Maternal resolution of child diagnosis: stability and relations with child attachment across the toddler to preschooler transition

Maternal and paternal insightfulness and reaction to the diagnosis in families of preschoolers with Autism spectrum disorder: associations with observed parental sensitivity and inter-parent interaction

Sensitivity among parents of children with Autism Spectrum Disorder (ASD) is based on parental insightfulness and on resolution regarding the child's diagnosis. This has been supported in studies of mothers, and we examined whether the same is true regarding fathers. Also, we asked whether parents' Insightfulness and Resolution tap general mentalization and therefore also be expressed in parent-parent interactions. Eighty preschooler boys with ASD and both of their parents participated. As expected, fathers who were more insightful and mothers who were more resolved were more sensitive. Contrary to expectations, no associations were found between fathers' resolution and mothers' insightfulness and their sensitivity. Associations were found between parental insightfulness and resolution and positive parent-parent interaction. The findings are the first to demonstrate the insightfulness-sensitivity link among fathers of children with ASD. Also, they suggest that both insightfulness and resolution involve general mentalization that is evident both in parent-child and parent-parent interactions.

Hardiness as a Resilience Factor for Adaptation in Families of Children With 22q11.2 Deletion Syndrome: A Mixed Methods Study of Parents' Perspectives

22q11.2 deletion syndrome is a rare multisystem genetic disorder with over 200 associated characteristics, occurring in various combinations and severity. Extensive biomedical research has been undertaken on 22q11.2 deletion syndrome, however, there is a dearth of research on families' experiences of managing a family member with this condition. The complex and at times serious phenotypical presentation of the syndrome can make the management of the condition difficult for families. The aim of this mixed method explanatory sequential study was to investigate family hardiness as a resilience factor for adaptation in families of children with 22q11.2 deletion syndrome from parents' perspectives. We found that adaptation scores increased by 0.57 points (95% CI: 0.19-0.94) for every one-point increase in family hardiness score. Qualitative results indicated that acceptance of the child's diagnosis and support positively influenced hardiness whereas fears about the future and their experiences of loss negatively influenced hardiness.

A pilot study of disease related education and psychotherapeutic support for unresolved grief in parents of children with CF

Diagnosis of chronic disease in a child can result in unresolved grief (UG) in parents. This study aimed to evaluate the efficacy of psychological insight-oriented therapy (IOT) as a treatment for UG compared to disease related education in parents of children with cystic fibrosis (CF). Sequence of delivery, first IOT then disease related education (or vice versa) was also examined, to let all participants experience both interventions. Parents were screened for UG. Parents with UG were randomised to either five 1-h sessions of IOT or five 1-h sessions of education. Measures were assessed pre-intervention, after the first intervention period (primary efficacy assessment), and after the second intervention period (swapping intervention). Forty-seven parents were screened of which 46.8% (22/47) had UG. Median duration of UG was 5 years (range: 6 months–14 years). Anxiety (50% vs. 20%, p = 0.03) and stress (59% vs. 28%, p = 0.03) were significantly more prevalent in parents with UG. There was no difference between arms in the odds of UG resolving either following the first intervention period (OR 0.88; 95% CI 0.5, 1.5) or the second intervention period (OR 0.91; 95% CI 0.5, 1.6). While not statistically significant, adjusted mean values for seven of the eight mental health measures were lower in the IOT (first) arm compared to the ED (first) arm, following the first intervention period. UG is a significant burden for families affected by CF. Provision of disease related education and psychological support, regardless of sequence, can result in resolution of grief.

Trial registration number: ACTRN12621000796886, date of registration 24/06/2021, retrospectively registered.

