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Sandberg DE, Gardner M. Differences/Disorders of Sex Development: Medical Conditions at the Intersection of Sex and Gender. Annu Rev Clin Psychol 2022; 18:201-231. [PMID: 35216524 PMCID: PMC10170864 DOI: 10.1146/annurev-clinpsy-081219-101412] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Defined as congenital conditions in which development of chromosomal, gonadal, or anatomic sex is atypical, differences or disorders of sex development (DSDs) comprise many discrete diagnoses ranging from those associated with few phenotypic differences between affected and unaffected individuals to those where questions arise regarding gender of rearing, gonadal tumor risk, genital surgery, and fertility. Controversies exist in numerous areas including how DSDs are conceptualized, how to refer to the set of conditions and those affected by them, and aspects of clinical management that extend from social media to legislative bodies, courts of law, medicine, clinical practice, and scholarly research in psychology and sociology. In addition to these aspects, this review covers biological and social influences on psychosocial development and adjustment, the psychosocial and psychosexual adaptation of people born with DSDs, and roles for clinical psychologists in the clinical management of DSDs. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 18 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- David E Sandberg
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan Medical School, Ann Arbor, Michigan, USA;
| | - Melissa Gardner
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan Medical School, Ann Arbor, Michigan, USA;
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Hashemipour-Zavareh M, Yousofi Z, Hashemipour M. Comparison of Family Life Quality in Type 1 Diabetic and Healthy Children from the Perception of their Mothers. Int J Prev Med 2020; 11:154. [PMID: 33209224 PMCID: PMC7643571 DOI: 10.4103/ijpvm.ijpvm_200_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 10/14/2019] [Indexed: 11/04/2022] Open
Abstract
Background Given the fact that the quality of care of diabetic children and their mothers' psychological health and family life quality have mutual effects on each other; in this study, we aimed to compare family life quality of type 1 diabetic (T1DM) patients with healthy children from the perception of their mothers. However, our findings would be helpful for further interventional studies in order to improve both diabetes management and psychological health of their parents. Methods In this case control study, mothers of children with T1DM, who referred to endocrine and metabolism clinics of Isfahan city, were enrolled. Demographic and familial characteristics of studied population were recorded. Family life quality was evaluated using Retting and Leichtentritt questionnaire and compared between two groups. The questionnaire consists of 32 items, which were representative of six resources including love, status, services, information, goods, and money. Results In this study, 50 children with T1DM and 50 healthy children and their mothers were evaluated. Mean total score of family life quality and its resource classes were significantly higher in mothers of T1DM patients than mothers of healthy children (P < 0.05) except for love (P = 0.05). Conclusions The findings of this study indicated that the total family life quality score was significantly lower in families of diabetic patients than healthy children families from the perception of their mothers. Our results indicated that most of the family-life-related dimensions including attitude and service, services, information, goods, and money affected by the disease conditions and its related comorbidities.
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Affiliation(s)
- Maryam Hashemipour-Zavareh
- Department of Psychology, School of Educational Sciences, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
| | - Zahra Yousofi
- Department of Psychology, School of Educational Sciences, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
| | - Mahin Hashemipour
- Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Sofer L, D'Oro A, Rosoklija I, Leeth EA, Goetsch AL, Moses S, Chen D, Finlayson C, Johnson EK. Impact of cell-free DNA screening on parental knowledge of fetal sex and disorders of sex development. Prenat Diagn 2020; 40:1489-1496. [PMID: 32683746 DOI: 10.1002/pd.5801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/01/2020] [Accepted: 07/14/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Discrepancies between cfDNA and ultrasound predicted fetal sex occur, possibly indicating disorders/differences of sex development (DSDs). Among expectant/recent parents, this study assessed cfDNA knowledge/use, fetal sex determination attitudes/behaviors, general knowledge of DSD, and possible psychological impact of discrepancy between fetal sex on cfDNA and ultrasound. METHOD Parents were surveyed about fetal sex determination methods, knowledge of cfDNA and DSD, distress related to possible cfDNA inaccuracy. RESULTS Of 916 respondents, 44% were aware of possible discrepancy between cfDNA and ultrasound, 22% were aware of DSD. 78% and 75% would be upset and worried, respectively, with results showing fetal sex discrepancy. Most (67%) revealed predicted fetal sex before delivery. 38% were offered cfDNA. Of those revealing fetal sex, 24% used cfDNA results, 71% ultrasound, and 7% both. cfDNA users were more frequently aware of possible discrepancy between cfDNA and ultrasound (76% vs 41%, P < .0001), but not of DSD (29% vs 23%, P = .29). CONCLUSION Fetal sex determination is favored, and cfDNA is frequently used for predicting fetal chromosomal sex. Many parents are unaware of possible discrepancies between cfDNA and ultrasound, and potential for DSD. Most would be distressed by discordant results. Accurate counseling regarding limitations cfDNA for fetal sex determination is needed.
