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Walkowiak D, Domaradzki J. Parental experiences and needs of caring for a child with 22q11.2 deletion syndrome. Orphanet J Rare Dis 2023; 18:379. [PMID: 38049864 PMCID: PMC10696670 DOI: 10.1186/s13023-023-02980-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 11/18/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND For a variety of reasons, raising a child with 22q11.2DS has significant psychosocial and financial repercussions for the family caregivers. Our aim was to identify and explain the expectations and concerns of Polish parents of 22q11.2DS children. An online survey was developed consisting of four sections: demographics, emotions experienced by caregivers while performing their duties, attitudes of the respondents about providing care, and finally different aspects of the caregivers' life satisfaction. The study was conducted with the support of the Polish 22q11 Association. RESULTS Forty-four caregivers of Polish origin completed the survey, all but one of whom were mothers. Thirty-four per cent (n = 15/44) declared full-time employment. According to 73% (n = 32/44) of those surveyed, the child's disease has not harmed their relationship with the partner. In spite of the fact that the median diagnosis time was 1.9 years (ranging from 0 to 12 years), the caregivers indicated that they had contacted on average 3.9 doctors before obtaining the right diagnosis (range 1-17). The Internet was the main source of information and knowledge about their child's disease for 93% of respondents (n = 41/44), while for 54% (n = 24/44) it was the association for people with 22q11DS. Only 26% rated as very good or good the support for caregivers offered by the central and local government or its agendas. The physicians' knowledge about 22q11DS was positively rated by 14% of respondents (n = 6/44). The most frequently chosen source of support for 66% of respondents (n = 29/44) turned out to be their families, and for 34% - a Facebook support group (n = 15/44). Asked how often they rated their quality of life (QoL) highly, none of our respondents chose the option "always", although 64% (28/44) gave the answer "often". CONCLUSION Our study is the first one in Poland to develop an online survey specifically for use with caregivers of paediatric patients with 22q11.2DS. Our respondents revealed that caring for 22q11.2 children entails a burden that extends far beyond clinical facets and has a significant impact on every dimension of the caregivers' lives, including their mental health, everyday activities, families, professional career and social lives. At the same time, caregivers are de facto left alone with the bureaucracy of the healthcare system.
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Affiliation(s)
- Dariusz Walkowiak
- Department of Organization and Management in Health Care, Poznan University of Medical Sciences, Przybyszewskiego 39, Poznań, 60-356, Poland.
| | - Jan Domaradzki
- Department of Social Sciences and Humanities, Poznan University of Medical Sciences, Poznań, Poland
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2
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Parental Expressed Emotion, Parenting Stress, and Behavioral Problems of Young Children with 22q11.2 Deletion Syndrome and Idiopathic Autism Spectrum Disorder. Child Psychiatry Hum Dev 2022:10.1007/s10578-021-01310-7. [PMID: 35083589 DOI: 10.1007/s10578-021-01310-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/14/2021] [Indexed: 11/03/2022]
Abstract
This study examined the associations of parents' expressed emotion (EE) and parenting stress, with behavioral problems of children with 22q11.2 deletion syndrome, idiopathic autism (iASD) and typically developing (TD) children. Parents of children aged 3-8 years completed the five-minute-speech-sample (FMSS), parental stress index and children behavioral checklist. Parents' FMSS-EE-criticism was higher among parents of children with 22q11DS and iASD compared to parents of TD children. FMSS-EE scores predicted children's behavioral problems, above and beyond parenting stress. The associations between FMSS-EE, parenting stress and children's behavioral problems were consistent across 22q11DS, iASD and TD children. These findings highlight the need for targeting parents' EE and parenting stress as integral elements in the screening and prevention of behavioral problems of young children with 22q11DS and iASD.
