Physical status and psychosocial adjustment in children with spina bifida

Investigated the relationship between the physical status and psychosocial adjustment of chronically physically handicapped children. The status of 61 children with spina bifida regarding six specific disease or disability parameters was determined from medical charts. Their mothers completed the Child Behavior Checklist as a measure of the children's psychosocial adjustment. Children with spina bifida were reported to display on the average significantly more behavior and social competence problems than expected for children in general. However, children with differing degrees of physical problems and disability did not differ significantly in their psychosocial adjustment. The general lack of relationship between physical status and adjustment as it relates to a conceptual model guiding this research is discussed.     

Psychological adjustment and perceived social support in children with congenital/acquired limb deficiencies

The negative impact on psychological adjustment from the chronic strain of living with limb deficiencies appears to be mediated by perceived social support. A multifactorial investigation was conducted to identify empirically psychological adjustment correlates of perceived social support in 49 children with congenital/acquired limb deficiencies. A multiplicity of adjustment factors (depression, trait anxiety, self-esteem) was variously related to perceived parent, teacher, classmate, and friend social support. Hierarchical multiple regression analyses provide initial evidence of the potentially powerful effects of the social environment of the school setting, with perceived classmate social support the only significant predictor variable across depressive symptomatology, trait anxiety, and general self-esteem. The results are discussed as the first step in identifying the potential correlates of multiple perceived social support domains, which may provide empirical guidance for future intervention studies designed to modify adjustment factors in chronically ill and handicapped children.This research was supported by grants from the Shriners Hospitals for Crippled Children Research Fund and the Milo B. Brooks Foundation for Limb Deficient Children.     

Cautions in using the Child Behavior Checklist: observations based on research about children with a chronic illness

The Child Behavior Checklist (CBCL) and the related instruments, the Teacher's Report Form (TRF) and Youth Self-Report (YSR), are frequently used in research assessing the behavioral adjustment of children. This paper describes some issues relevant to children with a chronic physical illness that should be considered when using these instruments. Salient problems include (a) possible bias in interpreting data concerning physical symptoms; (b) limited sensitivity to identify mild adjustment problems of the sort most often encountered in children with chronic physical illnesses; and (c) incomplete and potentially misleading assessment of social competence. When using these instruments investigators should also be aware of several general methodologic issues before collecting, analyzing, and interpreting data regarding children with chronic illnesses.     

Psychosocial adjustment among pediatric cancer patients: a multidimensional assessment

Identified types and frequencies of psychological difficulties manifested by pediatric oncology patients and child-, family-, and illness-related correlates of adjustment. Parents of 48 children with cancer, 4 to 17 years of age, completed the Personality Inventory for Children (PIC). Analysis of mean PIC scores indicated that the children had a high frequency of somatic concerns and problems in academic functioning. Similar mean PIC profiles were obtained for children across gender, age, and diagnostic groups. Overall, 52% of the children had profiles with two or more clinically significant problem areas. Children's adjustment was associated with gender, social competence, and parental coping. Boys exhibited significantly more problems than did girls. Children whom teachers rated as less socially competent and whose parents reported few effective coping responses exhibited greater difficulties in adjustment.     

Dimensional analysis of behavior setting demands in a community residence for chronically mentally ill women

Care of chronic psychiatric clients in community settings is a priority issue in mental health, and current thinking proposes an interactional model encompassing both individual skills and environmental demands to explain clients' adjustment to community life. Although functional skills of chronic clients are readily measurable, we lack systematic and precise methods for describing and evaluating community settings in commensurate terms. The present study used Barker's (1968) theory of behavior settings to assess 55 structured activities and other settings in a large community residence for chronically mentally ill women. Factor analysis identified dimensions of behavioral demands involving entry requirements, levels of social interaction, dress, cooperation, and competition, and also size and frequency/duration of settings. Implications for the assessment, selection, modification, and creation of community settings for the chronically mentally ill are discussed.     

Adjustment of siblings of handicapped children: a comparison

Compared 55 older siblings (ages 7 1/2 to 15 years) of young handicapped children (ages 1-7 years) with 55 matched siblings of nonhandicapped children. Results of standardized children's assessment scales show that siblings of handicapped children are comparable to siblings of nonhandicapped children in self-concept, behavior problems, and social competence. Differences, however, appear along certain psychological dimensions and great variations exist within each group of siblings. Further, demographic and personal attributes are differentially related to measures of adjustment in different groups of siblings. Implications for research and intervention are drawn.     

