Mindfulness and Acceptance as Potential Protective Factors for Mothers of Children With Fragile X Syndrome

An escalating continuum of learning and attention difficulties from premutation to full mutation in female carriers of FMR1 expansion

Objective

Carriers of Fragile X premutation may have associated medical comorbidities, such as Fragile X-associated tremor and ataxia (FXTAS) and Fragile X-associated premature ovarian insufficiency (FXPOI). We examined the Fragile X premutation effect on cognition, and we assumed that there is a direct correlation between the continuous spectrum of specific learning and attention deficits to the number of CGG repeats on the FMR1 gene.

Methods

A total of 108 women were referred to our center due to a related Fragile X syndrome (FXS) patient, 79 women carried a premutation of 56-199 repeats, and 19 women carried a full mutation of more than 200 CGG repeats on FMR1 gene. Genetic results of CGG repeats, demographic information, structured questionnaires for ADHD, learning disabilities of language and mathematics, and independence level were analyzed in women carrying the FMR1 premutation and compared to the group carrying the full mutation. Women with FXS and FXTAS were excluded.

Results

When analyzed as a continuum, there was a significant increase in the following complaints which were associated with a higher number of repeats: specific daily function skills such as driving a car, writing checks, disorientation in directions, and also specific learning difficulties such as spelling and math difficulties. Additionally, when tested as a categorical independent variable, we observe that women with the full mutation were more likely to have ADHD or other learning disability diagnoses in the past than during premutation (<200 CGG repetitions).

Conclusion

Specific learning and attention difficulties and resulting daily function difficulties correlate with an increased number of CGG repeats and are more likely to be associated as a common feature of premutation and full mutation in a female premutation carrier. Despite evidence of learning and attention difficulties, it is encouraging that most female carriers of the premutation and full mutation function well in most areas. Nevertheless, they face significant difficulties in specific areas of functioning such as driving, and confusion in times and schedules. Those daily function skills are mostly impacted by dyscalculia, right and left disorientation, and attention difficulties. This may aid to design specific interventions to address specific learning deficits in order to improve daily function skills and quality of life.

Mental Health Challenges, Parenting Stress, and Features of the Couple Relationship in Parents of Children With Fragile X Syndrome

BACKGROUND

Individuals with fragile X syndrome (FXS) have significant delays in cognition and language, as well as anxiety, symptoms of autism spectrum disorder, and challenging behaviors such as hyperactivity and aggression. Biological mothers of children with FXS, who are themselves FMR1 premutation or full mutation carriers, are at elevated risk for mental health challenges in addition to experiencing stress associated with parenting a child with significant disabilities. However, little is known about fathers in these families, including the ways in which parental well-being influences the mother-father relationship and the impact of child characteristics on paternal and couple functioning.

METHOD

The current study examined features of, and relationships between, parental well-being, couple well-being, and child functioning in 23 families of young boys with FXS. Mothers and fathers independently completed multiple questionnaires about their individual well-being, couple functioning, and child behavior. One parent per family also completed an interview about the child's adaptive skills.

RESULTS

Results suggest that both mothers and fathers in these families experience clinically significant levels of mental health challenges and elevated rates of parenting stress relative to the general population. Findings also indicate that the couples' relationship may be a source of strength that potentially buffers against some of the daily stressors faced by these families. Additionally, parents who reported less parenting stress had higher couples satisfaction and dyadic coping. Finally, parents of children with less severe challenging behaviors exhibited fewer mental health challenges, less parenting stress, and higher levels of both couples satisfaction and dyadic coping. Parents of children with higher levels of adaptive behavior also reported less parenting stress and higher couples satisfaction.

CONCLUSION

Overall, this study provides evidence that families of children with FXS need access to services that not only target improvements in the child's functioning, but also ameliorate parental stress. Family-based services that include both mothers and fathers would lead to better outcomes for all family members.

Psychometric Properties of the Chinese Version of the Brief-Mindful Self-Care Scale: A Translation and Validation Study

Objective: This study aimed to translate the Brief-Mindful Self-Care Scale (B-MSCS) into Chinese and validate its reliability and validity among hospice nurses. Methods: A total of 510 hospice nurses were recruited from three provinces in China. The reliability of the translated scale was measured by internal consistency, split-half reliability, and test-retest reliability. The validity of the translated scale was evaluated by expert consultation, exploratory factor analysis, and confirmatory factor analysis. Results: The Cronbach's α value of the Chinese version of B-MSCS was 0.920, and the Cronbach's α value of the dimensions ranged from 0.850 to 0.933. The split-half reliability and test-retest reliability were 0.770 and 0.723, respectively. Furthermore, the content validity index of the scale (S-CVI) was 0.946. The 6-factor structure, supported by the eigenvalues, total variance explained, and scree plot were obtained by using exploratory factor analysis. Moreover, as a result of the confirmatory factor analysis, the model fitting indexes were all in the acceptable range. Conclusion: The Chinese version of B-MSCS had suitable reliability and validity among hospice nurses. The developed scale will evaluate the level of mindful self-care of Chinese hospice nurses, providing an opportunity for development of targeted educational plans. Each item is a direct guide for hospice nurses to develop their mindful self-care practice.

