Parental stress in families of children with a genetic disorder/disability and the resiliency model of family stress, adjustment, and adaptation

A secondary analysis examining the influence of emotional support on the mental health of caregivers of children with autism spectrum disorder

PURPOSE

The study purpose was to examine the effect of emotional support on the overall mental health and stress for caregivers of children with autism spectrum disorder (ASD).

METHODS

A cross-sectional retrospective study using secondary data from the 2016-2019 National Survey of Children's Health was conducted using single variable and multivariable linear regression analyses.

RESULTS

More informal emotional support sources were associated with better overall mental health (β = 0.124, SE = 0.015, p < .001) and reduced stress (β = -0.261, SE = 0.039, p < .001) for caregivers of children with ASD, controlling for covariates. The number of formal emotional support sources was not significantly associated with caregiver overall mental health or stress when controlling for covariates. Increased amounts of total emotional support sources were significantly associated with increased overall mental health (β = 0.042, SE = 0.010, p < .001) and reduced stress (β = -0.093, SE = 0.024, p < .001) for caregivers. Other factors significantly associated with caregiver outcomes included caregiver sex, caregiver marital status, caregiver education level, economic hardship, child sex, child race/ethnicity, ASD severity, and child receipt of ASD treatment.

CONCLUSION

More emotional support sources, in particular informal support sources, may be a protective factor for well-being for caregivers of children with ASD.

PRACTICE IMPLICATIONS

Health care providers should evaluate the impact of their formal support services on caregivers of children with ASD and advocate for increased informal and formal support resources for these caregivers.

Disability Is Not a Burden: The Relationship between Early Childhood Disability and Maternal Health Depends on Family Socioeconomic Status

Narratives rooted in ableism portray disabled children as burdens on their families. Prior research highlights health disparities between mothers of disabled children and mothers of nondisabled children, but little is known about how socio-structural contexts shape these inequities. Using longitudinal data from the Future of Families and Child Wellbeing Study (n = 2,338), this study assesses whether the relationship between early childhood disability and maternal health varies by household socioeconomic status (SES). Findings reveal that, on average, mothers of children disabled by age five report worse health than mothers of nondisabled children; however, this pattern is only evident among lower SES mothers and disappears for higher SES mothers. Contextualizing the findings within the systemic ableism literature highlights how-instead of portraying disabled children as burdens on their families-scholars and policymakers should focus on how ableism and poverty burden disabled people and their families in ways that pattern health risks.

The resilient process of the family after diagnosis of childhood chronic illness: a qualitative meta-synthesis

PROBLEM

Childhood chronic illness has a serious effect on the whole family. As there is yet little known about how the families adjust to the diagnosis of childhood chronic illness, this qualitative meta-synthesis aims to further our knowledge regarding the resilient process.

ELIGIBILITY CRITERIA

A meta-synthesis review was conducted to explore the resilient process of the family after diagnosis of childhood chronic illness using nine electronic databases PubMed (MEDLINE), Web of Science, the Cochrane Library, SCOPUS, PsycINFO, CINAHL, Wan Fang, CBM, and CNKI from each database's inception to December 31,2020. Snowball sampling and manual search were performed to identify other relevant studies.

SAMPLE

Seventeen qualitative studies met the inclusion criteria and were analyzed into meta-synthesis.

RESULTS

Three key meta-themes were identified across the studies: (a) disintegration and vulnerability: emotional fluctuation and household chaos; (b) adjustment and adaptation: struggle with family needs; (c) recovery and reconstruction: growth and expectation.

CONCLUSION

Family adjustment to childhood chronic illness presents a complex, multifaceted and dynamic process. Identifying characteristics of family processes provides some practical interventions for families with a chronically ill child.

IMPLICATIONS

There is a need for all health professionals and social care services to be aware of the experience of family adjustment of children diagnosed with chronic illness. The specific intervention targeted at different periods of the family adjustment process is warranted to help families to recover from crises and deal better with challenges.

