Long-term coping in childhood cancer survivors: influence of illness, treatment and demographic background factors

In 30 survivors of childhood cancer, long-term psychological coping with experience of disease and treatment was studied in relation to factors associated with illness, treatment and demographic background. Coping was assessed in a prior study, in which three groups of varying levels of coping where delineated (good, 40%; intermediate, 33%; poor, 27%, coping). The present study showed that poor individual coping was related to diagnosis, a shorter time of continuous complete remission, more severe illness and treatment impairments, and lower scores on a test of intellectual abilities. In addition, a longer time of treatment tended to be followed by poorer coping. However, no association was found for gender, parents' occupational level, age at illness onset, neuro-cranial irradiation, irradiation dose (total) or age at investigation. A tentative path-analysis was executed, displaying a model for the relationships between medical and demographic background variables, and for their influence on coping. It was concluded that a complex of factors--associated particularly with severity of disease and treatment--appears to be related to, and affects, coping with the illness experience. Patients' long-term coping with their illness trauma is most likely determined by multiple factors. Intellectual capabilities are related to coping.     

Risk factors for adolescent cigarette smoking. The Muscatine study

Smoking among adolescents is a developmental phenomenon with several factors exerting an influence on cigarette use at different times. We examined the longitudinal influences of several behavioral and social variables on the smoking status of 443 students followed from early to late adolescence. Of the factors examined, association with friends who smoke and previous smoking status were consistently associated with an adolescent's future smoking status. Other factors, such as attachment to father or to mother, parental supervision, extracurricular activity, perceived negative and positive effects of smoking, and academic involvement, were all related to late adolescent smoking status. These observations suggest that strategies that influence smoking behavior need to be directed not only to the individual child but also to influences within the child's home and school environment.     

Assessing the effects of age,sex and shared environment on the genetic aetiology of depression in childhood and adolescence

BACKGROUND: Depressive symptoms and disorder are experienced by a significant proportion of young people and have long-lasting deleterious effects. The aims of the current investigation were to examine the aetiology of depressive symptoms using a twin design. In particular to examine the effects of sex, age, maternal depression and anxiety symptoms and to examine the aetiology of high depression scores. METHODS: Questionnaires were sent to the families of a population-based sample of twins aged between 8 and 17 years. Parents and children over the age of 11 were asked to complete the Mood and Feelings Questionnaire and Hospital Anxiety and Depression Scale (mothers only). Responses were obtained from 1463 families and data were analysed using genetic model fitting and DeFries and Fulker regression analysis. RESULTS: Depressive symptoms, particularly when self-rated, were significantly genetically influenced. There was evidence of significant heterogeneity according to age, with shared environmental factors more important and genetic factors less important for children aged 8 to 10 than for adolescents aged 11 to 17 years. Some but not all of the shared environmental influences on parent-rated depressive symptoms were accounted for by maternal symptoms of depression and anxiety. There was a significant effect of gender for self-rated depressive symptoms. For boys, genetic factors were of greater importance and common environmental influences of less importance than for girls. Shared environmental effects had a substantial influence on high self-rated depression scores. Adolescents who scored highly on self-rated depression questionnaires experienced significantly more shared life events and their mothers had significantly higher internalising symptoms than adolescents who scoredwithin the normal range. CONCLUSIONS: The results of this study add to the evidence that the aetiology of depressive symptoms differs by age, with genetic factors becoming more important from childhood to adolescence. Some but not all of the shared environmental effect observed for mother-rated depression scores is due to maternal depression and anxiety symptoms. For self-rated depressive symptoms, the importance of genetic and environmental factors may also differ by sex, with genetic influences more important for boys. The aetiology of high depression symptom scores, when self-rated, appears to differ from scores within the normal range in that shared environmental factors appear to be more important. Further research is needed to identify these shared environmental factors using longitudinal models that test genetic and environmental mediation.     

A genetic analysis of individual differences in dissociative behaviors in childhood and adolescence

BACKGROUND: Dissociation--a pattern of general disruption in memory and consciousness--has been found to be an important cognitive component of children's and adults' coping with severe trauma. Dissociative experiences include amnesia, identity disturbance, age regression, difficulty with concentration, and trance states. Stable individual differences in dissociative behaviors may represent a dissociative tendency trait that varies in the population independent of the influence of trauma. METHOD: In the current study, we examined genetic and environmental sources of variance in some of these behaviors by comparing 86 pairs of adoptive siblings and 102 pairs of full siblings from the Colorado Adoption Project (parents' and teachers' ratings), and 218 pairs of identical and 173 pairs of same-sex fraternal twins from the British Register for Child Twins (parents' ratings). The study used a dissociation scale comprised of six CBCL items. RESULTS: Developmentally, there was no change in mean dissociation scores across middle childhood and adolescence, and individual differences were moderately stable. Both parents' and teachers' ratings showed moderate to substantial amounts of genetic and nonshared environmental variance and negligible shared environmental variance, and most of the parent-teacher agreement in their ratings was accounted for by overlapping genetic variance. CONCLUSIONS: The results support further research into possible genetic and environmental factors that contribute to dissociative tendencies in children and adolescents.     

