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Traino KA, Ciciolla LM, Perez MN, Chaney JM, Welch G, Baskin LS, Buchanan CL, Chan YM, Cheng EY, Coplen DE, Wisniewski AB, Mullins LL. Trajectories of illness uncertainty among parents of children with atypical genital appearance due to differences of sex development. J Pediatr Psychol 2024:jsae043. [PMID: 38857449 DOI: 10.1093/jpepsy/jsae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 04/14/2024] [Accepted: 05/25/2024] [Indexed: 06/12/2024] Open
Abstract
OBJECTIVE The present study aimed to identify distinct trajectories of parental illness uncertainty among parents of children born with atypical genital appearance due to a difference of sex development over the first year following diagnosis. It was hypothesized that four trajectory classes would emerge, including "low stable," "high stable," "decreasing," and "increasing" classes, and that select demographic, familial, and medical factors would predict these classes. METHODS Participants included 56 mothers and 43 fathers of 57 children born with moderate to severe genital atypia. Participants were recruited from eleven specialty clinics across the U.S. Growth mixture modeling (GMM) approaches, controlling for parent dyad clustering, were conducted to examine classes of parental illness uncertainty ratings over time. RESULTS A three-class GMM was identified as the best-fitting model. The three classes were interpreted as "moderate stable" (56.8%), "low stable" (33.0%), and "declining" (10.3%). Findings suggest possible diagnostic differences across trajectories. CONCLUSIONS Findings highlight the nature of parents' perceptions of ambiguity and uncertainty about their child's diagnosis and treatment the year following their child's birth/diagnosis. Future research is needed to better understand how these trajectories might shift over the course of the child's development. Results support the development of tailored, evidence-based interventions to address coping with uncertainty among families raising a child with chronic health needs.
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Affiliation(s)
- Katherine A Traino
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, United States
| | - Lucia M Ciciolla
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, United States
| | - Megan N Perez
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - John M Chaney
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, United States
| | - Ginger Welch
- Department of Human Development and Family Sciences, Oklahoma State University, Stillwater, OK, United States
| | - Laurence S Baskin
- Department of Urology, University of California San Francisco Medical Center, San Francisco, CA, United States
| | - Cindy L Buchanan
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Yee-Ming Chan
- Division of Endocrinology, and Harvard Medical School, Boston Children's Hospital, Boston, MA, United States
| | - Earl Y Cheng
- Department of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Douglas E Coplen
- Division of Urologic Surgery, St. Louis Children's Hospital, St Louis, MO, United States
| | - Amy B Wisniewski
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, United States
| | - Larry L Mullins
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, United States
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DeLone AM, Fisher RS, Traino KA, Basile NL, Buchanan CL, Cheng EY, Poppas DP, Baraldi AN, Wisniewski AB, Mullins LL. Exploratory factor analysis of the Illness Intrusiveness Rating Scale for parents of children with atypical genital appearance due to differences of sex development (DSD). J Pediatr Psychol 2024:jsae027. [PMID: 38578612 DOI: 10.1093/jpepsy/jsae027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/06/2024] Open
Abstract
OBJECTIVE Illness intrusiveness refers to the subjective cognitive appraisal of a chronic health condition interfering in daily, valued activities and may be highly relevant for parents of children with atypical genital appearance due to differences of sex development (DSD). However, a measure of illness intrusiveness has not been validated for this population. The current study aimed to evaluate the factor structure of the Illness Intrusiveness Scale for Parents (IIS-P) and examine convergent validity. METHODS Participants included 102 parents (Mage = 33.39 years, SD = 6.48; 58% mothers) of 65 children (<2 years old) diagnosed with DSD participating in a larger, longitudinal study. Parents completed the IIS-P as well as self-report measures of stigma, and anxious and depressive symptoms. An exploratory factor analysis (EFA) was conducted. RESULTS EFA results supported a 1-factor intrusiveness solution (α = .93), as well as a 2-factor solution measuring intrusiveness on daily living (α = .92) and community connectedness (α = .85). The 1-factor solution and both factors of the 2-factor solution demonstrated significant convergent validity with stigma as well as anxious and depressive symptoms. CONCLUSIONS Support emerged for both 1- and 2-factor solutions of the IIS-P in parents of children with DSD. The decision to evaluate illness intrusiveness as a total score or to examine the subscales of daily living and community connectedness should be tailored to the unique aims of researchers and clinicians. Future research should conduct a confirmatory factor analysis with both 1- and 2-factor models with larger, more diverse samples of caregivers.
