Associations Among Perceived Parent and Peer Support, Self-Esteem, and Cancer-Related Worry in Adolescent and Young Adult Cancer Survivors.

Purpose: Cancer-related worry is common among adolescent and young adult (AYA) cancer survivors, and is associated with adverse psychosocial outcomes. Thus, it is crucial to identify possible modifiable covariates of cancer-related worry to aid in developing targeted interventions. This study aimed to explore the cross-sectional associations between cancer-related worry and potential covariates (i.e., perceived parental support, perceived peer support, self-esteem). Methods: One hundred fifty-two survivors between the ages of 15 and 25 who had been diagnosed with cancer between the ages of 14 and 21 completed the Inventory of Parent and Peer Attachment, the Rosenberg Self-Esteem Scale, the Self-Perception Profile for Adolescents, and a measure of cancer-related worry. Relationships among variables were assessed through structural equation modeling. Results: The model showed good fit [χ2(13) = 13.26, p = 0.43; comparative fit index = 0.997; root mean square error of approximation = 0.01 (90% confidence interval = 0.00-0.08); standardized root mean square residual = 0.04]; however, not all associations were in expected directions. Higher perceived parent and peer support were each significantly associated with lower self-esteem, which, in turn, was significantly associated with higher cancer-related worry. There was no direct association between support variables and cancer-related worry. Conclusion: These findings, which contradict existing theory about self-esteem development in healthy AYAs and prior research about the association between support and self-esteem in children and adolescents with cancer, suggest complex, and likely reciprocal, relationships among perceived support, cancer-related worry, and self-esteem in AYA cancer survivors. Support interventions involving peers with cancer and cognitive behavioral interventions targeting parent and peer relationships, self-esteem, and cancer-related worry may be beneficial in fostering AYA cancer survivors' psychosocial development.

Associations Between Parenting Stress at School Entry and Later Psychosocial Adjustment: A Longitudinal Study of Children With Congenital Craniofacial Anomalies.

OBJECTIVE: To examine the reciprocal relationships between parenting stress and psychosocial adjustment of children with congenital craniofacial anomalies (CFAs) at 2 time points: school entry and approximately 2.5 years later, after children had time to adjust to school. DESIGN: Retrospective review of medical charts of children with CFAs. SETTING: Department of reconstructive plastic surgery at an urban medical center. PARTICIPANTS: Parents of 42 children aged 3.9 to 6.5 years at time 1 and 6.5 and 9.8 years at time 2. MAIN OUTCOME MEASURES: Parenting Stress Index/Short Form and Child Behavior Checklist (CBCL), both completed by parents at time 1 and time 2. RESULTS: Compared to norms, more parents scored in the clinical range on parenting stress both at time 1 and time 2. Parenting stress remained stable across the 2 time points. Although rates of psychosocial problems for boys were comparable to those of the CBCL normative sample, higher-than-expected rates of clinically significant internalizing and externalizing were found for girls at time 2. Parenting stress at time 1 was associated with child internalizing and externalizing problems at time 2. Whereas child externalizing problems at time 1 predicted parenting stress at time 2, child internalizing at time 1 showed trivial effects on time 2 parenting stress. CONCLUSIONS: Early school years may be a period that is particularly stressful for parents of children with CFAs. There appears to be a transactional relationship between parenting stress and child psychosocial adjustment during the early school years.

The relationship between cancer-related worry and posttraumatic growth in adolescent and young adult cancer survivors.

OBJECTIVES: To examine cancer-related worry in adolescent and young adult (AYA) cancer survivors and its relationship with posttraumatic growth over time, as the relationship between these constructs has not been assessed longitudinally in this population. METHODS: A total of 153 AYA cancer survivors completed measures of cancer-related worry and posttraumatic growth 3 times across approximately 1 year. Descriptive statistics were calculated for cancer-related worry items, and mixed-effects modeling assessed the relationship between cancer-related worry and posttraumatic growth. RESULTS: Most participants reported at least moderate cancer-related worry in at least 1 area at each assessment (88.2-93.9% across time points). Worry about future health was the most prevalent concern (65.4%-83.7% across time points). Cancer-related worry was positively related to posttraumatic growth in the mixed-effects model. However, post hoc analyses indicated that cancer-related worry and posttraumatic growth were modestly related; there was no evidence that either construct predicted the other over time. CONCLUSIONS: Cancer-related worry appears to be a common psychosocial outcome in AYA cancer survivors. However, cancer-related worry appears to be only modestly related to the development of posttraumatic growth, implying that these may be independent constructs despite theoretical literature suggesting that posttraumatic growth may stem from posttraumatic distress. Thus, it is necessary to assess AYA survivors for cancer-related worry and posttraumatic growth, and develop interventions to target cancer-related worry and foster posttraumatic growth.

