ability; (b) approximately 9% of the sample had learning disabilities; (c) although the mean maternal ratings of behavioral adjustment did not differ from those reported for children without anomalies, approximately 18% of the children had deviant adjustment scores; (d) a multivariate risk and resistance model accounted for a significant amount of the variance in children's adjustment; and (e) child, maternal, and family utilitarian and psychological risk and resistance resources contributed independently to children's overall behavioral adjustment.     

Family functioning, neurocognitive functioning, and behavior problems in children with sickle cell disease

OBJECTIVE: To investigate the independent and combined contributions of neurocognitive and family functioning to mother-reported behavior problems in children with sickle cell disease (SCD) and evaluate the factor structure of the Family Environment Scale (FES) with African American families. METHOD: The study sample included 289 children enrolled in the multisite Cooperative Study of Sickle Cell Disease. The study protocol included neuropsychological evaluation and brain magnetic resonance imaging (MRI) of the children, and mothers completed the Child Behavior Checklist and Family Environment Scale. RESULTS: With child and maternal demographic parameters controlled, conflicted family functioning, but not neurocognitive functioning, accounted for a significant portion of the variance in mother-reported behavior problems. The factor structure of the FES for families of children with SCD was found to be similar to that for other families. CONCLUSIONS: Family functioning may be a salient target for fostering adaptation to chronic childhood illness.     

A longitudinal examination predicting emergency room use in children with sickle cell disease and their caregivers

OBJECTIVE: To examine in a longitudinal investigation perceptions of disease severity among children and adolescents with sickle cell disease (SCD) and their caregivers and to determine whether perceptions of disease severity and self-reported adjustment would account for a greater percentage of the variance in emergency room (ER) use than objective measures of disease severity. METHODS: Participants were 58 African-American children (ages 8-18 years) diagnosed with SCD who were recruited from an outpatient clinic. Children and their caregivers were administered a series of measures designed to assess caregivers' adjustment and perceptions of children's disease severity. Frequency of ER visits was tabulated over an average 4-year period. RESULTS: Caregivers' and children's social adjustment accounted for a unique portion of the variance beyond that accounted by subjective perceptions of disease severity, demographic, and objective biological markers of disease severity. Poorer psychological adjustment of caregivers as well as communication patterns among children were associated with ER use frequency after controlling for objective disease severity variables and demographic factors. Child social adjustment, specifically friendship quality, accounted for variance in children's use of the ER beyond that accounted for by social class and objective markers of disease severity. CONCLUSIONS: Support is provided for the notion that ER use for children with SCD may be independent of disease severity and predicted by caregivers' psychological adjustment and children's peer adjustment.     

Psychological adjustment of adults with sickle cell anemia: Stability over 20 months,correlates, and predictors

The stability of psychological adjustment was assessed across three time points spanning a 20-month period with 59 African—American adults with sickle cell anemia. Stable good adjustment was associated with lower levels of daily and illness-related stress, palliative methods of coping with stress, and pain coping strategies characterized by negative thinking/passive adherence. With baseline levels of illness and demographic parameters controlled, baseline levels of daily and illness-related stress made significant independent contributions to adjustment at 20 months follow-up. The findings are discussed in relation to the potential utility of improving methods of coping with stress and pain to enhance the adjustment of patients with sickle cell anemia. © 1996 John Wiley & Sons, Inc.     

Relationships among attention deficit hyperactivity disorder, induced labor, and selected physiological and demographic variables

We investigated whether events associated with physiological maternal and fetal stress during the birth process were associated with diagnosis of attention deficit hyperactivity disorder (ADHD), alone or in combination with demographic variables. We gathered data through maternal responses to a 17-item questionnaire. Sex, mother's educational level, mother's age at delivery, interval between the beginning of labor and birth, and presence or absence of complications during the delivery process accounted for 42% of the variance in the diagnostic (ADHD) category. The model correctly classified 87% of the non-ADHD group (n = 90) and 48% of the children with ADHD (n = 40), for an overall correct classification rate of 75%. A differential effect for sex was indicated, but a low number of females in the diagnostic category limited meaningful analysis. Maternal age at delivery and maternal education level emerged as the strongest predictors, with the exception of sex, of ADHD in the full model.     