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Affiliation(s)
- Alexandra M DeLone
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, United States
| | - Rachel S Fisher
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, United States
| | - Katherine A Traino
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, United States
| | - Nathan L Basile
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, United States
| | - Cindy L Buchanan
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, United States
| | - Earl Y Cheng
- Department of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, United States
| | - Dix P Poppas
- James Buchanan Brady Department of Urology, Komansky Children's Hospital, New York Presbyterian Hospital-Weill Cornell Medicine, New York, United States
| | - Amanda N Baraldi
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, United States
| | - Amy B Wisniewski
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, United States
| | - Larry L Mullins
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, United States
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Crocetti D, Berry A, Monro S. Navigating the complexities of adult healthcare for individuals with variations of sex characteristics: from paediatric emergencies to a sense of abandonment. CULTURE, HEALTH & SEXUALITY 2024; 26:332-345. [PMID: 37199261 DOI: 10.1080/13691058.2023.2208194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 04/25/2023] [Indexed: 05/19/2023]
Abstract
Intersex people and those with variations of sex characteristics face significant health and social issues. This paper analyses the complexities of adult healthcare for this diverse population, including the root causes of deficiencies in care provision. Many minors with variations of sex characteristics are subjected to irreversible, non-consensual medical interventions, which can have negative effects on their health and wellbeing as adults. This 'emergency' approach to intersex paediatric healthcare has been challenged since the 1990s, but there is still a lack of understanding about how the paradigm affects adult care. This paper aims to raise awareness of the health challenges faced by adults with variations of sex characteristics. It identifies themes related to the challenges associated with accessing appropriate adult care, including the repercussions of childhood treatment, the lack of transitional services and psychological support, the limited general medical knowledge about variations of sex characteristics, and the reluctance to access services due to fear of stigma or past medical trauma. The paper indicates the need for more attention to intersex people's health needs as adults, moving away from attempts to 'fix' them as minors towards approaches which consider and provide for their diverse healthcare needs in a broader temporal context.
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Affiliation(s)
- Daniela Crocetti
- School of Human & Health Sciences, University of Huddersfield, Huddersfield, UK
- subsequently Independent Researcher, Intersexesiste NGO, Bologna, Italy
| | - Adeline Berry
- School of Human & Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Surya Monro
- School of Human & Health Sciences, University of Huddersfield, Huddersfield, UK
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Orozco-Poore C, Keuroghlian AS. Neurological Considerations for "Nerve-Sparing" Cosmetic Genital Surgeries Performed on Children with XX Chromosomes Diagnosed with 21-Hydroxylase Congenital Adrenal Hyperplasia and Clitoromegaly. LGBT Health 2023; 10:567-575. [PMID: 37319358 DOI: 10.1089/lgbt.2022.0160] [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] [Indexed: 06/17/2023] Open
Abstract
Congenital adrenal hyperplasia (CAH) is most often caused by adrenal deficiency of 21-hydroxylase (21-OH). The resulting increase in androgens can cause clitoromegaly in fetuses with XX chromosomes. 21-OH CAH is the most common reason for cosmetic clitoroplasty in childhood. "Nerve-sparing" (NS) clitoral reduction surgeries are described as offering optimal cosmesis, while sparing sensation and nerve function. The methods used to demonstrate NS surgery efficacy, however, such as electromyography and optical coherence tomography, do not evaluate the small-fiber axons that comprise the majority of axons in the clitoris and that transduce sexual pleasure. Although some data show sparing of a portion of the main dorsal nerve trunk of the clitoris, the overall neurobiological consequences of elective clitoral reductions have received little attention. NS surgeries remove dorsal nerve branches that transduce sexual sensation, as well as the corpora cavernosa and cavernous nerve, which provide clitoral autonomic function. While most outcome studies focus on surgeons' perceptions of cosmetic results, studies that assess small-fiber function indicate significant nervous system and sexual impairment. Studies assessing children's clitoral function after surgery with vibrational testing have been ethically condemned. Decades of advocacy against medically unnecessary childhood genital surgeries have highlighted the subsequent physical and psychological harm. Recent studies with CAH patients indicate gender diversity and a lower prevalence of female gender identification than is often cited to justify feminizing surgery. The most effective and ethical NS technique for CAH may be acceptance of gender, sexual, and genital diversity as the infant develops into childhood, adolescence, and adulthood.
