Posttraumatic stress symptoms in parents of children with acute burns

OBJECTIVE: To develop a model of risk factors for posttraumatic stress disorder (PTSD) symptoms in parents of children with burns. METHODS: Immediately following the burn and 3 months later, parents reported on their children's and their own psychological functioning and traumatic stress responses. RESULTS: Approximately 47% of the parents reported experiencing significant posttraumatic stress symptoms 3 months after the burn. Our model indicates three independent pathways to PTSD symptoms (i.e., parent-child conflict, parents' dissociation, and children's PTSD symptoms). Additionally, parents' anxiety predicted increased parent-child conflict, conflict with extended family and size of the burn predicted parents' dissociation, and size of the burn and children's dissociation predicted children's PTSD symptoms. CONCLUSIONS: This study suggests that many parents of children with burns suffer from posttraumatic stress symptoms. Interventions that target factors such as family conflict, children's symptoms, and parents' acute anxiety and dissociation may diminish the risk for PTSD.     

Posttraumatic stress and behavior problems in infants and toddlers with burns

This study assessed posttraumatic stress disorder (PTSD) and behavior problems in young children with burns and examined individual, injury-related, and family-related determinants. Seventy-six children, aged 12-49 months, were assessed at an average of 15 months after their burn injury, using parents as informants on the posttraumatic stress disorder semi-structured interview and observational record for infants and young children and the child behavior checklist. Ten children (13.2%) met the alternative criteria for PTSD proposed by Scheeringa et al. Number of PTSD symptoms were associated with family-related variables (maternal PTSD, quality of family relations). Compared to community norms, children with burns showed less externalizing behavior problems, and internalizing behavior problems were within the normal range. Overall, behavioral adjustment was associated with the quality of family relations (cohesion, expressiveness, conflicts). Whereas behavior was found to be normal in young children with burns, this study provides evidence for a substantial prevalence of PTSD.     

Review: psychosocial well-being of parents and their children born after assisted reproduction.

OBJECTIVE: To critically review the empirical literature published from 1980 through June 2000 on the psychosocial well-being of parents and their children born after assisted reproduction. METHODS: A computer-based literature search of PsycINFO and Medline was conducted. Empirical studies were reviewed to document the psychosocial impact of infertility and its treatment on the families involved in terms of quality of parenting, family functioning, and child development. RESULTS: Several common findings appeared across the studies reviewed. With regard to quality of parenting and family functioning, mothers of children born using assisted reproduction report less parenting stress and more positive mother- and father-child relationships than mothers of naturally conceived children. In most cases, no statistically significant differences in child functioning in terms of emotions, behavior, self-esteem, or perceptions of family relationship have been reported. CONCLUSIONS: The summary findings are positive and reassuring for parents and their children born after assisted reproduction. This critique of the published literature provides interpretative and methodological refinements for future research.     

Offspring psychological and biological correlates of parental posttraumatic stress: Review of the literature and research agenda

Millions of individuals with posttraumatic stress disorder (PTSD) are parents. A burgeoning literature suggests that offspring of parents with this condition may be at increased risk for psychological problems. The current paper provides an integrative and comprehensive review of the diverse research literature examining the sequelae of parental posttraumatic stress among offspring. Over 100 studies that evaluated psychological and/or biological variables among children of parents with PTSD are reviewed. Findings suggest parental symptoms of posttraumatic stress are uniquely related to an array of offspring outcomes, including internalizing-type problems, general behavioral problems, and altered hypothalamic-pituitary-adrenal axis functioning. Although very little work has directly evaluated mechanisms of transmission, there is increasing support for genetic and epigenetic effects as well as parenting behaviors. These and other mechanisms are discussed; drawing upon findings from other literatures to consider how parental PTSD may impart psychobiological vulnerability upon offspring. We conclude with a detailed discussion of the methodological strengths and challenges of the extant research, along with a recommended agenda for future research in this important area of study.     

Childhood chronic illness as a family stressor.

