Jan L. Wallander

Effects of pediatric chronic physical disorders on child and family adjustment.

Research conducted primarily over the past 5-8 years on the psychosocial effects of pediatric chronic physical disorders on children and their families is reviewed. A large body of studies show that both children and their mothers, as groups, are at increased risk for psychosocial adjustment problems compared to peers, but that there is considerable individual variation in outcome. Since the last review on this topic (Eiser, 1990a), many studies have been conducted to identify risk and resistance factors associated with differences in adjustment among these children and their mothers. Improvements are noted in the theoretical basis for this work, programmatic nature of some of the research, and efforts at producing clinically relevant information. Evaluations of interventions, however, are lagging. Critical issues and future directions regarding developmental approaches, theory, method, measurement, and intervention are discussed.

Social support and adjustment in chronically ill and handicapped children

The relationship between social support and adjustment was investigated in children with a chronic physical illness or handicap. Mothers of 153 children with juvenile diabetes, juvenile rheumatoid arthritis, chronic obesity, spina bifida, or cerebral palsy reported on these childrens family support, peer support, externalizing behavior problems, and internalizing behavior problems. Children reported as having high social support from both family and peers showed a significantly better adjustment than those with high social support from only one of these sources. Chronically ill or physically handicapped children without high support from both family and peers were reported to have significantly more behavior problems than children in general. Both family and peer support contributed negatively and independently to the variance in externalizing behavior problems, whereas only peer support did so for internalizing behavior problems. There were no interactions between type of support and either sex or age in predicting adjustment.

Racial and Ethnic Health Disparities among Fifth-Graders in Three Cities

BACKGROUND For many health-related behaviors and outcomes, racial and ethnic disparities among adolescents are well documented, but less is known about health-related disparities during preadolescence. METHODS We studied 5119 randomly selected public-school fifth-graders and their parents in three metropolitan areas in the United States. We examined differences among black, Latino, and white children on 16 measures, including witnessing of violence, peer victimization, perpetration of aggression, seat-belt use, bike-helmet use, substance use, discrimination, terrorism worries, vigorous exercise, obesity, and self-rated health status and psychological and physical quality of life. We tested potential mediators of racial and ethnic disparities (i.e., sociodemographic characteristics and the childs school) using partially adjusted models. RESULTS There were significant differences between black children and white children for all 16 measures and between Latino children and white children for 12 of 16 measures, although adjusted analyses reduced many of these disparities. For example, in unadjusted analysis, the rate of witnessing a threat or injury with a gun was higher among blacks (20%) and Latinos (11%) than among whites (5%), and the number of days per week on which the student performed vigorous exercise was lower among blacks (3.56 days) and Latinos (3.77 days) than among whites (4.33 days) (P<0.001 for all comparisons). After statistical adjustment, these differences were reduced by about half between blacks and whites and were eliminated between Latinos and whites. Household income, household highest education level, and the childs school were the most substantial mediators of racial and ethnic disparities. CONCLUSIONS We found that harmful health behaviors, experiences, and outcomes were more common among black children and Latino children than among white children. Adjustment for socioeconomic status and the childs school substantially reduced most of these differences. Interventions that address potentially detrimental consequences of low socioeconomic status and adverse school environments may help reduce racial and ethnic differences in child health. (Funded by the Centers for Disease Control and Prevention.).

Daily stress variability, learned resourcefulness, regimen adherence, and metabolic control in Type I diabetes mellitus: Evaluation of a path model.

A model of daily stress and metabolic control in Type I diabetes was tested in which stress has dual effects upon glycemic level: (a) direct, through psychophysiological mechanisms, and (b) mediated, through regimen adherence. Learned resourcefulness was postulated to moderate both effects. Two approaches to measuring daily stress were also compared: stress mean and variability. Daily stress and adherence were measured in 62 adult diabetics on six occasions over 2 months, after which glycosylated hemoglobin levels were obtained. Stress had a direct association with metabolic control that was not mediated by adherence. Although learned resourcefulness failed to moderate this relationship, it did relate directly to metabolic control, in the unexpected direction. The variables combined to explain 37% of the variance in metabolic control. The utility of the intraindividual approach to daily stress measurement was supported.

Association of early childbearing and low cognitive ability.

CONTEXT Teenage pregnancy remains a pressing social issue and public health problem in the United States. Low cognitive ability is seldom studied as a risk factor for adolescent childbearing. METHODS Data from the National Longitudinal Survey of Youth were used in a matched-pairs nested case-control study comparing women who had a first birth before age 18 with those who did not. Significant differences in Armed Forces Qualifications Test scores and in reproductive and social intervening variables were determined using chi-square analyses and t-tests. Multiple logistic regression models determined the independent effects of specific factors on early childbearing. RESULTS Women who had their first birth before age 18 had significantly lower cognitive scores than others; women with a second birth before age 20 had significantly lower scores than those with one teenage birth. On average, women with the lowest cognitive scores initiated sexual activity 1.4 years earlier than those with the highest cognitive scores. Among those who had had a sexuality education course, a smaller proportion of women had scores in the first quartile for the overall sample than in the fourth quartile (20% vs. 28%); an even greater difference was seen among women who correctly answered a question about pregnancy risk (14% vs. 43%). Both poverty and low cognitive ability increased the odds of early childbearing. CONCLUSIONS Young women with low cognitive ability are at increased risk for early initiation of sexual activity and early pregnancy. Further research is needed to design interventions that consider this populations specific information and support needs.

