Behavioral and mental health problems in adolescents with ADHD: Exploring the role of family resilience

Family management structural model for children with atopic dermatitis

PURPOSE

To construct a structural model of family management for children with atopic dermatitis.

DESIGN AND METHODS

In this cross-sectional study, data were collected using a structured questionnaire. Participants included primary caregivers of children aged 2-12 years who had received a medical diagnosis of atopic dermatitis and had been experiencing the condition for over three months. We used SPSS/WIN 26.0 to analyze the variables and AMOS 23.0 for structural equation modeling.

RESULTS

Family functioning resilience, social support, and family coping had significant direct effects on family management. Illness severity, illness duration, and family life difficulty indirectly influenced family management, demonstrating significant total effects. The severity and duration of atopic dermatitis, family life difficulty, family functioning resilience, social support, and family coping explained 78.9% of the model.

CONCLUSIONS

The final model was suitable for predicting family management for children with atopic dermatitis. By confirming mediating effects, this study contributes to enhancing family management through nursing interventions. These findings offer valuable insights for developing family-centered nursing strategies to improve family management for children with atopic dermatitis.

PRACTICE IMPLICATIONS

Nursing interventions targeting the alleviation of family management challenges and enhancement of family functioning resilience, social support, and family coping are pivotal for improving the well-being of children with atopic dermatitis. Furthermore, tailored intervention development must take into account not only the severity and illness duration of atopic dermatitis in children but also the characteristics of the family. Improving family nursing through such tailored interventions can help enhance children's health and quality of life.

Family resilience mediates exposure to adverse childhood experiences on insufficient sleep among children: findings from a population-based study

Background

Sleep plays a vital role in the well-being of children and adolescents. Researchers have identified adverse childhood experiences (ACEs) as an important factor associated with poor sleep among adolescents. The objective of this study was to examine the mediating role of family resilience on the association between ACEs and insufficient sleep among adolescents in the United States.

Methods

Data for this study came from the 2018-2019 National Survey of Children's Health (N = 28,097). The outcome variable in this study was insufficient sleep, and the main explanatory variable was exposure to ACEs. The mediating variable was family resilience. Data were analyzed using binary logistic regression.

Results

Based on parent reports, one in five (22.4%) adolescents did not meet the recommended sleep hours on an average night. About half of the adolescents had no ACEs, 24.2% had one ACE, and 14.6% had three or more ACEs. Controlling for the effect of other factors and family resilience, the odds of having insufficient sleep were 1.63 times higher for children exposed to three or more ACEs (AOR = 1.63, 95% CI = 1.30-2.05). Family resilience partially mediates the association between exposure to ACEs and insufficient sleep. Each additional increase in family resilience decreased the odds of having insufficient sleep by a factor of 12% (AOR = 0.88, 95% CI = 0.86-0.91).

Conclusions

Family resilience partially mediated exposure to ACEs on insufficient sleep. There are modifiable factors that may improve sleep outcomes among adolescents who have been exposed to adversity. Future research can help elucidate findings and establish the directionality of this association.

Discrepancies in perceived family resilience between adolescents with chronic illness and parents: using response surface analysis to examine the relationship with adolescents' psychological adjustment

BACKGROUND

This study aimed to explore discrepancies in adolescents with chronic illness and their parents' perceptions of family resilience, as well as the relationship between these differences and the psychological adjustment of adolescents with chronic illness.

METHODS

A cross-sectional study was conducted. A total of 264 dyads of parents (77.7% mothers, mean age 41.60 years, SD = 6.17) and adolescents (48.5% girls, mean age 12.68 years, SD = 2.11) with chronic illness were recruited through convenience sampling from three children's hospitals in Wenzhou, Hangzhou, and Shanghai, China between June 2022 and May 2023. The Chinese version of the Family Resilience Scale and the Psychological Adjustment Scale, which are commonly used measures with good reliability and validity, were employed to assess family resilience and psychological adaption, respectively. The data were analyzed using polynomial regression and response surface analysis.

RESULTS

Adolescents with chronic illness reported higher family resilience than their parents (t=-2.80, p < 0.05). The correlations between family resilience and adolescents' psychological adjustment reported by the adolescents (r = 0.45-0.48) were higher than parents (r = 0.18-0.23). In the line of congruence, there were positive linear (a1 = 1.09-1.60, p < 0.001) and curvilinear (a2=-1.38∼-0.72, p < 0.05) associations between convergent family resilience and adolescents' psychological adjustment. In the line of incongruence, when adolescents reported lower family resilience than parents, adolescents had a lower level of psychological adjustment (a3=-1.02∼-0.45, p < 0.05). Adolescents' sociability decreased when the perceived family resilience of parent-adolescent dyads converged (a4 = 1.36, p < 0.01).

