The Impact of Educational Materials on Parental Anxiety and Productivity: A Clinical Trial in Pediatric Appendicitis

OBJECTIVES

There is limited literature on how acute appendicitis, the most common acute children's surgical illness, affects the family. We conducted a prospective study to assess the impact of educational materials on parents' anxiety and productivity during the child's illness.

METHODS

A quasi-experimental clinical trial was conducted among parents of children undergoing laparoscopic appendectomy. In Phase I, parents received the standard explanations at diagnosis and throughout the postoperative period. In Phase II, parents also received a comprehensive educational brochure on pediatric appendicitis at diagnosis. The primary outcome, parental preoperative anxiety, was assessed using the Amsterdam Preoperative Anxiety and Information Scale (APAIS). The secondary outcome, parental productivity, was evaluated through a post-recovery online questionnaire based on the Productivity and Disease Questionnaire (PRODISQ). Baseline characteristics and outcomes were compared between the two cohorts using t-tests, Mann-Whitney, chi-square, or Fischer's exact test as appropriate.

RESULTS

Phases I and II included 67 and 66 families, respectively. Patient demographics and disease severity were similar between both groups. Of the 53 parents (80.3%) in Phase II who answered the postoperative questionnaire, most recommended the booklet (96.2%), as it decreased their stress (78.0%) and enhanced their understanding of appendicitis (94.1%). However, the two groups showed similar preoperative anxiety levels and postoperative productivity loss.

CONCLUSIONS

Educational materials increased satisfaction with surgical care but did not mitigate the high parental preoperative anxiety levels and postoperative productivity loss. Additional research is required to elucidate interventions that may improve these important patient and family-centered outcomes.

TYPE OF STUDY

Non-Randomized Clinical Trial.

LEVEL OF EVIDENCE

II.

Fear-related associations in children of parents with an anxiety disorder

BACKGROUND AND OBJECTIVES

Children of parents with an anxiety disorder are at elevated risk for developing an anxiety disorder themselves. According to cognitive theories, a possible risk factor is the development of schema-related associations. This study is the first to investigate whether children of anxious parents display fear-related associations and whether these associations relate to parental anxiety.

METHODS

44 children of parents with panic disorder, 27 children of parents with social anxiety disorder, and 84 children of parents without an anxiety disorder filled out the SCARED-71, and the children performed an Affective Priming Task.

RESULTS

We found partial evidence for disorder-specificity: When the primes were related to their parent's disorder and the targets were negative, the children of parents with panic disorder and children of parents with social anxiety disorder showed the lowest error rates related to their parents' disorder, but they did not have faster responses. We did not find any evidence for the expected specificity in the relationship between the parents' or the children's self-reported anxiety and the children's fear-related associations, as measured with the APT.

LIMITATIONS

Reliability of the Affective Priming Task was moderate, and power was low for finding small interaction effects.

CONCLUSIONS

Whereas clearly more research is needed, our results suggest that negative associations may qualify as a possible vulnerability factor for children of parents with an anxiety disorder.

Effect of Multimedia Teaching Tools in Parental Anxiety and Comprehension of Informed Consent Procedure in Pediatric Surgical Procedures: A Single Centre Randomized Control Trial

INTRODUCTION

Informed consent is an essential component of medical ethics. In children, the parent or legally authorized guardian must consent to any medical or surgical intervention. A number of adjuncts have been developed to supplement the consent process including multimedia tools. Unfortunately, there is little information regarding the use of Multimedia teaching tools (MMT) in pediatric settings in developing countries with diversities in language, socioeconomic and educational status.

OBJECTIVES

The objectives of the study were to compare the parental comprehension of the surgery through the informed consent obtained either by conventional method or by multimedia tool and the effect of MMT in alleviating parental anxiety against the conventional method and to assess their overall satisfaction.

METHODS

A randomized control trial was conducted between 2018 and 2020, including MMT and conventional groups. A novel Multimedia tool with a Microsoft PowerPoint presentation was created. A 5-Question knowledge-based test, State-Trait Anxiety Inventory (STAI) tool, and a Likert-based questionnaire were used to assess the comprehension, anxiety, and satisfaction of parents.

RESULTS

Among 122 randomized cohorts, the mean value of percentage fall in anxiety STAI score in the MMT group was 44.64 ± 10.14 whereas in the Conventional group it was 26.6 ± 11.91 (p < 0.05). MMT cohort scored higher in the knowledge-based test (p < 0.05) and recorded higher parental satisfaction.

CONCLUSION

The Multimedia tool aided consent procedure is effective in reducing parental anxiety and improving their comprehension and overall satisfaction. Thus, they can be used as an effective supplement in preoperative surgical education and consent procedure.

