Suicide-bereaved children and adolescents: a controlled longitudinal examination.

OBJECTIVE: The current study examined emotional and behavioral sequelae in children who have experienced parental suicide by completing a secondary analysis of data from the Grief Research Study, a longitudinal study of childhood bereavement. METHOD: Twenty-six suicide-bereaved (SB) children, aged 5 to 17 years, were compared with 332 children bereaved from parental death not caused by suicide (NSB) in interviews 1, 6, 13, and 25 months after the death. Children's emotional reactions to the death, psychiatric symptomatology, and psychosocial functioning after the parent's death were determined. RESULTS: Grief emotions were common in both groups. SB children were more likely to experience anxiety, anger, and shame than NSB children. SB children were more likely to have preexisting behavioral problems and more behavioral and anxiety symptoms throughout the first 2 years compared with NSB children. Indices of depression, suicidality, and psychosocial functioning differed minimally between groups. CONCLUSIONS: SB children experience some "common" elements of bereavement. In addition, they demonstrate some lifetime risk factors as well as subsequent pathology that suggests a negative behavioral trajectory. As these cohorts have not yet passed through the age of risk, long-term follow-up is critical.     

Parental cancer--parents ways of coping, family functioning, and psychosocial adjustment of dependent children

Children exposed to parental cancer have an increased risk of mental health problems. However, the parental illness itself and its features do not predict children's psychological adjustment. Parent- and family-related factors are more predictive for children's well-being and the incidence of psychopathological symptoms, respectively. This study focuses on parental ways of coping with illness from both, the ill and healthy parent's perspective, and the relationship with family functioning and children's adjustment. Results show a significant impact of parental coping styles on children's health-related quality of life and psychopathological symptoms and, furthermore, that this relationship is mediated by aspects of family functioning. This study support the importance of family systems approaches. Implications for further studies and practical issues are discussed.     

Parental problem drinking and adolescent externalizing behaviors: The mediating role of family functioning

This study explored relationships among parental problem drinking, family functioning, and adolescent externalizing behaviors. The unique effects of maternal and paternal drinking were examined separately for girls and boys. The sample included 14–19 year old U.S. adolescents (M_age = 16.15; SD = .75; 52.5% female) and their parents. Participants completed surveys in the spring of 2007 and 2008. Structural equation modeling was used to conduct path analysis models. Results showed the distinctive and adverse effects of parental problem drinking on adolescent alcohol use, drug use, rule breaking, and aggressive behavior over time. Findings also highlighted the indirect and mediating roles of family functioning. For both girls and boys, family cohesion mediated the relationship between parental problem drinking and adolescent externalizing behaviors. For girls, adolescent–father communication predicted increased externalizing behaviors over time. These findings draw attention to the importance of exploring adolescent and parent gender when examining parental problem drinking, family functioning, and externalizing behaviors.     

Obsessive-compulsive disorder in children and adolescents: A study of phenomenology and family functioning in 20 consecutive Danish cases

Twenty child and adolescent patients with obsessive-compulsive disorder (OCD) were compared with 20 age- and sex-matched comparison patients regarding phenomenology and family functioning. The test-results indicated a possibly limited capacity for social interaction in a subgroup of the OCD patients. Depression and suicidal thoughts were commonly encountered in children with OCD. The families of OCD children seemed to differ from comparison families only with regard to mothers' view on adaptability. No specific type of OCD family was described.

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Zusammenfassung 20 Kinder und Jugendliche mit Zwangsstörungen wurden mit 20 nach Alter und Geschlecht parallelisierten Kontrollpatienten im Hinblick auf PhÄnomenologie und Familienfunktion verglichen. Die Testergebnisse deuten auf eine möglicherweise eingeschrÄnkte KapazitÄt für soziale Interaktion in einer Untergruppe der Patienten mit Zwangsstörungen. Depressive und suizidale Gedanken fanden sich hÄufig bei den Kindern mit Zwangsstörungen. Die Familien von Kindern mit Zwangsstörungen unterschieden sich von Vergleichsfamilien lediglich im Hinblick auf die mütterliche Beurteilung der AdaptationsfÄhigkeit. Es wurde kein spezifischer Typ einer Zwangsfamilie beschrieben.

