Pain coping strategies in paediatric patients newly diagnosed with leukaemia compared with healthy peers.

OBJECTIVE: Children with leukaemia experience special difficulties adapting to stressful medical procedures and to the adverse effects of chemotherapy, though they can implement their coping strategies. The aims of the study were to assess whether the coping-with-pain strategies could be influenced by a child's personal and illness factors and to render possible comparisons between children with leukaemia and healthy peers. Another aim was to compare parents' and children's reports on coping strategies. METHODS: A total of 125 patients (average age = 6.79 years; SD = 3.40) with acute leukaemia (lymphocytic leukaemia 90.4% and myeloid leukaemia 9.6%) and age-matched healthy children with their parents were enrolled in the study. A socio-demographic questionnaire and the Waldon-Varni Pediatric Pain Coping Inventory, parent and self-report versions, were administered 1 month after diagnosis. Data regarding the therapy's side effects were recorded. RESULTS: The comparison between proxy-reports of the two groups of parents found significant differences in terms of social support, self-cognitive instructions and catastrophising strategies. Children aged 6-10 years relied more heavily on distraction than children of other ages, using more problem-solving and self-cognitive instructions. The results indicated moderate parent-child agreement. CONCLUSION: Health professionals could help paediatric leukaemic patients in adopting more efficiently pain coping strategies applicable for different ages.

Health-related quality of life in AYA cancer survivors who underwent HSCT compared with healthy peers.

This study was aimed at comparing adolescent and young adult (AYA) Hematopoietic Stem Cell Transplantation (HSCT) paediatric cancer survivors and a control group of healthy peers in terms of Health-Related Quality of Life (HRQOL) and frequency of posttraumatic stress symptoms (PTSS). The participants were 32 AYA HSCT survivors and 28 matched healthy peers. The survivors were, on average, 19.4 years old (SD = 3.8), with an average age of 8.1 years (SD = 4.3) at diagnosis, and with a mean time, since treatment was completed, of 8.5 years (SD = 3.2). The majority of survivors (78.1%) did not show clinical PTSS, with intrusion symptoms most frequently reported in those who had undergone autologous HSCT (F = 3.3; df = 2; p = 0.05) and relapse presence in their treatment associated with more PTSS avoidance symptoms (r = 0.4; p = 0.002). Women reported more problems in the SF-36 pain scale (t = 2.1; df = 31; p = 0.04) than men. Additionally, 87.5% of survivors fell below the 25th percentile in the SF-36 general well-being scale, and 70.8% had the same trend for the SF-36 fatigue scale. Survivors reported better emotional well-being (t = 2.6, df = 27, p = 0.01) and fewer limitations than their healthy peers (t = 2.5, df = 27, p = 0.02), while they perceived a lower life satisfaction referring to the past (t = -2.8, df = 27, p = 0.009).

The Influence of Gifted Children's Stress Management on Parental Stress Levels.

This study explores the associations between gifted children's stress management and parental stress level. A sample of 78 primary school children and their 76 parents took part in this study. Children were screened for intelligence and emotional quotients, while parents were tested for stress levels. Results show that the more children are aware of their stress-management skills, the less parents are stressed out. Moreover, the intelligence quotient is not significant in mediating this association, supporting the idea that it is not an a priori protective factor from a developmental perspective. The study findings suggest that when a child is equipped with the skills to handle stress by harnessing their emotional intelligence, it can have a beneficial effect on the entire family's well-being. Given that these skills can be developed, and the significant positive influence they have on a child's growth and adaptation, it is essential to offer specialized educational programs to gifted children. These programs should aim to enhance their emotional skills, which, in turn, can indirectly bolster the psychological health of the family unit as a whole.

Impact of the COVID-19 Pandemic on Psychosocial Well-being and Adaptation in Children and Adolescents with Asperger's Syndrome.

