Role of the family in the onset and outcome of childhood disorders: selected research findings

Healthy siblings' perspectives about paediatric palliative care: A qualitative systematic review and meta-synthesis

BACKGROUND

Siblings of children requiring palliative care are often forgotten and overlooked, as the focus tends to be on the ill child and their parents. Limited knowledge of non-bereaved siblings' perspectives makes it challenging to provide appropriate support for them. A review of existing literature is thus needed to better understand the experiences of these siblings and to identify research gaps that may require further examination.

AIM

To consolidate the available qualitative evidence on the perspectives of non-bereaved healthy siblings regarding paediatric palliative care.

DESIGN

A qualitative systematic review using a meta-synthesis approach was conducted.

DATA SOURCES

Six electronic databases (PubMed, CINAHL, PsycINFO, Embase, Scopus and ProQuest Dissertations and Theses Global) were searched from each database's inception date until October 2022. The search included qualitative and mixed-method studies that reported the perceptions and associations of siblings of patients receiving paediatric palliative care. Data were synthesised using thematic analysis.

RESULTS

Eleven studies were included. The overarching theme of the review would be 'A walking shadow: Living in the darkness shaped by the dying sibling', and three key themes and nine subthemes were identified from the included articles: (1) Changing family dynamics; (2) Impact on school and socialisation and (3) Psychological impact and coping.

CONCLUSION

Siblings demonstrated negative psychological impacts and were affected by changing family structure and relationships. However, socialisation with society, and varied coping skills such as cognitive coping and using distraction techniques, were significant for siblings to go through this journey and even led to some positive outcomes for them.

Impact of ADHD on Household Chores

Objective: To assess the relationship between ADHD and performance of household chores. Method: A 72-question online questionnaire was developed to collect demographic/clinical information as well as parents' assessment of their child's performance of self-care (SC) and family-care (FC) chores. Results: The sample consists of 797 primary caregivers of children with ADHD. The overwhelming majority of parents believed that ADHD to some extent affected their child's ability to independently and satisfactorily complete SC and FC chores. An inverse relationship was noted between parent ratings of a child's ability to do chores independently and satisfactorily and the likelihood they believed ADHD affected chore performance. There was no difference in chore performance between children with or without co-morbid oppositional defiant disorder. Conclusion: Given that household routines, including chores, play an important role in children's development and psychosocial adjustment, clinicians must be sensitive to the adverse impact that ADHD may have in this regard.

Predictors of Marital Physical Violence: Personal and Relational Characteristics

Abstract Conjugal violence is a complex phenomenon that deserves attention because of its prevalence. The aim of this study was to verify the predictive power of the family-of-origin experiences, early maladaptive schemas, love, marital adjustment and family climate to marital physical violence occurrence. In this quantitative, correlational and explanatory study 186 men and 186 women took part, aged from 19 to 81 (M=41,17; SD=12,75). The instruments used measured general information, family of origin (FBQ), maladaptive schemes (YSQs), love (TLS), marital adjustment (DAS), family climate (FCI) and marital conflicts (CTS2). The results showed an association between the studied variables. In addition, the variables family conflict and sexual abuse in childhood were predictive of physical violence committed by women, while marital dissatisfaction was the predictor of marital violence committed by men. In view of the results, it can be established that the phenomenon of violence in intimate relationships is multidetermined, requiring attention from health professionals.

Demographic Predictors of Family Functioning and Its Change Over the First 5 Years Postpartum: Findings From the Healthy Beginnings Trial

There are very few longitudinal studies examining family functioning in early childhood. This was a prospective cohort study to identify maternal sociodemographic factors associated with family functioning over the first 5 years postpartum, using data from the Healthy Beginnings Trial. Family functioning was measured using the General Functioning Subscale of the McMaster Family Assessment Device. A total of 667 first-time mothers participated, of which 369 remained at 5 years. Family functioning did not change significantly over the 5 years. Mothers being Australian born, being employed, and having a partner were predictors for healthy family functioning. Targeting support for immigrants, low-income and single-mother families may therefore improve family functioning.

Family-Based Integrated Care (FBIC) in a Partial Hospital Program for Complex Pediatric Illness: Fostering Shifts in Family Illness Beliefs and Relationships

The heuristic model of family-based integrated care (FBIC) was developed from 1998 to 2016 in the context of the development of the Hasbro Children's Partial Hospital Program (HCPHP) along with the development of a family therapy training program for Brown University child psychiatry and triple board residents. The clinical experience of the HCPHP team in treating more than 2000 patients and families in combination with the authors' experience in training residents for diverse practice settings highlights the usefulness of the FBIC paradigm for interdisciplinary family-based treatment for a broad range of illnesses and levels of care.

Psychoeducation and Expressed Emotion by Parents of Children with Learning Disorders

The present study assessed use of a psychoeducation group program on expressed emotion, family functioning, and child behavior by parents of children with learning disorders. 81 parents of children with learning disorders were randomly assigned to a psychoeducation group program ( n = 46) or to a regular treatment group ( n = 35). A semistructured interview for parental expressed emotion, self-reports of family functioning, and child behavior were utilized at baseline and after an 8-session psychoeducation group program. Parents who attended the program differed significantly from parents in the regular treatment group on measures of criticism, warmth, and positive remarks, and overall expressed emotion, but not on measures of perceived family functioning and child behavior. Findings indicate a psychoeducation group program could be effective in helping parents to establish a more positive emotional climate in their relationships with their children who have learning disorders.