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3
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Morishima R, Kumakura Y, Usami S, Kanehara A, Tanaka M, Okochi N, Nakajima N, Hamada J, Ogawa T, Ando S, Tamune H, Nakahara M, Jinde S, Kano Y, Tanaka K, Hirata Y, Oka A, Kasai K. Medical, welfare, and educational challenges and psychological distress in parents caring for an individual with 22q11.2 deletion syndrome: A cross-sectional survey in Japan. Am J Med Genet A 2021; 188:37-45. [PMID: 34480405 PMCID: PMC9290134 DOI: 10.1002/ajmg.a.62485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/09/2021] [Accepted: 08/05/2021] [Indexed: 12/05/2022]
Abstract
Parents of children with 22q11.2 deletion syndrome (22q11DS) experience distress not only due to multimorbidity in the patients, but also due to professionals' lack of understanding about 22q11DS and insufficient support systems. This study investigated relationships between medical, welfare, and educational challenges and parental psychological distress. A cross‐sectional survey was conducted on primary caregivers of children with 22q11DS. Participants included 125 parents (114 mothers, 91.2%; average age = 44.3 years) who reported their challenges, psychological distress, and child's comorbidities of 22q11DS. Results showed that the difficulty in going to multiple medical institutions (β = 0.181, p < 0.05) and lack of understanding by welfare staff and insufficient welfare support systems for 22q11DS (β = 0.220–0.316, all p < 0.05) were associated with parental psychological distress, even after adjusting for child's comorbidities. In the subsample of parents whose child attended an educational institution, inadequate management in classroom and mismatch between service and users in educational settings were associated with psychological distress (β = 0.222–0.296, all p < 0.05). This study reveals the importance of assessing not only severity of comorbidities in 22q11DS, but also the medical, welfare, and educational challenges for parental mental health.
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Affiliation(s)
- Ryo Morishima
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,The Health Care Science Institute, Tokyo, Japan
| | - Yousuke Kumakura
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoshi Usami
- The Graduate School of Education, University of Tokyo, Tokyo, Japan
| | - Akiko Kanehara
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Miho Tanaka
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Noriko Okochi
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Naomi Nakajima
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Junko Hamada
- Department of Child Psychiatry, University of Tokyo Hospital, Tokyo, Japan
| | - Tomoko Ogawa
- Department of Child Psychiatry, University of Tokyo Hospital, Tokyo, Japan
| | - Shuntaro Ando
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hidetaka Tamune
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mutsumi Nakahara
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Graduate School of Clinical Psychology, Kagoshima University, Kagoshima, Japan
| | - Seiichiro Jinde
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yukiko Kano
- Department of Child Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kyoko Tanaka
- Division of Pediatric Consultation Liaison, Department of Psychosocial Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Yoichiro Hirata
- Department of Pediatrics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akira Oka
- Department of Pediatrics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kiyoto Kasai
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,The International Research Center for Neurointelligence (WPI-IRCN), The University of Tokyo Institutes for Advanced Study (UTIAS), Tokyo, Japan
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4
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Campbell LE, Swaab L, Freeman EE, McCormack L, Simon TJ, Angkustsiri K, McCabe KL. The Importance of Understanding Individual Differences of Emotion Regulation Abilities in 22q11.2 Deletion Syndrome. J Autism Dev Disord 2021; 52:3076-3087. [PMID: 34251567 DOI: 10.1007/s10803-021-05172-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2021] [Indexed: 11/29/2022]
Abstract
Chromosome 22q11.2 deletion syndrome (22q11DS) is characterised by a complex behavioural phenotype including anxiety, attention-deficit/hyperactivity disorder and psychosis. In the current study, we aimed at improving our understanding of the heterogeneity of behavioural characteristics in a group of 129 young people (aged 4-22) with a confirmed 22q11.2 microdeletion and 116 age and gender matched typically developing controls. Half the participants with 22q11DS had behaviour characterised by emotion dysregulation. A cluster analyses, of the participants with 22q11DS, revealed four groups characterised by intact emotion regulation; predominantly internalizing problems; both internalizing and externalizing problems; and predominantly externalizing difficulties. Importantly, it was found that young people with 22q11DS whose emotion dysregulation was characterised by externalizing problems had the poorest levels of functioning. As our understanding of 22q11DS improves, it is becoming increasingly clear that we need a better understanding of how individual differences and psychosocial factors contribute to, and interact with one another, to result in the observable individual differences in the 22q11DS behavioural phenotype.
