Depression and Anxiety in the Postnatal Period: An Examination of Infants' Home Language Environment, Vocalizations, and Expressive Language Abilities.

This longitudinal study investigated the effects of maternal emotional health concerns, on infants' home language environment, vocalization quantity, and expressive language skills. Mothers and their infants (at 6 and 12 months; 21 mothers with depression and or anxiety and 21 controls) provided day-long home-language recordings. Compared with controls, risk group recordings contained fewer mother-infant conversational turns and infant vocalizations, but daily number of adult word counts showed no group difference. Furthermore, conversational turns and infant vocalizations were stronger predictors of infants' 18-month vocabulary size than depression and anxiety measures. However, anxiety levels moderated the effect of conversational turns on vocabulary size. These results suggest that variability in mothers' emotional health influences infants' language environment and later language ability.

Mentoring Program Enhancements Supporting Effective Mentoring of Children of Incarcerated Parents.

Children of incarcerated parents (COIP) are at risk for a range of negative outcomes; however, participating in a mentoring relationship can be a promising intervention for these youth. This study examined the impact of mentoring and mentoring program enhancements on COIP. Secondary data analyses were conducted on an archival database consisting of 70,729 matches from 216 Big Brothers Big Sisters (BBBS) local agencies to establish the differential effects of mentoring on COIP. A subset of 45 BBBS agencies, representing 25,252 matches, participated in a telephone interview about program enhancements for better serving COIP. Results revealed that enhanced program practices, including having specific program goals, providing specialized mentor training, and receiving additional funding resulted in better outcomes for COIP matches. Specifically, specialized mentor training and receiving additional funding for serving matches containing COIP were associated with longer and stronger matches. Having specific goals for serving COIP was associated with higher educational expectations in COIP. Results are discussed in terms of benefits of a relationship-based intervention for addressing the needs of COIP and suggestions for program improvements when mentoring programs are serving this unique population of youth.

Feasibility of a multidisciplinary caregiving training protocol for young caregivers in families with ALS.

Feasibility of a multidisciplinary caregiving training protocol for young caregivers in families with ALS. OBJECTIVES: To assess the feasibility of a multidisciplinary young caregiver group training protocol for children and youth who provide care to a family member with ALS. METHOD: Peer group experiential young caregiver model based on theories of self-management and self-efficacy. Training conducted by a multidisciplinary team of therapists in ALS (PT, OT, Speech and social work), as well as assistive device vendors. Demographic data, caregiving tasks and evaluations were collected. RESULTS: The model is feasible for both youth and therapists. Youth found benefit, skill acquisition, and mastery by asking questions, teaching back skills to the group and engaging with peers. CONCLUSION: This project demonstrates young caregivers will participate in training, and engage with "like" peer group. Future projects will focus on developing a structured survey and observation, testing efficacy in larger groups.

Poor school performance in offspring of patients with schizophrenia: what are the mechanisms?

BACKGROUND: Offspring of patients with schizophrenia exhibit poorer school performance compared with offspring of non-schizophrenic parents. We aimed to elucidate the mechanisms behind this association. METHOD: We linked longitudinal national population registers in Sweden and compared school performance among offspring of schizophrenic parents with offspring of non-schizophrenic parents (1 439 215 individuals with final grades from compulsory school 1988-2006). To investigate the mechanisms, we studied offspring of schizophrenic patients and controls within the same extended families. We investigated genetic effects by stratifying analyses of parent-child associations according to genetic relatedness (half-cousins, full cousins and half-siblings). Environmental effects were investigated by comparing school performance of offspring of schizophrenic fathers and of schizophrenic mothers, respectively, and by stratifying the analyses according to environmental relatedness while controlling genetic relatedness (paternal and maternal half-cousins, paternal and maternal half-siblings). RESULTS: Offspring of parents with schizophrenia had poorer overall school performance than unrelated offspring of non-schizophrenic parents (-0.31 s.d.). Variability in genetic relatedness greatly moderated the strength of the within-family association (ß=-0.23 within exposure-discordant half-cousins, ß=-0.13 within exposure-discordant full cousins, ß=0.04 within exposure-discordant half-siblings), while no evidence was found that the environment affected offspring school performance. CONCLUSIONS: Genetic factors account for poorer school performance in children of parents with schizophrenia. This supports that cognitive deficits found in individuals with schizophrenia and their relatives might be genetically inherited. Early detection of prodromal signs and impaired functioning of offspring of patients with schizophrenia could lead to earlier and better tailored interventions.

