Maternal distress and discrepancy in reports of psychopathology in chronically ill children

Online parent-targeted cognitive-behavioural therapy intervention to improve quality of life in families of young cancer survivors: study protocol for a randomised controlled trial

BACKGROUND

Due to advances in multimodal therapies, most children survive cancer. In addition to the stresses of diagnosis and treatment, many families are now navigating the challenges of survivorship. Without sufficient support, the ongoing distress that parents experience after their child's cancer treatment can negatively impact the quality of life and psychological wellbeing of all family members.

METHODS/DESIGN

The 'Cascade' (Cope, Adapt, Survive: Life after C AncEr) study is a three-arm randomised controlled trial to evaluate the feasibility and efficacy of a new intervention to improve the quality of life of parents of young cancer survivors. Cascade will be compared to a peer-support group control and a 6-month waitlist control. Parents (n = 120) whose child (under 16 years of age) has completed cancer treatment in the past 1 to 12 months will be recruited from hospitals across Australia. Those randomised to receive Cascade will participate in four, weekly, 90-minute online group sessions led live by a psychologist. Cascade involves peer discussion on cognitive-behavioural coping skills, including behavioural activation, thought challenging, mindfulness and acceptance, communication and assertiveness skills training, problem-solving and goal-setting. Participants randomised to peer support will receive four, weekly, 90-minute, live, sessions of non-directive peer support. Participants will complete measures at baseline, directly post-intervention, one month post-intervention, and 6 months post-intervention. The primary outcome will be parents' quality of life. Secondary outcomes include parent depression, anxiety, parenting self-agency, and the quality of life of children in the family. The child cancer survivor and all siblings aged 7 to 15 years will be invited to complete self-report quality of life measures covering physical, emotional, social and school-related domains.

DISCUSSION

This article reviews the empirical rationale for group-based, online cognitive-behavioural therapy in parents of children who have recently finished cancer treatment. The potential challenges of delivering skills-based programs online are highlighted. Cascade's videoconferencing technology has the potential to address the geographic and psychological isolation of families after cancer treatment. Teaching parents coping skills as they resume their normal lives after their child's cancer may see long-term benefits for the quality of life of the family as a whole.

TRIAL REGISTRATION

ACTRN12613000270718 (registered 6 March 2013).

Psychosocial distress and functioning of Greek youth with cystic fibrosis: a cross-sectional study

Background

To assess psychosocial functioning and distress of children and adolescents with cystic fibrosis compared to healthy controls.

Methods

Thirty-six patients with cystic fibrosis aged 8–18 years (24 boys, mean age ± SD: 11.5 ± 2.6 years) and 31 sex- and age-matched healthy control subjects (18 boys, mean age ± SD: 12 ± 2.5 years) were enrolled in the study. In order to assess the self-esteem, social adjustment, and family functioning of these young people, the Culture-free Self-esteem Inventory, the Social Adjustment Scale–Self-Report, and the Family Assessment Device were administered. Emotional/ behavioral problems were assessed through the Youth Self Report and the Child Behavior Checklist given to both the subjects and their parents.

Results

No significant differences were found for self-esteem between the two study groups. Regarding social adjustment, children with cystic fibrosis reported significantly worse friendship and overall adjustment (P < 0.05). Moreover, no difference was found in the levels of family functioning between the two groups. No significant differences between the groups were found in emotional/ behavioral problems from the self-reports. On the contrary, parents of children with cystic fibrosis reported significantly higher levels of withdrawal/ depression, thought problems, and delinquent behavior (P ≤ 0.01) as compared to controls.

Conclusions

Children and adolescents with cystic fibrosis appear to be a psychosocially vulnerable group. A biopsychosocial approach should emphasize the assessment and treatment of the psychosocial distress of these patients alongside multiple somatic treatments.

Parent-child agreement on health-related quality of life (HRQOL): a longitudinal study

Background

Few studies have evaluated changes on parent–child agreement in HRQOL over time. The objectives of the study were to assess parent–child agreement on child’s HRQOL in a 3-year longitudinal study, and to identify factors associated with possible disagreement.

Methods

A sample of Spanish children/adolescents aged 8–18 years and their parents both completed the KIDSCREEN-27 questionnaire. Data on age, gender, family socioeconomic status (SES), and mental health (Strengths and Difficulties Questionnaire, SDQ) was also collected at baseline (2003), and again after 3 years (2006). Changes in family composition were collected at follow-up. Agreement was assessed through intraclass correlation coefficient (ICC), and Bland and Altman plots. Generalizing Estimating Equation (GEE) models were built to analyze factors associated with parent–child disagreement.