Role of Psychologists in Pediatric Metabolic Disorders

Metabolic disorders or inborn errors of metabolism (IEMs) can have a wide range of neurodevelopmental and behavioral presentations. These can vary with age and/or management or stressors from common childhood/intercurrent illnesses/procedures/interventions. Collaborative care models such as multidisciplinary metabolic clinics or colocated models with behavioral health clinics and metabolic clinics in the same location can be valuable resources in improving long-term outcomes in patients with IEM. Psychologists' expertise using behavioral interventions, screening, or adaptive/cognitive measures can help with diagnosis, treatment adherence, school performance, family support, community resources, transition to adolescence and young adulthood using health belief concepts to improve outcomes.

Family resilience of patients requiring long-term care: A meta-synthesis of qualitative studies

BACKGROUND

Long-term care of patients with chronic illnesses is an important global public health issue, compromising the well-being of family members and the family functioning. Previous studies have examined the interactive experiences and processes of various systems in the families coping with long-term care stress; however, these studies have not been systematically reviewed and integrated.

AIMS

This review aimed to synthesise the existing qualitative evidence on the experiences and processes of family resilience operate in families providing long-term care for patients with chronic illnesses and to provide suggestions for the development of interventions in future studies.

MATERIALS & METHODS

We searched databases including PubMed, CINAHL, EMBASE, Web of Science, ProQuest and CNKI from their inception to March 2022. We used the JBI Critical Appraisal Tool for qualitative studies to evaluate the quality of the included studies was evaluated according to. We followed The Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) statement. The results were integrated using the thematic and content analysis method.

RESULTS

Fourteen studies from eight countries covering 11 diseases reported on the experiences and coping processes of long-term care families. Based on McCubbin's Resiliency Model of Family Stress, Adjustment and Adaptation (FAAR), five analytical themes were synthesised: stressors (risk factors), family belief system, internal family coping strategies, external support and resilient adaptation indicators; the relationships between themes and subthemes were illustrated.

DISCUSSION

This review synthesized qualitative evidence on the experiences and processes of family resilience operate in families providing long-term care. The results of this study found that the cognition and belief of family members regarding dilemmas have a two-way effect and act on the adaptation process of family members. In family adaptation, spirituality, hope, internal and external support are extremely important. In 14 studies, caregivers were from different countries with intercultural differences, but due to less reports on this content, it is difficult to compare the differences or impact that culture or ethnicity may have.

CONCLUSIONS

Family resilience plays an important role in coping with stressors associated with the long-term care of a loved one through family belief systems, internal support systems and external support systems. The development of family resilience-based interventions for long-term care families should consider the family as a whole and further construct a multidisciplinary, multilevel and multi-type social support network to enhance family resilience.

Difficulties of Prenatal Genetic Counseling for a Subsequent Child in a Family With Multiple Genetic Variations

Many parents with a disabled child caused by a genetic condition appreciate the option of prenatal genetic diagnosis to understand the chance of recurrence in a future pregnancy. Genome-wide tests, such as chromosomal microarray analysis and whole-exome sequencing, have been increasingly used for prenatal diagnosis, but prenatal counseling can be challenging due to the complexity of genomic data. This situation is further complicated by incidental findings of additional genetic variations in subsequent pregnancies. Here, we report the prenatal identification of a baby with a MECP2 missense variant and 15q11.2 microduplication in a family that has had a child with developmental and epileptic encephalopathy caused by a de novo KCNQ2 variant. An extended segregation analysis including extended relatives, in addition to the parents, was carried out to provide further information for genetic counseling. This case illustrates the challenges of prenatal counseling and highlights the need to understand the clinical and ethical implications of genome-wide tests.

Care Coordination Needs of Families of Children with Down Syndrome: A Scoping Review to Inform Development of mHealth Applications for Families

Care coordination is a critical component of health management aimed at linking care providers and health-information-involved care management. Our intent in this scoping review was to identify care coordination needs of families of children with Down syndrome (DS) and the strategies they used to meet those needs, with the goal of contributing to the evidence base for developing interventions by using an mHealth application (mHealth apps) for these families. Using established guidelines for scoping reviews, we searched five databases, yielding 2149 articles. Following abstract and full-text review, we identified 38 articles meeting our inclusion criteria. Studies incorporated varied in regard to research designs, samples, measures, and analytic approaches, with only one testing an intervention by using mHealth apps. Across studies, data came from 4882 families. Common aspects of families' care coordination needs included communication and information needs and utilization of healthcare resources. Additional themes were identified related to individual, family, and healthcare contextual factors. Authors also reported families' recommendations for desirable characteristics of an mHealth apps that addressed the design of a personal health record, meeting age-specific information needs, and ensuring access to up-to-date information. These results will further the development of mHealth apps that are tailored to the needs of families with a child with DS.