A Qualitative Study of Children's Perspectives on Their Peer Relationships in the Context of Living With a Craniofacial Anomaly.

OBJECTIVE: To gain understanding of perspectives on peer relationships from children with congenital craniofacial anomalies (CFA). DESIGN: This was qualitative research based in a phenomenological approach, using narratives that captured children's responses to open-ended and objective questions about peer relations and life with a CFA. Interviews were audio recorded and transcribed. Transcripts were coded according to thematic categories. SETTING: Children were patients at a reconstructive plastic surgery center in an urban hospital and medical school and were recruited from a regional support organization for families of children with CFA that was associated with the hospital. PATIENTS, PARTICIPANTS: Nine children with congenital CFA aged 9 to 14 years. MAIN OUTCOME MEASURES: Thematic coding categories were developed from the narratives using an open coding strategy; these categories focused on aspects of children's interactions with peers and their appraisals of the role of their CFA in their lives. RESULTS: Children reported satisfaction with most aspects of their peer relationships and expressed confidence in their ability to manage challenges. They acknowledged some difficulties with living with a CFA but tended to hold a balanced perspective on the impact of a CFA on their lives, and they expressed optimism about their future lives. CONCLUSIONS: This sample of children with CFA exhibited much resilience. Although they may not be representative of all children with CFA, they provide examples that can be used to generate hypotheses for future research.

Fathers' perspectives on parenting a child with a craniofacial anomaly.

INTRODUCTION: Although research on healthy children indicates that fathers exert specific and beneficial influences on children's development, there is little research on fathers of children with chronic medical challenges, and none on fathers of children with craniofacial anomalies (CFA). This exploratory study aimed to obtain preliminary information about fathers' experiences of parenting a child with CFA. METHOD: Structured telephone interviews were conducted with a volunteer sample of nine fathers of children with CFA. Interviews were summarized using percentages of responses for questions using a rating-scale format, and with excerpts of narratives from open-ended questions. RESULTS: Most fathers (90%) felt highly optimistic about their children's potential for happiness and life success, although a smaller percentage also expressed worry (21% a lot; 33% some) and concern (11% a lot; 44% some). All fathers described positive attributes in their children. Fathers tended to support their children's peer relationships through encouraging and organizing activities with friends. DISCUSSION: Fathers' focus on children's effective engagement in the world is consistent with findings on fathering of healthy children. Findings provide hypotheses for future research on fathers' role in the positive development of children with CFA.

Psychosocial adjustment in children and adolescents with a craniofacial anomaly: diagnosis-specific patterns.

OBJECTIVE: To obtain descriptive information about diagnosis-specific patterns of psychosocial adjustment for children and adolescents with craniofacial anomalies. DESIGN: Chart review of medical records was used to obtain psychosocial checklists. Scores were compared with published norms to evaluate elevated risk of problems, separately for six diagnostic groups. SETTING: Plastic surgery department in urban university medical center. PARTICIPANTS: As part of routine ongoing care, 408 caregivers completed checklists assessing psychosocial adjustment of children aged 2 to 18 years with diagnosis of cleft lip and palate, cleft lip only, cleft palate only, craniosynostosis, hemifacial microsomia, and hemangioma. MAIN OUTCOME MEASURE: Child Behavior Checklist ( Achenbach, 1991 , 1992 ). RESULTS: The craniosynostosis group showed elevated rates (beyond norms) of social, academic, and attention problems. The cleft lip and palate group showed elevations in social problems and deficits in social, academic, and activities competencies. The other diagnostic groups had few areas of elevated problems and had reduced risk in some areas. CONCLUSION: Specific patterns of strengths and weaknesses in psychosocial adjustment may vary by craniofacial anomaly diagnosis. Replication of these findings, with extension to other craniofacial anomaly diagnoses, is warranted.

Mothers' reflections on raising a child with a craniofacial anomaly.

OBJECTIVE: To conduct a qualitative evaluation of parenting among families with school-aged and young adolescent children with craniofacial anomalies (CFAs). METHODS: Interview responses were obtained from nine mothers of children ages 9 to 14 years old with CFAs. Mothers were asked to describe their perceptions of their children, their children's special needs because of CFAs, and their parenting strategies. Narratives were coded into categories, including maternal concerns and worries, children's strengths, proactive maternal behaviors, and role of CFAs in the families' lives. RESULTS AND CONCLUSIONS: Mothers' responses indicated concern and protectiveness because of the challenges of having a CFA, as well as parenting strategies intended to promote autonomy and positive social and emotional adjustment.

Adolescents with craniofacial anomalies: psychosocial adjustment as a function of self-concept.