Results

A total of 418 parent–child pairs were analyzed. At baseline the level of agreement on HRQOL was low to moderate and it was related to the level of HRQOL reported. Physical well-being at baseline showed the highest level of parent–child agreement (ICC=0.59; 0.53-0.65) while less “observable” dimensions presented lower levels of agreement, (i.e. Psychological well-being: ICC= 0.46; 0.38-0.53). Agreement parent–child was lower at follow-up. Some interactions were found between rater and child’s age; with increasing age, child scored lower than parents on Parents relationships and Autonomy (Beta [B] -0.47; -0.71 / -0.23) and the KIDSCREEN-10 (−0.49; -0.73 /-0.25).

Conclusions

Parent–child agreement on child’s HRQOL is moderate to low and tends to diminish with children age. Measuring HRQOL of children/adolescents mainly in healthy population samples might require direct self-assessments.

Pediatric patient-reported outcome instruments for research to support medical product labeling: report of the ISPOR PRO good research practices for the assessment of children and adolescents task force

BACKGROUND

Patient-reported outcome (PRO) instruments for children and adolescents are often included in clinical trials with the intention of collecting data to support claims in a medical product label.

OBJECTIVE

The purpose of the current task force report is to recommend good practices for pediatric PRO research that is conducted to inform regulatory decision making and support claims made in medical product labeling. The recommendations are based on the consensus of an interdisciplinary group of researchers who were assembled for a task force associated with the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). In those areas in which supporting evidence is limited or in which general principles may not apply to every situation, this task force report identifies factors to consider when making decisions about the design and use of pediatric PRO instruments, while highlighting issues that require further research.

GOOD RESEARCH PRACTICES

Five good research practices are discussed: 1) Consider developmental differences and determine age-based criteria for PRO administration: Four age groups are discussed on the basis of previous research (<5 years old, 5-7 years, 8-11 years, and 12-18 years). These age groups are recommended as a starting point when making decisions, but they will not fit all PRO instruments or the developmental stage of every child. Specific age ranges should be determined individually for each population and PRO instrument. 2) Establish content validity of pediatric PRO instruments: This section discusses the advantages of using children as content experts, as well as strategies for concept elicitation and cognitive interviews with children. 3) Determine whether an informant-reported outcome instrument is necessary: The distinction between two types of informant-reported measures (proxy vs. observational) is discussed, and recommendations are provided. 4) Ensure that the instrument is designed and formatted appropriately for the target age group. Factors to consider include health-related vocabulary, reading level, response scales, recall period, length of instrument, pictorial representations, formatting details, administration approaches, and electronic data collection (ePRO). 5) Consider cross-cultural issues.

CONCLUSIONS

Additional research is needed to provide methodological guidance for future studies, especially for studies involving young children and parents' observational reports. As PRO data are increasingly used to support pediatric labeling claims, there will be more information regarding the standards by which these instruments will be judged. The use of PRO instruments in clinical trials and regulatory submissions will help ensure that children's experience of disease and treatment are accurately represented and considered in regulatory decisions.

Understanding parent-child social informant discrepancy in youth with high functioning autism spectrum disorders

We investigated discrepancies between parent- and self-reported social functioning among youth with autism spectrum disorders (ASD). Three distinct samples showed discrepancies indicating that parents viewed their children as performing one standard deviation below a standardization mean, while youth viewed themselves as comparably-skilled relative to peers. Discrepancies predicted lower parental self-efficacy, and lower youth-reported hostile attributions to peers, marginally-lower depression, and decreased post-treatment social anxiety. Discrepancies predicted outcomes better than parent- or youth-report alone. Informant discrepancies may provide valuable additional information regarding child psychopathology, parental perceptions of parenting stress, and youth treatment response. Findings support a model where abnormal self-perceptions in ASD stem from inflated imputation of subjective experiences to others, and provide direction for improving interventions for youth and parents.

Development and validation of the Child Activity Limitations Interview: a measure of pain-related functional impairment in school-age children and adolescents

Recurrent pain in childhood are common and frequently impact children's everyday functioning. However, there are currently limited tools available to measure the impact of recurrent pain on children's daily activities, in particular, that can be used to identify appropriate targets for intervention and measure response to such interventions. The purpose of this study was to develop and validate a new measure, the Child Activity Limitations Interview (CALI), to improve the assessment of functional impairment due to recurrent pain in school-age children and adolescents, and to compare this measure to the Functional Disability Inventory. Participants included 189 children, aged 8-16 years (M=12.4, SD 2.5), 60% female, 40% minority, who were part of a longitudinal study of recurrent pain in children with headaches, juvenile idiopathic arthritis, and sickle cell disease. Measures of socio-demographics, pain, anxiety and depression, and functional disability were completed. A subset of participants (47%) were re-administered the CALI 1 month later and completed prospective ratings of pain and activity limitations using the CALI in daily diaries. Internal consistency of the CALI was excellent (alpha=0.88, child version; alpha=0.95, parent version). One-month test-retest reliability (r = 0.33, child report) and cross-informant reliability (r = 0.43) were moderate. Results demonstrate support for face, construct, and concurrent validity as well as responsiveness to pain symptom fluctuation. Findings demonstrate that the CALI is a promising measure for assessing and monitoring subjective report of functional impairment in school-age children and adolescents with recurrent and chronic pain.

