Eline Van Hoecke

Problem Behavior, Parental Stress and Enuresis

PURPOSEnWe determined maternal and paternal ratings of problem behavior in 5 to 13-year-old children with (non)monosymptomatic enuresis and investigated parental stress and the association between parental ratings of child behavior and parental stress.nnnMATERIALS AND METHODSnWe compared problem behavior in 78 children with (non)monosymptomatic enuresis vs that in 110 without enuresis using the Child Behavior Checklist and the Disruptive Behavior Disorders Rating Scale. Parental stress was measured using the Parenting Stress Index.nnnRESULTSnMaternal results replicated previous findings of significantly higher Child Behavior Checklist scores for externalizing and total problems compared with those in the control group, whereas no significant differences were found for paternal ratings. Mothers and fathers of enuretic children reported significantly higher scores on the Disruptive Behavior Disorders Rating Scale inattention, hyperactivity/impulsivity and oppositional defiant disorder subscales than parents of children without enuresis. The Parenting Stress Index revealed significantly higher overall stress in mothers and fathers of children with (non)monosymptomatic enuresis compared with that in parents of controls. Especially parental stress related to child characteristics was associated with a greater report of child behavior problems.nnnCONCLUSIONSnEach parent but especially mothers reported more problem behavior in children with (non)monosymptomatic enuresis than in controls. They also reported more stress, which correlates highly with parental ratings of problem behavior in children with (non)monosymptomatic enuresis.

Body image and sexuality in adolescents after hypospadias surgery.

OBJECTIVEnPatients operated on for hypospadias often display a range of emotional and functional postoperative problems at an early age. This study explores the social, psychosocial and sexual development of adolescent boys operated on for hypospadias at an early age.nnnPATIENTS AND METHODnTen boys between the ages of 11 and 18 years and an age-matched reference group of 10 boys completed three mailed questionnaires: the Child Behavior Checklist/4-18, the Youth Self Report, and the Self-Perception Profile for Adolescents. Data on body image and genital perception, and on social, psychosocial and sexual development were gathered by interview and standardized questionnaire.nnnRESULTSnInternalizing or externalizing problems were not reported to be increased. Boys operated on for hypospadias had a significantly lower score on the Self-Perception Profile for Adolescents, Social Acceptance subscale. Fewer boys in the clinical group considered their penis to be normal or judged their penis as similar to that of friends. No difficulties were found regarding psychosocial or sexual development; there was however a tendency towards a more negative genital appraisal.nnnCONCLUSIONnBoys operated on for hypospadias appear to experience normal social, psychosocial and sexual development.

Resilience Factors in Children with Juvenile Idiopathic Arthritis and Their Parents: The Role of Child and Parent Psychological Flexibility

ObjectivenChronic pain is central to juvenile idiopathic arthritis (JIA) and is predictive of impaired functioning. Whereas most work has focused on identifying psychosocial risk factors for maladaptive outcomes, we explored the idea that child and parental psychological flexibility (PF) represent resilience factors for adaptive functioning of the child. We also explored differences between general vs pain-specific PF in contributing to child outcomes.nnnMethodsnChildren with JIA (age eight to 18u2009years) and (one of) their parents were recruited at the Department of Pediatric Rheumatology at the Ghent University Hospital in Belgium. They completed questionnaires assessing child and parent general and pain-specific PF and child psychosocial and emotional functioning and disability.nnnResultsnThe final sample consisted of 59 children and 48 parents. Multiple regression analyses revealed that child PF contributed to better psychosocial functioning and less negative affect. Child pain acceptance contributed to better psychosocial functioning, lower levels of disability, and lower negative affect, and also buffered the negative influence of pain intensity on disability. Bootstrap mediation analyses demonstrated that parental (general) PF indirectly contributed to child psychosocial functioning and affect via the childs (general) PF. Parent pain-specific PF was indirectly linked to child psychosocial functioning, disability, and negative affect via child pain acceptance.nnnConclusionsnOur findings indicate that child and parental PF are resilience factors and that pain acceptance buffers the negative impact of pain intensity. Implications for psychosocial interventions that target (pain-specific) PF in children and parents are discussed.

Enuresis and daytime wetting as a biopsychosocial problem : a review

Enuresis is considered to be the most prevalent of all childhood problems with important psychosocial consequences. Thorough research by both medical and psychological disciplines has resulted in a lack of agreement concerning definitions and terminology. Psychiatric classification systems stress phenomenological aspects such as age, frequency and duration of wetting episodes, but are not based on pathophysiologic aspects, whereas the International Children’s Continence Society recommend distinguishing between monosymptomatic enuresis and complex/non-monosymptomatic enuresis depending on the absence or presence of bladder dysfunctions. Several epidemiological and cross-sectional studies show higher scores for behavioral problems in children with enuresis. Parental reports suggest more externalizing problems, attention/hyperactive problems and anxious/withdrawn behavior, however, no difference has been demonstrated in children’s self-report concerning internalizing problems. Four different viewpoints relating to the association between enuresis and psychopathology are described, including their clinical implications. In conclusion, enuresis and daytime wetting is seen as a ‘biopsychosocial’ problem with evidence for pathophysiologic causes and is often associated psychiatric/psychological problems.