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Affiliation(s)
- Laurel Sofer
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Anthony D'Oro
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Ilina Rosoklija
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Elizabeth A Leeth
- Division of Genetics, Birth Defects and Metabolism, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Graduate Program in Genetic Counseling, Northwestern University, Chicago, Illinois, USA
| | - Allison L Goetsch
- Division of Genetics, Birth Defects and Metabolism, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Graduate Program in Genetic Counseling, Northwestern University, Chicago, Illinois, USA
| | - Scott Moses
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Diane Chen
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Science, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Courtney Finlayson
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Endocrinology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Emilie K Johnson
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Szymanski KM, Salama AK, Whittam B, Frady H, Cain MP, Rink RC. Beyond changing diapers: stress and decision-making among parents of girls with congenital adrenal hyperplasia seeking consultation about feminizing genital restoration surgery. J Pediatr Urol 2019; 15:653-658. [PMID: 31685391 DOI: 10.1016/j.jpurol.2019.09.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 09/27/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION/BACKGROUND The impact of having a child with atypical genitalia due to a life-threating chronic medical condition like congenital adrenal hyperplasia (CAH) is poorly understood. OBJECTIVE The aim of the study was to determine parental stress and impact of CAH on parental decisions, including decisions regarding female genital restoration surgery (FGRS). STUDY DESIGN The authors surveyed consecutive parents of girls with CAH ≤3 years presenting at a tertiary referral center for FGRS consultation (2016-2019). The survey was developed by three families of daughters with CAH and six clinicians. Nine potentially stressful past experiences were rated on a 6-point Likert scale ('not at all' to 'extremely' stressful). Overall parental stress and strain (broader negative consequences) were reported using validated instruments (Perceived Stress Scale and Caregiver Strain Questionnaire Short Form, respectively). Impact of CAH on past decisions about childcare, social interactions, and who changes diapers were also assessed. Non-parametric tests were used for analysis. RESULTS Twenty-nine parents (median age: 32years) of 22 consecutive children participated (Prader 3/4/5: 59.1%/36.4%/4.5%). After the study, 20 girls (90.9%) underwent FGRS at a median age of 8 months. The most stressful experiences were having an adrenal crisis ('very much' stressful), waiting for the CAH diagnosis, and making sense of the diagnosis (both 'quite a bit') (Figure 1). Remaining issues were 'somewhat' stressful. Deciding whether to proceed with FGRS was ranked as the least stressful issue. Overall parental stress was similar to overall stress previously reported by spousal caregivers of stroke or heart failure survivors (P ≥ 0.15). Overall parental strain was similar to parents of adolescents receiving mental health counseling (P = 0.77). Congenital adrenal hyperplasia impacted decisions about babysitting, daycare, who changed diapers, and choosing a pediatrician (P ≤ 0.02), but did not impact parental social interactions (P ≥ 0.11). Diapers were typically changed by parents (100.0%) and grandmothers (50.0%). Parents anticipated that some individuals currently not allowed to change diapers would be allowed after FGRS: grandfathers (+18.2%), aunts/uncles (+27.3-32.8%), cousins (+18.2%), and family friends (+45.5%). DISCUSSION The authors present the first assessment of parental stress with respect to different aspects of care of a daughter with CAH. Larger studies are required to determine if the parental stress associated with these experiences varies over time and how these stressors rank relative to each other through the child's development. CONCLUSION Parents experience multiple stressors after having a daughter with CAH. Parental stress surrounding a decision about FGRS appears less severe than events pertaining to the diagnosis and medical management of CAH. Congenital adrenal hyperplasia impacts multiple parental decisions.
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Affiliation(s)
- Konrad M Szymanski
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, IN, USA.
| | - Amr K Salama
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, IN, USA
| | - Benjamin Whittam
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, IN, USA
| | - Heather Frady
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, IN, USA
| | - Mark P Cain
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, IN, USA
| | - Richard C Rink
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, IN, USA
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Perez MN, Delozier AM, Aston CE, Austin P, Baskin L, Chan YM, Cheng EY, Diamond DA, Fried A, Greenfield S, Kolon T, Kropp B, Lakshmanan Y, Meyer S, Meyer T, Nokoff N, Palmer B, Paradis A, Poppas D, Scott Reyes KJ, Swartz JM, Tishelman A, Wisniewski AB, Wolfe-Christensen C, Yerkes E, Mullins LL. Predictors of Psychosocial Distress in Parents of Young Children with Disorders of Sex Development. J Urol 2019; 202:1046-1051. [PMID: 31268850 DOI: 10.1097/ju.0000000000000424] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE We evaluated demographic, financial and support predictors of distress for parents of young children with disorders of sex development including atypical genital development, and characterized early parental experiences. This work extends our previous findings to identify those parents at risk for distress. MATERIALS AND METHODS Participants included mothers (76) and fathers (63) of a child (78) diagnosed with disorders of sex development characterized by moderate to severe genital atypia. Parents completed a demographic questionnaire, measures of anxious and depressive symptoms, quality of life, illness uncertainty and posttraumatic stress symptoms, and rated their satisfaction with the appearance of their child's genitalia. RESULTS Depressive and posttraumatic stress symptoms of caregivers were comparable to standardized norms while levels of anxious symptoms were below norms. A subset of parents reported clinically elevated symptoms. Overall 26% of parents reported anxious symptoms, 24% reported depressive symptoms and 17% reported posttraumatic stress symptoms. Levels of illness uncertainty were lower than those of parents of children with other chronic illnesses. Differences by parent sex emerged, with mothers reporting greater distress. Lower income, increased medical care and travel expenses, and having no other children were related to increased psychosocial distress. CONCLUSIONS Early psychosocial screening is recommended for parents of children with disorders of sex development. Clinicians should be aware that financial burden and lack of previous parenting experience are risk factors for distress.
