The health-related quality of life of children and adolescents in home-based foster care.

OBJECTIVE: To compare the health-related quality of life (HRQL) of 326 children and adolescents aged 6-17 years living in home-based foster care in metropolitan Adelaide, South Australia with the HRQL of a random sample of 3,582 children aged 6-17 years living in the community in Australia. METHOD: In both groups, HRQL was assessed using the 50-item version of the Child Health Questionnaire (CHQ-PF50) completed by caregivers/parents, and the 87-item self-report version of the Child Health Questionnaire (CHQ-CF87) completed by 13-17 year olds. RESULTS: Young people in home-based foster care had significantly poorer HRQL in a wide range of different domains than those in the general community. Furthermore, among children in home-based foster care, those with mental health problems had significantly poorer HRQL in many domains than those without mental health problems. Demographic and placement characteristics of the children in home-based foster care were not significantly associated with differences in HRQL. CONCLUSION: The findings highlight the importance of providing services and resources to improve the quality of life of children living in home-based foster care.

The mental health and wellbeing of children and adolescents in home-based foster care.

OBJECTIVE: To identify the prevalence of mental health problems, rates of suicidal ideation and behaviour, and use of professional mental health services among children and adolescents residing in home-based foster care, and to compare these rates with those reported for children and adolescents in the general Australian community. DESIGN: Cross-sectional survey. PARTICIPANTS AND SETTING: 326 children and adolescents (aged 6-17 years) residing in home-based foster care in the Adelaide metropolitan region between August 2004 and January 2006. MAIN OUTCOME MEASURES: Prevalence of emotional and behavioural problems, suicidal ideation and behaviour, and use of professional services to obtain help for emotional and behavioural problems. RESULTS: 61.0% of children and adolescents living in home-based foster care scored above the recommended cut-off for behaviour problems on the Child Behavior Checklist and 35.2% of adolescents scored above the cut-off on the Youth Self Report. 6.7% of 13-17- year olds in home-based foster care reported a suicide attempt that required medical treatment during the previous year. Caregivers reported that 53.4% of children needed professional help for their mental health problems but only 26.9% had obtained help during the previous 6 months. CONCLUSION: Children in home-based foster care experience high rates of mental health problems but only a minority receive professional help for their problems.

Early childhood externalising behaviour problems: child, parenting, and family-related predictors over time.

This study examined the dynamic relationships between child, parenting, and family-related predictor variables and early childhood externalising behaviour problems. A community sample of 395 Australian children was followed longitudinally, and assessed at 4 and 6 years with the Child Behavior Checklist, Teacher Report Form, and standard measures of parenting, temperament, and familial adversity. Variables based on the average scores across the two assessments and the change in scores between assessments were utilised as predictors of parent-reported and teacher-reported externalising behaviour problems at age 6. It was hypothesised that both higher average scores and more detrimental changes in scores, would independently predict externalising problems at age 6. Multivariable analyses found that the presence of parent-reported child externalising problems in six-year-olds were predicted by: (i) the presence of parent-reported child externalising problems at age 4, (ii) higher average "teacher-reported child externalising behaviour," "inflexible temperament," "non-persistent temperament," and "over-reactive parenting," and (iii) an increased "inflexible temperament" score between age 4 and age 6. The presence of teacher-reported child externalising problems at age 6 was predicted by higher average "parent-reported child externalising behaviour," and "over-reactive parenting." The results provide further evidence of the adverse impact of continuing high levels of temperament difficulties and over-reactive parenting on externalising behaviour in early childhood. However, contrary to expectations, the contribution of including the dynamic change scores was limited.

Treatment burden and health-related quality of life of children with diabetes, cystic fibrosis and asthma.

AIM: To identify the time required by children with cystic fibrosis (CF), diabetes or asthma to complete daily treatment tasks and the hassle they experienced when completing these tasks. To compare parent and child reports of daily treatment time and hassle. To investigate the relationship between treatment time and hassle, and (i) children's health-related quality of life (HRQL); and (ii) disease severity. METHODS: 160 children aged 10-16 years with CF, type 1 diabetes, or asthma were followed over a 2-year period. Information about children's treatment time and hassle, and their HRQL was obtained from parents and children at baseline, 1-year and 2-year follow-up assessments. RESULTS: On average, children with CF reported spending 74.6 +/- 57.0 min completing treatment tasks, children with diabetes spent 56.9 +/- 27.8 min and children with asthma spent 6.4 +/- 9.3 min. Parents reported that children spent less time that was reported by their children. Over the two years, parent and child reports describing treatment time for children with CF did not vary significantly (P = 0.3). Treatment time for children with diabetes increased (P = 0.02) whereas that for children with asthma reduced (P = 0.001). The level of hassle experienced by children when completing individual treatment tasks was low for all three conditions. There was no significant relationship between treatment time and children's HRQL. CONCLUSION: Children with CF or diabetes spent a substantial amount of time each day completing the treatment tasks. Although this was not related to HRQL, it could impact the ability to comply with complex and all home-based-therapies for some children.

The relationship between health-related quality of life, pain, and coping strategies in juvenile arthritis--a one year prospective study.

The aim of this 12-month prospective study was to compare reports describing the health-related quality of life (HRQL) of children with Juvenile idiopathic arthritis (JIA) obtained from parents and children, to investigate the extent to which the children's HRQL changed over a 12-month period, and to describe the relationship between children's HRQL, and their experience of pain and use of pain coping strategies. Fifty-four children aged 8-18 years with JIA and their parents completed standard questionnaires assessing children's HRQL, pain intensity, and pain coping strategies at baseline, 6 months, and 12 months. In general, children reported that their HRQL was better than was reported by parents. Both informants described children's HRQL as being very stable over the 12 months of the study. Consistent with the Biobehavioural Model of Pain, there was a significant negative relationship between children's HRQL and their experience of pain. However, there was little evidence that pain coping strategies mediated the relationship between children's experience of pain and their HRQL.