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Affiliation(s)
- Casey Orozco-Poore
- Department of Medical Education, Harvard Medical School, Boston, Massachusetts, USA
| | - Alex S Keuroghlian
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
- The National LGBTQIA+ Health Education Center at The Fenway Institute, Boston, Massachusetts, USA
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Alderson J, Hamblin R, Kovell R. Psychosexual functioning and mental health and psychological considerations in adult patients with congenital urologic issues. J Pediatr Urol 2023:S1477-5131(23)00442-4. [PMID: 38782682 DOI: 10.1016/j.jpurol.2023.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/30/2023] [Indexed: 05/25/2024]
Affiliation(s)
- Julie Alderson
- D. Clin. Psychol., Psychological Health Services, University Hospitals Bristol and Weston NHS Foundation Trust, UK
| | - Rachel Hamblin
- D. Clin. Psychol., Psychological Health Services, University Hospitals Bristol and Weston NHS Foundation Trust, UK
| | - Robert Kovell
- University of Pennsylvania, Perelman School of Medicine and Children's Hospital of Philadelphia, UK.
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McCloskey K, Neuzil K, Basak R, Chan KH. Quality of reporting for qualitative studies in pediatric urology-A scoping review. J Pediatr Urol 2023; 19:643-651. [PMID: 37481426 DOI: 10.1016/j.jpurol.2023.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 04/20/2023] [Accepted: 04/23/2023] [Indexed: 07/24/2023]
Abstract
INTRODUCTION Qualitative research has gained popularity in pediatric urology due to rich data and insights about quantitative results. To date, there has been no study evaluating the comprehensiveness of the reporting of these studies based on established guidelines. OBJECTIVE The objective of this study is to perform a scoping review of the quality of reporting in recent qualitative studies in pediatric urology based on a predominant checklist, the 21-item Standards of Reporting Qualitative Research (SRQR) and identify areas for improvement. STUDY DESIGN In accordance with the Preferred Reported Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews, we performed a systematic literature search to identify qualitative studies on pediatric urology topics published from 2015 to 2021. We used clustering technology to eliminate articles with unrelated keywords. Articles not in English and those published prior to 2015 were excluded. Two reviewers performed title/abstract screening and full text review and resolved discrepancies by consensus. We reported the median and interquartile range of total SRQR scores (maximum: 21). SRQR-reported items were summarized; overall proportion of reported items for each article was estimated. Bivariate analyses examined the association between study characteristics and SRQR tertile. Simple linear regression was performed to examine the relationship between year and SRQR score. RESULTS Of the 2562 titles/abstracts screened, 26 studies were included. The most common topics were hypospadias and congenital adrenal hyperplasia (Summary Figure). The median total score was 18.0 of 21 possible items (interquartile range: 3). All studies reported an abstract, problem formulation, purpose/context of the study, data collection methods, integration with prior work, limitations, and ethics review board approval. Most (25/26; 96.2%) reported sampling strategy, data analysis, synthesis/interpretation of findings and links to empirical data. Less fulfilled items included: a title identifying the study as qualitative (11/26, 42.3%), qualitative approach & research paradigm (11/26, 42.3%) and researcher characteristics & reflexivity (9/26, 34.6%). There was no association between study characteristics and SRQR score. There was a statistically significant increase in the SRQR score during the study period (β = 1.0, p < 0.0001). DISCUSSION Studies fulfilled most SRQR checklist items. There was significant improvement in quality during the study period. Limitations include possible recency bias and exclusion of articles due to inconsistent categorizations in Pub Med. CONCLUSION The quality and trajectory of qualitative study reporting in pediatric urology is encouraging. SRQR standards should be implemented by journals to continue improving the robustness and transparency of future qualitative manuscripts in pediatric urology.
