Health-related quality of life in parents of school-age children with Asperger Syndrome or High-Functioning Autism

Quality of life in mothers of preschoolers with high-functioning pervasive developmental disorders

BACKGROUND

Parents of children with pervasive developmental disorders (PDD) are likely to experience serious distress. The aims of this study were to (i) assess distress among mothers of preschoolers with high-functioning PDD (HFPDD); and (ii) examine its relation to the child's behavioral characteristics.

METHODS

Participants were 30 mothers of preschoolers with HFPDD, and 30 mothers of a matched control group. Short Form 36 Health Survey Questionnaire (version 2), and the Strengths and Difficulties Questionnaire were used for assessment. The children's autistic traits were assessed using the total number of items for the DSM-IV-TR autistic disorder diagnosis.

RESULTS

Mothers in the HFPDD group were more distressed mentally than physically. Neither physical nor mental distress in the group was related to the child's autistic traits, while their mental distress was significantly related to the child's behavior problems.

CONCLUSIONS

Mothers in the HFPDD group were at increased risk of impaired mental wellbeing. Maternal mental distress in the group was significantly related to general behavior problems, but not to autistic traits in the child.

Caregiver burden and preventive dental care use for US children with special health care needs: a stratified analysis based on functional limitation

The objectives of this study were to evaluate the association between caregiver burden and preventive dental care use for children with special health care needs (CSHCN) and assess if caregiver burden explains the relationship between child- and family-level characteristics and preventive dental care use. Samples of US CSHCN ages 3-17 years with a functional limitation (n = 7,559) and those without (n = 26,345) were derived from the 2005-2006 National Survey of CSHCN. We generated structural equation models, stratified by functional limitation, to describe the relationships between caregiver burden and preventive dental utilization. We measured caregiver burden using six items on whether the child's health condition impacted work, time spent on health management, and finances. About 80.9 % of CSHCN used preventive dental care. Higher levels of caregiver burden were associated with significantly lower odds of preventive dental care use for CHSCN with a functional limitation (β = -0.06; P < 0.001) and those without (β = -0.07; P < 0.001). For CSHCN with a functional limitation, family poverty and being uninsured were significantly associated with greater caregiver burden and less preventive dental use. Findings were similar for CSHCN without a functional limitation, except that lower caregiver education was also associated with greater caregiver burden and less preventive dental care use. Caregiver burden is potential barrier to preventive dental care use for CSHCN and explains the relationship between child- and family-level characteristics and preventive dental care use. Interventions to improve the oral health of CSHCN should include strategies to reduce caregiver burden, especially within socioeconomically vulnerable families.

Differences in empowerment and quality of life among parents of children with food allergy

BACKGROUND

Living with food allergy has been found to adversely affect quality of life. Previous studies of the psychosocial impact of food allergy on caregivers have focused on mothers.

OBJECTIVE

To describe differences in food allergy-related quality of life (FAQOL) and empowerment of mothers and fathers of a large cohort of children with food allergy.

METHODS

Eight hundred seventy-six families of children with food allergy were studied. Food allergy was defined by stringent criteria, including reaction history, skin prick testing, and specific IgE. Parental empowerment and FAQOL were assessed by the adapted Family Empowerment and FAQOL-Parental Burden scales. Parental scores were compared by Wilcoxon signed rank test. Multiple regression models examined the association of parental empowerment with FAQOL.

RESULTS

Mothers reported greater empowerment (P < .001) and lower FAQOL (P < .001) compared with fathers, regardless of allergen severity, type, or comorbidities. However, parental empowerment was not significantly associated with FAQOL for mothers or fathers. Although parents of children with peanut, cow milk, egg, and tree nut allergies were similarly empowered, milk and egg allergies were associated with lower FAQOL (P < .01). Parental concern in the QOL assessment was greatest for items involving fear of allergen exposure outside the home.

CONCLUSION

Parental empowerment and FAQOL vary significantly among mothers and fathers of children with food allergy. Greater effects on FAQOL were seen for milk and egg compared with other food allergies. Although parents of children with food allergy might be empowered to care for their child, they continue to experience impaired FAQOL owing to fears of allergen exposure beyond their control.

Multidisciplinary parent education for caregivers of children with autism spectrum disorders

This quasi-experimental study aimed to determine the effectiveness of a multidisciplinary parent education program focused on improving health-related quality of life (HRQOL) for caregivers of children with autism spectrum disorders (ASD). This study included 42 participants (22 intervention, 20 wait-list control) who were the main caregivers of children with ASD. Data were collected at baseline and post-intervention. At the end of the multidisciplinary parent education program, significant improvements were observed in the mental HRQOL, family functioning, self-efficacy and positive coping style. The results indicate that a multidisciplinary parent education program, designed for caregivers of children with ASD, may have positive effects on caregivers' mental health-related quality of life, while having little effect on their physical health-related quality of life.

Mental health services for individuals with high functioning autism spectrum disorder

Adolescents and adults with an autism spectrum disorder (ASD) who do not have an intellectual impairment or disability (ID), described here as individuals with high-functioning autism spectrum disorder (HFASD), represent a complex and underserved psychiatric population. While there is an emerging literature on the mental health needs of children with ASD with normal intelligence, we know less about these issues in adults. Of the few studies of adolescents and adults with HFASD completed to date, findings suggest that they face a multitude of cooccurring psychiatric (e.g., anxiety, depression), psychosocial, and functional issues, all of which occur in addition to their ASD symptomatology. Despite this, traditional mental health services and supports are falling short of meeting the needs of these adults. This review highlights the service needs and the corresponding gaps in care for this population. It also provides an overview of the literature on psychiatric risk factors, identifies areas requiring further study, and makes recommendations for how existing mental health services could include adults with HFASD.