Investigated the impact of childhood chronic illness within a family context. We interviewed 30 mothers of 6- to 14-year-old children with asthma or diabetes and 30 mothers of healthy children of the same age and sex. Family functioning, extrafamilial social support available to mothers, and child life stress events were examined in relation to the children's psychological adjustment and illness events. The mothers of asthmatic children reported a greater number of internalizing behavior problems in their children, perceived their own social support as less adequate, and reported a greater number of stressful events. Regression analyses demonstrated that family functioning, maternal social support, and chronic illness were significantly related to the psychological adjustment of the child. The importance of family functioning and resources available to the family, such as social support, are discussed as protective influences in coping with childhood chronic illness.     

Family issues in child anxiety: attachment, family functioning, parental rearing and beliefs

Family studies have found a large overlap between anxiety disorders in family members. In addition to genetic heritability, a range of family factors may also be involved in the intergenerational transmission of anxiety. Evidence for a relationship between family factors and childhood as well as parental anxiety is reviewed. Four groups of family variables are considered: (I) attachment; (II), aspects of family functioning, such as marital conflict, co-parenting, functioning of the family as a whole, and sibling relationships; (III) parental rearing strategies; and (IV) beliefs that parents hold about their child. The reviewed literature provides evidence for an association between each of these family factors and child anxiety. However, there is little evidence as yet that identified family factors are specific to child anxiety, rather than to child psychopathology in general. Moreover, evidence for a relationship between child anxiety and family factors is predominantly cross-sectional. Therefore, whether the identified family factors cause childhood anxiety still needs to be investigated. Further research that investigates mechanisms mediating the relationship between family factors and child anxiety is also called for. Finally, parental beliefs are identified as important predictors of parental behaviour that have largely not been investigated in relation to child anxiety disorders.     

Pediatric parenting stress among parents of children with type 1 diabetes: the role of self-efficacy, responsibility, and fear

OBJECTIVE: Parents of children with type 1 diabetes are crucial to promoting positive disease adaptation and health outcomes among these youngsters, yet this success may come at some consequence to parents' own well-being. Little research has examined the stress faced by parents, or explored the psychological and behavioral correlates of their stress. METHODS: One hundred and thirty-four parents of children with type 1 diabetes completed measures of diabetes self-efficacy, responsibility for diabetes management, fear of hypoglycemia, and a recently developed measure of pediatric parenting stress (the Pediatric Inventory for Parents [PIP]; R. Streisand, S. Braniecki, K. P. Tercyak, & A. E. Kazak, 2001). RESULTS: Bivariate analyses suggest that pediatric parenting stress is multifaceted; the frequency of parenting stress is negatively related to child age and family socioeconomic status and positively related to single parent status and regimen status (injections vs. insulin pump). Difficulty of parenting stress is negatively related to child age and positively related to regimen status. In multivariate analyses, a significant portion of the variance in stress frequency (32%) and difficulty (19%) are associated with parent psychological and behavioral functioning, including lower self-efficacy, greater responsibility for diabetes management, and greater fear of hypoglycemia. CONCLUSIONS: Each area of parent functioning associated with pediatric parenting stress is amenable to behavioral intervention aimed at stress reduction or control and improvement of parent psychological and child-health outcomes.     

Parental reinforcement of recurrent pain: the moderating impact of child depression and anxiety on functional disability

OBJECTIVE: To examine whether children's distress moderates the relationship between parental responses to children's pain behaviors and functional disability. METHODS: Participants were 215 children (ages 8 to 16 years) diagnosed with either headaches, juvenile idiopathic arthritis, or sickle cell disease. Children and parents completed questionnaires assessing sociodemographics, pain, depression, anxiety, parental solicitous responses to pain behaviors, and functional disability. RESULTS: Hierarchical linear regressions computed for parental responses to children's pain significantly predicted child functional disability, controlling for children's pain intensity. Significant interactions between parental solicitous behaviors and child depressive symptoms (beta =.74, p <.01) and between solicitous behaviors and child anxiety symptoms (beta =.91, p <.01) indicated that for children with more psychological distress, parental solicitous behaviors were associated with greater child functional disability. CONCLUSIONS: Child psychological distress may exacerbate the impact of parental solicitous responses to pain on functioning, suggesting the potential role of family intervention to enhance optimal functioning in children with recurrent pain.     