Parents' resolution of their child's diagnosis: A scoping review

This scoping review focused on parents' resolution of their reactions to receiving a diagnosis for their child, based on Marvin and Pianta's model and Reaction to Diagnosis Interview (RDI). We aimed to map the populations examined, the prevalence of parents' narrated resolution, and what is known about its outcomes and determinants. A structured search identified 47 peer-reviewed papers published between 1992-2021. All employed the RDI and most had a cross-sectional design. Studies focused on a wide range of children's health and mental health diagnoses. Days to years after receiving the diagnosis, RDI narratives of 18.43% to 72.49% of the parents (44% on average) indicated lack of resolution. Studies reported associations between unresolved narratives and children's insecure attachment, higher parenting stress, and poorer parental health. However, findings on the associations of narrated resolution with parents' representations of their child, sensitivity, and psychological symptoms were equivocal, and findings on factors that may shape narrated resolution were limited. To advance the understanding of parents' narrated resolution and its effects, we recommend researchers employ prospective and longitudinal designs, evaluate narrated resolution as a continuous phenomenon, focus on outcomes derived from attachment theory, and systematically sample families from heterogenous cultures.

Development and Validation of a Nomogram for Predicting the Unresolved Risk of Parents of Adolescents With Psychiatric Diagnoses

Evaluating the resolution of parents of ill children can help in taking measures to alleviate their distress in a timely manner and promote children's rehabilitation. This study aims to develop and validate a nomogram for predicting the unresolved risk of parents of adolescents with psychiatric diagnoses. The data for 130 parents (modeling dataset = 90; validation dataset = 40) were collected. A nomogram was first developed to predict the unresolved risk for parents based on the logistic regression analysis in the modeling dataset. The internal and external validation then were conducted through quantifying the performance of the nomogram with respect to discrimination and calibration, respectively, in the modeling and validation datasets. Finally, the clinical use was evaluated through decision curve analyses (DCA) in the overall dataset. In the results, the nomogram consisted of six risk factors and provided a good discrimination with areas under the curve of 0.920 (95% CI, 0.862-0.978) in internal validation and 0.886 (95% CI, 0.786-0.986) in external validation. The calibration with good consistency between the observed probability and predicted probability was also found in both internal and external validation. DCA showed that the nomogram had a good clinical utility. In conclusion, the proposed nomogram exhibited a favorable performance with regard to its predictive accuracy, discrimination capability, and clinical utility, and, thus, can be used as a convenient and reliable tool for predicting the unresolved risk of parents of children with psychiatric diagnoses.

Early childhood attachment stability and change: a meta-analysis

Examining degrees of stability in attachment throughout early childhood is important for understanding developmental pathways and for informing intervention. Updating and building upon all prior meta-analyses, this study aimed to determine levels of stability in all forms of attachment classifications across early childhood. Attachment stability was assessed between three developmental epochs within early childhood: infancy, toddlerhood, and preschool/early school. To ensure data homogeneity, only studies that assessed attachment with methods based on the strange situation procedure were included. Results indicate moderate levels of stability at both the four-way (secure, avoidant, resistant, and disorganised; κ = 0.23) and secure/insecure (r = 0.28) levels of assessment. Meta-regression analysis indicated security to be the most stable attachment organisation. This study also found evidence for publication bias, highlighting a preference for the publication of significant findings.

Resolution of diagnosis and parental attitudes among parents of adolescent kidney recipients

The diagnosis of a chronic illness is described as an upsetting event that implies an emotional crisis for parents. Some are able to come to terms with their child's chronic condition and feel a sense of resolution, but for others, strong negative emotions persist through time. The present study examines diagnostic resolution among parents of teenagers with a transplant. The design was qualitative and involved individual interviews with nine parents. Five were donor to their child. Data were analyzed according to the principles of IPA. Early reactions to the diagnosis suggest that parents with an unresolved status experienced trauma. Many factors seem to contribute to diagnostic resolution such as good communication between spouses, positive relationship with the medical staff, and being the parent donor. For all parents, concerns over adherence are central to their relationship with their youth. Results call attention to the support needs of all parents and particularly those with an unresolved status.