Benefits of exenatide on obesity and non-alcoholic fatty liver disease with elevated liver enzymes in patients with type 2 diabetes

BACKGROUND

The purpose of this study was to evaluate the advantages of exenatide treatment on obesity and non-alcoholic fatty liver disease (NAFLD) with elevated liver enzymes in patients with type 2 diabetes (T2D).

METHODS

A total of 60 newly diagnosed patients with obesity, NAFLD with elevated liver enzymes and T2D were included in the study. The patients were randomly divided into two groups. The exenatide treatment group (n = 30) were treated with exenatide and insulin glargine, and the intensive insulin therapy group (n = 30) were treated with insulin aspart and insulin glargine for 12 weeks. Selected clinical characteristics were determined, and ultrasonography was performed at both baseline and 12 weeks following treatment.

RESULTS

At baseline, the clinical characteristics were matched between the two groups. After 12 weeks, fasting blood glucose (FBG), postprandial blood glucose (PBG), glycosylated haemoglobin (HbA1c), total cholesterol (TC), triglyceride (TG) and total bilirubin levels were significantly decreased in the two groups (p < 0.001). Body weight and waist circumference were significantly decreased in the exenatide group but increased in the intensive insulin group (p < 0.001). The levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and γ-glutamyl transpeptidase (γGGT) in the exenatide group were significantly lower than in the intensive insulin group (p < 0.001). The mean body weight change correlated with the levels of ALT, AST and γGGT change (ALT, r = 0.761; AST, r = 0.733; γGGT, r = 0.752; p < 0.001). Moreover, the reversal rate of fatty liver was significantly higher in the exenatide group (93.3%) than the intensive insulin group (66.7%) (p < 0.01).

CONCLUSIONS

Exenatide has a better hepatic-protective effect than intensive insulin therapy and perhaps represents a unique option for adjunctive therapy for patients with obesity, non-alcoholic fatty liver disease with elevated liver enzymes and T2D.

Health and well-being in midlife parents of children with special health needs

The objectives of this study were to delineate variation in mental and physical health outcomes over a 10-year period among parents with a child with special health needs as compared to parents of a typically developing child; and evaluate the possible protective effects of parental perceived control and social support. The sample consisted of 646 parents from the longitudinal Midlife Development in the United States (MIDUS) study. Nearly one-quarter of the sample (n = 128; 22.3%) reported having a child with a special health care need. Cross-sectional analyses indicated that parents of a child with special care needs reported poorer self-rated mental health, greater depressive symptoms, and more restrictions in instrumental activities of daily living (IADL). Parents of a child with special health care needs had greater increases in depressive symptoms over time and greater declines in instrumental activities of daily living than parents of typically developing children. Perceived control was a robust predictor of all health outcomes over time. The added stressors of parenting a child with special health needs may undermine the long-term health of parents. Behavioral interventions and clinical practices that facilitate parental perceived control may enable resilience and better health.

Self-assessed health in caregivers of persons with autism spectrum disorder: associations with depressive symptoms, positive cognitions, resourcefulness, and well-being

PURPOSE

Caregiving for children with autism spectrum disorder (ASD) can affect family caregivers' self-assessed health. The purpose of this study was to determine whether depressive symptoms, positive cognitions, resourcefulness, and well-being will differ significantly among those who rated their health as fair, good, or excellent.

DESIGN AND METHODS

This study is a secondary analysis of 109 ASD caregivers who were recruited from the Interactive ASD Network.

FINDINGS

Depression was significantly lower among those who rated their health as excellent than among those who rated their health as fair. Positive cognitions, resourcefulness, and well-being were significantly higher among those who rated their health as excellent than among those who rated their health as fair.

PRACTICE IMPLICATIONS

Interventions to enhance caregivers' positive cognitions, resourcefulness, and well-being are recommended.

Family impacts among children with autism spectrum disorder: the role of health care quality

OBJECTIVE

To compare health care quality and family employment and financial impacts among children with special health care needs (CSHCN) with autism spectrum disorder (CSHCN + ASD), CSHCN with functional limitations (CSHCN + FL), and CSHCN lacking these conditions (other CSHCN); to test whether high health care quality was associated with reduced family impacts among CSHCN + ASD.

METHODS

Data from the 2009-2010 National Survey of CSHCN were used to compare 3025 CSHCN + ASD, 6505 CSHCN + FL, and 28,296 other CSHCN. Weighted multivariate logistic regression analyses examined 6 age-relevant, federally defined health care quality indicators and 5 family financial and employment impact indicators. Two composite measures were additionally used: 1) receipt of care that met all age-relevant quality indicators; and 2) had ≥ 2 of the 5 adverse family impacts.