The buffering effect of family functioning on the psychological consequences of headache

The current study aimed to examine whether high family functioning mitigates the association between headache intensity and distress. The sample consisted of 124 patients with chronic or recurrent headache. Patients completed validated questionnaires about headache intensity, family functioning, and distress. Hierarchical regression analyses were performed to examine the interaction between headache intensity and family functioning on distress. Headache intensity was positively associated with distress (r = .28, p = .002). As hypothesized, family functioning moderated this association (B = -.01, p = .023). More specifically, the positive association between headache intensity and distress was significant only among patients with lower family functioning (B = .01, p < .001) and not among patients with higher levels of family functioning (B = .006, p = .075). Functional families appear to buffer the distress level in patients; they showed relatively low levels of distress regardless of the severity of their headache. In contrast, patients with dysfunctional families who experienced more pain reported more distress, presumably because they did not receive adequate help and support from these families. This study underlines the importance of a broader perspective on family dynamics in coping with pain.

Unpacking externalising problems: negative parenting associations for conduct problems and irritability

BACKGROUND

Reciprocal associations between negative parenting and child externalising problems are well documented, but measures commonly include child irritability, masking potential distinct associations for irritability and conduct problems.

AIMS

To illuminate links between negative parenting, child conduct problems and irritability over time.

METHOD

A cross-lagged monozygotic (MZ) twin differences design was used in a UK sample (3154 twin pairs) at 4, 7 and 9 years.

RESULTS

Within-pair MZ differences in negative parenting were found to relate longitudinally to differences in conduct problems and irritability. Of note, negative parenting at age 7 was found to relate particularly to increased irritability at 9 years.

CONCLUSIONS

Once genetics are taken into account, irritability in middle childhood may be particularly vulnerable to negative parenting, suggesting support for its malleability to parent-based intervention.

Carers' experiences of involvement in care planning: a qualitative exploration of the facilitators and barriers to engagement with mental health services

BACKGROUND

Formal recognition and involvement of carers in mental health services has been the focus of recent policy and practice initiatives as well as being supported by carers themselves. However, carers still report feeling marginalised and distanced from services. A prominent theme is that that they are not listened to and their concerns are not taken seriously. Compared to service user views, the reasons underpinning carers' dissatisfaction with care-planning procedures have been relatively neglected in the research literature, despite the substantial and significant contribution that they make to mental health services. The aim of the study was to explore carers' experiences of the care planning process for people with severe mental illness.

METHODS

Qualitative interviews and focus groups were undertaken with carers. Data were combined and analysed using framework analysis.

RESULTS

Whilst identifying a shared desire for involvement and confirming a potential role for carers within services, our data highlighted that many carers perceive a lack of involvement in care planning and a lack of recognition and appreciation of their role from health professionals. Barriers to involvement included structural barriers, such as the timing and location of meetings, cultural barriers relating to power imbalances within the system and specific barriers relating to confidentiality.

CONCLUSIONS

This qualitative study led by a researcher who was a carer herself has developed the understanding of the potential role of carers within the care planning process within mental health services, along with the facilitators and barriers to achieving optimal involvement.

Training Child Psychiatrists in Family-Based Integrated Care

Family-based assessment and intervention are essential skills for child psychiatrists that are often neglected in fellowship training. The Brown Model for Family Therapy Training described here has evolved during the past 15 years. It is a model for training residents in family-based integrated care (FBIC), which has data to support postgraduate perception of positive impact on real-world practice. Effective training in FBIC has value for clinicians, families, and systems of care wanting to respond to the growing evidence in child psychiatry about the power of family environment, beliefs, and relationships in promoting child mental health.

Children with bronchial asthma assessed for psychosocial problems in a teaching hospital in Nigeria

BACKGROUND

Paediatric bronchial asthma causes respiratory related mortality and morbidity globally and elevates the risk of psychological and social problems (psychosocial problems); which may result in poorer asthma control. The rate of and associated factors for psychosocial problems among our asthmatic children was assessed in this study.

METHODS

Seventy five (75) children aged 7 to 14 years with bronchial asthma who were attending clinics at the University of Ilorin Teaching Hospital, Ilorin, Nigeria, were assessed with Child behaviour questionnaire and a semi-structured questionnaire.

RESULTS

Probable psychological morbidity was present in 25% of the children. The most frequently reported social impairments associated with the disease were: interference with play (60%), domestic work (49%), fear of dying anytime (29%) and feeling of being a burden on the family (25%). Psychological morbidity was significantly associated with lower maternal education (p=0.020) and occupation (p=0.038), polygamy (p=0.012), fathers having more than 5 children (p=0.027) and mothers having inadequate spousal support (p=0.012). Inadequate spousal support and lower maternal occupational level were the significant predictors of morbidity following logistic regression.

CONCLUSION

Routine psychosocial assessment and care for children with asthma needs to be introduced into our clinics to help protect them and their families from avoidable suffering.

Friendship and romantic relationships among emerging adults with and without type 1 diabetes

OBJECTIVE

To examine whether friendship and romantic relationships of emerging adults with type 1 diabetes differed from those of a comparison group, and to determine whether these relationships were associated with psychological and diabetes health outcomes.

METHODS

High school seniors with (n = 122) and without (n = 118) type 1 diabetes were assessed annually for 3 years. Friend and romantic relationship variables, psychological distress, life satisfaction, eating disturbances, and, for those with diabetes, diabetes outcomes were assessed.

