Assessing readiness to change the balance of responsibility for managing type 1 diabetes mellitus: adolescent, mother, and father perspectives.

OBJECTIVE: This study examined the reliability and validity of items assessing adolescent and parent readiness to change the balance of responsibility for managing type 1 diabetes mellitus (T1DM). METHODS: Sixty-nine adolescents with T1DM and their caregivers completed questionnaires assessing readiness to change the balance of responsibility, division of responsibility for diabetes management tasks, self-efficacy, and parenting stress. Stages of change classifications were determined for individual respondents and families. RESULTS: Participant inclusion in the different readiness to change classifications was associated with the variability in scores for indices of responsibility, self-efficacy, and parenting stress. Adolescent, maternal, and paternal characteristics accounted for differing amounts of variance in predicting readiness to change the balance of responsibility scores. CONCLUSIONS: Individual assessment of youth and caregivers' readiness to change the balance of responsibility for diabetes management tasks may be beneficial to providers during the youths' transition from adolescence to young adulthood.

Use of the Family Interaction Macro-coding System with families of adolescents: psychometric properties among pediatric and healthy populations.

OBJECTIVE: To examine reliability and validity data for the Family Interaction Macro-coding System (FIMS) with adolescents with spina bifida (SB), adolescents with type 1 diabetes mellitus (T1DM), and healthy adolescents and their families. METHODS: Sixty-eight families of children with SB, 58 families of adolescents with T1DM, and 68 families in a healthy comparison group completed family interaction tasks and self-report questionnaires. Trained coders rated family interactions using the FIMS. RESULTS: Acceptable interrater and scale reliabilities were obtained for FIMS items and subscales. Observed FIMS parental acceptance, parental behavioral control, parental psychological control, family cohesion, and family conflict scores demonstrated convergent validity with conceptually similar self-report measures. CONCLUSIONS: Preliminary evidence supports the use of the FIMS with families of youths with SB and T1DM and healthy youths. Future research on overall family functioning may be enhanced by use of the FIMS.

Families' perspectives on the effect of constipation and fecal incontinence on quality of life.

OBJECTIVES: Understanding families' quality of life can be important for interdisciplinary treatment planning. The present study examined child and parent perspectives about how constipation and fecal incontinence affect families' quality of life. PATIENTS AND METHODS: Semistructured interviews were conducted with 8 children/adolescents and 8 caregivers. All of the children met Rome II criteria for functional constipation. Interviews were analyzed by an interdisciplinary team using a content analysis approach, which included developing a coding manual that described emergent themes from the interview transcripts. RESULTS: Qualitative and quantitative responses revealed the varied experiences of participating families. Child and parent views may be misaligned, which can affect treatment planning and effectiveness. Families described variable satisfaction with the treatment recommendations they had been offered and experienced difficulty finding appropriate care. Children's social and family functioning were significantly affected by constipation and fecal incontinence difficulties. Both children and parents described the challenges of discussing the problems with others. CONCLUSIONS: Multiple domains of individual and family functioning are affected by children's constipation and fecal incontinence difficulties, thereby affecting the quality of life of both children and their parents. The findings underscore the need for providers to consider the influence of symptoms on adjustment to both the medical condition and treatment adherence and discuss concerns with children and parents. The results provide the foundation for developing a standardized tool for quantitative assessment of quality of life for children with constipation.

Reciprocal influences in children's and families' adaptation to early childhood wheezing.

OBJECTIVE: The objective of the present study was to demonstrate the reciprocal relationships between family adaptation to illness and children's medication use over time among children who presented with wheezing illness in infancy but have varying illness outcomes by age 4. DESIGN: A longitudinal design and latent growth curve models (LGM) were used to predict change in family and caregiver adaptation to illness and children's medication use over three years among 140 infants with wheezing, among families from low socioeconomic, multi-ethnic backgrounds. MAIN OUTCOME MEASURES: One LGM predicted level and change (slope) of family adaptation to illness from children's baseline medication use. The second LGM predicted level and change (slope) of children's medication use from baseline family adjustment to illness. In both models, illness severity, caregivers' psychological resources, and emergency department use were covaried with the independent variable. RESULTS: Two latent growth models were found to adequately fit the data and demonstrate full reciprocal relations between family adaptation to illness and children's medication use while accounting for baseline variables. Baseline measures of caregiver psychological functioning and illness severity were also significant predictors of family adaptation and children's medication use over time. The two models were not statistically different for children with and without active asthma at 4 years of age. CONCLUSION: Findings support the reciprocal effects model of child and family influences on pediatric illness and underscore the importance of early indicators of individual and family functioning.

Introduction to the special issue: Advances in methods and measurement in family psychology.

This special issue presents a collection of reports that highlight recent advances in methods and measurement and also shed light on the complexity of family psychology. The importance of theory in guiding solid family science is evident throughout these reports. The reports include guides for researchers who incorporate direct observation into their research protocols and the ever-expanding field of tele-health interventions. Advanced analytic approaches are offered in the areas of grid sequence analysis, latent fixed-effects models, and the Factors of Curves Model (FOCUS). These sophisticated analytic approaches may be applied to advance systemic thinking in family psychology. The last set of articles illustrate how complex and innovative methodologies are applied to address important societal issues. Work experiences and marital relationships in African American couples address the importance of spillover effects in contemporary families. The creation of biobehavioral plasticity index has the potential to inform gene x environment contributions to family functioning. Finally, the unique methodological issues that are particularly germane to the diverse nature of stepfamilies and nonresident fathers are addressed. We hope that readers of this special issue will return to these reports as resources and examples of theory-driven methods and measurements. (PsycINFO Database Record

Sibling relationships and behavior after pediatric traumatic brain injury.

To evaluate long-term outcomes for siblings of children with traumatic brain injury (TBI), measures of sibling relationships and sibling behavior were collected an average of 4 years postinjury. The study sample included participants in a larger longitudinal study who had school-aged siblings, including 34 with severe TBI, 30 with moderate TBI, and 39 with orthopedic injuries not involving brain insult (ORTHO group). Group comparisons revealed more negative sibling relationships in families of children with TBI than in families of children in the ORTHO group, but only for mixed-gender sibling pairings. Behavior problems in children with TBI predicted both sibling relationships and sibling behavior problems. The findings indicate a need to monitor the adjustment of siblings and sibling relationships after TBI and to include siblings in family interventions.

Validity of the Five Minute Speech Sample in families with infants from low-income backgrounds.

Caregivers of 169 infants from low-income and multi-ethnic backgrounds completed the Five Minute Speech Sample (FMSS). Validity of the FMSS was supported by demonstrating significant associations among positive and negative affect dimensions of the FMSS and other indices of the caregiving environment.

Family influences on pediatric asthma.

OBJECTIVE: To describe pathways by which families may influence the onset and course of a child's asthma. METHODS: We critically reviewed published articles and book chapters to identify research findings and integrated conceptualizations that demonstrate how families affect pediatric asthma. RESULTS: Family emotional characteristics, asthma management behaviors, and physiological factors account for key influences on pediatric asthma onset and outcomes. CONCLUSIONS: Multiple family characteristics are associated with pediatric asthma onset and outcomes. Behavioral and physiological mechanisms may act independently or may interact to affect asthma manifestations. Families with specific emotional characteristics may be at an elevated risk for poorer asthma outcomes.