1
|
Kaufmann WE, Percy AK, Neul JL, Downs J, Leonard H, Nues P, Sharma GD, Bartolotta TE, Townend GS, Curfs LMG, Mariotti O, Buda C, O'Leary HM, Oberman LM, Vogel-Farley V, Barnes KV, Missling CU. Burden of illness in Rett syndrome: initial evaluation of a disorder-specific caregiver survey. Orphanet J Rare Dis 2024; 19:296. [PMID: 39138481 PMCID: PMC11323357 DOI: 10.1186/s13023-024-03313-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 08/06/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Rett syndrome (RTT) is a severe X-linked neurodevelopmental disorder associated with multiple neurologic impairments. Previous studies have shown challenges to the quality of life of individuals with RTT and their caregivers. However, instruments applied to quantify disease burden have not adequately captured the impact of these impairments on affected individuals and their families. Consequently, an international collaboration of stakeholders aimed at evaluating Burden of Illness (BOI) in RTT was organized. METHODS Based on literature reviews and qualitative interviews with parents of children and adults with RTT, a caregiver questionnaire was constructed to evaluate 22 problems (inclusive of core characteristics, functional impairments, and comorbidities) often experienced with RTT, rated mainly with a 5-level Likert scale. The questionnaire was administered anonymously online to an international sample of 756 caregivers (predominantly parents) of girls and women with RTT. Descriptive statistics were used to identify problems of high frequency and impact on affected individuals and caregivers. Chi-square tests characterized the relationship between problem severity and impact responses, while nonparametric ANOVAs of raw and z-score adjusted scores identified agreement between severity and impact on individual and caregiver. Secondary inferential tests were used to determine the roles of age, clinical type, and country of residence on BOI in RTT. RESULTS There was variability in reported frequency of problems, with the most prevalent, severe and impactful being those related to the core features of RTT (i.e., communication and fine and gross motor impairments). Chi-square analyses demonstrated interdependence between severity and impact responses, while ANOVAs showed that many problems had disproportionately greater impact than severity, either on affected individuals (e.g., hand stereotypies) or their caregivers (e.g., sleep difficulties, seizures, pain, and behavioral abnormalities). With certain exceptions (e.g., breath-holding, seizures), age, clinical type, or country of residence did not influence these BOI profiles. CONCLUSIONS Our data demonstrate that core features and related impairments are particularly impactful in RTT. However, problems with mild severity can also have disproportionate impact on affected individuals and, particularly, on their caregivers. Future analyses will examine the role of factors such as treatment outcomes, healthcare services, and healthcare provider's perspectives, in these BOI profiles.
Collapse
Affiliation(s)
- Walter E Kaufmann
- Anavex Life Sciences Corp, New York, NY, USA.
- Emory University School of Medicine, Atlanta, GA, USA.
| | - Alan K Percy
- University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Jeffrey L Neul
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jenny Downs
- Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia
| | - Helen Leonard
- Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia
| | - Paige Nues
- International Rett Syndrome Foundation (IRSF), Cincinnati, OH, USA
| | | | | | | | | | | | - Claude Buda
- Rett Syndrome Association of Australia (RSAA), Grovedale, VIC, Australia
| | | | - Lindsay M Oberman
- National Institute of Mental Health Intramural Research Program, National Institutes of Health, Bethesda, MD, USA
| | | | | | | |
Collapse
|
2
|
Larsen JL, Hansson H, Bisgaard AM, Stahlhut M. Psychological aspects of being a parent of an individual with Rett syndrome: A scoping review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13188. [PMID: 38369306 DOI: 10.1111/jar.13188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 09/28/2023] [Accepted: 12/09/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND Rett syndrome (RTT) causes multiple disabilities with a lifelong need for substantial care, placing a tremendous lifelong responsibility on the parents. Parenting an individual with RTT can therefore be challenging. Research on the psychological aspects of parenting individuals with RTT is limited and unclear. We aimed to identify and map the existing literature on this subject. METHOD A scoping review was conducted with systematic searches in PubMed, PsycINFO and CINAHL. RESULTS Eighteen studies were included. Negative and positive psychological aspects were described with the majority focusing on the negative. Three factors seemed to especially affect the parents: severity of the diagnosis, time (increasing age of parents or individual with RTT; years of caretaking), work-status of the mother. CONCLUSIONS Seemingly, parents are highly affected; however, the literature is scarce and has several gaps. Future research should include older parents, fathers, parents of individuals living in group homes, and positive aspects.
Collapse
Affiliation(s)
- Jane Lunding Larsen
- Department of Pediatrics and Adolescent Medicine, Center for Rett Syndrome, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Helena Hansson
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Marie Bisgaard
- Department of Pediatrics and Adolescent Medicine, Center for Rett Syndrome, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Michelle Stahlhut
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| |
Collapse
|
3
|
Chi Z, Devine RT, Wolstencroft J, Skuse D, Hughes C, Baker K. Rare neurodevelopmental conditions and parents' mental health - how and when does genetic diagnosis matter? Orphanet J Rare Dis 2024; 19:70. [PMID: 38360654 PMCID: PMC10870533 DOI: 10.1186/s13023-024-03076-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 02/03/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Parents of individuals with rare neurodevelopmental conditions and intellectual disabilities (ID) are vulnerable to mental health difficulties, which vary between parents and within parents over time. The underlying cause of a child's condition can influence parents' mental health, via uncertain pathways and within unknown time-windows. RESULTS We analysed baseline data from the IMAGINE-ID cohort, comprising 2655 parents of children and young people with ID of known genetic origin. First, we conducted a factor analysis of the SDQ Impact scale to isolate specific pathways from genetic aetiology to parents' mental health. This suggested a two-factor structure for the SDQ Impact scale, with a "home & distress" dimension and a "participation" dimension. Second, we tested via structural equation modelling (SEM) whether genetic diagnosis affects Impact and mental health directly, or indirectly via children's characteristics. This analysis identified an indirect pathway linking genetic aetiology to parents' mental health, serially through child characteristics (physical disabilities, emotional and behavioural difficulties) and Impact: home & distress. Third, we conducted moderation analysis to explore the influence of time elapsed since genetic diagnosis. This showed that the serial mediation model was moderated by time since diagnosis, with strongest mediating effects among recently diagnosed cases. CONCLUSIONS There are multiple steps on the pathway from ID-associated genetic diagnoses to parents' mental health. Pathway links are strongest within 5 years of receiving a genetic diagnosis, highlighting opportunities for better post-diagnostic support. Recognition and enhanced support for children's physical and behavioural needs might reduce impact on family life, ameliorating parents' vulnerabilities to mental health difficulties.