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Affiliation(s)
| | | | | | - Paul Austin
- Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Laurence Baskin
- University of California San Francisco Medical Center, San Francisco, California
| | | | - Earl Y Cheng
- Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | - Allyson Fried
- John R. Oishei Children's Hospital, Buffalo, New York
| | | | - Thomas Kolon
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | - Sabrina Meyer
- John R. Oishei Children's Hospital, Buffalo, New York
| | - Theresa Meyer
- Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | - Blake Palmer
- Cook Children's Medical Center, Ft. Worth, Texas
| | | | - Dix Poppas
- New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
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Delozier AM, Gamwell KL, Sharkey C, Bakula DM, Perez MN, Wolfe-Christensen C, Austin P, Baskin L, Bernabé KJ, Chan YM, Cheng EY, Diamond DA, Ellens REH, Fried A, Galan D, Greenfield S, Kolon T, Kropp B, Lakshmanan Y, Meyer S, Meyer T, Nokoff NJ, Reyes KJ, Palmer B, Poppas DP, Paradis A, Tishelman AC, Yerkes EB, Chaney JM, Wisniewski AB, Mullins LL. Uncertainty and Posttraumatic Stress: Differences Between Mothers and Fathers of Infants with Disorders of Sex Development. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:1617-1624. [PMID: 31144217 PMCID: PMC7265677 DOI: 10.1007/s10508-018-1357-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 11/13/2018] [Accepted: 11/21/2018] [Indexed: 06/09/2023]
Abstract
Parents of children with disorders of sex development (DSD) report significant psychological distress, including posttraumatic stress symptoms (PTSS), with mothers consistently reporting higher rates of psychological distress than fathers. However, psychological factors contributing to PTSS in both parents are not well understood. The present study sought to fill this gap in knowledge by examining PTSS and illness uncertainty, a known predictor of psychological distress, in parents of children recently diagnosed with DSD. Participants were 52 mothers (Mage = 32.55 years, SD = 5.08) and 41 fathers (Mage = 35.53 years, SD = 6.78) of 53 infants (Mage = 9.09 months, SD = 6.19) with DSD and associated atypical genital development. Participants were recruited as part of a larger, multisite study assessing parents' psychosocial response to their child's diagnosis of DSD. Parents completed measures of illness uncertainty and PTSS. Mothers reported significantly greater levels of PTSS, but not illness uncertainty, than fathers, and were more likely than fathers to report clinical levels of PTSS (21.2% compared to 7.3%). Hierarchical regression revealed that parent sex, undiagnosed or unclassified DSD status, and illness uncertainty were each associated with PTSS. The overall model accounted for 23.5% of the variance associated with PTSS. Interventions targeting illness uncertainty may be beneficial for parents of children with newly diagnosed DSD.
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Affiliation(s)
| | - Kaitlyn L Gamwell
- Department of Psychology, Oklahoma State University, Stillwater, OK, 74078, USA
| | - Christina Sharkey
- Department of Psychology, Oklahoma State University, Stillwater, OK, 74078, USA
| | - Dana M Bakula
- Department of Psychology, Oklahoma State University, Stillwater, OK, 74078, USA
| | - Megan N Perez
- Department of Psychology, Oklahoma State University, Stillwater, OK, 74078, USA
| | - Cortney Wolfe-Christensen
- Department of Pediatric Urology, Cook Children's Medical Center, Fort Worth, TX, USA
- Department of Pediatric Urology, Children's Hospital of Michigan, Detroit, MI, USA
| | - Paul Austin
- Department of Urology, Texas Children's Hospital, Houston, TX, USA
| | - Laurence Baskin
- Department of Urology, University of California San Francisco Medical Center, San Francisco, CA, USA
| | - Kerlly J Bernabé
- Department of Urology, Komansky Children's Hospital, New York Presbyterian Weill Cornell Medicine, New York, NY, USA
| | - Yee-Ming Chan
- Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Earl Y Cheng
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - David A Diamond
- Department of Urology, Boston Children's Hospital, Boston, MA, USA
| | - Rebecca E H Ellens
- Department of Pediatric Urology, Children's Hospital of Michigan, Detroit, MI, USA
| | - Allyson Fried
- Department of Pediatric Urology, Oishei Children's Hospital, Buffalo, NY, USA
| | - Denise Galan
- Department of Urology, Komansky Children's Hospital, New York Presbyterian Weill Cornell Medicine, New York, NY, USA
| | - Saul Greenfield
- Department of Pediatric Urology, Oishei Children's Hospital, Buffalo, NY, USA
| | - Thomas Kolon
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Bradley Kropp
- Department of Pediatric Urology, Cook Children's Medical Center, Fort Worth, TX, USA
| | - Yegappan Lakshmanan
- Department of Pediatric Urology, Children's Hospital of Michigan, Detroit, MI, USA
| | - Sabrina Meyer
- Department of Pediatric Urology, Oishei Children's Hospital, Buffalo, NY, USA
| | - Theresa Meyer
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Natalie J Nokoff
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Section of Endocrinology, Aurora, CO, USA
| | - Kristy J Reyes
- Department of Pediatric Urology, Cook Children's Medical Center, Fort Worth, TX, USA
| | - Blake Palmer
- Department of Pediatric Urology, Cook Children's Medical Center, Fort Worth, TX, USA
| | - Dix P Poppas
- Department of Urology, Komansky Children's Hospital, New York Presbyterian Weill Cornell Medicine, New York, NY, USA
| | - Alethea Paradis
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Amy C Tishelman
- Department of Endocrinology, Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Elizabeth B Yerkes
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - John M Chaney
- Department of Psychology, Oklahoma State University, Stillwater, OK, 74078, USA
| | - Amy B Wisniewski
- Department of Pediatric Urology, Cook Children's Medical Center, Fort Worth, TX, USA
| | - Larry L Mullins
- Department of Psychology, Oklahoma State University, Stillwater, OK, 74078, USA
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Kung KTF, Spencer D, Pasterski V, Neufeld SAS, Hindmarsh PC, Hughes IA, Acerini CL, Hines M. Emotional and behavioral adjustment in 4 to 11-year-old boys and girls with classic congenital adrenal hyperplasia and unaffected siblings. Psychoneuroendocrinology 2018; 97:104-110. [PMID: 30015005 DOI: 10.1016/j.psyneuen.2018.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 06/20/2018] [Accepted: 07/02/2018] [Indexed: 01/27/2023]
Abstract
It has been suggested that atypical hormone environments during early development may contribute to subsequent development of psychopathology. Also, it has been suggested that individuals with the autosomal recessive genetic variant, classic congenital adrenal hyperplasia (CAH), might be at increased risk of psychopathology. The present study examined emotional and behavioral adjustment in young children with CAH and their unaffected siblings in the United Kingdom. The parent-reported version of the Strengths and Difficulties Questionnaire (SDQ) was employed to assess adjustment in children aged 4 to 11 years. There were 38 boys with CAH, 43 girls with CAH, 23 unaffected brothers, and 31 unaffected sisters. No differences in emotional or behavioral problems were found between boys or girls with CAH and unaffected same-sex siblings. In addition, affected and unaffected boys in the current sample generally did not differ from boys in the general population. However, compared with girls in the general population, girls with CAH had more difficulties related to conduct problems, hyperactivity/ inattention, and prosocial behavior, and unaffected sisters had more difficulties related to peer problems, conduct problems, and prosocial behavior. These findings suggest that both girls with CAH and unaffected sisters of girls or boys with CAH may be at increased risk of developing behavioral problems. Potential influences related to the early hormone environment, familial process, and social stigma are considered.