The reaction to diagnosis questionnaire: a preliminary validation of a new self-report measure to assess parents' resolution of their child's diagnosis

Parents' resolution of their child's diagnosis is associated with parental sensitivity and secure child attachment. The Reaction to Diagnosis Interview (RDI) is the accepted measure for assessing resolution, but its administration and coding are time and labor intensive. This study examined the psychometric properties of the Reaction to Diagnosis Questionnaire (RDQ), a new self-report measure that assesses resolution. 75 mothers of children diagnosed with Cerebral Palsy or Developmental Delay completed the RDI and the RDQ and reported on family characteristics. The RDQ showed good internal consistency. Mothers who were classified as resolved using the RDI had higher RDQ scores compared with mothers who were classified as unresolved. The networks of associations of the RDI and the RDQ with family characteristics were similar, although formal equivalence testing could not be performed. The RDQ may be a promising time- and cost-effective tool. Nevertheless, more research is needed to further establish its validity.

Personal Growth Experiences of Parents to Children with Autism Spectrum Disorder

Experiences of parenting a child with Autism Spectrum Disorder (ASD) have mostly been studied in relation to hardship. The current study explored personal growth experiences of Israeli parents to children with ASD, specifically in relation to Tedeschi and Calhoun's crisis-related growth model. Nineteen parents were interviewed, and qualitative categorical content analysis was performed. Four major growth themes emerged: Empowerment and personal strength, Existential perspective/spiritual-emotional experience, Interpersonal and Expertise, professional or political involvement. Themes were largely consistent with the crisis-related growth model, with some being unique to the current subject of inquiry. Findings indicated growth might occur differently in different cultures. Clinically, with some parents, the focus regarding the parenting of their child with ASD should be shifted from adjustment to growth.

Reaction to diagnosis and subsequent health in mothers of children with autism spectrum disorder

The current study assessed whether reactions to diagnosis are associated with health status for mothers of children with autism spectrum disorder at the time of diagnosis, and whether such diagnostic-reaction resolution status is associated with changes in health status over time. A total of 84 mothers of children newly diagnosed with autism spectrum disorder, with stable reactions to diagnosis over a year, participated. Their perceptions of their physical and psychological functioning, and quality of life, were taken at the time of diagnosis and 1 year later. The mothers were also given the Reaction to Diagnosis Interview. Mothers who had an unresolved reaction to diagnosis had a worse health status in terms of their perception of the physical symptoms at the time of the diagnosis, and showed worsening levels of health over the period of a year, relative to mothers who had a resolved diagnostic status. These relationships were independent of other potential predictors of ill health in this sample. The findings point to the potential of the diagnostic process to negatively impact parental health. Given that this can have negative consequences for child prognosis, as well as parental health, there is a need to develop better understanding of the impacts of diagnostic practices.

Young children with significant developmental delay differentiate home observed attachment behaviour towards their parents

BACKGROUND

The hallmark of attachment is that contact, proximity and relief from stress are sought from specific individuals, laying important groundwork for healthy socioemotional functioning. This study investigated the extent to which differentiated attachment behaviour can be observed in young children with significant developmental delay (DD).

METHOD

Video-taped observations of the parent-child and stranger-child interaction were conducted at home and complemented with questionnaires in 20 families with a child with significant DD (age 2-7 years with an average DD of 49 months).

RESULTS

Children displayed more intense and persistent contact-seeking, contact-maintaining and resistant behaviour in the episodes with their parent compared to the episodes with the stranger. Parent-reported secure attachment behaviour was slightly more characteristic towards mother compared to father.

CONCLUSIONS

Even children with significant DD develop differentiated attachment behaviour. Detailed observations may support parents in identifying the interactions that make the attachment relationship with their child special.

A role for epistemic trust in speech-language pathology: A tutorial paper

This paper provides an introduction to epistemic trust for speech-language pathologists (SLPs). 'Epistemic trust' describes a specific form of trust that an individual places in others when learning about the world, particularly the social world. To date, the relevance of epistemic trust to SLP clinical practice has received little theoretical or empirical attention. The aim of this paper is to define epistemic trust and explain its relationship with parent-child attachment and mentalization which have, in turn, been linked with language development and use. Suggestions are made for ways in which SLPs may encourage epistemic trust in clients, emphasizing the need to establish strong therapeutic alliances. The authors conclude that epistemic trust is an important consideration for SLPs and that further research exploring the relationship between epistemic trust and language skills is needed to better understand the interplay of these variables and inform clinical practice.