Collapse
Affiliation(s)
- Zhaotian Chi
- MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, CB2 7EF, Cambridge, UK
| | - Rory T Devine
- School of Psychology, University of Birmingham, Birmingham, UK
| | | | - David Skuse
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Claire Hughes
- Centre for Family Research, Department of Psychology, University of Cambridge, Cambridge, UK
| | - Kate Baker
- MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, CB2 7EF, Cambridge, UK.
- Department of Medical Genetics, University of Cambridge, Cambridge, UK.
| |
Collapse
|
4
|
Downs J, Ludwig NN, Wojnaroski M, Keeley J, Schust Myers L, Chapman CAT, Hecker J, Conecker G, Berg AT. What does better look like in individuals with severe neurodevelopmental impairments? A qualitative descriptive study on SCN2A-related developmental and epileptic encephalopathy. Qual Life Res 2024; 33:519-528. [PMID: 38064015 PMCID: PMC10850209 DOI: 10.1007/s11136-023-03543-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 02/08/2024]
Abstract
PURPOSE There are limited psychometric data on outcome measures for children with Developmental Epileptic Encephalopathies (DEEs), beyond measuring seizures, and no data to describe meaningful change. This study aimed to explore parent perceptions of important differences in functional abilities that would guide their participation in clinical trials. METHODS This was a descriptive qualitative study. Semi-structured one-on-one interviews were conducted with 10 families (15 parent participants) with a child with a SCN2A-DEE [8 male, median (range) age 7.5 (4.5-21)] years. Questions and probes sought to understand the child's functioning across four domains: gross motor, fine motor, communication, and activities of daily living. Additional probing questions sought to identify the smallest differences in the child's functioning for each domain that would be important to achieve, if enrolling in a traditional therapy clinical trial or in a gene therapy trial. Data were analyzed with directed content analysis. RESULTS Expressed meaningful differences appeared to describe smaller developmental steps for children with more limited developmental skills and more complex developmental steps for children with less limited skills and were different for different clinical trial scenarios. Individual meaningful changes were described as important for the child's quality of life and to facilitate day-to-day caring. CONCLUSION Meaningful change thresholds have not been evaluated in the DEE literature. This study was a preliminary qualitative approach to inform future studies that will aim to determine quantitative values of change, applicable to groups and within-person, to inform interpretation of specific clinical outcome assessments in individuals with a DEE.
Collapse
Affiliation(s)
- Jenny Downs
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, PO Box 855, West Perth, WA, 6872, Australia.
- Curtin School of Allied Health, Curtin University, Perth, Australia.
| | - Natasha N Ludwig
- Department of Neuropsychology/Psychiatry and Behavioral Sciences, Kennedy Krieger Institute/Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Mary Wojnaroski
- Department of Psychiatry and Behavioral Health/Pediatrics, Nationwide Children's Hospital/Ohio State University, Columbus, OH, USA
| | - Jessica Keeley
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, PO Box 855, West Perth, WA, 6872, Australia
| | | | | | - JayEtta Hecker
- DEEP Connections/SCN8A Alliance Wishes for Elliott, Washington, DC, USA
| | | | - Anne T Berg
- FamilieSCN2A Foundation, E. Longmeadow, MA, USA
- DEEP Connections/SCN8A Alliance Wishes for Elliott, Washington, DC, USA
- Department of Neurology, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
5
|
Niarchou M, Cunningham AC, Chawner SJRA, Moulding H, Sopp M, Hall J, Owen MJ, van den Bree MBM. Psychopathology in mothers of children with pathogenic Copy Number Variants. J Med Genet 2023; 60:706-711. [PMID: 36446581 PMCID: PMC10359584 DOI: 10.1136/jmg-2022-108752] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 11/10/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Caring for children with pathogenic neurodevelopmental Copy Number Variants (CNVs) (ie, deletions and duplications of genetic material) can place a considerable burden on parents and their quality of life. Our study is the first to examine the frequency of psychiatric diagnoses in mothers of children with CNVs compared with the frequency of psychiatric problems in age-matched mothers from a large community study. METHODS Case-control study. 268 mothers of children with a CNV diagnosed in a medical genetics clinic and 2680 age-matched mothers taking part in the Avon Longitudinal Study of Parents and Children study. RESULTS Mothers of children with CNVs reported higher frequency of depression, anorexia, bulimia, alcohol abuse and drug addiction problems compared with the age-matched mothers from the community sample. Focusing on psychiatric problems arising immediately after the birth of the index child, we found that the levels of depression symptoms were similar between the two groups (48% in mothers of children with CNVs vs 44% in mothers of the community sample, p=0.43), but mothers of children with CNVs had higher frequency of anxiety symptoms (55%) compared with mothers from the community sample (30%, p=0.03). CONCLUSION Our study highlights the need for healthcare providers to devise treatment plans that not only focus on meeting the child's needs but also assess and, if needed, address the mental health needs of the parent.