RESULTS

Across all health care quality indicators, CSHCN + ASD fared poorly, with only 7.4% meeting all age-relevant indicators. CSHCN + ASD had worse health care quality than other CSHCN, including CSHCN + FL. CSHCN + ASD also had high rates of adverse family impact, with over half experiencing ≥ 2 adverse impacts. Rates of adverse family impact were higher in CSHCN + ASD than other CSHCN, including CSHCN + FL. Among CSHCN + ASD, those whose health care that met federal quality standards were less likely to have multiple adverse family impacts than CSHCN + ASD whose health care did not meet federal quality standards.

CONCLUSIONS

CSHCN + ASD are more prone to experience poor health care quality and family impacts than other CSHCN, even CSHCN + FL. Receipt of care meeting federal quality standards may potentially lessen adverse family impacts for CSHCN + ASD.

Psychometric properties of the Parenting Stress Index with parents of children with autistic disorder

PURPOSE

The purpose of this study was to examine the psychometric properties and the theoretical structure of the Parenting Stress Index-short form (PSI-SF) with Jordanian parents of children with autistic disorder.

METHODS

Using a cross-sectional design for data collection, the convenience sample of the study was composed of 184 Jordanian parents of children with autistic disorder. The factor structure for the PSI-SF was examined using confirmatory and exploratory factor analyses.

RESULTS

We found that the modified three-factor model (30 items) fits the data significantly better than the 36-item model. The results showed that the 12 items of the Parental Distress sub-scale support the original scale structure. However, items in the Parent-Child Dysfunctional Interaction and Difficult Child sub-scales did not show stability in their structure. The results in this study showed that the PSI-SF in its 30-item model has endorsed the necessary validity of the scale with parents of children with autistic disorder. The study provides information on the effects of Arab culture on the validity of PSI-SF.

CONCLUSION

It is recommended to use the new factors structure of the PSI-SF with the 30 items in the studies that intend to examine the stress among parents with children with autistic disorder in the Arab world.

Quality of life in children and adolescents with autism spectrum disorders: what is known about the effects of pharmacotherapy?

A diagnosis of autistic spectrum disorder (ASD), now estimated to affect one in 88 children, requires deficits in social communication and interactions, and restricted interests and/or repetitive behaviors. Almost all children with ASD have deficits in adaptive skills, many have intellectual disability, and others have co-occurring psychiatric disorders or symptoms. Thus, this complex disorder has shown to have a substantial impact on patients' quality of life (QoL) and that of their families. Medication treatment is considered by clinicians and families to address problems with functioning due to psychiatric problems, and, as such, one-third of children and adolescents with ASD take at least one psychotropic medication and many use complementary and alternative medicine. This paper reviews what is known about the benefits and risks of psychotropic medications on the QoL of children with ASD. Although scarce, there are studies of psychiatric medications in autistic patients that include QoL measures, such as the pediatric studies of aripiprazole for irritability and one adult study of oxytocin. The aripiprazole study showed a positive effect on QoL in treated patients, as did the oxytocin study. Several other psychotropic medications are used in the treatment of children with ASD, and although information is available on the risks and benefits of each, we do not have specific data on the QoL impact of these medications. The aripiprazole and oxytocin studies exemplify how researchers can include QoL measures and use this information to guide clinicians. Additionally, we will recommend areas of further study in pharmacotherapy and QoL research in the context of treating children with ASD.

Conceptualisation and development of a quality of life measure for parents of children with autism spectrum disorder

Parents of children with autism spectrum disorder (ASD) tend to experience greater psychological distress than parents of typically developing children or children with other disabilities. Quality of Life (QoL) is increasingly recognised as a critical outcome measure for planning and treatment purposes in ASD. There is a need for ASD-specific QoL measures as generic measures may not capture all relevant aspects of living with ASD. This paper describes the conceptualisation and development of an autism-specific measure of QoL, the Quality of Life in Autism Questionnaire (QoLA) for parents and caregivers of children with ASD, that is suitable to clinical and research settings. Preliminary psychometric properties (reliability and validity) of the measure are also presented. The QoLA has 48 items in two subscales: one comprising QoL items and the second a parent report of how problematic their child's ASD symptoms are. A study involving 39 families suggested the QoLA has excellent internal consistency as well as good known-groups validity between parents of children with ASD and those who were typically developing. The QoLA also showed good convergent validity with other measures of QoL and ASD symptom severity, respectively. The QoLA may be a valuable assessment tool and merits further psychometric evaluation.

Health-related quality of life after cardiac surgery--the effects of age, preoperative conditions and postoperative complications

BACKGROUND

Factors influencing the postoperative health-related quality of life (HRQOL) after cardiac surgery have not been well described yet, mainly in the older people. The study's aim was to explore differences in clinical conditions and HRQOL of patients before and after cardiac surgery taking into account the influence of age and to describe factors influencing changes of HRQOL in the postoperative period.

METHODS

This was a prospective consecutive observational study with two measurements using the SF-36 questionnaire before surgery and 1 year after surgery. It considered main clinical characteristics of participants prior to surgery as well as postoperative complications.