RESULTS

Those with diabetes reported less friend support but similar friend conflict compared with controls. Aspects of romantic relationships and friend relationships were associated with health outcomes, but there were more effects involving romantic relationships. On some indices, romantic support was more beneficial for controls and romantic conflict was more troublesome for those with diabetes.

CONCLUSIONS

Both friendship and romantic relationships were associated with psychological and diabetes outcomes among emerging adults.

Family function and its relationship to injury severity and psychiatric outcome in children with acquired brain injury: a systematized review

AIM

The psychological and psychiatric outcome of children with acquired brain injury is influenced by many variables. A review was undertaken to clarify the contribution of family function, how it relates to injury severity, and what particular aspects of family function influence psychological outcome in this group.

METHOD

A systematized review of the literature of studies published between 1970 and 2012 from OvidMedline, PsychoInfo, PsycARTICLES, and Cochrane was undertaken focusing on family function, injury severity, and psychiatric outcome.

RESULTS

Thirty-six papers met the inclusion criteria. Injury severity was linked to the development of organic personality change. Family function before injury, measured by the Family Assessment Device or the Clinical Rating Scale, had a statistically significant effect on general psychological functioning in six out of eight studies. Family function had a significant effect for oppositional defiant disorder and secondary attention-deficit-hyperactivity disorder. The effects of family function may differ depending on the age of the child and the severity of the injury. Some styles of parenting moderated recovery. After injury, family function was related to the child's contemporaneous psychiatric symptoms. The level of evidence for these papers was 3 or 4 (Oxford Centre for Evidence-based Medicine criteria).

INTERPRETATION

Screening for some aspects of family functioning before injury and family function during the rehabilitation phase may identify children at risk of psychiatric disorders.

Expressed emotion as an assessment of family environment with mothers and fathers of 1-year-old children

BACKGROUND

High levels of expressed emotion (EE) in parents have been found to put children at risk for emotional and behavioural problems. However, the majority of existing studies have focused on mothers of school-aged children and adolescents rather than younger children, and have only rarely included fathers.

METHODS

The present study examined the reliability of EE in mothers and fathers of 1-year old children. It also investigated whether depression and marital problems in the postnatal period predicted EE toward the child at 12 months. EE was assessed with the Preschool Five Minute Speech Sample in 163 families.

RESULTS

The rater-interrater and code-recode reliability was high for most EE dimensions. Mothers and fathers were found to display quite similar EE scores. Regression analyses showed that depression and couple relationship significantly predicted EE in mothers, but not fathers.

CONCLUSIONS

The findings suggest that EE provides a reliable and useful assessment of the family environment in families of young children.

PTSD and conflict behavior between veterans and their intimate partners

This study examined the influence of trauma history and PTSD symptoms on the behavior of veterans and their intimate partners (287 couples; N=574) observed during conflict discussions and coded using the Rapid Marital Interaction Coding System (Heyman, 2004). Dyadic structural equation modeling analyses showed that PTSD was associated with more frequent displays of hostility and psychological abuse and fewer expressions of acceptance and humor in both veterans and their partners. Findings provide new insight into the social and emotional deficits associated with PTSD and emphasize the importance of addressing the trauma histories and PTSD of both partners when treating veteran couples with relationship disturbance.

Quick, simple measures of family relationships for use in clinical practice and research. A systematic review

BACKGROUND

Family functioning has been implicated in the onset of child and adult psychopathology. Various measures exist for assessing constructs in the areas of parent-child relationships, parental practices and discipline, parental beliefs, marital quality, global family functioning and situation-specific measures.

OBJECTIVES

To identify systematically all questionnaire measures of family functioning appropriate for use in primary care and research.

METHODS

A systematic literature review was conducted, following PRISMA guidelines and searching 14 bibliographic databases using pre-determined filters, to identify family functioning measures suitable for use in families with children from 0 to 3 years old.

RESULTS

One hundred and seven measures of family functioning were reported and tabulated and the most commonly used measures were identified.

CONCLUSIONS

There are numerous measures available demonstrating characteristics, which make them suitable for continued use. Future research is needed to examine the more holistic measurement of family functioning using integration of multi-informant data.

African American parents'/guardians' health literacy and self-efficacy and their child's level of asthma control

Nearly 1 of 10 American children has asthma. Asthma is addressed in Healthy People 2010 as a public health problem. This study examined the relationship between parents'/guardians' health literacy levels and their perceived self-efficacy to manage their child's asthma. A four-page asthma questionnaire was developed to assess the self-efficacy of parents/guardians of African American children with asthma. There was a statistically significant relationship among the parents'/guardians health literacy levels and their perceived efficacy expectations to manage their child's asthma. There is evidence that high parental/guardian self-efficacy and successful asthma management contribute to a child with well-controlled asthma. It is necessary for patient educators to capitalize on physician/nurse visits and use the time for asthma education, particularly to increase the efficacy expectations of parents/guardians with limited health literacy skills.

Impact of a family-oriented rehabilitation programme on behavioural and emotional problems in healthy siblings of chronically ill children

OBJECTIVE

To evaluate the impact of a family-oriented inpatient rehabilitation programme on behavioural and emotional problems in healthy siblings of chronically ill children and to assess the association between these problems and quality of life.

METHODS

A total of 259 healthy children (4-16 years, M = 8.6 years, SD = 3.3) with a chronically ill sibling were enrolled in the study. Parents filled in the Strengths and Difficulties Questionnaire, while the children answered a self-report quality of life instrument (LQ-KID) at the time of admission and discharge from the clinic and at a 6-month follow-up. Comparisons were performed with a matched control group from the German general population (n= 777).