Paternal Stress and Child Outcomes in Youth with Sickle Cell Disease

OBJECTIVE

The objective of this study was to investigate the relationship between parental stress and health-related quality of life (HRQOL) among children with sickle cell disease (SCD).

METHODS

A cross-sectional correlational survey research design was used for this quantitative study. One hundred-fifty patients between the ages of 8-17 years old and their caregivers were enrolled from an outpatient comprehensive sickle cell program within a hospital setting. Patients completed the Pediatric Quality of Life Scale 3.0 SCD Module, whereas parents completed the Parental Stress Scale and demographic information questionnaire. Multiple regression analysis was used to determine if parental stress scores predicted the HRQOL of children diagnosed with SCD after controlling for demographic variables.

RESULTS

The sample included 150 patients (median age: 12 years old; female: 52%) who were diagnosed with SCD along with 150 of their caregivers. Higher levels of parental stress predicted lower HRQOL scores (p < .001).

CONCLUSION

As parents reported elevated levels of stress related to caring for their child with SCD, patients reported worsening HRQOL. More evidence is needed in order to determine, which constructs of parental stress had a significant impact on HRQOL. It may be helpful for healthcare workers to be aware of familial influences of reduced HRQOL among children diagnosed with SCD. Parents reporting increased stress related to raising their child with SCD may benefit from additional support and resources.

Problem-solving and coping in family adaptation of children with Down Syndrome

OBJECTIVE

To analyze problem-solving and coping strategies of parents of children with Down Syndrome in family adaptation.

METHOD

This is a qualitative research that used the Resiliency Model of Family Stress, Adjustment, and Adaptation. Participants were mothers and/or fathers from 40 families of children aged 1 to 7 years diagnosed with DS. Directed content analysis was performed, supported by software and considering a code dictionary.

RESULTS

Problem-solving and coping proved to be a set of actions, behaviors, efforts, and communications that contributed to family adaptation and favored balance between the demands imposed by Down Syndrome and the acquisition of resources by the family.

CONCLUSION

In the first moment, which corresponds to the time of news or diagnosis of the syndrome and the first days after birth, internal and external resources, which represent coping, are developed to accept and refocus ideas and feelings towards Down Syndrome. Over time these resources have an effect and cause changes in family functioning patterns and in the relationship of these families with the outside world, as they seek child development.

Parental peritraumatic distress and feelings of parental competence in relation to COVID-19 lockdown measures: What is the impact on children's peritraumatic distress?

The objective of this study was to measure, via an online survey, the peritraumatic impact of COVID-19-related lockdown measures on parents and their sense of parental competence, as well as the link with their children's peritraumatic distress. We investigated the links between the distress felt by the parent and the distress felt by the child in the lockdown from March to May 2020. Participants were 287 parents and 161 children. The results of our study indicated that there is a significant association between the parents' and the children's peritraumatic stress. We also found a significant relationship between the sense of parental competence and the trauma suffered as a result of the lockdown. We also showed that people who usually felt more stressed have lower peritraumatic distress. In addition, the data indicated that mothers were more affected than fathers by the lockdown, whereas there was no difference between girls and boys in the sample of children. The peritraumatic feelings appeared to be more related to the difficulty of combining teleworking with the daily management of children than to the fear of the virus itself. All these results bear witness to the differences in the experience of lockdown between mothers and fathers, and the impact on their children's well-being.

Guarantee of the social rights of children with chronic conditions: reinventing care towards civil rights

OBJECTIVE

To analyze the experiences of families in the exercise of the rights of children with chronic conditions in public health, education and social assistance institutions.

METHOD

ethnographic multiple case study, with qualitative approach, following the theoretical approach of Boaventura Santos. Experiences of the families of these children in a city were studied through interviews with family members, managers and professionals from social institutions (35), participant observations in social spaces (13) and creation of eco-maps (3). Critical Discourse Analysis was performed.