"Knowledge is power": educating children about their parent's mental illness.

Given the prevalence and associated vulnerabilities of children of parents with a mental illness (COPMI) it is essential to develop appropriate interventions. While education is an important component in many interventions, little is known about what topics are covered, delivery mode, and the efficacy in meeting the needs of this target group. Eighteen facilitators responsible for delivering COPMI programs across Australia were interviewed, fifteen of whom include education about mental illness in their treatment programs. According to program facilitators, education about mental health was important because they believed that knowledge equates to power, and can be cathartic. Education chiefly consisted of signs, symptoms, and treatments of various mental illnesses. The dominant mode of delivery was small and large group discussion. When delivering education, there was some consideration for children's ages. However, there was less differentiation in programs according to the diagnosis of parents' mental illness. Clinical and research implications conclude the article.

'Daddy is going to be sick'. Interview by Catherine Quinn.

Motor neurone disease is a devastating diagnosis at any age, but for people with young children there is an added dimension. Now there is accessible information that can help.

Early outcomes of a pilot psychoeducation group intervention for children of a parent with a psychiatric illness.

OBJECTIVE: This study reports early findings of a still-developing Youth Education and Support (YES) pilot intervention of multifamily group psychoeducation for youth with a parent with a psychiatric illness. METHODS: Hypotheses predicted YES participants would increase pre-to-post: 1) Knowledge of psychiatric illness and recovery, and 2) Coping. A purposive sample of 17 youth, ages 10-16, participated in six lively, activity-focused, two-hour sessions within four groups facilitated by the PI and professionals employed within two public mental health agencies. Data revealed a significant increase in pre-to-post youth-reported knowledge (p= less than .001) and no significant change in overall coping. At post-intervention, youth reported significantly increased use of the coping skills of avoiding problems and relaxing, as indicated within these coping subscales. CONCLUSIONS: Study limitations merit interpretation caution. They are useful for future research, including development and testing of youth psychoeducation programs with longer interventions, more emphases on coping, parent-inclusion, and larger samples using randomized, experimental designs. Suggestions for research, practice, and policy are provided.

Sources of uncertainty: experiences of Alzheimer's disease.

Uncertainty is an inherent part of most illness experiences and Alzheimer's disease in particular is fraught with uncertainties, especially for the family. In an investigation of sources of uncertainty, 33 adult children with a parent diagnosed with probable Alzheimer's disease were interviewed. Participants described medical, personal, and social sources of uncertainty related to their parent's diagnosis. This research contributes to literature on uncertainty management and addresses the specific illness experiences of families coping with uncertainty related to Alzheimer's disease. Recommendations are made for further research that focuses on the ways family members are affected by illness.

Evaluation of a resilience-based intervention for children of parents with mental illness.

OBJECTIVE: The purpose of the present study was to evaluate the effectiveness of a group psychosocial intervention for children (aged 12-18) of a parent with mental illness (copmi). METHOD: A treatment and waitlist-control design study with pre- and post-treatment, and 8 week follow up, was carried out. The treatment (n=27) and control (n=17) groups were compared on three groups of dependent variables: intervention targets (mental health literacy, connectedness, coping strategies), adjustment (depression, life satisfaction, prosocial behaviour, emotional/behavioural difficulties), and caregiving experiences. RESULTS: Group comparisons failed to show statistically significant intervention effects, but reliable clinical change analyses suggested that compared to the control group, more intervention participants had clinically significant improvements in mental health literacy, depression, and life satisfaction. These treatment gains were maintained 8 weeks after treatment. Participant satisfaction data supported these treatment gains. CONCLUSIONS: Given study limitations and the modest support for intervention effectiveness it is important that this and other similar interventions should continue to be revised and undergo rigorous evaluation.