LEVEL OF EVIDENCE

Level I.

Perioperative stress and anxiety in parents of children operated on for congenital heart disease

INTRODUCTION

Levels of stress and anxiety suffered by parents of children with congenital heart disease (PCUCS) during their children's admission for cardiac surgery may be higher than those suffered by other parents who go through the same experience.

OBJECTIVE

General objective of this study was to measure the stress and anxiety suffered by PCUCS and parents of children undergoing renal surgery (PCURS) in relation to the intervention of their children. The specific objective of the quantitative study was to compare global stress and anxiety according to sex, time of the perioperative period, and cohort. The general objective of the qualitative section is to explore the experience that PCUCS and PCURS have during their hospital stay and to identify the specific factors that influence the genesis of stress and anxiety.

METHOD

A cohort study was carried out in which PCURS and PCUCS were included. The quantitative part was performed by comparing the scores of three questionnaires that measure stress levels (PSS-14), state anxiety (STAIE) and trait anxiety (STAIR) throughout three perioperative moments. At the same time, a qualitative study was carried out with semi-structured interviews and collection of diaries on which a descriptive phenomenological analysis was carried out, according to Munhall. The analysis of the text was carried out according to Colaizzi.

RESULTS

Stress and anxiety levels were significantly higher in PCUCS compared to PCURS. Mothers in the cardiac cohort were those with the highest scores on all scales. In the qualitative study, four themes emerged: "stress and anxiety from the moment of diagnosis", "surgical intervention as a critical moment", "harshness of the postoperative period in the Intensive Care Unit" and "joy and gratitude versus dependence and fear for the future".

CONCLUSIONS

PCUCS suffer higher levels of stress and anxiety than PCURS, being the mothers of the cardiac cohort those who suffer these disorders with greater intensity. This study can constitute a starting point to develop strategies that cover these parental needs.

Therapeutic communication improves patient comfort during venipuncture in children: a single-blinded intervention study

The aim of this study was to examine whether therapeutic communication improves children's comfort during venipuncture compared to standard communication. This study was registered in the Dutch trial register (NL8221), December 10, 2019. This single-blinded interventional study was carried out in an outpatient clinic of a tertiary hospital. Inclusion criteria were age between 5 and 18 years, use of topical anesthesia (EMLA) and sufficient understanding of the Dutch language. 105 children were included, 51 assigned to the standard communication group (SC group) and 54 patients to the therapeutic communication group (TC group). The primary outcome measure was self-reported pain based on the Faces Pain Scale Revised (FPS-R). Secondary outcome measures were observed pain (numeric rating scale (NRS)), self-reported/observed anxiety in child and parent (NRS), self-reported satisfaction in child, parent and medical personnel (NRS), and procedural time. No difference was found for self-reported pain. Self-reported and observed anxiety (by parents and medical personnel) was lower in the TC group (p-values ranged from p = 0.005 to p = 0.048). Procedural time was lower in the TC group (p = 0.011). Satisfaction level of medical personnel was higher in the TC group (p = 0.014).   Conclusion: TC during venipuncture did not result in lower self-reported pain. However, secondary outcomes (observed pain, anxiety and procedural time) were significantly improved in the TC group. What is Known: • Medical procedures, especially needle related procedures, cause anxiety and fear in children and adults. • In adults communication techniques based on hypnosis are effective in reducing pain and anxiety during medical procedures. What is New: • Our study found that with a small change in communication technique (called therapeutic communication or TC), the comfort of children during venipuncture improves. • This improved comfort was mainly reflected by reduced anxiety scores and shorter procedural time. This makes TC suitable for the outpatient setting.

The Mediating Role of Mindful Parenting in the Relationship Between Parental Anxiety and Youth's Emotional and Behavioral Difficulties

One of the central questions in the theory of the intergenerational transmission of psychological symptoms is to identify whether parenting practices explain the transmission of psychological symptoms from parents to youth. This study examined the mediating mechanism of mindful parenting in the relationship between parental anxiety and youth's emotional and behavioral difficulties. In three waves separated by six months, longitudinal data were collected from 692 Spanish youth (54% girls) aged between 9 and 15 years (Mage = 12.84 years, SD = 1.22 years at Wave 1) and their parents. Path analysis showed that maternal mindful parenting mediated the relationship between maternal anxiety and the youth's emotional and behavioral difficulties. No mediating effect was found concerning fathers; however, marginal bidirectional relationships were obtained between paternal mindful parenting and youth's emotional and behavioral difficulties. This study addresses one of the main concerns about the theory of intergenerational transmission using a multi-informant and longitudinal study design, concluding that maternal anxiety predicts less mindful parenting practices and these in turn predict youth's emotional and behavioral difficulties.