RESULTS

the offer of services is lower than the demand, and exclusion processes persist. Given the hegemony of neoliberal and normality ideologies, meetings between family members and professionals revealed obstacles to civil rights; however, when these ideologies were challenged, the realization of their rights was enhanced.

FINAL CONSIDERATIONS

the care to promote civil rights requires family members, managers and professionals to develop subjectivities that overcome neoliberal and normality ideologies, recognizing these children as subjects of law.

Poverty and family resilience in Belém-Pará

Family resilience is a complex, multi-determined behavior caused by the inseparable action of risk and protection factors. The purpose of this paper is to associate aspects of family resilience with multiple dimensions of poverty through a quantitative, descriptive, correlative, exploratory study with a sample of 448 low-income families in thirteen Social Assistance Reference Centers in Belém, Pará. The instruments used in the study were the Family Resilience Profile Questionnaire, the Social and Demographic Inventory, and the Family Poverty Rate. The results state that the families are not living in extreme poverty; however, they still face adversities due to the poverty. A significant presence of women, where 90.6% of the participants were mothers living in a single-parent family, attests that women are still the part of the population most affected by poverty. Furthermore, the results showed that the higher the poverty level, the lower the family resilience, and aspects such as work, knowledge and human development, especially child development, are aspects that enhance family resources to face adversities.

Rehabilitation in a rare case of coffin-siris syndrome with major cognitive and behavioural disorders

BACKGROUND

Coffin-Siris syndrome is a rare genetic disease with heterozygous variants in the ARID1A, ARID1B, ARID2, DPF2, SMARCA4, SMARCB1, SMARCE1 or SOX11 genes. It may manifest with somatic anomalies, deafness, urogenital malformations, recurrent infections, mental retardation, speech deficit, agenesis of the corpus callosum, convulsions, hypotonia, developmental delay, and scoliosis.

CASE REPORT

A 14-year-old boy with Coffin-Siris syndrome due to variants in the ARID1A gene was referred to the clinic. His rehabilitation over a 9-year period was described. The problem of assessment and the approach to rehabilitation was discussed, enabling a progressive remodelling of the cognitive-behavioural disorders that most hindered the possibility of his acquiring new skills and achieving social and family integration.

CLINICAL REHABILITATION

A protracted, customised, multiprofessional rehabilitation approach, centred on realistic functional objectives, implemented with the direct involvement of the family and school, was the only way to achieve the maximum independence and social and family integration permitted by his residual disability.

Parental Stress and Family Quality of Life: Surveying Family Members of Persons with Intellectual Disabilities

(1) Background. This study assesses the quality of life in families with a member with an intellectual disability using the Family Adjustment and Adaptation Response framework. (2) Methods. The study included 515 Spanish participants whose family members with disabilities range in age from infancy to adulthood. We hypothesized that it is possible to predict parenting stress by paying attention to the meaning families give to themselves and their circumstances while controlling for the impact of other variables such as family capabilities and characteristics of the family member with disabilities. We used the Beach Center Family Quality of Life Scale and the section on Exceptional needs of medical and behavioral support from the Supports Intensity Scale, together with other potential predictors. The subscale on parental stress from the Parenting Stress Index-Short Form was utilized as a criterion measure. (3) Results. Hierarchical multiple regression analysis revealed that 49% of parental stress was predicted by dysfunctional interaction, difficult behaviors, low emotional wellbeing, poor family interaction, as well as kinship as parents, and the severity of both the medical needs and intellectual disability. (4) Conclusions. The stress experienced by those families is mostly predicted by the meaning they give to themselves and their circumstances. Implications of these findings for service delivery are discussed.