Psychopathology in children and adolescents with intellectual disability: Measurement, prevalence, course, and risk [IF: 0.952]

Publisher Summary This chapter describes the measurement, prevalence, course, and risk of psychopathology in children and adolescents with intellectual disability (ID). Children, including adolescents, with intellectual disability, are at higher risk than children without ID for developing psychopathology, a term used to subsume similar terms, such as mental illness or health problems, psychiatric or behavior disorders, and behavior and emotional problems. Psychopathology in children with ID is also more likely to go unrecognized and untreated. The clinical–medical assessment tradition seeks syndromes of signs and symptoms to distinguish between and among disorders expected to have distinctive organic etiologies and course. Situation specificity of problem behaviors likely contributes to the moderate cross-informant correlation coefficients. The study of the development of psychopathology requires a longitudinal design to enable the explanation of the variance in change of psychopathology from one time point to another, based on the factors measured at the first time point.

Weight status, quality of life, and self-concept in African American, Hispanic, and white fifth-grade children.

This study examined the association between weight status and quality of life (QOL) in fifth‐grade African American, Hispanic, and white children and the potential mediation of this relationship by self‐concept. A sample was recruited from fifth‐grade public school students in three sites, of whom 599 were African American (40%), Hispanic (34%), or white (26%). During a home interview, physical and psychosocial QOL and global and body‐specific self‐concept were measured. Measured height and weight were used to calculate BMI. In this sample, 57% were classified by BMI as not overweight, 17%, overweight, and 26%, obese. Although there was no significant interaction between weight classification and race/ethnicity for QOL, obese children reported significantly lower psychosocial but not physical QOL than those classified as not overweight. There was a significant association between BMI (measured continuously) and psychosocial QOL, but only 2% of the variance was accounted for. Both global self‐concept and body dissatisfaction independently mediated significant portions of the association between BMI and psychosocial QOL. Being obese in childhood may have negative psychosocial effects.

Improving Health Care Utilization, Improving Chronic Disease Utilization, Health Status, and Adjustment in Adolescents and Young Adults With Cystic Fibrosis: A Preliminary Report

We conducted a randomized clinical trial of a 3-session written self-disclosure intervention for patients with cystic fibrosis (CF). Patients (n = 39) who were at least 15 years of age and diagnosed with CF participated in the intervention. Participants in the intervention arm were asked to write in the health care setting about an important emotionally distressing issue of personal significance for a 20-min period of time and two additional 20-min writing episodes at the patients home, which were prompted by telephone calls. Patients in the control condition received standard care alone. Findings revealed that the intervention resulted in a reduction of the number of days patients spent in the hospital over a 3-month period. The intervention did not have an impact on physiological (Forced Expiratory Volume and Body Mass Index or subjective markers of health status. These findings extend those of Pennebakers (cf., J. Smyth, 1998) demonstrating an effect of the written-self-disclosure intervention on health care utilization. These preliminary findings are promising and justify further investigation of the modified intervention in other chronic illness populations.

Self-Concept of Young People with Physical Disabilities: Does Integration Play a Role?.

Different countries have approached the education of students with a disability in different ways. Some have advocated for maximum integration, while others have maintained separate schools for those with special needs. The impact of the different educational settings on the self-concept of young people with a physical disability so far has received very little empirical attention. This study compared four groups of students with a physical disability who differed in their level of school integration: (a) US integrated students ( n = 53), (b) Czech integrated students ( n = 14), (c) Czech students educated at special schools on a daily basis ( n = 51), and (d) Czech students attending special schools on a residential basis ( n = 66). In addition, these young people with a disability were compared to a normative sample of Czech students without a disability. The comparisons were made on self-reported self-perceptions, aggression/emotional instability, view of the world, and dependency using the Personality Assessment Questionnaire (Rohner, 1991). Significant between group differences favouring integration were found. More integrated students reported lower levels of aggression, more positive views of themselves, and more positive views of the world. Discussion addressed implications for educational policies for children with special needs.

Quality of Life as reported by children and parents: a comparison between students and child psychiatric outpatients

BackgroundDuring the recent decade, a number of studies have begun to address Quality of Life (QoL) in children and adolescents with mental health problems in general population and clinical samples. Only about half of the studies utilized both self and parent proxy report of child QoL. Generally children with mental health problems have reported lower QoL compared to healthy children. The question whether QoL assessment by both self and parent proxy report can identify psychiatric health services needs not detected by an established instrument for assessing mental health problems, i.e. the Child Behavior Checklist (CBCL), has never been examined and was the purpose of the present study.MethodsNo study exists that compares child QoL as rated by both child and parent, in a sample of referred child psychiatric outpatients with a representative sample of students attending public school in the same catchment area while controlling for mental health problems in the child. In the current study patients and students, aged 8-15.5 years, were matched with respect to age, gender and levels of the CBCL Total Problems scores. QoL was assessed by the self- and parent proxy-reports on the Inventory of Life Quality in Children and Adolescents (ILC). QoL scores were analyzed by non-parametric tests, using Wilcoxon paired rank comparisons.ResultsBoth outpatients and their parents reported significantly lower child QoL on the ILC than did students and their parents, when children were matched on sex and age. Given equal levels of emotional and behavioural problems, as reported by the parents on the CBCL, in the two contrasting samples, the outpatients and their parents still reported lower QoL levels than did the students and their parents.ConclusionsChild QoL reported both by child and parent was reduced in outpatients compared to students with equal levels of mental health problems as reported by their parents on the CBCL. This suggests that it should be helpful to add assessment of QoL to achieve a fuller picture of children presenting to mental health services.