Mental health could worsen in children and adolescents with autism spectrum disorder during the COVID-19 pandemic. In addition, their parents could be more at risk for an increase in anxiety and depression symptomatology. This study aims to understand the adaptation and the psychosocial well-being in a sample of 16 males aged 10-21 years old with Asperger's syndrome after the quarantine for COVID-19 when they return to school and partially to their activities in September 2020. The adopted approach is multi-informant with a battery of questionnaires on psychological health and adaptation given by a secure online web data Qualtrics both to adolescents and also to their parents. Paralleling matched peers with typical developments were assessed by adopting the same methodology. The results evidenced several difficulties in psychological health in population with Asperger's syndrome, especially in anxiety and socialization. Adaptation is put in crisis, even if they reported a good comprehension and adoption of the right behaviors anti-COVID-19. Parents of children with Asperger's syndrome reported similar psychological difficulties and general health to those of the group of children typically developing. Some clinical indications could be discussed for psychologists who follow children and adolescents with Asperger's syndrome.

Adolescents and young adults with oncohematological disease: use of social networks, impact of SARS-COV-2, and psychosocial well-being.

Objective: Adolescents and young adults (AYA) with oncohematological diseases could have important psychosocial difficulties that could be worsened by the effects of the COVID19 pandemic. At this developmental stage, it is also important to assess the use of social networks (SNs). This study aims to investigate the type of social network use and the consequences of the COVID19 period. These patients are compared with matched healthy peers. Methods: After the informant consent signature, the adolescents completed a series of self-report questionnaires on the use of SNs, on communication preferences, on social anxiety and on Covid19 impact through the online platform of LimeSurvey. Most of the adolescents belonged to the 18-20 age group (42.5%), were female (62%) and mainly off therapy (72%). Results: Adolescents spent more than 2 h/day on Instagram and 1 h and half on Whatsapp, while Tik Tok use was on average 1 h/day, especially used by younger patients (r = -0.33, p = 0.023). Males used Twitch (t45 = -2.06, p = 0.05) and Youtube (t45 = -2.18, p = 0.03) for longer than females. AYA in therapy used more Tik Tok (U = 137.50; p = 0.03), Ask/Tellonym (U = 172.50; p = 0.05) and Twitch (U = 144; p = 0.017) than those off therapy. Healthy AYA showed lower levels of exposure (Z = -4.17; p = 0.00001) and impact (Z = -5.12; p = 0.00001) to Covid19, while the level of social anxiety is comparable and is in the normal range in both groups. Discussion: Some clinical considerations and suggestions could be given based on these empirical results to health professionals in the care of AYA cancer patients.

Social Networking in Adolescents: Time, Type and Motives of Using, Social Desirability, and Communication Choices.

The evolution of digital media has changed the patterns and motives for its use among adolescents and has impacted their communication choices within their family and social networks. The objectives of this study are to understand whether peers communicate through a social network (SN) or by voice and their view of the relative social desirability of these alternatives. After the informant's consent signature, adolescents completed a series of self-report questionnaires on the use of SN, communication preferences, and social desirability online. Most of the adolescents belonged to the 17-19 age group (83.6%) and were female (68.9%). Adolescents spent more than 3 h/day on Whatsapp and more than 2 h/day on Instagram, while the use of Facebook was on average only 35 min/day. Females used digital media longer than males. Adolescents aged 17-19 years choose more Facebook and voice modes compared to adolescents aged 14 and 16 years. Alternative modes of Whatsapp and voice were chosen more than social networks in their communication strategies, especially for negative topics. Motives for use were, in addition to boredom, related to maintaining one's social sphere with peers. Some educative considerations were made based on these results.

Psychological Well-Being, Cognitive Functioning, and Quality of Life in 205 Adolescent and Young Adult Childhood Cancer Survivors Compared to Healthy Peers.