Collapse
Affiliation(s)
- Maria Niarchou
- Vanderbilt Genetics Institute, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adam C Cunningham
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Samuel J R A Chawner
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
- Centre for Human Development Science, School of Psychology, Cardiff University, Cardiff, UK
| | - Hayley Moulding
- Biotechnology and Biological Sciences Research Council, Swindon, UK
| | - Matthew Sopp
- Psychology Department, University of Southampton, Southampton, UK
| | - Jeremy Hall
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Michael J Owen
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Marianne B M van den Bree
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| |
Collapse
|
6
|
Rihm L, Dreier M, Rezvani F, Wiegand-Grefe S, Dirmaier J. The psychosocial situation of families caring for children with rare diseases during the COVID-19 pandemic: results of a cross-sectional online survey. Orphanet J Rare Dis 2022; 17:449. [PMID: 36572906 PMCID: PMC9791975 DOI: 10.1186/s13023-022-02595-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/07/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic is affecting many areas of life and has posed additional strains on the highly vulnerable group of caregivers of children with rare diseases (RDs). The psychosocial situation of the family caregivers deserves more attention, both in research and practice. The current study explores the distress level of caregivers of children with RDs, their psychosocial information needs, and caregiver-reported health-related quality of life (HRQoL) of children with RDs in times of the COVID-19 pandemic. METHODS Data from a cross-sectional online survey conducted within the German CARE-FAM-NET project (children affected by rare diseases and their families-network) between March and August 2020 were examined. The study sample included 149 family caregivers, mostly mothers (83.2%) of 167 children with RDs. The survey assessed demographic and disease-related characteristics, distress and everyday problems of caregivers (Distress Thermometer for Parents; scale 0-10), psychosocial information needs (self-developed items; scale 0-100), and caregiver-reported HRQoL of the children with RDs (DISABKIDS Chronic Generic Measure, short-form; scale 0-100). Using descriptive statistics, we analyzed the psychosocial situation of families during the COVID-19 pandemic. We further conducted correlation analysis to investigate interrelations. RESULTS The distress level among caregivers was high (M = 6.84, SD = 2.43); 89.6% reported clinical distress (≥ 4). Everyday problems (e.g., sleep problems, fatigue, being out of shape, fears, feeling tense or nervous, and worry) were frequent. Caregivers reported a wide range of psychosocial information needs. In about half of the children (49.5%), caregiver-reported HRQoL was low, while average HRQoL (M = 58.7, SD = 19.5) was comparable to parent-reported norm data of children with severe clinical conditions. Distress correlated positively with psychosocial information needs (r = 0.40), and negatively with the caregiver-reported HRQoL of the children (r = - 0.46). CONCLUSIONS This study indicates a high psychosocial burden on family caregivers of children with RDs during the early COVID-19 pandemic, characterized by high distress levels and wide-ranging everyday problems, unmet psychosocial information needs, and reduced caregiver-reported HRQoL in children with RDs. The findings highlight the ongoing need for target group-specific, low-threshold support services (e.g., websites) during and after the pandemic.
Collapse
Affiliation(s)
- Lydia Rihm
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Mareike Dreier
- grid.13648.380000 0001 2180 3484Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Farhad Rezvani
- grid.13648.380000 0001 2180 3484Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Silke Wiegand-Grefe
- grid.13648.380000 0001 2180 3484Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jörg Dirmaier
- grid.13648.380000 0001 2180 3484Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
7
|
Riches VC, O'Brien P, Manokara V, Mueller A. A study of caregiver support services: Perspectives of family caregivers of persons with intellectual disabilities in
Singapore. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2022. [DOI: 10.1111/jppi.12441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Vivienne C. Riches
- Centre for Disability Studies, an Affiliate of the Faculty of Medicine and Health University of Sydney Sydney New South Wales Australia
| | - Patricia O'Brien
- Centre for Disability Studies, an Affiliate of the Faculty of Medicine and Health University of Sydney Sydney New South Wales Australia
| | - Vimallan Manokara
- Movement for the Intellectually Disabled of Singapore (MINDS) Singapore Singapore
| | - Arne Mueller
- Centre for Disability Studies, an Affiliate of the Faculty of Medicine and Health University of Sydney Sydney New South Wales Australia
- Manchester Metropolitan University Manchester UK
| |
Collapse
|
8
|
Ak M, Akturk Z, Bowyer K, Mignon L, Pasupuleti S, Glaze DG, Suter B, Pehlivan D. Assessing the Burden on Caregivers of MECP2 Duplication Syndrome. Pediatr Neurol 2022; 133:1-8. [PMID: 35716604 DOI: 10.1016/j.pediatrneurol.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/23/2022] [Accepted: 05/13/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND MECP2 duplication syndrome (MDS) is a rare neurogenetic disorder characterized by severe neurodevelopmental disorder, refractory epilepsy, recurrent infections, and functional gastrointestinal problems. Because of the significant clinical problems and lifelong disability of children with this disorder we hypothesized that the burden on parents/caregivers of these children is significant. However, there are no reports of the impact on caregivers of individuals with MDS. METHODS We developed and validated a burden scale to investigate the challenges of caregivers of children and adults with MDS and identified factors contributing to the burden on caregivers. We developed a Health Insurance Portability and Accountability Act-compliant patient registry for families with MDS and delivered caregiver burden survey through the registry. RESULTS Of 237 completed surveys, 101 were eligible for the study. We identified increased levels of self-perceived anxiety, depression, and emotional exhaustion in caregivers that correlated with higher burden scores. Epilepsy was the only clinical feature that caused a higher burden in caregivers of individuals with MDS. In addition, a higher burden was found in Hispanic caregivers. The duration of care negatively correlated with burden score. CONCLUSIONS This is the first study to investigate the burden on caregivers of individuals with MDS and identify several factors contributing to increased burden. Addressing these concerns has the potential to improve the health of individuals with MDS and contribute to the well-being of their caretakers.