The Effects on Children's Anxiety and Quality of Life of a Psychoeducational Program for Families Living With Parental Cancer and Their Network: A Randomized Controlled Trial Study.

BACKGROUND: Families living with parental cancer report lack of social support. The Cancer PEPSONE Program (CPP) was developed to bridge the gap between the families and their network. OBJECTIVE: The aims of this study were to study the effect of the CPP on children's anxiety and quality of life (QOL) and examine the association between the CPP's effect on their well parents' received social support, QOL, and psychological distress and the children's anxiety and QOL. METHODS: The CPP, a psychoeducational program for the families and their social network, was evaluated using a randomized controlled trial design. The children and their well parents completed questionnaires measuring QOL, psychological distress, and social support at baseline and after 3 and 6 months. RESULTS: Thirty-five families were enrolled (18 intervention, 17 controls). The CPP stabilized the children's family function, although the family function largely (d = 0.86) decreased in the control group (P = .018). No significant effects were found on anxiety, overall QOL, or QOL subdimensions. Significant correlations were documented between the children's levels of anxiety and the well parents' received social support (r = -0.196, P < .001), QOL (r = -0.138, P < .05), and psychological distress (r = 0.166, P < .05). CONCLUSIONS: The CPP seems to stabilize the children's perceived family function but did not target the other outcomes. Further studies with larger samples are needed. IMPLICATIONS FOR CLINICAL PRACTICE: Optimizing social network for families living with parental cancer may support the family's function. Actions should be initiated to increase the well parents' social support, QOL, and psychological distress, which may also benefit the children.

famoses: a modular educational program for children with epilepsy and their parents.

BACKGROUND: It is known that most adult patients with epilepsy often have poor knowledge of their disorder, treatment options, and social and vocational consequences, despite the huge amount of information available. Being pressed for time, health care professionals often are not able to provide the repetitive counseling and instruction necessary to address epilepsy care adequately. Therefore educational programs are considered extremely important in filling the gap. METHOD: For German-speaking countries, two educational programs called famoses, modulares Schulungsprogramm Epilepsie fur Familien [modular service package epilepsy for families], were developed by a multidisciplinary group of neuropediatricians, psychologists, social workers, and educators. The aims of the famoses programs are to improve children's and parents' knowledge about epilepsy and to help patients of childhood age and their parents achieve a better understanding of their disease, gain more self-confidence, and reduce specific fears regarding epilepsy. famoses comprises two different educational programs: famoses for kids with epilepsy within the developmental period of ages 7 to 13, and famoses for parents or caretakers. The programs are designed for interactive small-group education. RESULTS: The child-centered educational program is based on a fictional story: The children are sailors on a virtual cruise, sailing from island to island, accompanied by educated trainers. On each island there is something new to discover about epilepsy. The parent (and caretaker)-centered educational program covers different topics-overview and content of the program, basic knowledge, diagnostics, therapy, prognosis and development, and living with epilepsy-within six modules. The program was implemented in Germany and Switzerland in the spring of 2005 and is now operating in different epilepsy centers. CONCLUSION: Within comprehensive therapeutic management of epilepsy, educational programs for patients, and for parents (caretakers) of children with epilepsy, are considered to be extremely important. Such educational programs have two main goals: to increase knowledge about the disorder, and to strengthen the patients' responsibility for themselves, with the consequence of living with as few limitations as possible. famoses is an effective component of this comprehensive care. The program has been operating successfully in different epilepsy centers in Germany and Switzerland since the spring of 2005.

Education and nutritional status of orphans and children of HIV-infected parents in Kenya.