The majority of the studies underlined how adolescent and young adult (AYA) Cancer Survivors had no significant differences in their well-being and quality of life compared with a control group of healthy counterparts, although French et al. (2013) found less years of education among cancer survivors. The present study aimed at comparing AYA cancer survivors and a control group of peers who had no history of serious illness, in terms of well-being, cognitive functioning, and perceptions of life. Participants in this study were 205 AYA cancer survivors, 126 males, off therapy from a mean of 10.87 years (SD = 4.91), with a mean age of 18.96 (SD = 3.08), recruited during follow-up visits and healthy counterparts (n = 205), matched for age and gender. They all completed self-report questionnaires: Ladder of Life, BSI-18 and Cognitive problems. Paired t test evidenced significant differences between survivors (Mean = 6.19; SD = 2.07) and controls (Mean = 6.88; SD = 2.02) in perceptions of quality of life regarding 5 years before the current time [t (204) = -3.39; p = 0.001], with a lower level for childhood cancer survivors. Specifically, Hierarchical regression (R 2 = 0.05, p = 0.04) identified a shorter time since the completion of treatment (ß = 0.18, p = 0.03) and a trend of stem cell transplantation experience (ß = -0.11, p = 0.06) as factors associated with negative perception of precedent quality of life. The AYA cancer survivors reported lower cognitive difficulties (Mean = 1.46) than controls (Mean = 1.56) [t (204) = -3.41; p = 0.001]: in memory (Meanclinical = 1.32 vs Meancontrol = 1.50) [t (204) = -4.52; p = 0.001], in concentration (Mean clinical = 1.36 vs Meancontrol = 1.54) [t (204) = -4.66; p = 0.001] and in mental organization skills (Mean clinical = 1.47 vs Meancontrol = 1.56) [t (204) = -2.56; p = 0.01], even if they had a lower educational attainment [X ( 9 ) 2 = 131.28; p = 0.001]. They showed similar satisfaction with their psychological well-being and their lives as healthy counterparts, except for past life perceptions associated with the cancer period. Important recommendations for future research and clinical suggestions could be given.

ADAPTIVE BEHAVIORS IN YOUNG CHILDREN: A UNIQUE CULTURAL COMPARISON IN ITALY.

On account of a series of unique historical events, the present-day denizens of South Tyrol inhabit a cultural, political, and linguistic autonomous region that intercalates Italians and Austrian/German Italians. We compared contemporary Italian and Austrian/German Italian girls' and boys' adaptive behaviors in everyday activities in this region. Using the Vineland Adaptive Behavior Scales, we first interviewed mothers about their children's communication, daily living, socialization, and motor skills. Main effects of local culture (and no interactions with gender) emerged: Austrian/German Italian children were rated higher than Italian children in both adaptive daily living and socialization skills. Next, we explored ethnic differences in childrearing. Austrian/German Italians reported fostering greater autonomy in their children than Italians, and children's autonomy was associated with their adaptive behavior. Children living in neighboring Italian and Austrian/German Italian cultural niches appear to experience subtle but consequentially different conditions of development that express themselves in terms of differing levels of adaptive behaviors.

Oncological Children and Well-Being: Occupational Performance and HRQOL Change after Fine Motor Skills Stimulation Activities.

Cancer children experience long periods of hospitalization, which are associated with limited performance in several developmental domains and participation restrictions in age appropriate occupations. Fine motor abilities represent building blocks in performing daily life skills and have been found to be closely connected with later academic success. Moreover, medical and psychological sequelae for cancer inpatients may result in diminished daily activities functioning, poor perceived health related quality of life (HRQOL), and increase the likelihood of long-term impairments. This study examines the variations in the occupational performance of children hospitalized for acute lymphoblastic leukemia (ALL) after their participation to a stimulation program designed to enhance fine motor skills. Parents reported significant gains in children's motor functioning, a slight improvement in overall occupational performance related to an increase in the area of productivity and self-care, and a better quality of life perception following the stimulation activities. Feasibility of the stimulation program in a health care setting are discussed evaluating its benefits for cancer children and their families.

The Complex Relation between Executive Functions and Language in Preschoolers with Developmental Language Disorders.