RESULTS

At baseline assessment the study considered 310 patients, predominantly male (69%). Mean age was 65 (SD 10.4) years and 101 patients (33%), who were older than 70, constituted the older group. This older group showed greater comorbidity, higher cardiac operative risk and lower HRQOL in the preoperative period as well as a higher prevalence of postoperative complications than the younger group. Thirty-day mortality was 1.4% in the younger group and 6.9% in the older group (p < 0.001). One year mortality was 3.3% in the younger group and 10.9% in the older group (p < 0.001). There was a significant improvement in all 8 health domains of the SF-36 questionnaire (p < 0.001) in the overall sample. There was no significant difference in change in a majority of HRQOL domains between the younger and the older group (p > 0.05). Logistic multivariate analysis identified a higher values of preoperative PCS (Physical component summary) scores (OR 1.03, CI 1.00 - 1.05, p = 0.0187) and MCS (Mental component summary) scores (OR 1.02, CI 0.997 - 1.00, p = 0.0846) as the only risk factors for potential non-improvement of HRQOL after cardiac surgery after correction for age, gender and type of surgery.

CONCLUSIONS

Older patients with higher operative risk have lower preoperative HRQOL but show a similar improvement in a majority of HRQOL domains after cardiac surgery as compared with younger patients. The multivariate analysis has shown the higher preoperative HRQOL status as a only significant factor of potential non-improvement of postoperative HRQOL.

The impact on Iranian mothers and fathers who have children with an autism spectrum disorder

BACKGROUND

To date, most research with families who have a child with autism spectrum disorder (ASD) has been undertaken in English-speaking countries. Increased levels of stress allied with poorer health have been commonly reported for mothers, with less attention paid to fathers. This study aimed to document the personal impact on Iranian mothers and fathers and identify the correlates of increased stress and poorer emotional well-being.

METHOD

In all, 103 parents (58 mothers and 45 fathers) from 74 families who had a child with ASD volunteered to take part in the study. Each participant completed through interview, standardised rating scales of parenting stress, emotional well-being and family functioning as well as rating their child's autistic symptoms, including stereotyped behaviours.

RESULTS

Mothers had significantly higher scores than fathers on measures of stress and emotional well-being. Although these variables were highly correlated, binary logistic regression identified that the poorer health was also associated with lower educational levels of the parents, more behavioural problems with the child and fewer autistic symptoms overall. A similar regression analysis of stress scores identified no gender differences but found that lower stress was associated with mothers and fathers who were joint caregivers and when the family lived with relatives.

CONCLUSIONS

Iranian parents experience broadly similar responses to parents in other countries, which suggests that the impact of ASD outweighs any cultural differences that might otherwise be present in parental responses to caring for children. In common with families internationally, these parents are likely to benefit from opportunities to become better informed about ASD and the management of their child at home allied with increased support from families and friends.

The association between child autism symptomatology, maternal quality of life, and risk for depression

Parents raising children with autism spectrum disorders (ASDs) have been shown to experience high levels of stress and report a lower quality of life. The current study examined the association between child autism symptomatology, mother's quality of life, and mother's risk for depression in a sample of 1,110 mothers recruited from a web-based registry of families with children with an ASD. Higher autism symptomatology and a greater number of co-occurring psychiatric disorders in the child were associated with an increased risk for current treatment of maternal depression and a lower maternal quality of life. The results highlight the importance of screening for depression, particularly in mothers of children with ASD and mental health and behavioral challenges.

Parenting stress in parents of children with cochlear implants: relationships among parent stress, child language, and unilateral versus bilateral implants

Little attention has been focused on stress levels of parents of children with cochlear implants (CIs). This study examined the stress experience of 70 parents of children with CIs by comparing stress levels in this group of parents to those in parents of children without disabilities, identifying primary stressors, examining the relationship between parent stress and child language, and comparing stress in parents of children with bilateral and unilateral CIs. Parents completed a parent stress questionnaire, and the receptive vocabulary and language abilities of the children were evaluated. Results indicated that these parents had a higher incidence of stress than the normative population. Parent stress levels and child language outcomes were negatively correlated. Child behavior and lack of spousal and social support were the prime causes of parent stress. Parents of children with bilateral CIs were significantly less stressed than were parents of children with unilateral CIs.

Reducing maladaptive behaviors in preschool-aged children with autism spectrum disorder using the early start denver model

The presence of maladaptive behaviors in young people with autism spectrum disorder (ASD) can significantly limit engagement in treatment programs, as well as compromise future educational and vocational opportunities. This study aimed to explore whether the Early Start Denver Model (ESDM) treatment approach reduced maladaptive behaviors in preschool-aged children with ASD in a community-based long day care setting. The level of maladaptive behavior of 38 children with ASD was rated using an observation-based measure on three occasions during the intervention: on entry, 12 weeks post-entry, and on exit (post-intervention) over an average treatment duration of 11.8 months. Significant reductions were found in children's maladaptive behaviors over the course of the intervention, with 68% of children showing a treatment response by 12 weeks and 79% on exit. This change was accompanied by improvement in children's overall developmental level as assessed by the Mullen scales of early learning, but not by significant changes on the Vineland Adaptive Behavior Scales-II or Social Communication Questionnaire. Replication with a larger sample, control conditions, and additional measures of maladaptive behavior is necessary in order to determine the specific factors underlying these improvements; however, the findings of the present study suggest that the ESDM program may be effective in improving not only core developmental domains, but also decreasing maladaptive behaviors in preschool-aged children with ASD.