Coherence of Representations Regarding the Child, Resolution of the Child's Diagnosis and Emotional Availability: A Study of Arab-Israeli Mothers of Children with ASD

This study examined the interplay of mothers' coherent representations of their child (i.e., multidimensional and balanced view); resolution of the child's ASD diagnosis (i.e., acceptance); and emotional availability to the child in the unique cultural context of Arab-Israeli families. Participants were 46 mothers and their 2-8 year old sons. Coherent representations and resolution of the diagnosis were assessed using narrative measures. Emotional availability (namely, sensitivity, structuring, and lack of intrusiveness and hostility) was observed during mother-child play interactions. Results suggested that coherent and resolved mothers were more emotionally available than incoherent and/or unresolved mothers. These findings highlight the importance of supporting mothers' ability to accept the child's diagnosis and see the unique characteristics of the child beyond his ASD symptoms.

Maternal resolution of preterm birth from 1 to 18 months

Preterm birth can be traumatic for some mothers, involving feelings of grief over the hoped-for full-term pregnancy. In this longitudinal study, we interviewed 50 mothers of preterm infants, using the reaction to diagnosis interview when their child was 1 month and 18 months old. We examined change and stability in resolution status over time. Additionally, we explored possible predictors of resolution trajectories between 1 and 18 months. Findings indicated that resolution at 1 month was not yet common. The rate of resolution at 18 months was 62.6%, compared with 38.2% at 1 month. Prenatal precursors of preterm birth, lower medical neonatal risk, and lower maternal stress at 1 month significantly differentiated mothers who attained resolution as early as at 1 month from those who were unresolved at 1 and 18 months. Lower maternal stress at 1 month was the only predictor that significantly differentiated initially unresolved mothers who later attained resolution from those who remained unresolved at 18 months. Discussion focuses on maternal stress, which may mark a subgroup of mothers of preterm infants who are at risk of being unresolved through the first 18 months, and who may benefit from resolution-focused intervention.

Stress and resolution in mothers of children with cerebral palsy

Parental resolution of diagnosis represents coming to terms with and accepting the diagnosis of a serious condition in their child. As risk factors for achieving resolution, we investigated: a child's functional status, cumulative stress, and maternal depression. The current study tested the hypothesis that mothers who are unresolved to their child's diagnosis would have considerably higher levels of risk factors, compared to resolved mothers. We also examined whether the observed risk factors could predict the resolution status. Maternal resolution was assessed by means of the Reaction to Diagnosis Interview. The sample consisted of 100 mothers of children aged 2-7, diagnosed with cerebral palsy. The results showed that unresolved mothers had children with poorer functional status, experienced more stressful life events, and were more depressed compared to resolved ones. The functional status of a child and maternal depression were shown to be significant resolution predictors. Importantly, they were more successful in predicting the resolved than the unresolved status. Further research is needed in order to investigate more extensively the unresolved parental status.

Stability and change in resolution of diagnosis among parents of children with autism spectrum disorder: Child and parental contributions

The contribution of change over time in parent and child characteristics to parents’ resolution of child's diagnosis was examined among 78 mothers and fathers of children with autism spectrum disorder. Children's characteristics (e.g., mental age and severity of symptoms), parental characteristics (e.g., attachment-related anxiety and stress level), and parents’ resolution of their child's diagnosis (resolved vs. unresolved) were examined at Time 1, and reassessed 3 years later at Time 2. Results indicated a deferential contribution of change in parent and child characteristics among mothers and fathers. An increase in child symptom severity and in maternal attachment-related anxiety, as well as longer durations of time since receiving the diagnosis, significantly predicted maternal resolved status at Time 2. Conversely, none of the changes in children's or paternal characteristics predicted paternal resolved status at Time 2. Results are discussed in relation to child and parental contributions to resolution, the differences in the adjustment and well-being of mothers and fathers of children with autism spectrum disorder, parental growth following receiving the diagnosis, and the need for intervention components specific to parental resolution and attachment-related anxiety.