The human capacity to thrive in the face of potential trauma

For decades, researchers have documented remarkable levels of resilience in children who were exposed to corrosive early environments, such as those in which poverty or chronic maltreatment were present; however, relatively little research has examined resilience in children or adults who were exposed to isolated and potentially traumatic events. The historical emphasis on psychological and physiologic dysfunction after potentially traumatic events has suggested that such events almost always produce lasting emotional damage. Recent research, however, has consistently shown that across different types of potentially traumatic events, including bereavement, serious illness, and terrorist attack, upward of 50% of people have been found to display resilience. Research has further identified substantial individual variation in response to potentially traumatic events, including 4 prototypical and empirically derived outcome trajectories: chronic dysfunction, recovery, resilience, and delayed reactions. Factors that promote resilience are heterogeneous and include a variety of person-centered variables (eg, temperament of the child, personality, coping strategies), demographic variables (eg, male gender, older age, greater education), and sociocontextual factors (eg, supportive relations, community resources). It is surprising that some factors that promote resilience to potentially traumatic events may be maladaptive in other contexts, whereas other factors are more broadly adaptive. Given the growing evidence that resilience is common, psychotherapeutic treatment should be reserved for those in genuine need.     

The modifiable biopsychosocial drivers of psychological distress for adolescents with asthma: Implications for Clinical Care

PurposeOverwhelming distress exceeds the capacity of healthy coping strategies to feel better using healthy coping strategies alone, resulting in the use of unhealthy coping strategies. Unhealthy coping strategies may exacerbate asthma symptoms and asthma can contribute to overwhelming distress. This study aimed to review the modifiable drivers of overwhelming distress in adolescents with asthma.MethodsThe biopsychosocial drivers of psychological distress for adolescents with asthma were explored within the domains of the modifiable biopsychosocial model of health and wellbeing.ResultsAsthma in adolescents is associated with problems in the domains of environment, developmental outcomes, sense of belonging, health behaviours, coping, and treatment of illness.ConclusionsThe relationship between asthma and psychological distress highlights the need for holistic treatment of asthma. Further research is needed to establish causation between variables and to investigate whether interventions that address either asthma symptoms or biopsychosocial drivers of distress can improve both factors.     

Heritability for adolescent antisocial behavior differs with socioeconomic status: gene-environment interaction

BACKGROUND: Socioeconomic status is often assumed to be of importance for the development of antisocial behavior, yet it explains only a fraction of the variance. One explanation for this paradox could be that socioeconomic status moderates the influence of genetic and environmental effects on antisocial behavior. METHOD: TCHAD is a Swedish longitudinal population-based twin study that contains 1,480 twin pairs born 1985-1986. The present study included 1,133 twin pairs, aged 16-17 years. Antisocial behavior was measured through self-report. Family socioeconomic status was assessed by parental-reported education and occupational status. Neighborhood socioeconomic conditions were assessed using five aggregated level variables: ethnic diversity, basic educational level, unemployment level, buying power, and crime-rate. We used structural equation modeling to test whether socioeconomic status interacted with latent genetic and environmental effects for antisocial behavior. RESULTS: Genetic influences on antisocial behavior were more important in adolescents in socioeconomically more advantaged environments, whereas the shared environment was higher in adolescents in socioeconomically less advantaged environments. Heritability for antisocial behavior was higher in girls than in boys, irrespective of socioeconomic background. CONCLUSIONS: Our results suggest that different intervention policies should be considered in different socioeconomic areas. In socioeconomically advantaged areas, it might be more fruitful to focus on individually based preventions and treatments. In socioeconomically disadvantaged areas, intervention and prevention policies might be more effective on a community level, to account for shared environmental risk factors.     

