Psychometric properties of a new measure of fathers' involvement in the management of pediatric chronic diseases

OBJECTIVE: Despite theoretical and empirical reasons suggesting its potential importance, paternal involvement in the management of pediatric chronic diseases has rarely been a primary focus of research on family adaptation to pediatric disease. This may be due to a lack of appropriate tools to measure relevant behaviors. This study assessed the reliability and validity of the Dads' Active Disease Support scale (DADS), which was designed to measure male and female caregivers' estimates of the amount and helpfulness of paternal involvement in managing six pediatric chronic diseases. METHOD: A sample of 224 heterosexual couples completed the DADS and measures of mother, child, and family functioning, yielding 190 who completed data sets. Of these, 91 mothers and 88 fathers completed the DADS again after a 1-month interval. RESULTS: Results confirmed DADS internal consistency, test-retest reliability, and interparent agreement. Confirmatory factor analysis supported its construct validity: A two-factor model (amount and helpfulness of fathers' involvement) best accounted for participants' responses. Significant correlations with scores on the Family Assessment Device supported DADS convergent validity. DADS scores of mothers and fathers suggest substantial room for improvement in both the amount and the helpfulness of paternal involvement in disease management. Mothers provided significantly higher ratings of the helpfulness of fathers' involvement than did fathers. CONCLUSIONS: The DADS appears to be a reliable and valid measure for studies of the associations between paternal involvement in disease management and child, maternal, and family adaptation to pediatric chronic medical conditions.     

Paternal involvement in the management of pediatric chronic diseases: associations with adherence, quality of life, and health status

OBJECTIVES: This article reports associations among paternal involvement in pediatric chronic disease management and child outcomes. METHODS: The Dads' Active Disease Support scale (DADS) and measures of treatment adherence, quality of life, health status, and health care utilization were obtained for youths with six chronic diseases, with complete data sets obtained from 190 couples. RESULTS: Paternal involvement was not associated with these outcomes among younger children. Among adolescents, mother-reported and father-reported DADS scores indicating more paternal involvement were associated with maintenance, rather than deterioration, of treatment adherence and more favorable quality of life. Youths' health status and health care utilization were not related significantly to paternal involvement. CONCLUSIONS: More paternal involvement was associated with more favorable adherence and quality of life among adolescents but not associated with health status or health care utilization. Longitudinal studies could verify whether paternal involvement merits clinical intervention.     

Attachment patterns across multiple family relationships in adulthood: associations with maternal depression

We explored attachment in a family context by applying family systems principles to the investigation of multiple attachment relationships within families. This study focused on maternal adult attachment with respect to family of origin experiences (assessed using the Adult Attachment Interview [AAI]) as well as maternal marital attachment (assessed using the Marital Attachment Interview [MAI]). We examined associations between maternal adult attachment (or marital attachment) and three levels of family functioning including individual maternal depression symptoms, dyadic marital satisfaction (reported by mothers), and family unit functioning. We also examined associations between combined attachment security (consistent secure, AAI secure/MAI insecure, AAI insecure/MAI secure, and consistent insecure) and family outcomes. Finally, we assessed the extent to which attachment representations operate differently in the context of family stress, namely maternal depression. We found that attachment security with respect to particular relationships was differentially associated with different levels of family functioning. Examination of the security of combined adult and marital attachment further supported the multilevel organization of the family system.     

Expressed emotion in multiple subsystems of the families of toddlers with depressed mothers

Expressed emotion was examined in families of toddlers (N = 101) whose mothers had experienced major depressive disorder occurring since the child's birth, and contrasted with expressed emotion in demographically comparable families (N = 54) with no history of parental mental disorder to elucidate family systems processes as contributors to child functioning. Both mothers and fathers provided Five-Minute Speech Samples on their child, their spouse, and themselves, and completed measures of marital adjustment, trait affect, relationship quality with their own parents in childhood, and child behavior problems. Maternal-expressed emotion criticism regarding child, self, and spouse was higher in the families with depressed mothers; paternal criticism regarding self and spouse also was higher in the depressed families. Mothers and fathers in the depressed group also differed on relational/ affective features, exhibiting lower marital satisfaction, higher trait negative affect, and more negative childhood relationship representations, relative to the nondepressed group, and mothers reported more child behavior problems. Mediational models were evaluated separately for the different targets of maternal and paternal criticism and child behavior problems, and findings supported both individual parent and spouse contributions as mediators of the relation between depression group status and expressed criticism and child behavior problems. The findings are discussed in terms of the multiple levels of family system influence on negativity in the emotional environment of toddlers of depressed mothers, developmental risk, and the need for family-level interventions.     