Parental stress and adjustment in the context of rare genetic syndromes: A scoping review

Chromosomal abnormalities are now considered a common cause of intellectual disability. With increased genetic testing, phenotyping and technological advancements, many new syndromes have been identified. This review sought to explore parental stress and adjustment in the context of rare genetic syndromes to evaluate their clinical impact. A systematic review of English peer-reviewed literature across three databases (PsycINFO, Medline, CINAHL) was completed and 69 articles were included. Parents of children with rare genetic syndromes experienced greater distress relative to other disabilities. Differences in parental wellbeing were syndrome-specific relative to ASD thus demonstrating the need to consider the contribution of syndrome-specific phenotypes. Child emotional and behavioural difficulties were the most consistent predictor of parental distress. Research reflecting other factors such as physical health, syndrome-specific behaviours, benefit finding and, parental appraisal in the context of a rare genetic aetiology is required in order to support parental adjustment in these conditions.

Maternal Mental Health and Parenting Stress and Their Relationships to Characteristics of the Child With Fragile X Syndrome

Although previous research supports the notion that characteristics of both the child and the mother impact maternal well-being and parenting stress in mothers of children with FXS, more work is needed in which self-report measures are supplemented by physiological measures of stress and well-being. The inclusion of physiological measures, such as heart rate variability (HRV), may provide a window into the biological origins and consequences of maternal perceptions of their experiences, including the challenges of raising a child with developmental challenges. The proposed project, therefore, involved the collection of multimodal assessment data from mothers and their school-aged children with FXS. Further, given the importance of understanding how mothers of youth with FXS are faring in their everyday environment, the present study collected all data using telehealth procedures and wearable technology. Participants were 20 biological mothers and their children with FXS between the ages of 6 and 11 years. We measured maternal mental health and parenting stress through self-report as well as through HRV as a more objective measure of psychological well-being. We also examined the associations between these variables and child characteristics such as externalizing and internalizing behaviors as well as autism symptomatology. We found significant support for an elevated rate of depressive symptoms in the sample of mothers (35%) and some potential indicators for heightened rates of anxiety (15%) when compared to normed samples and rates in the general population. We also found that the mothers presented with an atypical HRV profile akin to those experiencing depression or chronic stress, although limitations of the present measure suggest the need for additional confirmatory research. Further, we found that child externalizing behaviors were the primary correlates of maternal well-being. These findings contribute to the growing body of literature regarding the unique challenges faced by these mother-child dyads and supports the importance of increasing the availability of services available to these mothers, not only for meeting the needs of their children's development and behavior, but in supporting their own well-being as well.

Association of mindfulness to resilience, anxiety, and depressive symptoms after spinal cord injury-a correlational study

STUDY DESIGN

Online survey of individuals with spinal cord injuries (SCI).

OBJECTIVE

This pilot study examined associations between mindfulness factors, resilience, and levels of depression and anxiety after SCI.

SETTING

Community-based; United States.

METHODS

A survey was posted online and shared with individuals with recent SCI (≤5 years).

RESULTS

Thirty-four individuals responded to the survey. The Five Facet Mindfulness Questionnaire (FFMQ) measures mindfulness with the following subscales: observing, describing, acting with awareness, nonjudging of inner experience, and nonreactivity of inner experience. Nonjudgment of inner experience was significantly associated with depression (β = -0.74, p = 0.007) and anxiety (β = -0.60, p = 0.01). Nonreactivity to inner experience was significantly associated with anxiety (β = -0.57, p = 0.007) and resilience (β = 0.55, p = 0.004); and there was a trend with depression (β = -0.45, p = 0.07). Higher resilience was significantly associated with less anxiety (r = -0.62, p = 0.04) and less depression (r = -0.75, p < 0.001). Depression and anxiety were significantly correlated (r = 0.84, p < 0.001). When comparing those who are employed to those who are not, they differed significantly in terms of anxiety (t(32) = 2.53, p = 0.02).

CONCLUSIONS

These findings suggest that factors of mindfulness, specifically the practice of acting nonjudgmentally and nonreactively to one's inner experience, may act as protective factors against depression and anxiety following SCI. These preliminary data support the literature that individuals with lower resilience are more susceptible to depression following SCI. Interventions aimed at maximizing mental well-being following SCI may benefit from incorporating these factors of mindfulness practice.