Research review: structural language in autistic spectrum disorder - characteristics and causes

Background: Structural language anomalies or impairments in autistic spectrum disorder (ASD) are theoretically and practically important, although underrecognised as such. This review aims to highlight the ubiquitousness of structural language anomalies and impairments in ASD, and to stimulate investigation of their immediate causes and implications for intervention. Method: Studies of structural language in ASD are reviewed (based on a search of the literature and selected as meeting defined inclusion criteria), and explanatory hypotheses are discussed. Results: Some individuals with ASD never acquire language. Amongst those who do, language abilities range from clinically normal (ALN) to various degrees of impairment (ALI). Developmental trajectories and individual profiles are diverse, and minority subgroups have been identified. Specifically: language is commonly but not always delayed and delayed early language is always characterised by impaired comprehension and odd utterances, and sometimes by deviant articulation and grammar. Nevertheless, by school age an ‘ASD‐typical’ language profile emerges from group studies, with articulation and syntax least affected, and comprehension, semantics and certain facets of morphology most affected. Thus, even individuals with ALN have poor comprehension relative to expressive language; also semantic‐processing anomalies and idiosyncratic word usage. It is argued that impaired socio‐emotional‐communicative relating, atypical sensory‐perceptual processing, and uneven memory/learning abilities may underlie shared language anomalies across the spectrum; and that varying combinations of low nonverbal intelligence, semantic memory impairment and comorbidities including specific language impairment (SLI), hearing impairment, and certain medical syndromes underlie ALI and variation in individual profiles. Conclusions: Structural language is universally affected in ASD, due to a complex of shared and unshared causal factors. There is an urgent need for more research especially into the characteristics and causes of clinically significant language impairments.     

Adaptational process of parents of pediatric oncology patients

This study, based on grounded theory, explores the adaptational process of parents of pediatric oncology patients. Thirty-two Taiwanese parents (26 mothers and 6 fathers) were interviewed. Data were collected through individual in-depth and focus group interviews, observations, medical chart review, nurses' note, and researchers' reflexive journals. The findings suggest that parents adapt to their children's cancer by a dynamic process; i.e., they modify their coping tasks and related strategies as clinical events (e.g., diagnosis, side effects, relapses, or death) occur. This adaptational process consisted of five components: confronting treatment, maintaining family integrity, establishing support, maintaining emotional well-being, and searching for spiritual meaning. Related factors such as coping tasks are described.     

Pre-attack stress-load, appraisals, and coping in children's responses to the 9/11 terrorist attacks

BACKGROUND: Appraisal and coping following a disaster are important factors in children's post-traumatic stress (PTS) symptoms. However, little is known about predictors of disaster coping responses. This study examined stress-load, appraisals and coping styles measured prior to the September 11 terrorist attacks as predictors of 9/11-specific appraisals, coping and PTS. METHODS: A community sample of children and parents (N = 143) participating in an ongoing study were interviewed by phone approximately 1 month following 9/11. RESULTS: Pre-attack stress-load, appraisal and coping styles predicted children's 9/11-specific appraisals, coping, and PTS. 9/11-specific threat appraisals and avoidant coping predicted higher PTS and mediated the effects of pre-attack stress-load and threat appraisal. CONCLUSIONS: Pre-disaster stress-load, appraisal and coping styles predict disaster-specific appraisal and coping, which in turn, contribute to PTS. Coping interventions might mitigate PTS symptoms following a disaster.     

A prospective study of the role of coping and family functioning in health outcomes for adolescents with sickle cell disease

Risk-and-resistance models identify factors that predict psychosocial adjustment to pediatric chronic illness, including sickle cell disease (SCD), but have not been applied to understand health outcomes. The study objectives were to examine prospectively the relationship of coping and family functioning with health outcomes for adolescents with SCD, accounting for sociodemographic and psychosocial risk. Forty-one adolescents and their families (41 primary caregivers, 9 second caregivers, and 15 healthy siblings) completed paper-and-pencil measures of coping and family functioning at a baseline assessment (time 1). At both time 1 and time 2 (1 y later), disease severity, SCD complications, healthcare utilization, and average hemoglobin level were derived from medical file reviews. Time 1 disease-related parenting stress predicted time 2 health outcomes; however, there were no significant associations for coping. Families concordant in reporting lower family functioning had teens with increased disease severity and greater healthcare utilization. Examination of moderation of disease-related parenting stress by a risk index showed main effects for risk and for disease-related parenting stress for time 2 disease severity and time 2 healthcare utilization. Interaction effects were not significant. Efforts to explore specific mechanisms by which adaptive family functioning contributes to health outcomes for adolescents with SCD should continue, with particular attention to addressing the potential role of multiple sociodemographic and psychosocial risk variables.     