The parental COVID-19 anxiety and emotional exhaustion in healthcare workers: exploring the roles of resilience, prosocialness, and optimism

Healthcare workers (HCWs) also became the main protagonist of the tragic pandemic story. They have had a markedly higher risk of becoming infected with COVID-19. Outside work, healthcare workers with children have experienced mental health challenges, including the worry that they may carry COVID-19 home and infect their children. Based on these, the current study aimed to examine the effect of parental COVID-19 anxiety on emotional exhaustion and identify the roles of resilience, prosocialness, and optimism in this relationship. The findings demonstrated that prosocialness moderated the relationship between personal COVID-19 anxiety and emotional exhaustion by alleviating the depleting effects of personal COVID-19 anxiety. At the same time, prosocialness reinforced the negative effect of resilience on emotional exhaustion. On the other side, optimism moderated the relationship between parental COVID-19 anxiety and resilience by alleviating the adverse effect of parental COVID-19 anxiety. Moreover, it buffered the exacerbating effect of parental anxiety on personal anxiety. In conclusion, promoting personal resources (i.e., resilience, prosocialness, and optimism) seems an excellent way to mitigate the adverse consequences of the pandemic on mental health. Furthermore, the increment in parental mental health problems during COVID-19 pandemic may have long-term effects on children. Considering this perspective, we need to develop a proactive approach for parents' now and children's futures.

Parental Depressive Symptoms, Parent Attributional Style, and Child Coping as Predictors of Depressive Symptoms in Children of Parents with Anxiety or Mood Disorders

Few studies have examined the effects of parental depressive symptoms on children in China. The present study examined the relationships between parental depression, parental attributional style, children's coping strategies and 5-12-year-old children's depressive symptoms in a sample of Chinese children whose parents had been diagnosed with an anxiety or a mood disorder. The present study confirmed that children of parents with anxiety or mood disorders would show high levels of depressive symptoms. Parents with an optimistic or neutral attributional style rated their children as showing fewer depressive symptoms than parents with a pessimistic style. This study showed a significant positive relationship between children's disengagement coping and children's reports of depressive symptoms. The findings highlight the need for early identification of, and support and intervention programs for, parents suffering from depression and children of depressed parents as a means of protecting the psychological well-being of both parents and children.

Effects of early childhood behavioral inhibition and parental anxiety disorder on adolescents' startle response to predictable and unpredictable threat

Numerous studies in children, adolescents and adults have reported that anxiety disorders and symptoms are associated with greater threat-potentiated startle responses. This suggests that it may also be related to risk factors that have been implicated in the genesis of anxiety disorders. Therefore, we examined the roles of early childhood temperamental behavioral inhibition (BI) and parental history of anxiety disorders in predicting threat-potentiated startle response in a community sample of 346 adolescents. Parental history of anxiety disorders moderated the effects of BI on subsequent startle responses. For both total startle response and unpredictable threat startle potentiation, higher levels of BI at age 3 predicted larger startle responses at age 15, but only among offspring of parents with a history of anxiety disorders. Among offspring of parents with no lifetime history of anxiety disorder, BI was unrelated to startle magnitude. These findings were evident even after adjusting for youth's biological sex, concurrent anxiety symptoms, and lifetime history of anxiety disorders. In contrast, neither BI nor parental anxiety significantly predicted startle potentiation to predictable threat. These findings have implications for tracing pathways to the development of anxiety disorders.

Anxiety levels in parents of asymptomatic neonates and young infants referred for echocardiography

INTRODUCTION

Previous studies in children with innocent murmurs have shown that parental concern is common.

METHODS

We assessed the anxiety levels among parents of asymptomatic neonates or infants up-to 6 weeks referred for cardiologic consultation because of a heart murmur. A six-item short-form of the state scale of the Spielberger State-Trait Anxiety Inventory (STAI) was completed by the parents before and after consultation.

RESULTS

The average STAI score decreased from 14.42 ± 4.54 on arrival to 9.69 ± 4.26 after the consultation (p < 0.001). Overall, the parents felt more calm, less tense, less upset, more relaxed, more content and less worried after the consultation (p < 0.001). Multivariable linear regression analysis showed that the STAI score prior to consultation was related to infants age (coefficient β = - 0.172; P = 0.046) and STAI score post consultation was related to the final diagnosis (β = 0.312; P < 0.001).

