Bryan D. Carter

Role strain in couples with and without a child with a chronic illness: Associations with marital satisfaction, intimacy, and daily mood

This study examined marital role strain in 33 couples caring for a child with cystic fibrosis (CF) and 33 couples with a healthy child. The relationship between role strain, marital satisfaction, and psychological distress was tested. Couples completed a structured interview, questionnaires, a card sort procedure, and 4 daily diaries assessing activities and mood. Couples in the CF versus comparison group reported greater role strain on measures of role conflict, child-care tasks, and exchanges of affection. They also spent less time in recreational activities, but no reliable group differences were found in marital satisfaction or depression. Regression analyses indicated that role strain was related to marital satisfaction and depression and that recreation time accounted for additional variance. Path analysis suggested that recreation mediated the negative relationship between role strain and distress. The importance of using a contextual, process-oriented approach is discussed.

Psychological symptoms in chronic fatigue and juvenile rheumatoid arthritis.

Objective. To determine if psychological morbidity in youth with chronic fatigue is caused by the stress of coping with a chronic illness. Study Design. Case–control study comparing pediatric patients with debilitating chronic fatigue and matched subjects with juvenile rheumatoid arthritis, a chronic medical illness with similar functional sequelae. Setting. Pediatric Infectious Diseases Clinic and Juvenile Rheumatoid Arthritis Clinic of Kosair Childrens Hospital. Participants. Nineteen children and adolescents with debilitating chronic fatigue and 19 age- and sex-matched peers with juvenile rheumatoid arthritis. Outcome. Structured Interview, Kaufman Brief Intelligence Test, Child Behavior Checklist, and Youth Self-Report. Results. Intellectual functioning on the Kaufman Brief Intelligence Test Composite was average (103, standard score) for both groups. Pediatric patients with chronic fatigue had higher levels of internalizing psychological distress than patients suffering from juvenile rheumatoid arthritis, despite the fact that both groups had a similar pattern of decline in social and physical activities. Duration of illness did not explain the difference in psychological symptoms. Conclusions. Psychological factors may play a more active role in debilitating chronic fatigue in pediatric patients than can be explained by the stress of coping with a similar chronic, non–life-threatening illness.

Parent relationships and compliance in cystic fibrosis

INTRODUCTION Marital adjustment, family characteristics, and parent-child stress and compliance with treatment were investigated in 41 families with a preadolescent child (age 3 to 11 years) who had cystic fibrosis (CF). METHOD Mothers completed the Dyadic Adjustment Scale, the Family Adaptability and Cohesion Evolution Scale, and the short form of the Parenting Stress Index. Parents and medical staff completed questionnaires assessing the childs compliance with diet/nutritional intake, vitamins, pancreatic enzymes, other medications (such as oral antibiotics), and chest physiotherapy. RESULTS Preadolescents with CF were viewed as generally cooperative with most aspects of treatment. Parental ratings of compliance with dietary and nutritional intake were associated with increased marital consensus and decreased parenting stress. Medical staff ratings of dietary compliance, medication compliance, and chest physiotherapy compliance were associated with lower parenting stress. DISCUSSION Parent-child stress and lack of agreement between parents is associated with problems in compliance with treatment, which may have an adverse impact on the disease and health status of the child with CF.

Differential diagnosis of chronic fatigue in children : behavioral and emotional dimensions

A battery of self-report questionnaires and structured diagnostic interviews was administered to 20 children and adolescents who presented to a pediatric specialty clinic with chronic fatigue. Matched groups of healthy and depressed control subjects (aged 8 to 19 years) were also studied. Criteria were established to identify those items in the assessment battery that reliably differentiated among the three groups. Analysis of item content suggested several clusters of characteristics that discriminated among the subject groups, including life changes, cognitive difficulties, negative self-attributions, social relationship disruption, and somatic symptom presentation. The results suggest that certain psychological factors can discriminate chronic fatigue from depressive symptomatology, as well as normal functioning. Items discriminating among groups are presented in an organized questionnaire format to assist with the understanding and assessment of pediatric chronic fatigue cases.