Do risk factors for problem behaviour act in a cumulative manner? An examination of ethnic minority and majority children through an ecological perspective

Background: Extensive research has identified risk factors for problem behaviour in childhood. However, most of this research has focused on isolated variables, ignoring possible additive influences. The purpose of this study was to examine whether risk factors for problem behaviour act in a cumulative manner, and to investigate whether cumulative risk stemming from distinct ecological levels ( Bronfenbrenner, 1979 ) differentially influences the manifestation of problem behaviours in middle childhood. In addition, ethnic differences between minority (i.e., Indian) and majority (i.e., English) families were examined. Methods: The sample consisted of 125 children (59 English and 66 of Indian origin) between the ages of 7 and 9.6 (M = 8.51, SD = .62) and their parents. Both mothers and fathers completed questionnaires regarding the children's problem behaviour and provided reports of the children's characteristics and environment. Children were also assessed and provided reports about themselves and their relationships. Finally, parent–child mutuality and parenting behaviour were coded from a videotaped parent–child interaction task. Results: Risk factors acted in a cumulative manner – the more risk children experienced, the more problem behaviour they exhibited. Total problem behaviour was predicted by all three levels: individual, microsystem and exosystem. However, externalising problems were mainly predicted by microsystem‐level cumulative risk, whereas internalising problems were predicted by both individual‐level cumulative risk and exosystem‐level cumulative risk. These results were similar for both ethnic groups. Conclusions: The support for the cumulative hypothesis highlights the importance of having a broad picture of children's characteristics and environmental components when analysing children's adjustment. The distinct influence of risk stemming from the different ecological levels suggests that the trajectories of internalising, externalising and total problem behaviour may be different.     

Heritability and prevalence of specific fears and phobias in childhood

Fears and phobias are relatively common in childhood. Both environmental and genetic theories have tried to explain the etiology behind these conditions. However, data supporting the different theories are sparse. To investigate the relative importance of genetic and environmental influences on specific phobias and fears, parental reports of animal, situational, and mutilation fears and phobias were completed for 1106 pairs of 8- to 9-year-old Swedish twins. The prevalence of specific phobias was 7.3% for boys and 10.0% for girls. Genetic. shared environmental, and nonshared environmental effects contributed to individual differences in fears and phobias in young children, but the magnitude of the effects differed between sexes. Shared environmental effects contributed to a general susceptibility for fearfulness. Genetic and nonshared environmental effects, on the other hand, contributed both to the general susceptibility and specific fearfulness, even though these effects primarily were fear specific. These results indicate that both heritable factors as well as environmental factors such as trauma, vicarious learning, and/or negative information are important for differences in fearfulness and phobias--at least in children.     

Psychological adjustment and coping in a population of children with recurrent syncope

The authors examined the association of psychological adjustment, styles of coping, and disease severity for children with recurrent syncope. Participants were 44 children and adolescents with a history of recurrent syncope and 40 healthy comparison control children. Dependent variables were measures of internalizing adjustment (e.g., anxiety, depression, withdrawal) reported by children and their parents and styles of coping reported by children. Parents reported higher frequencies of the internalizing of behavioral symptoms (i.e., anxiety, withdrawal) for children with recurrent syncope compared with their healthy counterparts. Children's self-reports did not reveal significant differences between the syncope and comparison groups in psychological adjustment and styles of coping. The authors conclude from these findings that adjustment difficulties, including symptoms of anxiety and social withdrawal, may occur with recurrent syncope. Implications for clinical practice and future research are discussed.     

The Impact of Childhood Non-malignant Life-threatening Illness on Parents: Gender Differences and Predictors of Parental Adjustment

Mental health, family functioning, effects on employment and relationships, coping style, and perceptions of prognosis were assessed in 93 mothers and 78 fathers of children with a life-threatening non-malignant condition. Results indicated high levels of psychological distress, significant effects upon employment and relationships, and a family environment characterised by low expressiveness, cohesion, and high conflict. Differences between mothers and fathers were found on a number of variables. Length of time since diagnosis, level of family cohesion, and sex of parent significantly predicted parental mental health.     

An analysis of individual, household, and environmental risk factors for intestinal helminth infection among children in Qena Governorate, Upper Egypt

During 1994 a cross-sectional survey was carried out on a sample representative of the population in Qena Governorate, Upper Egypt, to investigate the relationship between intestinal helminthic infection among children and a wide range of variables (demographic, behavioural, cultural, socioeconomic, and environmental). Data were collected by direct observation and by administering a questionnaire to mothers in charge of the household in a sample of 768 households representative of the entire population in the governorate. A stool sample survey was conducted at the same time on all children 2-12 years of age living in the selected households (n = 2657). Diagnosis of intestinal helminths was made on the basis of the Kato-Katz thick-smear technique. After univariate analyses, conducted to define associations among individual, familial, and community variables and prevalence of infection, the relevant variables were included in a multivariate logistic model to assess the importance of each factor as an independent determinant of infection. Several factors were independently associated with increased risk of intestinal helminth infection. In particular, the age of the child (between 4 and 5 years) (individual), the age of marriage for the mother (cultural), type of garbage disposal (household), and type of settlement (environmental) gave the highest predictive value for infection. The present results are consistent with those of former studies and highlight the importance of a multisectorial approach in the control of intestinal helminth infection.     

