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Turner EM, Cassidy AR, Rea KE, Smith-Paine JM, Wolfe KR. [Formula: see text] The multifaceted role of neuropsychology in pediatric solid organ transplant: preliminary guidelines and strategies for clinical practice. Child Neuropsychol 2024; 30:503-537. [PMID: 37291962 DOI: 10.1080/09297049.2023.2221759] [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: 11/23/2022] [Accepted: 05/31/2023] [Indexed: 06/10/2023]
Abstract
The incidence of pediatric solid organ transplantation (SOT) has increased in recent decades due to medical and surgical advances as well as improvements in organ procurement. Survival rates for pediatric kidney, liver, and heart transplantation are above 85% but patients continue to experience complex healthcare needs over their lifetime. Long-term developmental and neuropsychological sequelae are becoming increasingly recognized in this population, although preliminary work is limited and deserves further attention. Neuropsychological weaknesses are often present prior to transplantation and may be related to underlying congenital conditions as well as downstream impact of the indicating organ dysfunction on the central nervous system. Neuropsychological difficulties pose risk for functional complications, including disruption to adaptive skill development, social-emotional functioning, quality of life, and transition to adulthood. The impact of cognitive dysfunction on health management activities (e.g., medication adherence, medical decision-making) is also an important consideration given these patients' lifelong medical needs. The primary aim of this paper is to provide preliminary guidelines and clinical strategies for assessment of neuropsychological outcomes across SOT populations for pediatric neuropsychologists and the multidisciplinary medical team, including detailing unique and shared etiologies and risk factors for impairment across organ types, and functional implications. Recommendations for clinical neuropsychological monitoring as well as multidisciplinary collaboration within pediatric SOT teams are also provided.
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Affiliation(s)
- Elise M Turner
- Department of Pediatrics, Section of Neurology, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, CO, USA
| | - Adam R Cassidy
- Departments of Psychiatry & Psychology and Pediatric & Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kelly E Rea
- Division of Pediatric Psychology, Department of Pediatrics, C. S. Mott Children's Hospital, Michigan Medicine, Ann Arbor, MI, USA
| | - Julia M Smith-Paine
- Division of Developmental-Behavioral Pediatrics & Psychology, Department of Pediatrics, Rainbow Babies & Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Kelly R Wolfe
- Department of Pediatrics, Section of Neurology, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, CO, USA
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Butsriphum N, Getsuwan S, Prabpram W, Chuthapisith J, Tanpowpong P, Lertudomphonwanit C, Treepongkaruna S. Family Function in Pediatric Liver Transplant Recipients Residing In a Developing Country. Transplant Proc 2020; 52:920-925. [PMID: 32173590 DOI: 10.1016/j.transproceed.2020.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 01/10/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Pediatric liver transplantation (LT) can affect recipients' family function; however, inconsistent results between studies exist, and data from developing nations are sparse. We aimed to evaluate family function and identify factors associated with suboptimal function in pediatric LT recipients. METHODS A cross-sectional study was performed at a teaching hospital in Bangkok, Thailand between May 2018 and December 2018. We included the families of children aged 2 to 18 years who underwent LT for at least 1 year. Chulalongkorn Family Inventory (CFI) was used to evaluate the family function in these children comparing with families of healthy children. Family function was interpreted from the total CFI score and characterized as dysfunctional, normal-functioned, and well-functioned. RESULTS We enrolled families of 82 LT recipients and 72 healthy children. LT recipients had median age of 7.4 (interquartile range: 4.5-10.3) years. Eighteen children (22%) had a single parent, and at least one unemployed parent was reported in 25%. Most (96%) had well-functioned families, and none had a dysfunctional family. Furthermore, the total score was not significantly different between families of LT and healthy children (P = .95). LT families had a higher score in problem-solving (P < .01) and lower score in the affective involvement and general functioning dimension (P < .01 and .02, respectively). Among the LT children, postoperative bile leakage was associated with lower overall family function score. CONCLUSIONS Even though most recipients had good family function, physicians should pay close attention to specific aspects of family function, especially in children with certain postoperative complications.