Hypnotherapy in the Treatment of Childhood Psychogenic Coughing: A Case Report

Abstract A case study is presented of an 11-year-old child evidencing severe, intractable psychogenic coughing. The patient was treated with hypnotherapy consisting of mental imagery, direct suggestion, and self-hypnosis. In addition, the parents were instructed to avoid reinforcing the patients symptoms through attention. A 7-month follow-up revealed a rapid and complete elimination of the psychogenic cough and good adjustment.

Psychosocial perspectives in the treatment of pediatric chronic pain

Chronic pain in children and adolescents is associated with major disruption to developmental experiences crucial to personal adjustment, quality of life, academic, vocational and social success. Caring for these patients involves understanding cognitive, affective, social and family dynamic factors associated with persistent pain syndromes. Evaluation and treatment necessitate a comprehensive multimodal approach including psychological and behavioral interventions that maximize return to more developmentally appropriate physical, academic and social activities. This article will provide an overview of major psychosocial factors impacting on pediatric pain and disability, propose an explanatory model for conceptualizing the development and maintenance of pain and functional disability in medically difficult-to-explain pain syndromes, and review representative evidence-based cognitive behavioral and systemic treatment approaches for improving functioning in this pediatric population.

The chronically ill child and family stress. Family developmental perspectives on cystic fibrosis.

The authors take a developmental and family systems perspective in reviewing research on the family stressors inherent in caring for a child with a chronic disease. Cystic fibrosis, a genetically transmitted and life-shortening disorder, exemplifies a chronic disease that places demands on the family that are both unique and shared with other prolonged illnesses. The authors chronicle the interaction of the debilitating features of this disease and its demanding treatment regimen with family dynamics from the point of initial diagnosis to the terminal stages.

The Influence of Maternal Stress Resistance and Family Relationships on Depression in Children with Cancer

Abstract The current study proposed a theoretical model for explaining the potential influences on child adjustment to the complex and often painful treatment regimens required in the management of childhood cancer. The primary psychosocial factors of parental coping beliefs and behavior are explored, both directly and through their influence on family relationships, for their impact on child depression in pediatric oncology patients. The study sample included 27 children and their mothers with a variety of childhood cancers, whose treatment protocols were classified as either “more aggressive” (12) or “less aggressive” (15). Results indicated that maternal confidence in her coping efficacy was strongly related to the mothers use of approach coping strategies, the overall quality of the family environment, and the childs self-reported level of depression. Few significant relationships were found between demographic and disease variables (despite selection of cases for extremes in disease and treatment severity) and the psychological mediator and outcome variables. Parental education and financial status were found to function as personal resources for the mothers. Maternal confidence in her ability to cope was found to decrease with time after diagnosis. Recommendations are made for future studies to minimize the limitations inherent in the present small sample size.

Pediatric limb amputation: Aspects of coping and psychotherapeutic intervention

This paper addresses the assessment of and intervention with pediatric patients undergoing limb amputation. A multicomponent treatment package is advocated including the use of play and cognitive-behavioral strategies to enhance coping and adjustment to the loss of a limb.

Brief Report: Illness Factors and Child Behavior Before and During Pediatric Hospitalization

OBJECTIVE Little is known about factors predicting in-hospital adjustment in children with chronic illnesses or about risk/protective factors for in-hospital behavior compared to out-of-hospital behavior. This study investigated the relationship between illness factors (chronicity and severity) and child adjustment in and out of the hospital. METHODS Parents and nurses completed questionnaires about in-hospital and home behavior for a sample of 85 hospitalized children. RESULTS In the hospital, children with acute illnesses demonstrated more internalizing behavior problems than children with chronic illnesses. Children with life-threatening illnesses had more internalizing and externalizing problems than children with non-life-threatening illnesses. Out of the hospital, children with chronic illnesses demonstrated more internalizing problems and a trend toward more externalizing problems than healthy children who later developed acute illnesses. Out of hospital behavior problems were unrelated to illness severity. CONCLUSIONS Results suggest that different illness factors may predict in-hospital as compared to out-of-hospital behavioral adjustment.