Backgrounds: The relationship between linguistic difficulties and cognitive impairments in children with developmental language disorders (DLDs) is receiving growing interest in international research. Executive functions (EF) appear to be weak in these children. The current investigation aims at exploring the relationship between difficulties in two components of EF (i.e., updating and inhibition) and the linguistic and narrative skills of 16 DLD preschoolers matched with 24 typically developing peers. Methods: Updating skills were tested by administering the forward and backward digit recall subtests of the Wechsler Scales, while children's inhibition abilities were assessed by completion of Developmental Neuropsychological Assessment (NEPSY-II) inhibition tasks. Information on the linguistic skills of the participants was collected through a set of subtests included in the Batteria per la Valutazione del Linguaggio in bambini dai 4 ai 12 anni (Batteria per la Valutazione del Linguaggio; BVL_4-12), assessing articulatory and phonological discrimination skills, lexical production/comprehension, grammatical production/comprehension, and narrative production skills. Results: Findings revealed that DLD children performed significantly lower than their peers on both updating and inhibitory tasks. Linguistic difficulties were found in the DLD group on articulatory/phonological skills, grammatical production/comprehension, and lexical informativeness on narrative production. Measures of EF correlated with linguistic and narrative measures. Conclusion: The current study confirms a significant association between DLD's performances on EF and displayed linguistic skills, suggesting the need to include the assessment of executive functions to target early intervention rehabilitation programs for children with DLDs.

Health Locus of Control in Parents of Children with Leukemia and Associations with Their Life Perceptions and Depression Symptomatology.

In childhood cancer, parents have an important role in the promotion of their children's wellbeing and in their adoption of a locus of control style towards their children's health. The current study aimed at identifying types of locus of control in parents of children with leukemia and the possible association with depressive symptomatology and current life perception. One hundred and four parents were recruited at the Hematology-Oncology Clinic of the Department of Woman's and Child's Health, University of Padua, one month after a leukemia diagnosis. Participants were Caucasian with a mean age of 37.28 years (SD = 5.89), mostly mothers (87.5%) and with a mean of 12.16 years of education (SD = 3.82). After signing the informed consent, they filled in the Ladder of Life, the Brief Symptom Inventory-18 and the Parental Health Locus of Control (PHLOC) questionnaires. Paired-samples t-test (t = -14.42; df = 103; p = 0.0001) showed that parents of children with leukemia were more inclined to have an external locus of control than an internal one. The hierarchical regression analysis model (R2 = 0.34; F = 4.32; p = 0.0001) identified health professional influence (ß = -0.28; p = 0.004), current life perception (ß = -0.3; p = 0.013) and future life perception (ß = -0.26; p = 0.012) as significant predictors of parental depression. Current life perception was best predicted (R2 = 0.25; F = 3.96; p = 0.01) by the parental influence locus of control style (ß = 0.25; p = 0.03). Improving trust in the medical staff care and strengthening the internal locus of control in parents could be a preventive program to cope with parental depression symptomatology.

Pediatric Patients Treated for Leukemia Back to School: A Mixed-Method Analysis of Narratives about Daily Life and Illness Experience.

In the last few years, more children and adolescents healed from leukemia go back to their daily life, even if they can show some psycho-social difficulties. The study adopted semi-structured interviews and a mixed-method approach to examine the narratives of 75 children and adolescents about their return to school post 2-years treatment for leukemia. The aims are to collect their illness experiences, to understand how they feel about school and daily routines and to identify the best socio-demographic and illness predictors of a good re-adaptation to school and daily life. The results show that by increasing age and when the pediatric patient have received a hematopoietic stem cell transplantation, at the stop-therapy time, her/his perception about relationships at school and academic performance decrease, especially if his/her feelings about the disease and follow-up visits are negative.

Impact of Psycho-Educational Activities on Visual-Motor Integration, Fine Motor Skills and Name Writing among First Graders: A Kinematic Pilot Study.

This pilot study presents the effects on acquisition of pre-writing skills of educational activities targeting visual-motor integration and fine motor skills on a convenient sample of first graders. After a 10-week intervention program, visual perceptual skills and fine motor control were tested on 13 six-year-old aged children. Participants completed the Beery-Buktenica VMI and the manual dexterity scale of the Movement ABC-2 at baseline (T1), after the intervention program (T2), and one month after the end of the educational activities (T3). Children's writing pressure, frequency, and automaticity were measured using a digitizer during the administration of name writing test at T1, T2, and T3. The purpose of the study was to investigate changes in visual-perceptual abilities and fine motor skills after the intervention program and examine correlational effects on children's kinematic writing performances. Findings reveal that educational activities impacted positively on children's visual motor coordination component of writing improving VMI scores. No statistically significant difference was detected across the three time points on students' manual dexterity skills. Measurement of writing kinematics allows to report and document variations in children's writing during intervention. This pilot study discusses these findings and their implications for the field on early childhood acquisition of foundational skills for handwriting. It also proposes potential topics for future research on this field.

