Adolescent diabetes mellitus: parent/child perspectives of the effect of the disease on family and social interactions

To investigate the perceived effects of adolescent diabetes mellitus on family and social interactions from the children's and parents' perspectives, 50 teenagers with diabetes were studied: 21 from a private practice and 29 from a diabetes camp. Children and parents answered separately a specially prepared questionnaire dealing with daily life situations; the adolescents also responded to the Firo B questionnaire. On corresponding questions agreement between the responses of children and parents varied from as high as 86% to as low as 30%. Questions referring to the effect of diabetes on scholastic performance, concentration, and social life were associated with poor agreement. No correlation was found between the measure of agreement between parents and children on various responses and glycosylated hemoglobin determinations. The adolescents' perspectives were clearly influenced by sex and age of onset of diabetes. Female compared with male adolescents perceived significantly less effect from diabetes on scholastic performance and concentration, and the age of onset of their diabetes affected the measure of agreement with parents. In their responses to the Firo B questionnaire female diabetic adolescents differed significantly from norms in 2 of the 6 subscales measured, unlike male adolescents, whose scores were similar to those of norm groups. Male diabetic adolescents felt the most effect from diabetes on social life, scholastic performance, and concentration when they had developed the disease between 9 and 12 yr of age. Although the parents of this subgroup of adolescents underestimated these feelings, in general, parents of male and female diabetic adolescents perceived more effect from diabetes than their children.     

Cultural differences in parent-adolescent agreement on the adolescent's asthma-related quality of life

The primary purpose of this exploratory, cross-sectional study was to determine the degree of agreement between parents' and adolescents' rating of adolescents' asthma-related quality of life (QOL). A secondary aim was to compare the degree of agreement between parent-adolescent dyads in two countries; 15 dyads each were recruited from Kentucky and Iceland. Both adolescent and adult participants completed separate paper surveys at the time of the adolescent's clinic appointment. The QOL instrument used (PedsQL 3.0 Asthma Module) contains the subscales of asthma symptoms, asthma treatment, worry, and communication. Parent-adolescent differences were determined using paired t-tests; associations were assessed with intraclass correlation coefficients (ICCs). Two-sample t-tests investigated between-country differences in parent-child consistency in the assessment of the adolescent's asthma-related QOL. Adolescents rated their QOL higher than their parents did, but not significantly. The ICC of the QOL score for the 30 dyads was 0.39. The degree of agreement was high for asthma symptoms, but low for asthma treatment, worry, and communication. U.S. parents tended to underrate their child's QOL, while parents from Iceland overrated it (p = 0.007). Family-centered interventions may improve parents' understanding of how asthma affects QOL in adolescents, and such interventions may have to be tailored for cultural differences.     

Themes Arising in Group Therapy for Adolescents With Cancer and Their Parents

The introduction of a diagnosis such as cancer to an adolescent confounds an already stressful existence, as chronically ill adolescents face the same developmental tasks and challenges as healthy adolescents. Understanding and enhancing the unique coping strategies employed by teenagers is an important method to improve adjustment to cancer. Through two series of group therapy sessions for adolescents with cancer and their parents we discovered four primary challenges that adolescent cancer survivors face as well as various strategies that they use to cope with these challenges.     

Parents of Children with Disabilities: Resilience, Coping, and Future Expectations

On the basis of characteristics of family resilience, the study examined the perspectives of parents of children with an intellectual, physical, or learning disability. Thirty-two parents were interviewed as to past, present, and the modes of coping. The questions examined various aspects of family ecology domains: parents' responses to the child's diagnosis; patterns of adjustment; family support and services used by parents; and parents' feelings and future expectations. Although, it was found that most parents had to make changes in their social life and expressed high levels of frustration and dissatisfaction, many try to maintain their routine life. The majority expressed the need for a strong belief in the child and in the child's future, an optimistic outlook, and a realistic view and acceptance of the disability. The study highlighted the importance of social resources and support, and the need for effective programs of intervention.     

Transitioning to survivorship: a pilot study.

There are no clear transition guidelines for adolescent and young adult cancer patients, their parents, and their primary care providers (PCPs) when completing active therapy and within the first few years after therapy. The purpose of this pilot study was to identify needs and concerns of recently treated adolescent cancer patients and their parents, young adult cancer survivors, and the community PCPs of adolescent patients. Four focus group interviews were conducted with survivors and parents, and 3 in-depth interviews were conducted with PCPs. All interviews were audiotaped and transcribed for content analysis. A range of needs were identified, including lack of adequate written and verbal information about their prior treatment, its potential side effects, and appropriate follow-up care. The best sources for education were identified as the primary oncologist, nurse practitioner, or nurse. At completion of treatment, parents and adult survivors felt a lack of psychosocial support. Suggestions from participants included use of informational videos for survivors, weekend education and support programs, ongoing support groups, use of the Internet, and educational newsletters. The PCPs reported a lack of general pediatric oncology knowledge and specific patient information, time constraints in their patient schedules, and having few survivors in their practices as barriers to optimal survivorship care. Further research is needed to look at the unmet educational and psychological needs of childhood cancer survivors and their parents during the critical time when they transition off treatment.     

