Alanna Long

Symptoms of post-traumatic stress in children with cancer and their parents: Effects of informant and time from diagnosis

Post‐traumatic stress disorder (PTSD) has been put forth as a model for understanding the adjustment of children with cancer and their parents, but findings in the literature regarding the prevalence of post‐traumatic stress symptoms (PTSS) have been mixed. This study examined PTSS levels in both patients and parents as a function of time elapsed from diagnosis, and by use of parent versus child reports for assessing patient PTSS.

Posttraumatic Stress and Psychological Growth in Children With Cancer: Has the Traumatic Impact of Cancer Been Overestimated?

PURPOSE To examine posttraumatic stress disorder and posttraumatic stress symptoms (PTSD/PTSS) in children with cancer using methods that minimize focusing effects and allow for direct comparison to peers without a history of cancer. PATIENTS AND METHODS Children with cancer (n = 255) stratified by time since diagnosis, and demographically matched peers (n = 101) were assessed for PTSD using structured diagnostic interviews by both child and parent reports, and survey measures of PTSS and psychological benefit/growth by child report. RESULTS Cancer was identified as a traumatic event by 52.6% of children with cancer, declining to 23.8% in those ≥ 5 years from diagnosis. By diagnostic interview, 0.4% of children with cancer met criteria for current PTSD, and 2.8% met lifetime criteria by self-report. By parent report, 1.6% of children with cancer met current criteria and 5.9% met lifetime criteria for PTSD. These rates did not differ from controls (all Ps >.1). PTSS levels were descriptively lower in children with cancer but did not differ from controls when all were referring to their most traumatic event (P = .067). However, when referring specifically to cancer-related events, PTSS in the cancer group were significantly lower than in controls (P = .002). In contrast, perceived growth was significantly higher in the cancer group when referring to cancer (P < .001). CONCLUSION These findings suggest no evidence of increased PTSD or PTSS in youths with cancer. Although childhood cancer remains a significant and challenging event, these findings highlight the capacity of children to adjust, and even thrive, in the face of such challenge.

Symptoms of post-traumatic stress in children with cancer: Does personality trump health status?

Objective: To examine the symptoms of post‐traumatic stress (PTSS) in children as a function of health status (cancer vs healthy) and adaptive style.

Parents of Children With Cancer: At-Risk or Resilient?

OBJECTIVE To examine adjustment in parents of children with cancer using a design that minimizes focusing effects and allows for direct comparison with parents of healthy children. METHOD Parents of 305 children with cancer and a demographically similar sample of 231 parents of healthy children were evaluated using diagnostic interviews for posttraumatic stress disorder (PTSD), and questionnaire measures of posttraumatic stress symptoms (PTSS) and psychological growth (PG), as well as measures of global psychological functioning. RESULTS Rates of current and lifetime PTSD in parents of children with cancer were low, and did not differ from comparison parents. Likewise, levels of PTSS were not significantly different from comparison parents, but differed as a function of time since diagnosis, with parents of children who were ≥ 5 years from diagnosis reporting significantly lower PTSS than comparison parents. PG was higher in parents of children with cancer than in comparison parents regardless of time since diagnosis. CONCLUSION Parents of children with cancer demonstrate resilience to this challenge.

Profiles of Resilience and Growth in Youth With Cancer and Healthy Comparisons

OBJECTIVE Inconsistent links between posttraumatic stress symptoms (PTS) and posttraumatic growth (PTG) in youth following a stressful life event have been observed in previous literature. Latent profile analysis (LPA) provides a novel approach to examine the heterogeneity of relations between these constructs. METHOD Participants were 435 youth (cancer group=253; healthy comparisons = 182) and one parent. Children completed measures of PTS, PTG, and a life-events checklist. Parents reported on their own PTS and PTG. LPA was conducted to identify distinct adjustment classes. RESULTS LPA revealed three profiles. The majority of youth (83%) fell into two resilient groups differing by levels of PTG. Several factors predicted youths profile membership. CONCLUSIONS PTS and PTG appear to be relatively independent constructs, and their relation is dependent on contextual factors. The majority of youth appear to be resilient, and even those who experience significant distress were able to find benefit.

