Birgit Möller

Gender identity disorder in children and adolescents.

C 1 c w t t T f d d d w c a t G ender identity disorder (GID) has increasingly garnered media attention over the past several years: Ma Vie en Rose (“My Life in Pink,” 997), a sympathetic but realistic story about the ribulations and triumphs of a young transgender child, nd “Boys Don’t Cry” (1999), based on a true story in hich a girl passing as a boy meets a tragic end, ocused on this subject. News articles regarding this opic have appeared in Time, the New York Times, nd Newsweek; ABC’s 20/20 has featured several ransgendered children and their families that can be atched on YouTube. The Atlantic ran a piece on ransgender children, and on May 7-8, 2008 in a wo-part series, National Public Radio also explored he complex issue of the various therapeutic aproaches to GID, including the controversial topic of uberty-delaying therapy for preteens struggling with ID. As a result of this increasing media coverage and esearch indicating that cross-gender interests and ehavior are not rare (see below), families who have oncerns about a child’s gender identity development re increasingly likely to bring their child to the ttention of the pediatrician or others taking care of hildren. Pediatricians may be the first to be called on when arents have concerns about their child’s atypical ender behaviors. These are often not the chief comlaint for the encounter but are brought up toward the nd of an office visit, or the so-called “out-the-door” uestion. Alternatively the parent may wait to see if

Use and need for psychosocial support in cancer patients: a population-based sample of patients with minor children.

Cancer patients and their minor children have been shown to experience psychological distress. The objectives of the current study were to 1) describe the need for and use of psychosocial support and 2) determine predictors of family‐centered support use in patients with minor children.

Children of cancer patients: Prevalence and predictors of emotional and behavioral problems

Children of patients with cancer are at increased risk for developing emotional and behavioral problems. This study explored the prevalence and predictors of emotional and behavioral problems in Children of cancer patients in a multisite research project.

Psychosoziale Versorgung von Kindern mit einem an Krebs erkrankten Elternteil – Eine Bestandsaufnahme spezifischer Versorgungsangebote in Deutschland

Children of a parent having cancer are at greater risk to develop mental health problems. Aim is to investigate specific psychosocial care for children having a parent with cancer, as well as to characterize and assess utilization and needs of affected minor children. Employees of institutions in Germany supplying psychosocial care to families with a parent having cancer were surveyed, using a semi-structured interview (n = 29). Specific psychosocial care for affected children is limited and heterogeneous in Germany. Regarding different distress stages of those families, the situation could be interpreted as eligible. However, this primarily reflects the low quality assurance of care. Results suggest that in addition to preventive care needs of children having a parent with cancer, increased needs exist in specific risk constellations, like in single parent families.

Parental palliative cancer: psychosocial adjustment and health-related quality of life in adolescents participating in a German family counselling service

BackgroundParental palliative disease is a family affair, however adolescents well-being and coping are still rarely considered. The objectives of this paper were a) to identify differences in psychosocial adjustment and health-related quality of life (HRQoL) among adolescents and young adults with parents suffering from palliative cancer or cancers in other disease stages, b) to relate psychosocial adjustment and health-related quality of life to adolescent coping, and c) to explore significant mediator and predictor variables.MethodsCross-sectional data were derived from a multi-site research study of families before child-centered counselling. N=86 adolescents and young adults were included, their mean age 13.78 years (sd 2.45), 56% being female. Performed analyses included ANCOVA, multiple linear regression, and mediation analysis.ResultsAdolescents with parents suffering from palliative cancers reported significantly less total psychosocial problems, and better overall HRQoL. There were no significant group differences regarding coping frequency and efficacy. Our set of coping items significantly mediated the effect of parental disease stage on psychosocial problems and HRQoL. Further, parental disease status and general family functioning predicted psychosocial problems (R2adj =.390) and HRQoL (R2adj =.239) best.ConclusionThe study indicates distress among adolescents throughout the entire parental disease process. Our analysis suggests that counselling services could offer supportive interventions which focus particularly on adolescent coping as well as family functioning.

Parental cancer: Health-related quality of life and current psychosocial support needs of cancer survivors and their children.

The presence of cancer and additional parental responsibilities can increase strain for individual patients as well as for their children. The construct of health‐related quality of life (HRQL) is appropriate to measure a combination of physical, mental and social consequences as a result of disease. However, previous research has merely focused on symptom checklists. This study addresses the following questions: (i) does HRQL in children and their parents with cancer differ compared to the general population? (ii) Are there any variables that are associated with HRQL in children? (iii) What are current psychosocial support needs? A population‐based survey of 976 survivors (<6 years post diagnosis) with minor children between 6 and 18 years (n = 1,449) was conducted with two German cancer registries. HRQL was assessed using SF‐8 (survivors) and Kidscreen (children). The results were compared to normative populations, and predictors associated with HRQL in children were evaluated within a multilevel model. We found that the HRQL in children was better compared to the norm. Only children with support needs had worse HRQL. Older age, having a mother with cancer, having a parent not living together with a partner, and worse parental physical and mental health influenced HRQL in children. Illness characteristics were irrelevant. Even with a mean of 3.5 years after diagnosis, survivors had lower physical and mental health compared to the norm. Our findings reinforce the need for health professionals to pay attention to younger patients and their children. Even years after diagnosis, life might not have returned to normal.

There is still so much ahead of us-family functioning in families of palliative cancer patients.