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Affiliation(s)
- N Butsriphum
- Division of Gastroenterology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - S Getsuwan
- Division of Gastroenterology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - W Prabpram
- Division of Gastroenterology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - J Chuthapisith
- Division of Child Development, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - P Tanpowpong
- Division of Gastroenterology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - C Lertudomphonwanit
- Division of Gastroenterology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - S Treepongkaruna
- Division of Gastroenterology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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A Comparison of Caregiving Burden and Social Support Levels of Parents of Children Undergoing Liver Transplant. J Pediatr Nurs 2019; 47:e45-e50. [PMID: 31064678 DOI: 10.1016/j.pedn.2019.04.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 04/20/2019] [Accepted: 04/20/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE This study was conducted to compare caregiving burden and social support levels of parents of children who have undergone a liver transplant. DESIGNS AND METHODS This study utilized a descriptive, cross-sectional research design. Data were collected using a parent information form, the Zarit Burden Interview, and the Multidimensional Scale of Perceived Social Support. Data were collected via face-to-face interview after written consent was obtained from the parents of children who had received a liver transplant. RESULTS Parent participants were found to have a high caregiving burden and low levels of social support from their surroundings. Parents who experienced change in their work life, social and family relationships, and had economic problems post-transplant, had a higher caregiving burden and may have lower social support. Parents whose children had a transplant from a cadaveric donor and continued to attend school were found to have a lower caregiving burden. There was a negative correlation between parent caregiving burden and social support scores; that is, caregiving burden (R2 = 0.57, p < 0.01) was significantly affected by social support (B = -0.682, β = -0.757). CONCLUSIONS This study concluded that parents receiving social support may have a lower caregiving burden, and some of their socio-demographic characteristics may have a positive effect on social support and caregiving burden. PRACTICE IMPLICATIONS Health professionals need to pay special attention to the social support and caregiving burden of parents whose children have had an organ transplant.
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de-Paula EM, Porta G, Tannuri ACA, Tannuri U, Befi-Lopes DM. Language assessment of children with severe liver disease in a public service in Brazil. Clinics (Sao Paulo) 2017; 72:351-357. [PMID: 28658434 PMCID: PMC5463267 DOI: 10.6061/clinics/2017(06)04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 03/10/2017] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE: The aim of this research was to compare language development (expressive and receptive skills) in children awaiting liver transplantation with that of children who have already undergone the surgical procedure. METHODS: An observational, descriptive, cross-sectional study was conducted with 76 children divided into groups, as follows: 31 children who were candidates for liver transplantation (Group 1; G1), 45 children who had already undergone liver transplantation (Group 2; G2), and a control group (CG) of 60 healthy, normally developing children. Health status information was gathered, and the Test of Early Language Development (TELD)-3 was used to assess language skills. Family household monthly income data were also gathered using a specific questionnaire. RESULTS: G1 had poorer language performance compared with G2 and the CG. G2 had lower language performance when compared with the CG. However, when considering the TELD-3 standard scores, G2 had scores within normal limits. The regression analysis indicated age as a risk factor for language deficits in Group 1 and family income as a risk factor for language deficits in G2. CONCLUSIONS: The results suggested that children with chronic liver disease have delays in language development. Transplanted children have linguistic performance within normal limits, but their scores tended to be lower than the CG.
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Affiliation(s)
- Erica Macêdo de-Paula
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Gilda Porta
- Unidade de Hepatologia, Instituto da Crianca, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Ana Cristina Aoun Tannuri
- Divisão de Cirurgia Pediatrica e Unidade de Transplante de Figado, Instituto da Crianca, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade Sao Paulo, Sao Paulo, SP, BR
| | - Uenis Tannuri
- Divisão de Cirurgia Pediatrica e Unidade de Transplante de Figado, Instituto da Crianca, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade Sao Paulo, Sao Paulo, SP, BR
| | - Debora Maria Befi-Lopes
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Cousino MK, Rea KE, Schumacher KR, Magee JC, Fredericks EM. A systematic review of parent and family functioning in pediatric solid organ transplant populations. Pediatr Transplant 2017; 21. [PMID: 28181361 DOI: 10.1111/petr.12900] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2017] [Indexed: 12/23/2022]
Abstract
The process of pediatric solid organ transplantation (SOT) places new and increased stressors on patients and family members. Measures of family functioning may predict psychological and health outcomes for pediatric patients and their families, and provide opportunity for targeted intervention. This systematic review investigated parent and family functioning and factors associated with poorer functioning in the pediatric SOT population. Thirty-seven studies were identified and reviewed. Studies featured a range of organ populations (eg, heart, liver, kidney, lung, intestine) at various stages in the transplant process. Findings highlighted that parents of pediatric SOT populations commonly report increased stress and mental health symptoms, including posttraumatic stress disorder. Pediatric SOT is also associated with increased family stress and burden throughout the transplant process. Measures of parent and family functioning were associated with several important health-related factors, such as medication adherence, readiness for discharge, and number of hospitalizations. Overall, findings suggest that family stress and burden persists post-transplant, and parent and family functioning is associated with health-related factors in SOT, highlighting family-level functioning as an important target for future intervention.