Longitudinal relations between parental drinking problems, family functioning, and child adjustment

Relations between maternal and paternal problem drinking symptoms and destructive marital conflict, parenting problems, and children's internalizing and externalizing problems were investigated. Participants were community families with a child in kindergarten who completed questionnaire measures at baseline (N=235), 1 year later (N=227), and 2 years later (N=215). Structural equation modeling revealed that paternal problem drinking at Time 1 was associated with greater destructive marital conflict 1 year later. In turn, destructive marital conflict was related to decreased parental warmth and increased parental psychological control; these parenting problems were associated with greater child internalizing and externalizing problems at the third time point. Further analyses revealed that the indirect effects of paternal drinking on children's adjustment were significant, and that relations remained even after including autoregressive effects. Findings are discussed in terms of family process models for relations between parental drinking and child adjustment problems.     

Familial risk factors to oppositional defiant disorder and conduct disorder: parental psychopathology and maternal parenting.

In a sample of 177 clinic-referred children aged 7-13, an association was found between a diagnosis of conduct disorder (CD) and several aspects of family functioning: maternal parenting (supervision and persistence in discipline) and parental adjustment (paternal antisocial personality disorder and paternal substance abuse). Children with oppositional defiant disorder (ODD) were intermediate to families of children with CD and clinic control children on all variables, but differed from control children only in having a higher rate of paternal substance abuse and paternal antisocial personality disorder (APD). When both parental APD and deviant maternal parenting were entered into 2 x 2 logit-model analyses predicting CD, only parental APD was significantly associated with CD, and no interactions between parental adjustment and maternal parenting were found. The importance of these findings for understanding the etiology of CD and for disentangling correlated risk factors in future studies is discussed.     

Maternal depression,paternal psychopathology,and adolescent diagnostic outcomes

The authors examined the relationship between maternal depression, paternal psychopathology, and adolescent diagnostic outcomes in a community sample of 522 Australian families. They also examined whether chronic family stress, father's expressed emotion, and parents' marital satisfaction mediated the relationship between parental psychopathology and adolescent outcomes. Mother's education, child's gender, and family income were covaried in all analyses. Results revealed that maternal depression and paternal depression had an additive effect on youth externalizing disorders. In addition, maternal depression interacted with both paternal depression and paternal substance abuse in predicting youth depression but not youth nondepressive disorders. Chronic family stress and father's expressed emotion appeared to mediate the relationship between parental psychopathology and youth depression.     

Family functioning in school-age children with cystic fibrosis: an observational assessment of family interactions in the mealtime environment

OBJECTIVE: To examine, using direct observation methodology, differences in family functioning at mealtime between families of school-age children with cystic fibrosis (CF) and families of school-age children without a chronic illness. METHOD: Family functioning was rated using the McMaster Mealtime Interaction Coding System (MICS) during a videotaped dinner among 28 families of children with CF and 27 families of non-ill, age-matched peers. Families were rated on overall family functioning and on six dimensions of the MICS: task accomplishment, communication, affect management, interpersonal involvement, behavior control, and role allocation. RESULTS: Ratings for families of a child with CF were significantly lower than they were for comparison families on overall family functioning and on four of the six MICS dimensions: communication, affect management, interpersonal involvement, and behavioral control. Moreover, a significantly greater percentage of families of children with CF were rated in the unhealthy range on overall family functioning and on five of six MICS dimensions. There was no relationship between family functioning and child weight status for children with CF. CONCLUSIONS: The current study suggests that for families of school-age children with CF, the family system is negatively affected during mealtime. Dietary interventions need to address family-centered, as well as child-centered, interventions to help families manage challenges presented during the family meal.     