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Résumé 20 patients enfants et adolescents souffrant de troubles obsessifs-compulsifs (TOC) ont été comparés avec un groupe de patients appariés selon le sexe et l'âge (20 ans) en ce qui concerne la phénoménologie et le fonctionnement familial. Les résultats des tests ont montré la capacité limitée pour l'interaction sociale dans le sous groupe des patients TOC. La dépression et des pensées suicidaires furent recontrées communément chez les enfants avec TOC. Les familles des enfants TOC ont semblé différer des famille témoin, seulement en ce qui concerne la vision des mères sur l'adaptabilité. Aucun type spécifique de famille TOC a été décrit.

     

Psychiatric and family functioning in children with leukemia and their parents.

The present study reports data from a cross-sectional investigation of the psychiatric and psychosocial functioning of 55 children diagnosed with acute lymphocytic leukemia and their families at three points in time: diagnosis (newly diagnosed), 1 year postdiagnosis, and 1 year after the completion of chemotherapy (off-therapy). Results reveal minimal psychopathology in these children and their parents based on self- and informant-reports and structured diagnostic interviews. These families appear to be functioning adequately and report more family cohesiveness and marital satisfaction after chemotherapy was completed. Coping strategies commonly used by children and their parents include problem-solving, a positive outlook, and good communication. Implications for psychiatric consultation are presented.     

Psychological functioning in children and adolescents with Sturge-Weber syndrome

Previous studies of individuals with Sturge-Weber syndrome have focused on the medical aspects of this syndrome, but little has been known about the affective and behavioral correlates. We collected psychological and medical data from parents and teachers for 79 children and adolescents with Sturge-Weber syndrome and a group of their siblings. We also obtained the results of intellectual assessment for a subset of the Sturge-Weber syndrome group. The young people with Sturge-Weber syndrome exhibited more problems than the group of siblings across a number of behavioral domains: intellectual/academic, social skills, mood, and compliance. Those children most at risk for psychological problems were those with lower levels of intellectual functioning, those with seizure disorders, and those with more frequent seizures. Larger port-wine stains were also associated with an increase in mood and social problems but only for older children. Increased age was not associated with lower levels of intellectual or academic functioning, but mood and social problems were more common in older children.     

Fronto-limbic functioning in children and adolescents with and without autism

We used neuropsychological tasks to investigate integrity of brain circuits linking orbitofrontal cortex and amygdala (orbitofrontal-amygdala), and dorsolateral prefrontal cortex and hippocampus (dorsolateral prefrontal-hippocampus), in 138 individuals aged 7-18 years, with and without autism. We predicted that performance on orbitofrontal-amygdala tasks would be poorer in the Autism group compared to the Non-Autism group regardless of intellectual level (verbal mental age, VMA) and that performance on dorsolateral prefrontal-hippocampus tasks would be associated primarily with intellectual level. Predicted differences between Autism and Non-Autism groups on orbitofrontal-amygdala tasks were present but greater in individuals with higher VMA. On dorsolateral prefrontal-hippocampus tasks, poorer performance by the Autism compared to the Non-Autism group was found at all VMA levels. Group differences suggest both brain circuits are impaired in autism, but performance on all tasks is also associated with intellectual level.     

Language and social functioning in children and adolescents with epilepsy

Individuals with epilepsy have difficulties with social function that are not adequately accounted for by seizure severity or frequency. This study examined the relationship between language ability and social functioning in 193 children with epilepsy over a period of 36 months following their first recognized seizure. The findings show that children with persistent seizures have poorer language function, even at the onset of their seizures, than do their healthy siblings, children with no recurrent seizures, and children with recurrent but not persistent seizures. They continue to demonstrate poorer language function 36 months later. This poor language function is associated with declining social competence. Intervention aimed at improving social competence should include consideration of potential language deficits that accompany epilepsy and social difficulty.     