CONCLUSION

In conclusion, parents of asymptomatic neonates and young infants with a murmur exhibit moderate levels of anxiety which can be ameliorated after consultation. Parental education in the field is of paramount importance and the role of both paediatric cardiologists as well as primary care physicians is crucial and decisive.

The role of parental anxiety symptoms in the treatment of childhood social anxiety disorder

The study investigated the role of parental anxiety symptoms in treatment outcomes for children with a primary social anxiety disorder compared to children with other primary anxiety disorders. Participants were 152 children between 7 and 18 years and their parents (146 mothers, 123 fathers). Anxiety was assessed pretreatment, posttreatment, and at three months and one year follow ups. There were no baseline differences in parental anxiety symptoms between the two groups. In both groups parental anxiety symptoms decreased from pretreatment to posttreatment, and only mothers' anxiety symptoms decreased further from posttreatment to the one year follow up. Parental anxiety symptoms before the treatment were not related to the being free of all anxiety diagnoses in the children at posttreatment. However, some indications were found for greater improvements during treatment when parents had higher anxiety symptoms before treatment. Changes in parental anxiety symptoms were found to be related to changes in child anxiety symptoms. This was not found for the total clinical severity of all inclusion anxiety disorders. This relation was visible independently in fathers or mothers, or in groups of children with a primary social anxiety disorder or with another primary anxiety disorder. In conclusion, we did not find clear indications that parental anxiety symptoms explain the differences in treatment outcomes for children with a primary social anxiety disorder compared to children with other primary anxiety disorders. More research with larger samples is needed to draw stronger conclusions.

Oral health-related quality of life and parental anxiety in chinese children undergoing Dental General Anesthesia: a prospective study

Dental general anesthesia (DGA) is an effective treatment for very young children or those who have severe dental fear and mental or physical disabilities. However, the long-term impacts of DGA on oral health-related quality of life (OHRQoL) and parents' anxiety in China are still questionable. This study aimed to assess the influence of DGA on OHRQoL in Chinese children and their parents' psychological status. A total of 204 children and their parents participated in this study. The ECOHIS was applied to evaluate OHRQoL in children. The parents' anxiety was analyzed using the Chinese version of the Kessler 10 scale. The internal consistency was evaluated with Cronbach's alpha coefficient, and Wilcoxon signed-rank test was used for statistical analyses. The scores of each section of ECOHIS decreased one month after the procedure except for the self-image and social sections (P < 0.05). The scores of the Kessler 10 scale decreased one month after DGA and kept decreasing six months later (P < 0.05). The parents' Kessler 10 scores exhibited a moderately positive correlation with the children's ECOHIS scores (r = 0.480, P < 0.05). After DGA, the OHRQoL of Chinese children and their parents' mental health continued to improve. And they exhibited positive correlation.

State and trait anxiety in children with incontinence and their parents

BACKGROUND

Maternal anxiety increases the risk for incontinence in children. The aim was to analyze anxiety in children with incontinence and their parents before (t1) and after 6 months of incontinence treatment (t2).

METHODS

40 children with incontinence and 40 controls completed the State-trait Anxiety Inventory for Children, their parents the Child Behavior Checklist (CBCL) and the State-trait Anxiety Inventory at baseline (t1) and 6 months later (follow-up, t2). Psychiatric disorders were assessed by a standardized parental diagnostic interview (Kinder-DIPS), IQ was tested by a one-dimensional test. All children were neurologically examined. Children with incontinence underwent a guideline-based treatment during the 6 months.

RESULTS

At baseline, child and parental state and trait anxiety scores, as well as all CBCL scores were significantly higher in the patient group compared to the control group. At t2, parental anxiety, CBCL scores, and child trait anxiety were significantly higher in patients versus controls, whereas child state anxiety decreased, and parental state anxiety increased from t1 to t2.

CONCLUSIONS

Incontinence and anxiety are associated. While state anxiety decreases, trait anxiety can remain stable over time. Higher levels of anxiety can influence incontinence treatment and should be assessed in every patient.

Attention Biases to Threat in Infants and Parents: Links to Parental and Infant Anxiety Dispositions