We examined whether orphaned and fostered children and children of HIV-infected parents are disadvantaged in schooling, nutrition, and health care. We analyzed data on 2,756 children aged 0-4 years and 4,172 children aged 6-14 years included in the 2003 Kenya Demographic and Health Survey, with linked anonymous HIV testing, using multivariate logistic regression. Results indicate that orphans, fostered children, and children of HIV-infected parents are significantly less likely to attend school than non-orphaned/non-fostered children of HIV-negative parents. Children of HIV-infected parents are more likely to be underweight and wasted, and less likely to receive medical care for ARI and diarrhea. Children of HIV-negative single mothers are also disadvantaged on most indicators. The findings highlight the need to expand child welfare programs to include not only orphans but also fostered children, children of single mothers, and children of HIV-infected parents, who tend to be equally, if not more, disadvantaged.

Long-term effects from a randomized trial of two public health preventive interventions for parental depression.

This article presents long-term effects of a randomized trial evaluating 2 standardized, manual-based prevention strategies for families with parental mood disorder: informational lectures and a brief, clinician-based approach including child assessment and a family meeting. A sample of 105 families, in which at least 1 parent suffered from a mood disorder and at least 1 nondepressed child was within the 8- to 15-year age range, was recruited. Parents and children were assessed separately at baseline and every 9 to 12 months thereafter on behavioral functioning, psychopathology, and response to intervention. Both interventions produced sustained effects through the 6th assessment point, approximately 4.5 years after enrollment, with relatively small sample loss of families (<14%). Clinician-based families had significantly more gains in parental child-related behaviors and attitudes and in child-reported understanding of parental disorder. Child and parent family functioning increased for both groups and internalizing symptoms decreased for both groups, with no significant group differences. These findings demonstrate that brief, family-centered preventive interventions for parental depression may contribute to long-term, sustained improvements in family functioning.

Children's needs when facing the death of a parent from cancer: part two.

A small exploratory study was conducted to identify the psychosocial needs of children facing the death and subsequent bereavement of a parent from cancer. The focus was on the palliative phase of care through the bereavement period with the aim of identifying the best way forward in further developing a community-based service for children in Fife. Part one selectively reviewed the literature related to children's and families' needs when facing and dealing with the death of a parent, and described. Part two presents the results and reports the issues which will be considered as a basis for future service development.

How home care and hospice nurses can assist adolescents when a parent is seriously ill: adolescents with seriously ill family members.

Anne's mother died of cancer last year when Anne was 13 years old. Shortly thereafter her brother, Andy, received a diagnosis of stage IV cancer. Anne and her dad, Mr. H., struggled to provide care for Andy while they at the same time grieved the death of her mother. Mr. H. worries about how to communicate with Anne. He notes that Anne was always closer to her mother. He struggles to establish a relationship with Anne and to support her through this difficult time. Bert's dad is terminally ill with liver cancer. Bert is 16 years old. His dad is constantly in and out of the hospital. Currently at home, he requires assistance with all activities of daily living. Health professionals visit the home on a regular basis. Mrs. N., Bert's mother, reports that Bert's grades have dropped and he avoids being in the home. She wonders how to help him while identifying that it is easier to focus on her husband when Bert is not at home.

Genetic susceptibility testing for Alzheimer disease: motivation to obtain information and control as precursors to coping with increased risk.

OBJECTIVE: This study investigated appraisals, including motivation, and coping preferences for undergoing Apolipoprotein E (APOE) susceptibility testing for Alzheimer disease (AD). METHODS: Participants were 60 adult children of individuals affected with AD enrolled in a trial investigating use and impact of APOE susceptibility testing. An exploratory qualitative study was undertaken in which participants were interviewed about their testing experience. RESULTS: Most participants viewed genetic testing as providing valuable information that could help direct future health care decisions and meet their emotional concerns about living at increased risk. Participants related their motivation for genetic testing to their worries about developing AD, preference to seek information about health threats, and need to feel in control of their health. CONCLUSION: Even without prevention or treatment options, genetic testing may be a useful coping strategy for some at-risk individuals. PRACTICE IMPLICATIONS: Once testing becomes clinically available, practitioners need to address the value and limitations of testing as well as appraisals and efforts to cope.