Psychological Wellbeing in Adolescents with Leukaemia: A Comparative Study with Typical Development Peers.

There is still little research on psychological wellbeing, life satisfaction and reported problems in preadolescents and adolescents under therapy for leukaemia, and also little research comparing them with their healthy peers. The present study aimed to analyse the life satisfaction, hope, psychological wellbeing and reported problems' intensity in 60 patients aged 8-18 during the first year of therapy, to identify those more at risk and to compare their reports with matched healthy peers. A battery of self-reported questionnaires was administered during hospitalisation or day hospital admissions post 6 months and post 12 months from the diagnosis. Younger patients (aged 8-13 years) were more at risk than older ones in their problems' intensity and psychological symptoms; females and Acute Myeloid Leukaemia patients reported lower current life satisfaction perceptions; hope was associated with lower depression symptoms and mood problems. Healthy peers have a better perception of current life, but reported a lower hope score, more anxiety symptoms and more cognitive problems than patients. The first 6 months were more critical for patients' psychological health. Basing on these empirical data, the inclusion of mental health care professionals or supportive psychotherapy into the treatment is recognized as extremely useful.

Who Benefits from An Intervention Program on Foundational Skills for Handwriting Addressed to Kindergarten Children and First Graders?

This study examined the effectiveness of a 10-wk intervention program based on occupational therapy principles on visual-motor integration skills and fine motor abilities in kindergartners and first graders. We recruited 55 students tested three times with the Visual-Motor Integration Test (VMI) and Movement Assessment Battery for Children-2 (MABC-2): before the intervention (T1), post-intervention (T2) and one month later (T3). Research findings: Significant improvements were found on VMI between T1 and T2, particularly for kindergartners. Neither group of children demonstrated changes on manual dexterity scores. The present study showed that the intervention program led to different changes in the at-risk of motor impairment group than in the not at-risk children. Results indicated that games and stimulation activities helped children below the 16th percentile over time in the manual dexterity domain. A gender effect was observed, with female children increasing their abilities over time more than male peers. Future research should concentrate on stimulating fine motor skills in hand manipulation and test how these abilities influence graphomotor skills and handwriting over time. Finally, more research is needed to determine the impact of activities and games carried out in educational settings.

Which Factors Influence Attentional Functions? Attention Assessed by KiTAP in 105 6-to-10-Year-Old Children.

This research revealed the children with difficulties in attentional functions among healthy children attending primary school and aimed to identify the possible sociodemographic factors, such as the child's age, gender, and school grade, that could influence attentive performance. The participants were 105 children aged 6⁻10 years (M age = 8.6; SD = 1.04), attending primary schools. Family economic condition was mostly at a medium level (63.5%), and parents most frequently had 13 years of schooling. The computerized test KiTAP was administered to children to assess their attentional functions. Results showed a higher frequency of omissions and false alarms and a reduced speed in alertness, go/no-go, and sustained attention tasks compared to Italian norms. Hierarchical regression analyses were run with school grade, gender, and current age as independent variables and mean reaction times (and standard deviation), number of omissions, and false alarms as dependent ones. The results showed that male gender and attending a lower grade impacted on lower attentional performance in several subtests. Girls showed the best performances in tests of distractibility and impulsive reaction tendencies, while higher school grade positively influenced divided and sustained attention. These results could be useful to identify children with major attentional difficulties, and some recommendations for future studies and the implementation of attention empowerment programmes are proposed.

The Developmental Pathways of Preschool Children with Acute Lymphoblastic Leukemia: Communicative and Social Sequelae One Year after Treatment.