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Affiliation(s)
- L E Campbell
- School of Psychological Science, University of Newcastle, Newcastle, Australia. .,Priority Research Centre GrowUpWell, University of Newcastle, University Drive, Callaghan, Newcastle, NSW, 2320, Australia.
| | - L Swaab
- School of Psychological Science, University of Newcastle, Newcastle, Australia
| | - E E Freeman
- School of Psychological Science, University of Newcastle, Newcastle, Australia.,Priority Research Centre Brain and Mental Health Research, University of Newcastle, Newcastle, Australia
| | - L McCormack
- School of Psychological Science, University of Newcastle, Newcastle, Australia
| | - T J Simon
- Department of Psychiatry and Behavioural Sciences, University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA.,M.I.N.D. Institute, University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA
| | - K Angkustsiri
- M.I.N.D. Institute, University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA.,Department of Pediatrics, Section of Developmental &, Behavioral Pediatrics University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA
| | - K L McCabe
- Department of Psychiatry and Behavioural Sciences, University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA.,M.I.N.D. Institute, University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA
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5
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Fitzgerald J, Gallagher L. Parental stress and adjustment in the context of rare genetic syndromes: A scoping review. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2021; 26:1744629521995378. [PMID: 33866895 PMCID: PMC9168905 DOI: 10.1177/1744629521995378] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/24/2021] [Indexed: 06/10/2023]
Abstract
Chromosomal abnormalities are now considered a common cause of intellectual disability. With increased genetic testing, phenotyping and technological advancements, many new syndromes have been identified. This review sought to explore parental stress and adjustment in the context of rare genetic syndromes to evaluate their clinical impact. A systematic review of English peer-reviewed literature across three databases (PsycINFO, Medline, CINAHL) was completed and 69 articles were included. Parents of children with rare genetic syndromes experienced greater distress relative to other disabilities. Differences in parental wellbeing were syndrome-specific relative to ASD thus demonstrating the need to consider the contribution of syndrome-specific phenotypes. Child emotional and behavioural difficulties were the most consistent predictor of parental distress. Research reflecting other factors such as physical health, syndrome-specific behaviours, benefit finding and, parental appraisal in the context of a rare genetic aetiology is required in order to support parental adjustment in these conditions.
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Affiliation(s)
| | - Louise Gallagher
- Trinity College Dublin, Ireland; Children Health Ireland at Tallaght Hospital, Ireland;
Cherry Orchard Hospital, Ireland
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6
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Briegel W, Andritschky C. Psychological Adjustment of Children and Adolescents with 22q11.2 Deletion Syndrome and Their Mothers' Stress and Coping-A Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052707. [PMID: 33800178 PMCID: PMC7967431 DOI: 10.3390/ijerph18052707] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/25/2021] [Accepted: 03/02/2021] [Indexed: 12/30/2022]
Abstract
At present, there is a lack of longitudinal studies on the psychological adjustment of both children and adolescents with 22q11.2 deletion syndrome (22q11.2DS) and their primary caregivers. To fill this gap, we performed a four-year follow-up study. Mothers filled out the Child Behavior Checklist 4–18, the Social Orientation of Parents with Handicapped Children questionnaire to assess maternal stress and coping strategies, and the Freiburger Personality Inventory-Revised—subscales strain and life satisfaction. Fifty-five subjects with 22q11.2DS (26 males and 29 females; age: M = 10.79 years, SD = 3.56 years) and their biological mothers (age: M = 40.84 years, SD = 4.68 years) were included in this study. Significantly higher levels of behavior problems than in the general population and an increase in these problems, especially internalizing ones, over time could be found. In contrast, maternal stress did not change significantly over time, but mothers demonstrated increased levels of strain and reduced life satisfaction at T2. Thus, careful monitoring as well as early and adequate interventions, if indicated, should be offered to families with a child with 22q11.2DS, not only for somatic complaints but also for problems with psychological adjustment.
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Affiliation(s)
- Wolfgang Briegel
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Leopoldina Hospital, 97422 Schweinfurt, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, 97080 Würzburg, Germany;
- Correspondence: ; Tel.: +49-9721-720-3370
| | - Christoph Andritschky
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, 97080 Würzburg, Germany;
- Department of Pneumology, Critical Care and Allergology, Lung Centre South-West, 88239 Wangen im Allgäu, Germany
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7
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Arganbright JM, Tracy M, Hughes SS, Ingram DG. Sleep patterns and problems among children with 22q11 deletion syndrome. Mol Genet Genomic Med 2020; 8:e1153. [PMID: 32222065 PMCID: PMC7284043 DOI: 10.1002/mgg3.1153] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 01/08/2020] [Accepted: 01/11/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND To delineate sleep habits and problems in children with 22q11.2 deletion syndrome (22q11DS). METHODS Thirty children, age 1-15 (mean 6.8) years, participated in the study, which was an internet-based anonymous survey of parents of children with 22q11DS administered via the 22q11.2 Foundation. The main outcome was the Childhood Sleep Habits Questionnaire (CSHQ). RESULTS Scores on the CSHQ demonstrated clinically significant sleep problems in 29 of the 30 children. When compared with previously reported normative values for typically developing children of the same age, children with 22q11DS had significantly greater sleep problems. Only 30% of children had previously undergone sleep study. While about half of children had tried a medication for sleep, it usually was not felt to be helpful. In contrast, parents reported that behavioral interventions, such as consistent bedtime routine and appropriate sleep environment, were helpful. This is one of the first studies to specifically address sleep problems other than obstructive sleep apnea in children with 22q11DS. CONCLUSIONS The findings suggest children with 22q11DS may have a higher risk of experiencing clinical sleep problems, compared to typically developing children. Consideration of additional screening and treatment of sleep disorders in children with 22q11DS is warranted.