Parents’ Experience With Their Child’s Cancer Diagnosis

Objectives: This study assessed the experience of parents who have a child diagnosed with cancer and whether parental hope, family functioning, and perceptions of care distinguish those parents who have adapted to the diagnosis versus those who have not adapted. Methods: Fifty parents completed an interview about the diagnosis experience and questionnaires about hopefulness, family functioning, and family-centered care. Results: A majority of parents had come to terms with the diagnosis; however, a subset indicated feeling emotionally disengaged from the experience and having persistent thoughts about why this had happened to them. In addition, parents who were having a difficult time adapting reported lower hopefulness and felt that they received more information about support services from medical providers compared with parents who had come to terms with the diagnosis. Conclusions: By recognizing families who continue to struggle with the diagnosis, nurses may be better equipped to approach families and evaluate their needs, including coping and adaptation. Asking parents about their experience can also lead to more appropriate and timely care and referral and allows nurses to provide care that engenders hopefulness.

Parental reaction to early diagnosis of their children's autism spectrum disorder: an exploratory study

This study explores parental reactions subsequent to receiving their child’s autism spectrum disorder (ASD)-diagnosis. Seventy seven parents of recently diagnosed children participated in the Reaction to Diagnosis Interview. Within this group, associations between parental reaction to diagnosis, parental and child characteristics and prediagnostic circumstances were analysed. In a sub-sample, the stability of reaction to diagnosis was examined. The majority of parents were classified as ‘resolved’ regarding their child’s diagnosis. Conversely, parents of children with more severe ASD symptoms or non-Dutch parents were more likely to be classified as ‘unresolved’. Sub-sample analysis revealed stability of reaction to ASD-diagnosis. The majority of parents adapted well to the circumstances and the care for their child. Autism severity and parental nationality were significant factors affecting parental reactions. Thus, early identification of parental reaction to children’s ASD-diagnosis may aid in providing more tailored parental support programs.

Parent adaptation and family functioning in relation to narratives of children with chronic illness

BACKGROUND

This study assessed the experience of parents who have a child diagnosed with chronic illness and whether children's narratives mirror these experiences.

METHOD

A total of 66 parents completed assessments about adaptation and family functioning. Children with type 1 diabetes or asthma participated in a story-stem narrative task.

RESULTS

Forty-one percent of parents were unresolved about their child's diagnosis, regardless of time since diagnosis. Unresolved parents reported lower family functioning, and children in these families had more family conflict themes.

CONCLUSIONS

Parental/Child narratives may provide unique insights into family adjustment. Future work may consider interventions related to family communication and expression of emotion.

The impact of an infant's severe congenital heart disease on the family: a prospective cohort study

OBJECTIVE

The aim of this article is to investigate the impact of a child's severe congenital heart disease on the family and to prospectively examine the influence of disease specific and psychosocial factors on the family.

DESIGN

A prospective cohort study.

PATIENTS

Parents of 104 infants who had undergone cardiopulmonary bypass surgery before the age of 12 months for congenital heart disease were included.

INTERVENTIONS

None.

OUTCOME MEASURES

Parents completed the generic Impact on Family scale and a social support questionnaire; a large number of medical data were extracted from the patients' hospital records.

RESULTS

Parents most frequently reported that they were thinking about not having more children and living on a "roller coaster." No difference was found in the total Impact on Family scale score between fathers and mothers. The presence of a genetic disorder in the child and lower levels of perceived social support was significantly associated with a greater impact on the family.

CONCLUSIONS

The impact of an infant's congenital heart disease on the family is determined both by child's medical condition and family's psychosocial factors. Families with poorer social support network may have the greatest need for professional interventions, especially if their child has an underlying genetic disorder.

Paternal versus maternal coping styles with child diagnosis of developmental delay

Parents of children with disabilities vary in their reaction to their children's diagnosis. The current study focused on fathers in addition to mothers and examined their resolution and coping styles when having children diagnosed with developmental delay (DD). Sixty-five fathers and 71 mothers were interviewed using the reaction to the diagnosis interview (RDI; Pianta & Marvin, 1992a). Results indicated that the majority of parents were unresolved with their child's diagnosis, with no differences found between fathers' and mothers' rates of resolution. Furthermore, both parents of children that were diagnosed at a later age and parents that were less educated tended to be unresolved, as did fathers of a lower socioeconomic status. Older age of both children and mothers was related to maternal lack of resolution. Finally, an in-depth examination revealed significant differences in the manner in which fathers and mothers cope with their children's diagnosis: whereas mothers were more prone to using an emotional coping style, fathers tended to use a cognitive coping style. The clinical implications of paternal versus maternal coping styles are discussed.