RESULTS

Significant behavioural or emotional symptoms were found in 30.5% of the healthy siblings, the relative risk of having elevated scores being 2.2 compared with the control group. Symptoms were inversely correlated with quality of life (r=-0.42). During the inpatient rehabilitation, symptoms decreased significantly to a normal level. Similarly, quality of life significantly improved, except in the dimension family relations.

CONCLUSIONS

Family-oriented inpatient rehabilitation is a promising approach to improve the mental health of children with a chronically ill sibling.

A longitudinal investigation of the relationship between disordered eating attitudes and behaviors and parent-child conflict: a monozygotic twin differences design

Few studies have examined nonshared environmental risk factors for disordered eating, and none have done so using a longitudinal design. The current project used a longitudinal, monozygotic twin differences design to examine parent-child conflict as a nonshared environmental risk factor for disordered eating. Participants included 468 monozygotic female twins (234 pairs) from the Minnesota Twin Family Study, who completed surveys every 3 years from ages 11 to 17 years. Twin differences in disordered eating were assessed with the Total Score, Body Dissatisfaction, Weight Preoccupation, and Binge Eating subscales of the Minnesota Eating Behavior Survey. Differences in parent-child conflict were assessed with the Parental Environment Questionnaire. Cross-lagged models were used to examine longitudinal associations among these variables, controlling for within-age associations. Only the longitudinal association between twin differences in disordered eating at age 14 years and differences in parent-child conflict at age 17 years were significant; twin differences in disordered eating predicted later differences in parent-child conflict rather than the reverse. Findings suggest differences in parent-child conflict between genetically identical twins may be a consequence of, rather than a risk factor for, differences in disordered eating.

Expressed emotion displayed by the mothers of inhibited and uninhibited preschool-aged children

In the current study, the Five Minute Speech Sample was used to assess the association between parent attitudes and children's behavioral inhibition in mothers of 120 behaviorally inhibited (BI) and 37 behaviorally uninhibited preschool-aged children. Mothers of BI children demonstrated significantly higher levels of emotional over-involvement (EOI) and self-sacrificing/overprotective behavior (SS/OP). However, there was no significant relationship between inhibition status and maternal criticism. Multiple regression also indicated that child temperament, but not maternal anxiety, was a significant predictor of both EOI and SS/OP.

Having a child with asthma--quality of life for Jordanian parents

This study was conducted to assess the quality of life (QoL) of Jordanian parents of children with asthma and its associated factors. Three hundred and twenty-six parents of 200 children participated in the study. The Pediatric Asthma Caregivers' Quality of Life Questionnaire (PACQLQ) was used to measure how parents of children with asthma disease impaired their daily life during the previous week on two domains 'activity limitations' and 'emotional function'. In this study, parents of children with asthma scored their QoL during the past week moderately to the positive end of the scale but they scored more limitations in the domain of activities than in emotions. Parents in the same family scored activity domain fairly similar and there was a significant difference in their scoring of total emotional function. Parents with older children, living in the rural areas, mothers of children with mild asthma were associated with higher QoL. Children received needed daily asthma medication during the preceding week. Asthma medication might mean to the parents that the child was getting the best possible treatment. Further studies to identify the factors that influence QoL of parents of children with asthma in Jordan are needed.

Parental Criticism and Adolescent Depression: Does Adolescent Self-Evaluation Act as a Mediator?

Background: A better understanding of relationships between adolescent depression and family functioning may help in devising ways to prevent development of depression and design effective therapeutic interventions. Aims: This study explored the relationship of parental emotional attitudes, (perceived criticism and expressed emotion) to adolescent self-evaluation and depression. Methods: A sample of 28 clinic-referred adolescents and their mothers participated. The Five Minute Speech Sample was used to measure parental expressed emotion, and the adolescents completed the Children's Depression Inventory, Self-Perception Profile for Children global self-worth scale, a self-criticism scale and a perceived parental criticism scale. Results: There was partial support for a model of adolescent negative self-evaluation as a mediator in the relationship between parental emotional attitudes and adolescent depressive symptoms. The data also supported an alternative hypothesis whereby adolescent depressive symptoms are related to negative self-evaluation. Conclusions: The overall pattern of results emphasizes the significance of adolescents' perceptions of parental criticism, rather than actual levels, in understanding the relationship between parental emotional attitudes and adolescent depressive symptoms.

Medical adherence in young adolescents with spina bifida: longitudinal associations with family functioning

OBJECTIVE

The purpose of this study was 2-fold: (1) to explore the transfer of responsibility of medical tasks from parent to child during the transition to adolescence, and (2) to examine the associations between family functioning and medical adherence in youth with spina bifida.

METHODS

Seventy families of children with spina bifida participated in this study. Data were collected during family interaction sessions by using questionnaires completed by mothers, fathers, youth, teachers and health professionals.

RESULTS

Findings suggest that responsibility for medical regimens transfers gradually from parent to child over time. Additionally, family conflict and cohesion were correlated with medical adherence. Finally, family conflict over medical issues was related to a decrease in medical adherence over time.

CONCLUSIONS

Results suggest that as youth take more responsibility over their medical regimens, family conflict regarding medical issues becomes a contributor to their adherence behaviors. Interventions that target family conflict may facilitate adherence behaviors.

