Psychosocial Experiences That Support Positive Self-Concept in Children with Cleft Lip and Palate Adopted From China.

OBJECTIVE: Existing psychosocial research offers little information on the unique challenges and strengths of children adopted from China with cleft lip and/or palate (CL/P). The present study aimed to understand biopsychosocial factors that support positive self-concept in this population. DESIGN: Qualitative, semistructured interviews were conducted with children and their parents. Interpretive phenomenological analysis of transcribed interviews was utilized for data analysis. SETTING: Participants were recruited in an outpatient, pediatric multidisciplinary cleft clinic during a standard team visit. PATIENTS, PARTICIPANTS: Participants were ages 8 to 12 years with a diagnosis of isolated cleft lip-palate who were internationally adopted from China before the age of 2 years and English-speaking. Participants also included English-speaking parents. RESULTS: Themes reflecting data from the child and parent subsamples include: (1) child's characteristics, (2) family strengths, (3) adoption identity, (4) cultural identity, (5) coping with a cleft, and (6) social factors. Additional 2 to 3 subthemes were identified for the parent and child subsamples within each broader theme. CONCLUSIONS: Findings from this sample suggested factors supporting positive self-concept included pride and self-efficacy in activities, family support, instilment of family values, strategies for coping with a cleft, family belonging, cultural exposure, and normalization of differences. Medical providers can support patients and families by providing education on surgeries, CL/P sequelae and outcomes, and pediatric medical stress. Mental health providers can screen for social and emotional challenges and provide psychoeducation on racial/ethnic socialization, identity development, and coping.

Child Sexual Behavior Inventory: normative, psychiatric, and sexual abuse comparisons.

A normative sample of 1,114 children was contrasted with a sample of 620 sexually abused children and 577 psychiatric outpatients on the Child Sexual Behavior Inventory (CSBI), a 38-item behavior checklist assessing sexual behavior in children 2 to 12 years old. The CSBI total score and each individual item differed significantly between the three groups after controlling for age, sex, maternal education, and family income. Sexually abused children exhibited a greater frequency of sexual behaviors than either the normative or psychiatric outpatient samples. Test-retest reliability and interitem correlation were satisfactory. Sexual behavior problems were related to other generic behavior problems. This contributed to the reduced discrimination between psychiatric outpatients and sexually abused children when compared to the normative/sexually abused discrimination.

Brief report: a cognitive behavioral intervention for distressed adolescents with type I diabetes.

OBJECTIVE: To examine the impact of a cognitive behavioral intervention for distressed adolescents with Type I diabetes. METHODS: Six youths with elevated levels of anxiety, anger, or diabetes stress received training in cognitive restructuring and problem solving in individual sessions. A multiple baseline design across participants was used. Treatment effectiveness was assessed through measures of anxiety, anger expression, and diabetes stress. RESULTS: Four youths displayed some improvement on one or more variables for which they had elevated levels during baseline, while others showed no impact. CONCLUSIONS: Cognitive behavioral interventions show some promise for distressed youths with Type I diabetes. Individual youths responded to treatment differently. Further research is needed in developing procedures to better meet the needs of youths, improve youth participation, and enhance treatment effectiveness.

A stress management intervention for adolescents with type 1 diabetes.

PURPOSE: The purpose of this project was to examine the effectiveness of a stress management training program in helping adolescents with diabetes cope with stress. METHODS: Youths who displayed evidence of metabolic control problems received training in the use of both cognitive-restructuring and problem-solving strategies. Treatment impact was assessed on measures of coping, anxiety level, diabetes-specific stress, and metabolic control. RESULTS: Analyses of covariance showed no differences between the training group and a control group at posttest and follow-up. However, the small sample size and within-group variability may have precluded finding significant results. Therefore, within-group comparisons were conducted, and improvements were found in the training group on pretest to posttest and pretest to follow-up comparisons for anxiety, stress, and coping measures. No differences were found in the control group. CONCLUSIONS: Results suggest that the intervention had some positive impact, although this interpretation must be considered preliminary. Future research should replicate this study and explore the applicability and effectiveness of this intervention in specific populations.

Social, emotional, and behavioral functioning of children with cancer.

