Cognitive status as a risk factor for maladjustment in children with a physical disability

Investigated the association between cognitive status and adjustment in children who have a physical disability, in three independent studies. In Study 1, 119 mothers reported on the cognitive status and behavioral adjustment of their children, ages 2-18, who had varying physical or sensory impairments. In Study 2, the intellectual level of 50 children, ages 6-1 1, with either spina bifida or cerebral palsy, was estimated from cognitive test information while mothers reported on the children’s behavioral adjustment. In Study 3,66 adolescents, ages 11-18, with a physical disability completed an IQ test and reported on their behavioral adjustment, as did their mothers. Severity of physical disability was also assessed in each study. No relationships could be found between any index of cognitive status and any adjustment measure when controlling for severity of physical disability. The overwhelming majority of zero-order relationships were also not significant. These findings were discussed in relation to Wallander and Varni’s Disability- Stress-Coping model of adjustment in children with chronic physical conditions.Este artigo descreve investigag6es sobre a associação entre o estatuto cognitivo e o ajustamento em crianças com deficiência física, em três estudos independentes. No Estudo 1, 1 19 m5es prestaram informaq20 acerca do estatuto cognitivo e do ajustamento comportamental dos seus filhos, com idades entre OS 2 e OS 18 anos, e com graus variáveis de deficiência física ou sensorial. No Estudo 2, o nível intelectual de 50 crianças, com idades entre OS 6 e OS 11 anos e com spina bifida ou com paralisia cerebral, foi estimado a partir de testes cognitivos e de relatos maternos sobre o seu ajustamento comportamental. No Estudo 3, 66 adolescentes, com idades entre OS 11 e OS 18 anos e com deficiência física, realizaram um teste de QI e prestaram informação sobre o seu ajustamento comportamental, relato que também foi feito pelas suas mães. Em cada estudo, a gravidade da deficiência física foi também avaliada. Controlando a variável «gravidade da deficiência física», não foi possivel encontrar relação entre qualquer índice de estatuto cognitivo e qualquer medida de ajustamento. A grande maioria de relações de ordem zero também não era significativa. Estes resultados são discutidos em função do modelo de Wallander e Varni «Disability-Stress-Coping» sobre o ajustamento em crianças com deficiências físicas cronicas.National Institutes of Healthinfo:eu-repo/semantics/publishedVersio

The role of family functioning and self-esteem in the quality of life of adolescents referred for psychiatric services: a 3-year follow-up.

PurposeTo investigate, in adolescents referred for psychiatric services, the associations of initial self-esteem and family functioning with level and change of quality of life (QoL) over a 3-year period, over and above the effect of their emotional problems.MethodsOf 1648 eligible 13-18 years old patients attending the child and adolescent psychiatric clinic (CAP) at least once, 717 (54.8% females) were enrolled at baseline (a response rate of 43.5%). Self- and parent reports on the McMaster Family Assessment Device were obtained. Adolescents reported self-esteem on the Rosenberg Scale, and emotional problems on the Symptom Check List-5. Adolescents completed the Inventory of Life Quality in Children and Adolescents (ILC). After 3 years, 570 adolescents again completed the ILC, and for 418 adolescents parent information was available. The longitudinal analysis sample of 418 adolescents was representative of the baseline sample for age, gender, emotional problems, and QoL. We used modified growth-model analysis, adjusted for SES, age, gender and time of contact with CAP, where residual variances for ILC at baseline and follow-up were fixed to 0.ResultsA poorer family functioning at baseline, reported by parents, was significantly associated with worsening QoL during the 3 years follow-up period (p = 0.001).ConclusionsParents have important knowledge about their families that may reflect long-term influences on QoL development in adolescent psychiatric patients. Health care providers and policy makers should optimize treatment outcomes by addressing family functioning in adolescents with emotional problems

Racial/ethnic disparities in health-related quality of life and health status across pre-, early-, and mid-adolescence: a prospective cohort study.

