Pediatric asthma morbidity: the importance of symptom perception and family response to symptoms

OBJECTIVE: To determine whether family response to asthma symptoms mediates the relationship between child symptom perception and morbidity. METHODS: A total of 122 children with asthma, aged between 7 and 17 years (47% females; 25% ethnic minorities), were recruited from three sites. Participants completed a family asthma management interview and 5-6 weeks of symptom perception assessment. RESULTS: Family response to symptoms mediated the relationship between child underestimation of symptoms and asthma morbidity and partially mediated the relationship between accurate symptom perception and morbidity. In contrast, although child overestimation of symptoms and family response to symptoms were independently related to asthma morbidity, a mediational model was not supported. CONCLUSIONS: Our study found support for the role of family response to symptoms in mediating the relationship between child symptom perception and morbidity, particularly with regard to underestimation of symptoms, underscoring the need for behavioral tools to accurately recognize and optimally respond to exacerbations.     

Family Context in Pediatric Psychology: A Transactional Perspective

The degree to which the family is seen as a significant contributorto child health conditions impacts directly on the successfulfunctioning of the pediatric psychologist. A transactional modelof family functioning is proposed for pediatric psychology.Development is considered to be the result of a three-part processthat starts with child behavior that triggers family interpretationthat produces a parental response. Family interpretation ispresented as part of a regulatory system that includes familyparadigms, family stories, and family rituals. Correspondingto the proposed three-part regulation model, three forms ofintervention are discussed: remediation, redefinition, and reeducation.Clinical decision making based on this model is outlined withexamples given from different treatment approaches. Implicationsfor the treatment of families in pediatric psychology are discussed.     

Donor insemination: child development and family functioning in lesbian mother families

Findings are presented of a comparative study investigating the family relationships and the emotional and gender development of children raised in lesbian mother families. A total of 30 lesbian mother families with 4-8 year old children created as a result of donor insemination (DI) were compared with 38 heterosexual families with a DI child and with 30 heterosexual families who had a naturally conceived child. A variety of assessment measures, including a standardized interview and questionnaires from the parents and psychological testing of the child were used to collect the data. The quality of the couples' relationships and the quality of the mother-child interaction did not differ between lesbian mother families and either of the heterosexual family groups. The quality of the interaction between the social mother and the child in lesbian families was superior to that between the father and the child in both groups of heterosexual families. Childrens' own perception of their parents was similar in all family types; the social mother in lesbian families was regarded by the child to be as much a 'parent' as the father in both types of heterosexual families. With regard to their emotional/behavioural development, boys and girls raised in lesbian mother families were well adjusted and their gender role development did not differ from that of children raised in heterosexual families. These results indicate that child and family development in lesbian mother families is similar to that of heterosexual families.      

Family Context in Pediatric Psychology from a Transactional Perspective: Family Rituals and Stories as Example

Reviewed the transactional model as applied to the family contextof pediatric psychology. A three-part sequence of child behavior,parent behaviour, and family interpretation was used to describedevelopmental adaptation and trasitions. It was proposed thatfamilies are regulated by practices that are proximal to thechild's experience and representations thatare more distal tothe child's experience. Family practices are examined throughfamily routines and rituals. Family representations are examinedthrough family stories. Case examples of low birth weight prematureinfants and an adolescent referred for repeated hospitalizationsdue to diabetic ketoacidosis were presented to illustrate themodel. Guidelines for thepracticing pediatric psychologist arepresented to asses family organization through family ritualsand family meaning-making in the telling of family stories.     

Pediatric cancer: Predicting sibling adjustment

Within the context of a coping model, the present study attempted to determine variables associated with good and poor adjustment for siblings (N = 129) of pediatric cancer patients. Family cohesion and adaptability were found to mediate the impact of pediatric cancer on the healthy sibling. Specifically, high levels of family cohesion and adaptability were associated with better adaptation for siblings. Some support also was found for Folkman, Schaefer, and Lazarus' (1979) coping model, as the following variables, proposed by the model, predicted sibling adjustment to pediatric cancer: health/energy/morale, social support, and utilitarian resources. Results from this study stress the need to examine the child in a variety of ecological contexts (e.g., parental and familial functioning; neighborhood/community support).     