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Affiliation(s)
- Jill M Arganbright
- Division of Otolaryngology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Meghan Tracy
- Division of Otolaryngology, Children's Mercy Hospital, Kansas City, MO, USA
| | | | - David G Ingram
- Division of Pulmonary and Sleep Medicine, Children's Mercy Hospital, Kansas City, MO, USA
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8
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Sandini C, Schneider M, Eliez S, Armando M. Association Between Parental Anxiety and Depression Level and Psychopathological Symptoms in Offspring With 22q11.2 Deletion Syndrome. Front Psychiatry 2020; 11:646. [PMID: 32792992 PMCID: PMC7390875 DOI: 10.3389/fpsyt.2020.00646] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/22/2020] [Indexed: 12/11/2022] Open
Abstract
22q11.2 deletion syndrome (22q11DS) is recognized as one of the strongest genetic risk factors for the development of psychopathology, including dramatically increased prevalence of schizophrenia anxiety disorders, mood disorders, and Attention Deficit Hyperactivity Disorder (ADHD). Despite sharing a homogenous genetic deletion, the psychiatric phenotype in 22q11DS still present significant variability across subjects. The origins of such variability remain largely unclear. Levels of parental psychopathology could significantly contribute to phenotypic variability of offspring psychopathology, through mechanisms of gene x gene (GxG) and gene x environment (GxE) interactions. However, this hypothesis has not been explicitly tested to date in 22q11DS. In the present manuscript, we employed a longitudinal design to investigate bi-directional interactions of parental anxiety and depressive symptoms, estimated with Beck Depression Inventory and Beck Anxiety Inventory, and offspring level of psychopathology assessed with a combination of parentally reported Child Behavioral Checklist, Youth Self Report Questionnaire, and Structured Clinical Interviews for Prodromal Syndromes (SIPS). We tested associations in both typically developing healthy controls (HCs) (N = 88 participants; N = 131 time points) and in individuals with 22q11DS (N = 103 participants; N = 198 time points). We observed that 22q11DS individuals with higher levels of parental anxiety and depression presented significant increases in multiple forms of psychopathology, including higher internalizing and externalizing symptoms, as estimated both by parental and self-report questionnaires, along with higher negative and generalized symptoms as measured with the SIPS. Associations for positive and disorganized dimensions of the SIPS were not statistically significant. Purely longitudinal analysis pointed to bi-directional interactions of parental and child psychopathology, with marginally stronger longitudinal associations between early parental anxiety-depression and subsequent child psychopathology. Interestingly, associations between psychopathology across generations were significantly stronger in 22q11DS individuals compared to HCs. Our results show that parental levels of anxiety and depression are associated with levels of offspring psychopathology, particularly in individuals with 22q11DS. These findings point to the existence of GxG or GxE mechanisms, that should be investigated in future work. From a clinical perspective, they highlight a strong rational for the management of parental psychological well-being in 22q11DS.