Early childhood is considered to be a period of rapid development, with the acquisition of abilities predicting future positive school competences. Motor, cognitive, and social difficulties related to cancer therapies heavily impact the development of children with cancer. This study focused on two main aims: To assess the developmental pathways of preschool children with acute lymphoblastic leukemia one year post-treatment and to compare these abilities both with those of a control group of healthy peers and with Italian norms. Forty-four children and their families, recruited through the Hematology-Oncologic Clinic of the Department of Child and Woman Health (University of Padua), agreed to participate in this study. The children's mean age was 4.52 years (SD = 0.94, range = 2.5-6 years), equally distributed by gender, all diagnosed with acute lymphoblastic leukemia. Matched healthy peers were recruited through pediatricians' ambulatories. Each family was interviewed adopting the Vineland adaptive behavior scales. Paired sample Wilcoxon tests revealed that children were reported to have significantly more developmental difficulties than their healthy peers. When compared with Italian norms, they scored particularly low in verbal competence, social, and coping skills. No significant association was found between treatment variables and developmental abilities. These findings suggest that the creation of specialized interventions, both for parents and children, may fill the possible delays in children's development probably due to stress, lack of adequate stimulation, or difficult adaptation.

Self-Esteem and Academic Difficulties in Preadolescents and Adolescents Healed from Paediatric Leukaemia.

Adolescents with cancer may demonstrate problems in their self-esteem and schooling. This study aims to screen the preadolescents and adolescents more at risk in their self-esteem perception and schooling difficulties post-five years from the end of therapy. Twenty-five paediatric ex-patients healed from leukaemia were recruited at the Haematology-Oncologic Clinic (University of Padua). The mean age of the children was 13.64 years (Standard Deviation (SD)) = 3.08, range = 10-19 years), most were treated for acute lymphoblastic leukaemia (ALL) (84%) and relatively equally distributed by gender. They filled in the Multidimensional Self-Esteem Test, while parents completed a questionnaire on their child's schooling. Global self-esteem was mostly below the 50 percentile (58.5%), especially regarding interpersonal relationships (75%). An independent sample t-test showed significant mean differences on the emotionality scale (t = 2.23; degree of freedom (df) = 24; p = 0.03) and in the bodily experience scale (t = 3.02; df = 24; p = 0.006) with survivors of Acute Myeloid Leukaemia (AML) having lower scores. An Analysis of Variance (ANOVA) showed significant mean differences in the bodily experience scale (F = 12.31; df = 2, p = 0.0001) depending on the survivors' assigned risk band. The parent reports showed that 43.5% of children had difficulties at school. Childhood AML survivors with a high-risk treatment were more at risk in their self-esteem perceptions. Preventive interventions focusing on self-esteem and scholastic wellbeing are suggested in order to help their return to their normal schedules.

Motor skill delays in pre-school children with leukemia one year after treatment: Hematopoietic stem cell transplantation therapy as an important risk factor.

CNS-directed therapies for the treatment of leukemia can adversely affect the acquisition of new skills, such as reading/writing and math. Two years after the end of treatments, children show gross and fine motor skill delays that may persist even when patients are considered healed. The goal of the present study was to assess motor skills difficulties in pre-school children with leukemia one year after treatment. Particular attention has been paid to those patients who had undergone Hematopoietic Stem Cell Transplantation (HSCT) and to the relationship between motor delays and age bands. Participants were 60 children (median age of 5; inter quartile range: 3.07-5.76), including 31 females and 29 males, 91.7% of them were affected by acute lymphoblastic leukemia (ALL), and 8.3% by acute myeloid leukemia (AML). Five children had undergone HCST. Parents were interviewed by Vineland Adaptive Behavior Scales (VABS) on children's motor skills and filled in the Italian Temperament Questionnaire (QUIT). VABS's total scores were converted into equivalent mental age scores (EMA). A score difference of at least three months between current age and equivalent mental age was considered a developmental delay. Non-parametric analyses were run to understand if HSCT treatment and a specific age band influence children's motor skills. Significant delays were found in global motor skills (56.7%) as well as in fine and gross motor domains. Mann Whitney U tests showed that children with HSCT were reported to have lower gross motor mean ranks (U = 62; p = 0.004; Mean rank = 15.40) than peers without HSCT (Mean rank = 31.87) and lower mean rank values on motor temperament scale (U = 9; p = 0.003; HSCT Mean rank = 4.75 versus no HSCT Mean rank = 27.81). Kruskal Wallis' tests identified the high risk treatment showing that HSCT experience negatively impacted the motor skills and temperamental motor activity of pre-school children one year after the diagnosis of leukemia.