Madelyn H. Labella

Psychiatric functioning and quality of life in young patients with cardiac rhythm devices

BACKGROUND: Less is known about depression, anxiety and quality of life (QoL) in children and adolescents with pacemakers (PMs) and implantable cardioverter-defibrillators (ICDs) than is known in adults with these devices. METHODS: A standardized psychiatric interview diagnosed anxiety/depressive disorders in a cross-sectional study. Self-report measures of anxiety, depression and post-traumatic stress disorder were obtained. Medical disease severity, family functioning and QoL data were collected. A total of 166 patients were enrolled (52 ICD, 114 PM; median age 15 years). RESULTS: Prevalence of current and lifetime psychiatric disorders was higher in patients with ICDs than PMs (Current: 27% vs. 11%, P = .02; Lifetime: 52% ICD vs. 34% PM, P = .01). Patients with ICDs had more anxiety than a healthy population (25% vs. 7%, P < .01). Patients with ICDs and PMs had similar levels of depression as a healthy population (ICD 10%, PM 4%, reference 4%, P = .29). In multivariate analysis including a medical disease score, demographics, exposure to beta-blockers, activity limitations, hospitalizations, shocks and procedures, the type of device (PM versus ICD) did not predict psychiatric diagnoses when age at implantation and the severity of medical disease were controlled for. Patients with ICDs and PMs had lower physical QoL scores (ICD 45, PM 47.5, Norm 53, P ≤ .03), but similar psychosocial functioning scores (ICD 49, PM 51, Norm 51, P ≥ .16) versus a normal reference population. CONCLUSIONS: Anxiety is highly prevalent in young patients with ICDs, but the higher rates can be attributed to medical disease severity and age at implantation instead of type of device.

Quality of Life and Parental Adjustment in Pediatric Pulmonary Hypertension

BACKGROUND This study examines the impact of pulmonary hypertension (PH) on the quality of life (QoL) of affected youth, as well as the relationships among PH disease severity, parental adjustment variables, and family relational functioning. METHODS Subjects were 47 eligible parents of children with PH aged 2 to 18 years who were evaluated at Boston Childrens Hospital. Measures of patient QoL and of parental stress, coping, and adjustment were administered to the caregivers. Clinicians rated illness severity and family relational functioning. RESULTS Youth with PH scored significantly lower than healthy norms on a measure of parent-reported QoL (total, psychosocial, and physical QoL, each P < .0001). The parents reported encountering stressful events more frequently than published norms of parents of children with cancer (P < .0001). Thirty-four percent of parents of children with PH met criteria for presumed psychiatric diagnosis, and they reported using psychologic coping strategies significantly more often than a normative sample. A summary parental stress measure correlated inversely with child QoL, an effect that held true even after controlling for disease severity (P = .03). CONCLUSIONS PH takes a major toll on children and their families. Decreased QoL among youth with PH was significantly associated with high levels of parental stress, over and above the effect of illness severity. These findings suggest that interventions to better support the caretakers of affected children and adolescents should accompany medical treatment advances so as to improve QoL for patients facing pediatric PH.

Family influences on the development of aggression and violence

Recent research confirms that many of the most salient risk and protective factors for the development of aggression and violence reside in the family system. Family-based risks begin before birth, encompassing genetic and epigenetic processes. Contextual stressors (e.g., poverty, conflict) may impact development directly or indirectly through disrupted parenting behavior, including high negativity, low warmth, harshness, and exposure to violence. The family can also serve as a powerful adaptive system counteracting the risk of aggression and violence. Parents can promote healthy behavioral development through warmth, structure, and prosocial values, as well as by fostering adaptive resources in the child and community. Successful interventions often reduce aggression and violence by supporting parents and families. Recent insights and future directions for research and practice are discussed.

Intergenerational Continuity of Adverse Childhood Experiences in Homeless Families: Unpacking Exposure to Maltreatment Versus Family Dysfunction.

Despite the expanding research on adverse childhood experiences (ACEs) and corpus of studies on intergenerational maltreatment in high-risk families, studies have not examined intergenerational ACEs more broadly, much less in severely disadvantaged families. This study investigated the intergenerational continuity of ACEs in mothers and young children aged 4 to 6 years living in emergency homeless shelters. It also examined whether unpacking ACEs into categories of exposure to maltreatment versus family dysfunction affected intergenerational continuity patterns or child socioemotional problems in school. Negative parenting, in the form of observed inept coercive discipline with children, and cumulative sociodemographic risk were examined as additional predictors of child ACEs and socioemotional problems. Mothers (N = 95; aged 20–45; 64.2% African American, 3.2% African Native, 11.6% Caucasian, 7.4% biracial/multiracial, and 13.6% other) completed questionnaires on parent and child ACEs and cumulative risk factors. They participated in videotaped parent–child interactions rated for observed coercive discipline, and teachers provided reports of children’s socioemotional problems. Results indicated that higher parental ACEs predicted higher child ACEs, with higher numbers of parental ACEs in either category (maltreatment or family dysfunction) predicting higher levels of child ACEs in both categories. However, child exposure to maltreatment, but not family dysfunction, significantly predicted elevations in children’s socioemotional problems. Findings underscore the role of intergenerational childhood adversity in homeless families and also emphasize that unpacking ACEs in children may illuminate key areas of vulnerability for school adjustment.