Parent-to-child transmission of information processing biases to threat is a potential causal mechanism in the family aggregation of anxiety symptoms and traits. This study is the first to investigate the link between infants’ and parents’ attention bias to dynamic threat-relevant (versus happy) emotional expressions. Moreover, the associations between infant attention and anxiety dispositions in infants and parents were explored. Using a cross-sectional design, we tested 211 infants in three age groups: 5-to-7-month-olds (n = 71), 11-to-13-month-olds (n = 73), and 17-to-19-month-olds (n = 67), and 216 parents (153 mothers). Infant and parental dwell times to angry and fearful versus happy facial expressions were measured via eye-tracking. The parents also reported on their anxiety and stress. Ratings of infant temperamental fear and distress were averaged across both parents. Parents and infants tended to show an attention bias for fearful faces with marginally longer dwell times to fearful versus happy faces. Parents dwelled longer on angry versus happy faces, whereas infants showed an avoidant pattern with longer dwell times to happy versus angry expressions. There was a significant positive association between infant and parent attention to emotional expressions. Parental anxiety dispositions were not related to their own or their infant’s attention bias. No significant link emerged between infants’ temperament and attention bias. We conclude that an association between parental and infant attention may already be evident in the early years of life, whereas a link between anxiety dispositions and attention biases may not hold in community samples.

Anxiety and Depression in Parents of Children Born with Esophageal Atresia: An International Online Survey Study

PURPOSE

Caring for a chronically ill child can be stressful and requires additional care from parents. Parental mental health and stress may impact both parental and child wellbeing, leading to maladaptive parenting practices, and interference with illness management. The aim of the study was to explore the levels of anxiety and depression in parents of children born with esophageal atresia (EA) and to investigate whether parental anxiety and depression were associated with child's medical characteristics or with parental factors.

DESIGN AND METHODS

An international online survey was developed and disseminated to parents of children born with EA, aged 0-12 years, via EA patient charity social network sites. A one-way between subjects ANOVA and post hoc statistical analyses were used to examine differences in mean scores of parental anxiety and depression between sub-groups that described child's medical characteristics and parental characteristics.

RESULTS

A total of 240 parents completed the survey from 17 different countries. Of these, nearly 70% self-reported raised levels of anxiety, whilst 38% self-reported raised levels of depression. Statistically significant differences in mean scores of parental anxiety and depression were found between sub-groups that described the child's feeding problems, parental age, and perceived support for caring, caring stress and money matters.

CONCLUSION

Child's feeding problems related to esophageal atresia, and parental factors, such as younger age, perceived lack of support for caring, caring stress, and money worries, may contribute to the increased levels of parental anxiety and depression in parents of children born with EA.

The effects of primary and recurrent pediatric urological surgeries on parental anxiety levels

INTRODUCTION

Invasive diagnostic and therapeutic procedures in pediatric urology may generally cause distress and pain in children. As a result, it may have a negative effect on adult and child behaviors. The anxiety, depression levels or distress and fear status caused by recurrent diseases or repetitive medical interventions in adult patients or the parents of pediatric patients have been investigated previously.

OBJECTIVE

To the best of our knowledge, we have not found a study evaluating the effects of primary or recurrent pediatric urological operations on parental anxiety. Our main aim was to compare the effects of primary and repetitive pediatric urological surgeries on the anxiety levels of both mothers and fathers. We also aimed to investigate the effects of other factors related to parents and children on parental anxiety.

DESIGN

A total of 163 patients under 14 years old who had undergone primary or recurrent pediatric urological operations and also their parents were included in a prospective, cross-sectional study. Demographic and clinical data of the patients and their parents were recorded. Before the surgeries, the Children's Fear Scale was applied to all patients over 3 years old and the State-Trait Anxiety Inventory was applied to all parents. The participants were divided into two main groups: primary surgery group (n:84) and recurrent surgery group (n:79). A subgroup analysis was performed according to surgery type (day surgery, minor surgery and major surgery).

RESULTS

We found that repetitive surgeries, higher fear scores of children, parents' being younger, having low education level, not having enough information about the surgeries and presence of someone in the immediate vicinity who previously experienced the same surgery increased parental anxiety levels. Day surgeries did not affect fathers' state anxiety levels as much as minor and major surgeries, whereas mothers' state anxiety levels were higher than fathers' regardless of the surgery type. Children's fear level was not affected by child age, gender, surgery type or previous history of surgery.

DISCUSSION

The majority of studies in the literature show no significant difference in terms of pain and fear levels in pediatric patients undergoing repeated diagnostic interventions but there are contradictory results about parental anxiety levels. There is also a lack of studies on the effects of recurrent surgeries.

CONCLUSION

According to our findings, repetitive surgeries and presence of someone who previously experienced the same surgery are the most significant predictive factors increasing parental anxiety levels.