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Affiliation(s)
- Kyle McCloskey
- Brody School of Medicine at East Carolina University, USA.
| | - Kevin Neuzil
- Department of Urology, University of North Carolina, Chapel Hill, NC, USA.
| | - Ram Basak
- Department of Urology, University of North Carolina, Chapel Hill, NC, USA.
| | - Katherine H Chan
- Department of Urology, University of North Carolina, Chapel Hill, NC, USA.
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Basile NL, Dattilo TM, DeLone AM, Kraft JD, Edwards CS, Buchanan CL, Cheng EY, Poppas DP, Wisniewski AB, Mullins LL. Parental Uncertainty Scale Factor Structure in Pediatric DSD With Ambiguous Genitalia. J Pediatr Psychol 2023; 48:386-395. [PMID: 36728708 PMCID: PMC10118853 DOI: 10.1093/jpepsy/jsad001] [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: 11/01/2022] [Revised: 01/12/2023] [Accepted: 01/14/2023] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE Illness uncertainty is a salient experience for caregivers of children with disorders/differences of sex development (DSD) presenting with ambiguous genitalia; however, no validated measure of illness uncertainty exists for this unique population. Thus, the current study aimed to preliminarily identify the factor structure of the Parental Perception of Uncertainty Scale (PPUS) in caregivers of children with DSD presenting with ambiguous genitalia and examine the convergent validity of the PPUS. METHODS Participants included 115 caregivers (Mage = 32.12 years, SD = 6.54; 57% mothers) of children (<2-year-olds) diagnosed with DSD participating in a larger, longitudinal study. Caregivers completed the PPUS as well as self-report measures of anxious, depressive, and posttraumatic stress symptoms. An exploratory factor analysis was conducted. RESULTS Exploratory factor analysis results indicated that a 23-item 1-factor solution was the most parsimonious and theoretically sound factor structure (α = 0.92). Convergent validity analyses demonstrated further support for the use of the 23-item 1-factor solution over the original PPUS factor structure. CONCLUSION These results demonstrate the preliminary clinical and research utility of the PPUS with caregivers of children with DSD presenting with ambiguous genitalia. The PPUS may benefit from further refinement through qualitative research and item adaptation to capture uncertainties unique to DSD presenting with ambiguous genitalia. In addition, future research should replicate the proposed factor structure using confirmatory factor analysis with a separate, larger sample of caregivers of children with DSD to confirm the factor structure.