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Affiliation(s)
- Karson T F Kung
- Department of Psychology, University of Cambridge, Free School Lane, Cambridge CB2 3RQ, UK.
| | - Debra Spencer
- Department of Psychology, University of Cambridge, Free School Lane, Cambridge CB2 3RQ, UK
| | - Vickie Pasterski
- Department of Psychology, University of Cambridge, Free School Lane, Cambridge CB2 3RQ, UK; Department of Paediatrics, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - Sharon A S Neufeld
- Department of Psychology, University of Cambridge, Free School Lane, Cambridge CB2 3RQ, UK
| | - Peter C Hindmarsh
- Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
| | - Ieuan A Hughes
- Department of Paediatrics, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - Carlo L Acerini
- Department of Paediatrics, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - Melissa Hines
- Department of Psychology, University of Cambridge, Free School Lane, Cambridge CB2 3RQ, UK
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8
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Psychosocial implications of disorders of sex development treatment for parents. Curr Opin Urol 2018; 27:11-13. [PMID: 27584026 DOI: 10.1097/mou.0000000000000344] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Historically, studies of caregivers of children with disorders of sex development (DSD) have been limited. RECENT FINDINGS Recent data reveal that parents of young children with DSD report increased stress, anxiety, depression, and decreased quality of life in ways that are similar to parents of children with other types of chronic illnesses. Also similar to other chronic illnesses of childhood, parents of children with DSD exhibit overprotective parenting and perceive their child as being vulnerable. These emotions and behaviors exhibited by parents are concerning as they may limit an affected child's emotional and social development over time. Perhaps, more unique to the situation of DSD is the perceived, or real, child-focused stigma experienced by parents of children with DSD. SUMMARY Interventions to improve parents' psychosocial adaptation to their child's medical condition, including coaching in how to discuss their child's condition in a manner that makes them feel safe and supported, are needed to optimize outcomes for families.
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Chivers C, Burns J, Deiros Collado M. Disorders of sex development: Mothers' experiences of support. Clin Child Psychol Psychiatry 2017; 22:675-690. [PMID: 28752770 DOI: 10.1177/1359104517719114] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND An increasing body of research has sought to determine the impact of Disorders of Sex Development (DSD) on the family of the affected child. Little is currently understood about the support needs of the family and how well these needs are met. METHODS Interpretive Phenomenological Analysis was used to analyse semi-structured interviews with eight mothers of children with DSD about their experiences of support. RESULTS Four master themes emerged which encapsulated (a) the stages in their child's development when mothers most needed support, (b) the importance of developing an understanding of the child's condition, (c) the lack of acknowledgement of the emotional needs of the parent and (d) the importance of having close and trusted networks for support. Continuity and availability of support were considered important and while all participants prioritised maintaining privacy about the condition, a minority felt that this impacted the level of support they received. CONCLUSIONS Key time points for support were identified and while some felt that they were well supported others felt that the support available did not meet their emotional needs. Clinical implications and directions for future research were considered.
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Affiliation(s)
- Clare Chivers
- 1 Greenwich Child and Adolescent Mental Health Services, Oxleas NHS Foundation Trust, UK.,2 Faculty of Social and Applied Sciences, Canterbury Christ Church University, UK
| | - Jan Burns
- 2 Faculty of Social and Applied Sciences, Canterbury Christ Church University, UK
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10
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Nordenström A, Butwicka A, Lindén Hirschberg A, Almqvist C, Nordenskjöld A, Falhammar H, Frisén L. Are carriers of CYP21A2 mutations less vulnerable to psychological stress? A population-based national cohort study. Clin Endocrinol (Oxf) 2017; 86:317-324. [PMID: 27654981 DOI: 10.1111/cen.13242] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 09/17/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Congenital adrenal hyperplasia (CAH) is one of the most common monogenic autosomal recessive disorders with an incidence of one in 15 000. About one in 70 individuals in the general population are carriers of a severe CYP21A2 mutation. It has been suggested that this confers a survival advantage, perhaps as a result of increased activity in the hypothalamic-pituitary-adrenal axis. We investigated vulnerability to psychological stress in obligate carriers. METHOD The Swedish CAH Registry encompasses more than 600 patients. Parents, that is obligate carriers of the CYP21A2 mutation, were identified through the Multigeneration Register. The diagnosis of the child was used as the psychological stressor. Psychiatric diagnoses before and after the birth of a child with CAH were compared to those of controls derived from (i) the general population, (ii) parents of children with hypospadias and (iii) parents of children with diabetes mellitus type 1 (T1DM). RESULTS Parents of children with CAH had less risk of being diagnosed with any psychiatric disorder (OR, 0·6), an affective disorder (OR, 0·5) or substance misuse (OR, 0·5) after the diagnosis of the child, compared to the general population. Their risk was also decreased compared to parents of a child with hypospadias (OR, 0·6, 0·4 and 0·2, respectively) and parents of a child with T1DM (OR 0·7, 0·6 and 0·2, respectively). The CYP21A2 carriers had a lower risk of developing mood and stress-related disorders after the diagnosis of the child. CONCLUSION Obligate CYP21A2 carriers had a reduced risk of a psychiatric diagnosis and were less vulnerable to a psychologically stressful situation, at least with respect to receiving a psychiatric diagnosis. This indicates a better ability to cope with psychological stress among heterozygous carriers of severe CYP21A2 mutations, which may contribute to the apparent survival advantage.