Assessing Parental Anxiety in Pediatric Food Allergy: Development of the Worry About Food Allergy Questionnaire

Food allergies (FAs) in children are increasingly common, and strict allergen avoidance and safety concerns place parents at risk for anxiety (Lau et al. in Pediatr Allergy Immunol 25:236-242, 2014). Assessing parental anxiety with generic instruments may not capture the unique experience of parents managing children's FAs. This study developed and preliminarily validated the 13-item Worry About Food Allergy (WAFA) questionnaire, a measure of FA-specific parental anxiety, in an online sample of 265 parents aged 22-66 (M = 40.25) of children with FAs. The WAFA showed good internal reliability (Cronbach's α = .89) and moderate convergent validity with other anxiety measures, indicating support for a reliable measure of a discrete, specific construct. Exploratory factor analysis indicated a single factor structure. Criterion validity was established through significant, small, positive correlations with relevant allergy variables. A coherent single factor measure, the WAFA, shows promise as a screening tool for parental anxiety in pediatric practice and FA management.

Increased parental anxiety and a benign clinical course: Infants identified with short-chain acyl-CoA dehydrogenase deficiency and isobutyryl-CoA dehydrogenase deficiency through newborn screening in Georgia

The long-term consequences and need for therapy in children with short-chain acyl-CoA dehydrogenase deficiency (SCADD) or isobutyryl-CoA dehydrogenase deficiency (IBDD) identified via newborn screening (NBS) remains controversial. Initial clinical descriptions were severe; however, while most cases identified through NBS have remained asymptomatic, clinical concerns have been raised in these populations. It is not clear whether these children are asymptomatic because of the success of NBS, or because the normal clinical course of these disorders is relatively benign. To evaluate these possibilities in our program, we evaluated the clinical outcomes of children with SCADD or IBDD identified by the Georgia NBS compared to the health status of a healthy age-matched control group. We also assessed parental anxiety during a phone interview both subjectively and objectively using the Pediatric Inventory for Parents (PIP), a validated measure of illness-related parental stress. The general health of 52 SCADD and nine IBDD cases from 2007 to 2016 were compared to the general health of unaffected control children obtained through the Centers for Disease Control and Prevention (CDC) parent listserv. We also collected statements from parents who participated in a phone survey regarding events they experienced during and after their diagnostic process. Overall, the children with SCADD and IBDD had no major health problems. There was no significant difference in cognitive development (p = .207). We identified a slightly higher incidence of reported neonatal hypoglycemia in the SCADD group; two of these occurred in the context of maternal diabetes. All interviewed parents reported extreme anxiety during the diagnostic period and current feelings of uncertainty about their child's future. PIP scores for all six caregivers who responded to that portion of the survey were consistent with some degree of parental stress. The greatest reported stressor was the unknown long-term impact of the illness. All children with SCADD and IBDD had no significant long-term sequelae. The phone interviews revealed substantial parental anxiety about the identification and follow-up of SCADD and IBDD. Based on our findings, the anxiety parents experience may be unwarranted given that we see no disease-associated morbidity or mortality in these children. Consideration should be given to the removal of these conditions from NBS panels, or if that is not possible, clinicians could educate parents on the benign nature of these diagnoses and release them from follow-up without treatment.

Impact of a multimedia teaching tool on parental anxiety and knowledge during the informed consent process

PURPOSE

Before performing a surgical procedure, informed consent (IC) is obtained. Parents may exhibit anxiety and/or a desire for more knowledge during the IC process for their child. The purpose of this study was to measure the impact of a multimedia intervention (MMI) versus conventional discussion on parental understanding and anxiety during the IC process for infants undergoing surgery for hypertrophic pyloric stenosis.

METHODS

A time-interrupted series design was employed over a 9-month period. In the first phase, conventional discussion for IC was performed. In the second phase, a MMI was utilized. In both phases, anxiety scores and post-consent knowledge tests were collected.

RESULTS

31 participants were included in the study, 17 in the conventional consent and 14 in the MMI phase. Parental anxiety around the IC discussion was measured. There was a significant decrease in anxiety noted with use of the MMI (p = 0.046) but no significant difference in knowledge (p = 0.84).

CONCLUSION

The MMI significantly reduced parental anxiety during the IC process. Providers may consider applying this type of MMI to other surgical procedures. Securing IC in a manner that improves knowledge and decreases anxiety may improve long-term understanding and parental satisfaction with the health care process.

Brief Report: Postsecondary Work and Educational Disruptions for Youth on the Autism Spectrum

This study examined vocational/educational disruption in the 2-3 years after high school for 36 youth with autism spectrum disorder (ASD). Data were collected three times from parents: during youth's last year of high school and two times after high school exit. Data were coded into categories indicating any versus no disruptions in postsecondary vocation/education, and group differences in individual (behavior problems, IQ, adaptive behavior, autism severity, stress reactivity) and family (parent depression, anxiety, quality of life; family income and climate) factors were examined. One-half of youth had experienced a postsecondary vocational/educational disruption; parents of those with a disruption had more depressive and anxiety symptoms and lower quality of life while their son/daughter was still in high school.