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Affiliation(s)
- Corrado Sandini
- Developmental Imaging and Psychopathology lab, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Maude Schneider
- Developmental Imaging and Psychopathology lab, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Clinical Psychology Unit for Intellectual and Developmental Disabilities, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland.,Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Stephan Eliez
- Developmental Imaging and Psychopathology lab, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Marco Armando
- Developmental Imaging and Psychopathology lab, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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9
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Klein-Tasman BP, Lee K. Problem behaviour and psychosocial functioning in young children with Williams syndrome: parent and teacher perspectives. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2017; 61:853-865. [PMID: 28271572 DOI: 10.1111/jir.12367] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 11/11/2016] [Accepted: 02/01/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND There is sparse literature about problem behaviour in young children with Williams syndrome (WS) and little consideration of the perspectives of multiple respondents. METHODS Problem behaviour of 35 children with WS ages 2 to 6 was examined based on both parent and teacher report using the Achenbach preschool forms. RESULTS The most prominent areas of difficulty based on both parent and teacher report were attention problems, pervasive developmental problems and emotion reactivity difficulties. Some rater differences were observed; most notably, teachers reported more externalising behaviour problems including more aggressive behaviour, Attention Deficit/Hyperactivity problems and Oppositional Defiant problems than did parents. Few relations to intellectual functioning, age or gender were observed. DISCUSSION Some aspects of problem behaviour evident in older children (e.g. attention problems, social problems) are also apparent for young children with WS, while other areas are less prominent (e.g. anxiety). The implications of the findings for understanding the behavioural phenotype associated with WS are discussed.
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Affiliation(s)
- B P Klein-Tasman
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - K Lee
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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10
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Stephenson DD, Beaton EA, Weems CF, Angkustsiri K, Simon TJ. Identifying patterns of anxiety and depression in children with chromosome 22q11.2 deletion syndrome: comorbidity predicts behavioral difficulties and impaired functional communications. Behav Brain Res 2014; 276:190-8. [PMID: 24906195 DOI: 10.1016/j.bbr.2014.05.056] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 05/17/2014] [Accepted: 05/26/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Chromosome 22q11.2 deletion syndrome (22q11.2DS) is a complex genetic disorder with a variable clinical presentation that can include cardiac, neural, immunological, and psychological issues. Previous studies have measured elevated anxiety and depression in children with 22q11.2DS. Comorbity of anxiety and depression is well established in the pediatric literature but the nature of comorbidity patterns has not been empirically established in children with 22q11.2DS. Comorbidity of anxiety and depression has important implications for treatment and prognosis, and may be a marker of risk in this population of children at high-risk for developing schizophrenia. METHOD Participants were 131 boys and girls ages 8-14 with (n=76) and without (n=55) 22q11.2DS and their mothers. Children and mothers independently completed self- and parent-report measures of anxiety and depression. Mothers also completed measures of behavioral functioning including the Behavioral Assessment for Children, 2nd ed. (BASC-2). Cluster analyses were conducted to test if theoretically based groupings of anxiety and depression could be identified. We hypothesized four psychological profiles based on child- and mother-reports: low/no anxiety and low/no depression, higher depression and low/no anxiety, higher anxiety and no/low depression, and a comorbid profile of higher anxiety and higher depression. BASC-2 subscale scores were then compared across subgroups of children to determine if a comorbid profile would predict greater behavioral difficulties. RESULTS In the full sample of children both with and without 22q11.2DS, cluster analyses of self and maternal reported anxiety and depression revealed the expected subgroups: (1) a group of children with higher anxiety/lower depression (anxious); (2) a group with primary depression (lower anxiety/higher depression (depressed)); (3) a comorbid group with higher anxiety/higher depression (comorbid); and, (4) a lowest anxiety/lowest depression group (NP). Mothers' reports produced highly similar groupings. Furthermore, the 22q11.2DS youth were more likely to be in anxiety, depressed or comorbid clusters than the typically developing (TD) youth. Children with 22q11.2DS comorbid for anxiety and depression exhibited the worst functional outcomes (e.g., poor poorer functional communication, and reduced daily life activities). CONCLUSIONS Anxiety, comorbid with depression may be of particular concern in children with 22q11.2DS who arguably carry a greater burden on their stress coping resources than children without a complex genetic disorder. Furthermore, the manifestation of negative mood, anxiety and difficult behavior is likely to reverberate between the child and her or his environment. This can lead to negative interactions with family, peers, and teachers, which in turn further taxes coping resources. Comorbidity of anxiety and depression within a vulnerable population highlights the need for the development of tailored interventions.