Are parents able to rate the symptoms and quality of life of their offspring with IBD?

The aim of this study was to investigate the degree of agreement between parents and their offspring with inflammatory bowel disease for the presence of symptoms and the assessment of health-related quality of life (HRQOL). Factors influencing parent-child agreement were studied. Eighty-three Children and 81 parents separately filled out a five-item symptom card and a validated generic HRQOL instrument, which assesses seven domains of HRQOL, using the child and parent form. The parent also filled out the GHQ-30, an instrument assessing nonpsychotic psychiatric disorder in the parent, and an item on marital status. Intraclass correlation coefficients and paired student t-test were used to assess the level of agreement between raters. On one domain, parents reported their children as having a worse QOL than did the children themselves (social functioning). The parents were adequate raters of objective components of their child's HRQOL (overall correlation coefficient: 0.88). However, on more subjective components, the coefficient dropped to 0.62. In 82% of the cases did parents correctly classify their child into the disease activity category the child classified him- or herself. In conclusion, agreement between parents and offspring is good for the child's symptoms, but for HRQOL assessment only when it concerns objective states.

Parental report of health-related quality of life in children with sickle cell disease

Health-related quality of life (HRQOL) of youths with sickle cell disease (SCD) has not been described, despite the psychosocial and physical consequences associated with the disease. We compared the HRQOL of 58 children with SCD to a demographically similar sample of 120 healthy children and examined predictors of HRQOL. Child HRQOL was assessed using the Child Health Questionnaire--Parent Report Form. Review of medical charts of children with SCD provided data on disease-related complications. Results demonstrated that caregivers of children with SCD reported that their children had more limited physical, psychological, and social well-being than healthy children. Older child age, female gender, and more disease-related complications predicted limitations in the physical health of children with SCD. The findings indicated that SCD significantly affects the HRQOL of youths. Certain subgroups of patients (e.g., children with more disease complications) may benefit from interventions specifically designed to improve their physical functioning.

Identifying characteristics of older and younger females with attention-deficit hyperactivity disorder

This study examines the manifestation of attention-deficit hyperactivity disorder (ADHD) among females of varying ages by testing the utility of particular tests to discriminate older from younger females with ADHD. A retrospective clinical chart review was conducted at a community outpatient mental health center for 75 girls from 4 to 19 years of age with a diagnosis of ADHD or subthreshold symptoms of ADHD. Signal detection methods were used to identify which variables best differentiate older (mean age = 12.06, SD = 2.61) from younger (mean age = 7.11, SD = 1.08) girls with ADHD. Girls with comorbid diagnoses of a depressive disorder and higher verbal IQ scores were more likely to be older. Overall, the findings suggest that approaches to diagnosing ADHD among females may need to be modified to include appropriate age-based criteria.

Health-related quality of life in childhood cancer: discrepancy in parent-child reports

The purpose of our study was to describe reports of parents and of children with cancer on items taken from 4 domains of health-related quality of life (HRQL), bodily pain/distress, general health perceptions, physical functioning and limitations in role/social functioning as a result of physical health, and to examine whether differences in parent-child reports varied as a function of the child's health condition (cancer vs. healthy). Twenty-seven child-parent dyads with cancer and 27 child-parent dyads who were healthy (child ages 8 to 18 inclusive) completed measures of child HRQL [Child Health Questionnaire-Parent Form (CHQ-PF50) and Child Health Questionnaire (CHQ-CF87)] and demographic information at a scheduled out-patient general pediatric or pediatric oncology clinic appointment. Sixteen items included on both the CHQ-CF87 and CHQ-PF50 were examined to compare parent and child reports of child HRQL. As hypothesized, greater discrepancies were evident in the reports of parents of children with cancer than parents of children who are healthy [F(16,31) = 3.98, p < 0.0001]. Statistically significant discrepancies emerged in parent and child responses on 50% of the items in the sample of children with cancer, with parents reporting that their children experience more limitations in their lives than did the children themselves. In the healthy group, statistically significant discrepancies emerged on only 1 of the 16 items (6.3%).

Chronic childhood illness and maternal mental health--why should we care?

