Psychological Correlates of Quality of Life in Children with Cerebral Palsy

Psychosocial outcomes have come to the front as a main concern for individuals with Cerebral Palsy (CP), promoting the need to understand the quality of life experienced by children and adolescents diagnosed with CP. As a result, the current study examined the relationships among quality of life in children with CP, the psychological symptoms and parenting characteristics of the parents of these children, and the emotional and behavioral functioning of these children. Results of this study suggested that these variables are related in interesting ways. Further, parenting stress, parents’ depressive symptoms, and children’s internalizing behavior problems were significant predictors of the quality of life experienced by the children in this sample. Thus, the direct benefits from optimizing parents’ mental health as well as that of their children may prove to be an important intervention in helping to improve the quality of life of children who have been diagnosed with CP.     

Distorted Cognitive Processing in Youth: The Structure of Negative Cognitive Errors and Their Associations with Anxiety

The Children’s Negative Cognitive Error Questionnaire (CNCEQ) is commonly used to measure four errors in young people’s thinking, but research has failed to support the factorial validity of the measure. The primary objective of the present study was to examine the factor structure of a refined and extended version of the CNCEQ. Revision of the CNCEQ involved the exclusion of items rated as contaminated, and the addition of items measuring cognitive errors closely associated with anxiety (‘threat conclusion’ and ‘underestimation of the ability to cope’). A secondary objective was to determine the relation between the negative cognitive errors and anxiety. Principal component analysis of data from 481 children and adolescents indicated five distinct negative cognitive error subscales labeled ‘underestimation of the ability to cope’, ‘personalizing without mind reading’, ‘selective abstraction’, ‘overgeneralizing’, and ‘mind reading’ which contained the new ‘threat conclusion’ items. Confirmatory factor analysis in an independent sample of 295 children and adolescents yielded further support for the five-factor solution. All cognitive errors except ‘selective abstraction’ were correlated with anxiety. Multiple regression analysis indicated that the strongest predictors of anxiety were the two subscales containing new items, namely ‘underestimation of the ability to cope’ and ‘mind reading’. The results are discussed with respect to further development of the instrument so as to advance the assessment of distorted cognitive processing in young people with internalizing symptoms.     

Direct Parenting Methods to Facilitate the Social Functioning of Children with Cerebral Palsy

Studies with typically developing children have supported the efficacy of parents’ direct efforts to facilitate social development. In this study, it was hypothesized that use of direct parenting methods would be associated with aspects of social functioning of children with cerebral palsy. Study participants were 60 children with cerebral palsy, ages 5–12 (M = 8.75; SD = 1.82), 62.3% male and their parents or guardians. Direct parenting methods were assessed with a modified empirically validated survey strategy. In contrast with findings from the typically developing population, there were no significant associations between direct parenting methods and children’s social functioning. Findings suggest the need to develop alternative models of multidimensional influences on social development of children with cerebral palsy.     

Music��s relevance for pediatric cancer patients: a constructivist and mosaic research approach

Purpose  

Music is important in most children’s lives. To advance efficacious pediatric supportive care, it is necessary to understand young cancer patients’ thoughts about music. Concern about inviting unwell children to express opinions has resulted in scant research examining their views. “Mosaic” research examines children’s experiences through investigating multiple perspectives which inform a “co-constructed meaning.” This study examines pediatric cancer patients’ and their parents’ perspectives about music and music therapy’s role in the children’s lives.     

Resounding attachment: cancer inpatients’ song lyrics for their children in music therapy

Goals of work  Scant attention focuses on supporting parent–child communication during the parents’ cancer hospitalizations. Parents may struggle to remain emotionally available. Caregiver absences may threaten secure attachment relationships with infants and elicit problems amongst older children. Music therapists help many parents with cancer to compose songs for their children. Their lyric analysis may provide insight into song writing’s communicative and therapeutic potential. Materials and methods  Two song lyric groups were comparatively analyzed (based on grounded theory). One group included 19 songs written by 12 patients with the first author. Another included 16 songs written by 15 patients with three music therapists (including two authors), which were previously published or recorded for the public. Songs were composed by 20 mothers and seven fathers for at least 46 offspring. All parents had hematological or metastatic diseases. Qualitative inter-rater reliability was integrated. Main results  Comparable lyrical ideas in the two parent song groups included: love; memories; yearning for children; metaphysical presence (now and afterlife); loss and grief; the meaning and helpfulness of the children in their lives; hopes for and compliments about their children; encouragement; requests; personal reflections; existential beliefs; and suggestions about to whom the children can turn. Conclusions  Parents’ song lyric messages may support their children during the parents’ illnesses and through the children’s developmental transitions and possible bereavement. Some parents use song writing for catharsis and to encourage their children’s continuing attachment with them after death. Through promoting parent–child connectedness and emotional expression, therapeutic song writing can be a valuable oncologic supportive care modality.