OBJECTIVE: To evaluate associations between self-concept and psychosocial adjustment among adolescents with craniofacial anomalies. DESIGN: Retrospective chart review. SETTING: Reconstructive plastic surgery department in urban medical center. PARTICIPANTS: Forty-nine adolescents with congenital craniofacial anomalies, aged 14 to 18 years, and their parents. MAIN OUTCOME MEASURES: Psychosocial adjustment (internalizing problems and social competence), assessed by self-report and parent-report forms of the Child Behavior Checklist; appearance self-concept and global self-worth, assessed by the Self-Perception Profile for Adolescents. RESULTS: Both appearance self-concept and global self-worth were associated with psychosocial adjustment; however, global self-worth remained associated with adjustment when the effects of appearance self-concept were controlled, whereas appearance self-concept was no longer associated with adjustment when global self-worth was controlled. Demographic variables (ethnicity, socioeconomic status, and adolescent gender) largely failed to moderate the associations between self-concept and adjustment. CONCLUSIONS: Adolescent dissatisfaction with appearance is linked to psychosocial adjustment problems only when it is part of a negative overall view of the self.

Psychosocial adjustment in adolescents with craniofacial anomalies: a comparison of parent and self-reports.

OBJECTIVE: To assess rates of psychosocial adjustment problems in adolescents with craniofacial anomalies (CFAs) and to evaluate the correspondence between adolescent and parent reports of adjustment. DESIGN: Retrospective chart review. SETTING: Reconstructive plastic surgery department in urban medical center. PARTICIPANTS: Sixty-four adolescents aged 14 to 18 years with CFAs and their parents. MAIN OUTCOME MEASURES: Child Behavior Checklist, Youth Self-Report. RESULTS: Adolescent and parent reports were compared with published norms. Adolescents with CFAs did not differ from norms on rates of self-reported problems in the clinical range. Parents of sons and daughters with CFAs reported elevations in the clinical range for deficits in social and scholastic competence; parents of daughters also reported higher clinical rates of withdrawn and somatic problems. Correlations between adolescent and parent reports were generally higher than seen in norms, especially for boys. Parents and adolescents did not differ in reported rates of problems in the clinical range. CONCLUSIONS: Adolescents with CFAs showed elevated risk for problems with academics and peer relationships; there was limited evidence for clinical levels of other adjustment problems. When parent and adolescent reports differed, parents reported more problems.

Parenting stress in infancy and psychosocial adjustment in toddlerhood: a longitudinal study of children with craniofacial anomalies.

OBJECTIVE: To evaluate the association between parenting stress during infancy and child psychosocial adjustment during toddlerhood, within a sample of children with craniofacial anomalies (CFAs). DESIGN: Retrospective chart review. SETTING: Urban medical center department of reconstructive plastic surgery. PARTICIPANTS: Parents of 47 children aged birth to 24 months at time 1 and 24 to 46 months at time 2. MAIN OUTCOME MEASURES: Parenting Stress Index/Short Form completed at times 1 and 2; Child Behavior Checklist completed at time 2. RESULTS: Relative to norms, more parents of children with CFAs experienced serious levels of parenting stress at times 1 and 2; however, fewer children with CFAs experienced serious levels of adjustment problems. Parenting stress during infancy predicted psychosocial adjustment in toddlerhood but was mediated by parenting stress in toddlerhood. Parents high on stress at both assessments showed clinical levels of total parenting stress and parent-child dysfunctional interaction when their children were infants; their toddlers showed higher levels of maladjustment than those with parents elevated on parenting stress during only infancy. CONCLUSIONS: Elevated levels of parenting stress during infancy may be stable through toddlerhood for families having a child with a CFA. The relation between parenting stress and child adjustment is likely to be reciprocal. These findings should be replicated with a larger sample and multiple informants.

Psychosocial adjustment in children and adolescents with a craniofacial anomaly: age and sex patterns.

OBJECTIVE: To examine rates of psychosocial adjustment problems and competencies in a sample of children with congenital craniofacial anomalies (CFAs). METHODS: Retrospective chart review. SETTING: Urban hospital plastic surgery primary care unit. PATIENTS: A total of 724 children aged 2 to 18 years with completed Child Behavior Checklists in their medical charts. MAIN OUTCOME MEASURE: Child Behavior Checklist. RESULTS: Higher rates of problems in the clinical range were seen for withdrawn, attention, social, thought, and internalizing problems and lower rates for externalizing and somatic complaints; specific patterns varied according to age and sex. Elevated rates of competency deficits were seen in some groups. CONCLUSIONS: Most children with CFAs do not appear to experience psychosocial adjustment problems. Although elevated risk may be seen for certain problems, this group may be protected in other areas. Research identifying the mechanisms responsible for varying age and sex patterns of adjustment is needed.