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Mindfulness Interventions for Attention Deficit Hyperactivity Disorder: A Systematic Review and Meta-Analysis. PSYCHIATRY INTERNATIONAL 2022. [DOI: 10.3390/psychiatryint3040031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental condition impacting children and adults. Current treatments are limited and there is increasing interest in the use of mindfulness, which is growing in popularity. Previous systematic reviews have typically focused on specific ages, outcome measures or interventions. The current review aimed to take a more comprehensive approach. Title and abstract searches were performed in five databases for randomized and non-randomized controlled trials or pre-post studies with participants with an ADHD diagnosis or a score above a clinically relevant cut-off on a validated ADHD measure. Studies had to measure symptoms of ADHD, global or social functioning. Extraction of key information including participant status (i.e., diagnosis, scale scores, comorbidities, medication use), study design, and outcome measures was conducted. Effect sizes (Hedge’s g) were calculated and where a measure had been used in at least three studies with the same population, meta-analyses were considered. Twenty-nine studies were initially identified, with seven deemed poor quality and removed from further analysis leaving, 22 studies containing data from 1237 children and adults with ADHD along with data from 525 family members. The data indicate possible benefits of mindfulness on self-compassion, quality of life, wellbeing, depression, and anxiety. The findings also suggest that mindfulness may also improve ADHD symptoms, executive function, problematic behaviours, and emotional dysregulation, although results vary by age of patient and measures used. Parent stress and parenting style have received limited attention, highlighting the need for more studies in these areas. Whilst the data presented suggest that mindfulness may be beneficial, the evidence base is not as strong as the popularity of the approach. Many of the studies lacked blind assessment, adequate randomization, or suitable control conditions. As such high-quality controlled studies considering medication, other psychosocial interventions, use of active and in active controls and comorbidity as well as longer follow-up periods, are needed to confirm this.
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Risi A, Pickard JA, Bird AL. The implications of parent mental health and wellbeing for parent-child attachment: A systematic review. PLoS One 2021; 16:e0260891. [PMID: 34914730 PMCID: PMC8675743 DOI: 10.1371/journal.pone.0260891] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 11/18/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Parent mental health and wellbeing may have implications for understanding attachment transmission. In this systematic review, we synthesise the published literature to determine the nature of the relationship between parent mental health and wellbeing and the intergenerational transmission of attachment and to provide recommendations for future research, clinical practice and intervention. METHOD Using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) approach, five electronic databases were searched for peer-reviewed empirical studies, published in English. Articles were considered for inclusion if data was collected on adult attachment, child attachment, and a domain of parent mental health/wellbeing. No date parameters were applied to the search strategy. The review was registered with PROPSERO (registration number: CRD42020157247). RESULTS Eleven studies examining the impact on parent mental health and wellbeing on the intergenerational transmission of attachment were identified for inclusion in this review. Our review found preliminary evidence that parent mental health and wellbeing play a role in the intergenerational transmission of attachment. Other key findings from the review were: evidence quality is mixed due to variable measurement of attachment and mental health; studies have mostly included correlational analysis or do not utilise contemporary methodological approaches to testing mediating or moderating relationships; and literature is largely focused on psychopathology and negative factors of mental health. CONCLUSIONS The limited scope of parent mental health and wellbeing constructs examined in the literature, the sparse use of robust statistical analyses, and the lack of literature in general makes it difficult to draw conclusions on how and why parent mental health impacts attachment transmission. Addressing these limitations will further progress attachment-related literature and may have particular implications for attachment-informed interventions with clinical populations.