Complementary and alternative medicines for use in supportive care in pediatric cancer

Introduction Complementary and alternative medical practices (CAM) are being used by increasing numbers of children with cancer. Discussion Recent surveys report CAM use prevalence rates of 24–90% in children with cancer. Interest in supporting children through the side effects or stress of conventional treatment has been described as one of the major motivating factors for the use of CAM therapies. Research is difficult secondary to the complexity of the therapies and lack of standardization. However, several research studies investigating CAM therapies for supportive care in children with cancer are ongoing. Information on several studies in progress through the Children’s Oncology Group and other institutions will be reviewed. Conclusion The progress made in the development of these studies demonstrates that CAM therapies can be investigated for their supportive care roles in the therapy of children with cancer. Presented as an invited lecture at the MASCC/ISOO 18th International Symposium of Supportive Care in Cancer in Toronto, Canada, June 2006.     

Children’s Attitudes Toward Their Diabetes,Locus of Control,and HbA1c Levels

Children’s health attitudes and whether they are able to exert control over their chronic illness is related to disease management. For the current study, we assessed illness representations, general attitude toward having diabetes and health locus of control for 65 children with Type 1 Diabetes Mellitus (T1DM) and how these were related to parent report of child HbA1c levels. Results of our regression model indicated that internal locus of control moderated the relationship between illness attitude and HbA1c levels. Specifically, children with a high internal locus of control had lower (better) HbA1c levels. Additionally, children with a low internal locus of control for their diabetes and positive attitudes demonstrated lower HbA1c levels, whereas children with a low internal locus of control and negative attitudes had higher HbA1c levels. The generalizability of study findings is limited because the sample was mostly Caucasian youth reporting a fairly high locus of control. Future research is needed to determine whether changes in children’s perceptions of control over illness correspond to long-term improvements in health outcomes.     

Coping, Negative Cognitive Style and Depressive Symptoms in Children of Depressed Parents

Coping and negative cognitive style were studied in relation to depressive symptoms in children at risk for depression. In a sample of 165 children (ages 9–15) of depressed parents, the main and interaction effects of coping and negative cognitive style were examined in association with children’s depressive symptoms measured by parent and child report on questionnaires and diagnostic interviews. Negative cognitive style was related to three types of coping (primary control, secondary control, and disengagement). Furthermore, coping and negative cognitive style made independent contributions to depressive symptoms. Little support emerged for interactive effects on depressive symptoms. Implications for future research with this high-risk population of children are considered.     

A non-randomized comparison of mindfulness-based stress reduction and healing arts programs for facilitating post-traumatic growth and spirituality in cancer outpatients

Goals of work The aim of this study was to compare a mindfulness-based stress reduction (MBSR) program and a healing through the creative arts (HA) program on measures of post-traumatic growth (PTGI-R), spirituality (FACIT-Sp), stress (SOSI), and mood disturbance (POMS) in cancer patients. Materials and methods A sample of cancer outpatients (MBSR, n = 60; HA, n = 44) with a variety of diagnoses chose to attend either an 8-week MBSR program or a 6-week HA program and were assessed pre- and post-intervention. The majority of participants were female, married, and had breast cancer. Main results Repeated measures analysis of variance indicated that participants in both groups improved significantly over time on overall post-traumatic growth (p = 0.015). Participants in the MBSR group improved on measures of spirituality more than those in the HA group (p = 0.029). Participants in the MBSR group also showed more improvement than those in HA on measures of anxiety (POMS, p = 0.038), anger (POMS, p = 0.004), overall stress symptoms (SOSI, p = 0.041), and mood disturbance (POMS, p = 0.023). Several main effects of time were also observed in both groups. These results were found despite attrition in both groups. Conclusions Both programs may improve facilitation of positive growth after traumatic life experiences for those who choose to participate. MBSR may be more helpful than HA in enhancing spirituality and reducing stress, depression, and anger.     