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Affiliation(s)
- Melissa K Cousino
- Department of Pediatrics, University of Michigan Health System, Ann Arbor, MI, USA.,University of Michigan Transplant Center, Ann Arbor, MI, USA
| | - Kelly E Rea
- University of Michigan Transplant Center, Ann Arbor, MI, USA
| | - Kurt R Schumacher
- Department of Pediatrics, University of Michigan Health System, Ann Arbor, MI, USA.,University of Michigan Transplant Center, Ann Arbor, MI, USA
| | - John C Magee
- University of Michigan Transplant Center, Ann Arbor, MI, USA.,Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Emily M Fredericks
- Department of Pediatrics, University of Michigan Health System, Ann Arbor, MI, USA.,University of Michigan Transplant Center, Ann Arbor, MI, USA.,Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
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Kaller T, Petersen I, Petermann F, Fischer L, Grabhorn E, Schulz KH. Family strain and its relation to psychosocial dysfunction in children and adolescents after liver transplantation. Pediatr Transplant 2014; 18:851-9. [PMID: 25307019 DOI: 10.1111/petr.12367] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2014] [Indexed: 12/01/2022]
Abstract
Parental functioning is essential to children's development. Therefore, this cross-sectional single-center study examined the prevalence of family strain in 181 parents and its associations to psychosocial functioning in their children after LT. Median age at LT was one yr. Mean time elapsed since LT was 5.8 yr. The IFS, and the SDQ were applied to parents. Family strain in the present sample was comparable to that in the German normative group of families with a chronically ill or disabled child, but families of LT recipients showed a significantly higher financial impact, impact on coping, and impact on siblings (p < 0.001). Younger age of patients at survey, a more severe clinical course, child's restrictions, and financial losses following LT were determined as significant predictors of family strain (R(2) = 0.42). Parents reported less family strain after living-related compared with deceased donation. Family strain was significantly correlated to psychosocial dysfunction in children post-LT. Present findings demonstrate a risk of maladjustment to the post-LT condition in families. They emphasize the importance of psychological assessment of parents and patients during transplant and follow-up to ensure the best achievable long-term outcome of patients.
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Affiliation(s)
- T Kaller
- Center of Clinical Psychology and Rehabilitation, University Bremen, Bremen, Germany
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Changing definitions of successful outcomes in pediatric liver transplantation. Curr Opin Organ Transplant 2014; 19:480-5. [DOI: 10.1097/mot.0000000000000116] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Andersen MN, Dore-Stites D, Gleit R, Lopez MJ, Fredericks EM. A pilot study of the association between sleep disturbance in children with liver transplants and parent and family health-related quality of life. J Pediatr Psychol 2014; 39:735-42. [PMID: 24947272 DOI: 10.1093/jpepsy/jsu037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To investigate the relationship between sleep disturbance in children with liver transplants and parent and family health-related quality of life (HRQOL). METHOD 47 parents of children with liver transplants completed measures of child sleep and family HRQOL. Relationships between sleep and HRQOL and differences in HRQOL between groups with scores above and below the cutoff on a pediatric sleep measure were examined. RESULTS Parents endorsed higher rates of sleep-related breathing disorder (SRBD) and restless legs syndrome and periodic limb movements during sleep (RLS/PLMS) and lower HRQOL compared with published data. Significant correlations were found between SRBD and RLS/PLMS and HRQOL, and significant group differences in HRQOL were found between groups above and below the cutoff for behavior problems and RLS/PLMS. CONCLUSION There are significant relationships between symptoms of SRBD and RLS/PLMS in children with liver transplants and family HRQOL. Behavior problems may account for these strong relationships.
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Affiliation(s)
- Melissa N Andersen
- C.S. Mott Children's Hospital, University of Michigan Medical School, Division of Child Behavioral Health, Department of Pediatrics and Communicable Diseases, Division of Pediatric Gastroenterology, Department of Pediatrics and Communicable Diseases, and Division of Child Behavioral Health, Child Health Evaluation and Research (CHEAR) Unit, Department of Pediatrics and Communicable Diseases, University of MichiganC.S. Mott Children's Hospital, University of Michigan Medical School, Division of Child Behavioral Health, Department of Pediatrics and Communicable Diseases, Division of Pediatric Gastroenterology, Department of Pediatrics and Communicable Diseases, and Division of Child Behavioral Health, Child Health Evaluation and Research (CHEAR) Unit, Department of Pediatrics and Communicable Diseases, University of MichiganC.S. Mott Children's Hospital, University of Michigan Medical School, Division of Child Behavioral Health, Department of Pediatrics and Communicable Diseases, Division of Pediatric Gastroenterology, Department of Pediatrics and Communicable Diseases, and Division of Child Behavioral Health, Child Health Evaluation and Research (CHEAR) Unit, Department of Pediatrics and Communicable Diseases, University of Michigan