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Affiliation(s)
- Anna Nordenström
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Paediatric Endocrinology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Agnieszka Butwicka
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Child Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Angelica Lindén Hirschberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Obstetrics and Gynaecology, Karolinska University Hospital, Stockholm, Sweden
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Lung and Allergy Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Agneta Nordenskjöld
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Paediatric Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Henrik Falhammar
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Louise Frisén
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Child and Adolescent Psychiatry Research Centre, Stockholm, Sweden
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Wolfe-Christensen C, Wisniewski AB, Mullins AJ, Reyes KJ, Austin P, Baskin L, Bernabé K, Cheng E, Fried A, Frimberger D, Galan D, Gonzalez L, Greenfield S, Kolon T, Kropp B, Lakshmanan Y, Meyer S, Meyer T, Nokoff NJ, Palmer B, Poppas D, Paradis A, Yerkes E, Mullins LL. Changes in levels of parental distress after their child with atypical genitalia undergoes genitoplasty. J Pediatr Urol 2017; 13:32.e1-32.e6. [PMID: 28041823 PMCID: PMC5889974 DOI: 10.1016/j.jpurol.2016.10.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 10/17/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The birth of a child with a disorder of sex development (DSD) and atypical genitalia can be traumatizing and isolating for families. Parents of children with DSD are at risk for increased levels of psychological distress, including depression, anxiety, illness uncertainty (IU), post-traumatic stress symptoms (PTSS), and impairments in quality of life (QOL). Our previous report indicated that although the majority of parents of children with atypical genitalia were coping well prior to the child's genitoplasty, approximately 25% of them reported experiencing some type of psychological distress. OBJECTIVE The current study sought to examine the trajectory of parental psychological distress prior to, and 6 months after their child underwent genitoplasty. METHODS Parents were recruited as part of an ongoing, prospective, multi-site study involving 10 pediatric hospitals with specialized care for children with atypical genitalia. Results from 49 parents (27 mothers, 22 fathers) of 28 children (17 female sex of rearing, 11 male sex of rearing) born with atypical genitalia (Prader rating of 3-5 in 46,XX DSD or by a Quigley rating of 3-6 in 46,XY DSD or 45,XO/46,XY) were included in the study. RESULTS There were no significant changes in level of depressive or anxious symptoms or quality of life between baseline and 6-month post-operative follow-up, although mothers continued to report significantly higher levels of depressive symptoms than fathers, and as a group, these parents reported lower QOL than published norms. The level of PTSS significantly decreased for all parents, suggesting that parents may have come through the acute stress phase associated with their child's diagnosis. Finally, while there were no significant changes in IU over the time period, the level of IU for parents of boys actually increased, while parents of girls reported no change (Figure). CONCLUSION Six months after their child has undergone genitoplasty, the majority of parents report minimal levels of psychological distress. However, a subset of these parents continue to experience significant distress related to their child's diagnosis. Specifically, parents of boys appear to be at increased risk for difficulties, which may be related to either the lack of clinical diagnosis for almost half of these children or the necessity of two-stage surgeries for the majority of them. We will continue collecting data on these families to better understand the trajectory of these adjustment variables.
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Affiliation(s)
- Cortney Wolfe-Christensen
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Children's Hospital of Michigan, Detroit, MI, USA.
| | - Amy B Wisniewski
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - Kristy J Reyes
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Paul Austin
- St. Louis Children's Hospital, St. Louis, MO, USA
| | - Laurence Baskin
- University of California San Francisco Medical Center, San Francisco, CA, USA
| | - Kerlly Bernabé
- New York Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Earl Cheng
- Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Allyson Fried
- Women and Children's Hospital of Buffalo, Buffalo, NY, USA
| | | | - Denise Galan
- New York Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Lynette Gonzalez
- University of California San Francisco Medical Center, San Francisco, CA, USA
| | | | - Thomas Kolon
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Bradley Kropp
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - Sabrina Meyer
- Women and Children's Hospital of Buffalo, Buffalo, NY, USA
| | - Theresa Meyer
- Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | | | - Blake Palmer
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Dix Poppas
- New York Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
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12
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Rohrer TR, Horikawa R, Kappelgaard AM. Growth hormone delivery devices: current features and potential for enhanced treatment adherence. Expert Opin Drug Deliv 2016; 14:1253-1264. [DOI: 10.1080/17425247.2017.1243526] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Tilman R. Rohrer
- Department of Pediatrics and Adolescent Medicine, Saarland University Medical Center, Homburg/Saar, Germany
| | - Reiko Horikawa
- Division of Endocrinology and Metabolism, National Center for Child Health and Development, Tokyo, Japan
| | - Anne-Marie Kappelgaard
- Clinical, Medical and Regulatory, Novo Nordisk International Operations A/G, Zurich, Switzerland
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13
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Abstract
Purpose The purpose of this study was to explore the feasibility of using human patient simulation (HPS) to teach type 1 diabetes (T1DM) management to grandparents of grandchildren with T1DM. Methods Thirty grandparents (11 male, 19 female) of young grandchildren (aged 12 and under) with T1DM were recruited from an urban medical center. Experimental group (n = 14) grandparents received hands-on visual T1DM management education using an HPS intervention, and control group (n = 16) grandparents received similar education using a non-HPS intervention. Findings This study demonstrated the feasibility of recruiting and retaining grandparents into a clinical trial using HPS to teach T1DM management. Post intervention, all grandparent scores for T1DM knowledge, confidence, and fear showed significant improvement from time 1 to time 2, with HPS group grandparent scores showing consistently larger improvement. Conclusions The consistency of larger HPS-taught grandparent score improvement is suggestive of a benefit for the HPS teaching method. Early multimethod Certified Diabetes Educator (CDE)–provided T1DM education is an important point of entry for inducting grandparent members onto the grandchild’s diabetes care team.