Helping mothers cope with a critically ill child: A pilot test of the COPE intervention

The purpose of this study was to pilot test the effects of a theoretically driven intervention program (COPE = Creating Opportunities for Parent Empowerment) on the coping outcomes of critically ill children and their mothers. Thirty mothers of 1- to 6-year-old children in a pediatric intensive care unit (PICU) were randomly assigned to receive COPE or a comparison program. Mothers who received the COPE program: (a) provided more support to their children during intrusive procedures; (b) provided more emotional support to their children; (c) reported less negative mood state and less parental stress related to their children's emotions and behaviors; and (d) reported fewer post-traumatic stress symptoms and less parental role change four weeks following hospitalization. Results indicate the need to educate parents regarding their children's responses as they recover from critical illness and how they can assist their children in coping with the stressful experience. © 1997 John Wiley & Sons, Inc. Res Nurs Health 20: 3–14, 1997     

Mothers’ Perceptions Regarding the Social Competence of Preschool Children with Mental Retardation

This study explored mothers’ perceptions of the social competence of preschool children with mental retardation. Fifty-four mothers completed a 42 item questionnaire regarding children’s social competence. Children’s cognitive and communicative developmental ages were determined using the Battelle Developmental Inventory. Data are presented as percentage of mothers providing different response options. Response differences were examined using the Test for Significance of Difference Between Two Proportions. Association among developmental ages and mothers’ responses were analyzed using Pearson Product Moment Correlations. Mothers’ perceptions of their children’s social opportunities and skills were generally positive including interacting with children with and without disabilities, initiating play interactions with other children, responding positively to initiations by other children, playing with others for more than brief amounts of time, and demonstrating relatively sophisticated social play skills. Associations among developmental ages and selected maternal responses support the notion that mothers are accurate observers of their children’s social activity and developmental ability. Results are discussed relative to the extant literature.     

Exploring Modeling-based Hypotheses in Preadolescent Girls’ and Boys’ Cognitive Vulnerability to Depression

In a community sample of 163 children (ages 9–12) and their mothers, we explored modeling-based hypotheses that may underlie how cognitive vulnerability components to depression (negative cognitive triad and negative attributional style) are transmitted from mother to preadolescent children. Results found mothers’ negative cognitive triad partially mediated the relation between mothers’ depressive symptoms and children’s negative cognitive triad. Moreover, mothers’ negative cognitive triad was uniquely and significantly related to children’s negative cognitive triad, after statistically adjusting for the effects of mothers’ depressive and anxiety symptoms in our full sample, as well as in a subsample of our mothers with more depressive symptoms. Most importantly, in our full sample and our subsamples with more depressive symptoms, the amount of time that mothers reported spending with their children moderated the relation between mothers’ and children’s negative cognitive triad, with significantly stronger relations found between mothers’ and children’s negative cognitive triad when mothers reported spending higher in comparison to lower amounts of time spent together. Our modeling-based hypotheses with respect to attributional style, and child sex, were not supported. Implications of our findings for further understanding of family-based modeling mechanisms of risk, and directions for future research, are highlighted. This work is based, in part, on the Masters-level research project of Tabatha Blount, conducted under the direction of Catherine Epkins.     

Child and Parent Variables Associated with Texture Problems in Children’s Feeding

Despite prevalence of texture selectivity among children with feeding problems, no research has developed a psychometrically tested measure of Texture Problems or examined variables associated with them. The present study develops a simple measure of Texture Problems in children’s feeding behavior, examines associations between Texture Problems and outcome measures of clinical importance (such as children’s weight, diet variety, and mealtime behavior problems), and identifies child and parent variables associated with increased risk for Texture Problems. Participants included 248 children from a hospital feeding clinic (163 boys, 85 girls; mean age = 48.9 months; 50 with autism, 96 with other special needs, 102 with no special needs). Parents completed questionnaires to report their children’s demographic and medical information, ability to consume foods of various textures, variety of foods consumed, mealtime behavior problems and the parent’s mealtime actions. Factor analysis identified a new four-item measure of Texture Problems, which was associated with heavier weight status, reduced diet variety, less disruptive behavior, a decreased desire to drink, more food refusal and limited variety. Children’s demographic and medical variables associated with texture problems were younger age, male, and prematurity. Parents of children with more texture problems often served their children special meals other than shared family meals.     