Parental anxiety among children undergoing cardiac catheterisation

BACKGROUND

Parents may experience anxiety and stress when their children undergo cardiac catheterisation. The goal of this study was to assess the level of anxiety in parents of children undergoing cardiac catheterisation and to identify factors that were associated with level of anxiety.

METHODS

This was a cross-sectional survey of parents of children who underwent cardiac catheterisation. Anxiety levels were measured using a validated self-report questionnaire - State-Trait Anxiety Inventory, which generates state anxiety scores on the current state of anxiety and trait anxiety scores on the stable aspects of anxiety proneness. One sample t-test was used to compare the data with normative data. Multiple linear regression was used to assess the factors associated with the state score.

RESULTS

A total of 113 parents completed the survey. The mean age of parents was 34.0±7.7 years and the mean age of children undergoing catheterisation was 6.7±5.7 years. Compared with normative data, mean state score was significantly higher in our cohort (p<0.05) despite no difference in the trait score. Final multivariate model showed that the state score was significantly associated with child age group (<1 year [coefficient β 7.2] and 10-18 years [6.3], compared to 1 to <10 years of age [reference]) and history of previous catheterisation (-5.2) (p<0.05).

CONCLUSIONS

Concurrent state anxiety level was high among parents of children undergoing cardiac catheterisation, whereas trait anxiety level was not. Higher anxiety was experienced by parents of infants and adolescents without a history of previous catheterisation.

Social functioning in pediatric epilepsy reported by parents and teachers: Contributions of medically related variables, verbal skills, and parental anxiety

Children with epilepsy are at increased risk for deficits in social functioning, though the underlying causes are not well-understood. We examined multiple seizure-related, demographic, and cognitive variables in a group of 93 pediatric patients with intractable seizures who were at risk for social skills deficits and social problems at home and in the classroom. Verbal intelligence and parental anxiety about epilepsy were found to be the two primary predictors of social functioning in children with epilepsy as reported by parents and teachers. Though other social variables and secondarily generalized seizures were significantly correlated with certain aspects of parent-reported social functioning, the impact of these variables appeared to be mediated through verbal intelligence and/or parental anxiety about epilepsy. These findings emphasize the importance of family characteristics on social functioning in children with epilepsy and also suggest that parental anxiety about their child's epilepsy may be a specific risk factor for this population. The findings from this study suggest that the factors associated with social functioning in children with epilepsy are similar regardless of whether social functioning is assessed by the parent or the classroom teacher.

The effects of parental mental health and social-emotional coping on adolescent eating disorder attitudes and behaviors

This study examined whether social-emotional coping skills moderate the association between parental mental health symptoms and adolescent disordered eating attitudes and behaviors in a clinical sample of adolescents with internalizing and/or externalizing symptoms. Fifty-nine adolescent-parent dyads (N = 118 total participants) recruited from a metropolitan area in the Northeastern United States completed assessments at baseline and 12-month follow-up. Generally, higher parental depression and anxiety were only found to be associated with greater disordered eating attitudes and behaviors among adolescents who reported poorer (versus stronger) emotional awareness/expression skills and less (versus greater) ability to regulate emotions. Results may suggest that adolescents who lack the ability to effectively recognize, express, and manage negative emotions that arise in the context of a challenging home environment may be at greater risk for engaging in maladaptive coping behaviors, such as disordered eating. Thus, bolstering adolescent social-emotional coping skills may help protect against adolescent disordered eating.

Predicting children's behaviour during dental treatment under oral sedation

AIMS

The primary aim of this study was to assess whether parents' own anxiety and their perception of their child's dental fear and child's general fear can predict preoperatively their child's behaviour during dental treatment under oral sedation. The secondary aim was to assess whether the child's age, gender and ASA classification grade are associated with a child's behaviour under oral sedation.

STUDY DESIGN

Cross-sectional prospective study.

METHODS

The Corah's Dental Anxiety Scale (DAS), Children's Fear Survey Schedule Dental-Subscale (CFSS-DS) and Children's Fear Survey Schedule Short-Form (CFSS-SF) questionnaires were completed by parents of children undergoing dental treatment with oral midazolam. Behaviour was rated by a single clinician using the overall behaviour section of the Houpt-Scale and scores dichotomised into acceptable or unacceptable behaviour. Data were analysed using χ (2), t test and logistic regression analysis.

RESULTS

In total 404 children (215 girls, 53 %) were included, with the mean age of 4.57 years, SD = 1.9. Behaviour was scored as acceptable in 336 (83 %) and unacceptable in 68 (17 %) children.