Educational achievements of children of parents with multiple sclerosis: A nationwide register-based cohort study.

Little is known about the impact of parental multiple sclerosis (MS) on offspring's educational attainment. The objective of the study was to examine educational achievements in offspring of parents with MS compared with matched children of parents without MS in a nationwide register-based cohort study. Children of all Danish-born residents with onset between 1950 and 1986 were identified by linking the Danish Multiple Sclerosis Registry with the Civil Registration System. Twins, children with MS, and emigrated persons were excluded. The reference cohort consisted of randomly drawn individuals from the Civil Registration System without parental MS matched 8:1 to the MS offspring by sex and year of birth. Information about education was linked to the cohorts from nationwide educational registries. We included 4177 children of MS parents and 33,416 reference persons. Children of MS parents achieved statistically significant higher average grades than the reference cohort in their final exam of basic school with a mean grade difference of 0.46 (95 % CI 0.22-0.69; p = 0.0002). We found no difference in achievement of educational level above basic school (OR 1.04; 95 % CI 0.98-1.10; p = 0.20). There was a trend toward more MS offspring attaining health-related educations (OR 1.10; 95 % CI 1.00-1.21; p = 0.06). In conclusion, children of MS parents showed a small advantage in grade point average in final examinations in basic school, and they more often tended toward health-related educations. This study revealed no negative consequences of parental MS on grades and highest educational level achieved.

Information for young people when multiple sclerosis enters the family.

Multiple sclerosis (MS) typically affects people aged 20-40 years and, by its very nature, is characterized by unpredictability, uncertainty and variability, and is therefore bound to have an impact on children who have a parent with MS. There has been little work done to assess the needs of young people living with MS in their family. A series of workshops specifically aimed at 9-14-year-olds who have a parent with MS have been successfully conducted. This article reviews the background to setting up the workshop and identifies implications for future MS specialist nurses to help this potentially vulnerable group of people. By breaking the silence and talking about MS with young people, the myths can be removed and the anxieties reduced.

Parental health shocks, child labor and educational outcomes: Evidence from Tanzania.

This paper examines the impact of parental illness on children's education. We find that only father's illness decreases children's school attendance. Father's illness also has long-term impacts on child education, as it decreases children's likelihood of completing primary school and leads to fewer years of schooling. However, we find no evidence that father's illness affects schooling through increased child labor. Instead, father's illness decreases household's income and reduces school attendance possibly because of the reduced ability of the family to afford education. In contrast, mother's illness and illness of other household members have no effect on children's schooling.

Effectiveness of home-based early intervention on the language development of children of mothers with mental retardation.

The authors evaluated the effects of a home-based parent training program for mothers with mental retardation on the language development of their children who were at risk for language delay. The participants, 28 mothers labelled mentally retarded with children under 28 months of age, initially showed significantly fewer positive mother-child interactions and child vocalizations and verbalizations than did a comparison group of 38 families with children of similar age whose mothers were not mentally retarded. The 28 mothers with low IQ were then matched on child entry age and randomly assigned to either an interaction training or attention-control group (this group received training in safety and emergency skills unrelated to interactions). Interaction training consisted of verbal instruction, modelling, feedback, and tangible reinforcement. After training, the training group scores were no longer lower than those of the comparison group of mothers without mental retardation and were also significantly higher than the scores of the attention-control group on all maternal positive interactions, child vocalizations, verbalizations, and language and social domains of the Bayley Scales of Infant Development. Speech emerged significantly sooner in the training group as compared to the control group. The training group parents and children maintained improvements up to 82 weeks following training, and the attention-control group, when subsequently trained, replicated the original training group results. Thus, home-based parent training increased positive maternal interactions of mothers with mental retardation, which facilitated language development in their young children.