Profiles of Resilience, Distress, and Posttraumatic Growth in Parents of Children with Cancer and the Relation to Subsequent Parenting and Family Functioning.

OBJECTIVE: The aim of this study was to identify patterns of distress and growth in parents of children with cancer and examine associations with subsequent parenting, parent-child relationship, and family environment. METHODS: Participants included children with cancer history (8-17 years) stratified by time since diagnosis and their parent. At enrollment, parents (n = 254) reported depression and anxiety, and post-traumatic stress symptoms, posttraumatic growth (PTG), and benefit finding in relation to their child's cancer. Three years later, children (n = 214) reported parenting behavior, parent reactions to their distress, and family environment. Parents reported their reaction to children's distress and qualities of the parent-child relationship. RESULTS: Latent profile analysis empirically identified 3 cross-sectional profiles using baseline data: "Resilience, High Growth" (50%), characterized by the lowest distress and the highest PTG/benefit finding; "Moderate Distress with Growth" (33%), characterized by relatively high levels of all indicators; and "Resilience, Low Growth" (17%), characterized by relatively low distress with low PTG/benefit finding. Membership in profiles was associated with parent gender; parents' stressful life events; socioeconomic status; and child diagnosis, on versus off treatment status, and treatment intensity. Parent membership in the Moderate Distress with Growth profile was generally linked with poorer parenting behavior, parent-child relationship quality, and family functioning. CONCLUSION: The majority of parents exhibited resilience and growth. However, a subset of parents displaying moderate distress may be at risk for subsequent parenting and family functioning challenges. Findings further highlight the importance of screening for even moderate parent distress and the possible impact of parent psychosocial interventions indirectly on parenting and family functioning.

Psychosocial adjustment of U.S. college students in the early months of the COVID-19 pandemic.

Objective: Examine the psychosocial adjustment of U.S. college and university students during the early months of the COVID-19 pandemic. Participants: Higher education students in the U.S. (N = 228), recruited between March 2020 and May 2020. Methods: Participants completed self-report measures regarding their psychosocial functioning online. Qualitative and quantitative methods were used to explore participants' psychosocial adjustment. Results: Participants reported increased concerns about such stressors as academics, job loss, health, and social isolation. They reported significantly elevated symptoms of depression, anxiety, perceived stress, and somatization, and prior history of psychological counseling was associated with greater levels of distress. Approximately one-third of participants reported inadequate perceived social support, which in turn was linked to psychosocial adjustment. Conclusions: College students reported experiencing a wide range of stressors related to the pandemic. Increasing access to mental health services and providing supportive services in such areas as social connection and employment are encouraged.

Profiles and predictors of resilient functioning in youths with pediatric cancer history.

OBJECTIVE: To identify and predict resilient functioning over time among youths with pediatric cancer experience (YPCE). DESIGN: YPCE aged 8-17 years (N = 231) were followed prospectively for 3 years. Their psychosocial adjustment was assessed using self-report and parent-report at 1 year (T2) and 3 years (T3) post-baseline. METHODS: Latent profile analysis identified subgroups of YPCE with different patterns of adjustment over time. Self-reported factors from baseline and T2 were examined as predictors of subgroup membership. FINDINGS: Three subgroups of youths were found. Two exhibited average (52.5% of the sample) to better-than-average (41.3%) functioning. One subgroup (6.2%) exhibited subclinical but at-risk range of adjustment. Low optimism and low connectedness to parents and school predicted membership in this group. CONCLUSIONS: Most YPCE exhibit resilient functioning across time. However, approximately 6% report persistent maladjustment. IMPLICATIONS: Most YPCE are well-adjusted, but those with low optimism and poor connection to parents or school may require monitoring for psychosocial difficulties.

Adjustment in Childhood Cancer Survivors, Healthy Peers, and Their Parents: The Mediating Role of the Parent-Child Relationship.