Childrearing style in families of anxiety-disordered children: between-family and within-family differences

This study examined whether (1) parents of anxiety-disordered (AD) children differed from those of non-clinical controls in their childrearing style, and whether (2) the child-rearing style of parents towards AD children is different from that towards their siblings. A clinical sample of 25 AD children, age range 8-13 years, was compared with 25 siblings and a non-clinical control group (n = 25). Childrearing was assessed by means of parental self-report, child report and through an expressed emotion interview measure. AD children perceived more parental rejection than non-clinical control children or the AD children's siblings. High-expressed emotion was scored significantly more often towards AD children than non-clinical control children, or their siblings. On [Symbol: see text]care' and [Symbol: see text]control' parental self-report showed some differences regarding AD children on the one hand and non-clinical control children or siblings of AD children on the other. These results suggest that the rearing of AD children differs significantly both from the rearing of their siblings and that of non-clinical control children.

Review of the literature regarding early intervention for children and adolescents aged 0-15 experiencing a first-episode psychiatric disturbance

AIM

The purpose of this review is to report on existing literature regarding children and adolescents younger than 16 years of age experiencing a first-episode psychiatric disturbance. Rather than providing a comprehensive list of service implications, this paper identifies some of the gaps in knowledge and practice to encourage ongoing analysis regarding better practices for early intervention for children and adolescents experiencing a first-episode psychiatric disturbance.

METHODS

A search was conducted to identify key evidence-based literature published from 1985 to 2007 discussing various aspects of child and youth mental health in Canada, the USA, the UK, Australia and New Zealand. The review also included 'grey' literature. Categories of information include diagnoses, pharmacological and non-pharmacological treatment, prevalence, environmental and other risk factors, and demographic variables.

RESULTS

Understanding first-episode psychiatric disturbance for patients under the age of 16 years is limited because of a scarcity of controlled studies focusing on this population. Programme evaluations are sparse, perhaps because of the small number of specialized units servicing this population. It may be helpful to enlist early intervention psychosis programmes that have been successful in assisting young people aged 16-24 in the development of better practices and care outcomes for younger age groups.

CONCLUSIONS

The authors highlight information that has the potential to assist in optimizing care for those youth younger than 16 years experiencing or exhibiting signs of a first-episode psychiatric disturbance.

Risk factor clustering for psychopathology in socially at-risk Spanish children

BACKGROUND

Data based on general population studies of exposure-to-risk factors is not adequate to describe the mental health of children living in the most extreme "high-risk" environments.

METHODS

Data were collected in a longitudinal prospective study of two cohorts of 9 and 13 year-old socially at-risk children. Cluster analysis was used to classify youths based on the reports about potential areas of risk. The psychopathological structure of empirical clusters was compared through cross-sectional and longitudinal epidemiological indexes and through multiple regression and multivariate analysis of variance.

RESULTS

Cluster analysis provided eight binary high-low risk classifications. Exposure to risk was highly prevalent. In preadolescence, broken family, parenting style and contextual profiles were the highest risk factors for psychopathology. In adolescence, they were psychological variables, verbal comprehension, pre-peri-postnatal history, physical health and family characteristics. Cumulative risk followed a linear trend for psychopathology and functional impairment. The child's perception of low marital discord and good school achievement were protective factors.

CONCLUSIONS

Extreme socially at-risk populations have specific profiles of risk that can be identified through a person-centered approach and may be amenable to selective preventive interventions.

Avoiding Conflict

Music therapy is an integral part of the inpatient treatment programme for young women with disordered eating at the Royal Children's Hospital in Melbourne. As part of ongoing clinical audit activities, an investigation was undertaken to analyse retrospectively the lyrics of young women who had participated in the music therapy programme. The purpose was to monitor and improve local clinical practice and clarify the specific contribution of music therapy to the diagnosis of anorexia nervosa. Results highlighted the role of mothers in the experiences of the young participants, with references to this relationship exceeding those to any other relationships. These findings are discussed in conjunction with an abandoned study where parental consent was not forthcoming for participation in a group music therapy research project. This article promotes a continuing awareness of the importance of the mother-daughter relationship in the treatment of eating disorders.

Family management styles and ADHD: utility and treatment implications

A previous study identified four family management styles (FMSs) exhibited in families with children with attention-deficit/hyperactivity disorder (ADHD) and suggested that understanding how families deal with a child's ADHD would provide additional information from which to create effective interventions. The present study used the FMS typology with a sample of children and adolescents with ADHD with the aims of demonstrating that FMSs could be reliably identified in a different clinical sample and clarifying changes in FMS that occur with treatment. All four FMSs were reliably identified in the sample and more than half of the families (56.3%) improved to a higher functioning FMS with treatment. The findings suggest that FMSs can elicit important information about family functioning and may assist clinical understanding of the child-family interaction that in turn facilitates treatment.

The potential for reducing asthma disparities through improved family and social function and modified health behaviors

The National Workshop To Reduce Asthma Disparities assembled a multidisciplinary group comprised of scientists, clinicians, and community representatives to examine factors related to asthma disparities. Attention was given to the importance of discerning family, social, and behavioral factors that facilitate or impede the use of health-care services suitable to the medical status of an individual. This review highlights select biopsychosocial factors that contribute to these disparities, the manner in which they may contribute or protect persons affected by asthma, and recommended directions for future research.

Parents of children with enduring epilepsy: predictors of parenting stress and parenting

OBJECTIVE

The goals of the work described here were (1) to predict parenting stress and parenting from stressors, resources, and parental coping behaviors in parents of children with epilepsy, and (2) to determine whether parenting stress mediates the effects of these predictors on parenting.