Couples’ Resolution of an Infertility Diagnosis Before Undergoing in Vitro Fertilization

Although the use of assisted reproductive technology has today become more familiar, the suffering associated with the experience of infertility remains. This study assesses the emotional resolution of couples faced with an infertility diagnosis by examining their narratives. Fifty-seven couples were recruited from fertility clinics to participate in a semistructured interview prior to in vitro fertilization. Two aspects of the couples’ reactions to the infertility diagnosis were assessed: (1) each individual’s capacity to acknowledge the emotional reality of the diagnosis (diagnosis resolution) and (2) the couple’s ability to construct a shared meaning of the infertility diagnosis experience (narrative co-construction). Associations between these aspects and self-reported marital satisfaction, infertility-related stress, and diagnosis-related variables were analyzed. 73.7% of women and 61.4% of men had acknowledged the emotional reality of the diagnosis, and their scores for narrative co-construction were comparable to reference samples. Marital satisfaction, but not infertility-related stress, was associated with diagnosis resolution and narrative co-construction. The results indicate the importance of detecting couples with fewer individual and marital resources needed to face the reality of the diagnosis. A couple’s capacity to perceive the infertility diagnosis as a shared problem is also essential for dealing with this common life event.

Resolution of the diagnosis and maternal sensitivity among mothers of children with Intellectual Disability

We examined mothers' resolution of their children's diagnosis of Intellectual Disability (ID) and its link to maternal sensitivity, and we hypnotized that mothers' who are "resolved" will show more sensitivity during their interactions with their children than "unresolved" mothers. We assessed maternal resolution using the Reaction to Diagnosis Interview and maternal sensitivity in three different play episodes using the Emotional Availability Scales. Our sample included 40 children between the ages of 2.5 and 5.5 with clinical diagnoses of non-syndromic ID and their mothers. Supporting our hypothesis we found that mothers who were resolved regarding the diagnosis of their children showed more maternal sensitivity to their children in two of the three play episodes. Another important finding was that resolution and sensitivity were associated even when we controlled for the child's responsiveness to and involvement with the mother, suggesting that the link between resolution and sensitivity cannot be accounted by the impact of the child's behavior on the mother.

Planning with parents for seriously ill children: preliminary results on the development of the parental engagement scale

OBJECTIVE

The objective of this study was to develop a clinically relevant tool to assess parental engagement in decision making and planning for seriously ill children during palliative care consultations. Although little is known about the structure and process of planning meetings between parents and providers, less is known about the nature of parental engagement as it relates to decision making ability in pediatric end-of-life care. Using attachment and caregiving as a framework, this study clarified important dimensions of parental engagement.

METHOD

Using a multi-phase, template-matching technique, both literature and pediatric palliative care consultation data were analyzed, iteratively reviewed, matched, and categorized to create a measure of parental engagement. The attachment paradigm serves as the theoretical framework for the study, which focuses on parental engagement in decision making as a caregiving system function. Attachment and related literatures as well as coping and pediatric palliative care literatures were used in the initial conceptual sampling phase.

RESULTS

The study yielded two groups of findings. The first set of findings centered on the findings of the literature and consultation template-matching phases of the work. These two phases yielded a conceptual model of parental engagement as a psychobehavioral complex consisting of three dimensions: information-centered dialogue, insightful participation, and achievement of a collaboratively agreed-upon plan. The final phases consisted of creation of a 9 point Parental Engagement Scale, scoring of the consultations, and establishment of initial inter- rater reliability at .80. Psychometric testing continues.

SIGNIFICANCE OF RESULTS

Parental engagement in decision making is a critical area for study and intervention. If we can support parents in their caregiving executive functions while understanding the psychological and emotional underpinnings of the caregiving system and parental engagement itself, we can move inquiry forward in understanding parental needs for intervention during this most profoundly challenging time.