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Affiliation(s)
- Nathan L Basile
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, USA
| | - Taylor M Dattilo
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, USA
| | - Alexandra M DeLone
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, USA
| | - Jacob D Kraft
- Department of Psychiatry, University of Michigan, USA
| | - Clayton S Edwards
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, USA
| | - Cindy L Buchanan
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, USA
| | - Earl Y Cheng
- Department of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, USA
| | - Dix P Poppas
- Institute for Pediatric Urology, Komansky Children’s Hospital, New York Presbyterian Hospital-Weill Cornell Medicine, USA
| | - Amy B Wisniewski
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, USA
| | - Larry L Mullins
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, USA
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Fisher RS, Datillo TM, Baskin LS, Buchanan CL, Cheng EY, Kolon T, Nokoff NJ, Poppas DP, Reyes KJ, Mullins LL, Wisniewski AB. Decisional Regret Among Caregivers of Infants with Differences of Sex Development Reared as Male. J Dev Behav Pediatr 2023; 44:e225-e230. [PMID: 36729523 PMCID: PMC10065892 DOI: 10.1097/dbp.0000000000001159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 10/25/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Differences of sex development (DSD) are congenital conditions in which individuals are discordant in their chromosomal, phenotypic, and/or gonadal sex. Treatment of DSD can involve surgical intervention to external genitalia to make anatomy seem male-typical (i.e., male genitoplasty). Caregiver-perceived decisional regret regarding young boys with DSD was explored quantitatively and qualitatively. METHOD Participants (N = 39) were caregivers of infants (N = 23) diagnosed with DSD (mean age = 8.9 months, standard deviation = 5.9 months) reared male participating in a longitudinal investigation of psychosocial outcomes. Qualitative data were collected at 6 to 12 months after baseline enrollment to evaluate caregiver decision-making corresponding to levels of regret concerning their child's treatment. All but one infant received genital surgery before caregiver reporting on their decisional regret. Quantitative exploratory analyses evaluated longitudinal predictors of decisional regret at 6 to 12 months. RESULTS When completing a write-in item inquiring about decision-making and potential regret, most caregivers (n = 16, 76%) reported that their child's genital surgery was their first medical decision. Two caregivers referenced gender assignment as a decision point. One-third of caregivers reported some level of decisional regret (33%), with 67% reporting no regret. No hypothesized predictors of decisional regret were statistically significant. CONCLUSION Many caregivers of infants with DSD reared male view genital surgery as a first health care decision. Approximately one-third of caregivers reported some level of decisional regret. Further research is warranted to explore long-term decisional regret; it will be particularly important to investigate the decisional regret of patients with DSD.
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Affiliation(s)
- Rachel S. Fisher
- Oklahoma State University, Department of Psychology, Center for Pediatric Psychology, Stillwater, OK, USA
| | - Taylor M. Datillo
- Oklahoma State University, Department of Psychology, Center for Pediatric Psychology, Stillwater, OK, USA
| | - Laurence S. Baskin
- University of California San Francisco Medical Center, Department of Urology, San Francisco, CA, USA
| | - Cindy L. Buchanan
- University of Colorado Anschutz Medical Campus, Department of Psychiatry, Aurora, CO, USA
| | - Earl Y. Cheng
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Department of Urology, Chicago, IL, USA
| | - Thomas Kolon
- Children’s Hospital of Philadelphia, Division of Urology, Philadelphia, PA, USA
| | - Natalie J. Nokoff
- University of Colorado Anschutz Medical Campus, Department of Pediatrics, Division of Endocrinology, Aurora, CO, USA
| | - Dix P. Poppas
- New York Presbyterian Weill Cornell Medicine, Department of Urology, Komansky Children’s Hospital, New York, NY, USA
| | - Kristy J. Reyes
- Cook Children’s Medical Center, Department of Pediatric Urology, Fort Worth, TX, USA
| | - Larry L. Mullins
- Oklahoma State University, Department of Psychology, Center for Pediatric Psychology, Stillwater, OK, USA
| | - Amy B. Wisniewski
- Oklahoma State University, Department of Psychology, Center for Pediatric Psychology, Stillwater, OK, USA
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Szymanski KM. Real-life significance of decisional regret scores among parents of girls with CAH undergoing surgery: Why they do not necessarily mean parents wish they had made a different choice. J Pediatr Urol 2022; 18:34-35. [PMID: 34876379 DOI: 10.1016/j.jpurol.2021.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 11/25/2022]
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Babu R. Changing Paradigms in Intersex Management: Legal, Ethical, and Medical Implications. J Indian Assoc Pediatr Surg 2022; 27:372-375. [PMID: 36238319 PMCID: PMC9552657 DOI: 10.4103/jiaps.jiaps_41_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 03/13/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ramesh Babu
- Department of Pediatric Urology, Sri Ramachandra Institute of Higher Education and Research, Past Chairman of Society of Pediatric Urology (IAPS), Chennai, Tamil Nadu, India,Address for correspondence: Dr. Ramesh Babu, Department of Pediatric Urology, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai - 600 116, Tamil Nadu, India. E-mail:
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