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Affiliation(s)
- Alixandra Risi
- School of Psychology and Early Start, University of Wollongong, Wollongong, New South Wales, Australia
| | - Judy A. Pickard
- School of Psychology and Early Start, University of Wollongong, Wollongong, New South Wales, Australia
| | - Amy L. Bird
- School of Psychology and Early Start, University of Wollongong, Wollongong, New South Wales, Australia
- School of Psychology, University of Waikato, Hamilton, New Zealand
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Petcharat M, Liehr P. Feasibility of a brief mindfulness intervention: Examining stress, anxiety and mindfulness for Thai parents of children with developmental disabilities. Arch Psychiatr Nurs 2021; 35:418-426. [PMID: 34561054 DOI: 10.1016/j.apnu.2021.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/16/2021] [Accepted: 06/03/2021] [Indexed: 11/24/2022]
Abstract
AIM To examine the feasibility of using a 2-weekend Brief Culturally Tailored Thai Mindfulness intervention (BCTTMi) to affect stress, anxiety, and mindfulness in Thai parents of children with developmental disabilities (DDs), based on eight feasibility study criteria. METHODS A BCTTMi was implemented with 22 Thai parents and caregivers of children with DDs with an experimental waitlist control crossover design. All participants were Thai and Buddhist; more than half had practiced meditation. The outcomes (stress, anxiety, mindfulness) were assessed with three Thai translated questionnaires, which had reported acceptable reliabilities. To address the feasibility criteria, data were gathered using virtual engagement, diary recordings, and a pre-, post-test trial. RESULTS Assessment of the eight qualities of feasibility indicated: 1) acceptability: the BCTTMi appealed to the participants; 2) demand: the participants practiced mindfulness at home; 3) implementation: the mindfulness practitioner was qualified; 4) practicality: anxiety was the only outcome measure sensitive to the BCTTMi (p = .005); 5) adaptation: there was no attrition with the shortened mindfulness intervention; 6) integration: the BCTTMi may be included as part of the participants' routine club meeting; 7) expansion: a home visit and booster sessions may add strength; 8) limited efficacy: future work with 50 participants will allow adequate power when anxiety is the outcome. CONCLUSIONS Further studies testing the BCTTMi are warranted in broader populations and across varied settings. However, it will be important to do preliminary work to identify outcomes measures, other than anxiety, that are sensitive to the BCTTMi.
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Affiliation(s)
| | - Patricia Liehr
- Christine E. Lynn College of Nursing, Florida Atlantic University, FL, USA.
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McIntyre LL, Neece CL, Sanner CM, Rodriguez G, Safer-Lichtenstein J. Telehealth Delivery of a Behavioral Parent Training Program to Spanish-Speaking Latinx Parents of Young Children With Developmental Delay: Applying an Implementation Framework Approach. SCHOOL PSYCHOLOGY REVIEW 2021. [DOI: 10.1080/2372966x.2021.1902749] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Roberts LR, Boostrom GG, Dehom SO, Neece CL. Self-Reported Parenting Stress and Cortisol Awakening Response Following Mindfulness-Based Stress Reduction Intervention for Parents of Children With Developmental Delays: A Pilot Study. Biol Res Nurs 2019; 22:217-225. [PMID: 31755301 DOI: 10.1177/1099800419890125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Many parents of children with developmental delays (DDs) experience high levels of parental stress, and young children with DDs are likely to exhibit clinical levels of behavioral problems. The reciprocal relationship between the two issues makes these families vulnerable to stress-related health risks. To address this, the current study aims to investigate the effectiveness of mindfulness-based stress reduction (MBSR) at reducing parent stress, as measured by both psychological self-report and a physiological biomarker. METHOD A pretest-posttest design with a 6-month follow-up assessment was used to establish effectiveness with analyses of within-subject effects. Parents (N = 47) of children (2.5-5 years of age) with DDs participated in a standard 8-week MBSR intervention. Measures included the Parenting Daily Hassles, a self-report measure of perceived frequency and intensity of parenting stress, and salivary samples for measurement of the cortisol awakening response (CAR), a biological marker of stress response. RESULTS Both self-reported parenting stress and CAR decreased following MBSR for parents of children with DDs. The greatest difference in means over time was between baseline and follow-up, where changes in effect size were even stronger for biological markers than for self-report measures. CONCLUSION The MBSR intervention reduced both perceived and physiologic stress. Health-care professionals caring for these families might consider encouraging parents to participate in MBSR as both treatment and prevention of parenting stress.