PURPOSE:To examine (1) racial/ethnic disparities in health-related quality of life (HRQOL) and overall health status among Black, Latino, and White youth during adolescence; (2) whether socioeconomic status (SES) and family contextual variables influence disparities; and (3) whether disparities are consistent from pre- to early- to mid-adolescence. METHODS:A population sample of 4823 Black (1755), Latino (1812), and White (1256) youth in three US metropolitan areas was prospectively assessed in a longitudinal survey conducted on three occasions, in 5th, 7th, and 10th grades, when youth reported their HRQOL using the PedsQL™ short-form Total, Physical and Psychosocial scales and youth and parents separately reported on youth's overall health status. Parents reported their education and household income to index SES, family structure, and use of English at home. RESULTS:Based on analysis conducted separately at each grade, marked racial/ethnic disparities were observed across all measures of HRQOL and health status, favoring White and disfavoring Black, and especially Latino youth. More strongly present in 5th and 7th grade, HRQOL disparities decreased by 10th grade. Most disparities between White and Black youth disappeared when adjusting for SES. However, even after adjusting for SES, family structure, and English use, overall health status disparities disfavoring Latino youth remained across all three assessments. CONCLUSIONS:Racial/ethnic disparities in adolescent HRQOL and health are substantial. These disparities appear consistent from pre- to early-adolescence but diminish for HRQOL by mid-adolescence. As disparities appear influenced by SES and other family contextual variables differently in different racial/ethnic groups, efforts to reduce health disparities in youth should address culturally specific conditions impinging on health

Patterns of Exposure to Cumulative Risk Through Age 2 and Associations with Problem Behaviors at Age 4.5: Evidence from Growing Up in New Zealand.

Exposure to cumulative risk (CR) has important implications for child development, yet little is known about how frequency, persistence, and timing of CR exposure during early childhood predict behavioral problems already before school start. We examine prospective longitudinal associations between patterns of CR exposure from third trimester through 2 years and subsequent behavior problems at 4.5 years. In 6156 diverse children in the Growing Up in New Zealand longitudinal study, the presence of 12 risk factors, spanning maternal health, social status, and home and neighborhood environment, defined CR and were assessed at last trimester and 9 months and 2 years of age. At child age 4.5 years, mothers completed the Strengths and Difficulties Questionnaire, where a score ≥ 16 indicated an abnormal level of problem behaviors (ALPB). Children exposed to a CR ≥ 1 at least once in early development, compared to those with consistent CR = 0, showed a significantly higher likelihood of ALPB at 4.5 years. Consistent high exposure to CR ≥ 4 across all three assessments had the highest prevalence (44%) of ALPB at age 4.5. Children with high CR exposure on two of three, compared to on all three, time points in early development did not evidence a significantly reduced prevalence (32%-41%) of ALPB. The common co-occurrence of risk factors and their significant developmental impact when accumulated early in life underscore the need for systematic multisector intervention and policy implementation during pregnancy and shortly after birth to improve outcomes for vulnerable children

Racial and Ethnic Health Disparities among Fifth-Graders in Three Cities

http://dx.doi.org/10.1056/NEJMsa111435

Associations between socioeconomic status and obesity in diverse, young adolescents: Variation across race/ethnicity and gender.

ObjectiveThis study examined the association between socioeconomic status (SES) and obesity risk during early adolescence, ages 10-13 years, and whether this association is present in different racial/ethnic and gender groups during 2 time points in early adolescence.MethodData were from the Healthy Passages study, which enrolled 4,824 African American, Hispanic, and White 5th graders (ages 10-11) in a population-based, longitudinal study conducted in 3 U.S. metropolitan areas, and assessed them again 2 years later. Weight status was classified from measured body mass index using standard criteria into nonobese and obese (27% in 5th grade). SES was indexed based on highest education attainment in the household.ResultsYouth in the highest SES had a significantly lower prevalence of obesity than those of lower SES at both 5th and 7th grades when disregarding race/ethnicity. Within-racial/ethnic group analyses mostly confirmed this pattern for Hispanic and White youth, but not for African American youth. When also considering gender, the SES differential in obesity risk was more pronounced among White girls and 5th-grade Hispanic boys.ConclusionGrowing up in a high SES home, marked by having a member with at least a college degree, is associated with lower risk for obesity among Hispanic and White youth. For African American youth, there appears to be no association between SES and obesity. Thus the health advantage generally attributed to higher SES does not appear consistently across racial/ethnic groups for obesity in youth. Further research should identify influences on weight status beyond SES, especially among African American youth

Parents' psychological adjustment in families of children with Spina Bifida: a meta-analysis