Social environment and vulnerability of low birth weight children: a social-epidemiological perspective

This study examined the impact of low birth weight on children's health and assessed the influence of the social environment on various aspects of health in low birth weight and normal birth weight children. Data on 8661 children aged 2 through 11 from the 1981 Child Health Supplement of the National Health Interview Survey provided strong evidence for two major conclusions: (1) Low birth weight children in high-risk social environments are at increased for poor health outcomes compared with comparable normal birth weight children. This vulnerability was found across all age groups, suggesting that the effects of low birth weight are long-lasting. The poor health outcomes for low birth weight children in high-risk social environments were found for all seven aspects of child health status studied: excessive bed days, restricted-activity days, and school-loss days; school failure, low school-ranking, behavior problems, and maternal perception of child health status as fair/poor. (2) The mechanism of risk was complex and differed by birth weight group. Whereas certain combinations of individual risk factors protected normal birth weight children from several adverse outcomes, none for low birth weight children were identified. However, low birth weight children in low- or moderate-risk social environments were not at greater risk for poor outcomes compared with comparable normal birth weight children. This study underscores the importance of a healthy social environment for children who are already at high risk for poor health outcomes by virtue of being low birth weight.     

FAMILY AND SCHOOL INFLUENCES ON BEHAVIOURAL DEVELOPMENT

Research findings are reviewed with respect to possible family and school influences on behavioural development, but with special reference to socially disapproved conduct. The hypothesis that statistical associations between environmental variables and children's disorders represent causal connections is considered in terms of the three main alternatives--hereditary influences, the effect of children on their parents, and the operation of some third variable. It is concluded that each has some validity but that nevertheless there are true environmental effects. The mechanisms underlying their operation are discussed with respect to parental criminality, family discord, weak family relationships, ineffective discipline, and peer group influences. Individual differences in response to adversity are discussed in terms of age, sex, temperament, genetic factors, coping processes, patterning of stressors, compensatory good experiences and catalytic factors. The various ways in which environmental effects may persist over time are considered in terms of linkages within the environment as well as within the child. It is concluded that long-term effects are far from independent from intervening circumstances.     

The Psychological Impact of War and the Refugee Situation on South Sudanese Children in Refugee Camps in Northern Uganda: An Exploratory Study

This paper presents the results of an exploratory study on the psychosocial effects of the war situation and subsequent flight on South Sudanese children who were compared to a group of Ugandan children who did not have these experiences of war and flight. In addition to the independent variables such as sociodemographic variables and traumatic events and daily life stress, the dependent variable psychological consequences--according to parents and children themselves--as well as the influence of the mediating factors of social support and coping behaviour are presented. Results showed that Sudanese refugee children had experienced significantly more traumatic events and suffered more daily hassles than the Ugandese comparison group. They were less satisfied with the social support they received. At the same time, they used more coping modes. Compared to Ugandan children, the Sudanese reported significantly more PTSD-like complaints, behavioural problems, and depressive symptoms.     

Coping patterns in mothers/caregivers of children with chronic feeding problems.

INTRODUCTION: In this study, with use of the Coping Health Inventory for Parents (CHIP), coping behaviors were examined in 35 mothers/ caregivers of children with chronic feeding problems during hospitalization for treatment of these problems. Coping in families of children with these problems has not been addressed in research. This information is beneficial in planning and implementing treatment and follow-up services. METHOD: Correlations and t tests were used to look at variables related to the mothers'/caregivers' coping patterns and to compare their frequency of usage of these patterns. RESULTS: The mothers/caregivers in this study were most likely to cope with their child's feeding problems by making active attempts to understand the problems and by doing activities with family members. Several child and family variables were significantly related to maternal coping patterns. DISCUSSION: These results suggest that it is important to provide a variety of resources to families of children with chronic feeding problems during their children's hospitalizations, including access to support and information groups. The results also suggest that it is beneficial for these families to acquire a thorough understanding of their child's medical situation because this understanding seems to help them in their ability to cope.