CONCLUSION

The findings highlighted the importance of considering the discrepancies and congruence of family resilience in the parent-child dyads when developing interventions to improve the psychological adjustment of adolescents with chronic illness. Interventions aimed at strengthening family communication to foster the convergence of perceptions of family resilience in parent-adolescent dyads were warranted.

Family resilience and caregiver's well-being across different age groups of children with ADHD in the United States: a cross-sectional study

PURPOSE

This study aimed to investigate the impact of family resilience on caregiver well-being across various age groups of children diagnosed with ADHD (attention-deficit/hyperactivity disorder) groups (0-5, 6-11, and 12-17 years).

METHODS

Utilizing secondary data from the 2022 US National Survey of Child Health, this cross-sectional study involved 2,752 children who were formally diagnosed with ADHD. Statistical analysis included descriptive analysis, Spearman's rank correlation, chi-square tests, and linear regression, conducted using SPSS version 27.

RESULTS

The study revealed a moderate positive correlation (r=.35, p<.001) between family resilience and caregiver well-being. Controlling for covariates, family resilience accounted for 25.2%, 21.1%, and 22.1% of caregiver well-being variance in age groups 0-5, 6-11, and 12-17 years, respectively. Additionally, factors like employment status, family structure, and caregiver age showed varying influences on caregiver well-being across these developmental stages. A consistent pattern emerged across these age groups: unemployment and non-traditional family structures were associated with negative impacts on caregiver well-being, whereas older caregiver age positively influenced well-being.

CONCLUSION

This research underscores the importance of age-specific family resilience strategies to improve caregiver well-being and family interactions in ADHD contexts. Investigating these aspects through qualitative studies across various cultures could deepen our understanding of well-being and inform culturally sensitive interventions.

A systematic review of the use of the concept family resilience in interventions with families with children and young people

OBJECTIVE

To review the evidence on using family resilience as a concept in interventions by public health nurses/health visitors with families with children and young people as part of an evaluation of the evidence base for the Family Resilience Assessment Instrument and Tool (FRAIT). FRAIT was developed by University faculty with Health Visitors and a Community of Practice in Wales, and is used by Health Visitors in Wales with families with children under 5 years to assess family resilience.

METHOD

A standard Cochrane Systematic Review methodology was used to review published literature. A protocol (crd.york.ac.uk/PROSPERO/display_record.php?RecordID = 230845) was submitted to Prospero in September 2021, and reviewing began in January 2022. Title and abstract searching were undertaken 12 databases and results were captured using PRISMA and Excel spreadsheet. Second reviewers reviewed title and abstract screening, and full-text extraction.

RESULTS

Initial title screening brought back 1350 papers across 12 databases. Titles and abstract screening reduced these to 106, 44 papers were considered for full-text extraction, with 25 papers included for review.

DISCUSSION

Results demonstrated a focus on specific demographics, and use of family resilience with families living with specific health problems. Existing family resilience scales showed improved results in selected specific demographic groups, albeit in a reactive way. FRAIT has originality within the literature as it is used in a universal, preventative way with all families regardless of demographic or health issues. There is evidence to show that using a family resilience program in this way has originality and implications for the physical and mental health of children and young people.

NO PATIENT OR PUBLIC CONTRIBUTION

This was a systematic review of existing literature so public or patient contribution would not have been appropriate.

Patterns of Adverse Childhood Experiences and Psychiatric Disorders Among Adolescents with ADHD: A Latent Class Analysis

There is limited existing research on whether specific combinations of Adverse Childhood Experiences (ACEs) are associated with different psychiatric disorders among adolescents with ADHD. This study aimed to address this gap by identifying classes of ACEs and examining their association with behavioral problems, anxiety, and depression in adolescents with ADHD aged 11-17 (n = 1,806), using data from the 2018 National Survey of Children's Health (NSCH). A latent class analysis revealed a four-class solution: (1) low-risk ACEs (61.6%), (2) moderate-risk ACEs (25.2%), (3) high discrimination and neighborhood violence exposure (7.6%), and (4) high-risk ACEs (5.6%). The "high-risk ACEs" and the "high discrimination and neighborhood violence exposure" class showed a higher likelihood of behavioral problems and depression, and anxiety and depression respectively. These findings provide some insight into the ACE patterns that are more likely to be associated with mental health problems among adolescents with ADHD.

