A Longitudinal Assessment of Parenting Stress in Parents of Children with New-Onset Epilepsy

Investigating family resilience factors for enhancing family adaptation in children with epilepsy

PURPOSE

To identify and understand the key family resilience factors that contribute to the improved family adaptation of children with epilepsy.

METHODS

Parent of children with epilepsy treated in the outpatient unit and general ward at Severance Children's Hospital in Seoul, Korea, completed a structured online questionnaire between April and May 2023. This study examined risk (epilepsy severity, time since diagnosis, parental depression, and perceived stigma) and protective factors (child temperament, epilepsy knowledge, family communication skills, parent's educational level, monthly household income, and social support) of family adaptation based on Patterson's Family Resilience Model. Furthermore, general characteristics such as daily caregiving time, perceived parental health, family type, and primary caregiver role were analyzed.

RESULTS

This study included 131 participants with a mean age of 41.79 ± 5.77 years, with children having an average age of 9.19 ± 4.94 years. The regression model was significant, and revealed the impact of communication skills, social support, and primary caregivers other than parents. Moreover, a shorter time since diagnosis has a more positive impact on family adaptation.

CONCLUSIONS

To improve family adaptation in children with epilepsy, the focus should be placed on improving communication skills, increasing social support, and providing access to external support services. Furthermore, families expecting longer illness duration require proactive measures to support them. These findings could guide future strategies to enhance adaptation in families with children with epilepsy.

Explaining the Parenting Styles of Epileptic Children: A Content Analysis

Objectives

Understanding the parenting practices of parents of children with epilepsy can be a practical guide for care and education planners to prevent mental disorders in these children. This study aimed to explain the parenting practices of parents of children with epilepsy in Shahrekord.

Materials & Methods

This study is a qualitative study with conventional content analysis. Participants in the study consisted of 20 mothers with epileptic children in Shahrekord, who were included in the study by purposive sampling method with maximum variance in terms of child age, number of family children, and child sex. The data collection method was a semi-structured interview using the interview guide. Data analysis was performed using a conventional content analysis at the same time as data collection. Interviews continued until data saturation was reached.

Results

The present study revealed five main themes in discipline methods, including over-support / over-protection, forcing to support, rejecting, parental conflict in discipline methods, and using harmful discipline methods.

Conclusion

In conclusion, the experiences of mothers in the present study show that using inappropriate discipline methods can have adverse effects on the mental-emotional and social health of the child in the future and raise the need to design educational interventions to empower parents of epileptic children in coping with parenting stress effectively.

Affiliate stigma and caregiver burden in parents of children with epilepsy

Objective

This study aimed to investigate the current status of affiliated stigma and caregiver burden among parents of children with epilepsy, analyze their correlation, and identify factors influencing affiliated stigma.

Methods

A cross-sectional survey was conducted among 194 parents of children with epilepsy who met the inclusion and exclusion criteria in Shenzhen City, Guangdong Province, China. Data were collected through questionnaires, including a demographic information sheet, an affiliated stigma scale, and a caregiver burden scale.

Results

The results revealed that parents of children with epilepsy experienced a moderate level of affiliated stigma, with an average score of 54.92 ± 10.44. Similarly, caregiver burden scores fell within the moderate range, with an average score of 44.14 ± 16.02. Factors influencing affiliated stigma scores included the frequency of epileptic seizures in children, the types of anti-epileptic medications taken by children, and the place of residence. The total caregiver burden score and scores in various dimensions (emotional, cognitive, and behavioral) of caregivers for epilepsy patients were positively correlated with the affiliated stigma score. Affiliated stigma was found to independently explain 21.3 % of the variation in caregiver burden.

Conclusion

In the future, healthcare professionals should develop targeted interventions for children with epilepsy and their parents to reduce affiliated stigma, decrease caregiver burden, and enhance the caregiving capabilities of parents of children with epilepsy. These measures are essential to improve the overall well-being of both parents and children affected by epilepsy.