Longitudinal study of observed and perceived family influences on problem-focused coping behaviors of preadolescents with spina bifida

OBJECTIVE: To study coping socialization longitudinally by examining reported and observed family environment and parenting variables in relation to children's problem-focused coping in a sample of 68 families of preadolescents with spina bifida and 68 matched able-bodied comparison families. METHODS: Family environment and parenting variables were assessed with mother and father reports and observational measures. Children's problem-focused coping was self-reported. RESULTS: Prospective analyses revealed that maternal responsiveness, paternal responsiveness, and family cohesion predicted an increase in children's use of problem-focused coping strategies, while change in paternal responsiveness and maternal responsiveness and demandingness was related concurrently to change in coping. Few group (spina bifida vs. able-bodied) or gender differences with respect to parenting and family influences on children's coping behaviors were found. CONCLUSIONS: Multimethod findings suggest that the quality of parenting and family environment is associated with children's problem-focused coping behaviors. We discuss clinical implications.     

Interpersonal and family functioning of female survivors of childhood sexual abuse

The empirical literature that addresses the association between childhood sexual abuse (CSA) and the interpersonal functioning of female survivors within their adult family context is critically examined. Specifically, research on relationship difficulties, problems in attachment, marital conflict and divorce, secondary traumatization, sexual dysfunction, maternal attitudes and functioning, and the heightened risk for having children who themselves are sexually abused is reviewed. There is converging evidence in both clinical and community samples that, compared to other women, female CSA survivors do experience more relationship problems and more problems in sexual functioning. Based on community samples, there is an indication that CSA survivors experience problems in marital functioning and attachment. Beyond this, little sound research has addressed the issues of secondary traumatization, maternal attitudes, maternal functioning, or intergenerational patterns of abuse. The use of specificity designs, improved sampling strategies, and standardized, psychometrically strong measures in future research would greatly improve the quality of our knowledge on the interpersonal and family functioning of CSA survivors.     

Association between parental depressive symptoms and impaired bonding with the infant

Impaired bonding with the infant is associated with maternal postpartum depression but has not been investigated extensively in fathers. The primary study aim was to evaluate associations between maternal and paternal depressive symptoms and impaired bonding with their infant. A secondary aim was to determine the associations between parents’ marital problems and impaired bonding with the infant. The study is part of a population-based cohort project (UPPSAT) in Uppsala, Sweden. The Edinburgh Postnatal Depression Scale (EPDS) at 6 weeks and 6 months postpartum and the Postpartum Bonding Questionnaire at 6 months postpartum were completed by 727 couples. The prevalence of impaired bonding was highest among couples in which both spouses had depressive symptoms. Impaired bonding was associated with higher EPDS scores in both mothers and fathers, as well as with experiencing a deteriorated marital relationship. The association between maternal and paternal impaired bonding and the mothers’ and fathers’ EPDS scores remained significant even after adjustment for relevant confounding factors. Depressive symptoms at 6 weeks postpartum are associated with impaired bonding with the infant at 6 months postpartum for both mothers and fathers. It is critical to screen for and prevent depressive symptoms in both parents during early parenthood.     

Coping and family functioning predict longitudinal psychological adaptation of siblings of childhood cancer patients

OBJECTIVE: To assess associations of coping and family functioning with psychosocial adjustment in siblings of pediatric cancer patients at 1, 6, 12, and 24 months after diagnosis. METHODS: Eighty-three siblings (ages 7-19 years) participated. Effects on anxiety, quality of life, behavioral-emotional problems, and emotional reactions to the illness were investigated. Data-analysis was performed with multilevel mixed modeling. RESULTS: Psychosocial functioning was impaired at 1 month but ameliorated over time. Adjustment problems were associated with high family adaptation and cohesion, older age, and female gender. Lower anxiety, insecurity, loneliness, and illness involvement were related to siblings' ability to remain optimistic. Insecurity and illness involvement were positively related to reliance on the medical specialist and a tendency to seek information about the illness. CONCLUSIONS: Siblings of pediatric cancer patients are most affected by the illness in the first months. Children at risk may be identified according to sibling age and gender and according to long-term family adaptation processes and sibling coping abilities.     