Neurocognitive development of young children with sickle cell disease through three years of age

OBJECTIVE: To determine (1) the neurocognitive development of children with sickle cell disease (SCD) from 6 months through 36 months of age, (2) the independent and combined contributions of biomedical risk and parenting risk to child neurocognitive functioning, and (3) the independent and combined contributions of biomedical risk, parent cognitive processes, and family functioning to parent adjustment. METHOD: The study sample included 89 African American children and their parents served through the Duke University-University of North Carolina Comprehensive Sickle Cell Center. Measures of cognitive and psychomotor development were obtained at 6, 12, 24, and 36 months of age, and parents completed self-report measures of the cognitive processes of daily stress and attributional style, psychological adjustment, and family functioning. RESULTS: There was no significant decrease in psychomotor functioning (PDI) over time but cognitive functioning (MDI) declined, with a significant decrease occurring between the 12- and 24-month assessment points. At 24 months, poorer cognitive functioning was associated with parenting risk, in terms of a learned-helplessness attributional style, and biomedical risk, in terms of HbSS phenotype. Levels of psychological distress within the clinical range were reported by 24% of the parents, and poorer parent adjustment was associated with high levels of daily stress, less knowledge about child development, lower expectations of efficacy, and HbSC phenotype. CONCLUSIONS: The findings indicate that young children with SCD are at risk for neurocognitive impairment and provide support for the initiation of early intervention studies to promote neurocognitive development.     

Spina Bifida Children and Their Parents: A Population Prone to Family Dysfunction?

Spina bifida children of normal intelligence and their parentswere compared with a carefully matched control group of nondisabledchildren and their parents in a hierarchically oriented assessmentof individual, marital, and family functioning. Contrary topopular hypotheses that families with a handicapped child areespecially vulnerable to stress and psychological problems,results across all measures revealed no differences betweenthe two groups. Further, no differences were found between mothersand fathers on the various measures. These results support theview that nonretarded spina bifida children and their parentshave no special psychological characteristics that distinguishthem from nonhandicapped children and their parents. The findingsalso underscore the strengths and coping skills of handicappedchildren and their families. The tendency of researchers andclinicians to focus on the deviant aspects of these populationsmay obscure the fact that many may be adapting successfully.     

Mutual influences on maternal depression and child adjustment problems

Often undetected and poorly managed, maternal depression and child adjustment problems are common health problems and impose significant burden to society. Studies show evidence of mutual influences on maternal and child functioning, whereby depression in mothers increases risk of emotional and behavioral problems in children and vice versa. Biological mechanisms (genetics, in utero environment) mediate influences from mother to child, while psychosocial (attachment, child discipline, modeling, family functioning) and social capital (social resources, social support) mechanisms mediate transactional influences on maternal depression and child adjustment problems. Mutual family influences in the etiology and maintenance of psychological problems advance our understanding of pathways of risk and resilience and their implications for clinical interventions. This article explores the dynamic interplay of maternal and child distress and provides evidence for a biopsychosocial model of mediating factors with the aim of stimulating further research and contributing to more inclusive therapies for families.     

Family Chaos and Child Functioning in Relation to Sleep Problems Among Children at Risk for Obesity

This study evaluated the influence of child and family functioning on child sleep behaviors in low-income minority families who are at risk for obesity. A cross-sectional study was utilized to measure child and family functioning from 2013 to 2014. Participants were recruited from Head Start classrooms while data were collected during home visits. A convenience sample of 72 low-income Hispanic (65%) and African American (32%) families of preschool-aged children were recruited for this study. We assessed the association of child and family functioning with child sleep behaviors using a multivariate multiple linear regression model. Bootstrap mediation analyses examined the effects of family chaos between child functioning and child sleep problems. Poorer child emotional and behavioral functioning related to total sleep behavior problems. Chaos associated with bedtime resistance significantly mediated the relationship between Behavioral and Emotional Screening System (BESS) and Bedtime Resistance. Families at high risk for obesity showed children with poorer emotional and behavioral functioning were at higher risk for problematic sleep behaviors, although we found no link between obesity and child sleep. Family chaos appears to play a significant role in understanding part of these relationships. Future longitudinal studies are necessary to establish causal relationships between child and family functioning and sleep problems to further guide obesity interventions aimed at improving child sleep routines and increasing sleep duration.     