Collapse
Affiliation(s)
- Muharrem Ak
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Zekeriya Akturk
- Institute of General Practice and Health Services Research, School of Medicine, Technical University of Munich, Munich, Germany
| | | | | | - Sasidhar Pasupuleti
- Bioinformatics Core, Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, Texas
| | - Daniel G Glaze
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Blue Bird Circle Rett Center, Texas Children's Hospital, Houston, Texas
| | - Bernhard Suter
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Blue Bird Circle Rett Center, Texas Children's Hospital, Houston, Texas
| | - Davut Pehlivan
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Blue Bird Circle Rett Center, Texas Children's Hospital, Houston, Texas.
| |
Collapse
|
9
|
Robles‐Bello MA, Sánchez‐Teruel D. The Family-Centred Practices Scale: Psychometric properties of the Spanish version for use with families with children with Down syndrome receiving early childhood intervention. Child Care Health Dev 2022; 48:634-642. [PMID: 35048415 PMCID: PMC9306559 DOI: 10.1111/cch.12970] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 12/09/2021] [Accepted: 01/15/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Family-Centred Practices Scale (FCPS) assesses the degree to which staff in early childhood intervention and development centres use this therapeutic approach. However, there is no adaptation of this scale to families of children with Down syndrome, which is one of the most prevalent intellectual disabilities in early intervention. OBJECTIVES To validate and analyse the psychometric properties of the FCPS in Spanish parents with children with Down syndrome receiving early childhood intervention. METHODS Descriptive analyses, exploratory factor analysis (n = 131), confirmatory factor analysis (n = 126) and scale reliability analyses were performed. In addition, the invariance of the scale by parents' age and gender was assessed, and a longitudinal analysis of the scores was performed. RESULTS A new scale was obtained with a two-factor structure, similar to the original version, but with fewer items. Goodness-of-fit indices were excellent (root mean square error of approximation [RMSEA] [95% confidence interval {CI}] = 0.02 [0.01; 0.04]; comparative fit index [CFI] = 0.98; Tucker-Lewis index [TLI] = 0.97; root mean residual [RMR] = 0.02; goodness-of-fit index [GFI] = 0.91; adjusted GFI [AGFI] = 0.90). However, the measure was not gender invariant. Additionally, internal consistency of the two dimensions showed high values in this sample, and comparing the means between the two measurement time points (initial and at about 6 months) showed no differences; the test was powerful but had a very small effect size. CONCLUSIONS The psychometric properties of this FCPS are adequate, and it uses fewer items, which makes it faster to apply and gives it better clinical applicability. This new version of the scale is a valid, reliable tool for evaluating family-centred practices in Spanish families with children with Down syndrome.
Collapse
Affiliation(s)
| | - David Sánchez‐Teruel
- Faculty of PsychologyUniversity of GranadaGrandaSpain,Spanish Society of Clinical and Health PsychologyMadridSpain
| |
Collapse
|
10
|
Leonard H, Downs J, Benke TA, Swanson L, Olson H, Demarest S. CDKL5 deficiency disorder: clinical features, diagnosis, and management. Lancet Neurol 2022; 21:563-576. [PMID: 35483386 PMCID: PMC9788833 DOI: 10.1016/s1474-4422(22)00035-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 12/19/2021] [Accepted: 01/18/2022] [Indexed: 12/25/2022]
Abstract
CDKL5 deficiency disorder (CDD) was first identified as a cause of human disease in 2004. Although initially considered a variant of Rett syndrome, CDD is now recognised as an independent disorder and classified as a developmental epileptic encephalopathy. It is characterised by early-onset (generally within the first 2 months of life) seizures that are usually refractory to polypharmacy. Development is severely impaired in patients with CDD, with only a quarter of girls and a smaller proportion of boys achieving independent walking; however, there is clinical variability, which is probably genetically determined. Gastrointestinal, sleep, and musculoskeletal problems are common in CDD, as in other developmental epileptic encephalopathies, but the prevalence of cerebral visual impairment appears higher in CDD. Clinicians diagnosing infants with CDD need to be familiar with the complexities of this disorder to provide appropriate counselling to the patients' families. Despite some benefit from ketogenic diets and vagal nerve stimulation, there has been little evidence that conventional antiseizure medications or their combinations are helpful in CDD, but further treatment trials are finally underway.
