Comparing parental distress,family functioning,and the role of social support for caregivers with and without a child with juvenile rheumatoid arthritis

OBJECTIVE: To assess parental distress, family functioning, and social support among parents of children with a lifetime diagnosis of juvenile rheumatoid arthritis (JRA) and comparison families. METHODS: Parents of 64 children with JRA (64 mothers, 46 fathers) completed questionnaires and in-home interviews along with 64 matched comparison families. Average time since diagnosis for children with JRA was 70 months. RESULTS: Families of children with JRA generally reported levels of parental distress, family functioning, and social support similar to those for comparison families. More mothers of children with JRA exceeded the clinical cutoff on the SCL-90-R than comparison mothers. Although disease characteristics and social support did not distinguish subgroups of parents at greater risk for problems, family supportiveness and conflict were associated with caseness for mothers of children with JRA. CONCLUSIONS: Families of children with JRA exhibited substantial resilience over the long term. Further multisite study of children recently diagnosed and with more severe forms of JRA is warranted to determine intervention needs, especially for mothers.     

Parent and family factors associated with child adjustment to pediatric cancer

OBJECTIVE: To identify factors that influence the association between parent and child distress among families of children with cancer and comparison peers. METHODS: Parent and child distress, social support, and family environment were assessed among families of 95 children with cancer (94 mothers, 67 fathers) and 98 comparison peers (97 mothers, 77 fathers). RESULTS: Significant associations were found between parent and child distress. For models examining the impact of fathers' distress on children, several moderators were identified (i.e., family environment, child age and gender, a cancer diagnosis, and treatment severity). Family environment also partially mediated father and child distress. CONCLUSIONS: Children whose parents were distressed were more likely to be distressed themselves. Subgroups of children were particularly vulnerable, indicating a need to identify further mechanisms of risk and resilience and to develop family-based interventions. Support was found for including fathers as independent sources of information in pediatric psychology research and clinical practice.     

Surviving childhood cancer, social support, and parents' psychological adjustment.

Assessed whether the continuing emotional strain of parenting a child cancer survivor is associated with elevated levels of psychological distress (depression and anxiety) in parents. The role of social support in moderating this relationship was also evaluated. When parents of cancer survivors (63 mothers and 49 fathers) were compared to a matched sample of parents (64 mothers and 62 fathers) with healthy children there were no differences in levels of depression or anxiety overall but among parents experiencing low levels of social support, parents of cancer survivors were more depressed and anxious than parents of healthy children. Perceived social support has a significant inverse relationship with psychological distress for both parents but seems to be more important for mothers. The elevated risk for psychological distress noted for those experiencing low levels of support appears to be more generalized for fathers than mothers.     

Parenting a child with Marfan syndrome: Distress and everyday problems

Marfan syndrome (MFS) is a multisystemic, autosomal dominant connective tissue disorder that occurs de novo in 25%. In many families, parent and child(ren) are affected, which may increase distress in parents. To assess distress, 42 mothers (29% MFS) and 25 fathers (60% MFS) of 43 affected children, completed the validated screening‐questionnaire Distress thermometer for parents of a chronically ill child, including questions on overall distress (score 0–10; ≥4 denoting “clinical distress”) and everyday problems (score 0–36). Data were compared to 1,134 control‐group‐parents of healthy children. Mothers reported significantly less overall distress (2, 1–4 vs. 3, 1–6; p = .049; r = ?.07) and total everyday problems (3, 0–6 vs. 4, 1–8; p = .03; r = ?.08) compared to control‐group‐mothers. Mothers without MFS reported significantly less overall distress compared to mothers with MFS, both of a child with MFS (1, 0–4 vs. 3.5, 2–5; p = .039; r = ?.17). No significant differences were found between the father‐groups, nor between the group of healthy parents of an affected child living together with an affected partner compared to control‐group‐parents. No differences in percentages of clinical distress were reported between mothers and control‐group‐mothers (33 vs. 42%); fathers and control‐group‐fathers (28 vs. 32%); nor between the other groups. Distress was not associated with the children's MFS characteristics. Concluding, parents of a child with MFS did not show more clinical distress compared to parents of healthy children. However, clinical distress was reported in approximately one‐third and may increase in case of acute medical complications. We advise monitoring distress in parents of a child with MFS to provide targeted support.     