Protocol for the MATCH study (Mindfulness and Tai Chi for cancer health): A preference-based multi-site randomized comparative effectiveness trial (CET) of Mindfulness-Based Cancer Recovery (MBCR) vs. Tai Chi/Qigong (TCQ) for cancer survivors

PurposeA growing number of cancer survivors suffer high levels of distress, depression and stress, as well as sleep disturbance, pain and fatigue. Two different mind-body interventions helpful for treating these problems are Mindfulness-Based Cancer Recovery (MBCR) and Tai Chi/Qigong (TCQ). However, while both interventions show efficacy compared to usual care, they have never been evaluated in the same study or directly compared. This study will be the first to incorporate innovative design features including patient choice while evaluating two interventions to treat distressed cancer survivors. It will also allow for secondary analyses of which program best targets specific symptoms in particular groups of survivors, based on preferences and baseline characteristics.Methods and significanceThe design is a preference-based multi-site randomized comparative effectiveness trial. Participants (N = 600) with a preference for either MBCR or TCQ will receive their preferred intervention; while those without a preference will be randomized into either intervention. Further, within the preference and non-preference groups, participants will be randomized into immediate intervention or wait-list control. Total mood disturbance on the Profile of mood states (POMS) post-intervention is the primary outcome. Other measures taken pre- and post-intervention and at 6-month follow-up include quality of life, psychological functioning, cancer-related symptoms and physical functioning. Exploratory analyses investigate biomarkers (cortisol, cytokines, blood pressure/Heart Rate Variability, telomere length, gene expression), which may uncover potentially important effects on key biological regulatory and antineoplastic functions. Health economic measures will determine potential savings to the health system.     

The Neuropsychological and Neurobehavioral Consequences of ADHD Comorbid with LD and Otitis Media

The purpose of this study was to identify a possible subtype of attention deficit hyperactivity disorder (ADHD) comorbid with learning disabilities (LD) and otitis media (OM). Data collected from children with ADHD, LD and otitis media included: Wechsler Intelligence Scale for Children—III, Intermediate Visual and Auditory continuous performance test, neurobehavioral rating, neuropsychological testing, neurophysiological function, and school grades. Findings included deficits in: auditory processing, interpersonal relations, increased social stress, external locus of control, and academic impairment. Parents rated ADHD as mild despite high theta to beta ratios along with neuropsychological dysfunction. Increased severity of ADHD and LD was associated with OM. There may be a unique ADHD subtype with phonological processing deficits. Implications for auditory vs. visual information transmission are discussed. The data collected was obtained from the author’s dissertation completed at The Union Institute & University.     

Evaluation of a Demystification Workshop for Children with ADHD

The ADHD Demystification Workshop was designed to provide children in grades two to seven with accurate information about ADHD and its treatments. The main goal was to evaluate the workshop’s effectiveness in increasing children’s knowledge about ADHD. The 25 children who participated showed an increase in their knowledge of ADHD, demonstrated more favorable opinions of both medication and psychosocial interventions, and evidenced a significant increase in their understanding of the various impacts of ADHD and potential coping strategies. The parents were found to be inaccurate in their predictions of their child’s knowledge and opinions of ADHD, and there was no relationship between the parent’s own knowledge and their child’s knowledge of ADHD. Overall, the “demystification workshop” was found to be a positive experience for the children with ADHD and shows promise as an effective means of sharing information about ADHD to latency-aged children with this disorder.     