| | - Dawn Dore-Stites
- C.S. Mott Children's Hospital, University of Michigan Medical School, Division of Child Behavioral Health, Department of Pediatrics and Communicable Diseases, Division of Pediatric Gastroenterology, Department of Pediatrics and Communicable Diseases, and Division of Child Behavioral Health, Child Health Evaluation and Research (CHEAR) Unit, Department of Pediatrics and Communicable Diseases, University of MichiganC.S. Mott Children's Hospital, University of Michigan Medical School, Division of Child Behavioral Health, Department of Pediatrics and Communicable Diseases, Division of Pediatric Gastroenterology, Department of Pediatrics and Communicable Diseases, and Division of Child Behavioral Health, Child Health Evaluation and Research (CHEAR) Unit, Department of Pediatrics and Communicable Diseases, University of MichiganC.S. Mott Children's Hospital, University of Michigan Medical School, Division of Child Behavioral Health, Department of Pediatrics and Communicable Diseases, Division of Pediatric Gastroenterology, Department of Pediatrics and Communicable Diseases, and Division of Child Behavioral Health, Child Health Evaluation and Research (CHEAR) Unit, Department of Pediatrics and Communicable Diseases, University of Michigan
| | - Rebecca Gleit
- C.S. Mott Children's Hospital, University of Michigan Medical School, Division of Child Behavioral Health, Department of Pediatrics and Communicable Diseases, Division of Pediatric Gastroenterology, Department of Pediatrics and Communicable Diseases, and Division of Child Behavioral Health, Child Health Evaluation and Research (CHEAR) Unit, Department of Pediatrics and Communicable Diseases, University of MichiganC.S. Mott Children's Hospital, University of Michigan Medical School, Division of Child Behavioral Health, Department of Pediatrics and Communicable Diseases, Division of Pediatric Gastroenterology, Department of Pediatrics and Communicable Diseases, and Division of Child Behavioral Health, Child Health Evaluation and Research (CHEAR) Unit, Department of Pediatrics and Communicable Diseases, University of MichiganC.S. Mott Children's Hospital, University of Michigan Medical School, Division of Child Behavioral Health, Department of Pediatrics and Communicable Diseases, Division of Pediatric Gastroenterology, Department of Pediatrics and Communicable Diseases, and Division of Child Behavioral Health, Child Health Evaluation and Research (CHEAR) Unit, Department of Pediatrics and Communicable Diseases, University of Michigan
| | - M James Lopez
- C.S. Mott Children's Hospital, University of Michigan Medical School, Division of Child Behavioral Health, Department of Pediatrics and Communicable Diseases, Division of Pediatric Gastroenterology, Department of Pediatrics and Communicable Diseases, and Division of Child Behavioral Health, Child Health Evaluation and Research (CHEAR) Unit, Department of Pediatrics and Communicable Diseases, University of MichiganC.S. Mott Children's Hospital, University of Michigan Medical School, Division of Child Behavioral Health, Department of Pediatrics and Communicable Diseases, Division of Pediatric Gastroenterology, Department of Pediatrics and Communicable Diseases, and Division of Child Behavioral Health, Child Health Evaluation and Research (CHEAR) Unit, Department of Pediatrics and Communicable Diseases, University of MichiganC.S. Mott Children's Hospital, University of Michigan Medical School, Division of Child Behavioral Health, Department of Pediatrics and Communicable Diseases, Division of Pediatric Gastroenterology, Department of Pediatrics and Communicable Diseases, and Division of Child Behavioral Health, Child Health Evaluation and Research (CHEAR) Unit, Department of Pediatrics and Communicable Diseases, University of Michigan
| | - Emily M Fredericks
- C.S. Mott Children's Hospital, University of Michigan Medical School, Division of Child Behavioral Health, Department of Pediatrics and Communicable Diseases, Division of Pediatric Gastroenterology, Department of Pediatrics and Communicable Diseases, and Division of Child Behavioral Health, Child Health Evaluation and Research (CHEAR) Unit, Department of Pediatrics and Communicable Diseases, University of MichiganC.S. Mott Children's Hospital, University of Michigan Medical School, Division of Child Behavioral Health, Department of Pediatrics and Communicable Diseases, Division of Pediatric Gastroenterology, Department of Pediatrics and Communicable Diseases, and Division of Child Behavioral Health, Child Health Evaluation and Research (CHEAR) Unit, Department of Pediatrics and Communicable Diseases, University of MichiganC.S. Mott Children's Hospital, University of Michigan Medical School, Division of Child Behavioral Health, Department of Pediatrics and Communicable Diseases, Division of Pediatric Gastroenterology, Department of Pediatrics and Communicable Diseases, and Division of Child Behavioral Health, Child Health Evaluation and Research (CHEAR) Unit, Department of Pediatrics and Communicable Diseases, University of Michigan
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Kosmach-Park B. The impact of liver transplantation on family functioning in pediatric recipients: can "healthy" families contribute to improved long-term survival? Pediatr Transplant 2013; 17:321-5. [PMID: 22624661 DOI: 10.1111/j.1399-3046.2012.01728.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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