Disease management, coping, and functional disability in pediatric sickle cell disease

BackgroundYouth with sickle cell disease (SCD) experience chronic symptoms that significantly interfere with physical, academic, and social-emotional functioning. Thus, to effectively manage SCD, youth and caregivers must work collaboratively to ensure optimal functioning. The goal of the current study was to examine the level of involvement in disease management tasks for youth with SCD and their caregivers. The study also examined the relationship between involvement in disease management tasks, daily functioning, and coping skills. The study utilized collaborative care and disease management theoretical frameworks.MethodsYouth and caregivers participated in the study during an annual research and education day event. Forty-seven patients with SCD aged 6 to 18 years and their caregivers completed questionnaires examining level of involvement in disease management tasks, youth functional disability, and youth coping strategies. Caregivers also completed a demographic and medical history form.ResultsParents and youth agreed that parents were significantly more involved in disease management tasks than youth, although level of involvement varied by task. Decreased parent involvement was related to greater coping strategies used by patients, including massage, prayer, and positive thinking. Higher functional disability (lower functioning) was related to greater parent involvement in disease management tasks, suggesting that greater impairment may encourage increased parent involvement.ConclusionsHealth professionals working with families of youth with SCD should discuss with parents and youth how disease management tasks and roles will be shared and transferred during adolescence. Parents and youth may also benefit from a discussion of these issues within their own families.     

Impact of family environment and support on adherence,metabolic control,and quality of life in adolescents with diabetes

Background: Diabetes is a common disease in pediatric populations. Family functioning has been related to child adaptation to diabetes. Purpose: To determine the impact of family factors on diabetes, particularly the influence of family support and family environment on adherence to treatment, quality of life, and metabolic control in Portuguese adolescents with type 1 diabetes, taking in consideration age, sex, duration of disease, and social class. Method: This study used a cross-sectional design. A sample of 157 Portuguese diabetic patients filled disease-specific measures on adherence and quality of life and family functioning measures. Hypotheses were that family support and an organized family environment (high cohesion and low conflict) would be positively associated with better adherence, metabolic control, and quality of life. Results: This study’s results confirmed that adherence was predicted by family support for females and lower-class patients while metabolic control was predicted by family conflict for upper-class patients. Quality of life was predicted by lack of family conflict and family social support for both males and females as well as lower-class patients. Conclusion: The results highlight the importance of studying family variables in adolescents’ diabetes care within the wider cultural factors affecting the patient.     

Paternal age and birth defects: how strong is the association?

BACKGROUND: Although the association between maternal age and the risks of birth defects has been well studied, the evidence from population data linking paternal age with birth defects was limited and inconsistent. METHODS: We conducted a population-based retrospective cohort study of 5,213,248 subjects from the 1999-2000 birth registration data of the USA. Multiple logistic regressions were used to estimate the independent effect of paternal age on all birth defects and 21 specific defects groups after adjusting for potential confounding of maternal age, race, education, marital status, parity, prenatal care initiation, maternal smoking and alcohol drinking during pregnancy. RESULTS: A total of 77,514 (1.5%) birth defects were recorded in the study cohort. The adjusted odds ratios were 1.04 (1.01, 1.06), 1.08 (1.04, 1.12), 1.08 (1.02, 1.14) and 1.15 (1.06, 1.24), respectively, for infants born to fathers 30-35, 40-44, 45-49 and over 50 years (test for trend, P = 0.0155), when compared with those infants born to fathers aged 25-29 for any birth defect. Advanced paternal age was associated with increased risks of heart defects, tracheo-oesophageal fistulaoesophageal atresia, other musculoskeletal/integumental anomalies, Down's syndrome and other chromosomal anomalies. Fathers under 25 years of age were also at increased risks of spina bifida/meningocele, microcephalus, omphalocele/gastroschisis and other musculoskeletal/integumental anomalies. CONCLUSIONS: Infants born to older fathers have a slightly increased risk of birth defects. Young paternal age is also associated with slightly increased risk of several selected birth defects in their offspring. However, given the weak association, paternal age appears to play a small role in the aetiology of birth defects.     