Educating Homeless and Highly Mobile Students: Implications of Research on Risk and Resilience

Abstract. Homelessness among children in poverty continues to confront schools, educators, and policymakers with major challenges. This commentary summarizes findings from 2 decades of research on academic risk and resilience in children experiencing homelessness. Recent research corroborates the early conclusion that although children experiencing homelessness share many risks with other disadvantaged children, they fall higher on a continuum of cumulative risk. Research also indicates resilience, with many homeless students succeeding in school. Implications for educational practice, training, research, and policy are discussed, particularly regarding school psychology. Evidence underscores the importance of identification, assessment, and administrative data; outreach and communication to ensure that mandated educational rights of homeless children are met; and coordinating education across schools and systems to provide continuity of services and learning. Early childhood education, screening, and access to quality programs are important for preventing achievement disparities that emerge early and persist among these students. Additional research is needed to inform, improve, and evaluate interventions to mitigate risk and promote school success of students facing homelessness.

The legacy of early childhood violence exposure to adulthood intimate partner violence: Variable- and person-oriented evidence.

This study examined prospective pathways from exposure to interparental violence (EIPV) during infancy (ages 0–24 months) and toddlerhood/preschool (ages 25–64 months) to intimate partner violence (IPV) perpetration and victimization in adulthood (ages 23, 26, and 32 years) using 2 complementary approaches. Building on past findings, a variable-oriented approach was used to examine the effects of developmental timing of EIPV in infancy versus toddlerhood/preschool to IPV involvement in early adulthood, at age 23 years. A person-oriented approach next examined whether continuity and change in IPV (persisting, increasing, and decreasing vs. nonviolent patterns) across the transition from early adulthood to adulthood (ages 26 to 32 years) were predicted by developmental timing of EIPV within early childhood and/or contemporaneous adulthood factors (life stress and behavior problems). In this fully prospective longitudinal study beginning at birth, mothers reported on EIPV in infancy and toddlerhood/preschool, and participants (N = 179) reported on IPV and contemporaneous stress and behavior in early adulthood and adulthood. Results indicated that according to the variable-oriented approach, EIPV in toddlerhood/preschool but not in infancy predicted both IPV perpetration and victimization at age 23. The person-oriented approach revealed that, along with life stress and externalizing behavior, EIPV in toddlerhood/preschool, but not in infancy, also differentiated patterns of IPV from ages 26 to 32. Findings converge on toddlerhood/preschool as a particular promising developmental period to intervene and deter long-term effects of EIPV on IPV across the transition from early adulthood to adulthood.

Childhood abuse and neglect, attachment states of mind, and non-suicidal self-injury

ABSTRACT This investigation examined preoccupied attachment states of mind as both a risk factor for non-suicidal self-injury (NSSI) and as a mechanism by which prospectively assessed childhood experiences of abuse and neglect predicted the frequency/severity of NSSI behavior up to age 26 years in 164 individuals (83 females) who were followed from birth in the Minnesota Longitudinal Study of Risk and Adaptation. Preoccupied (but not dismissing) states of mind regarding both childhood caregivers and adult romantic partners were correlated with more frequent/severe NSSI. Furthermore, preoccupied states of mind regarding caregivers partially accounted for the association between childhood abuse/neglect and NSSI. This work represents a rare prospective test of a developmental psychopathology framework for understanding NSSI behavior, in which atypical caregiving experiences are carried forward through attachment representations of caregivers that reflect behavioral risk.

Experiential avoidance, dyadic interaction and relationship quality in the lives of veterans and their partners

This study assessed the mediating pathways of observed couple communication on the dyadic associations between experiential avoidance (EA) and relationship quality. A sample of 228 military couples following combat deployment participated in a conflict discussion and completed self-report measures to assess EA and relationship quality. Results of an actor–partner interdependence model using structural equation modeling indicated that for both dyad members greater EA was associated with their own lower relationship quality. Higher EA in men was associated with more observed negative communication, as well as lower relationship quality in their female partners. Positive couple communication was associated with higher relationship quality in men and in women. Overall, EA demonstrated associations with relationship quality above and beyond couple communication skills. This study points to the importance of EA for the marital system and suggests that interventions targeting EA and positive couple communication skills may strengthen military marital relationships following deployment to war.

The sociocultural context of emotion socialization in African American families

The current paper systematically reviews empirical research on parental emotion socialization in African American families, addressing gaps in a literature that has historically focused on White middle class samples. Of the 1210 studies screened, 329 were inspected, 280 were excluded, and 49 were included. Studies addressed emotion-related beliefs and attitudes, emotion expressiveness, discussion of emotion, and responses to childrens emotion. Mixed findings are interpreted in light of sociocultural factors. An emerging body of research suggests that the celebration and restriction of childrens emotions coexist closely in African American families, perhaps reflecting the joint influence of traditional Afro-cultural values and the historical context of slavery and discrimination. Methodological issues are identified and future directions for research and practice are discussed.

Promoting Resilience by Improving Children's Sleep: Feasibility Among Families Living in Supportive Housing

Abstract: Background: Poverty has been linked to sleep disruption, which is in turn associated with health and behavior problems. Sleep disturbance may be a key mechanism by which poverty affects child development. Objective: To evaluate the feasibility, appeal, and promise of a brief sleep-promoting intervention for low-income families with 4- to 8-year-old children in site-based supportive housing. Methods: University researchers and community partners developed a sleep-promoting intervention (family workshop and bedtime relaxation routine) that was implemented at one supportive housing site. Multiple methods were used to assess feasibility and preliminary effectiveness in 11 participating families. Results: Intervention and research activities were acceptable to families, but adherence to daily sleep measures was low. Most parents reported high satisfaction, and data showed trends of improvement in children’s sleep, behavior, and executive function (EF). Conclusions: A brief sleep-promoting intervention for children in disadvantaged families showed feasibility and promise. Future studies are needed to test the efficacy of a refined version of this sleep intervention with families in similar situations, focusing on decreasing burden, tailoring interventions, and sustaining change.