STATISTICS

The level of a child's dental fear, as perceived by their parent, was significantly associated with the behaviour outcome (p = 0.001). Logistic regression analysis revealed that if the parentally perceived child's dental fear (CFSS-DS) rating was high, the odds of the child exhibiting unacceptable behaviour under oral sedation was two times greater than if their parents scored them a low dental fear rating (OR 2.27, 95 % CI 1.33-3.88, p = 0.003).

CONCLUSIONS

CFSS-DS may be used preoperatively to help predict behaviour outcome when children are treated under oral sedation and facilitate treatment planning.

Parental involvement in youth anxiety treatment: conceptual bases, controversies, and recommendations for intervention

Parents are often perceived as a contributing or maintaining source of youth anxiety disorders, making them natural targets for either intervention or involvement in treatment protocols. Efforts to increase the efficacy and durability of standard treatments by incorporating parents have been successful, yet they often do not outperform child-focused treatment. Breinholst et al. (2012) review and discuss several overlooked parental research variables (anxiety, overcontrol, beliefs and assumptions, global family dysfunction) found to promote and maintain child anxiety. However, it remains unclear how these proposed variables interfere with active therapeutic ingredients (e.g., exposure) or how the identified problems might be addressed. We propose that insufficient attention to exposure-based treatment and family behavioral responses explain the comparatively low added value for parental involvement in child anxiety treatment and outline directions for research to address them. With meaningful attention being given to exposure and its accompanying variables in the treatment of childhood anxiety, we believe that treatment outcomes and intervention acceptability can be improved.

Linguistic markers of emotion in mothers of sickle cell carrier infants: what are they and what do they mean?

OBJECTIVE

The objectives were to examine emotion-related language in mothers' narratives about newborn screening, and test the correlations between language and self-reported emotion and behavior.

METHODS

Transcripts of interviews with mothers of infant sickle cell carriers were analyzed with word count software for the prevalence of emotion-related words in narratives about newborn screening. Word counts were compared to population norms for spoken language using one-sample t-tests. Anxiety-related words were correlated with self-reported anxiety and avoidance of genetic testing.

RESULTS

187 transcripts were analyzed, in which there was a higher percentage of anxiety words (m=.38%) than population norms (m=.18%), t(186)=10.59, p<.001, CI=.16-.23. Anxiety-related word use was positively correlated with self-reported previous anxiety, rs(185)=.24, p=.001. Self-reported previous anxiety, but not word use, was correlated with mothers' avoidance of undergoing genetic testing themselves rs(152)=.25, p=.002.

CONCLUSION

Mothers of sickle cell carrier infants reported anxiety upon learning their child's condition. Anxiety-related words in maternal narratives were correlated with their reports of past, but not present, emotions.

PRACTICE IMPLICATIONS

Researchers and clinicians should use caution in assuming that word choices reflect state emotions. Self-report methods may be preferable for predicting behavioral outcomes.

Parental anxiety and family disruption following a first febrile seizure in childhood

OBJECTIVE

To evaluate the degree of parental anxiety and family disruption following a child's first febrile seizure.

PATIENTS AND METHODS

The families of all children presenting with their first febrile seizure to any of the three emergency departments in the Saskatoon District, Saskatchewan, were invited to participate in a telephone interview to assess the degree of parental anxiety and family dysfunction that was experienced. Parameters measured included co-sleeping with the child, parental sleep disturbance, parental fatigue, monitor use, the number of night time checks on a child, child care use, parental outings, parental fear of missing a seizure, parental perception of a child's increased vulnerability and the family's stress level. The interview, which was conducted shortly after presentation at the emergency departments, compared anxiety and dysfunction experienced during the two weeks immediately preceding the visit with that experienced during the two weeks following a febrile seizure. Potential predictors of anxiety and dysfunction, including details of the presenting seizure, past medical illnesses, family history, the family's socioeconomic status and parental perception of the risk of a febrile seizure were queried.

RESULTS

Thirty-one (89%) of 35 families who were eligible for the study participated. Parental anxiety and family dysfunction were significantly greater for nearly all of the parameters assessed during the two weeks following a seizure. Socioeconomic factors correlated most closely with anxiety and dysfunction before a febrile seizure; however, socioeconomic factors were less predictive of anxiety and dysfunction during the two weeks following a seizure.

CONCLUSIONS

Parental anxiety and family dysfunction are the rule following a child's first febrile seizure. Neither higher socioeconomic status nor an understanding of the low risk of sequelae associated with febrile seizures was strongly predictive of improved coping during the two weeks following a seizure.