OBJECTIVE: It was hypothesized that children with cancer would have more social problems and difficulties with emotional well-being than case control, same race/gender, similarly aged classmates. STUDY DESIGN: Using a case controlled design, children with any type of cancer requiring chemotherapy except brain tumors (n = 76), currently receiving chemotherapy, ages 8 to 15, were compared with case control classroom peers (n = 76). Peer relationships, emotional well-being, and behavior were evaluated based on peer, teacher, parent, and self-report, and were compared using analysis of variance and structural equation modeling. RESULTS: Relative to case controls, children with cancer were perceived by teachers as being more sociable; by teachers and peers as being less aggressive; and by peers as having greater social acceptance. Measures of depression, anxiety, loneliness, and self-concept showed no significant differences, except children with cancer reported significantly lower satisfaction with current athletic competence. There were also no significant differences in mother or father perceptions of behavioral problems, emotional well-being, or social functioning. Scores on all standardized measures were in the normal range for both groups. Comparisons of the correlation matrices of children with cancer and to the correlation matrix of the comparison children using structural equation modeling suggested they were not significantly different. CONCLUSIONS: Children with cancer currently receiving chemotherapy were remarkably similar to case controls on measures of emotional well-being and better on several dimensions of social functioning. These findings are not supportive of disability/stress models of childhood chronic illness and suggest considerable psychologic hardiness.

Post-traumatic stress disorder in children and adolescents exposed to violence.

The common biopsychosocial sequelae of violence exposures are reviewed, with a focus on post-traumatic stress disorder in developmental, clinical, and familial contexts. Challenges to assessment are reviewed, and implications for prevention and treatment are presented. Pediatricians have an essential role to play in secondary and tertiary prevention through the use of anticipatory guidance and victimization as a marker of developmental risk.

Conceptualizing and scaling the developmental structure of behavior disorder: the Lifetime Alcohol Problems Score as an example.

We contrast the current, clinically based framework for behavior disorder against a life course framework, as an alternative structure upon which to map the variations in onset and stability of clinical symptomatology known to take place in adult life. This alternative developmental framework is used as a base around which to understand known variations in rates of alcohol abuse/dependence over the life course and to review existing schemes for the evaluation of developmental variation in "caseness." From this work, it was proposed that symptom structure be regarded as a mass of greater or lesser breadth, with properties of extensiveness in time and life course invasiveness, as a function of where in the life course the symptomatology first emerged, and the degree to which the mass sustained itself in developmental time. This framework guided the construction of a time-based measure of alcohol related symptomatology, called the Lifetime Alcohol Problems Score (LAPS). The LAPS discriminated among a variety of alcohol-specific and nonalcohol-specific measures of alcohol-related difficulty, including diagnosis of alcohol dependence, having been in treatment, level of other psychopathology, and measures of family disorganization. The measure has potential applicability for prospective studies, and in estimating clinical prognosis. The utility of the paradigm as a framework within which to conceptualize the emergence, ebb, and flow of other behavior disorders is also discussed.

Potential bias in classroom research: comparison of children with permission and those who do not receive permission to participate.

Compared both the social reputation and preference/acceptance of children who received (n = 4,073) and did not receive parental consent (n = 469) to participate in classroom-based sociometric research. Peers and teachers described nonparticipants as less sociable. Peers described nonparticipants as being lower on social acceptance, more aggressive, and less academically competent. No significant differences were obtained for sensitive/isolated characteristics, appearance, or athleticism. There were no significant interactions between consent status and sex or age. Associations between social reputation and social preference scores were similar for participants and nonparticipants. The findings suggest that children who do not return consent forms are systematically different from classmates who participate, although these differences were modest. Further work is needed to determine why children do not participate.

Cognitive behavioral interventions for adolescents with cystic fibrosis.

Examined the effectiveness of a cognitive behavioral intervention to help adolescents with cystic fibrosis (CF) cope with daily stressors. Five youths were referred for the therapy by medical staff because of perceived problems with anxiety or coping. Treatment impact was assessed on measures of coping, anxiety, perceptions of functional disability, and parental reports of behavior. A multiple baseline design across subjects was used. Reductions in anxiety, a decrease in maladaptive coping efforts with CF-related problems, and an increase in positive coping with CF-related problems were obtained. Youths also reported a decrease in functional disability due to CF after the initiation of the intervention. Follow-up assessment indicated that most youths maintained gains in anxiety and perceived functional disability, but not coping efforts. Results suggest that cognitive behavioral treatment is a viable intervention for anxious youths with CF.

Peer relationships and emotional well-being of youngsters with sickle cell disease.