Caregiver's burden and psychosocial issues in alternating hemiplegia of childhood

Alternating hemiplegia of childhood (AHC) is rare disorder characterised by recurrent attacks of hemiplegia followed by developmental delay. We investigated the parental perceptions and psychosocial issues of AHC. Using a questionnaire sent to the French AHC association, we investigated families' concerns and needs of support. Additionally, we evaluated the impact of this disease.

RESULTS

We analysed 47 questionnaires from 30 families. At time of diagnosis, the concern of the parents was highest for the hemiplegic spells and abnormal eye movements. These concerns decreased over time. The highest concern at the time of the study was the outcome of the patients with an emphasis on cognitive consequences and the level of autonomy. The results showed that AHC has a significant impact on families.

INTERPRETATION

Our data enhance how the explanation of the disease by healthcare professional is important. This study also highlights the need for family support over time.

Lack of institutional support entails disruption in cortisol awakening response in caregivers of people with high-functioning autism

Several studies have found disruptions in cortisol awakening response in informal caregivers. Institutional support may modulate these effects, and this study analyses how the health of caregivers is affected when institutional support is provided for families of people with high-functioning autism. Self-reported health, depression and cortisol awakening response were analysed in three groups: supported caregivers, non-supported caregivers and non-caregivers. Non-supported caregivers presented higher somatic symptoms and lower cortisol awakening response than the supported caregiver and non-caregiver groups. A high number of somatic symptoms and low functionality of offspring were related to a lower cortisol awakening response only in the non-supported caregiver group. These findings demonstrate the importance of institutional support for improving the health of caregivers.

Recreational participation of children with High Functioning Autism

The recreation of children with High Functioning Autism (HFA) is not well understood. The objective of this cross-sectional study was to compare the recreational engagement of children with HFA and their typically developing peers. Children with HFA (n = 30) and peers (n = 31) were similar on key characteristics that may impact recreation except those related to the HFA attributes. Children with HFA differed from peers in terms of diversity (p = .002), social aspects (p = .006) and locations (p < .001) of recreation. The two groups were not statistically different in personal intensity (p = .684), enjoyment (p = .239) or preferences (p = .788) of recreation. A recreational profile was developed to benefit parents and clinicians in supporting the recreation of these children.

Health utility assessment using EQ-5D among caregivers of children with autism

OBJECTIVES

Health utility of caregivers of children with autism was assessed by using the EuroQol five-dimensional (EQ-5D) questionnaire. Utility scores of autism caregivers were compared with norms for the general adult US population. Predictors of health utility were identified.

METHODS

A cross-sectional online survey design was used. Caregivers registered with the Interactive Autism Network were approached for participation in the online survey. Three hundred and sixteen usable responses were received. Health utility among caregivers was calculated and compared with the US population norms by using Student's t test. Problems in EQ-5D questionnaire domains and utility scores were analyzed by study characteristics by using Kruskal-Wallis analysis of variance. Factors predicting health utility were identified by using ordinary least square regression.

RESULTS

Roughly 94% of the caregivers who participated in the study were females. As compared to their counterparts in the general US population, caregivers who were aged 18 to 44 years and were females had lower utility scores (P < 0.001). Significant differences in utility scores were observed among caregivers. When compared to males, females had lower health utility. Caregivers of lower socioeconomic status had lower utility scores and reported more problems in EQ-5D questionnaire domains than did those from higher socioeconomic status. Caregiver burden was inversely correlated with health utility. Caregiver physical and mental health status, objective strain, education, and relationship with the care recipient were found to significantly predict health utility (adjusted R(2) ~57%).

CONCLUSIONS

Autism caregivers had lower health utility than did the general adult US population. There is an immediate need to address health concerns among this growing population.

Quality of life in newly diagnosed children with specific learning disabilities (SpLD) and differences from typically developing children: a study of child and parent reports

INTRODUCTION

Research on quality of life (QoL) of school children with specific learning disabilities (SpLD) and their parents is scarce. The present study explores QoL deficits in newly diagnosed children with SpLD and their parents, in comparison to a similar age group of typically developing children. Possible associations between parental and child QoL were statistically explored in both groups of children.

METHODS

70 newly diagnosed children with SpLD [International Classification of Diseases-10 (ICD-10) criteria] (38 boys, 32 girls, mean age 10.1 years) and a control group of 69 typically developing children of the same age (40 boys, 29 girls, mean age 10.6 years) were recruited. Children were of normal intelligence quotient, attending mainstream schools. Their parents were also recruited so a child's scores could be associated with corresponding parental scores (mother or father). Children's QoL was assessed by the German questionnaire for measuring quality of life in children and adolescents (KINDL(R) ) questionnaire and parental QoL by World Health Organization Quality of Life brief questionnaire (WHOQOL-BREF) of the World Health Organization.

RESULTS

Children with SpLD in comparison to typically developing children reported according to the KINDL(R) measurement poorer emotional well-being, lower self-esteem and satisfaction in their relationships with family and friends. Surprisingly, school functioning was not reported by these children as an area of concern. Parents of children with SpLD indicated experiencing lower satisfaction in the WHOQOL-BREF domains of social relationships and environment. Correlational and regression analysis with parental-child QoL scores provided evidence that in the SpLD group, parental scores on WHOQOL-BREF social relationships and psychological health domains could be predictors of the child's emotional well-being, satisfaction with family, friends and school functioning. Stepwise regression analysis verified the effect of parents' WHOQOL-BREF social relationships domain on several dimensions of children's KINDL(R) QoL.