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14
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Rolston AM, Gardner M, Vilain E, Sandberg DE. Parental Reports of Stigma Associated with Child's Disorder of Sex Development. Int J Endocrinol 2015; 2015:980121. [PMID: 25918529 PMCID: PMC4396550 DOI: 10.1155/2015/980121] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 02/19/2015] [Indexed: 11/25/2022] Open
Abstract
Disorders of sex development (DSD) are congenital conditions in which chromosomal, gonadal, or anatomic sex development is atypical. DSD-associated stigma is purported to threaten positive psychosocial adaptation. Parental perceptions of DSD-related stigma were assessed in 154 parents of 107 children (newborn-17 years) questionnaire comprising two scales, child-focused and parent-focused, and three subscales, perceived stigmatization, future worries, and feelings about the child's condition. Medical chart excerpts identified diagnoses and clinical management details. Stigma scale scores were generally low. Parents of children with DSD reported less stigma than parents of children with epilepsy; however, a notable proportion rated individual items in the moderate to high range. Stigma was unrelated to child's age or the number of DSD-related surgeries. Child-focused stigma scores exceeded parent-focused stigma and mothers reported more stigma than fathers, with a moderate level of agreement. Within 46,XY DSD, reported stigma was higher for children reared as girls. In conclusion, in this first quantitative study of ongoing experiences, DSD-related stigma in childhood and adolescence, while limited in the aggregate, is reported at moderate to high levels in specific areas. Because stigma threatens positive psychosocial adaptation, systematic screening for these concerns should be considered and, when reported, targeted for psychoeducational counseling.
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Affiliation(s)
- Aimee M. Rolston
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI 48109-5456, USA
| | - Melissa Gardner
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI 48109-5456, USA
| | - Eric Vilain
- Department of Human Genetics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-7088, USA
| | - David E. Sandberg
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI 48109-5456, USA
- *David E. Sandberg:
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15
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Zhang Y, Wei M, Shen N, Zhang Y. Identifying factors related to family management during the coping process of families with childhood chronic conditions: a multi-site study. J Pediatr Nurs 2015; 30:160-73. [PMID: 25450446 DOI: 10.1016/j.pedn.2014.10.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 09/30/2014] [Accepted: 10/03/2014] [Indexed: 11/26/2022]
Abstract
This study was designed to determine the key predictors for each aspect of family management of families with children who have chronic conditions in China. The participants included 399 caregivers whose children have chronic illnesses. We used the following instruments: Child Behavior Checklist; Feetham Family Functioning Survey; and Family Management Measures. The final modes of the hierarchical regression explained 29-48% of the variance in aspects of family management. More family support should be provided for those with low family income, children with renal and genetic disorders and rheumatic diseases and those living in rural areas. Child and family functioning affects family management.
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Affiliation(s)
- Ying Zhang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China.
| | - Min Wei
- Peking Union Medical College Hospital, Pediatric Unit, Beijing, China.
| | - Nanping Shen
- Shanghai Children's Medical Center, Nursing Department, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Yaqing Zhang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China.
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16
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Gilban DLS, Alves Junior PAG, Beserra ICR. Health related quality of life of children and adolescents with congenital adrenal hyperplasia in Brazil. Health Qual Life Outcomes 2014; 12:107. [PMID: 25115634 PMCID: PMC4243953 DOI: 10.1186/s12955-014-0107-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 06/19/2014] [Indexed: 11/28/2022] Open
Abstract
Background Congenital Adrenal Hyperplasia (CAH) is an endocrine disorder characterized by enzymatic deficiency in adrenal steroidogenesis, leading to adrenal insufficiency and hyperandrogenism. Patients need continuous hormone replacement therapy, but adequate control has proven challenging, exposing patients to undesirable consequences of both disease and treatment. Objective To evaluate the health related quality of life (HRQoL) of children and adolescents with CAH due to 21-hydroxylase deficiency. Methods In an analytical study, generic questionnaires, validated and translated versions, Pediatric Quality of Life Inventory 4.0 (for self-assessment of patients) and Child Health Questionnaire - PF50 (for parents) were applied and mean scores were analyzed with Student’s t-test. Results We included 25 patients (19 female) with classical CAH (14 salt wasting/11 simple virilizing), mean age ± standard deviation (SD) of 11.4 ± 3.6 years (5–17.9), and their parents. Self-assessment of HRQOL showed decrease in mean scores: overall (67.8 ± 15.5 vs. 88.9 ± 7.4, p value = 0.015) and in the physical (75.2 ± 15.0 vs. 95.9 ± 5.8, p value = 0.014) and psychosocial (63.9 ± 17.8 vs. 85.0 ± 9.6, p value = 0.023) dimensions of patients, compared to healthy controls (previously published national data on children and adolescents). The assessment of the parent’s view was concordant, also showing losses in the physical (43.7 ± 8.0 vs. 55.1 ± 3.6, p value = 0.013) and psychosocial (41.9 ± 9.7 vs. 53.0 ± 7.0, p value = 0.025) dimensions. The comparison of HRQOL between subgroups 1) males versus females and 2) salt-wasting versus simple virilizing showed no significant differences. Conclusion There seems to be a loss of HRQOL in children and adolescents with classical CAH. The self-assessment was concordant in key areas with the assessment made by their parents. No differences were observed between genders or clinical presentation of the disease.