Objectives: Aims were to (1) determine whether the associations between parent psychological functioning and adjustment outcomes of childhood cancer survivors (CCS) were mediated by the parent-child relationship and (2) examine possible differences in pathways for CCS and healthy peers. Method: The study included CCS (n = 206), healthy peers (n = 132), and their primary caregivers. Youth (8-21 years) reported on the quality of the parent-child relationship and on their positive and negative adjustment outcomes. Parents reported on their own distress, posttraumatic growth, quality of the parent-child relationship, and their child's positive and negative adjustment outcomes. Two mediation models were tested, first examining youth-reported adjustment as the outcome and second examining parent-reported youth adjustment. Differences between model path coefficients of CCS and healthy peers were assessed by multigroup analyses. Results: In the youth-reported model, the parent-child relationship mediated the relation between parental distress and adjustment, with more care leading to better youth-reported adjustment outcomes and more overprotection leading to poorer adjustment outcomes. In the parent-reported model, relational frustration and attachment mediated the link between parental distress/growth and parent-reported youth adjustment, with more relational frustration and less attachment relating to poorer youth adjustment outcomes. Multigroup analyses revealed no differences in model path coefficients between CCS and healthy peers. Conclusions: Parental distress and the parent-child relationship likely play an important role in both youth- and parent-reported adjustment, and associations among these constructs do not differ between CCS and healthy peers. Families with less optimal parental functioning may benefit from interventions improving the quality of parent-child interactions.

Profiles of Adjustment in Pediatric Cancer Survivors and Their Prediction by Earlier Psychosocial Factors.

Objective: To examine individual differences in pediatric cancer survivors' psychosocial adjustment and test the psychosocial predictors, assessed 2-3 years earlier, of those differences. Method: Pediatric cancer survivors (n = 209, aged 8-17 years at baseline) and their parents were followed for 4 years. They provided reports of survivors' psychosocial adjustment at 3 years post-baseline, and latent profile analysis (LPA) was used to identify subgroups of survivors who differed on those reports. Multinomial logistic regression was used to predict group membership from self- and parent-reported psychosocial factors at baseline (child adjustment, disposition, and parental functioning) and at 1 year post-baseline (child social relations). Results: The LPA revealed a 3-class model as the best fit: a "Resilient" group (65%), characterized by good psychosocial adjustment; a "Self-Reported At-Risk" group (23%), characterized by subclinical elevations in self-reported internalizing and attention problems; and a "Parent-Reported At-Risk" group (12%), characterized by subclinical elevations in parent-reported internalizing, externalizing, and attention problems and in self-reported attention problems. Several psychosocial predictors, including child posttraumatic stress, affectivity, and connectedness to school, as well as parental distress and overprotection, differentiated the Resilient group from the other groups, in expected directions. Conclusions: The majority of pediatric cancer survivors exhibit enduring resilience. The protective factors identified for them-including positive affectivity and strong connectedness to school-may inform targeted prevention strategies for the minority of survivors who are at risk for maladjustment.

Trajectories of Mental Health-Related Service Use Among Adolescents With Histories of Early Externalizing Problems.

PURPOSE: To inform efforts to reduce costly service utilization, the present study examined longitudinal trajectories of mental health-related outpatient and residential service use among at-risk youth with a history of early externalizing problems. METHODS: A cohort of 809 children in the Fast Track Project, a multisite longitudinal study of children at risk for conduct disorder, were followed prospectively from kindergarten through 12th grade. They resided in high-risk areas with high rates of poverty, crime, and violence. Their outpatient and residential service use was assessed annually between sixth and 12th grades through parent report. Growth mixture modeling was applied to model individual differences in trajectories of service use during this period. Teacher, parent, and observer-reported childhood predictors of those trajectories were also examined. RESULTS: Most youths had minimal service use during preadolescence into adolescence. However, approximately 31% had moderate probability of using outpatient counseling services, and approximately 8% had elevated probability of seeing a family doctor for mental health needs. For residential services, approximately 6% had moderate to high probability of service use that peaked during transition to high school, whereas close to 5% had service use that dramatically increased during high school. Childhood predictors of these trajectories included earlier externalizing, internalizing, and emotion regulation problems. CONCLUSIONS: This study is the first to use person-centered analytic methods to examine longitudinal trajectories in mental health-related service use among at-risk adolescents. Timely treatment for severe externalizing problems, comorbid internalizing problems, and emotion dysregulation during childhood may be crucial for preventing chronic service use.

Effects of Time since Diagnosis on the Association between Parent and Child Distress in Families with Pediatric Cancer.