Parent/caregiver reported health-related functioning in Chinese children with epilepsy: A cross-sectional, parents-responded, hospital-based study

Due to epilepsy, children have faced several difficulties and challenges. Epilepsy shows an impact on a person quality of life (QoL) which can be associated with psychological, physical, and social aspects and can have a greater impact on the QoL of the person than that do through another chronic disease(s). Health-related quality of life (HRQoL) is a multidimensional concept that includes emotional, mental, physical, behavioral, and social aspects of the well-being and functioning of the patients. The objective of the study was to assess the level of HRQoL for childhood epilepsy in Chinese children under treatment for epilepsy. Also, to identify factors that can affect QoL. A descriptive, cross-sectional, parents-responded questionnaire-based study was performed on 382, 4 to 18 years old hospitalized and outpatient units' children from various backgrounds, varying socio-economic status, and of varying intellectual capability with the most recent epilepsy. The clinical and socio-demographic parameters were collected from medical records and by an interview with parents of children. The quality of life in the children with epilepsy (QoLCE) questionnaire-91 was used to access HRQoL. The average age of children was 10.4 ± 3.2 years. The duration of epilepsy in children was 3.90 ± 2.80 years. Among the enrolled children, 153 (40%) children were girls, and 229 (60%) individuals were boys. The overall QoLCE questionnaire-91 score was 69.40 ± 16.40 (minimum scores: 27.80, maximum scores: 87.80). A total of 324 (84%), 41 (11%), and 17 (5%) children were from urban, suburban, and rural types, respectively. The generalized seizure (198 (52%)) is the most common type of existing seizure followed by focal seizure (152 (40%)). Male (P = .015), older children (12-14 years, P = .019), those residing in urban areas (P = .021), and those with focal seizures (P = .049) had higher QoL scores. The overall QoL of Chinese CWE is affected by sex, age, urbanization, and seizure type but not with education or economic status of the families. The study provides helpful insight for the clinicians in the management of chronic childhood epileptic conditions (Level of Evidence: II; Technical Efficacy Stage: 5).

A randomized controlled study: Evaluating the efficacy of a mobile application developed for mothers who have children with epilepsy in Turkiye

PURPOSE

This study was conducted for the purposes of developing the Mobile Epilepsy Education Package (MEEP) for mothers who have children with epilepsy, and evaluating the efficacy of such a package.

DESIGN AND METHODS

The research consisted of a randomized, controlled experimental study. DISCERN measuring tool was used to evaluate the content of MEEP. The evaluation of the package was conducted with a total of 60 mothers-30 participants in the intervention group and 30 controls. This study was conducted in the Pediatric Neurology Outpatient Clinic of a hospital with mothers who had children with epilepsy, ages 3-6. A Description Form, the Epilepsy Knowledge Scale for Parents, and Parental Anxiety over Seizures Scale were used in the data collection.

RESULTS

The general quality evaluation of MEEP according to the experts was rated 70.35 ± 6.20, with interrater agreement at a good level. Knowledge and anxiety scores were similar in the groups prior to the mobile application. Following the application, a significant increase was seen in the level of knowledge about epilepsy among the intervention group mothers (p < .001), while a significant decrease was observed in anxiety over seizures (p = .009).

CONCLUSIONS

MEEP, which was developed to evaluate mothers' levels of knowledge about epilepsy and their state of anxiety over seizures, resulted in an increase in knowledge and reduced anxiety.

PRACTICE IMPLICATIONS

A simple-to-use, easy-to-access and low-cost mobile application has been developed that facilitates epilepsy diagnosis, follow-up and treatment, increases mothers' knowledge levels, and reduces anxiety levels.

Effect of nursing interventions based on the Kano model on symptom relief and parental psychological behavior in children with febrile seizures

Purpose

To analyze the effect of nursing interventions based on the Kano model on symptom relief and parental psychological behavior in children with febrile seizures (FS).

Methods

A total of 104 children with FS and their corresponding families admitted to our hospital from January 2021 to April 2022 as the research object. All children were divided into 2 groups according to their nursing regimen during treatment. Children who received general nursing interventions were enrolled in the general group (n = 52) and children who received nursing interventions based on the Kano model were enrolled in the Kano group (n = 52). In this study, an investigation was first conducted to analyze the attributes of the caring care service needs of the families of children with FS. Then, we compared 4 aspects of symptom relief during the hospital stay of the 2 groups of children, including FS seizure frequency, time to cessation of convulsions, time to recovery of consciousness and time to fever reduction. The parent symptom questionnaire (PSQ) was used to assess the psychological behavior of the two groups of children during the hospital stay. The Chinese perceived stress scale (CPSS) and the symptom checklist 90 (SCL-90) were used to assess the psychological behavior of the two groups of their families during the children's hospitalization. Finally, a questionnaire was administered on the satisfaction of this nursing intervention.