Anger correlated with psychosocial variables in rural youth

Uncontrolled anger is a contributing force in the three leading causes of adolescent death: homicide, suicide, and injuries. Anger may be one of the early warning signs which could lead to violent behavior. The purpose of this study was to examine the relationship between anger experience and expression with the potential correlates of life events, perceived social support, self-esteem, optimism, drug use, anxiety, and depressive symptoms in rural adolescents. The participants (n = 193) were aged 14 to 17 years old in ninth through eleventh grades enrolled at three rural Western Pennsylvania public high schools. Participants completed nine questionnaires. Negative life events, anxiety, drug use, and depressive symptoms had significant positive correlations with anger. In addition, anger was found to have significant negative correlations with the adolescents' perceived family support, self-esteem, and optimism. With this knowledge, health promotion programs conducted by pediatric nurses can target anxiety, drug use, and depressive symptoms while bolstering family support, self-esteem, and optimism to promote anger management in adolescent health care.     

Seeking and obtaining mental health services: what do parents expect?

This study examined parents' expectations about seeking and obtaining mental health care. Using the Expectations of Mental Health Care survey, structured interviews were conducted with 235 parents with children between the ages of 5 and 19; most were African American. Expectations were assessed in four areas: treatment effectiveness, provider/client relationship, accessibility of mental health services, and social and cultural factors, e.g., stigma. Parents reported a number of negative expectations, and black parents had significantly more negative expectations than white parents. The findings suggest that attitudes and expectations may influence parents' decision to seek mental health care for their child.     

A comparison of adolescents' and nurses' postoperative pain ratings and perceptions

Purpose: To examine the relationship between adolescents' subjective and nurses' objective pain ratings and their perceptions of each other's evaluation. Methodology: Twenty-two adolescent patients admitted for elective surgical procedures and the registered nurses responsible for their nursing management rated pain on a visual analog scale. Pearson Product Moment Correlation, Spearman Rank-Difference Correlation, and T-Test were used to analyze the results. Results: The correlation between patients' and nurses' pain rating was significant (r = .62; p less than .001). Nurses expected patients to rate pain higher than the nurses would (t = 3.467; p = .0005). There was no significant difference between adolescents' rating and their expectations of nurses' ratings. Conclusion: The relationship between patients' and nurses' pain assessment was moderate. Adolescents perceived that nurses' know how much pain they were experiencing. Nurses expected adolescents to rate pain higher than the nurses themselves would rate it.     

Why Thai parents do not discuss sex with their children: a qualitative study

This qualitative article explores the attitudes of Thai adolescents and parents concerning the barriers that prevent parents providing sex education to their adolescent children. Focus groups were conducted with 30 parents and 36 adolescents in rural north-eastern Thailand and were analyzed by using thematic analysis. The results showed that most Thai parents have not taught their children about sex education issues. Five themes emerged in relation to the limitations in providing sex education in Thai families. These were: restrictions imposed by traditional Thai culture; sex education is not a parental duty; parental limitations; the generation gap; and better not bring it up. We conclude that the core values in Thai society restrict the discussion of sex, resulting in youth missing the opportunity to acquire the knowledge that is needed about sexual issues from their family. This article provides evidence of how parents' knowledge and perceptions are linked to their ability and willingness to discuss sexual matters with their teenagers. Therefore, future sex education policies could be greatly enhanced by empowering parents to take part in the sex education of their teenage children.     

Adolescent subjective well-being and family dynamics

The purpose of this study was to examine the relationships between adolescent subjective well-being (SWB) and family dynamics perceived by adolescents and their parents. A sample of 239 pupils (51% female) from seventh and ninth grades completed the Berne questionnaire of SWB (youth form), two subscales from an original Finnish SWB scale and the Family Dynamics Measure II, and one of their parents (n = 239) filled in the Family Dynamics Measure II. Results indicated that parents assessed family dynamics better than did their adolescent child. Furthermore, there was no association between family dynamics perceived by adolescents and family dynamics assessed by one of their parents or between the adolescent SWB and parental perception of family dynamics. Multiple stepwise regression analysis indicated that certain aspects of family dynamics perceived by adolescents were related to adolescent global satisfaction and ill-being. Specifically, adolescents' perception of high level of mutuality and stability in the family as well as male gender and lack of serious problems in family were predictors of adolescent global satisfaction. Furthermore, disorganization in the family and poor parental relationship perceived by adolescents, being female, serious problems and illness in family predicted a high level of adolescent global ill-being.     