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Alexander K, Kronk R, Sekula K, Short V, Abatemarco D. Implementation of a Mindfulness Intervention for Women in Treatment for Opioid Use Disorder and Its Effects on Depression Symptoms. Issues Ment Health Nurs 2019; 40:690-696. [PMID: 31100036 DOI: 10.1080/01612840.2019.1585499] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Many women in treatment for opioid use disorder (OUD) also experience mental health co-morbidities. Mindfulness intervention has demonstrated effectiveness for improving mental health in the general population, but has not been tested with female populations in OUD treatment. The purpose of this study was to describe characteristics associated with participation in a mindfulness intervention provided to women in treatment for OUD, and also to evaluate the effectiveness of a mindfulness intervention on depression symptoms. Aims: To evaluate participation characteristics associated with a mindfulness intervention and to assess the impact of a mindfulness intervention on depression symptoms for women with OUD. Methods: A secondary data analysis of a mindfulness intervention with women in treatment for OUD was accomplished. Bivariate analysis was conducted to determine any sociodemographic variables associated with intervention participation. Depression scores were assessed pre and post intervention using paired samples t tests for the intervention group (n = 65) and the control group (n = 8). Results: A 45% of women in the study reported moderate to severe depression symptoms at baseline, and 63% reported high levels of childhood trauma. There was a significant decrease in depression scores (M = 3.6 [1.2,6.1]) following the mindfulness intervention for the intervention group (t(64) = 3.1, p = .003). Participants entering the intervention group with moderate to severe depression scores experienced the most significant decrease in depression symptoms (M = 6.6, SD = 13.5), (t(64) = -2.1, p < .05). Conclusions: Women in treatment for OUD experience high levels of depression symptoms and past trauma, and mindfulness is a feasible intervention for OUD populations which may improve depression symptoms.
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Affiliation(s)
- Karen Alexander
- a Jefferson College of Nursing , Thomas Jefferson University , Philadelphia , PA , USA
| | - Rebecca Kronk
- b School of Nursing , Duquesne University , Pittsburgh , PA , USA
| | - Kathleen Sekula
- b School of Nursing , Duquesne University , Pittsburgh , PA , USA
| | - Vanessa Short
- c Sidney Kimmel Medical College , Thomas Jefferson University , Philadelphia , PA , USA
| | - Diane Abatemarco
- c Sidney Kimmel Medical College , Thomas Jefferson University , Philadelphia , PA , USA
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Neece CL, Chan N, Klein K, Roberts L, Fenning RM. Mindfulness-Based Stress Reduction for Parents of Children with Developmental Delays: Understanding the Experiences of Latino Families. Mindfulness (N Y) 2018; 10:1017-1030. [PMID: 31191735 DOI: 10.1007/s12671-018-1011-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Parents of children with developmental delays (DD) report elevated mental health difficulties compared to parents of children with typical development, which appear largely associated with child behavior problems. Latino parents of children with DD may experience heightened risk for poor mental health outcomes due additional stressors associated with minority status. Mindfulness-Based Stress Reduction (MBSR) appears to be efficacious for reducing parenting stress and improving wellbeing in families of children with DD; however, studies have rarely focused on families from racial and ethnic minority backgrounds. The current study employed a mixed-methods, waitlist-control design to examine the efficacy of MBSR for improving parent and child outcomes in Latino and non-Latino families. Results indicate that MBSR is similarly efficacious for Latino and non-Latino families in improving parent mental health (parenting stress, depressive symptomatology, and life satisfaction) and reducing parent-reported child behavior problems. Qualitative analyses further highlight avenues for improving the efficacy of MBSR for Latino families by providing intervention directly in Spanish, rather than using translation services, for Spanish-speaking families. Findings reveal the efficacy of standard MSBR for Latino parents of children with DD and underscore the potential benefits of disseminating this practice to traditionally underrepresented families.