CONCLUSIONS

  The results may suggest certain significant effects of the SpLD condition on newly diagnosed children's QoL. Emotional and social deficits seem to be experienced by this cohort of children and their parents. Investigation into the possible interrelationships between parental and child QoL seems to indicate that parental social wellbeing may to a certain extend influence some dimensions of the child's QoL. The findings are useful for policy making and specialized interventions for children with SpLD and their families.

Investigation of Quality of Life Determinants Among Mothers of Children with Pervasive Developmental Disorders in Iran

Objective/Background

The objective of the study was to examine the association between socio-economic status (SES), marital satisfaction, and subtypes of pervasive developmental disorders (PDDs) with quality of life (QOL) in mothers of children with PDDs.

Methods

The study was conducted using a convenience sample of 210 mothers of children with PDDs. Data were collected using the World Health Organization QOL-BREF, Index of Marital Satisfaction, and SES Questionnaires. Data analysis was done by analysis of variance and multivariate analysis of variance tests.

Results

The findings of the study showed that SES is associated strongly with the environmental domain (p < .001, r2 = .421), marital satisfaction with the social domain (p < .001, r2 = .394), and PDDs’ subtype with the psychological domain (p < .001, r2 = .283). Mothers of children with autistic disorder subtype reported lower QOL in all domains compared with other subtypes (p < .05).

Conclusion

The determinants such as SES, marital satisfaction, and subtypes of PDDs have an important influence on QOL of mothers of children with PDDs. Further investigation in this regard is warranted.

Lack of father involvement in research on children with autism spectrum disorder: maternal parenting stress and family functioning

Autism spectrum disorder (ASD) has an estimated prevalence of greater than 1% of people in the U.S. Caring for children with ASD is stressful and challenging for parents. The purpose of the study is to understand the ramifications of the findings of a spouse/father's lack of participation for a study focused on stress and family functioning that attempted to recruit both parents of a child with ASD. The Kruskal-Wallis test compared medians of three groups of mothers of children with ASD in order to assess differences in parenting stress and family functioning discrepancy depending on their marital status and spouse survey participation. There were differences across the groups of mothers of children with ASD for the discrepancy in expectations for help, from the participants' spouse or relatives, with family tasks, meeting the demands of other work responsibilities, child care, challenging behaviors, and school absences. Mothers of children with ASD are at risk for isolation and stress from negotiating family functions with the fathers of the children. Health care providers can assess for stress and family functioning and may anticipate different needs based on marital status and by father's involvement in decision-making.

Qualidade de vida em irmãos de crianças incluídas no espectro do autismo

OBJETIVO: Avaliar a qualidade de vida em irmãos de crianças com espectro do autismo por meio da autorresposta ao questionário da World Health Organization Quality of Life (WHOQOL-A). MÉTODOS: Foram coletados dados sociodemográficos de 77 crianças com diagnósticos incluídos no espectro do autismo, com idades entre 3 e 16 anos. A partir destes, foram selecionados 21 irmãos mais velhos, com idades entre 16 e 30 anos, os quais responderam ao questionário WHOQOL-abreviado, elaborado pelo Programa de Saúde Mental da Organização Mundial de Saúde para avaliação da qualidade de vida. RESULTADOS: Os dados indicaram diferença entre o domínio Meio Ambiente e os domínios Psicológico e Físico. CONCLUSÃO: Os aspectos relacionados ao meio ambiente têm importante papel na percepção da qualidade de vida autorreferida pelos sujeitos. Porém, a individualidade familiar, as estratégias de enfrentamento, o suporte social e a assistência recebida influenciam diretamente esta percepção.

Parent and family impact of autism spectrum disorders: a review and proposed model for intervention evaluation

Raising a child with an autism spectrum disorder (ASD) can be an overwhelming experience for parents and families. The pervasive and severe deficits often present in children with ASD are associated with a plethora of difficulties in caregivers, including decreased parenting efficacy, increased parenting stress, and an increase in mental and physical health problems compared with parents of both typically developing children and children with other developmental disorders. In addition to significant financial strain and time pressures, high rates of divorce and lower overall family well-being highlight the burden that having a child with an ASD can place on families. These parent and family effects reciprocally and negatively impact the diagnosed child and can even serve to diminish the positive effects of intervention. However, most interventions for ASD are evaluated only in terms of child outcomes, ignoring parent and family factors that may have an influence on both the immediate and long-term effects of therapy. It cannot be assumed that even significant improvements in the diagnosed child will ameliorate the parent and family distress already present, especially as the time and expense of intervention can add further family disruption. Thus, a new model of intervention evaluation is proposed, which incorporates these factors and better captures the transactional nature of these relationships.

Children with developmental disabilities at a pediatric hospital: staff education to prevent and manage challenging behaviors

Children with developmental disabilities may get frustrated in unpredictable hospital environments. Frustration may escalate to challenging behaviors, which are a safety concern and may contribute to staff and patient injuries, use of restraints, and procedure delay or cancelations. The purpose of this article was to describe a pilot staff education program on preventing and managing challenging behaviors of children with developmental disabilities at a pediatric hospital. The 2-hour-long education (1 hour on-line and 1 hour instructor led) content focused on family-centered care and communication skills, including verbal judo™ modified for use in the health care setting. Participants in the instructor-led sessions reported improved knowledge and decreased fear about caring for children with developmental disabilities. Relationships of the education and fewer staff injuries, fewer canceled procedures, and decreased use of restraints merit further study.