Focal family therapy outcome study. I: Patient and family functioning

This pilot study compared the efficacy of two models of family therapy plus medication in the treatment of ten schizophrenic patients previously considered poor responders to neuroleptics alone. Focal Family Therapy (FFT), a limited psychodynamic model, was compared with Supportive Management Counselling (SMC), an educative, problem-solving approach. Family treatment was begun during admission to hospital and continued for up to six months post-discharge. Patient and family measures were administered on assessment, termination, and at three, six and 12 month follow-up interviews. Our data suggest that patients in both groups improved significantly following treatment on measures of social functioning and community tenure. The average increase in amount of time out of hospital was a full year, compared to previous rates. Patients receiving FFT demonstrated significantly greater improvement in symptoms, compared to patients in the SMC group. On average, families scored in the normal range on the family functioning measure at assessment and upon termination of treatment.     

Physically manifested illness in children and adolescents. A biobehavioral family approach.

This article presents a family systems approach to the assessment and treatment of children and adolescents with physically manifested illness. A biobehavioral continuum of psychologically and physically manifested disease is offered to replace the false dichotomy of organic versus psychological illness. The Biobehavioral Family Model, an empirically validated model of the mutual influence of family relational patterns and childhood illness, organizes the treatment approach. The Family Process Assessment Protocol provides a method of diagnosing the child's illness in the context of family relational functioning. Two cases, a child with conversion disorder and a child with asthma, illustrate this approach. Additional family systems approaches are referenced in a table with citations.     

Obsessive compulsive disorder in children and adolescents: phenomenology and family history

Phenomenology and family history in 21 clinically referred children and adolescents with obsessive compulsive disorder are described. Each child and family participated in a standard clinical psychiatric assessment. The most frequently reported symptoms were repeating rituals, washing, ordering and arranging, checking, and contamination concerns. Controlling behaviors involving other family members were seen in 57% of the patients. Associated psychopathology was common: 38% received an anxiety disorder diagnosis; 29% received a mood disorder diagnosis; tics were observed in 24%. Fifteen (71%) of the children had a parent with either obsessive compulsive disorder (N = 4) or obsessive-compulsive symptoms (N = 11). The clinical and research implications of these findings are discussed.     

Parental and family factors for attention-deficit hyperactivity disorder in Taiwanese children

OBJECTIVE: The present study aimed to examine the association between attention-deficit-hyperactivity disorder (ADHD) and maternal psychological distress, parenting style and perceived family support, and the child's interaction with parents and behavioural problems at home in Taiwan. METHODS: The sample included 375 medicated pediatric patients with DSM-IV ADHD, and 750 school controls selected based on the age and gender structures of the ADHD group. Mothers reported on the Chinese Health Questionnaire, the Chinese versions of the Parental Bonding Instrument, the Family Adaptation, Partnership, Growth, Affection, and Resolve, and the Home Behaviours of the Social Adjustment Inventory for Children and Adolescents. RESULTS: Mothers of children with ADHD reported greater psychological distress and perceived less support from their families than did mothers of controls. Moreover, mothers of children with ADHD were less affectionate and more overprotective and controlling toward their children than were mothers of controls. This difference was more apparent in boys than in girls. Children with ADHD were less likely to interact with their parents, yet demonstrated more severe behavioural problems at home. CONCLUSIONS: Although the Taiwanese children with ADHD were under treatment with methylphenidate, they and their families still encountered a variety of difficulties in interaction, support, and communication with each other. Therefore, the parental approach should be integrated into the medication treatment for ADHD in Taiwan.     

Neuropsychological functioning in adolescents with diabetes.