BACKGROUND: Spina Bifida (SB) is the second most common birth defect worldwide. Since the chances of survival in children with severe SB-forms have increased, medical care has shifted its emphasis from life-saving interventions to fostering the quality of life for these children and their families. Little is known, however, about the impact of SB on family adjustment. Reviewers have struggled to synthesize the few contradictory studies available. In this systematic review a new attempt was made to summarize the findings by using meta-analysis and by delimiting the scope of review to one concept of family adjustment: Parents' psychological adjustment. The questions addressed were: (a) do parents of children with SB have more psychological distress than controls? (b) do mothers and fathers differ? and (c) which factors correlate with variations in psychological adjustment? METHODS: PsycInfo, Medline, and reference lists were scanned. Thirty-three relevant studies were identified of which 15 were eligible for meta-analysis. RESULTS: SB had a negative medium-large effect on parents' psychological adjustment. The effect was more heterogeneous for mothers than for fathers. In the reviewed studies child factors (age, conduct problems, emotional problems, and mental retardation), parent factors (SES, hope, appraised stress, coping, and parenting competence), family factors (family income, partner relationship, and family climate), and environmental factors (social support) were found to be associated with variations in parents' psychological adjustment. CONCLUSION: Meta-analysis proved to be helpful in organizing studies. Clinical implications indicate a need to be especially alert to psychological suffering in mothers of children with SB. Future research should increase sample sizes through multi-center collaborations

Brain Research to Ameliorate Impaired Neurodevelopment - Home-based Intervention Trial (BRAIN-HIT)

<p>Abstract</p> <p>Background</p> <p>This randomized controlled trial aims to evaluate the effects of an early developmental intervention program on the development of young children in low- and low-middle-income countries who are at risk for neurodevelopmental disability because of birth asphyxia. A group of children without perinatal complications are evaluated in the same protocol to compare the effects of early developmental intervention in healthy infants in the same communities. Birth asphyxia is the leading specific cause of neonatal mortality in low- and low-middle-income countries and is also the main cause of neonatal and long-term morbidity including mental retardation, cerebral palsy, and other neurodevelopmental disorders. Mortality and morbidity from birth asphyxia disproportionately affect more infants in low- and low-middle-income countries, particularly those from the lowest socioeconomic groups. There is evidence that relatively inexpensive programs of early developmental intervention, delivered during home visit by parent trainers, are capable of improving neurodevelopment in infants following brain insult due to birth asphyxia.</p> <p>Methods/Design</p> <p>This trial is a block-randomized controlled trial that has enrolled 174 children with birth asphyxia and 257 without perinatal complications, comparing early developmental intervention plus health and safety counseling to the control intervention receiving health and safety counseling only, in sites in India, Pakistan, and Zambia. The interventions are delivered in home visits every two weeks by parent trainers from 2 weeks after birth until age 36 months. The primary outcome of the trial is cognitive development, and secondary outcomes include social-emotional and motor development. Child, parent, and family characteristics and number of home visits completed are evaluated as moderating factors.</p> <p>Discussion</p> <p>The trial is supervised by a trial steering committee, and an independent data monitoring committee monitors the trial. Findings from this trial have the potential to inform about strategies for reducing neurodevelopmental disabilities in at-risk young children in low and middle income countries.</p> <p>Trial Registration</p> <p>Clinicaltrials.gov NCT00639184</p

Gender role orientation is associated with health-related quality of life differently among African-American, Hispanic, and White youth

PurposeThis study examined the association between gender role orientation (GRO) and health-related quality of life (HRQOL) in youth, and how this relationship may differ between males and females as well as among African-American, White, and Hispanic individuals. GRO has been reported to influence serious health outcomes including cancer, heart disease, mental illness, and mortality rates. However, few studies have examined the link between GRO and health outcomes for children, even though gender identity is formed in childhood.MethodsData were examined from 4824 participants in the Healthy Passages™ project, a population-based survey of fifth-grade children in three US metropolitan areas. Children reported their own HRQOL using the PedsQL and degree of female, male, and androgynous GRO using the Children's Sex Role Inventory.ResultsBased on structural equations analysis, male GRO was positively associated with HRQOL for all racial/ethnic groups, regardless of sex, whereas female GRO was associated with better HRQOL for Hispanic and White females and poorer HRQOL for Hispanic males. Androgynous GRO was associated with better HRQOL among Hispanic and White females, but not males nor African-Americans of either sex.ConclusionsRacial/ethnic differences emerged for female and androgynous, but not male, GROs. Hispanic males are the only group for which GRO (female) was associated with poorer HRQOL. Future research should find ways to help youth overcome negative effects on health from gender beliefs and behavior patterns with sensitivity to racial/ethnic membership