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17
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Wolfe-Christensen C, Fedele DA, Kirk K, Mullins LL, Lakshmanan Y, Wisniewski AB. Caregivers of children with a disorder of sex development: associations between parenting capacities and psychological distress. J Pediatr Urol 2014; 10:538-43. [PMID: 24613141 DOI: 10.1016/j.jpurol.2013.11.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 11/22/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Caregivers of children with a disorder of sex development (DSD) are at increased risk for maladaptive parenting capacities, such as high levels of parental overprotection and perceived vulnerability of their child, in addition to parenting stress. The current study aims to examine whether there are relationships between these parenting capacities and psychological distress, including depressive and anxious symptoms. PATIENTS AND METHODS Participants included 134 caregivers of 90 children with a DSD. Caregivers completed measures of parental overprotection, perceived vulnerability, parenting stress, anxiety, and depression. RESULTS Hierarchical regression analyses revealed that higher levels of parenting stress were related to more anxious and depressive symptoms in caregivers. Higher levels of perceived vulnerability were related to more anxious symptoms. Levels of parental overprotection were unrelated to anxious or depressive symptoms. CONCLUSIONS There is a relationship between parenting capacities and mental health outcomes in caregivers of children with DSD, although the direction of this relationship is not clear. Given the strong relationships between parenting stress and anxious and depressive symptoms, targeting parenting stress and/or psychological distress in these caregivers could result in better functioning overall.
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Affiliation(s)
- Cortney Wolfe-Christensen
- Department of Pediatric Urology, Children's Hospital of Michigan, 3901 Beaubien, Detroit, MI 48201, USA.
| | - David A Fedele
- University of Florida, Department of Health and Clinical Psychology, Gainesville, FL, USA
| | - Katherine Kirk
- University of Oklahoma College of Nursing, Oklahoma City, OK, USA
| | - Larry L Mullins
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | - Yegappan Lakshmanan
- Department of Pediatric Urology, Children's Hospital of Michigan, 3901 Beaubien, Detroit, MI 48201, USA
| | - Amy B Wisniewski
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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18
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Cousino MK, Hazen RA. Parenting stress among caregivers of children with chronic illness: a systematic review. J Pediatr Psychol 2013; 38:809-28. [PMID: 23843630 DOI: 10.1093/jpepsy/jst049] [Citation(s) in RCA: 468] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To critically review, analyze, and synthesize the literature on parenting stress among caregivers of children with asthma, cancer, cystic fibrosis, diabetes, epilepsy, juvenile rheumatoid arthritis, and/or sickle cell disease. Method PsychInfo, MEDLINE, and Cumulative Index to Nursing and Allied Health Literature were searched according to inclusion criteria. Meta-analysis of 13 studies and qualitative analysis of 96 studies was conducted. Results Caregivers of children with chronic illness reported significantly greater general parenting stress than caregivers of healthy children (d = .40; p = ≤.0001). Qualitative analysis revealed that greater general parenting stress was associated with greater parental responsibility for treatment management and was unrelated to illness duration and severity across illness populations. Greater parenting stress was associated with poorer psychological adjustment in caregivers and children with chronic illness. Conclusion Parenting stress is an important target for future intervention. General and illness-specific measures of parenting stress should be used in future studies.
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Affiliation(s)
- Melissa K Cousino
- Department of Psychological Sciences, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA.
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19
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Bargiota A, Dimitropoulos K, Mouzas O, Melekos M, Tzortzis V, Koukoulis G. The Impact of Parental Bonding on Sexual Distress in Women with Type 1 Diabetes Mellitus. J Sex Med 2013; 10:378-85. [DOI: 10.1111/j.1743-6109.2012.02969.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Wisniewski AB. Gender Development in 46,XY DSD: Influences of Chromosomes, Hormones, and Interactions with Parents and Healthcare Professionals. SCIENTIFICA 2012; 2012:834967. [PMID: 24278745 PMCID: PMC3820494 DOI: 10.6064/2012/834967] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 09/18/2012] [Indexed: 06/02/2023]
Abstract
Variables that impact gender development in humans are difficult to evaluate. This difficulty exists because it is not usually possible to tease apart biological influences on gender from social variables. People with disorders of sex development, or DSD, provide important opportunities to study gender within individuals for whom biologic components of sex can be discordant with social components of gender. While most studies of gender development in people with 46,XY DSD have historically emphasized the importance of genes and hormones on gender identity and gender role, more recent evidence for a significant role for socialization exists and is considered here. For example, the influence of parents' perceptions of, and reactions to, DSD are considered. Additionally, the impact of treatments for DSD such as receiving gonadal surgeries or genitoplasty to reduce genital ambiguity on the psychological development of people with 46,XY DSD is presented. Finally, the role of multi-disciplinary care including access to peer support for advancing medical, surgical and psychosexual outcomes of children and adults with 46,XY DSD, regardless of sex of rearing, is discussed.
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Affiliation(s)
- Amy B Wisniewski
- Department of Urology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
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21
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Wolfe-Christensen C, Fedele DA, Kirk K, Phillips TM, Mazur T, Mullins LL, Chernausek SD, Lakshmanan Y, Wisniewski AB. Degree of external genital malformation at birth in children with a disorder of sex development and subsequent caregiver distress. J Urol 2012; 188:1596-600. [PMID: 22910249 DOI: 10.1016/j.juro.2012.02.040] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Indexed: 01/28/2023]
Abstract
PURPOSE We determined whether the degree of genital malformation at birth in children with a disorder of sex development is related to subsequent caregiver distress, specifically symptoms of depression and anxiety. MATERIALS AND METHODS A total of 66 caregivers of children with disorders of sex development were recruited from 3 centers that specialize in disorders of sex development medicine. The caregivers completed the Beck Depression Inventory, 2nd Edition and the Beck Anxiety Inventory. The child's Prader score at birth was determined by the child's treating pediatric endocrinologist and/or pediatric urologist at each institution. RESULTS Results from the current study revealed that for caregivers of male children, under masculinization of the child's genitals at birth was significantly related to higher levels of subsequent caregiver depression. In contrast, over masculinization of the genitals of female children at birth was unrelated to caregiver depression or anxiety. CONCLUSIONS These findings suggest that caregivers of male children with disorders of sex development may be at increased risk for psychological distress and could benefit from family based psychosocial interventions.