Investigated the relationship between disease variables, neuropsychological performance, and psychosocial status in adolescents with Insulin Dependent Diabetes Mellitus (IDDM). The study group consisted of 85 adolescents, aged 14 to 16.5 years who had been diabetic for longer than 12 months. Parameters of both recent and long-term metabolic control were determined, including diabetic incidents such as severe hypoglycemia or ketoacidosis. The mothers completed standardised measures of adolescent adjustment, and the adolescents provided self-reports of psychosocial status. Neuropsychological functioning was evaluated with standardised tests of verbal and nonverbal intelligence, memory and new learning, visuo-graphic skills, mental flexibility, and problem-solving ability. Using retrospective accounts of disease history, there was no relationship between neuropsychological functioning and variables such as age of onset, chronic poor control, or major metabolic crises. The findings emphasise the need for a long-term, prospective study of a cohort of diabetic children from the time of diagnosis to clarify causal relationships, if any, between illness variables, neuropsychological performance, and psychosocial factors.     

Taxonomy of family life styles: II. Homes with slow-learning children

A battery of instruments dealing with family social environment and family and child characteristics and behavior was administered to 218 families with slow-learning children in EMR and educably handicapped programs. Cluster analysis was performed on family environment variables. Seven unique family clusters, each with distinctive patterns of characteristics, were identified: child-oriented, cohesive; learning-oriented, high residential quality; low disclosure, unharmonious; disadvantaged, noncohesive; achievement-oriented, low residential quality; expression-oriented with few sociocultural interests; and outerdirected with little achievement-orientation. Comparisons among the clusters and ethnographic/interviewer observations revealed significant differences in other family and child characteristics and behavior. Development of a classification system for families with retarded children was discussed.     

ADHD and family functioning

Most of what is known about attention-deficit/hyperactivity disorder (ADHD) and family functioning has been derived from studies that used children with ADHD as the starting point for their investigations. Such research has consistently reported that parent- child interactions are often characterized by a high degree of negativity and conflict. Also commonly found in such families are the use of less effective parenting strategies, elevated levels of parenting stress, higher rates of parental depression and other types of psychological distress, lower levels of marital satisfaction, and increased sibling conflict. Although a great deal of progress has been made, many questions remain as to how ADHD plays out in families. Several research design issues have limited our understanding of this topic, including an absence of empirical attention to underlying conceptual processes that may serve to explain the link between ADHD and various family outcomes. Implications for future research and clinical practice are discussed.     

Cognitive and social functioning in children and adolescents after the removal of craniopharyngioma

Purpose  

The aim of this study is to assess cognitive, emotional and social functioning in children and adolescents after the removal of craniopharyngioma.     

Neuropsychological aspects of cognitive functioning in epileptic children and adolescents treated with lamotrigine

The aim of our study was to examine the influence of long term lamotrigine (LTG) add-on therapy on higher nervous function in patients at the developmental age with epilepsy and to analyse the correlation between changes in EEG and cognitive parameters as a consequence of applying LTG in bi- or polytherapy with conventional antiepileptic drugs (AEDs). There were 25 patients (pts), 8-18 years of age with epilepsy stated as "difficult to treat" with partial (12 pts) and generalised (13 pts) seizures. The frequency of seizures was estimated as one or more per month last year (before LTG treatment). The mean age of the patients who had the first seizure was 4.7 yrs. Doses of LTG were adjusted individually (depending on conventional AEDs) according to the recommendation of the producer. The serum levels of conventional AEDs were checked during LTG therapy. Psychological examination was administered three times: before introduction of LTG (as add-on drug) to the therapy, after 3- and after 16 months of the treatment. We measured the level of intelligence, short-term memory, attention, visuomotor integration and abilities of learning. EEG was recorded by Ceegraph (Biologic, USA) after 3 and 12 months of LTG treatment. After the treatment no statistically significant differences in Intelligence Quotient (IQ): global, verbal, nonverbal were noticed. Statistical significance has been stated in parameters of short-term memory. The number of seizures decreased more than 50% in 12 pts. EEG records improved in 6 pts (normalisation of background activity), minimising of epileptform discharges has been noticed in 3 pts. LTG introduced into polytherapy of epilepsy in children and adolescents modified EEG and had minimal influence on cognitive functions.