Kevin Baldwin

Psychiatric and Family Functioning in Children with Leukemia and Their Parents

The present study reports data from a cross-sectional investigation of the psychiatric and psychosocial functioning of 55 children diagnosed with acute lymphocytic leukemia and their families at three points in time: diagnosis (newly diagnosed), 1 year postdiagnosis, and 1 year after the completion of chemotherapy (off-therapy). Results reveal minimal psychopathology in these children and their parents based on self- and informant-reports and structured diagnostic interviews. These families appear to be functioning adequately and report more family cohesiveness and marital satisfaction after chemotherapy was completed. Coping strategies commonly used by children and their parents include problem-solving, a positive outlook, and good communication. Implications for psychiatric consultation are presented.

Adolescent Cancer Survivors: Psychosocial and Familial Adaptation

Adolescent cancer survivors were compared with nondiseased control subjects on measures of adaptation, coping, body image, sexual adjustment, psychopathology, and family functioning. Cancer survivors reported no major difficulties in social competence, overall coping, and family communication. Although their school teachers reported no symptoms of psychopathology, the cancer survivors did report body image disturbances and adjustment difficulties. Further, the surviving adolescents were eager to present themselves favorably. Compared with nondiseased control families, families of survivors were characterized as somewhat inflexible. Implications for clinical practice include the careful monitoring of youth who have survived cancer as well as sensitivity to underlying concerns that the survivors and their families may avoid.

Psychosocial and Family Functioning in Children with Sickle Cell Syndrome and Their Mothers

OBJECTIVE The purpose of this study was to compare the psychiatric functioning of 61 sickle cell youth and their families with nondiseased sibling controls. METHOD Functioning assessed by multiple informants included indices of behavioral, cognitive, and family/interpersonal functioning, self-esteem, life events, coping strategies, temperament, adaptive behavior, and parental psychopathology. RESULTS Key findings were that sickle cell patients evidenced more depressive symptoms and associated attributional style, and externalizing behavioral difficulties than did nondiseased siblings. With age, sickle cell youth evidence increasing adaptive behavior deficits and internalizing symptoms. Illness severity was related to symptoms of internalizing behavior and fewer daily living skills. Associations were found between maternal and child coping. CONCLUSIONS It is recommended that psychiatric consultations routinely be conducted with these children, particularly at times of family stress and developmental transitions. Psychiatric interventions should focus on ameliorating emotional difficulties via enhancing adaptive coping strategies.

Gender differences in a clinic-referred sample of attention-deficit-disordered children

This study of attention-deficit-disordered children revealed that females were more frequently retained in school and evidenced greater impairment on spatial memory tasks. Moreover, there was a trend for girls to be older at the time of referral. With age, the girls evidenced more severity across a wider array of measures, including cognitive functioning, poorer academic achievement, and more problems with peers.

Cognitive Status of Children Treated with Central Nervous System Prophylactic Chemotherapy for Acute Lymphocytic Leukemia

Treatment-related cognitive impairments have been reported for survivors of childhood leukemia following prophylactic central nervous system (CNS) treatment with craniospinal radiation. We examined the neurocognitive status of 46 children with acute lymphocytic leukemia (ALL) to assess the impact of a regimen consisting of systemic chemotherapy and prophylactic CNS chemotherapy. By comparing three groups of ALL children (i.e., patients whose diagnosis was recent, patients 1 year postdiagnosis currently receiving CNS prophylactic chemotherapy, and off-therapy patients who had been treated with chemotherapy for 3 years) and their healthy siblings on measures of sequential and simultaneous processing, we were able to examine the effects of CNS prophylactic and systemic chemotherapy at various points during treatment. Results indicate that the children who had received a 3-year course of chemotherapy (off-therapy patients) were more impaired on tasks involving right-hemisphere simultaneous processing than were sibling controls or ALL children whose diagnosis was recent and whose treatment had just begun. Age at diagnosis did not interact with the effects of chemotherapy. These findings support the need for continued evaluation of cognitive functioning in ALL, children receiving CNS prophylactic chemotherapy to identify potential harmful neurocognitive sequelae of treatment.