Problemas de Salud Mental en Niños con Fisura Labiopalatina

Los niños que padecen enfermedades genéticas son una población vulnerable para desarrollar problemas de salud mental. La fisura labiopalatina (FLAP) es una anomalía congénita de tipo estructural. Objetivo: Estudiar el impacto a nivel familiar del diagnóstico de FLAP. Metodología: Alcance descriptivo, de diseño mixto y corte transversal. Se construyó un cuestionario autoadministrado compuesto por un consentimiento informado, un cuestionario de datos sociodemográficos, el Child Behavior CheckList y preguntas abiertas. El muestreo fue intencional y la muestra fue de 42 casos. Resultados: El diagnóstico de una fisura labio palatina es una experiencia difícil en los padres, quienes viven este momento de manera negativa, con tristeza y miedo.  Los niños en edad preescolar con diagnóstico de fisura labiopalatina son una población en riesgo de desarrollar trastornos psicopatológicos, mayormente de tipo externalizantes.

Addressing Needs of Hospitalized Patients With Autism: Partnership With Parents

Evidence suggests that improved health outcomes and reducing the hospital length of stay of individuals with autism require working in partnership between parents and health care professionals. Parents' ability to cope in their daily caregiving responsibilities to their child with autism and assessment of their hospital experience can have an impact on their participation with the care team. Nurses working in the inpatient setting can provide support to parents during their encounter with them. This article presented some of the helpful approaches that can help in building positive relationships with parents that may help facilitate addressing the needs of their child with autism. Suggestions that nurses can implement to support the parents cope with their daily challenges are presented. The approaches were discussed in relation to literature and suggestions from parents of individuals with autism spectrum disorder.

“One does not forget, it all comes back”: elderly people with intellectual disability review adversities and stress-protection in their lives

Purpose

People with intellectual disability are reported to encounter many negative life events during their increasingly long lives. In the absence of protective elements, these may cause toxic stress and trauma. Given the reported negative effects of such adverse events on their quality of life (QoL), the perspective of older people with intellectual disability themselves may be of relevance. The paper aims to discuss these issues.

Design/methodology/approach

The authors questioned nine participants with mild intellectual disability, aged 61–88 years old, in four 90-min focus group sessions and thematically analysed the data.

Findings

Many recent and bygone negative life events still weighed heavily on the participants. Negative interactions, experiences of loss, lack of control and awareness of one’s disability caused stress. Their emotional response contrasted with their contentment, compliance and resilience. Having (had) good relationships, having learnt coping skills, remaining active, talking about past experiences and feeling free of pain, safe, well supported, capable, respected and involved seemed to heighten resilience and protect participants from toxic stress.

Research limitations/implications

Monitoring and preventing adverse (childhood) experiences, supporting active/emotional coping strategies, psychotherapy and life story work may facilitate coping with negative events and enhance QoL of elderly people with intellectual disability.

Originality/value

Elderly people with mild intellectual disability run a higher risk of experiencing (early) adverse events in life. They are very capable of talking about their experiences, QoL, and the support they need. Focus groups were a reliable method to capture their insights.

Family-centered practices and the parental well-being of young children with disabilities and developmental delay

BACKGROUND

Research evidence from studies in North America on the relationships between family-centered practices, parents' self-efficacy beliefs, parenting confidence and competence beliefs, and parents' psychological well-being was used to confirm or disconfirm the same relationships in two studies in Spain.

AIMS

The aim of Study 1 was to determine if results from studies in North America could be replicated in Spain and the aim of Study 2 was to determine if results from Study 1 could be replicated with a second sample of families in Spain.

METHODS AND PROCEDURES

A survey including the study measures was used to obtain data needed to evaluate the relationships among the variables of interest. The participants were 105 family members in Study 1 and 310 family members in Study 2 recruited from nine early childhood intervention programs. Structural equation modeling was used to test the direct and indirect effects of the study variables on parents' well-being.

OUTCOMES AND RESULTS

Results showed that family-centered practices were directly related to both self-efficacy beliefs and parenting beliefs, and indirectly related to parents' psychological well-being mediated by belief appraisals.

CONCLUSION AND IMPLICATIONS

The pattern of results was similar to those reported in other studies of family-centered practices. Results indicated that the use of family-centered practices can have positive effects on parent well-being beyond that associated with different types of belief appraisals.