Developmental prosopagnosia: A case analysis and treatment study

This paper reports a treatment case study focused on face perception impairments designed for AL, an 8-year-old child with prosopagnosia. AL's prosopagnosia was characterized by deficits at the level of structural encoding-that is, he was unable to achieve normal basic perception of faces. This impairment then impacted on all subsequent aspects of familiar- and unfamiliar-face processing. Detailed assessment of feature processing revealed impairments in perception of facial features with a dissociation between relatively good perception of the mouth feature and poor perception of eye and nose features. Interestingly, results also suggested at least partial internal representation of facial features despite long-standing deficits in perception of these features. A treatment programme focused on training in perception, and analysis of facial features and familiar-face naming was conducted. Treatment resulted in excellent face naming for familiar faces, a decreased reliance on nonfacial cues and a reduction in AL's tendency to misidentify unfamiliar faces as family members.     

A Structural Modeling Approach to the Understanding of Parenting Stress

Tested and cross-validated a multidimensional model of predictors of parenting stress on data from a population-based sample of Swedish mothers (N = 1,081) with children ages 6 months to 3 years. The study was a cross-sectional questionnaire study, focusing on the explanation of variance in parenting stress. Structural equation modeling procedures permitted disentanglement of total, direct, and indirect effects. A Swedish instrument based on parts of the Parent Domain in the Parenting Stress Index was used as a measure of stress. The results provided general support for the proposed model. High workload, low social support, perception of the child as fussy-difficult, negative life events, child caretaking hassles, more children in the family, and high maternal age related directly to more stress. Child irregularity contributed indirectly to mother´s experienced stress. No buffering effects of social support were found. Forty-eight percent of the variance in the parenting stress measure was explained by the model. Implications for interventions were discussed.     

Developmental prosopagnosia: A case analysis and treatment study

This paper reports a treatment case study focused on face perception impairments designed for AL, an 8-year-old child with prosopagnosia. AL's prosopagnosia was characterized by deficits at the level of structural encoding—that is, he was unable to achieve normal basic perception of faces. This impairment then impacted on all subsequent aspects of familiar- and unfamiliar-face processing. Detailed assessment of feature processing revealed impairments in perception of facial features with a dissociation between relatively good perception of the mouth feature and poor perception of eye and nose features. Interestingly, results also suggested at least partial internal representation of facial features despite long-standing deficits in perception of these features. A treatment programme focused on training in perception, and analysis of facial features and familiar-face naming was conducted. Treatment resulted in excellent face naming for familiar faces, a decreased reliance on nonfacial cues and a reduction in AL's tendency to misidentify unfamiliar faces as family members.     

Pain, fatigue, and school functioning in children with cerebral palsy: a path-analytic model

OBJECTIVE: This study tests a model of how pain and fatigue, independently or in combination, relate to school functioning in pediatric cerebral palsy (CP). METHODS: One hundred eighty-nine parents of children with CP completed the Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales and the PedsQL 3.0 Cerebral Palsy Module. Seventy-three children with CP completed the PedsQL. Path-analytic and mediational techniques were utilized to test the a priori model. RESULTS: Data from both parent proxy-report and child self-report were found to have acceptable model fit. Results supported the existence of an indirect relationship between diagnostic subtypes and school functioning that was partially mediated by both pain and fatigue. CONCLUSIONS: Pain and fatigue represent potentially modifiable targets for interventions designed to improve school functioning in children with CP.     

Infant Mental Health: A Model for Service Delivery

A model for the integration of infant mental health services with existing service delivery systems for high-risk infants and families is described. The Infant-Parent Program provides assessment and treatment for infants and families in situations of potential or actual child abuse, neglect, and disorders of attachment or socioemotional functioning. In addition, the program has established a collaborative network with pediatric care, child protective services, and community agencies serving infants and families at risk. The methods of assessment and treatment and the interface with other child services are described.     

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.     

Pediatric Psychology: Perspectives and Training Implications

With a clinical case as illustration, the range of clinicaland teaching demands made upon the pediatric psychologist isexplored. The roles of the pediatric psychologist in a medicalsetting as a data-gatherer, liaison-teacher, and "process consultant"among the professional disciplines engaged in child health careare described. The implications of these role demands for trainingin pediatric psychology are examined. It is proposed that preparationfor these functions requires that the pediatric psychologisthave basic training in clinical child psychology, child development,and in a broad range of psychometric assessment techniques.The ability to utilize consultation models of differing complexitiesis a necessary component in such training. In addition, thepediatric psychologist will require a solid background in research.This emerging model of practice, when compared to the traditional"practitioner-scientist" model, is described as the "practitioner-consultant-scientist"model.     