Lesbian families and family functioning: an overview

OBJECTIVES: In the last 30 years a growing body of studies on lesbian parents and the development of children has been published. METHODS: Four computerized databases were identified studies for inclusion in this review of research on lesbian families, namely PsychInfo, Educational Resources Information Centre (ERIC), Medline, and the Social Sciences Citation Index. RESULTS: Forty-four empirical studies on lesbian families published between 1978 and 2003 were reviewed. In the research on lesbian families two phases were identified. To begin with, systematic studies on lesbian families focused on lesbian families with children who were born in a previous heterosexual relationship. More recently, studies included lesbian families whose children were born to the lesbian couple (planned lesbian families). In both phases, articles reporting results on children's development (such as sexual identity, emotional/behavioral development, social relationships and cognitive functioning), and parental functioning (such as mental psychological health and parenting skills). This paper presents and discusses major finding of the reviewed articles. CONCLUSION: Studies in both phases have emphasized that lesbian and heterosexual families are very much alike. However, it is the stigma of lesbianism that makes the family situation of lesbian families different. PRACTICE IMPLICATIONS: Healthcare workers should be informed about the similarities and differences between lesbian families and heterosexual families, and about the non-traditional family situation of planned lesbian families.     

Psychosocial adjustment in children with kidney disease

Objective: To examine family environment, levels of parentingstress, and child behavior problems in children with one ofthree kidney diseases compared to healthy children and to examinepredictors of psychological distress in the full sample. Method: Parents of children with steroid sensitive nephroticsyndrome, chronic renal insufficiency, or kidney transplant (n = 41) were compared to 34 healthy children of similar demographic characteristics. Results: Mean scores on family functioning, parenting stress,and child behavior were within normal limits. Family environment variables significantly predicted child behavior and parentingstress for parents of ill and healthy children. Qualitativeresponses provided insight into developmentally specific stressorsand intervention needs in the illness groups. Conclusions: These data indicate that long-term survivors ofkidney disease function similarly to demographically matchedpeers and that the family environment may buffer stress causedby illness. Specific concerns raised by parents in the kidneydisease groups indicate the need to appropriately assess andintervene with this understudied population.     

A multimethod assessment of behavioral and emotional adjustment in children with asthma

OBJECTIVE: Examine behavioral adjustment and emotion regulation among 6-year-old children with asthma and a group of healthy controls. METHOD: Subjects were 81 children with asthma and 22 healthy controls. Asthma and allergy statuses were confirmed by objective measures. Emotional and behavioral functioning were assessed through parent report, child interview, and child participation in an emotional regulation paradigm. RESULTS: Maternal report revealed more internalizing and total behavior problems for children with asthma compared to controls. Child interview and behavioral observations of emotion regulation yielded no differences between groups. Severity of asthma was related to increased emotional difficulties by clinician interview and observation but not by maternal report. CONCLUSIONS: Two groups of children with asthma who have psychological difficulties include those with increased anxiety and those with poor emotion regulation and more asthma symptoms. Different measures of child adjustment yield a complex picture of the behavioral difficulties associated with pediatric asthma.     

Psychosocial and Family Functioning in Children with Insulin-Dependent Diabetes at Diagnosis and One Year Later

Examined the initial impact and subsequent adjustment to thediagnosis of insulin-dependent diabetes mellitus (IDDM). Childrenbetween 1 and 14 years of age and their families were assessedseveral weeks after diagnosis and again a year later using standardizedmeasures of child behavior, parental mental health, and familyfunctioning. Immediately after diagnosis, the children and bothparents exhibited mild symptoms of psychological distress butthese had largely resolved at 12-month follow-up. The impactof IDDM diagnosis on family functioning varied with informant,SES, and the age of the child, with an overall tendency forfamilies to become less flexible over the year. Findings suggestthat most children and their parents exhibit satisfactory individualadjustment after a period of initial stress but family functioningis affected in complex ways. Serial follow-up of the cohortis planned to establish whether the current findings are predictiveof longer term outcome.     