Although parental distress and child distress have been linked in families of children with cancer, how these associations change over time is unknown. The present study examined how the amount of time elapsed since the child's diagnosis moderates the associations between self-reported parent and child symptoms of depression, anxiety, and post-traumatic stress in 255 parent-child dyads. Time since diagnosis moderated the associations between parental symptoms and child-reported anxiety and post-traumatic stress. Dyads farther out from diagnosis exhibited stronger associations between parental and child symptoms. Findings suggest the importance of monitoring the psychological adjustment of parents and children over time.

Profiles of Resilience and Growth in Youth With Cancer and Healthy Comparisons.

OBJECTIVE: Inconsistent links between posttraumatic stress symptoms (PTS) and posttraumatic growth (PTG) in youth following a stressful life event have been observed in previous literature. Latent profile analysis (LPA) provides a novel approach to examine the heterogeneity of relations between these constructs. METHOD: Participants were 435 youth (cancer group=253; healthy comparisons = 182) and one parent. Children completed measures of PTS, PTG, and a life-events checklist. Parents reported on their own PTS and PTG. LPA was conducted to identify distinct adjustment classes. RESULTS: LPA revealed three profiles. The majority of youth (83%) fell into two resilient groups differing by levels of PTG. Several factors predicted youth's profile membership. CONCLUSIONS: PTS and PTG appear to be relatively independent constructs, and their relation is dependent on contextual factors. The majority of youth appear to be resilient, and even those who experience significant distress were able to find benefit.

Profiles of Dispositional Expectancies and Affectivity Predict Later Psychosocial Functioning in Children and Adolescents With Cancer.

OBJECTIVE: Examined how individual differences in disposition among pediatric cancer patients predict their later psychosocial functioning. METHODS: Patients aged 8-17 years (N = 223) reported on their disposition at baseline. One and three years later, self-reports and parent reports of patient psychosocial functioning were obtained. Latent profile analysis was used to identify subgroups that differed on baseline disposition and to compare them on later outcomes. ESULTS: Three groups were identified: The "Positive" group (59%) had high optimism and positive affectivity and low pessimism and negative affectivity; the "Moderate" group (39%) had a similar profile, with less exaggerated scores; a small, "Negative" group (2%) had the opposite profile (low optimism/positive affectivity; high pessimism/negative affectivity). These groups differed in psychosocial functioning at follow-up, generally in expected directions. CONCLUSIONS: Most patients have a disposition that may be protective. A small minority at high risk for maladjustment is distinguished by their disposition.

Parents of Children With Cancer: At-Risk or Resilient?

OBJECTIVE: To examine adjustment in parents of children with cancer using a design that minimizes focusing effects and allows for direct comparison with parents of healthy children. METHOD: Parents of 305 children with cancer and a demographically similar sample of 231 parents of healthy children were evaluated using diagnostic interviews for posttraumatic stress disorder (PTSD), and questionnaire measures of posttraumatic stress symptoms (PTSS) and psychological growth (PG), as well as measures of global psychological functioning. RESULTS: Rates of current and lifetime PTSD in parents of children with cancer were low, and did not differ from comparison parents. Likewise, levels of PTSS were not significantly different from comparison parents, but differed as a function of time since diagnosis, with parents of children who were ≥ 5 years from diagnosis reporting significantly lower PTSS than comparison parents. PG was higher in parents of children with cancer than in comparison parents regardless of time since diagnosis. CONCLUSION: Parents of children with cancer demonstrate resilience to this challenge.

Profiles of Connectedness: Processes of Resilience and Growth in Children With Cancer.

OBJECTIVE: Identified patterns of connectedness in youth with cancer and demographically similar healthy peers. METHOD: Participants included 153 youth with a history of cancer and 101 youth without a history of serious illness (8-19 years). Children completed measures of connectedness, posttraumatic stress symptoms (PTSS), and benefit-finding. Parents also reported on children's PTSS. RESULTS: Latent profile analysis revealed four profiles: high connectedness (45%), low connectedness (6%), connectedness primarily to parents (40%), and connectedness primarily to peers (9%). These profiles did not differ by history of cancer. However, profiles differed on PTSS and benefit-finding. Children highly connected across domains displayed the lowest PTSS and highest benefit-finding, while those with the lowest connectedness had the highest PTSS, with moderate PTSS and benefit-finding for the parent and peer profiles. CONCLUSION: Children with cancer demonstrate patterns of connectedness similar to their healthy peers. Findings support connectedness as a possible mechanism facilitating resilience and growth.