Psychosocial Factors in Children and Youth With Special Health Care Needs and Their Families

Children and youth with special health care needs (CYSHCN) and their families may experience a variety of internal (ie, emotional and behavioral) and external (ie, interpersonal, financial, housing, and educational) psychosocial factors that can influence their health and wellness. Many CYSHCN and their families are resilient and thrive. Medical home teams can partner with CYSHCN and their families to screen for, evaluate, and promote psychosocial health to increase protective factors and ameliorate risk factors. Medical home teams can promote protective psychosocial factors as part of coordinated, comprehensive chronic care for CYSHCN and their families. A team-based care approach may entail collaboration across the care spectrum, including youth, families, behavioral health providers, specialists, child care providers, schools, social services, and other community agencies. The purpose of this clinical report is to raise awareness of the impact of psychosocial factors on the health and wellness of CYSHCN and their families. This clinical report provides guidance for pediatric providers to facilitate and coordinate care that can have a positive influence on the overall health, wellness, and quality of life of CYSHCN and their families.

Grief and coping of parents whose child has a constant life-threatening disability, hypoplastic left heart syndrome with reference to the Dual-Process Model

This paper reports on a study that examined the grief and coping of 29 parents whose child has hypoplastic left heart syndrome using the Dual Process Model. The study employed a secondary thematic analysis of interviews at key times of treatment and recovery for the child. After the diagnosis, parents experienced intense loss (LO), but focused upon restoration-orientated tasks (RO) to support their child. Over time, most parents employed a healthy oscillation between LO coping and RO coping, with waves of grief and with some grieving suppressed. There are some specific grief and coping and gender patterns employed by parents.

Determinants of parent-delivered therapy interventions in children with cerebral palsy: A qualitative synthesis and checklist

INTRODUCTION

Parent-delivered therapy interventions for children with cerebral palsy can help achieve a sufficient therapy dose, improve parental mental well-being, and facilitate parent-child relationships creating a more relaxed familial environment. However, parent-delivered interventions may also lead to increased parental stress, guilt if the therapy is not delivered, and time constraints. The primary aim of this review was to gain a deeper understanding of the determinants of effective parent-delivered therapy interventions.

METHOD

Searches were conducted in the following databases: Medline, PubMed, Scopus, Embase, CINAHL, and Cochrane. Studies had to meet the following inclusion criteria: descriptions of parent/health care professional/child experiences of parent-delivered therapy interventions for children and young people age 0-18 years with cerebral palsy, published in the English language between January 1989 and May 2017, with qualitative or mixed methods research design. The articles were critically appraised, then synthesized using a meta-ethnographic approach.

RESULTS

A literature search identified 17 articles, which met the inclusion criteria. Three main themes were identified: (a) building trusting relationships, (b) enabling the parents to cope, and (c) for parents and health care professionals to see the intervention as a priority. Further synthesis presented three concepts identifying the important aspects of the interventions: empowerment, motivation, and relationships.

CONCLUSIONS

The themes and concepts emerging from this qualitative synthesis can be addressed by specific points of action to support parent-delivered therapy interventions. We have summarized these in a checklist for use by intervention developers, health care professionals, and parents.

Family management of childhood chronic conditions: Does it make a difference if the child has an intellectual disability?

The purpose of this analysis was to assess the applicability of the Family Management Measure (FaMM) to families in which there was a child with an intellectual disability versus a chronic condition. Drawing on data from 571 parents of children with a chronic physical condition and 539 parents of children with Down syndrome, we compared the two groups across the six FaMM scales. After accounting for the covariate effects of race, ethnicity, family income, and child age, we found significant differences in four of the six FaMM scales, with parents of children with Down syndrome reporting a significantly more positive view on the Condition Management Effort and View of Condition Impact scales and a significantly less positive view on the Child's Daily Life and Condition Management Ability scales than parents of children with a chronic physical condition. There were no significant differences between groups on the Family Life Difficulty and the Parental Mutuality scales. The analysis provided evidence of the applicability of the FaMM for studying families in which there is a child with Down syndrome and its utility in identifying the common and unique challenges of family management between the groups.

In the Dark: Challenges of Caring for Sons with Klinefelter Syndrome

The purpose of this mixed method study was to describe family management challenges for parents who have sons with Klinefelter Syndrome (KS). Standardized survey results showed that stress, quality of life and family management struggles varied by parent age. When interviewed, parents described feeling uninformed and without support to make decisions about managing their sons' KS. Parents reported that a lack of guidance and case coordination created barriers in caring for their sons throughout childhood. Given the prevalence of KS, health care providers need to be prepared to provide comprehensive evaluation and anticipatory guidance for KS boys and families.