The association between stress and physical health in parents caring for children with intellectual disabilities is moderated by children’s challenging behaviours

The present study examined the moderating role of social support and challenging behaviour on the stress–physical health relationship in parents caring for children with intellectual disabilities. Parents of children with intellectual disabilities ( n = 70) reported more physical health problems compared to control parents ( n = 45) and were more likely to visit their general practitioner. Furthermore, challenging behaviours, but not social support, moderated this association: parents of children with intellectual disabilities reported poorer physical health when both challenging behaviours and stress were perceived to be high. These findings suggest that interventions need to be directed towards ameliorating the impact of challenging behaviours.

Resilience in family members of persons with autism spectrum disorder: a review of the literature

Worldwide, caregivers find caring for children with Autism Spectrum Disorder (ASD) challenging. Family members must manage many aspects of care giving, which is demanding, overwhelming, and can affect the family members' mental health. However learning how to be resilient may help family members overcome the stress and burden associated with caring for a person with ASD. A search was completed in Medline, PsycINFO, Proquest, Web of Science, and CINAHL using the key words "autism," "caregivers," "mothers," and "fathers," alone and in combination. Inclusion criteria were English language articles reporting studies with samples of children with ASD, as distinct from children with other intellectual or developmental disabilities. Fifty-eight articles that met these inclusion criteria were summarized and, from those, the authors selected 22 articles that included indicators of resilience. This integrative review highlights current research on resilience in adult family members of persons with ASD. Indicators of resilience, risk factors, protective factors, and outcomes of resilience were identified. The review indicates that parents of children with ASD who possess indicators of resilience are better able to manage the adversity associated with caring for children with ASD. Thus, enhancing resilience among family members of persons with autism may be beneficial to both the caregivers and care recipients.

Health-related quality of life in Iranian women with different levels of physical activity

Purpose

One of the most significant current discussions is the effect of different levels of physical activity on health-related quality of life (HRQOL), but there have been no studies in Iran which investigate this issue. The aim of this study was to investigate the relationship between the level of physical activity and HRQOL in Iranian women.

Methods

This was an analytical cross-sectional study conducted from October 2010 to January 2011 in Karaj's gymnasiums. We selected gymnasiums using simple randomized sampling. The validated Persian short form 36-item HRQOL questionnaire version 2.0 (SF-36 v2) and the short form of the International Physical Activity Questionnaire were used for data collection. Based on IPAQ, participants were classified into two groups: one with a high level of physical activity (N=240) and another with a moderate level (N = 120).

Results

The group with a high level of physical activity had significantly higher vitality scores (P=0.01) and lower role limitation-physical scores (P=0.02) than the group with a moderate level. The high level of physical activity was associated with considerably higher scores in general health (73.94 ± 0.99 vs.70.82 ± 1.33) (P=0.06) and mental well-being (73.94 ± 1.18 vs.70.88 ± 1.82) (P=0.1) domains than moderate level.

Conclusions

It seems that the high level of physical activity, compared with the moderate level, tends to have positive association with more domains of SF-36 v2.

Quality of life of parents raising children with pervasive developmental disorders

BACKGROUND

It has been reported that parents of children with pervasive developmental disorders (PDDs) face higher levels of stress. The aims of the present study were; (i) to evaluate the quality of life (QOL) of parents caring for their children with PDDs, and (ii) to explore the correlates of their QOL.

METHODS

A consecutive sample of parents of children with PDDs aged 6 to 15 were approached. The MOS 36-item Short-Form Health Survey (SF-36) was used to measure the QOL of the parents by eight subscales and two summary measures. Parents' personality and marital relationships were assessed with the NEO Five Factor Inventory and the Intimate Bond Measure, respectively. We characterized the parents' SF-36 profiles in comparison with the national normative scores and explored variables which correlated with their summary measures.

RESULTS

Participants were 147 mothers and 122 fathers of 158 children with PDDs. Mothers had significantly lower scores in the areas of Role Physical (RP) Social functioning (SF), General health perceptions (GH), Vitality (VT), Role emotional (RE) and Mental Health (MH) than those among the general female population. The maternal mental component summary (MCS) was also significantly lower, but maternal physical component summary (PCS) and paternal PCS and MCS scores were not lower. Maternal PCS and MCS scores were both significantly associated with the high Care and the low Control scores, but regarding fathers only the paternal PCS scores were significantly associated with the low Control scores. Maternal PCS and MCS and paternal MCS scores were significantly associated with the high Agreeableness scores and the low Neuroticism scores. Multiple regressions have shown that Neuroticism was significantly related to the low MCS scores of mothers and fathers. Next, Care was related to maternal high PCS, and Control was related to maternal low MCS and paternal low PCS.

CONCLUSIONS

The mothers of children with PDDs had lower QOL scores than those of the Japanese general population especially in mental domains. Impairment of the maternal QOL is significantly associated with the personality tendency of the parents and relationships with their partners.