A novel Wim Hof psychophysiological training program to reduce stress responses during an Antarctic expedition

ObjectiveThe aim of this prospective observational study was to investigate the effects of a novel Wim Hof psychophysiological training program on stress responses and hormone release in healthy participants during an Antarctic expedition.MethodsAll members of an Antarctic expedition were included in the study. The participants were healthy volunteers allocated to an intervention group (n = 6) and a control group (n = 7). The intervention consisted of 8 weeks of Wim Hof training. The training program comprised three integrated parts: breathing exercises, cold exposure and meditation. Psychometric measures (the Beck Depression Inventory and the Trauma Symptom Checklist-40) and neuroendocrine measures (cortisol, melatonin) were assessed pre- and post-intervention.ResultsThe results showed that the 8-week training program significantly reduced stress responses, as indicated by a reduction in depressive symptoms. A non-significant reduction in cortisol was also observed.ConclusionsThese data constitute preliminary findings indicating that the Wim Hof Method may positively affect stress symptoms and adaptability of the hormonal system to respond adequately to the circadian rhythm in healthy volunteers who participated in an Antarctic expedition.     

When “don’t worry” communicates fear: Children’s perceptions of parental reassurance and distraction during a painful medical procedure

Children’s distress during painful medical procedures is strongly influenced by adult behavior. Adult reassurance (e.g., “it’s okay”) is associated with increased child distress whereas distraction is associated with increased child coping. It is unknown why reassurance shows this counterintuitive relationship with child distress. The present research investigated whether children perceive their parents as fearful when they reassure using complementary observational and experimental methodologies. One hundred children (40 boys, 60 girls) 5–10 years old (M = 8.02, SD = 1.69) and their parents (86 mothers, 14 fathers) participated. First, spontaneous parent–child interactions during pediatric venipuncture were captured and used for a video-mediated recall task in which the children viewed instances of parental reassurance and distraction and rated their parents’ fear and happiness. Second, the children were asked to rate the intensity of parental fear and happiness for 12 video vignettes showing an actor posing as a parent during venipuncture. To determine whether the children’s perceptions varied with the qualities of the behavior, the vignettes manipulated: facial expression (happy vs. fearful), vocal tone (rising vs. falling), and content (informative reassurance vs. uninformative reassurance vs. distraction). For both tasks, the children provided higher ratings of fear during reassurance than distraction. In response to the vignettes, the children gave higher ratings of parental fear for a fearful facial expression, but the influence of vocal tone differed with the verbal content of the utterance. The results provide insight into the complexity of adult reassurance and highlight the important role of parental facial expression, tone, and verbal content during painful medical procedures.     

Educational Priorities for Children with Cri-Du-Chat Syndrome

There are few data on the educational needs of children with cri-du-chat syndrome: a neurodevelopmental disorder that affects learning and development. We therefore designed an Internet survey to identify parents’ educational priorities in relation to children’s level of need/ability. The survey listed 54 skills/behaviors (e.g., toileting, expresses wants and needs, and tantrums) representing 10 adaptive behavior domains (e.g., self-care, communication, and problem behavior). Parents rated their child’s current level of ability/performance with respect to each skill/behavior and indicated the extent to which training/treatment was a priority. Fifty-four surveys were completed during the 3-month data collection period. Parents identified nine high priority skills/behaviors. Results supported the view that parent priorities are often based on the child’s deficits and emergent skills, rather than on child strengths. Implications for educational practice include the need for competence to develop high priority skills/behaviors and the value of assessing children’s deficits and emergent skills to inform the content of individualized education plans.     

Feasibility and efficacy of integrating resiliency training into a pilot nurse residency program

The high stress associated with the nursing profession can negatively affect the health of nurses and the quality of patient care that they provide. This quasi-experimental study aimed to 1) assess the feasibility of integrating a Stress Management and Resiliency Training (SMART) program within a nine-month pilot nurse residency program and 2) assess the effects of the program on participants’ stress, anxiety, mindfulness, and resilience relative to a comparison group. A pre- and post-intervention survey design was used, with measurements taken at baseline and at 1, 3, 9, and 12 months after baseline. We enrolled 51 registered nurses (intervention group, n = 23; comparison group, n = 28) at a Midwestern US academic medical center. Nurses in the intervention group had a participation rate of 93%–100% with SMART program events. Despite the relatively limited adherence to the protocol by intervention group participants, significant improvements were noted for stress (P < .001), mindfulness (P < .001), and resilience (P < .001) in the intervention group compared with the comparison group. The SMART program can potentially be successfully integrated into a nurse residency program and positively impact nurse stress, mindfulness, and resilience. Further research is needed to determine the proper dose of the intervention and methods to enhance adherence.