Effects of War, Terrorism and Armed Conflict on Young Children: A Systematic Review.

Millions of children have been maimed, displaced, orphaned and killed in modern warfare that targets civilian populations. Several reviews have documented the impact of political trauma on children's mental health but none has focused specifically on young children (ages 0-6). Since developmental factors influence the young child's perception and experience of traumatic events, this developmental period is characterized by a unique spectrum of responses to political trauma. This systematic review, comprising 35 studies that included a total of 4365 young children, examined the effects of exposure to war, conflict and terrorism on young children and the influence of parental factors on these effects. Results showed that effects include PTSD and post-traumatic stress symptoms, behavioral and emotional symptoms, sleep problems, disturbed play, and psychosomatic symptoms. Correlations emerged between parental and children's psychopathology and, additionally, family environment and parental functioning emerged as moderators of the exposure-outcome association for children.

Providing care to a child with cancer: a longitudinal study on the course, predictors, and impact of caregiving stress during the first year after diagnosis.

OBJECTIVE: This study investigated the course, predictors, and impact of caregiving stress on the functioning of primary caregivers of children with cancer during the first year after a child's cancer diagnosis. METHODS: Primary caregivers (N = 95, 100% mother, 86% response rate) of consecutive newly diagnosed paediatric cancer patients (0-18 years) completed measures of caregiving stress, depressive symptoms, anxiety, and self-reported health at diagnosis, and 3, 6, and 12 months thereafter. RESULTS: Results indicated a significant decrease in caregiving stress (especially during the first 3 months after diagnosis). Caregiving stress was predicted by single marital status and the ill child being the mother's only child. Multilevel analyses, controlled for socio-demographic and medical covariates, showed that, over time, the decline in caregiving stress was accompanied by a reduction in depressive symptoms and anxiety. The amount of variance explained by caregiving stress was 53% for depressive symptoms, 47% for anxiety, and 3% for self-reported health. CONCLUSIONS: The present study suggests that caregiving stress is an important factor in understanding parental adjustment to childhood cancer. This offers possibilities for developing interventions aimed at preventing caregiving stress, and strengthening mothers' confidence in their ability to provide good care.

Mental health professionals' awareness of the parental functioning of persons with severe mental disorders: a retrospective chart study.

BACKGROUND: The proportion of persons with severe mental illness (SMI) who are parents has increased in recent decades. Children of parents with SMI are at increased risk for medical, behavioral, emotional, developmental, academic, and social problems. They also have an increased risk for injuries, accidents, and mortality, addictions, and various psychiatric disorders compared to children of parents with no such diagnoses. We aimed to examine the extent to which mental health professionals (MHPs) who treat adult patients with SMI in ambulatory settings are aware of these individuals' functioning in three parenting domains: parental functioning, familial support system and children's conditions. We also compared psychiatrists' awareness with that of psychologists and social workers. METHODS: In this retrospective practice-oriented study, we reviewed 80 clinical files of individuals diagnosed with schizophrenia, affective disorder or personality disorder treated in a mental health outpatient clinic, using the Awareness of Family's Mental Health Checklist (AFMHC) developed for this study. Thus, awareness was determined on the basis of what was recorded in the patient file. RESULTS: Almost half of the MHPs were unaware to their patients' parental functioning as only 44% of files contained records relating to this issue. Awareness to other domains was even lower: 24% of files contained information on patient's support system and 12% had information about their children's mental and/or physical health. No statistically significant differences between psychiatrists and other MHPs were found with regards to awareness to the various domains. Positive correlations were found among MHP's for awareness in the three domains. CONCLUSION: Lack of awareness among MHPs to their patients' parental functioning is not specific to a certain profession and may be attributed to patients (e.g., reluctance to disclose relevant information) or to MHPs (e.g., lack of training). Awareness of family and parental functioning by MHPs working with persons with SMI should be part of a standard procedure, integrated into policy and training.

Social Determinants of Health and ADHD Symptoms in Preschool-Age Children.

OBJECTIVE: Attention-Deficit/Hyperactivity Disorder (ADHD) disproportionately affects socioeconomically disadvantaged children, but for unclear reasons. We examined the association between social determinants of health (SDH) and ADHD symptoms in a national sample of preschool-age children. METHODS: We conducted exploratory factor analysis (EFA) and exploratory structural equation modeling (ESEM) with a sample of 7,565 preschool-age children from the 2016 National Survey of Children's Health, to examine the association between ADHD symptoms and SDH. RESULTS: EFA indicated a one-factor structure for ADHD symptoms, and three factors for SDH (socioeconomic status, access to basic needs, and caregiver well-being). Independently, all three SDH were significantly associated with higher ADHD symptoms. However, in the ESEM model, only worse caregiver well-being (ß = .39, p < .01) was significantly associated with ADHD symptoms, and fully mediated the relationship between SDH and ADHD symptoms. CONCLUSION: Addressing caregiver well-being in preschoolers with ADHD symptoms could be an early intervention strategy.