Family Resilience and Dyadic Coping during the Outbreak of the COVID-19 Pandemic in Italy: Their Protective Role in Hedonic and Eudaimonic Well-Being

The COVID-19 pandemic outbreak has dramatically worsened people's psychological well-being. Our aim was to examine for the first time the concurrent and longitudinal relations of family resilience with hedonic and eudaimonic well-being, and the moderating role of socio-demographics. For people having a romantic partner, we also explored whether family resilience and dyadic coping were uniquely related to well-being. One cross-sectional study (N = 325) and one 10-week follow-up study (N = 112) were carried out during the outbreak of the COVID-19 pandemic (April-May 2020) in Northern Italy. Adult participants completed an online questionnaire in both studies. Correlation, multivariate regression, and moderation analyses were carried out with IBM SPSS version 28 and its PROCESS macro. Significance of differences in correlation and regression coefficients was tested through Steiger's procedure, Wald test, and SUEST method. Family resilience was found to relate more strongly to eudaimonic (versus hedonic) well-being concurrently and to hedonic (versus eudaimonic) well-being longitudinally. The concurrent or longitudinal relations with hedonic well-being were generally stronger for females, part-time workers, and people undergoing multiple stressors. For people having a romantic partner, family resilience was concurrently associated with well-being independently of dyadic coping, whereas dyadic coping was longitudinally related to well-being independently of family resilience. Family resilience was found to protect, in the short term, the psychological well-being of people facing the pandemic outbreak. Its protective role mainly concerned hedonic well-being and was more pronounced for more vulnerable people. For persons having a romantic partner, however, dyadic coping seemed to have equal, if not greater, positive short-term effects.

Examining the relationship between birth weight and attention-deficit hyperactivity disorder diagnosis

Background

Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition that is prevalent in children worldwide. We evaluated the potential relationship between birth weight and ADHD using newly released data from the National Survey of Children's Health 2019-2020.

Methods

This population-based survey study used parent recollection data that were collected and submitted by 50 states and the District of Columbia to the National Survey of Children's Health database from the National Survey of Children's Health database. Those aged < 3 years and without birth weight or ADHD records were excluded. Children were stratified according to ADHD diagnosis and birth weight: very low birth weight (VLBW, < 1,500 g), low birth weight (LBW, 1,500-2,500 g), and normal birth weight (NBW, ≥ 2,500 g). Multivariable logistic regression was applied to examine the causal association between birth weight and ADHD while controlling for child and household characteristics.

Results

The final sample consisted of 60,358 children, of whom 6,314 (9.0%) were reported to have an ADHD diagnosis. The prevalence of ADHD was 8.7% in NBW children, 11.5% in LBW, and 14.4% in VLBW. Compared with NBW children, LBW children [adjusted odds ratio (aOR), 1.32 (95% CI, 1.03-1.68)], and VLBW children [aOR, 1.51 (95% CI, 1.06-2.15)] had a significantly higher risk of ADHD after adjusting all variables. These associations persisted in the male subgroups.

Conclusion and relevance

This study found that LBW and VLBW children were at a higher risk of ADHD.

Association Between Maternal Health Status and Family Resilience: Results from a National Survey

OBJECTIVE

The relationship between maternal health and health outcome of offspring has been studied extensively. However, measures such as family resilience in the context of maternal health are not well understood. The objective of this study was to determine if overall maternal health status is associated with family resilience.

METHODS

Using the 2016 National Survey of Children's Health, a nationally representative survey of parents/guardians of children ages 0-17, we evaluated the association of overall maternal health status with measures of family resilience. The analysis was performed using descriptive and multivariable analyses. The study adjusted for current health insurance status, family structure of child's household, income level, highest education of adult in household, child race, primary household language, children with special health care needs, emotional support, neighborhood support, parental aggravation, and adverse childhood experiences.

RESULTS

Compared to mothers who reported their physical health to be good, mothers who had a very good/excellent physical health status reported significantly higher adjusted rates for family resilience measures [Adjusted Odds Ratio (AOR) 0.741, 95% Confidence Interval (CI) (0.640, 0.859); p < 0.001]. Results suggested also that mothers whose mental health was very good/excellent were more likely to exhibit greater family resilience as compared to those that were good [(AOR) 0.452, 95% (CI) (0.390, 0.525); p < 0.001] or poor/fair [(AOR) 0.283, 95% (CI) (0.223, 0.360); p < 0.001].

CONCLUSION

Our findings suggest that maternal mental and physical health may contribute to how families respond to adversity. Our findings highlight the importance of evaluating interventions that target both physical and mental aspects of maternal health status to better the resilience of the family unit. In the healthcare setting, maternal health services should ensure early detection and prevention of chronic conditions beyond obstetric care and detection and treatment of mental health.