Adherence among children and adolescents with insulin-dependent diabetes mellitus over a four-year longitudinal follow-up: I. The influence of patient coping and adjustment

An onset cohort of adolescents and children with insulin-dependent diabetes mellitus was studied over a 4-year period. Individual patient psychosocial and demographic factors were assessed at study inception and used to examine aspects of adherence over the follow-up. We found that initial assessment of patient coping (defense level, adaptive strength, and locus of control) and adjustment at study inception were predictive of the level of patient adherence to diabetic regimen over the 4 years of study. Psychosocial variables predicted adherence outcomes independent of patient age. This was found for three domains of adherence, i.e., diet, insulin adjustment, and metabolic monitoring, and for the composite index derived from the separate adherence scales. Preadolescents (ages 9-12) at study entry were more adherent than patients who were already adolescent (ages 13-16) when diagnosed. Using multiple regression, three factors (age, adjustment, ego defense level) accounted for 47% of the variance in adherence. No factors were predictive of change in adherence during the follow-up. Thus, psychosocial characteristics of diabetic children assessed shortly after diagnosis predicted typical or average adherence over a 4-year period. Identification of such characteristics may be useful in developing strategies for intervention early in the course of illness.     

Self-reported sleep, demographics, health, and daytime functioning in young old and old old community-dwelling seniors

Sleep, demographics, health, and daytime functioning were examined in young old (60-74 years; n = 175) and old old (75-98 years; n = 147) community-dwelling seniors. Sleep diaries (2 weeks), 6 daytime functioning measures, and a demographics-health questionnaire were collected. The old old reported worse sleep than the young old. Women reported worse sleep than men. Hierarchical regressions revealed demographic information alone was not sufficient for understanding sleep. Specifically, demographic information predicted sleep onset latency and sleep efficiency for both groups, but not number of awakenings or total nap time. Health and daytime functioning accounted for significant increases in the variance in sleep “over and above” that accounted for by demographics alone or demographics and health combined, respectively. All variables combined accounted for 15% to 30% of the variance in sleep. Because the importance of specific measures varied by group and sleep variable, research exploring the differential utility of specific measures for young old versus old old appears warranted.     

Do Flexible Goal Adjustment and Acceptance Help Preserve Quality of Life in Patients with Multiple Sclerosis?

Background

Goal regulation strategies such as flexible goal adjustment and acceptance are believed to be protective factors in persons with chronic illness, but research on their relative contributions to quality of life in multiple sclerosis (MS) is lacking.

Purpose

We aimed to test the idea that acceptance and flexible goal adjustment (in contrast to tenacious goal pursuit) may help preserve the quality of life in persons with MS.

Method

A sample of 117 patients with MS was recruited. They completed questionnaires measuring quality of life (physical functioning, psychological distress), acceptance, flexible goal adjustment, and tenacious goal pursuit.

Results

Acceptance significantly accounted for variance in all three indexes of quality of life, beyond the effects of demographic and illness characteristics. The role of goal regulation style was less clear. Flexible goal adjustment significantly accounted for psychological well-being only. Surprisingly, tenacious goal pursuit predicted better psychological functioning and less psychological distress. No support was found for the hypothesis that acceptance and flexible goal adjustment would moderate the relation between illness severity and quality of life.

Conclusion

The findings suggest the potential importance of acceptance in understanding MS patients’ quality of life, although its hypothesized protective function could not be confirmed. Further conceptual work on acceptance and goal regulation style is needed, as well as prospective work investigating their causal status.

     

Contextual Analysis of Child Oppositional and Maternal Aversive Behaviors in Families of Conduct-Disordered and Nonproblem Children

We examined the relationship between contextual variables and ongoing patterns of aversive interchange between parents and children in families of oppositional and nonproblem children. We obtained observational measures of child and maternal aversiveness and setting events (maternal activity, physical location, persons present) in each of five home settings on two separate occasions to derive a profile of families' typical patterns of interaction. We sought to determine how much levels of oppositional child and aversive maternal behavior varied as a function of contextual variables. As expected, the results showed that oppositional children and their mothers engage in higher levels of aversive interchange, compared to controls. However, both groups obtained a very similar profile in terms of how long mothers engaged in different household activities and stayed in different locations and how long children spent in the presence of their mother, father, and siblings. A regression analysis showed that a combined model that included both child aversiveness and all three sets of contextual variables accounted for a significantly greater amount of variance in maternal aversiveness than a model that included child aversiveness alone. A similar finding was obtained in a regression analysis to predict child aversiveness, However, the amount of variance accounted for by contextual variables varied considerably across families. We discuss implications of these findings for understanding family processes associated with oppositional behavior.     