Profiles of Connectedness: Processes of Resilience and Growth in Children With Cancer

OBJECTIVE Identified patterns of connectedness in youth with cancer and demographically similar healthy peers. METHOD Participants included 153 youth with a history of cancer and 101 youth without a history of serious illness (8-19 years). Children completed measures of connectedness, posttraumatic stress symptoms (PTSS), and benefit-finding. Parents also reported on childrens PTSS. RESULTS Latent profile analysis revealed four profiles: high connectedness (45%), low connectedness (6%), connectedness primarily to parents (40%), and connectedness primarily to peers (9%). These profiles did not differ by history of cancer. However, profiles differed on PTSS and benefit-finding. Children highly connected across domains displayed the lowest PTSS and highest benefit-finding, while those with the lowest connectedness had the highest PTSS, with moderate PTSS and benefit-finding for the parent and peer profiles. CONCLUSION Children with cancer demonstrate patterns of connectedness similar to their healthy peers. Findings support connectedness as a possible mechanism facilitating resilience and growth.

Predictors of psychological functioning in children with cancer: disposition and cumulative life stressors

This study examined psychological functioning in children with a history of cancer and a matched sample of healthy peers, while exploring the roles of disposition and stressful life events.

Life stress versus traumatic stress: The impact of life events on psychological functioning in children with and without serious illness.

OBJECTIVE To determine the differential impact of potentially traumatic events (PTEs) and other stressful life events on psychological functioning in 2 groups of children: those with cancer and those without history of serious illness. METHOD Children with cancer age 8-17 (n = 254) and age-, sex-, and race/ethnicity-matched controls (n = 142) completed self-report measures of stressful life events and psychological functioning. Stressful life events included those that may meet Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 2000) A1 criteria (PTEs; 9 events) and others that would likely not (other events; 21 events). RESULTS Children with cancer endorsed significantly more PTEs than control children. There were no differences between groups in number of other events experienced. Hierarchical regression analyses revealed that number of other events accounted for significant variance in psychological functioning, above and beyond group status, demographic factors (age and socioeconomic status), and number of PTEs. DISCUSSION The number of cumulative other events experienced is a significant predictor of psychological functioning in both youth with serious illness and controls. In contrast, cumulative PTEs appear to have a minor (albeit significant) impact on childrens psychological functioning. Assessment of psychological functioning would benefit from a thorough history of stressful life events, regardless of their potential traumatic impact.

Emotion Socialization in the Context of Childhood Cancer: Perceptions of Parental Support Promotes Posttraumatic Growth

Objective Examined youth’s perceptions of parental reactions to youth’s cancer and non-cancer event-related distress and the link between perceptions of parental reactions and youth posttraumatic growth (PTG). Method Participants included 201 youth (8–21 years) with a history of cancer. Participants self-identified their most stressful life event, which were characterized as cancer or non-cancer related, and then completed measures in reference to this event assessing (1) their perceptions of parent reactions to event-related distress and (2) PTG. Results Youth who identified a cancer-related event perceived their parents as reacting with more support and reassurance/distraction than those who identified a non-cancer event. Perceptions of parental support, reassurance/distraction, and magnification of youth distress were associated with more PTG, with event type (cancer vs. non-cancer) indirectly predicting PTG through perceptions of parental support. Conclusion Youth perceive their parents as reacting differently to cancer versus non-cancer distress, which is in turn predictive of their perceptions of growth. Findings suggest that parental support and reassurance/distraction are possible mechanisms facilitating resilience and growth in children with cancer.

Youth’s Adjustment to Cancer: Examination of Patterns of Adjustment and the Role of Peer Relations

Objective Examine unique forms of peer relations (i.e., peer group vs. friendships) in relation to patterns of youths resilience and challenge-related growth in the context of cancer. Methods In all, 279 youth (cancer, n = 156; control, n = 123) completed measures of posttraumatic stress, depression, anxiety, posttraumatic growth (PTG), and perceived positive changes. Youth also reported on their peer relations. Latent profile analysis (LPA) was used to examine patterns of youths adjustment. Peer relations were examined as predictors of youths adjustment. Results LPA revealed three profiles (42.1% resilient high growth, 21.4% resilient low growth, and 36.5% mild distress with growth). Youths peer relations, demographic factors, and disease-related factors predicted assignment to profiles. Differences in adjustment emerged depending on youths connection with their peers versus their friends. Summary Peer relations serve an important role in youths adjustment to stressful life events. Assessment of peer and friend support may provide a more nuanced understanding of adjustment processes.