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Affiliation(s)
- David D Stephenson
- Department of Psychology, University of New Orleans, 2000 Lakeshore Dr., New Orleans, LA 70148, United States
| | - Elliott A Beaton
- Department of Psychology, University of New Orleans, 2000 Lakeshore Dr., New Orleans, LA 70148, United States; Department of Psychiatry and Behavioral Sciences, University of California Davis, 2230 Stockton Bvld., Sacramento, CA 95817, United States; MIND Institute, University of California Davis, 2825 50th Street, Sacramento, CA 95817, United States.
| | - Carl F Weems
- Department of Psychology, University of New Orleans, 2000 Lakeshore Dr., New Orleans, LA 70148, United States
| | - Kathleen Angkustsiri
- MIND Institute, University of California Davis, 2825 50th Street, Sacramento, CA 95817, United States; Department of Pediatrics, 2516 Stockton Blvd., Sacramento, CA 95817, United States
| | - Tony J Simon
- Department of Psychiatry and Behavioral Sciences, University of California Davis, 2230 Stockton Bvld., Sacramento, CA 95817, United States; MIND Institute, University of California Davis, 2825 50th Street, Sacramento, CA 95817, United States.
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11
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Duijff SN, Klaassen PWJ, Swanenburg de Veye HFN, Beemer FA, Sinnema G, Vorstman JAS. Cognitive and behavioral trajectories in 22q11DS from childhood into adolescence: a prospective 6-year follow-up study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:2937-2945. [PMID: 23816629 DOI: 10.1016/j.ridd.2013.06.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 06/02/2013] [Accepted: 06/03/2013] [Indexed: 06/02/2023]
Abstract
Patients with 22q11DS are at risk of behavioral problems and cognitive impairment. Recent studies suggest a possible intellectual decline in 22q11DS children. To date it is unknown if cognitive development is related to the behavioral problems in 22q11DS. We studied 53 children with 22q11DS who underwent cognitive and behavioral assessments at 9.5 years (T1) and 15.3 years (T2). In about one third, IQ data obtained at 7.5 years (T0) were also available. Results showed that internalizing behaviors intensified while externalizing behaviors decreased. Simultaneously, in about a third a significant decline in IQ was found, which, surprisingly, was unrelated to the behavioral changes. It can be concluded that children with 22q11DS follow a unique developmental trajectory. Cognitive deterioration is severe in some but does not appear to predict behavioral problems in early adolescence.
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Affiliation(s)
- Sasja N Duijff
- Department of Pediatric Psychology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
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12
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Plück J, Beiling M, Hautmann C, Kuschel A, Heinrichs N, Schmeck K, Döpfner M. Die Erfassung von Verhaltensauffälligkeiten im Vorschulalter mit dem Elternfragebogen für Klein- und Vorschulkinder (CBCL/11/2 – 5). DIAGNOSTICA 2013. [DOI: 10.1026/0012-1924/a000087] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Der Elternfragebogen für Klein- und Vorschulkinder CBCL/11/2 – 5, die Übersetzung des englischsprachigen Originals aus der Fragebogenfamilie von Thomas Achenbach, wird anhand von Daten aus dem deutschsprachigen Raum hinsichtlich seiner Anwendbarkeit überprüft. Diese umfasst die Überprüfung der faktoriellen Struktur, der internen Konsistenzen der Skalen und ihrer Korrelationen untereinander sowie Mittelwertvergleiche verschiedener Teilstichproben. Die Ergebnisse lassen die Anwendung des Fragebogens für gruppenstatistische Analysen im Rahmen verschiedener Forschungsfragestellungen gerechtfertigt scheinen. Die übergeordneten Dimensionen Externales Problem und Internales Problem sowie die Problemskalen Aufmerksamkeitsprobleme und Aggressives Verhalten können auch in der klinischen Einzelfalldiagnostik zuverlässig eingesetzt werden.
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Klaassen P, Duijff S, Swanenburg de Veye H, Vorstman J, Beemer F, Sinnema G. Behavior in preschool children with the 22q11.2 deletion syndrome. Am J Med Genet A 2012; 161A:94-101. [DOI: 10.1002/ajmg.a.35685] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Accepted: 08/23/2012] [Indexed: 11/09/2022]
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Beaton EA, Simon TJ. How might stress contribute to increased risk for schizophrenia in children with chromosome 22q11.2 deletion syndrome? J Neurodev Disord 2010; 3:68-75. [PMID: 21475728 PMCID: PMC3056992 DOI: 10.1007/s11689-010-9069-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 11/26/2010] [Indexed: 01/19/2023] Open
Abstract
The most common human microdeletion occurs at chromosome 22q11.2. The associated syndrome (22q11.2DS) has a complex and variable phenotype with a high risk of schizophrenia. While the role of stress in the etiopathology of schizophrenia has been under investigation for over 30 years (Walker et al. 2008), the stress–diathesis model has yet to be investigated in children with 22q11.2DS. Children with 22q11.2DS face serious medical, behavioral, and socioemotional challenges from infancy into adulthood. Chronic stress elevates glucocorticoids, decreases immunocompetence, negatively impacts brain development and function, and is associated with psychiatric illness in adulthood. Drawing knowledge from the extant and well-developed anxiety and stress literature will provide invaluable insight into the complex etiopathology of schizophrenia in people with 22q11.2DS while suggesting possible early interventions. Childhood anxiety is treatable and stress coping skills can be developed thereby improving quality of life in the short-term and potentially mitigating the risk of developing psychosis.