METHODS

Participants were 91 parents of children with epilepsy (mean age of children=8 years, 5 months). Parental perceptions of stressors, resources, parental coping behaviors, parenting stress, and parenting were assessed by means of questionnaires. Regression analyses were used to analyze the unique and combined power of the predictors to predict parenting stress and parenting. Sobel tests were used to identify the mediational role of parenting stress.

RESULTS

Evidence was found for direct effects of stressors, resources, and coping behaviors on parenting stress and parenting, with relatively large effects for stressors. The mediational role of parenting stress was largest in the domain of parental behavioral control.

CONCLUSIONS

In the context of pediatric epilepsy, parenting stress mediates both disruptive and resilient family factors for their effects on parenting. Parents of children with epilepsy may benefit from parent training programs that, to reduce parenting stress, address epilepsy education, the management of difficult child temperament, building social support networks, and the modification of inadequate parental coping behaviors.

Practice parameter for the assessment of the family

The family assessment is one component of the comprehensive psychiatric assessment of the child or adolescent with a psychiatric disorder. This guideline reviews the basic principles in conducting a family interview that gathers history relevant to the child's disorder and observes family interaction associated with the child's disorder. It reviews basic information that must be covered in all evaluations and the information required in complex and specialized situations. The parameter emphasizes that all assessments should include a review of family strengths and resources.

The role of friendship in the lives of male and female adolescents: does diabetes make a difference?

PURPOSE

We examined differences in the nature of friendship between adolescents with diabetes and healthy adolescents. We also examined whether friend support and negative relations with friends were related to health for both groups.

METHOD

We interviewed 127 adolescents with diabetes and 129 healthy adolescents on two occasions, separated by one year. We measured aspects of friendship and psychological health among both groups as well as self-care behavior and metabolic control among adolescents with diabetes. We used logistic regression analysis to predict the presence of friends, repeated measures analysis of covariance to predict changes in friendship over time, and hierarchical multiple regression analysis to examine the relations of friendship to psychological health, self-care behavior, and metabolic control.

RESULTS

Both groups of adolescents were equally likely to have a best friend and boyfriend/girlfriend, but healthy adolescents were more likely to have an other-gender friend. Adolescents with diabetes and healthy adolescents reported similar levels of friend support, but support increased over the year for healthy girls only. Boys with diabetes had the lowest levels of friend support. Negative relations with friends were inversely related to psychological health and predicted a decline in psychological health over time. Negative relations also predicted poor metabolic control and a deterioration of metabolic control over time.

CONCLUSION

There are similarities and differences in the nature of friendship for adolescents with diabetes compared with healthy adolescents. Friendship serves a protective function for psychological health for both groups and has implications for physical health among those with diabetes.

Relational disorders and relational processes in diagnostic practice: introduction to the special section

The special section addresses a number of salient issues that will arise as the revision process for the Diagnostic and Statistical Manual of Mental Disorders (DSM) unfolds and the role of relational processes in mental health is considered. This collection of articles, which emphasize historical, conceptual, and empirical contributions to the discussion, is intended to stimulate debate in the field and to serve as a resource for individuals charged with proposing new diagnostic guidelines. Jointly, the articles make it clear that the authors can improve on the current treatment of relational processes in the DSM and that there is a solid foundation of family research that can inform any discussion on this topic.

Describing relationship problems in DSM-V: toward better guidance for research and clinical practice

The authors provide a description of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) and its limitations, as well as empirical connections between relational processes and mental health. Four types of relational processes are identified, with each type clearly distinguished in terms of its pattern of association with psychopathology. For illustrative purposes, examples are provided along with suggestions of how each might be accommodated in the DSM-V. In view of the importance and complexity of the connections between relational processes and mental health, the authors argue that reliable and standardized assessments of relational processes are needed and suggest 6 possible approaches for providing better coverage of relational processes and relational disorders in the DSM-V. The article concludes with a discussion of potential concerns about expansion of attention to relational processes in the DSM-V.

Family Predictors of Psychopathology in Children with Epilepsy

PURPOSE

To examine the contribution of epilepsy-related factors, proximal (parent-child relationship quality), distal (parental characteristics), and contextual (quality of other family relationships) family factors to psychopathology (both broad-band and narrow-band syndromes) in children with epilepsy and normal intelligence.

METHODS

Parents of 91 children (mean, 8.5 years) participated by filling out questionnaires about family factors and child psychopathology. Regression analyses were used to analyze the unique and combined predictive power of family factors in relation to psychopathology.

RESULTS

In contrast to epilepsy-related factors, family factors, especially those related to the quality of the parent-child relationship, appeared to be strong predictors of psychopathology. The results supported the mediational model: Distal and contextual factors affect child psychopathology by affecting proximal factors.

CONCLUSIONS

In treating children with epilepsy, clinicians should be aware of the importance of the parent-child relationship quality. Strengthening the relationship quality may prevent or reduce psychopathology.