Effects of Covid-19 lockdown on parental functioning in vulnerable families.

Objective: The aim of this study was to increase the knowledge about how the initial Covid-19 lockdown influenced parental functioning in vulnerable families. Background: The Covid-19 pandemic has caused major changes to family life. Using a natural experiment design can potentially adjudicate on former inconclusive findings about the effects of lockdown on parental functioning in vulnerable families. Method: Responses from parents in a sample of potentially vulnerable families in Norway were divided into a lockdown group if participating at baseline and during the initial Covid-19 lockdown (n = 820 responses) or into a control group if participating at baseline and before lockdown (n = 1368 responses). Mixed model regression analyses were used to mimic a wait-list design investigating direct lockdown effects on mental health, parenting stress, and three aspects of interparental conflicts, as well as moderation effects. Results: The lockdown group showed significantly higher levels of parenting stress compared with the control group, but no aversive lockdown effect on mental health or destructive conflicts were found. In fact, decreased levels of verbal aggression and child involvement in conflict were found during lockdown among parents living apart. Pre-existing financial problems and conflict levels, age of youngest child, and parent gender did not moderate the lockdown effects. Conclusion: The initial lockdown did not seem to adversely affect parental functioning, beyond increased parenting stress. Caution should be taken when generalizing the findings as child effects and long-term lockdown effects were not investigated.

Family Hardiness and Parent and Family Functioning in Households with Children Experiencing Adverse Life Conditions: a Meta-Analysis.

OBJECTIVE: The purposes of the meta-analysis were to evaluate the relationship between family hardiness and different dimensions of parent and family functioning in households experiencing adverse child or family life events and circumstances and determine if family hardiness had either or both stress-buffering and healthenhancing effects on parent and family functioning. METHOD: Studies were included if the correlations between family hardiness and different dimensions of parental or family functioning were reported. The synthesis included 53 studies (N = 4418 participants) conducted in nine countries between 1992 and 2017. RESULTS: showed that family hardiness was related to less parental stress, anxiety/depression, and parenting burden/demands and positively related to parental global health, well-being, and parenting practices. Results also showed that family hardiness was negatively related to family stress and positively related to family life satisfaction, adaptation, and cohesion. The effects sizes between family hardiness and positive parent and family functioning indicators were larger than those for stress-buffering indicators. Child and family life events and child age moderated the relationship between family hardiness and family but not parental functioning. CONCLUSION: The results are consistent with the hypothesis that family hardiness is an internal resource that simultaneously has stress-buffering and health-enhancing effects on parent and family functioning.

OBJETIVO: el presente metaanálisis buscó evaluar la relación entre resistencia y diferentes dimensiones del funcionamiento parental y familiar en hogares que experimentan acontecimientos vitales adversos tanto familiares como del niño/a. El segundo objetivo fue determinar si la resistencia familiar tenía un efecto amortiguador del estrés y/o el aumento de la salud en el funcionamiento parental y familiar. MÉTODO: Se incluyeron aquellos estudios que aportaban la correlación entre la resistencia familiar y una o más dimensiones de funcionamiento parental y familiar. La síntesis incluyo 53 estudios (N = 4418 participantes) llevados a cabo en nueve países entre 1992 y 2017. RESULTADOS: No se encontró sesgo en la publicación de los tamaños de los efectos de los informes de investigación en el metaanálisis. Los resultados mostraron que la resistencia familiar estaba relacionada con menos estrés parental, ansiedad/depresión y demandas/cargas parentales y se relacionaba positivamente con la salud parental global, el bienestar emocional y las prácticas parentales. Los resultados también mostraron cómo la resistencia familiar se relacionaba de manera negativa con el estrés familiar y de manera positiva con la satisfacción con la vida, adaptación y cohesión. Los tamaños del efecto entre resistencia familiar e indicadores positivos de funcionamiento familiar y parental fueron mayores que los de la amortiguación del estrés. CONCLUSIONES: Los acontecimientos de la vida del niño/a y de la familia, junto con la edad del niño/a, moderaban la relación entre la resistencia y el funcionamiento familiares, pero no el funcionamiento parental. Los resultados son consistentes con la hipótesis de que la resistencia familiar es un recurso interno que de manera simultánea tiene un efecto amortiguador del estrés y el aumento de la salud para el funcionamiento parental y familiar.