Adopting a systems approach, parental cancer has its impact on patients, spouses, and dependent children. The purpose of the current study was to examine family functioning dependent on parental disease stage and on family member perspective in families of cancer patients with adolescent children. The cross-sectional study was conducted within a German multisite research project of families before their first child-centered counseling encounter. The sample comprised individuals nested within N = 169 families. Analyses performed included analysis of covariance (ANCOVA) and intraclass correlation. Open answers were analyzed following quantitative content analysis procedures. Between 15% and 36% of family members reported dysfunctional general functioning scores. Parents indicated more dysfunctional scores on the Family Assessment Device scale Roles, and adolescents more dysfunctional Communication scores. Regarding assessment of family functioning, there was higher agreement in families with parents in a palliative situation. For adolescents with parents in palliation, incidents because of the disease tend to become more dominant, and spending time with the family tends to become even more important. As our study pointed out, parental cancer, and especially parental palliative disease, is associated with both perceived critical and positive aspects in family functioning. Supporting families in these concerns as well as encouraging perceptions of positive aspects are important components of psycho-oncological interventions for families with dependent children.

Psychometric properties of the Parenting Concerns Questionnaire in cancer survivors with minor and young adult children.

Although cancer patients with minor children have become more of a focus of psycho‐oncological research, little is known about specific parenting concerns. Instruments to assess the concerns and worries of parents with cancer are rare. The Parenting Concerns Questionnaire (PCQ) addresses this issue. We analyzed parenting concerns in cancer survivors and evaluated the German version of the PCQ.

Elternschaft und Krebserkrankung: Dyadische Analyse von psychosozialer Belastung und gesundheitsbezogener Lebensqualität von krebskranken Eltern minderjähriger Kinder

The purpose of this study was the analysis of psychological distress and health-related quality of life (HRQoL) of parents with minor children during curative resp. palliative treatment.Cross-sectional design with a sample of N=89 parent dyads. Dyadic analysis of demographic, illness and family variables via mixed linear models.Patients and healthy partners indicated psychological distress on different subscales. Intradyadic correlations were small-moderate. Most important predictors of psychological distress and HRQoL were treatment stadium, gender, family functioning, and employment status.Dependent on demographic variables, psychooncological support was evident mainly for parents in palliative care and for families with dysfunctional functioning.tion und den Umgang damit nachhaltig beeinfl ussen. Wünsche für die Zukunft der Familie können aufseiten beider Partner durch eine Krebserkrankung nachhaltig erschüttert werden. In der Palliativphase kann sich Elternschaft auch auf das Treff en von Behandlungsentscheidungen auswirken, wie eine Studie zeigt, nach der Palliativpa tienten eher bereit waren, sich aggressiven Behandlungsformen auszusetzen und seltener ihren Willen hinsichtlich Behandlung und Betreuung formal hinterlegt hatten [ 4 ] . An Krebs erkrankten Eltern minderjähriger Kinder ist es wichtig, im Alltag so lange wie möglich eine gewisse Normalität aufrechtzuerhalten, das Wohlbefi nden der Kinder in den Mittelpunkt zu Einleitung ▼ Eine schwerwiegende körperliche Erkrankung stellt, zumal in der Palliativphase, für alle Familienmitglieder ein einschneidendes Lebensereignis dar und spiegelt sich in der psychischen Belastung von Patienten und deren Lebenspartnern wider [ 1 – 3 ] . Sind Patienten und deren Partner Eltern minderjähriger Kinder [ 4 ] und ist das Behandlungsziel palliativ [ 2 , 3 ] , so scheint dies mit einer stärkeren psychosozialen Belastung beider Partner einherzugehen. Neben der eigenen Bestürzung und Hilfl osigkeit kann die Angst vor dem Verlust des Partners und der Bewältigung der alleinigen Elternrolle das Erleben der SituaAutoren Franziska Kühne 2 , Thomas Krattenmacher 1 , Corinna Bergelt 2 , Anna-Lena Bierbaum 3 , Johanna Christine Ernst 2 , Hans-Henning Flechtner 4 , Monika Keller 5 , Kai v. Klitzing 6 , Georg Romer 1 , Birgit Möller 1

Measuring family functioning in families with parental cancer: Reliability and validity of the German adaptation of the Family Assessment Device (FAD)

OBJECTIVE The concept of family functioning is gaining importance in psycho-oncology research and health care services. The Family Assessment Device (FAD) is a well-established measure of family functioning. Psychometric properties inherent in the German 51-item adaptation of the FAD are examined in different samples of families with parental cancer. METHODS Acceptance, reliability, and validity of FAD scales are analysed in samples from different study settings (N=1701 cancer patients, N=261 partners, N=158 dependent adolescent children 11 to 18years old). RESULTS Missing items in the FAD scales (acceptance) are rare for adults (<1.1%) and adolescent children (<4.4%). In samples of adults and older adolescents (15 to 18years), all FAD scales except for the Roles scale are significantly reliable (0.75≤Cronbachs α≤0.88). The scales correlate highly (0.46≤Pearsons r≤0.59) with the criterion satisfaction with family life (convergent validity), and have smaller correlations (0.16≤r≤0.49) with measures of emotional distress and subjective well-being (divergent validity). In most FAD scales, adults seeking family counselling report worse family functioning (0.24≤Cohens d≤0.59) than adults in other samples with parental cancer (discriminative validity). CONCLUSION Overall, the German 51-item adaptation of the FAD reveals good acceptance, reliability, and validity for cancer patients and their relatives. Particularly the scale General Functioning shows excellent psychometric properties. The FAD is suitable in the assessment of families with parental cancer for adults and adolescents older than 11years.