Pediatric pain: prevalence,assessment, and management in a teaching hospital

The goal of this study was to examine the prevalence, assessment and management of pediatric pain in a public teaching hospital. The study sample consisted of 121 inpatients (70 infants, 36 children, and 15 adolescents), their families, 40 physicians, and 43 nurses. All participants were interviewed except infants and children who could not communicate due to their clinical status. The interview included open-ended questions concerning the inpatients'' pain symptoms during the 24 h preceding data collection, as well as pain assessment and pharmacological/non-pharmacological management of pain. The data were obtained from 100% of the eligible inpatients. Thirty-four children/adolescents (28%) answered the questionnaire and for the other 72% (unable to communicate), the family/health professional caregivers reported pain. Among these 34 persons, 20 children/adolescents reported pain, 68% of whom reported that they received pharmacological intervention for pain relief. Eighty-two family caregivers were available on the day of data collection. Of these, 40 family caregivers (49%) had observed their child''s pain response. In addition, 74% reported that the inpatients received pharmacological management. Physicians reported that only 38% of the inpatients exhibited pain signs, which were predominantly acute pain detected during clinical procedures. They reported that 66% of patients received pharmacological intervention. The nurses reported pain signs in 50% of the inpatients, which were detected during clinical procedures. The nurses reported that pain was managed in 78% of inpatients by using pharmacological and/or non-pharmacological interventions. The findings provide evidence of the high prevalence of pain in pediatric inpatients and the under-recognition of pain by health professionals.     

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.     

A mutation in the nerve growth factor beta gene (NGFB) causes loss of pain perception

Identification of genes associated with pain insensitivity syndromes can increase the understanding of the pathways involved in pain and contribute to the understanding of how sensory pathways relate to other neurological functions. In this report we describe the mapping and identification of the gene responsible for loss of deep pain perception in a large family from northern Sweden. The loss of pain perception in this family is characterized by impairment in the sensing of deep pain and temperature but with normal mental abilities and with most other neurological responses intact. A severe reduction of unmyelinated nerve fibers and a moderate loss of thin myelinated nerve fibers are observed in the patients. Thus the cases in this study fall into the class of patients with loss of pain perception with underlying peripheral neuropathy. Clinically they best fit into HSAN V. Using a model of recessive inheritance we identified an 8.3 Mb region on chromosome 1p11.2-p13.2 shared by the affected individuals in the family. Analysis of functional candidate genes in the disease critical region revealed a mutation in the coding region of the nerve growth-factor beta (NGFB) gene specific for the disease haplotype. This NGF mutation seems to separate the effects of NGF involved in development of central nervous system functions such as mental abilities, from those involved in peripheral pain pathways. This mutation could therefore potentially provide an important tool to study different roles of NGF, and of pain control.     

Assessment of the effect of physical child abuse within an ecological framework: Measurement issues

The definition and classification of maltreatment and the assessment of its effects have serious implications for child protection and intervention. The present study seeks to clarify a number of interrelated issues involved in the assessment of the effects of child maltreatment.The study tested, within the context of an ecological model, the relative utility of two sources of information about child abuse, Child Protective Services records and parent interviews, for their ability to account for child functioning. The model is based on an ecological approach that places risk factors along a proximal/distal continuum with respect to the expected impact on the child. Risk for poor child functioning was found to increase as increasingly distal as well as proximal risk factors were included. A sample of 100 physically abused schoolchildren, ages 9–11, and their families was obtained from a pool of consecutive entries onto the New York State Register for Child Abuse. Information about child physical abuse and family functioning was obtained from NYS Child Protective Services records and a structured parent interview. Child functioning was measured by the Child Behavior Checklist (Achenbach, 1991a) and the Teacher Rating Form (Achenbach, 1991b). The findings suggest that for the purpose of evaluating risk factors for poor outcome in physically abused children, with the ultimate aim of improving protection and intervention, it is critical to gather information systematically from multiple sources about the abuse and the family context in which it occurs because both are predictive of child functioning, and different information about both is contributed by the different sources. © 2001 John Wiley & Sons, Inc.     

The role of the family in child and adolescent posttraumatic stress following attendance at an emergency department

OBJECTIVE: To evaluate the role of family factors in posttraumatic stress symptomatology (PTSS) in children and adolescents who have attended an emergency department following assaults or motor vehicle accident. METHODS: Children and their parents completed self-report questionnaires and semistructured interviews relating to their psychopathology and cognitive styles at 2-4 weeks and 6 months after trauma. RESULTS: Parental depression was correlated with child PTSS at each assessment point. Less consistent findings were observed for family functioning. Parental endorsement of worry was a correlate of child PTSS at each assessment and a mediator between parental depression and child PTSS. CONCLUSIONS: A role for family factors, in particular parental depression and parental endorsement of worry, in the development of child PTSS is supported. Weaknesses of the study are discussed, and suggestions for future research are given.     

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.