Parental illness intrusiveness and youth glycaemic control in type 1 diabetes: intergenerational associations and processes.

OBJECTIVE: This study examined associations between the functioning of youth with type 1 diabetes and their parents, including parenting dimensions as intervening mechanisms. The study adds to the existing literature by focusing on (1) the concept of parental illness intrusiveness; (2) the (understudied) periods of adolescence and emerging adulthood; and (3) maternal and paternal functioning. DESIGN: Questionnaires were completed by 317 patient-mother dyads and 277 patient-father dyads. All patients (aged 14-25) had type 1 diabetes. The hypothesised model was compared to an alternative model using structural equation modelling. MAIN OUTCOME MEASURES: Youth reported on depressive symptoms and treatment adherence; Physicians provided HbA1c-values. Parents reported on illness intrusiveness, depressive symptoms, and their child's treatment adherence. Patients and parents reported on psychological control and overprotection. RESULTS: The hypothesised path model had a good fit to the data. Parental illness intrusiveness was positively associated with depressive symptoms and both were positively related to overprotection and psychological control. Psychological control was positively related to patients' depressive symptoms and negatively to treatment adherence. Poorer treatment adherence was associated with worse HbA1c-values. CONCLUSION: These findings underscore the relevance of parental illness intrusiveness and emphasise the importance of mothers' and fathers' roles throughout adolescence and emerging adulthood.

The Relationship Between Parental Affective Temperament Traits and Disruptive Behavior Disorders Symptoms in Children With ADHD.

OBJECTIVE: This study investigated the relationship between parental affective temperaments and the oppositional defiant disorder (ODD) and conduct disorder (CD) symptoms of children with ADHD. METHOD: The sample consisted of 542 treatment-naive children with ADHD and their biological parents. Children were assessed via both parent- and teacher-rated behavioral disorder scales. Parental affective temperament and ADHD symptoms were measured by self-report inventories. The relationships between psychiatric variables were evaluated using structural equation modeling. RESULTS: According to parent-rated behavioral disorder scales, paternal cyclothymic and maternal irritable temperaments were associated with ODD scores, and maternal depressive temperament was associated with CD scores. In terms of teacher-rated behavioral disorder scales, maternal anxious temperament was associated with ODD scores, and paternal cyclothymic and maternal depressive temperaments were associated with CD scores. CONCLUSION: These results suggest that certain parental affective temperaments are related to an increase in symptoms of disruptive behavioral disorders in children with ADHD.

Managing Everyday Occupations as a Predictor of Health and Life Satisfaction Among Mothers of Children With ADHD.

OBJECTIVE: Raising a child with special needs disturbs the balance of family life and affects mothers' everyday life. The purpose of this study was to assess the contribution of occupational competence, occupational settings, and role load to the health and life satisfaction of Arab mothers of children with and without ADHD. METHOD: Participants included 40 Israeli Arab women aged 25 to 40 years. Half were mothers of children with ADHD and half were mothers of children without ADHD. Data were collected by using four self-report questionnaires. RESULTS: Occupational competence and occupational settings predicted mothers' mental health and life satisfaction. Having or not having a child with ADHD only reflects a minor contribution. CONCLUSION: Enhancing mothers' occupational competence and settings may increase their health and life satisfaction. This study highlights the need to focus on maternal occupational competence and settings as they affect mothers' health and well-being when providing intervention to children with ADHD.

Atypical Activations of Fronto-Cerebellar Regions During Forethought in Parents of Children With ADHD.

OBJECTIVE: Although several studies suggest heritability of ADHD, only a few investigations of possible associations between people at risk and neural abnormalities in ADHD exist. In this study, we tested whether parents of children with ADHD would show atypical patterns of cerebral activations during forethought, a feature of working memory. METHOD: Using Functional Magnetic Resonance Imaging (fMRI), we compared 12 parents of children with ADHD and 9 parents of control children during a forethought task. RESULTS: Parents of children with ADHD exhibited significantly increased neural activations in the posterior lobes of the cerebellum and in the left inferior frontal gyrus, relative to parents of control children. CONCLUSION: These findings are consistent with previous reports in children and suggest the fronto-cerebellar circuit's abnormalities during forethought in parents of children with ADHD. Future studies of people at risk of ADHD are needed to fully understand the extent of the fronto-cerebellar heritability.