Collapse
Affiliation(s)
- Helen Leonard
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.
| | - Jenny Downs
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia; Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Tim A Benke
- Department of Neurology, Children's Hospital Colorado, Aurora, CO, USA; Department of Pediatrics, University of Colorado at Denver, Aurora, CO, USA; Department of Pharmacology, University of Colorado at Denver, Aurora, CO, USA; Department of Neurology, University of Colorado at Denver, Aurora, CO, USA; Department of Otolaryngology, University of Colorado at Denver, Aurora, CO, USA
| | - Lindsay Swanson
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Heather Olson
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Scott Demarest
- Department of Neurology, Children's Hospital Colorado, Aurora, CO, USA; Department of Pediatrics, University of Colorado at Denver, Aurora, CO, USA; Department of Neurology, University of Colorado at Denver, Aurora, CO, USA
| |
Collapse
|
11
|
Improving clinical trial readiness to accelerate development of new therapeutics for Rett syndrome. Orphanet J Rare Dis 2022; 17:108. [PMID: 35246185 PMCID: PMC8894842 DOI: 10.1186/s13023-022-02240-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 02/06/2022] [Indexed: 12/16/2022] Open
Abstract
Rett syndrome is associated with severe functional impairments and many comorbidities, each in urgent need of treatments. Mutations in the MECP2 gene were identified as causing Rett syndrome in 1999. Over the past 20 years there has been an abundance of preclinical research with some studies leading to human clinical trials. Despite this, few viable therapeutic options have emerged from this investment of effort. Reasons for this lack of success as they relate both to preclinical research and the clinical trial landscape are discussed. Considering what needs to be done to promote further success in the field, we take a positive and constructive approach and introduce the concept of clinical trial readiness and its necessary ingredients for Rett syndrome. These include: listening to the needs of families; support from advocacy groups; optimising use of existing clinic infrastructures and available natural history data; and, finally, the validation of existing outcome measures and/or the development and validation of new measures. We conclude by reiterating the need for a collaborative and coordinated approach amongst the many different stakeholder groups and the need to engage in new types of trial design which could be much more efficient, less costly and much less burdensome on families.
Collapse
|
12
|
Leonard H, Junaid M, Wong K, Aimetti AA, Pestana Knight E, Downs J. Influences on the trajectory and subsequent outcomes in CDKL5 deficiency disorder. Epilepsia 2021; 63:352-363. [PMID: 34837650 DOI: 10.1111/epi.17125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 10/28/2021] [Accepted: 11/02/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The study investigated the effect of seizure and medication burden at initial contact with the International CDKL5 Disorder Database on subsequent development and clinical severity and compared quality of life among those whose development progressed, remained stable, or regressed between baseline and follow-up. METHODS The effects of seizure and medication burden at baseline (high or low) on the CDKL5 Disorder Severity Scores and CDKL5 Developmental Score (CDS) at follow-up were assessed using linear and negative binomial regressions, respectively, with adjustment for age at baseline, gender, and follow-up duration with and without genotype. Seizure and medication burden were defined by average daily seizure count (high, ≥5/day; low, <5/day) and number of antiseizure medications (high, ≥3/day; low, <3/day), respectively. The effects of change in CDS over time (improved, stable, or deteriorated) on Quality of Life Inventory-Disability (QI-Disability) total and domain scores at follow-up were assessed in those aged at least 3 years at follow-up using linear regression models with adjustment for baseline CDS, gender, and follow-up duration. RESULTS The expected follow-up CDS was lower for individuals with high compared to low seizure burden at baseline (β = -.49, 95% confidence interval [CI] = -.84 to -.13). The average total QI-Disability score was 5.6 (95% CI = -.2 to 11.5) points higher among those with improved compared with stable or deteriorating CDS and 8.5 (95% CI = 3.1-13.8) points lower for those with deteriorating compared to stable or improved CDS. SIGNIFICANCE Our finding that later development showed slight improvement in those with better earlier seizure control even after adjustment for genotype suggests that the trajectory for an individual child is not necessarily predetermined and could possibly be influenced by optimal seizure management. This has implications for children's quality of life.
Collapse
Affiliation(s)
- Helen Leonard
- Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia.,Faculty of Health and Medical Sciences, Centre of Child Health Research, University of Western Australia, Nedlands, Western Australia, Australia
| | - Mohammed Junaid
- Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Kingsley Wong
- Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | | | - Elia Pestana Knight
- Pediatric Epilepsy Section, Epilepsy Center, Cleveland Clinic, Neurological Institute, Cleveland, Ohio, USA
| | - Jenny Downs
- Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| |
Collapse
|
13
|
Mackay J, Nixon GM, Lafferty AR, Ambler G, Kapur N, Bergman PB, Schofield C, Seton C, Tai A, Tham E, Vora K, Crock P, Verge C, Musthaffa Y, Blecher G, Caudri D, Leonard H, Jacoby P, Wilson A, Choong CS, Downs J. Associations Between Hyperphagia, Symptoms of Sleep Breathing Disorder, Behaviour Difficulties and Caregiver Well-Being in Prader-Willi Syndrome: A Preliminary Study. J Autism Dev Disord 2021; 52:3877-3889. [PMID: 34498151 DOI: 10.1007/s10803-021-05265-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2021] [Indexed: 11/30/2022]
Abstract
Prader-Willi syndrome (PWS) is a rare genetic disorder characterised by neurodevelopmental delays, hyperphagia, difficulties with social communication and challenging behaviours. Individuals require intensive supervision from caregivers which may negatively affect caregiver quality of life. This study used data collected in the Australasian PWS Registry (n = 50, mean age 11.2 years) to evaluate associations between child behaviours and caregiver mental well-being. Symptoms of sleep-related breathing disorder, child depression and social difficulties were associated with poorer caregiver mental and physical well-being. Growth hormone therapy use was associated with better caregiver mental and physical well-being. Optimising management of problematic behaviours and sleep disturbances have the potential to support caregivers who are the most vital network of support for individuals affected by PWS.