Genetic and environmental influences on Anxious/Depression during childhood: a study from the Netherlands Twin Register

For a large sample of twin pairs from the Netherlands Twins Register who were recruited at birth and followed through childhood, we obtained parental ratings of Anxious/Depression (A/D). Maternal ratings were obtained at ages 3 years (for 9025 twin pairs), 5 years (9222 pairs), 7 years (7331 pairs), 10 years (4430 pairs) and 12 years (2363 pairs). For 60-90% of the pairs, father ratings were also available. Multivariate genetic models were used to test for rater-independent and rater-specific assessments of A/D and to determine the genetic and environmental influences on individual differences in A/D at different ages. At all ages, monozygotic twins resembled each other more closely for A/D than dizygotic twins, implying genetic influences on variation in A/D. Opposite sex twin pairs resembled each other to same extent as same-sex dizygotic twins, suggesting that the same genes are expressed in boys and girls. Heritability estimates for rater-independent A/D were high in 3-year olds (76%) and decreased in size as children grew up [60% at age 5, 67% at age 7, 53% at age 10 (60% in boys) and 48% at age 12 years]. The decrease in genetic influences was accompanied by an increase in the influence of the shared family environment [absent at ages 3 and 7, 16% at age 5, 20% at age 10 (5% in boys) and 18% at age 12 years]. The agreement between parental A/D ratings was between 0.5 and 0.7, with somewhat higher correlations for the youngest group. Disagreement in ratings between the parents was not merely the result of unreliability or rater bias. Both the parents provided unique information from their own perspective on the behavior of their children. Significant influences of genetic and shared environmental factors were found for the unique parental views. At all ages, the contribution of shared environmental factors to variation in rater-specific views was higher for father ratings. Also, at all ages except age 12, the heritability estimates for the rater-specific phenotype were higher for mother ratings (59% at age 3 and decreasing to 27% at age 12 years) than for father ratings (between 14 and 29%). Differences between children, even as young as 3 years, in A/D are to a large extent due to genetic differences. As children grow up, the variation in A/D is due in equal parts to genetic and environmental influences. Anxious/Depression, unlike many other common childhood psychopathologies, is influenced by the shared family environment. These findings may provide support for why certain family therapeutic approaches are effective in the A/D spectrum of illnesses.

Integrative module-based family therapy: a model for training and treatment in a multidisciplinary mental health setting

Thirty years ago, leaders in psychiatry expressed hope for more interdisciplinary collaboration with family therapy. Since then marriage and family therapy (MFT) has entered the mainstream of clinical practice in psychiatry and psychology. It is mandated for training in psychiatry and psychology. We propose a model for collaboration, training, and treatment in interdisciplinary mental health settings that strives to integrate empirical bodies of knowledge in MFT, psychiatry, and psychology and to provide a usable and testable clinical approach to treatment. It can be taught to trainees with various or limited training in MFT This model delineates nine critical domains that guide treatment. Flexibility is central to this model, focusing on techniques and clinical methods based on empirically supported treatments, when available, and best-practice standards.

Family-based treatment research: a 10-year update

OBJECTIVE

To provide an update on the state of the art of family-based treatment research.

METHOD

Randomized clinical trials conducted in the past 10 years that included parents as a primary participant in treatment of child and adolescent psychiatric problems were reviewed. Studies were identified from major literature search engines (e.g., PsycINFO, Medline). Current significant pilot work was identified in the National Institute of Mental Health Computer Retrieval of Information on Scientific Projects (CRISP) Web page or from the authors themselves.

RESULTS

Family treatments have proven effective with externalizing disorders, particularly conduct and substance abuse disorders, and in reducing the comorbid family and school behavior problems associated with attention-deficit/hyperactivity disorder. Several new studies suggest that family treatments or treatment augmented by family treatments are effective for depression and anxiety.

CONCLUSIONS

For many disorders, family treatments can be an effective stand-alone intervention or an augmentation to other treatments. Engaging parents in the treatment process and reducing the toxicity of a negative family environment can contribute to better treatment engagement, retention, compliance, effectiveness, and maintenance of gains. Recommendations for the next decade of research and some implications of family-based treatment for child and adolescent psychiatry are explored.

Asthma and internalizing behavior problems in adolescence: a longitudinal study

OBJECTIVE

Clinical studies of asthmatic children have found an association between lung disease and internalizing behavior problems. The causal direction of this association is, however, unclear. This article examines the nature of the relationship between behavior and asthma problems in childhood and adolescence.

METHODS

Data were analyzed on 5135 children from the Mater University Study of Pregnancy and its outcomes (MUSP), a large birth cohort of mothers and children started in Brisbane, Australia, in 1981. Lung disease was measured from maternal reports of asthma/bronchitis when the children were aged 5 and maternal reports of asthma symptoms when the children were aged 14. Symptoms of internalizing behaviors were obtained by maternal reports (Child Behavior Checklist) at 5 years and by maternal and children's reports at 14 years (Child Behavior Checklist and Youth Self Report).

RESULTS

Although there was no association between prevalence of asthma and externalizing symptoms, asthma and internalizing symptoms were significantly associated in cross-sectional analyses at 5 and 14 years. In prospective analyses, after excluding children with asthma at 5 years, internalizing symptoms at age 5 were not associated with the development of asthma symptoms at age 14. After excluding children with internalizing symptoms at 5 years, those who had asthma at 5 years had greater odds of developing internalizing symptoms at age 14.

CONCLUSION

Children who have asthma/bronchitis by the age of 5 are at greater risk of having internalizing behavior problems in adolescence.

Brief report: friendships of adolescents with and without diabetes

BACKGROUND

Friendships of adolescents with chronic illness have been rarely studied.

OBJECTIVE

To compare the friendships of boys and girls with diabetes with those between healthy adolescents.

METHODS

One hundred and thirty-eight adolescents were interviewed at summer camps. Participants indicated their number of close friends and rated friendships for support and conflict. Participants described aspects of their same-sex and other-sex friendships that they liked and disliked.

RESULTS

Adolescents with diabetes have friendships that are similar to those between healthy adolescents, with a few exceptions.

CONCLUSIONS

Emotional support may be especially valued by girls with diabetes, whereas differences among friends may be less valued among adolescents with diabetes.