This study evaluated which factors most influenced the impact of childhood asthma on the child's family. Seventy children/families seen at a tertiary-care hospital for asthma were evaluated. Stepwise multiple regression examined the effects of illness severity; family socioeconomic status (SES); family structure; social support; child's emotional characteristics; parent's health; family functioning; and maternal psychological distress on the Family Impact of Illness Scale. Analysis indicated that only the parent's Psychiatric Symptom Index significantly predicted impact scores. The most important predictors of how much impact a child's asthma has on the family are parental emotional distress and amount of social support.

Psychiatric illness and family support in children and adolescents with diabetic ketoacidosis: a controlled study

OBJECTIVE

To compare compliance, psychiatric disorders, and family support in children with insulin-dependent diabetes mellitus (IDDM) hospitalized with diabetic ketoacidosis (DKA) and clinic controls.

METHOD

Twenty-five youths hospitalized with DKA and 25 matched outpatient subjects with IDDM with no history of DKA during the preceding year were assessed cross-sectionally, using the Diagnostic Interview Schedule for Children, measures of general and diabetes-specific family functioning, and measures of self-esteem and social competence. Levels of glycosylated hemoglobin and information about compliance with the treatment regimen were obtained.

RESULTS

A significantly higher number of psychiatric disorders was observed in the hospitalized children, with 88% meeting criteria for at least one disorder (versus 28% of controls). Self-esteem and social competence were lower in the hospitalized group, and their families scored lower on problem-solving and diabetes-specific "warmth-caring."

CONCLUSIONS

Children with recurrent DKA may be at greater risk of associated psychopathology than diabetic controls with no such history. DKA children's reports of noncompliance may be more sensitive than their parents' reports, and their families may lack warm, caring parent-child relationships.

Consultation-liaison in child psychiatry: a review of the past 10 years. Part II: Research on treatment approaches and outcomes

OBJECTIVE

To critically review the research and reports on consultation-liaison psychiatry in the past 10 years.

METHOD

Articles contributing to the conceptualization of child psychiatric consultation in medical, epidemiological, and nonmedical domains were reviewed.

RESULTS

Information was organized into methodology and treatment outcome categories. Nonmedical consultation articles were briefly reviewed. Articles reporting therapeutic techniques in consultation-liaison work and outcome studies are described.

CONCLUSIONS

In spite of constraints imposed by managed care upon referral to specialists, the current epoch finds child psychiatrists both better equipped and more compelled to use their skills in innovative ways to help children in different domains.

Somatization and the vocabulary of everyday bodily experiences and concerns: a community study of adolescents

OBJECTIVE

To describe the frequency of everyday bodily experiences and health concerns in a general population of adolescents 12 to 16 years of age in Ontario and to explore whether the concept of "somatization," identified from those youths with many of these symptoms, is meaningful and related to other variables.

METHOD

A representative sample of the population was obtained by stratified random sampling. Children with a chronic medical condition were excluded. Parents and their adolescent children filled out a series of questionnaires to measure health concerns, complaints, and more dramatic losses of function. Information was also collected on certain background factors, psychiatric problems, and impairments in adaptive functioning.

RESULTS

Parents and youths endorsed the items with the same rank order of frequency, but there was virtually no agreement between parents and youths on the presence or absence of individual somatic symptoms. Users of medical services did not tend to have many more health concerns than others, and there was a weak relationship between the number of health concerns reported by a youth and both impairment in adaptive functioning and psychiatric problems.

CONCLUSION

These data suggest that the concept of somatization has limited general value over and above a relationship with other psychiatric problems.

Children's anticipation of and response to colposcopic examination

Just prior to and following general physical and colposcopic anogenital exams, 43 mothers and daughters (3-15 years), referred because of allegations of sexual abuse, were interviewed separately to determine their knowledge of and feelings about the exam. Children were not retraumatized by the examination of their anogenital anatomy. Although poorly prepared for it, children reported medical staff touch to their genitals, anus, and buttocks at a higher rate than touch to all other body locations, 84.5% versus 16%, but did not rate that touch as more painful. Children were significantly less distressed after the exam; mothers were not.

Music therapy research and applications in pediatric oncology treatment

Music therapy is a profession which meets multiple physical, social, and psychological needs. Music therapists can facilitate health objectives by reducing the intensity or duration of pain, alleviating anxiety, and decreasing the amount of analgesic medication needed. Rehabilitative objectives can include activities which incorporate exercise, range of motion therapy, or gait training. Reduction of fear, anxiety, stress, or grief are common psychological objectives. Music therapy is particularly effective in promoting social objectives such as increased interaction, verbalization, independence, and cooperation; enhanced relationships with health care personnel and family members; and increased stimulation during long-term hospitalization or isolation. Counseling techniques are often paired with music to achieve emotional objectives such as expression, adjustment, stability, or locus of control. The purpose of this article is to synthesize the extant music/medical research literature and clarify how music therapy can provide a quintessential combination of physical, social, and psychological benefits to enhance the health care of pediatric oncology patients.