Results

In terms of symptom relief, the children in the Kano group had less frequent of FS seizure than the general group, and the time to cessation of convulsions, time to recovery of consciousness and time to fever reduction were all earlier than in the genera group (p < 0.05). In terms of children's psychological behavior, the impulsivity-hyperactivity, anxiety, hyperactivity index and learning problems scores in the PSQ of the children in the Kano group were lower than those in the general group after the intervention (p < 0.05). In terms of family psychological behavior, the psychological behavioral problems of the families of the children in both groups improved after the intervention, and the CPSS scores of tension and dis-control, as well as the total SCL-90 score of the families of the children in the Kano group were lower than those of the general group (p < 0.05). In terms of family satisfaction, the Kano group was significantly better than the general group (p < 0.05).

Conclusion

The implementation of the nursing interventions based on the Kano model for children with FS was successful in dramatically reducing the clinical signs and symptoms of the children and meeting the psychological and behavioral needs of the children and their families.

Parenting Stress over the First Year of Inflammatory Bowel Disease Diagnosis

OBJECTIVE

A diagnosis of inflammatory bowel disease (IBD) in children can disrupt the family, including altered routines and increased medical responsibilities. This may increase parenting stress; however, little is known about parenting stress changes over the first year following an IBD diagnosis, including what demographic, disease, or psychosocial factors may be associated with parenting stress over time.

METHODS

Fifty-three caregivers of children newly diagnosed with IBD (Mage = 14.17 years; Mdays since diagnosis = 26.15) completed parenting stress (Pediatric Inventory for Parents), child anxiety (Screen for Child Anxiety-Related Disorders), and child health-related quality of life (HRQOL; IMPACT) measures within 1 month of diagnosis and 6-month and 1-year follow-ups. Multilevel longitudinal models assessed change and predictors of parenting stress.

RESULTS

Parenting stress was significantly associated with greater child anxiety and lower HRQOL at diagnosis (rs = 0.27 to -0.53). Caregivers of color and caregivers of female youth reported higher parenting stress at diagnosis (ts = 2.02-3.01). Significant variability and declines in parenting stress were observed across time (ts = -2.28 and -3.50). In final models, caregiver race/ethnicity and child HRQOL were significantly related to parenting stress over the first year of diagnosis (ts = -2.98 and -5.97).

CONCLUSION

Caregivers' parenting stress decreases across 1 year of diagnosis. However, caregivers of color and those rating their child's HRQOL as lower may be at risk for greater parenting stress. More research is needed to understand why caregivers of color reported greater parenting stress compared to White caregivers. Results highlight the importance of providing whole-family care when a child is diagnosed with IBD.

Parenting Stress in Mothers of Children and Adolescents with Down Syndrome

Parenting stress has deleterious effects on parents, children, and overall family functioning. Parents of children with intellectual disability, including Down Syndrome (DS), show higher levels of parenting stress than parents of typically developing children. This research aimed to (i) evaluate parenting stress levels in a group of mothers of youths with DS using a parent-report questionnaire, (ii) identify children’s individual and clinical features associated with maternal stress, and (iii) identify specific situational life/demographics factors related to maternal stress. Seventy-eight youths with DS underwent a neuropsychological evaluation, whereas mothers completed questionnaires for the assessment of parenting stress and of the child’s emotional and behavioral problems. We found that Parent–Child Difficult Interaction was the domain with the highest percentage of clinical scores (39.7%). Both internalizing and externalizing problems correlated with maternal stress, as well as autistic symptoms. The levels of maternal stress were not associated with any socio-demographic variable. After controlling for child-related correlates of maternal stress and for mothers’ age and education level, unemployed mothers exhibited higher levels of parental distress than employed mothers. The present study highlights that unemployment is related with parenting stress and potentially amenable to policy interventions supporting parents in combining work and family care.