Differential risk for late adolescent conduct problems and mood dysregulation among children with early externalizing behavior problems.

To investigate the differential emergence of antisocial behaviors and mood dysregulation among children with externalizing problems, the present study prospectively followed 317 high-risk children with early externalizing problems from school entry (ages 5-7) to late adolescence (ages 17-19). Latent class analysis conducted on their conduct and mood symptoms in late adolescence revealed three distinct patterns of symptoms, characterized by: 1) criminal offenses, conduct disorder symptoms, and elevated anger ("conduct problems"), 2) elevated anger, dysphoric mood, and suicidal ideation ("mood dysregulation"), and 3) low levels of severe conduct and mood symptoms. A diathesis-stress model predicting the first two outcomes was tested. Elevated overt aggression at school entry uniquely predicted conduct problems in late adolescence, whereas elevated emotion dysregulation at school entry uniquely predicted mood dysregulation in late adolescence. Experiences of low parental warmth and peer rejection in middle childhood moderated the link between early emotion dysregulation and later mood dysregulation but did not moderate the link between early overt aggression and later conduct problems. Thus, among children with early externalizing behavior problems, increased risk for later antisocial behavior or mood dysfunction may be identifiable in early childhood based on levels of overt aggression and emotion dysregulation. For children with early emotion dysregulation, however, increased risk for mood dysregulation characterized by anger, dysphoric mood, and suicidality--possibly indicative of disruptive mood dysregulation disorder--emerges only in the presence of low parental warmth and/or peer rejection during middle childhood.

Association between parent and child distress and the moderating effects of life events in families with and without a history of pediatric cancer.

OBJECTIVE: Examined the associations between parental and child distress, and moderating effects of child exposure to life events, in families with and without a history of pediatric cancer. METHODS: Children with cancer and their parents (N = 255) and healthy comparison dyads (N = 142) completed self-report measures of depression, anxiety, and posttraumatic stress symptoms. Children reported on the total number of stressful life events they had experienced. Correlations between parental and child symptoms were examined. Moderating effects of child exposure to life events were tested using multiple regression. RESULTS: Parent and child symptoms were significantly related only in the cancer group. Child exposure to life events attenuated this relationship. Moderation effects were significant at or below average levels of life stress. CONCLUSIONS: The experience of childhood cancer may strengthen the link between parent and child psychological functioning. However, child exposure to other life events may weaken this link.

Promoting School Readiness in the Context of Socio-Economic Adversity: Associations with Parental Demoralization and Support for Learning.

BACKGROUND: Existing research suggests that parenting stress and demoralization, as well as provision of learning activities at home, significantly affect the child's school readiness in low-income families. However, the degree to which these dimensions of parenting uniquely influence child school readiness remains unclear. OBJECTIVE: This study tested the hypotheses that parent demoralization and support for learning are distinct constructs and that they would independently influence child school readiness. METHODS: 117 children in Kindergarten with lower literacy and language skills and their parents were recruited from three Northeastern school districts serving primarily low-income families. Parents reported on their depressive symptoms, parenting difficulties, attitudes and behaviors related to learning activities, and the frequency of parent-child conversation at home. Teachers provided reports of the child's school readiness, as indicated by classroom behaviors, approaches to learning, and emergent language and literacy skills. Factor analysis and structural equation modeling were used to test the study hypotheses. RESULTS: Parent demoralization and support for learning emerged as distinct constructs based on factor analysis. Structural equation models revealed that parent demoralization is negatively associated with child school readiness, whereas parent support for learning is positively associated with child school readiness. Neither parenting construct mediated the effects of the other. CONCLUSIONS: Among low-income families with children at high risk for child school maladjustment, parental demoralization and support of learning opportunities at home appear to independently influence the child's school readiness. Parent-based interventions targeting child school readiness would likely benefit from enhancing both parental self-efficacy and provision of learning activities.