Collapse
Affiliation(s)
- Jessica Mackay
- Telethon Kids Institute, The Centre for Child Health Research, The University of Western Australia, PO Box 855, West Perth, WA, 6872, Australia.,School of Medicine, The University of Western Australia, Crawley, WA, Australia.,Royal Perth Hospital, Perth, WA, Australia
| | - Gillian M Nixon
- Melbourne Children's Sleep Centre, Monash Children's Hospital, Clayton, Victoria, Australia.,Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Antony R Lafferty
- Paediatric Endocrinology and Diabetes Service, Department of Paediatrics, Canberra Hospital, Garran, Australia.,Paediatric and Child Health, ANU Medical School, Canberra ACT, Australia
| | - Geoff Ambler
- The Sydney Children's Hospitals Network, Westmead, NSW, Australia.,Discipline of Child and Adolescent Health, The University of Sydney, Camperdown, NSW, Australia
| | - Nitin Kapur
- Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia.,School of Clinical Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Philip B Bergman
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia.,Department of Paediatric Endocrinology & Diabetes, Monash Children's Hospital, Clayton, Victoria, Australia
| | - Cara Schofield
- Telethon Kids Institute, The Centre for Child Health Research, The University of Western Australia, PO Box 855, West Perth, WA, 6872, Australia
| | - Chris Seton
- Department of Sleep Medicine, Children's Hospital Westmead, Westmead, NSW, Australia.,Woolcock Institute of Medical Research, Sydney University, Camperdown, NSW, Australia
| | - Andrew Tai
- Respiratory and Sleep Department, Women's and Children's Hospital, North Adelaide, SA, Australia
| | - Elaine Tham
- Endocrinology and Diabetes Department, Women's and Children's Hospital, North Adelaide, SA, Australia
| | - Komal Vora
- Department of Paediatric Endocrinology and Diabetes, John Hunter Children's Hospital, Newcastle, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Patricia Crock
- Department of Paediatric Endocrinology and Diabetes, John Hunter Children's Hospital, Newcastle, NSW, Australia.,Hunter Medical Research Institute, Newcastle, NSW, Australia.,The Priority Research Centre GrowUpWell®, Newcastle, NSW, Australia
| | - Charles Verge
- Department of Endocrinology, Sydney Children's Hospital, Randwick, NSW, Australia.,School of Women's and Children's Health, The University of New South Wales, Sydney, NSW, Australia
| | - Yassmin Musthaffa
- Department of Endocrinology and Diabetes, Queensland Children's Hospital, South Brisbane, Queensland, Australia.,Department of Paediatrics, Logan Hospital, Brisbane, Queensland, Australia.,School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Greg Blecher
- Department of Sleep Medicine, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Daan Caudri
- Telethon Kids Institute, The Centre for Child Health Research, The University of Western Australia, PO Box 855, West Perth, WA, 6872, Australia.,Discipline of Paediatrics, School of Medicine, The University of Western Australia, Crawley, WA, Australia.,Department of Paediatric Pulmonology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Helen Leonard
- Telethon Kids Institute, The Centre for Child Health Research, The University of Western Australia, PO Box 855, West Perth, WA, 6872, Australia
| | - Peter Jacoby
- Telethon Kids Institute, The Centre for Child Health Research, The University of Western Australia, PO Box 855, West Perth, WA, 6872, Australia
| | - Andrew Wilson
- Telethon Kids Institute, The Centre for Child Health Research, The University of Western Australia, PO Box 855, West Perth, WA, 6872, Australia.,Discipline of Paediatrics, School of Medicine, The University of Western Australia, Crawley, WA, Australia.,Respiratory and Sleep Medicine, Perth Children's Hospital, Nedlands, WA, Australia.,Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Catherine S Choong
- Telethon Kids Institute, The Centre for Child Health Research, The University of Western Australia, PO Box 855, West Perth, WA, 6872, Australia.,Department of Endocrinology, Perth Children's Hospital, Nedlands, WA, Australia
| | - Jenny Downs
- Telethon Kids Institute, The Centre for Child Health Research, The University of Western Australia, PO Box 855, West Perth, WA, 6872, Australia. .,Curtin School of Allied Health, Curtin University, Perth, WA, Australia.
| |
Collapse
|
14
|
The effect of functioning on Quality of Life Inventory-Disability measured quality of life is not mediated or moderated by parental psychological distress. Qual Life Res 2021; 30:2875-2885. [PMID: 33939076 DOI: 10.1007/s11136-021-02855-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The measurement of quality of life (QOL) in children with intellectual disability often relies upon proxy report via caregivers. The current study investigated whether caregiver psychological distress mediates or moderates the effects of impairment on their ratings of QOL in children with intellectual disability. METHODS Caregivers of 447 children with an intellectual disability reported their child's day-to-day functioning, their own psychological distress using the Kessler Psychological Distress Scale, and the Quality of Life Inventory-Disability (QI-Disability), a measure of QOL for proxy report of a child's observable behaviours that indicate quality of life. Linear regression was used to assess the effects of the child's functional abilities on their QI-Disability score and causal mediation analysis to estimate the extent to which these effects were mediated by caregivers' psychological distress. RESULTS A minority of caregivers (n = 121, 27.1%) reported no psychological distress. Lower day-to-day functional abilities, such as being fully dependent on others to manage their personal needs were associated with lower total QOL scores. There was no significant mediation effect of caregiver psychological distress on the association between child functioning and total QOL scores. Moderation analyses revealed small and largely nonsignificant interaction coefficients, indicating that caregiver psychological distress did not influence the strength of the relationship between child functioning and total QOL scores. CONCLUSION Caregiver psychological distress did not mediate or moderate the relationship between the level of functional abilities and QOL in children with intellectual disability. QI-Disability measured observable child behaviours which may reduce the influence of caregiver factors on the accurate measure of QOL for children with intellectual disability.