Social, emotional, and behavioral functioning of children with NF1

Children with neurofibromatosis type 1 (NF1) can have varying degrees of cognitive impairment, and are at risk for social, emotional, and behavioral dysfunction. We undertook an evaluation of social, emotional, and behavioral functioning of youth with NF1 and peers from multiple perspectives. We hypothesized that children with NF1 would have more psychosocial difficulties, which would be positively associated with neurological involvement. We compared 58 children with NF1, ages 7-15, with comparison classroom peers, classmates who were same race/gender and closest date of birth. Peer relationships, emotional well-being, and behavior were evaluated from multiple perspectives in multiple settings. Results showed that teachers perceived children with NF1 as more prosocial (i.e., polite, helpful to others). Teachers and peers viewed children with NF1 as displaying less leadership behavior and as more socially sensitive-isolated (i.e., often left out, trouble making friends). Children with NF1 had fewer friendships and were less well liked by peers. Mothers and fathers reported more problems with social functioning among children with NF1. Few group differences in emotional well-being and behavior were identified according to child and father report. However, mothers perceived children with NF1 to have more emotional problems relative to comparison peers, predominantly among older children. Neurological involvement was significantly related to psychosocial problems. We conclude that children with NF1 are frequently socially isolated and rejected by peers; and that greater neurological involvement is associated with more emotional problems. Central nervous system involvement appears to play a key role in identifying children at risk for problems with friendships, social acceptance, and emotional functioning (i.e., depression).     

Maternal, Paternal, and Marital Functioning in Families of Preadolescents with Spina Bifida

Based on a family systems/social-ecological perspective, mothersand fathers of 8-and 9-year-old children with spina bifida (n=55;28male, 27 female) were examined in comparison to a matched groupof parents with 8-and 9-year-old able-bodied children (n=55;29 male, 26 female) across several areas of functioning (individual,parental and marital). Findings suggested that mothers and fathersin the spina bifida sample tended to report more psychosocialstress than their counterparts in the able-bodied sample. Specifically,mothers and fathers in the spina bifida group reported lessparental satisfaction than parents in the able-bodied group.Mothers in the spina bifida group reported less perceived parentalcompetence, more social isolation, and less adaptability tochange; fathers in the spina bifida group reported more psychologicalsymptoms. No differences between the spina bifida and able-bodiedgroups were found with respect to marital satisfaction. Copingpredictors of adjustment tended to vary as a function of parentgender rather than group status.     

Social Support, Social Conflict, and Adjustment Among Adolescents With Cancer

Objective: Evaluate support and conflict in close relationshipsof adolescents in active medical treatment for cancer. Familyand friend perceptions of supportive and conflictual behaviorswere examined in relation to psychological distress, takinginto account the impact of functional impairment induced bythe illness. Methods: Using self-report questionnaires, 50 adolescents betweenthe ages of 12 and 20 years rated the frequency of supportiveand conflictual interactions with parents, siblings and bestfriends. Results: Results indicated that perceived maternalconflict was associated with psychological distress. Conflictwith fathers, siblings, and best friends was not associatedwith distress. Supportive aspects of close relationships didnot predict psychological distress. The amount of physical impairmentaccounted for the most variance In distress, contributing between35% and 38%; of the variance. Conclusions: Results suggest that mother-adolescent conflictwould be an appropriate target for psychoso-cial interventions.     

Social support in the transition to parenthood

The study explored the effects of different types of social support on the adjustment of first time parents in the postpartum period. At three months and nine months postpartum, questionnaires were filled out by 18 fathers and 23 mothers who attended parenting groups, and 23 mothers and 24 fathers in a comparison group. Four types of early postpartum social support (parenting group, marital instrumental, marital emotional, and network) were related to later postpartum adjustment (well-being, marital interaction, and parental sense of competence). The results suggest that the importance of a particular type of support may be different for fathers and mothers. Parenting group support and emotional marital support were found to be related to well-being, marital interaction, and parental competence for fathers. Emotional marital and network support were positively related to well-being and marital interaction for mothers. Implications for the provision of support by the naturally occurring informal networks of family and friends, and by specific group support systems were suggested. The limitations of the impact of social support and its assessment were discussed.     