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22
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Sanders C, Carter B, Goodacre L. Parents need to protect: influences, risks and tensions for parents of prepubertal children born with ambiguous genitalia. J Clin Nurs 2012; 21:3315-23. [PMID: 22672683 DOI: 10.1111/j.1365-2702.2012.04109.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM AND OBJECTIVES The aim of the study was to explore parents' experiences of and the influences, risks and tensions associated with their child's genital ambiguity and the place reconstructive surgeries had in their lives. BACKGROUND Research into the clinical management of disorders of sex development is a complex and growing field of study. A small number of studies have indicated that the decisions parents make with regard to their child's care during infancy are confounded by moral, social and emotional factors which can influence their choices. DESIGN Narrative methods. METHODS In-depth interviews elicited stories from 10 mothers and five fathers of 11 prepubertal children. RESULTS A key theme from the data focused on the parents' motivations to protect their child from the real or perceived threats arising from other people's attitudes and responses to their ambiguous genitalia. Several rationales for their protective behaviours were described, which encouraged the parents to actively manage their child's care. CONCLUSION The dilemmas that parents face in the complex and challenging situation following the birth of a child with ambiguous genitalia require early support from insightful professionals such as nurses. This support could better prepare the parents to recognise and discuss their protective behaviours and the impact these may have on their child's future. RELEVANCE TO CLINICAL PRACTICE These findings draw attention to the parents' need for nurses to be knowledgeable about the impact that disorders of sex development can have on family's emotional, psychosocial well-being and decision-making. Nurses' awareness of the debate surrounding genital surgeries is important if they are to understand the motivations that underpin parents' decision-making and how to support them sensitively. Nurses are the health professionals who have the most consistent direct contact with these families throughout the child's life and, therefore, can provide support in the ongoing decision-making process.
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Affiliation(s)
- Caroline Sanders
- Urology and Gynaecology, Children's Nursing Research Unit, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
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23
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Crissman HP, Warner L, Gardner M, Carr M, Schast A, Quittner AL, Kogan B, Sandberg DE. Children with disorders of sex development: A qualitative study of early parental experience. INTERNATIONAL JOURNAL OF PEDIATRIC ENDOCRINOLOGY 2011; 2011:10. [PMID: 21992519 PMCID: PMC3223129 DOI: 10.1186/1687-9856-2011-10] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Accepted: 10/12/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND Clinical research on psychological aspects of disorders of sex development (DSD) has focused on psychosexual differentiation with relatively little attention directed toward parents' experiences of early clinical management and their influence on patient and family psychosocial adaptation. OBJECTIVES To characterize parental experiences in the early clinical care of children born with DSD. STUDY DESIGN Content analysis of interviews with parents (n = 41) of 28 children, newborn to 6 years, with DSD. RESULTS Four major domains emerged as salient to parents: (1) the gender assignment process, (2) decisions regarding genital surgery, (3) disclosing information about their child's DSD, and (4) interacting with healthcare providers. Findings suggested discordance between scientific and parental understandings of the determinants of "sex" and "gender." Parents' expectations regarding the benefits of genital surgery appear largely met; however, parents still had concerns about their child's future physical, social and sexual development. Two areas experienced by many parents as particularly stressful were: (1) uncertainties regarding diagnosis and optimal management, and (2) conflicts between maintaining privacy versus disclosing the condition to access social support. CONCLUSIONS Parents' experiences and gaps in understanding can be used to inform the clinical care of patients with DSD and their families. Improving communication between parents and providers (and between parents and their support providers) throughout the early clinical management process may be important in decreasing stress and improving outcomes for families of children with DSD.
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Affiliation(s)
- Halley P Crissman
- Department of Pediatrics & Communicable Diseases Division of Child Behavioral Health University of Michigan Medical School 1500 East Medical Center Drive, SPC 5318 Ann Arbor, Michigan 48109-5318 USA
| | - Lauren Warner
- Department of Pediatrics & Communicable Diseases Division of Child Behavioral Health University of Michigan Medical School 1500 East Medical Center Drive, SPC 5318 Ann Arbor, Michigan 48109-5318 USA
| | - Melissa Gardner
- Department of Pediatrics & Communicable Diseases Division of Child Behavioral Health University of Michigan Medical School 1500 East Medical Center Drive, SPC 5318 Ann Arbor, Michigan 48109-5318 USA
| | - Meagan Carr
- Department of Pediatrics & Communicable Diseases Division of Child Behavioral Health University of Michigan Medical School 1500 East Medical Center Drive, SPC 5318 Ann Arbor, Michigan 48109-5318 USA
| | - Aileen Schast
- Division of Urology The Children's Hospital of Philadelphia Richard D Wood Center, 3rd Floor 34th Street and Civic Center Boulevard Philadelphia, Pennsylvania 19104 USA
| | - Alexandra L Quittner
- Departments of Psychology & Pediatrics University of Miami 5665 Ponce de Leon Blvd. Coral Gables, Florida 33146-2070 USA
| | - Barry Kogan
- Division of Urology Department of Surgery Albany Medical College 23 Hackett Boulevard Albany, New York 12208 USA
| | - David E Sandberg
- Department of Pediatrics & Communicable Diseases Division of Child Behavioral Health University of Michigan Medical School 1500 East Medical Center Drive, SPC 5318 Ann Arbor, Michigan 48109-5318 USA
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