Survivors of childhood brain tumors: behavioral,emotional, and social adjustment

This paper reviews the literature on the psychological adjustment and quality of life in children who survive brain tumors. A total of 31 studies were reviewed. Findings are discussed in terms of the rates of general psychological adjustment, internalizing behavior problems, externalizing behavior problems, social competence, correlates or predictors of adjustment, and quality of life among survivors. Although these survivors appear to be at risk for compromised social competence and long-term quality of life, reports in the literature on rates of psychological adjustment in this population vary widely. Limitations in the current literature are discussed including inadequate assessment techniques, lack of appropriate comparison groups, and small sample sizes. Directions for future research are offered.     

Stressors and coping strategies described during hospitalization by chronically ill children

Compared chronically ill with acutely ill/injured children on types of stressors encountered during hospitalization, the coping strategies used to manage these stressors, and the relation between coping strategy use and distress. There was no difference between the acutely ill/injured and chronically ill groups in type of hospital problems selected-illness related (e.g., "my disease is getting worse"), pain related, or hospital related (e.g., lack of privacy). Acutely ill"injured children were more likely to use avoidant-coping strategies (e.g., distraction, self-blame, and wishful thinking) than chronically ill children. Coping strategies did not differ across the different types of hospital problems. However, the greater the distress generated by the problem, the more frequent use of selected-coping strategies (e.g., problem-solving, social support, and wishful thinking). Clinical implications of the findings are discussed.     

Trajectories of peer victimization in elementary school children: Associations with changes in internalizing,externalizing, social competence,and school climate

The current study examines the developmental changes (internalizing and externalizing symptoms, social competence, and experiences of school climate) in children who follow distinct trajectories of peer victimization in a sample of elementary school children across 2 years. Data were from children, and their parents and teachers, in Grades 1–3 followed across five waves. Latent class analyses revealed four distinct victimization trajectory groups characterized by chronically high, increasing, decreasing, or low-stable levels across time. Multilevel analyses showed that children in the chronically high peer victimization group had higher initials levels of internalizing and externalizing symptoms, lower levels of social competence, and poorer experiences of school climate compared to children in the low-stable group. Over time, children in the increasing group had slower rates of increases in social competence than children in the low-stable group and had worsening experiences of school climate compared to children in the low-stable peer victimization group. Findings suggest children who are chronically victimized may be at a developmental disadvantage compared to children who report little or declining peer victimization over time.     

Social Competence in Children with IDDM and Asthma: Child, Teacher, and Parent Reports of Children's Social Adjustment, Social Performance, and Social Skills

Used Cavell's (1990) model of childhood social competence tocompare the social competence in peer relations of 25 children(ages 8–10 years) with insulin-dependent diabetes mellitus(IDDM), 19 children with asthma, and 24 physically healthy children.Children were individually matched for economic status, race,gender, and age. Children, their parents, and their teacherscompleted measures of children's social adjustment, social performance,and social skills in peer relations. Contrary to hypotheses,no differences between the groups of children were noted onany of the measures of social competence. Results are discussedin terms of the resiliency of children's social competence tothese chronic conditions.     

Parent and child reporting of negative life events: discrepancy and agreement across pediatric samples

OBJECTIVE: To examine the consistency in child and parent reporting of child's negative life events across child/pediatric samples. METHODS: A total of 613 child-parent dyads provided independent reports of negative life events. The pairs included three groups consisting of children who were healthy (n = 362), diagnosed with cancer (n = 130), and diagnosed with a chronic illness (juvenile rheumatoid arthritis, diabetes, or cystic fibrosis; n = 121). RESULTS: Children reported significantly more negative life events than their parents reported for them. Additionally, children in the chronically ill group self-reported significantly fewer negative life events than the other groups. However, parents of children with cancer reported significantly more negative life events than the other groups. Although discrepancies exist in all three samples, parents and children in the healthy group were significantly more discrepant than the other groups. CONCLUSIONS: These results suggest that communication of children's life events between parent and child may increase during children's experience of cancer or a chronic illness. However, significant discrepancies remain in child and parent report of negative life events. Because of this, clinicians are encouraged to recognize the strengths and limitations of using multiple reporters in assessing negative life events in children.     