Parenting stress and psychosocial well-being among parents with twins conceived naturally or by reproductive technology

This study compared parenting stress and psychosocial well-being among parents with 1 year old twins conceived in three different ways: (i) spontaneously without any medical assistance (54 families), (ii) spontaneously following hormonal treatment (25 families) and (iii) following in-vitro fertilization (IVF) or artificial insemination (AI) with the semen of the social father (24 families). The investigation included the Parenting Stress Index (PSI) and the General Health Questionnaire (GHQ-30). Since the presence of older children differed significantly between the three groups, this factor was included in the statistical analysis. Overall, no significant differences were found between the three study groups, either for the mothers or for the fathers. Nevertheless, we found a main effect of the presence of older children and an interaction effect of the presence of older children and the conception mode on some of the scales for the mothers: first-time mothers showed significantly higher stress related to parental competence, health and the partner relationship compared with mothers who had older children. First-time mothers with a history of infertility obtained significantly higher stress scores for parental competence and health and showed lower psychosocial well-being compared with naturally conceiving first-time mothers and mothers with a history of infertility who already had children.     

Parents of Children with Cancer: A Longitudinal Study of Emotional Distress, Coping Style, and Marital Adjustment Two and Twenty Months After Diagnosis

Evaluated emotional distress, coping style, and marital adjustmentin 84 parents (42 couples) of children with cancer 2 monthsafter diagnosis and again about 20 months after diagnosis. Asexpected, mothers' mean state anxiety and trait anxiety scoresdecreased to near normal levels over time. Fathers' scores werelower initially and did not change. Neither mothers' nor fathers'mean marital adjustment scores changed over time. Marital adjustmentat treatment follow-up was predicted by depression and the spouse'smarital satisfaction in mothers, and depression, child healthstatus, and spouse's marital satisfaction in fathers. In contrastto findings obtained 2 months after diagnosis, coping stylewas not related to marital adjustment at follow-up. Resultsare discussed in terms of possible gender differences in therole of social support in marital adjustment and the stabilityversus situational specificity of coping styles.     

Observed and perceived parental overprotection in relation to psychosocial adjustment in preadolescents with a physical disability: the mediational role of behavioral autonomy

The purpose of this study was to tes a mediational model of associations between parental overprotectiveness (OP), behavioral autonomy. and psychosocial adjustment in 68 families with 8- and 9-year-old preadolescents with spipa bifida and a demographically matched sample of 68 families with able-bodied children. Measures included questionnaire and observational assessments of parental OP; parent and child reports of behavioral autonomy; and parent, child, and teacher reports of preadolescent adjustment. On the basis of both questionnaire and observational measures of OP, mothers and fathers of children with spina bifida were significantly more overprotective than their counterparts in the able-bodied sample, although this group difference was partially mediated by children's cognitive ability. Across samples, mothers were more likely to be overprotective than fathers. Both questionnaire and observational measures of parental OP were associated with lower levels of preadolescent decision-making autonomy as well as with parents being less willing to grant autonomy to their offspring in the future. For the questionnaire measure of OP, and only for the spina bifida sample. the mediational model was supported such that parental OP was associated with less behavioral autonomy, which was, in turn, associated with more externalizing problems. Findings are discussed in relation to the literature on parenting, autonomy development, and pediatric psychology.     

Paternal and maternal influences on the psychological well-being, substance abuse, and delinquency of Chinese adolescents experiencing economic disadvantage

On two occasions separated by one year, Chinese adolescents with economic disadvantage in Hong Kong (N = 199) responded to instruments measuring perceived parental parenthood qualities (indexed by perceived parenting styles, support and help from parents, and conflict and relationship with the parents) and psychosocial adjustment (psychological well-being, substance abuse, and delinquency). Results showed that parental parenthood variables were concurrently associated with different measures of adolescent psychological well-being and problem behavior at Time 1 and Time 2. While paternal parenthood qualities at Time 1 predicted changes in existential well-being and delinquency in adolescent boys, but not in adolescent girls, at Time 2, maternal parenthood qualities at Time 1 predicted changes in the mental health and problem behavior in adolescent girls, but not in adolescent boys, at Time 2. There is no strong support for the thesis that adolescent adjustment influences perceived parental parenthood qualities over time. The present study suggests that the influences of fathers and mothers on the adjustment of Chinese adolescents experiencing economic disadvantage vary with the gender of adolescent children.     