Autism spectrum disorders: a review of measures for clinical, health services and cost-effectiveness applications

Autism spectrum disorders (ASDs) are characterized by impairments in social interaction, communication and behavioral functioning that can affect the health-related quality-of-life outcomes of the affected child and the family. ASDs have increased in prevalence, leading to a demand for improved understanding of the comparative effectiveness of different pharmacologic, behavioral, medical and alternative treatments for children as well as systems for providing services. This review describes outcome instruments that can be used for clinical, health services and cost-effectiveness applications. There is a pressing need to identify the most appropriate instruments for measuring health-related quality-of-life outcomes in this population. Studies evaluating the cost-effectiveness of interventions or treatments for children with ASDs using the cost per quality-adjusted life year metric are lacking. Researchers have the potential to contribute greatly to the field of autism by quantifying outcomes that can inform optimal treatment strategies.

Psychiatric comorbidities in asperger syndrome and high functioning autism: diagnostic challenges

Several psychiatric conditions, both internalizing and externalizing, have been documented in comorbidity with Asperger Syndrome (AS) and High Functioning Autism (HFA). In this review we examine the interplay between psychiatric comorbidities and AS/HFA. In particular, we will focus our attention on three main issues. First, we examine which psychiatric disorders are more frequently associated with AS/HFA. Second, we review which diagnostic tools are currently available for clinicians to investigate and diagnose the associated psychiatric disorders in individuals with AS/HFA. Third, we discuss the challenges that clinicians and researchers face in trying to determine whether the psychiatric symptoms are phenotypic manifestations of AS/HFA or rather they are the expression of a distinct, though comorbid, disorder. We will also consider the role played by the environment in the manifestation and interpretation of these symptoms. Finally, we will propose some strategies to try to address these issues, and we will discuss therapeutic implications.

Health-Related Quality of Life in Children with Developmental Coordination Disorder and Their Parents

This study measured health-related quality of life (HRQOL) in children with developmental coordination disorder (DCD) and their parents. A convenience sample of 369 children with DCD (144 girls; mean age: 11.2 ± 3.66 years) and 360 children with typical development (146 girls; mean age: 11.4 ± 4.09 years) was enrolled. The Bruininks—Oseretsky Test of Motor Proficiency-Second Edition was used to classify the DCD group into five levels of motor abilities. The HRQOL of the children was assessed with the Child Health Questionnaire-Parent Form 50, and the HRQOL of the parents was assessed with the 12-Item Short Form Health Survey (SF-12), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). Although the two groups had comparable physical health, the DCD group had significantly lower HRQOL in all psychosocial domains. The degree to which HRQOL is reduced is related to motor proficiency. Compared to parents of typically developing children, parents of children with DCD had significantly lower HRQOL ( p < .05 for both SF-12 and BAI). HRQOL of the parents was unassociated with the motor proficiency of the children. DCD significantly affects multiple HRQOL domains in both the child with DCD and the parents.

Longitudinal associations between teasing and health-related quality of life among treatment-seeking overweight and obese youth

OBJECTIVES

To examine concurrent and prospective associations between perceptions of teasing and health-related quality of life (HRQOL) over the course of a behavioral/educational intervention and the subsequent year in a sample of overweight and obese children and adolescents.

METHOD

A clinical sample of 93 overweight or obese youths (ages 7-17 years) and 1 parent/guardian completed measures of teasing and HRQOL at pre- and posttreatment and follow-up assessments. Structural equation modeling was used to examine the factor structure of the measures and to assess prospective associations over a 15-month period.

RESULTS

Results indicate that, concurrently, weight-related teasing is inversely associated with HRQOL and that, prospectively, HRQOL is inversely associated with subsequent teasing.

CONCLUSIONS

Study findings are suggestive of a directional relationship with lower quality of life predicting subsequent higher levels of teasing. Results suggest the potential for interventions designed to improve HRQOL to reduce teasing experiences for overweight and obese youth.

Autism in developing countries: lessons from iran

Most research into Autism Spectrum Disorders has been conducted in affluent English-speaking countries which have extensive professional support services. This paper describes a series of investigations that was undertaken in Iran, and these findings, together with reviews of research in other low-income countries, are used to identify key lessons in three areas of service provision of particular relevance to developing countries with scarce professional resources: first, the issues to be considered in establishing the prevalence of the condition nationally; second, identification of parental understanding of ASD and the impact it has on them as carers; third, the education and training that could be provided to families when professional supports are sparse. It is concluded that culturally sensitive, parental support strategies must be central to the planning and development of services. Moreover, future research should further elucidate the needs of families and evaluate the impact of culturally tailored interventions designed to promote the children's development and overall family quality of life.

Developing and refining the Taiwan Birth Cohort Study (TBCS): five years of experience

The Taiwan Birth Cohort Study (TBCS) is the first nationwide birth cohort database in Asia designed to establish national norms of children's development. Several challenges during database development and data analysis were identified. Challenges include sampling methods, instrument development and statistical approach to missing data. The purpose of this paper is to describe the pilot study underpinning the TBCS, testing of the TBCS developmental instrument and the resolution of methodological challenges. Bayesian analysis fill in missing data, three-step regression analysis for the investigation of mediating and moderating effect, the use of structural equation modeling in a large scale investigation, investigating direct and indirect effects, confounding factors and reciprocal relationships in children's development, and used latent growth model in longitudinal observations are described. The TBCS will provide ongoing longitudinal information regarding the predisposing and maintaining factors affecting the long term outcome of pediatric illnesses.