Assessment of Problem Behavior in Visually Handicapped Adolescents

Psychological and social adjustment of visually handicapped youths has not been well studied across different raters and settings. Child, parent, and teacher forms of the Child Behavior Checklist were administered to evaluate problem behavior in the following groups: (a) visually handicapped adolescents in a residential school, (b) mainstreamed visually handicapped adolescents in public schools, and (c) sighted adolescents in public schools. Visually handicapped subjects in the residential placement evinced greater dysfunction than other subjects, as reflected in parent, teacher, and child evaluations. Although little correspondence was found between teachers' and children's scores, a number of significant correlations were obtained between teachers' and parents' ratings of children's behavior. Results are discussed in terms of the need to evaluate the adjustment and functioning of visually handicapped children and adolescents, the potential utility of psychological intervention with a subset of this population, and the importance of additional controlled research with visually handicapped persons.     

Positive effects of a psycho-educational group intervention for children with a chronic disease: first results

OBJECTIVE: To determine the effectiveness of a psycho-educational group intervention for chronically ill children. METHODS: Based on principles from cognitive behavior therapy and information from previous research about children's experiences with coping with a chronic disease we developed an intervention to be used for children with different chronic diseases. The program, called Op Koers (OK), with six sessions for different age groups, was evaluated by standardised and researcher-developed psychological measures. RESULTS: A total of 109 patients participated in the study on the effects of the psycho-educational intervention. Improvements in behavioral-emotional outcomes, social competence, information seeking, relaxation and positive thinking were found both in short and medium term. Additionally, the sessions received positive appraisals. CONCLUSIONS: The program appears to have a significant and positive impact on chronically children. Further research is needed to establish the effects of the intervention. PRACTICE IMPLICATIONS: Beneficial effects can be expected from the implementation of a psycho-educational group intervention for children with heterogeneous chronic health conditions.     

Child and caregiver psychosocial functioning in pediatric immunodeficiency disorders.

BACKGROUND: Children with chronic illness have been found to be at an increased risk of behavioral and emotional difficulties. To date, children with pediatric immunodeficiency disorders (PIDDs) and their families have not been the focus of extensive published psychosocial research. OBJECTIVE: To determine if children with PIDDs and their caregivers have altered psychosocial function and whether the severity of the PIDD was associated with such difficulties. METHODS: Twenty children with PIDDs and 20 children with asthma were recruited for this study. Children and their caregivers completed various psychosocial questionnaire forms. Responses were compared with normative data for the appropriate measure and with other variables. RESULTS: Higher frequencies of children with PIDDs were found to have a number of elevated psychosocial concerns when contrasted with normative data, particularly from parent report. These concerns included depression, anxiety, somatization, social withdrawal, and social skills. The severity of the PIDDs was significantly associated with a number of behavioral adjustment issues, including receiving psychiatric diagnoses and special education services. Although children with PIDDs had significantly more psychiatric diagnoses than did asthmatic children, these groups did not differ significantly on questionnaire scores regarding child or caregiver psychosocial adjustment. CONCLUSIONS: Children with PIDDs have significant behavioral problems. Children receiving intravenous immunoglobulin or immunomodulatory treatments were reported to have more problems than children not receiving them. This study highlights the need for further research in psychosocial functioning of children with PIDDs in an effort to develop interventions to promote their overall adjustment.     

Social competence, externalizing, and internalizing behavioral adjustment from early childhood through early adolescence: developmental cascades

This study used a three-wave longitudinal design to investigate developmental cascades among social competence and externalizing and internalizing behavioral adjustment in a normative sample of 117 children seen at 4, 10, and 14 years. Children, mothers, and teachers provided data. A series of nested path analysis models was used to determine the most parsimonious and plausible cascades across the three constructs over and above their covariation at each age and stability across age. Children with lower social competence at age 4 years exhibited more externalizing and internalizing behaviors at age 10 years and more externalizing behaviors at age 14 years. Children with lower social competence at age 4 years also exhibited more internalizing behaviors at age 10 years and more internalizing behaviors at age 14 years. Children who exhibited more internalizing behaviors at age 4 years exhibited more internalizing behaviors at age 10 years and more externalizing behaviors at age 14 years. These cascades among social competence and behavioral adjustment obtained independent of child intelligence and maternal education and social desirability of responding.     