Comparable "risks" at the socioeconomic status extremes: preadolescents' perceptions of parenting

This study was focused on contextual variations in the parenting dimensions salient for preadolescent adjustment. The sample consisted of 614 sixth graders from two communities, one low and the other high income. Parenting dimensions included those known to be significant in each socioeconomic context: isolation from parents (emotional and physical), and parents' emphasis on achievements (overall expectations and emphasis on integrity over success). Adjustment outcomes included subjective well-being as well as school competence. Contradicting stereotypes, results showed that on average, very affluent children can perceive their parents as emotionally and physically unavailable to the same degree that youth in serious poverty do. The ramifications for adjustment also seem to be largely similar: Closeness to parents was beneficial for all, just as criticism was deleterious. Even after considering the quality of parent-child relationships, parents' physical absence (e.g., at dinner) connoted vulnerability for distress and for poor school performance in both groups. The connotations of a few parenting dimensions varied by context and gender; these variations are discussed as are overall implications for future research and practice.

Psychosocial functioning in youths at high risk to develop major depressive disorder

OBJECTIVE

To compare the psychosocial functioning of children and adolescents at high risk of major depressive disorder with youths with acute major depressive disorder and healthy controls.

METHOD

High-risk (n = 57), major depressive disorder (n = 71), and healthy control (n = 48) youths and their families were recruited from 1987 to 1996 and assessed for psychopathology using standardized instruments. Except for 16 children who had disruptive disorders, the high-risk children were free of psychopathology. A parent completed the Psychosocial Schedule to evaluate the mother-child, father-child, marital relationships, and child-friend relationships and the child's school performance.

RESULTS

Overall, high-risk and healthy controls had similar psychosocial functioning. Marital relationships were worse in the high-risk children with psychopathology. Youths with major depressive disorder had significantly more psychosocial problems and school difficulties than those at high risk and healthy controls in most domains measured. Controlling for age, pubertal stage, race, sex, family composition, current and lifetime parental depression, and current and lifetime parental nonmood psychopathology yielded similar results.

CONCLUSIONS

The family and peer interactions of high-risk youths were similar to the interactions of healthy controls. Although family dysfunctional patterns seem to mainly depend on the child's depressive symptoms, longitudinal studies are needed to establish causality.

Having a child with asthma--quality of life for Swedish parents

BACKGROUND

Asthma is the most common chronic childhood disease. Childhood asthma contributes significantly to morbidity among children and has a significant impact on the quality of life (QoL) and daily routines of both the children and their parents.

AIM AND OBJECTIVE

The purpose of this study was to investigate how Swedish parents of children with asthma experience their QoL, and to investigate whether there were differences concerning QoL between parents within the same family. The purpose was also to investigate possible connections between their QoL and background variables.

METHOD

A total of 371 parents of children with asthma (57% mothers and 43% fathers) participated in the study. The Paediatric Asthma Caregiver's Quality Of Life Questionnaire (PACQLQ) was used to measure the parents' QoL, i.e. how the child's asthma interferes with the parents' normal activities and how it has made them feel.

RESULTS

The findings show that most parents of children with asthma evaluated their QoL as close to the positive end of the scale, and there was close agreement in the scoring between parents within the same family. Significant associations were found between parents' lower QoL outcome and living in the North of Sweden. There were also significant associations between fathers' lower QoL outcome and having a child younger than 13 years of age and mothers' lower QoL outcome and having a child with severe asthma. Although the result shows that a child's asthma did not influence the parents' QoL to a greater degree, it is still important for healthcare workers to help these parents to sustain and improve their well-being.

CONCLUSIONS

The fact that they just evaluated their QoL during the preceding week only, and did so at the time when their children were being treated with asthma medication, might have influenced the results in a positive direction.

Multidisciplinary approach to childhood epilepsy: exploring the scientific rationale and practical aspects of implementation

The management of childhood epilepsy requires attention to more than seizure control because children with epilepsy often suffer from comorbidities that lead to an increased frequency of psychiatric disease, learning difficulties, and other problems of psychosocial development. These comorbidities can stem in part from the same genetic traits that determine seizure susceptibility. Thus, mutations affecting potassium, calcium, and sodium channels have been linked with epilepsy syndromes and affective and behavioral abnormalities. It is important to consider the effect of antiepilepsy drugs on comorbid conditions and the effect on seizures of drugs used to treat comorbidities. A number of antiepilepsy drugs are available that have minimal adverse cognitive effects, and some can have positive effects on mood and behavior. Epilepsy in a child is a condition that affects and is affected by the entire family situation. In addition to appropriate neuropsychologic evaluation, optimal management of childhood epilepsy also can require the involvement of the social worker, advanced practice nurse, and educational specialist. Many elements of the multidisciplinary team approach can be instituted by the child neurologist in community practice and at large, specialized epilepsy centers.

Relations governed by uncertainty: part of life of families of a child with asthma

This study identifies what influences and characterizes family relations in families of a child with asthma. Seventeen mothers of children aged between 6 and 16 years participated in audio-taped in-depth interviews. The researchers were inspired by grounded theory in data collection and data analysis. The core category that developed was being governed by disease-engendered uncertainty. The category mothers' availability was seen in two dimensions. The first dimension, mothers' being available for the child with asthma, created two subcategories: 1. control and 2. tight bonds. The second dimension, mothers' being less available for other family members, also created two subcategories: 3. being forsaken and 4. lack of understanding. Nursing implications are discussed in relation to the findings.