Adolescents' and parents' explanatory styles and parents' causal explanations about their adolescents

This pilot study compares the explanatory styles of adolescents, the explanatory styles of their parents, and the parents' causal explanations about their adolescents. Twenty-one adolescents with academic problems and their mothers (n =19) and fathers (n =15) completed the Attributional Style Questionnaire (Peterson et al., 1982). The parents also completed a parallel questionnaire, My Adolescent's Life (MAL). Both mothers' and fathers' explanations of events in their own lives and of events in their adolescents' lives were significantly associated. Fathers' explanations of events in their adolescents' lives were positively correlated with the adolescents' explanations of their own events. In this study, neither mothers' explanations of their own events nor of their adolescents' events nor fathers' explanations of their own events correlated with the adolescents' explanations of their own events. Significant findings with a small sample suggest that this line of inquiry and the MAL are promising for future research. This study was based on a master's thesis by the first author at Rutgers University under the direction of the second author. Portions of this article were presented at the annual meeting of the Eastern Psychological Association, Philadelphia, April 1990. This research was partially supported by NIDA grant DA05112 to Dr. Brenna H. Bry. The authors gratefully acknowledge the data collection assistance of Karen E. Krinsley, Shaun Whittaker, and Luis Guerreira.     

青少年抑郁障碍患者病前家庭因素研究

目的探讨病前家庭因素对青少年抑郁障碍患者的影响。方法对61名青少年抑郁障碍患者及其父母（研究组）与57名正常青少年及其父母（对照组）采用家庭评估问卷进行测评分析。结果研究组青少年病前与父母、同学或老师人际关系不良,早年负性生活事件及父母关心与控制两个方面有问题者均显著高于对照组（P〈0．01）。研究组父母有焦虑、抑郁问题,教育能力受损者占44．3％,情感表达困难占63．9％,均显著高于对照组（P〈0．05或0．01）;父母教育态度与各自婚姻关系感受呈正相关,研究组父母教育态度不一致占54．1％,显著高于对照组的31．6％（P〈0．05）。结论家庭因素对青少年抑郁障碍的发生有重要影响,因此,在制定青少年抑郁障碍预防及早期治疗策略时需考虑家庭危险因素与高危人群。     

Multiple informants in assessing stress and symptoms in adolescents with schizophrenia

We used exploratory data analysis to examine parents--adolescents congruencies and discrepancies and their correlates in assessing stress and symptoms in adolescents with schizophrenia. A total of 40 adolescents diagnosed with schizophrenia and their parents were drawn from a study of self-management therapy for youth with schizophrenia. Low to moderate congruencies in stress and symptoms were reported (r = .22~.41). Factors including adolescents' age, time spent with children, the number of hospitalizations, and level of disability explained the discrepancies. The results imply that health care providers should be aware that several factors are associated with the discrepancies between parents' and adolescents' reports.     

Self-transformation as a factor in the self-esteem and well-being of breast cancer survivors

Diagnosis with a life-threatening illness can lead to many changes in one's self. These changes, called self-transformation, are not well understood. The present study used triangulation of methods and measures to (i) describe individual differences in self-transformation among breast cancer survivors, (ii) examine factors associated with self-transformation in breast cancer survivors, and (iii) examine the relationships between self-transformation and self-esteem and well-being in breast cancer survivors and age-matched comparison women without cancer. Cancer survivors (n = 60) participated in structured interviews and both survivors and comparison women (n = 60) completed a set of questionnaires. Narrative analysis revealed three categories of transformation among breast cancer survivors: positive transformation, minimal transformation and feeling stuck. These groups differed by age, marital status and income, but not by disease or treatment variables. Breast cancer survivors in the positive transformation group had significantly higher self-esteem and well-being in comparison with (i) survivors grouped as feeling stuck and (ii) age-matched counterparts without cancer. Cancer survivors who reported feeling stuck had significantly lower self-esteem and well-being than the other groups of survivors and lower well-being in comparison with healthy women of the same age. Findings provide support for the concept of self-transformation and a new understanding of disease, demographic and treatment factors associated with the concept. Findings also suggest that self-transformation may be a factor in the self-esteem and well-being of breast cancer survivors.     

Patterns of mental distress following the violent death of a child and predictors of change over time

We observed 173 parents bereaved by the violent death of an adolescent or young adult child. Data were collected 4, 12, 24, and 60 months postdeath. Using latent growth modeling, we examined how initial levels of mental distress and the rate of change over time are influenced by nine predictors: parents' gender, self-esteem, three coping strategies, perceived social support, negative life stressors, posttraumatic stress disorder (PTSD) symptoms, and an intervention offered in the early bereavement period. The results support a multiple-risk and -protective factor model of loss accommodation. Parents' gender, self-esteem, and affective and repressive coping were predictive of changes in mental distress over time. Although parents' initial levels of PTSD were the best predictor of baseline mental distress, they did not predict reductions in distress 5 years later. Theoretical, empirical, and clinical implications are discussed.     

Parents' experiences of asthma: process from chaos to coping

The aim of the present qualitative study was to describe nine parents' everyday experiences of living with a child suffering from asthma. Data were collected by means of in-depth interviews and phenomenological content analysis. Four main themes emerged: feelings of uncertainty, helplessness and guilt; the need for support and help from healthcare professionals; adaptation to everyday life; and the development of coping strategies. In addition, two subthemes; trying out and seeking information, emerged. Trying out was found to be an important strategy for parents in managing the illness. In encounters with healthcare professionals, parents felt that they were not respected and that their competence was questioned. In conclusion, this study emphasizes the importance of a mutual dialogue between healthcare professionals and parents to enable the parents to develop the competence necessary to care for their child.