Family well‐being and disabled children: A psychosocial model of disability‐related child behaviour problems

Background: When parents receive a diagnosis that their child is disabled, many families adjust to this healthily and cope well, but others do not. Feelings of hopelessness, social isolation of the family within the community and child behaviour problems have all been reported. While utilization of social support systems is well documented in the literature as being a significant factor in family coping and adjustment to the child's disability, less attention has been focused on the role of psychological factors. Objective: This theoretical study aims to address this inbalance by integrating perspectives from a social model of disability with psychological research on the role of cognitive change in families' coping and adjustment to having a disabled child, and thus to produce a new psychosocial model of disability‐related child behaviour problems. Method: Negative societal attitudes to disability identified by a social model of disability are interpreted with respect to how they might translate to parent views of their disabled child within the family. Resultant parenting beliefs and their possible implications for family interaction, child behaviour and family health and well‐being are explored within this new framework. Conclusions: The psychosocial model of disability‐related child behaviour problems provides a useful conceptual framework that has both clinical and research implications for professionals working with families with disabled children.     

Predictors of psychological adjustment in school-age children infected with HIV

OBJECTIVE: To assess for significant differences in psychological functioning between HIV-infected children and a demographically matched healthy control group and to examine the utility of applying a stress and coping model to children with HIV disease. METHODS: Participants included HIV-infected children (ages 6-16) and their caregivers (n = 36) and a control group of healthy children and their caregivers (n = 32). During routine clinic visits, children completed measures of psychological adjustment, health locus of control, and coping style, and caregivers completed measures of their own and their child's psychological adjustment. RESULTS: Caregiver-reported and child self-reported psychological adjustment scores did not significantly differ between the HIV and control groups, with the exception of significantly more internalizing behavior problems reported in the control group. Hierarchical multiple regression analyses revealed that the stress and coping model accounted for 36% of the variance in HIV-infected children's self-reported psychological adjustment. In addition, child age and coping style were significant predictors of child self-reported psychological adjustment, but not of caregiver-reported child adjustment. CONCLUSIONS: Approximately 25% of children with HIV disease exhibited clinically significant emotional or behavioral problems; however, even higher rates of psychological adjustment problems were found in healthy children. Children with HIV disease who have not been told their diagnosis and children who endorse more emotion-focused coping strategies tend to exhibit more psychological adjustment problems.     

Family and Illness Predictors of Outcome in Pediatric Brain Tumors

Investigated the prediction of cognitive and behavioral outcomesin 63 children with heterogenous brain tumors. Hierarchicalmultiple regression analyses were used to determine how family-relatedvariables added to the prediction of children's outcome overand above illness measures. The best predictors of children'sbehavior problems and adaptive behavior were family and demographicvariables, whereas the best predictors of achievement were illnessand demographic variables. A combination of family and illnessvariables, however, was the best predictor of intellectual functioning.In addition to identifying specific predictors of cognitiveand behavioral outcome in children with brain tumors, theseresults lend initial support for the inclusion of contextualfactors such as family stress, maternal coping, number of parentsin the home, and family SES measures in studies of how diseasefactors affect outcomes in pediatric brain tumor patients.     

Psychological adjustment and treatment of children and families with parents deployed in military combat

The effects of the military deployment of parent-soldiers on children and families need to be understood in the context of military culture as well as from developmental risk for maladjustment. Although research addressing such effects is limited in both scope and certainty, we can identify several key factors that relate to psychological risk, adjustment, and outcome. Most children are resilient to the effects of deployment of at least one of their parents, but children with preexisting psychological conditions, such as anxiety and depression, may be particularly vulnerable, as well as children with specific risk factors, such as child abuse, family violence, or parental substance abuse. A series of case vignettes illustrate the psychological adjustment and treatment implications for children with parents deployed in support of military combat operations.