Brief report: psychosocial adjustment in adolescents with inflammatory bowel disease

BACKGROUND: Inflammatory bowel disease (IBD) is an ideal disease for investigating adolescent adjustment to chronic illness, given its embarrassing, socially limiting, appearance-changing symptoms and adolescent onset. OBJECTIVE: To compare psychosocial adjustment among adolescents with a chronic illness to that of healthy adolescents and examine the role of adolescent disease onset. METHODS: Participants were 50 adolescents with IBD and their parents, and parents of 42 healthy comparison adolescents who completed questionnaires assessing behavioral, emotional, social, and family functioning. RESULTS: Adolescents with IBD were reported to have worse anxious and/or depressed and social problems than healthy adolescents. More adolescents with IBD were reported to have clinically significant social problems. Those diagnosed during adolescence were reported to have significantly worse social competence scores. CONCLUSIONS: Adolescents with a chronic illness such as IBD may be at higher risk for specific psychosocial difficulties than healthy adolescents. Diagnosis of a chronic illness during adolescence may have implications for social functioning.     

Psychosocial adjustment in juvenile arthritis.

Psychosocial adjustment in 102 children with arthritis, ages 4-16, and their families was assessed by parents, who completed the Child Behavior Checklist (CBCL) and Profile of Mood States (POMS). On average, parental distress (POMS) was lower than reference norms. POMS distress was correlated with children's behavioral problems (r = .41) but not with children's social competence (r = .15). General linear models explained 25% of the variance in CBCL behavioral problem scores. Older age was associated with more behavior problems in males, but not females. Disease severity and disease activity were also associated with behavioral problems. Although 27% of the variance in CBCL social competence could be explained, no single predictor variable was especially strong. Poorer social competence was associated with older age and shorter disease duration. Teenagers, especially those with recent onset and those with mild disease activity, may be at increased risk for psychosocial maladjustment.     

Psychological Perspectives in Chronic Childhood Illness

Special perspectives in clinical work, consultation, and researchwith chronically ill children are elaborated. Clinical workwith the chronically ill requires a focus on the impact of illness-relatedstress on the entire family, and a consideration of coping asa process which varies with the stage and severity of physicaldisease. Moreover, the comprehensive care of chronically ill,children takes place in a highly charged interpersonal context.This process can disrupt communication among staff, can raisedifficult ethical questions and uncertainties, and should involvea close dialogue among various professional disciplines. Researchin chronic illness has been dominated by a personality-focusedparadigm associated with a counterproductive focus on differencesbetween chronically ill and physically healthy children anda neglect of factors which contribute to successful coping infamily, school, and social settings. Future research might profitablybe directed toward a study of the chronically ill children'sadjustment in various life contexts, the evaluation of the efficacyof psychosocial interventions, and exploration of how the survivorsof childhood chronic illnesses negotiate key developmental transitions.     

单纯性肥胖儿童社会适应能力,智商与行为问题研究

本文采用儿童适应行为评定量表和韦氏儿童智力量表对１９８例单纯性肥胖儿童进行测试。结果提示单纯性肥胖儿童社会适应能力差。突出表现为独立功能因子能力低，智商与对照组比较差别不显著（Ｐ＞０．０５）。提示应重视和加强对单纯性肥胖儿童有针对性的社会适应行为方面的教育和训练。     

Social Competence Among Children with Central Nervous System-Related Chronic Health Conditions: A Review

Reviewed empirical studies of social competence among childrenwith central nervous system (CNS)-related chronic health conditionspublished since 1975. The overwhelming majority of studies evaluatedsocial competence at the level of social adjustment; the domainsof children's social pegorrnance and social skills were relativelyneglected (Cavell, 1990). Findings are critiqued with respectto conceptualization of social competence among children withCNS conditions and methodological considerations. Directionsfor future research include expanding the conceptualizationof social competence in this population to include social demandsand competencies specifc to children with CNS conditions andutilizing explicit theoretical frameworks that allow for competinghypotheses to be tested.