Investigating Parenting Stress across Pediatric Health Conditions - A Systematic Review

The stress parenting responsibilities place on parents increases in situations involving pediatric illness, and therefore can potentially interfere with the normal family life. The present review examines sources of parenting stress across a wide spectrum of illnesses, using three illness groups as exemplars: Congenital heart disease, pediatric cancer, and Autism Spectrum Disorder. A systematic review of the literature using PubMed, CINAHL, Scopus, and PsycINFO databases yielded 66 observational studies investigating sources of parenting stress in parents of young children with congenital heart defects, cancer, and Autism Spectrum Disorder. Quality assessment, using the STROBE and COREQ quality indexes, was further conducted for the included studies. Stressors were categorized, and then analyzed in light of the diagnostic characteristics of the populations in focus. Findings indicate that parents across all illness groups experience increased levels of parenting stress. Several categories were identified in accordance to the parenting stress model as follows: illness-related factors, parental factors, child characteristics, familial factors, and social factors. Further analysis has revealed distinct parental concerns within the groups deriving from the diagnostics, care demands, or social responses specific to each group. Theoretical and practical implications for Family-Systems Nursing Practice were further discussed. Future research and assessment of parenting stress should account for the illness course and address family needs within the specific context of the illness.

Psychosocial adaptation: an evolutionary concept analysis exploring a common multidisciplinary language

AIMS

To provide the first known concept analysis of psychosocial adaptation, exploring its evolution from the concept adaptation. We also determine how psychosocial adaptation is conceptualized across nursing, health, sociobehavioural and education disciplines.

BACKGROUND

Psychosocial adaptation is an important conceptual term that is poorly defined in nursing and other health, sociobehavioural and education disciplines. A thorough understanding of the concept's application in nursing and across disciplines can help to clarify its meaning, facilitate a more effective common language between disciplines and inform future psychosocial adaptation research.

DESIGN

Rodger's evolutionary view guided this concept analysis.

DATA SOURCES

Peer-reviewed English and Spanish manuscripts published between 2011-2013 were retrieved from the following databases: CINAHL, Psych INFO, PubMed, Scopus and LILACS.

REVIEW METHODS

Eighty-nine articles related to psychosocial adaptation were included in the analysis. Findings identify key attributes, antecedents and consequences associated with the use of the concept. Findings were compared vis-a-vis reported characteristics of adaptation.

RESULTS

The attributes characterizing psychosocial adaptation are: change, process, continuity, interaction and influence. In psychosocial adaptation, new life conditions serve as antecedents, while consequences are good or bad outcomes. Important features of the evolution of this concept include its broad appropriation across the reviewed disciplines. The attributes of psychosocial adaptation, have some similarities to those of general adaptation. Both concepts include an aspect of change, but unlike adaptation, psychosocial adaptation has branched away from biological descriptors, such as homeostasis and tends to focus on relational characteristics, such as interaction and influences.

Reconceptualizing Family Adaptation to Developmental Delay

This study explores accurate conceptualization of the adaptation construct in families of children with developmental delay aged 3 to 8 years. Parents' self-reported measures of adaptation and observed dyadic relationship variables were examined. Confirmatory factor analysis and longitudinal growth modeling were used to evaluate the nature of adaptational processes. Results indicate that adaptational processes vary across adaptation index, child developmental level, and parent gender. Adaptation indices did not load onto a single construct at any time point. Several adaptational processes remained stable across time, although others showed linear or quadratic change. The findings of the current study indicate that it is time for a change in how adaptation is conceived for families of children with developmental delay.

Genetics' influence on patient experiences with a rare chronic disorder: a photovoice study of living with alpha-1 antitrypsin deficiency

Patients with rare chronic disorders and their caregivers increasingly form communities to support and exchange social experiences. Because up to 10% of the United States population is affected by one of 5000 to 6000 rare disorders, efforts to understand the individuals and affected communities are important. This study was conducted using community-based participatory research approaches within a community of patients and caregivers living with alpha-1 antitrypsin (AAT) deficiency. Patient populations at some risk for lung transplant include individuals who smoked cigarettes and patients who underwent liver transplant in infancy and later adulthood due to accumulation of misfolded AAT within hepatocytes.