Coping,social support,and attachment style as psychosocial correlates of adjustment in men and women with HIV/AIDS

The purpose of this study was to examine psychosocial correlates of adjustment to HIV/AIDS in a sample of 137 HIV-positive persons (78 men and 59 women). Multiple regression analysis was used to examine relationships between perceived quality of general social support, three attachment styles, and three coping styles with total score on Positive States of Mind Scale (PSOMS), our measure of adjustment. The influence of demographic and medical status variables was also accounted for. PSOMS total score was significantly associated with greater satisfaction with social support related to HIV/AIDS, more secure attachment style, and less use of behavioral disengagement in coping with HIV/AIDS. These results indicate that for people with HIV or AIDS, those individuals who are more satisfied with their relationships, securely engaged with others, and more directly engaged with their illness are more likely to experience positive adjustment. Implications for physical health outcome and opportunities for intervention are discussed.     

Illness specific patterns of psychological adjustment and cognitive adaptational processes in children with cystic fibrosis and sickle cell disease

Illness-specific patterns of adjustment and cognitive adaptational process were identified in children (7–12 years of age) with cystic fibrosis (CF, n = 40) or sickle cell disease (SCD, n = 40). Anxiety diagnoses were most frequent for both illness subgroups but children with CF had a higher rate of oppositional disorder (27.5%) than did children with SCD (2.5%). Significant portions of the variance in adjustment were accounted for by stress appraisal (19%), expectations of efficacy (9%) and health locus of control (9%) for children with CF and by stress appraisal (21%) and self-worth (12%) for children with SCD. The interaction of general and specific illness tasks and adaptational process with developmental tasks in delineating intervention opportunities is discussed. © 1998 John Wiley & Sons, Inc. J Clin Psychol 54: 121–128, 1998.     

Does hope predict adjustment to end‐stage renal failure and consequent dialysis?

Objectives Hope is important in determining positive outcomes in a range of chronic illnesses. This study examined the role of hope in adjustment to end‐stage renal failure (ESRF) and consequent dialysis. Design A cross‐sectional design examined the ability of hope to predict adjustment to ESRF over and above other relevant variables. Methods Individuals receiving dialysis at 4 units in the North‐West UK were invited to take part in the study. 103 questionnaire packs were included in the analysis. Multiple regression equations determined whether hope was able to predict significant variance in adjustment over and above that accounted for by other factors (demographic and illness‐related factors, perceived control, and social support). Measures of anxiety, depression, and quality of life constituted a multidimensional measure of adjustment to ESRF. Results Each of the regression models was significant. Hope emerged as an independent significant predictor in five of the multiple regressions: anxiety; depression; effects and symptoms of kidney disease; and mental health quality of life. Age also emerged as an important predictor of outcome. Conclusions It appears that hope is a significant predictor of adjustment to ESRF. Clinical implications of this research are discussed, along with suggestions for future research.     

Making Sense of Caregiving for Persons with Multiple Sclerosis (MS): The Dimensional Structure of Sense Making and Relations with Positive and Negative Adjustment

Background: Sense making is a meaning-making process that refers to the development of explanations for adversity. Despite a growing interest in this construct within the chronic illness literature, it has been neglected in research on carers. Purpose: This study examines the dimensional structure of a multi-item measure of sense making in carers of people with multiple sclerosis (MS) and investigates relations between sense making and both positive and negative adjustment outcomes. Method: Participants were 232 carers and their care recipients. Questionnaires were completed at first assessment (time 1) and 12 months later (time 2). Results: Factor analysis of the Carer Sense Making Scale (CSMS) revealed six psychometrically sound factors: catalyst for change, acceptance, spiritual perspective, incomprehensible, relationship ties, and causal attribution. Results of regression analyses indicated that the time 2 CSMS factors accounted for significant amounts of variance in each of the time 2 adjustment outcomes (life satisfaction, positive affect, anxiety, depression, care recipient adjustment ratings of carer) after controlling for time 1 adjustment and relevant demographic and illness variables. Conclusion: Findings delineate the dimensional structure of sense making in caregiving and the differential links between sense-making dimensions and adjustment, and have implications for the measurement of sense making. I would like to thank the MS Society of Queensland for assistance with recruiting participants for this research. In particular, I thank Dr. Wayne Sanderson (Client Services Manager, MS Society of Queensland) for recognizing the value of this research and for his support and encouragement in conducting the project.