Comparisons with measures of peer relationships and emotional well-being were made between youngsters with sickle cell disease (SCD) and same-classroom comparison peers. Relative to the comparison subjects, females with SCD were perceived by peers as being less sociable and less well accepted; males with SCD were perceived as being less aggressive than comparison peers. For both males and females with SCD, no other differences were identified on numerous measures of emotional well-being. None of the multiple measures of illness severity were significantly related to measures of psychological adjustment. The common side effects of SCD, chronic fatigue and small physical size, may divert males with the illness from manifesting difficulties related to aggressive behavior with peers. For females with the illness, the common side effects of the illness may hinder the development of normal social relationships. Despite chronic exposure to numerous stressful life events associated with SCD, the youngsters with the illness were remarkably similar to comparison peers, showing evidence of considerable hardiness.

Social competence of siblings of children with sickle cell anemia.

Examined the peer relationships of siblings of children with SCA (N = 37), comparing them to a matched group of classroom comparison children who were the same race/gender, closest date of birth. Social reputation was examined from the perspective of teacher and peers; peer ratings and nominations of social acceptance were obtained; and information was obtained about the sibling's own view of their peer relationships. No differences were found between the two groups, suggesting that the overall functioning of this group of siblings was comparable to peers in their classrooms. Findings are discussed in terms of professional biases, the lack of empirical data relevant to the issue of sibling competence, and resilience.

Mealtime interactions and family relationships of families with children who have cancer in long-term remission and controls.

This study investigated reports of parents (mothers and fathers) of 25 children with cancer in long-term remission and matched neighborhood control families on issues related to the quality of mealtime interactions, and the relationship between parental reports of overall family functioning and the quality of mealtime interactions. Results showed positive correspondence for both groups between fathers' and mothers' reports of favorable family environments (greater cohesion and expressiveness, less conflict) and positive mealtime interactions. No significant differences were found between parents of children with cancer and control parents with regard to mealtime conflicts, current concerns about their child's eating, or satisfaction with the child's food intake. The data demonstrate a moderate relationship between overall family functioning and the quality of mealtime interactions, but suggest a minimal relationship between children with cancer in long-term remission who are at low nutritional risk and the quality of mealtime interactions.

Adjustment in the peer system of adolescents with cancer: a two-year study.

Evaluated the psychosocial adaptations of adolescents with cancer who were primarily off treatment (n = 19, ages 11-18) as compared with matched classroom controls in a 2-year longitudinal study on indices of (a) teacher, peer, and self-perceptions of social reputation; (b) multiple measures of popularity and friendships; and (c) self-reported feelings of loneliness, depression, and self-concept. Adolescents with cancer continued to have a social reputation as being more socially isolated, but no significant differences were identified on multiple measures of social acceptance or the self-reported feelings. In general, adolescents with cancer were similar to peers on numerous dimensions of psychological functioning manifesting minimal discernable psychosocial late effects.

Social interactions between children with cancer or sickle cell disease and their peers: teacher ratings.

We evaluated the social reputation of children with cancer (nonprimary brain tumors) (n = 26) children with a primary malignancy involving the central nervous system (n = 15), and children with sickle cell disease (SCD) (n = 33) using a standardized measure of social reputation, the Revised Class Play (RCP). Each child's classroom teacher completed the RCP, an instrument designed to assess sociability-leadership, aggressive-disruptive, and sensitive-isolated interpersonal qualities. Matched-pairs analyses comparing the child with chronic illness to one peer in each class who was the same gender/race and the closest date of birth showed children with cancer were nominated more often for sociability-leadership roles and less often for aggressive-disruptive roles. Brain tumor survivors were nominated more often for sensitive-isolated roles. Children with SCD were not significantly different from peers. Findings suggest that the stressful life events associated with cancer or SCD did not have a significant negative impact on social adjustment for school-aged children with these diseases. The data demonstrate the critical need for appropriate controls when evaluating psychosocial morbidity and chronic illness. Better understanding of the processes of resilience for these children who are routinely exposed to heightened stress provides an opportunity to improve the competence of other high-risk youth.

Differences in the child-rearing practices of parents of children with cancer and controls: the perspectives of parents and professionals.

Obtained self-reports of parenting practices from fathers and mothers of 24 children with cancer, and 24 controls using the Child-Rearing Practices Report (CRPR). Cancer patients were primarily in long-term remission and represented a typical pattern of childhood malignancies. Same age/sex controls were recruited from the classrooms of the children with cancer. In addition, CRPR ratings were obtained from experts in pediatric oncology based upon their prediction of how a parent of a child with cancer would respond. The experts predicted differences in the areas of overinvolvement, discipline, worry about the child, nutritional concerns, and use of supernatural explanations. Results from parents showed surprising similarity between the parents of children with cancer and control parents, and disagreement with the experts. Discussion focuses on explanations for this apparent contradiction.