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Affiliation(s)
- Elliott A Beaton
- Department of Psychiatry and Behavioral Sciences and the M.I.N.D. Institute, University of California Davis, 2825 50th Street, Sacramento, CA 95817 USA
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Briegel W, Schneider M, Schwab KO. [22q11.2 deletion: handicap-related problems and coping strategies of primary caregivers]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2010; 37:535-40. [PMID: 19890816 DOI: 10.1024/1422-4917.37.6.535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate handicap-related problems of children and adolescents with 22q11.2 deletion syndrome and their primary caregivers' coping strategies. METHOD Primary caregivers of 153 subjects aged 2-16 years were anonymously asked to fill out questionnaires, e.g., the Handicap Related Problems for Parents Inventory. RESULTS Primary caregivers of 96 subjects (53 males, 43 females; mean age: 7;0 [2;1-16;11] years) sent back questionnaires. Patient's behaviour and discipline were the most important handicap-related problems. Significant correlations could be found between the patient's age and his/her relationship with the primary caregiver (rho=0.228; p=.029) and other family members (rho=0.293; p=.004). Compared to other parents of physically handicapped children or those with multiple handicaps, these parents did not experience increased stress. The more the coping strategies "self-fulfillment" and "intensification of partnership" were used, the lower parental stress was (p=.012, p=.025, respectively). "Focusing on the handicapped child" was positively correlated with high parental stress (p=.000). CONCLUSIONS With regard to parental stress and coping strategies, primary caregivers of children and adolescents with 22q11.2 deletion do not significantly differ from other parents of physically handicapped children. As handicap-related family problems increase with the patient's age, a growing need for counseling, especially for aspects of parenting and discipline, and for treatment can be presumed.
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Affiliation(s)
- Wolfgang Briegel
- Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Leopoldina-Krankenhaus, Schweinfurt.
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Briegel W. Deletion 22q11.2 und schizophrene Störungen im Kindes- und Jugendalter. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2007; 35:353-7; quiz 357-8. [DOI: 10.1024/1422-4917.35.5.353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung: Die Deletion 22q11.2 (Del.22q11.2) ist die häufigste bekannte Mikrodeletion beim Menschen und einer der wichtigsten Risikofaktoren für die Entstehung schizophrener Störungen. Fallberichte zu schizophrenen Störungen bei Kindern und Jugendlichen mit Del.22q11.2 wurden bisher jedoch kaum veröffentlicht. Nach einem Überblick über den aktuellen Wissensstand zu psychischen Störungen bei Del.22q11.2 werden Diagnostik und Behandlung eines bei Ersterkrankung 12;10-jährigen Jungen mit paranoider Schizophrenie dargestellt. Erst ca. 3 Jahre nach Erkrankungsbeginn konnte bei dem genannten Patienten nach verschiedentlichem Wechsel des Neuroleptikums das prämorbide Funktionsniveau wieder erreicht werden. Infolge Hypokalzämie kam es unter Clozapin-Gabe einmalig zu einem Krampfanfall. Der Fallbericht spricht für die Notwendigkeit regelmäßiger Kalziumspiegel-Kontrollen bei Menschen mit Del.22q11.2 und gleichzeitiger Neuroleptika-Gabe. Kinder und Jugendliche mit Del.22q11.2 sollten idealerweise bei psychischen Störungen in kinder- und jugendpsychiatrischen Spezialambulanzen behandelt werden, wegen der häufigen somatischen Probleme ist eine gute interdisziplinäre Zusammenarbeit unbedingt erforderlich.
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Affiliation(s)
- Wolfgang Briegel
- Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Leopoldina-Krankenhaus, Schweinfurt (Chefarzt: Dr. W. Briegel)
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