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Zhang N, Rudi JH, Zamir O, Gewirtz AH. Parent Engagement in Online Mindfulness Exercises Within a Parent Training Program for Post-Deployed Military Families. Mindfulness (N Y) 2018; 9:725-736. [PMID: 29963214 PMCID: PMC6020143 DOI: 10.1007/s12671-017-0810-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Mindfulness has drawn increased attention in prevention programs targeting parents. Commonly, mindfulness-based programs are provided to reduce parental stress and improve child outcomes. Less often, researchers incorporate a mindfulness-informed approach, integrating a low dose of mindfulness exercises into an existing evidence-based parent training model. Little is known about participant engagement with mindfulness exercises in such programs. This non-experimental study focuses on families who are at risk for impaired parenting due to the unique stressor of a parent's deployment to war. The goal is to examine military parents' online engagement in mindfulness exercises and associations between engagement and dispositional mindfulness within a web-enhanced parent training program. Online tracking records and self-reported data were obtained from 370 military parents (207 families) who were assigned to the program; at 6-month follow-up, 68.6% of these parents were retained (at least one parent reported from 75.4% of families). Results showed that nearly half (44.6%) of the parents engaged with the exercises. Participants who attended face-to-face group sessions (i.e., attendees) engaged throughout the intervention period whereas participants who never attended group sessions (i.e., non-attendees) mostly engaged during the first month in the program. Attendees and mothers engaged more than non-attendees and fathers. While engaged parents self-reported increased dispositional mindfulness at 6-month follow-up compared to baseline, only mothers' engagement accounted for a significant proportion of the variance (3%) in dispositional mindfulness at 6-month follow-up, after controlling for covariates. Implications for incorporating online mindfulness exercises into parent training are discussed in the context of programming for military families.
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Integrative Review of the Relationship Between Mindfulness-Based Parenting Interventions and Depression Symptoms in Parents. J Obstet Gynecol Neonatal Nurs 2018; 47:184-190. [DOI: 10.1016/j.jogn.2017.11.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2017] [Indexed: 11/20/2022] Open
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Jensen MP, Liljenquist KS, Bocell F, Gammaitoni AR, Aron CR, Galer BS, Amtmann D. Life impact of caregiving for severe childhood epilepsy: Results of expert panels and caregiver focus groups. Epilepsy Behav 2017; 74:135-143. [PMID: 28734197 DOI: 10.1016/j.yebeh.2017.06.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 06/09/2017] [Accepted: 06/11/2017] [Indexed: 01/24/2023]
Abstract
Severe epilepsy in children and young adults can significantly affect the lives of their caregivers. However, the lack of a reliable and valid measure of caregiver impact has limited our understanding of the scope and correlates of this impact, as well as our ability to measure the effects of treatments that could lessen it. The purpose of this study was to facilitate focus groups and interviews with an international group of clinician experts and caregivers to identify the most important domains that should be assessed in a measure of caregiver impact. Ten specific subdomains emerged from the panel discussions, which could be classified into the four overarching categories of physical health, mental health, social function, and financial resources. The caregivers highlighted the impact on the subdomains of sleep and fatigue as most critical. A review of existing caregiver impact measures confirmed that there is no measure currently available that assesses all of these relevant domains, indicating the need for the development of such a measure. The current findings highlight the significant life effects of caring for a child with severe epilepsy and can be used to inform the development of such a tool.
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Affiliation(s)
- Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
| | - Kendra S Liljenquist
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Fraser Bocell
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | | | - Carey R Aron
- Medical and Scientific Affairs, Zogenix, Inc., Emeryville, CA, USA
| | - Bradley S Galer
- Medical and Scientific Affairs, Zogenix, Inc., Emeryville, CA, USA
| | - Dagmar Amtmann
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
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Burke MM, Chan N, Neece CL. Parent Perspectives of Applying Mindfulness-Based Stress Reduction Strategies to Special Education. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2017; 55:167-180. [PMID: 28608774 DOI: 10.1352/1934-9556-55.3.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Parents of children with (versus without) intellectual and developmental disabilities report greater stress; such stress may be exacerbated by dissatisfaction with school services, poor parent-school partnerships, and the need for parent advocacy. Increasingly, mindfulness interventions have been used to reduce parent stress. However, it is unclear whether parents apply mindfulness strategies during the special education process to reduce school-related stress. To investigate whether mindfulness may reduce school-related stress, interviews were conducted with 26 parents of children with intellectual and developmental disabilities who completed a mindfulness-based stress reduction intervention. Participants were asked about their stress during meetings with the school, use of mindfulness strategies in communicating with the school, and the impact of such strategies. The majority of parent participants reported: special education meetings were stressful; they used mindfulness strategies during IEP meetings; and such strategies affected parents' perceptions of improvements in personal well-being, advocacy, family-school relationships, and access to services for their children. Implications for future research, policy, and practice are discussed.