Psychosocial experiences of parents of infants with hypoplastic left heart syndrome in the PICU

OBJECTIVE

To evaluate the psychosocial status of mothers and fathers of infants with hypoplastic left heart syndrome while in the PICU.

DESIGN

A retrospective study combining interviews and psychometric testing of parents.

SETTING

Tertiary hospital PICU.

SUBJECTS

Twenty-nine parents (16 mothers and 13 fathers) of surviving children.

INTERVENTION

A semistructured face-to-face interview was conducted to explore parental experiences, and a Structured Clinical Interview for Diagnosis-Clinical Version (posttraumatic stress disorder module) was conducted to determine the possibility of an acute stress disorder or a posttraumatic stress disorder.

MEASUREMENT AND MAIN RESULTS

All parents reported multiple stresses which commenced with their infant's diagnosis and endured throughout their infant's time in PICU. The Structured Clinical Interview for Diagnosis revealed that acute stress disorder or posttraumatic stress disorder developed in 24 parents (83%). Of 18 parents whose infants were diagnosed with hypoplastic left heart syndrome in utero, eight of nine mothers (88%) and six of nine fathers (66%) had posttraumatic stress disorder. Of 11 parents whose infants were diagnosed with hypoplastic left heart syndrome postbirth, six of seven mothers had acute stress disorder and one mother had posttraumatic stress disorder, and of four fathers, two fathers had acute stress disorder and one father had posttraumatic stress disorder. The prevalence of parental stress-related disorder was not different between mothers and fathers (p = 0.85). Only five parents were free of traumatic stress-related illness. Parents also experienced losses. Many parents were marginalized from their infant's care by the environment of PICU. Fifty percent of mothers experienced difficulties with parental-infant bonding. Ten parents (34%) began the process of adaptation to their infant's hypoplastic left heart syndrome and were assisted by the support and sensitivity of staff or had discovered other resources.

CONCLUSIONS

All parents of surviving infants with hypoplastic left heart syndrome in PICU, irrespective of timing of diagnosis, experienced numerous stresses and losses, and the majority exhibited clinical levels of traumatic stress. Receiving the diagnosis itself is very traumatic and is compounded by the environment of the PICU which alienates parents from their infants and interferes with parent-infant bonding. Parental adaptation to this situation can be assisted by staff.

Growing up in the genomic era: implications of whole-genome sequencing for children, families, and pediatric practice

Whole-genome sequencing (WGS) has advanced to a point where it is beginning to be integrated into pediatric practice. With little consensus on how to maximize the benefits of WGS for children, there is a growing need for focused efforts that connect researchers, clinicians, and families to chart a path forward. To illustrate relevant concerns, two contrasting applications of pediatric WGS are explored: clinical use with children who have undiagnosed conditions, and population-based screening. Specific challenges for health care services, policy development, and the well-being of children are discussed in light of current research. In the interest of ensuring evidence-based pediatric WGS, strategies are identified for advancing our understanding of what it means for children to grow up with WGS results guiding their health care.

Parenting stress among caregivers of children with chronic illness: a systematic review

OBJECTIVE

To critically review, analyze, and synthesize the literature on parenting stress among caregivers of children with asthma, cancer, cystic fibrosis, diabetes, epilepsy, juvenile rheumatoid arthritis, and/or sickle cell disease. Method PsychInfo, MEDLINE, and Cumulative Index to Nursing and Allied Health Literature were searched according to inclusion criteria. Meta-analysis of 13 studies and qualitative analysis of 96 studies was conducted. Results Caregivers of children with chronic illness reported significantly greater general parenting stress than caregivers of healthy children (d = .40; p = ≤.0001). Qualitative analysis revealed that greater general parenting stress was associated with greater parental responsibility for treatment management and was unrelated to illness duration and severity across illness populations. Greater parenting stress was associated with poorer psychological adjustment in caregivers and children with chronic illness. Conclusion Parenting stress is an important target for future intervention. General and illness-specific measures of parenting stress should be used in future studies.