Collapse
|
15
|
Fitzgerald J, Gallagher L. Parental stress and adjustment in the context of rare genetic syndromes: A scoping review. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2021; 26:1744629521995378. [PMID: 33866895 PMCID: PMC9168905 DOI: 10.1177/1744629521995378] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/24/2021] [Indexed: 06/10/2023]
Abstract
Chromosomal abnormalities are now considered a common cause of intellectual disability. With increased genetic testing, phenotyping and technological advancements, many new syndromes have been identified. This review sought to explore parental stress and adjustment in the context of rare genetic syndromes to evaluate their clinical impact. A systematic review of English peer-reviewed literature across three databases (PsycINFO, Medline, CINAHL) was completed and 69 articles were included. Parents of children with rare genetic syndromes experienced greater distress relative to other disabilities. Differences in parental wellbeing were syndrome-specific relative to ASD thus demonstrating the need to consider the contribution of syndrome-specific phenotypes. Child emotional and behavioural difficulties were the most consistent predictor of parental distress. Research reflecting other factors such as physical health, syndrome-specific behaviours, benefit finding and, parental appraisal in the context of a rare genetic aetiology is required in order to support parental adjustment in these conditions.
Collapse
Affiliation(s)
| | - Louise Gallagher
- Trinity College Dublin, Ireland; Children Health Ireland at Tallaght Hospital, Ireland;
Cherry Orchard Hospital, Ireland
| |
Collapse
|
16
|
Leonard H, Junaid M, Wong K, Demarest S, Downs J. Exploring quality of life in individuals with a severe developmental and epileptic encephalopathy, CDKL5 Deficiency Disorder. Epilepsy Res 2020; 169:106521. [PMID: 33341033 DOI: 10.1016/j.eplepsyres.2020.106521] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 11/02/2020] [Accepted: 11/29/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND CDKL5 Deficiency Disorder (CDD) is a rare genetic disorder caused by a mutation in the cyclin-dependent kinase-like 5 (CDKL5) gene. It is now considered to be a developmental and epileptic encephalopathy because of the early onset of seizures in association with severe global delay. Other features include cortical visual impairment, sleep and gastro-intestinal problems. Progress in clinical understanding, especially regarding the spectrum of functional ability, seizure patterns, and other comorbidities was initially slow but accelerated in 2012 with the establishment of the International CDKL5 Database (ICDD). Our aim was to use this data source to investigate quality of life (QOL) and associated factors in this disorder. METHOD A follow-up questionnaire was administered in 2018 to parents of children registered with the ICDD who had a pathogenic CDKL5 variant. QOL was assessed using QI Disability, an instrument, specifically developed to measure total and specific domains of QOL (physical health, positive emotions, negative emotions, social interaction, leisure and the outdoors (leisure) and independence) in children with intellectual disability. Associations with functional abilities, physical health, mental health and family factors were investigated, initially using univariate analyses followed by multivariate analyses for each of these groups with a final composite model which included the important variables identified from previous models. RESULTS Questionnaires were returned by 129/160 families with a child aged >3 years. Functional impairment, including lack of ability to sit, use hands and communicate had the greatest adverse impact on QOL. There were also some relationships with major genotype groupings. Individuals using three or more anti-epileptic medications had poorer QOL than those on one or no medication, particularly in the physical health domain. There was also variation by geographical region with those living in North America typically having the best QOL and those living in middle or lower income countries poorer QOL. CONCLUSION Although lower functional abilities were associated with poorer quality of life further research is needed to understand how environmental supports might mitigate this deficit. Comprehensive care and support for both the child and family have important roles to play in helping families to thrive despite the severity of CDD.
Collapse
Affiliation(s)
- Helen Leonard
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.
| | - Mohammed Junaid
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Kingsley Wong
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | | | - Jenny Downs
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| |
Collapse
|
17
|
Haseley A, Wallis K, DeBrosse S. Kleefstra syndrome: Impact on parents. Disabil Health J 2020; 14:101018. [PMID: 33189624 DOI: 10.1016/j.dhjo.2020.101018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 10/01/2020] [Accepted: 10/24/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Kleefstra syndrome (KS) is associated with developmental delay, autism, intellectual disability, psychosis, and regression. Research has not been conducted to assess the impact of KS on parents. OBJECTIVE/HYPOTHESIS A mixed-method study was conducted to assess the impact on parental well-being by evaluating parents' well-being, identifying factors of parental experience predicting well-being, and exploring the parental experience. METHODS Parents completed an online survey containing the PedsQL™ Family Impact Module (FIM) and a questionnaire created by the researchers. One-Way T-Test compared parents of children with KS to parents of children with Prader-Willi syndrome (PWS). Multiple linear regression used parents' total scale scores on PedsQL™ FIM to identify factors influencing parental well-being. Constant comparative analysis used open-ended responses to explore the parental experience of having a child with KS. RESULTS Parents of children with KS had statistically lower scores in daily activity and social functioning, but statistically higher scores in communication and emotional functioning compared to parents of children with PWS. However, the power was below 0.80, meaning additional research needs to be completed to confirm these findings. The linear multiple regression was not significant. Most importantly, the themes of establishing the diagnosis, importance of knowledge, sense of community, KS and relationships with others, how life changed, and what the future will hold, characterized the parental experience. CONCLUSIONS Knowledge and support were important to parents who had a child recently diagnosed with KS. Therefore, parents should be provided resources about KS and support groups at diagnosis.