Paternal age, stillbirths and mutation

Previous suggestions that accumulation of mutations in the germ line of ageing fathers causes an increased stillbirth rate were based on analyses of data which were heterogeneous for social variables whose effects were confounded with possible paternal age effects. This study was confined to the analysis of stillbirth rates of groups of women selected to be homogeneous for education, previous pregnancy outcomes, age, race and marital status. It is concluded that stillbirth rates do not increase with father's age independently of maternal variables. Neither accumulation of mutations in the paternal germ line nor other biological change associated with father's age can be inferred to cause an increase in risk of stillbirth with increasing paternal age.     

Maternal age affects brain metabolism in adult children of mothers affected by Alzheimer's disease

Cognitively normal (NL) individuals with a maternal history of late-onset Alzheimer's disease (MH) show reduced brain glucose metabolism on FDG-PET as compared to those with a paternal history (PH) and those with negative family history (NH) of Alzheimer's disease (AD). This FDG-PET study investigates whether metabolic deficits in NL MH are associated with advancing maternal age at birth. Ninety-six NL individuals with FDG-PET were examined, including 36 MH, 24 PH, and 36 NH. Regional-to-whole brain gray matter standardized FDG uptake value ratios were examined for associations with parental age across groups using automated regions-of-interest and statistical parametric mapping. Groups were comparable for clinical and neuropsychological measures. Brain metabolism in AD-vulnerable regions was lower in MH compared to NH and PH, and negatively correlated with maternal age at birth only in MH. There were no associations between paternal age and metabolism in any group. Evidence for a maternally inherited, maternal age-related mechanism provides further insight on risk factors and genetic transmission in late-onset AD.     

Influence of early life stress on later hypothalamic-pituitary-adrenal axis functioning and its covariation with mental health symptoms: a study of the allostatic process from childhood into adolescence

The hypothalamic-pituitary-adrenal (HPA) axis is a primary mechanism in the allostatic process through which early life stress (ELS) contributes to disease. Studies of the influence of ELS on children's HPA axis functioning have yielded inconsistent findings. To address this issue, the present study considers multiple types of ELS (maternal depression, paternal depression, and family expressed anger), mental health symptoms, and two components of HPA functioning (traitlike and epoch-specific activity) in a long-term prospective community study of 357 children. ELS was assessed during the infancy and preschool periods; mental health symptoms and cortisol were assessed at child ages 9, 11, 13, and 15 years. A three-level hierarchical linear model addressed questions regarding the influences of ELS on HPA functioning and its covariation with mental health symptoms. ELS influenced traitlike cortisol level and slope, with both hyper- and hypoarousal evident depending on type of ELS. Further, type(s) of ELS influenced covariation of epoch-specific HPA functioning and mental health symptoms, with a tighter coupling of HPA alterations with symptom severity among children exposed previously to ELS. Results highlight the importance of examining multiple types of ELS and dynamic HPA functioning in order to capture the allostatic process unfolding across the transition into adolescence.     

Latchkey children: Potential sources of support

Two studies examined factors facilitating the ability of latchkey children to care for themselves, and to function at a similar level to children who are under adult care. In the first study, 70 latchkey and 69 non-latchkey children were compared on measures of functioning, and on level of maternal perception of their children as independent. Children's level of functioning was not different across the latchkey condition. However, contrary to expectations, maternal perception of the child as independent was related to a lower level of fear only among the non-latchkey children. Among latchkey children, in contrast, maternal perception of the child as independent was related to a higher level of anxiety and fears on the part of the child. In the second study, the association between maternal and extra family support and child functioning was evaluated in two cohorts: 62 latchkey and 46 non-latchkey children. Results showed that maternal support was associated with functioning level of the non-latchkey children; functioning level of latchkey children, in contrast, was related to extra family supports. The role of parental and extra family support in the functioning of latchkey children is discussed. © 1998 John Wiley & Sons, Inc.