Parents' experiences of caring for a child with a cleft lip and/or palate: a review of the literature

This review brings together for the first time the existing quantitative and qualitative research evidence about the experiences of parents caring for a child with a cleft. It summarizes salient themes on the emotional, social and service-related experiences of parents and critiques the literature to date, comparing it with wider, selected literature from the field of children's long-term conditions, including disability. The review suggests that there are similarities and differences between the literatures, in terms of research focus and approach. Similarities are found across children's conditions in the perspectives of parents on emotional, social and service-related aspects, although much of the cleft literature is focused on the early stages of children's lives. However, the quality of cleft research to date about parents' experiences has also been variable, with a narrow emphasis on cross-sectional, deficit-orientated psychological approaches focused mainly on mothers. Despite a substantial literature, little qualitative research has examined parents' perspectives in-depth, particularly about their child's treatment journey. This contrasts with the wider children's literature, which has traditionally drawn not only on psychological approaches but also on the broader perspectives of sociology, social policy, nursing and health services research, using both qualitative and quantitative methods, often in integrated ways. Such approaches have been able to highlight a greater range of experiences from both mothers and fathers, about caring for a child with a long-term condition and views about treatment. The review identifies a lack of comparable research in the cleft field to examine parents' experiences and needs at different stages of their children's lives. Above all, research is needed to investigate how both mothers and fathers might experience the long-term and complex treatment journey as children become older and to elicit their views about decision making for cleft treatments, particularly elective surgeries.

Mothers' resolution of their young children's psychiatric diagnoses: associations with child, parent, and relationship characteristics

Maternal resolution of a child's diagnosis relates to sensitive caregiving and healthy attachment. Failure to resolve is associated with maternal distress, high caregiving burden, and the quality of marital and social support. This study examined maternal resolution of diagnosis in a child psychiatric population utilizing the Reaction to Diagnosis paradigm. Thirty-three mothers of children ages 2–7 years with psychiatric disorders were interviewed using the Reaction to Diagnosis Interview. Slightly over half of the sample was classified as resolved. Associations between maternal resolution status, maternal depression, childrearing stress, and child functioning were examined and a predictive model for maternal resolution status was tested. Specific findings included a significant association between childrearing stress and maternal resolution status with support for some additional predictive power for maternal depression on resolution status. Child functioning was not significantly associated with resolution status, and may exert influence indirectly through its association with childrearing stress. There were no significant associations between maternal or child demographic characteristics and maternal resolution status. Clinical and research implications are discussed.

Maternal resolution of grief after preterm birth: implications for infant attachment security

OBJECTIVE

This study explored the association between mothers' unresolved grief regarding their infant's preterm birth and infant-mother attachment security. We hypothesized that mothers with unresolved grief would be more likely to have insecurely attached infants at 16 months and that this association would be partially mediated by maternal interaction quality.

METHODS

This longitudinal study focused on 74 preterm infants (age of <36 weeks) and their mothers who were part of a larger study of high-risk infants. The present analysis included assessment of neonatal and socioeconomic risks at NICU discharge; maternal depression, Reaction to Preterm Birth Interview findings, and quality of parenting at a postterm age of 9 months; and infant-mother attachment at postterm age of 16 months. Associations among findings of grief resolution with the Reaction to Preterm Birth Interview, quality of parenting interactions, and attachment security were explored by using relative risk ratios and logistic and multivariate regression models.

RESULTS

The relative risk of developing insecure attachment when mothers had unresolved grief was 1.59 (95% confidence interval: 1.03-2.44). Controlling for covariates (adjusted odds ratio: 2.94), maternal feelings of resolved grief regarding the preterm birth experience were associated with secure infant-mother attachment at 16 months. Maternal grief resolution and interaction quality were independent predictors of attachment security.

CONCLUSION

Maternal grief resolution regarding the experience of preterm birth and the quality of maternal interactions have important implications for emerging attachment security for infants born prematurely.