Collapse
Affiliation(s)
- Alexandria Haseley
- Department of Genetics and Genome Sciences, Case Western Reserve University, Biomedical Research, 2109, Adelbert Rd Building, 6th FL, Cleveland, OH, USA.
| | - Kimberly Wallis
- Center for Human Genetics, University Hospitals Cleveland Medical Center, 11100 Euclid Ave #1500, Cleveland, OH, 44106, USA; Genetic Services, Akron Children's Hospital, 215 W Bowery St, Akron, OH, 44308, USA.
| | - Suzanne DeBrosse
- Department of Genetics and Genome Sciences, Case Western Reserve University, Biomedical Research, 2109, Adelbert Rd Building, 6th FL, Cleveland, OH, USA; Center for Human Genetics, University Hospitals Cleveland Medical Center, 11100 Euclid Ave #1500, Cleveland, OH, 44106, USA.
| |
Collapse
|
18
|
Glasson EJ, Buckley N, Chen W, Leonard H, Epstein A, Skoss R, Jacoby P, Blackmore AM, Bourke J, Downs J. Systematic Review and Meta-analysis: Mental Health in Children With Neurogenetic Disorders Associated With Intellectual Disability. J Am Acad Child Adolesc Psychiatry 2020; 59:1036-1048. [PMID: 31945412 DOI: 10.1016/j.jaac.2020.01.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/11/2019] [Accepted: 01/08/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The behavioral phenotype of neurogenetic disorders associated with intellectual disability often includes psychiatric comorbidity. The objectives of this systematic review and meta-analysis were to systematically review the prevalence of psychiatric disorders and symptoms in children and adolescents with these disorders and compare phenotypic signatures between syndromes. METHOD MEDLINE and PsycINFO databases were searched for articles from study inception to December 2018. Eligible articles were peer reviewed, were published in English, and reported prevalence data for psychiatric disorders and symptoms in children and adolescents aged 4 to 21 years using a formal psychiatric assessment or a standardized assessment of mental health symptoms. Pooled prevalence was determined using a random-effects meta-analysis in studies with sufficient data. Prevalence estimates were compared with general population data using a test of binomial proportions. RESULTS Of 2,301 studies identified for review, 39 articles were included in the final pool, which provided data on 4,039 children and adolescents. Ten syndromes were represented, and five were predominant: Down syndrome, 22q11.2 deletion syndrome, fragile X syndrome, Williams syndrome, and Prader-Willi syndrome. The Child Behavior Checklist was the most commonly used assessment tool for psychiatric symptoms. The pooled prevalence with total scores above the clinical threshold was lowest for Down syndrome (32% [95% confidence interval, 19%-44%]) and highest for Prader-Willi syndrome (74% [95% CI, 65%-82%]) with each syndrome associated with significantly higher prevalence than in the general population. Parallel trends were observed for the internalizing and externalizing domains and social subscale scores. CONCLUSION Differential vulnerability for psychiatric phenotype expression across the disorders was observed. Syndromes with higher levels of social ability or competence appear to offer relative protection against developing psychopathology. This preliminary finding merits further exploration.
Collapse
Affiliation(s)
- Emma J Glasson
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Nicholas Buckley
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Wai Chen
- Complex Attention and Hyperactivity Disorders Service, Perth, Australia; and the Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, The University of Western Australia, Perth, Australia
| | - Helen Leonard
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Amy Epstein
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Rachel Skoss
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Peter Jacoby
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | | | - Jenny Bourke
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Jenny Downs
- Telethon Kids Institute, The University of Western Australia, Perth, Australia; School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia.
| |
Collapse
|
19
|
Mori Y, Downs J, Wong K, Leonard H. Longitudinal effects of caregiving on parental well-being: the example of Rett syndrome, a severe neurological disorder. Eur Child Adolesc Psychiatry 2019; 28:505-520. [PMID: 30151799 DOI: 10.1007/s00787-018-1214-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 08/13/2018] [Indexed: 01/14/2023]
Abstract
Little longitudinal research has examined parental well-being in those with a child with specific genetic developmental disorder although the associated severe neurological impairments and multiple physical comorbidities likely place substantial burden of caregiving on the parent. We aimed to examine longitudinally the well-being of parents of individuals included in the Australian Rett Syndrome Database over the period from 2002 to 2011 using the Short Form 12 Health Survey. Residential remoteness, the child being a teenager at baseline, having frequent sleep disturbances or behavioural problems, and the type of MECP2 gene mutation were each associated with later poorer parental physical well-being scores. Being a single parent or on a low income was also associated with later poorer physical well-being, while the child having enteral feeding was associated with later poorer emotional well-being. Both the physical and emotional well-being of the parent improved if the child was living in out-of-home care. Our findings suggest that some opportunities do exist for clinicians to help optimise parental well-being. Being alert to the possibility and need for management of a child's sleep or emotional disturbance is important as is awareness of the additional likely parental burden as the child moves through adolescence into early adulthood and their need for additional support at that time. However, the findings also highlight the complex nature of parental well-being over time in parents of children with a severe neurological disorder and how they may be affected by a range of inter-related family and child factors.
Collapse
Affiliation(s)
- Yuka Mori
- Telethon Kids Institute, 100 Roberts Road, Subiaco, WA, 6008, Australia.,The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.,Department of Home Medical Treatment and Pediatrics, Osaka Developmental Rehabilitation Center, 5-11-21 Yamasaka Higashi-Sumiyoshi-ku, Osaka, 546-0035, Japan
| | - Jenny Downs
- Telethon Kids Institute, 100 Roberts Road, Subiaco, WA, 6008, Australia.,The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Building 408, Brand Drive, Bentley, WA, 6102, Australia
| | - Kingsley Wong
- Telethon Kids Institute, 100 Roberts Road, Subiaco, WA, 6008, Australia.,The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
| | - Helen Leonard
- Telethon Kids Institute, 100 Roberts Road, Subiaco, WA, 6008, Australia. .,The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.
| |
Collapse
|