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Affiliation(s)
- Meghan M Burke
- Meghan M. Burke, University of Illinois at Urbana-Champaign, Special Education; Neilson Chan, Department of Psychology, Loma Linda University; and Cameron L. Neece, Department of Psychology, Loma Linda University
| | - Neilson Chan
- Meghan M. Burke, University of Illinois at Urbana-Champaign, Special Education; Neilson Chan, Department of Psychology, Loma Linda University; and Cameron L. Neece, Department of Psychology, Loma Linda University
| | - Cameron L Neece
- Meghan M. Burke, University of Illinois at Urbana-Champaign, Special Education; Neilson Chan, Department of Psychology, Loma Linda University; and Cameron L. Neece, Department of Psychology, Loma Linda University
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Miller CJ, Brooker B. Mindfulness programming for parents and teachers of children with ADHD. Complement Ther Clin Pract 2017; 28:108-115. [PMID: 28779917 DOI: 10.1016/j.ctcp.2017.05.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 05/23/2017] [Accepted: 05/25/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Parents and teachers of children with attention-deficit/hyperactivity disorder (ADHD) are at-risk for a range of suboptimal psychosocial outcomes, including mental health difficulties and heightened stress, problems perhaps ameliorated through mindfulness-based programming. OBJECTIVE To show pilot data from an investigation of the outcomes of a purpose-built mindfulness training for parents and teachers of children with ADHD (N = 26). METHODS The program represents a purpose-driven modification of the Mindfulness-Based Stress Reduction (MBSR) curriculum. Namely, we reduced participant time commitment and added psychoeducation about ADHD with brief parent training. The measurement protocol included measures of stress, anxiety, depression, and mindfulness. RESULTS Following the 8-week program, parents and teachers reported reduced perceived stress, reduced self-reported anxiety, and improvements in some facets of mindfulness. CONCLUSION The work highlights the promise of specialized mindfulness-based interventions in promoting positive psychosocial outcomes in specific at-risk groups, such as the carers of children with ADHD.
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Marchal JP, Maurice-Stam H, van Trotsenburg ASP, Grootenhuis MA. Mothers and fathers of young Dutch adolescents with Down syndrome: Health related quality of life and family functioning. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 59:359-369. [PMID: 27690350 DOI: 10.1016/j.ridd.2016.09.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 08/07/2016] [Accepted: 09/15/2016] [Indexed: 05/25/2023]
Abstract
BACKGROUND Like any child, children with Down syndrome (DS) affect the lives of their families. Most studies focus on the adaptation of parents and families of young children with DS, while relatively few studies include the perspective of fathers. AIMS To determine 1) whether mothers and fathers of 11 to 13-year-olds with DS differ from reference parents in health related quality of life (HRQoL) and family functioning, and 2) whether HRQoL in parents of children with DS changes over time, from when the child was 6-8 years old to when the child was 11-13 years old. METHODS 80 mothers and 44 fathers completed HRQoL and family functioning questionnaires. 58 parents (53 mothers) had completed the HRQoL-questionnaire in a previous study. RESULTS Mothers differed from reference mothers in one HRQoL-domain (Sexuality), while fathers' HRQoL did not significantly differ from reference fathers. Both mothers and fathers scored in the (sub)clinical range more frequently than reference parents in Total family functioning, and in the domains Partner relation and Social network. Furthermore, fathers scored in the (sub)clinical range more frequently than reference parents in Responsiveness and Organization. HRQoL showed no significant change over time. CONCLUSIONS AND IMPLICATIONS Our findings indicate frequent family functioning problems but few HRQoL problems in parents and families of children with DS. In offering care, a family based approach with special attention for partner relation and social functioning is needed.
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Affiliation(s)
- Jan Pieter Marchal
- Psychosocial Department, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Post box 22660, 1100 DD, Amsterdam, The Netherlands; Department of Paediatric Endocrinology, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Post box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Heleen Maurice-Stam
- Psychosocial Department, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Post box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - A S Paul van Trotsenburg
- Department of Paediatric Endocrinology, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Post box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Martha A Grootenhuis
- Psychosocial Department, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Post box 22660, 1100 DD, Amsterdam, The Netherlands.
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