Dyadic profiles of family resilience among patients with first-episode stroke: A longitudinal study of the first 6 months after stroke

BACKGROUND

The importance of family resilience in the recovery of stroke patients has been demonstrated in numerous studies. However, little is known about post-stroke family resilience.

AIMS

To investigate the family resilience of stroke patients from a patient-caregiver dyadic perspective during the first 6 months after stroke.

METHODS

A total of 288 dyads of patients diagnosed with a first-episode stroke and their principal caregivers were recruited from neurology departments of 7 tertiary hospitals in Shanghai and Shangqiu, China. Family resilience and family function were assessed during hospitalisation and at 1, 3 and 6 months after stroke. K-means cluster analysis was used to identify different clusters of family resilience based on family resilience of patients and caregivers during hospitalisation. The STROBE guidelines for observational studies were followed.

RESULTS

Three clusters of family resilience were identified with distinct trajectories: cluster of high resilience (HR), cluster of low resilience (LR) and cluster of discrepant resilience (DR). The level of family function was consistently highest in cluster HR and lowest in cluster with LR at four time points. Most (69.8%) families fell into the cluster with low resilience and low family function. Characteristics such as the Rankin scores and education level of patients, education level of caregivers, family monthly income and living district were different among the three clusters.

CONCLUSIONS

We concluded that family resilience was linked to the family functioning of patients with a first-episode stroke, however, the levels of resilience in most families were low. Factors, including the education level, family income and stroke severity of patients were revealed to influence the family resilience and its development.

RELEVANCE TO CLINICAL PRACTICE

A resilience-focused approach to family-related treatment is beneficial for families. Therefore, understanding family resilience among stroke survivors is needed to inform the development of interventions for enhancing the recovery of stroke families.

Examining the Relationship Between Pediatric Behavioral Health and Parent Productivity through a Parent-Reported Survey in the time of COVID-19: An Exploratory Study

BACKGROUND

Pediatric behavioral health needs skyrocketed during the COVID-19-pandemic. Parents and caregivers lacked access to well-established tools to identify risk and protective factors while also experiencing decreased access to treatment options to meet their families' behavioral health needs.

OBJECTIVE

The aim of this study was to investigate the associations of known pediatric behavioral health risk factors and parents' reports of workplace productivity.

METHODS

A clinical research team at Brightline-a virtual, pediatric behavioral health solution-drew on standardized instruments to create a survey designed to understand pediatric behavioral health conditions, child stress, and family resilience and connection during the COVID-19 pandemic. Multivariable linear regression was used to characterize the relationship between these variables and parents' reports of workplace productivity.

RESULTS

Participants (n=361) completed the survey between October 2020 and November 2021. In the multivariable model, higher pediatric stress and time spent managing children's behavioral health needs were associated with greater productivity loss among working parents, whereas higher family connection was associated with lower productivity loss. COVID-19 diagnoses among parents and dependents, financial impact of COVID-19 on households, and family resilience were not associated with parents' workplace productivity.

CONCLUSIONS

This survey captured child stress, family connection, and productivity as reported by parents and caregivers during the COVID-19 pandemic. Exploratory studies are the first-step in understanding the relationship between these variables. Results from this study can empower parents by providing insights to help manage their child's behavioral health concerns and identify pediatric behavioral health services to aid working parents who are caregivers.

CLINICALTRIAL

Family Resilience and Adolescent Mental Health during COVID-19: A Moderated Mediation Model

Background: The COVID-19 pandemic has impacted and is still impacting people’s lives, including physical and mental health. Family plays an important role in adolescent mental health due to the long staying at home. Aims: This paper aimed to investigate the impact of family resilience on adolescent mental health during the COVID-19 pandemic, and the mediation role of pandemic stress perception and the moderation role of meta-mood. Methods: A total of 2691 Chinese adolescents were recruited using convenient sampling. Their mental health, family resilience, pandemic stress perception and meta-mood were surveyed. Multivariate statistics were used to analyze the data. Results: Our results showed that (1) about 36.7% adolescents in our sample have some mental health problems; (2) family resilience can positively predict adolescent mental health, whereas pandemic stress perception can negatively predict mental health; (3) pandemic stress perception mediates the relationship between family resilience and adolescent mental health; (4) meta-mood moderates the relationship between family resilience and pandemic perception, i.e., the first half of the mediation role. Conclusions: Our results indicate that one can either improve family resilience or improve adolescents’ meta-mood to relieve adolescents’ mental health problems.