Attention-deficit/hyperactivity disordered boys' relationships with their mothers and fathers: child,mother, and father perceptions

Self-perceptions of parent-child relationship quality were examined for 142 boys with attention-deficit/hyperactivity disorder (ADHD) and 55 control boys. Parent perceptions were examined as well. Mothers and fathers of ADHD boys perceived their relationships with their children more negatively than mothers and fathers of control boys. Interestingly, despite these differences in parental perceptions, ADHD boys did not differ from control boys in their perceptions of their relationships with their parents. Further, when ADHD boys' perceptions were compared directly to those of their parents, ADHD boys' reports were positively enhanced relative to those of control parent-child dyads. Together, these results may be viewed as providing support for a positive illusory bias in the social self-perceptions of ADHD children.     

Anxiety in children with recurrent abdominal pain and their parents

Multiple assessments of anxiety were completed for children with recurrent abdominal pain (RAP), behaviorally disordered (BD) children, and healthy children, as well as for their parents. Children and mothers in both the RAP and BD groups had higher levels of anxiety than existed in healthy families. Fathers of RAP children reported significantly more anxiety than fathers in the two comparison groups. These data support the clinical observation that families of children with RAP have high levels of anxiety.     

Functioning among mothers and fathers of children with juvenile rheumatic disease: a longitudinal study.

Examined the adaptation of mothers and fathers of children with juvenile rheumatic disease on two occasions, 1 year apart, using 159 married couples at Time 1, and 111 of these couples at Time 2. A stress and coping model was tested in which parental functioning is determined by ongoing life stressors (patient and spouse dysfunction), family resources, and parents' illness-related coping. Mothers reported more depression than fathers did. However, poorer concurrent functioning among both mothers and fathers was explained partly by patients having more functional disability, pain, and psychosocial problems. In addition, spouse's dysfunction and the parent's use of avoidance coping were related to poorer parental adaptation, both concurrently and 1 year later. The implications of the findings for developing stress and coping models of parental adaptation to having a chronically ill child, and for intervention strategies with parents, patients, and families, are discussed.     

Mothers', fathers', and children's perceptions of parental diabetes responsibility in adolescence: examining the roles of age, pubertal status, and efficacy

Objectives To examine how perceptions of parental responsibilityfor diabetes management are associated with age, pubertal status,adolescents’ self-efficacy, and parental perceptions ofadolescents’ efficacy, and if parental responsibilityis associated with better metabolic control as a function ofadolescents’ self-efficacy and parental perceptions ofadolescents’ efficacy. Methods Questionnairesassessing parental responsibility, pubertal status, adolescents’self-efficacy, and parental perceptions of adolescents’efficacy were given to 185 adolescents with type 1 diabetes,185 mothers, and 145 fathers. Results Greater parentalresponsibility was negatively associated with age, perceptionsof pubertal status, and efficacy for all reporters. Interactionsbetween parental responsibility and parental perceptions ofadolescents’ efficacy indicated that parental responsibilitywas associated with better metabolic control when adolescentswere perceived to have lower efficacy. Conclusions Adolescents’and parents’ perceptions of parental responsibility arerelated to multiple factors. Metabolic control is best whenhigh parental responsibility is maintained among adolescentswith lower efficacy.     

Finnish mother's and father's attachment representations during child's first year predict psychosocial adjustment in preadolescence

The aim of the longitudinal study was to examine, for the first time in a Nordic country, whether autonomous parenting in infancy affects psychosocial adjustment in preadolescence. Attachment representations of mothers and fathers were investigated with the Adult Attachment Interview in a community sample of two-parent Finnish families. Most mothers and fathers were classified as autonomous, a finding which is in line with normative Western distributions. Moreover, the ratio of dismissing versus preoccupied adults was similar to Western norms. Demographic characteristics such as family structure and years of education differentiated autonomous from non-autonomous mothers. In preadolescence, the children who had experienced at least one autonomous parent were more empathic and had fewer problems in social relationships and thought processes compared to children of two non-autonomous parents. The findings suggest that autonomous parenting has long-term parent gender specific influences on children's psychosocial adjustment.     