Maternal role attainment with medically fragile infants: Part 2. relationship to the quality of parenting

We examined which components of maternal role attainment (identity, presence, competence) influenced quality of parenting for 72 medically fragile infants, controlling for maternal education and infant illness severity. Maternal competence was related to responsiveness. Maternal presence and technology dependence were inversely related to participation. Greater competence and maternal education were associated with better normal caregiving. Presence was negatively related although competence was positively related to illness-related caregiving. Mothers with lower competence and more technology dependent children perceived their children as more vulnerable and child cues as more difficult to read. Maternal role attainment influenced parenting quality for these infants more than did child illness severity; thus interventions are needed to help mothers develop their maternal role during hospitalization and after discharge. © 2010 Wiley Periodicals, Inc. Res Nurs Health 34:35-48, 2011.

Short-term changes in parents' resolution regarding their young child's diagnosis of cerebral palsy

OBJECTIVE

This study aimed to describe changes in parents' resolution regarding their young child's diagnosis of cerebral palsy over a period of 1 year, and to describe the changes in strategies of resolution.

METHODS

In this longitudinal study, 38 parents of children with cerebral palsy (mean age 18.4 months, SD = 1.1 at baseline) were followed with the Reaction to Diagnosis Interview, assessing their personal reactions to their child's diagnosis (i.e. resolution status). Changes at main and subclassification level of the Reaction to Diagnosis Interview were investigated using a binominal test.

RESULTS

Twenty-nine parents (76%) were found to be stable with respect to their main resolution status (i.e. 'resolved' or 'unresolved'), while 24% of the parents either had changed from 'unresolved' to 'resolved' or in the opposite way. Furthermore, of the 28 parents who were classified as 'resolved' at both times, 15 (54%) had changed at subclassification level with respect to the specific strategies used.

CONCLUSION

Resolution at a main level of parental reactions to their child's diagnosis was predominantly stable. Most parents were classified as 'resolved' at both baseline and follow-up assessment. However, more detailed analyses at subclassification level showed that most parents with a 'resolved' main status showed changing patterns of resolution strategies to their child's diagnosis, suggesting that resolution is an ongoing process.

Parents' reactions to the diagnosis of cerebral palsy: associations between resolution, age and severity of disability

BACKGROUND

For parents, receiving a diagnosis, typically in early childhood, that their child has cerebral palsy may conjure up high distress and anxiety. Resolution of these initial reactions may help parents to focus on the challenges and needs of their children.

AIMS

of the study were to test whether parents of older children displayed resolution more often than parents of younger children, and whether parents of children with less severe cerebral palsy also showed more resolution.

METHOD

Resolution of reactions to diagnosis was assessed with the Reaction to Diagnosis Interview, in a clinic-based sample of 255 parents of children with cerebral palsy aged between 1.4 and 17.3 years. Physicians rated motor ability using the Gross Motor Function Classification System.

RESULTS

Overall, the responses of 81.6% of the parents were predominantly indicative of resolution. Unresolved reactions were significantly more often found among parents of younger children and parents of children with more severe motor disabilities. Among parents of teenage children, resolution was more often apparent from a focus on action to better the lives of their children, whereas in parents of younger children, it was more apparent from their focus on constructive thoughts and information seeking.

CONCLUSIONS

Given time, the large majority of parents may resolve their reactions to the diagnosis that their child has cerebral palsy. Parents of the most severely affected children may need specific support which, given the age trends, might be aimed at different resolution processes for parents of younger and older children.

Resolution of the diagnosis among parents of children with autism spectrum disorder: associations with child and parent characteristics

Resolution with the diagnosis of one's child involves coming to terms with and accepting the diagnosis and its implications. Parental resolution with the diagnosis was examined among 61 mothers and 60 fathers of 61 children with autism spectrum disorders aged 2-17 years. We investigated resolution rates and subtypes, and associations between resolution status and child characteristics (CA, gender, MA, adaptive behavior, diagnosis type, time elapsed since diagnosis) and parent characteristics (age, gender, IQ, broad autism phenotype index, special needs' impact on family). Nearly half of the parents were classified as resolved. Maternal but not paternal resolution status was associated with reported negative impact of raising a child with a disability on family life, but not with other characteristics of the child or the parent.