A comparison of characteristics in the families of patients with anorexia nervosa and normal controls

The present study compared families of patients with anorexia nervosa with families of non-anorexic adolescent daughters of a similar social class. All anorexics and adolescent comparison girls and their parents were studied using a variety of psychometric measures. Body size estimation and physical anhedonia were also measured. Family characteristics were assessed using the Family Assessment Measure (FAM). Contrary to the hypotheses, no abnormalities were found in terms of parental attitudes to weight control or dieting. The mothers of anorexics displayed no increase in psychopathology on any of the measures. The fathers scored very similarly to controls but with higher degrees of conscientiousness. Neither fathers nor mothers displayed abnormalities of their own body size estimates or body satisfaction. On the FAM the anorexic families reported an increased pathology on several sub-scales. It is not possible to say whether these disturbances are part of the pathogenesis or are sequelae to the illness.     

Left-Handedness as a Function of Sex, Maternal Versus Paternal Inheritance, and Report Bias

The right-shift (RS) theory suggests that sex differences for handedness are due to the displacement of a chance distribution of asymmetry farther to the right in females than males by about 20%. An analysis of studies in the literature shows that when handedness is assessed by self-report, paired samples of males and females differ for incidence of left-handedness as predicted, but for parents assessed by indirect-report, there are fewer left-handed mothers than expected. When handedness is assessed by self-report in both generations, the RS genetic model successfully predicts the distribution in families. It is also successful at different levels of criterion from left-writing to non-right-handedness. The RS predictions are not always consistent with the findings of studies that depended on indirect report of parental handedness. When parental incidences are low the proportion of left-handed children in the families of left-handed mothers is higher than expected. When parental incidences are high, predictions for the families of left-handed mothers are excellent, but the percentage of left-handed children in the families of left-handed fathers is lower than expected. Data for all indirect-report studies are combined to test the idea that the chief cause of poor fit is underreporting of left-handed mothers by right-handed children. Transfer of right-handed children from R × R to R × L families, thereby raising the percentage of left-handed mothers by about 1%, is sufficient to give good fits to RS predictions for both sexes.     

Toward Establishing the Transcultural Validity of Sluggish Cognitive Tempo: Evidence From a Sample of South Korean Children

All sluggish cognitive tempo (SCT) research has been conducted in North America and Western Europe, with the addition of 1 study in Chile. Our objective was to determine the internal and external validity of 9 SCT and 9 Diagnostic and Statistical Manual of Mental Disorders (5th ed.) attention deficit/hyperactivity disorder inattention (ADHD-IN) symptoms in South Korean children. Mothers, fathers, and teachers rated SCT, ADHD-IN, ADHD hyperactivity/impulsivity (HI), oppositional defiant disorder (ODD), anxiety, depression, academic impairment, and social impairment in 1st- to 6th-grade children (6–13 years of age) from South Korea (Sample 1: mothers rated 885 children and fathers rated 646 children; 941 unique children, 54% girls; Sample 2: 99 teachers rated 297 children, 44% girls). The SCT and ADHD-IN symptoms showed convergent validity (substantial loadings on their respective factors) and discriminant validity (loadings near zero on the alternative factor) across all three raters. Although ADHD-IN showed a positive relationship with ADHD-HI and ODD even after controlling for SCT across all three raters, SCT was nonsignificantly (mothers and fathers) or negatively (teachers) related to ADHD-HI and ODD after controlling for ADHD-IN. Higher SCT scores predicted higher anxiety, depression, academic impairment (teachers only), and social impairment (teachers only) even after controlling for ADHD-IN, whereas higher ADHD-IN scores predicted higher anxiety (mothers and fathers only), depression, academic impairment, and social impairment after controlling for SCT. The study provides initial evidence for the internal and external validity of SCT relative to ADHD-IN in South Korean children, thereby providing the first evidence for SCT’s validity in Asian children.