Mental Health of Parents as Caregivers of Children with Disabilities: Based on Japanese Nationwide Survey

The number of children with disability is increasing gradually in Japan. Previous researches in other countries have reported that parents as caregivers (CGs) of children with disability have mental health problems, but the actual situation has not been examined nationwide in Japan so far. The aim of this study was to evaluate the association between mental health of CGs who had children with disability and characteristics of children, CGs, and household based on the nation-wide survey. This study utilized data from 2010 Comprehensive Survey of the Living Conditions, and defined children with disability aged 6 to 17. Individual data of children and CGs were linked, and 549 pairs of them were extracted. The Japanese version of Kessler 6 (K6) was used to assess mental health status of caregiver, scored 5 and over represented to general psychological distress. Logistic regression was used to evaluate the associations of interest. The almost half (44.4%) of CGs had psychological distress (k6 score; 5 +) in nationwide, and 8.9% of CGs might have serious mental illness (K6 score; 13+). After adjusting covariates of child, CG, and household factors, CG having a current symptom (OR, 95% CI: 3.26, 1.97–5.39), CG''s activity restriction (OR, 95% CI: 2.95, 1.38–6.32), low social support (OR, 95%CI: 9.31, 1.85–46.8), three generation family (OR, 95% CI: 0.49, 0.26–0.92), and lower 25% tile group of monthly household expenditure (OR, 95% CI:1.92, 1.05–3.54), were significantly associated with psychological distress of CGs. This study encourages health care providers to pay more attentions toward parent''s mental health, especially for in case of having low social support, and lower income family. Further research should examine the detailed information of child''s disease and disability, medical service use, and quality and quantity of social support in nationwide to straighten the system for supporting services of both children with disabilities and their CGs.     

Quantitative Assessment of Cortical Auditory-tactile Processing in Children with Disabilities

Objective and easy measurement of sensory processing is extremely difficult in nonverbal or vulnerable pediatric patients. We developed a new methodology to quantitatively assess children''s cortical processing of light touch, speech sounds and the multisensory processing of the 2 stimuli, without requiring active subject participation or causing children discomfort. To accomplish this we developed a dual channel, time and strength calibrated air puff stimulator that allows both tactile stimulation and sham control. We combined this with the use of event-related potential methodology to allow for high temporal resolution of signals from the primary and secondary somatosensory cortices as well as higher order processing. This methodology also allowed us to measure a multisensory response to auditory-tactile stimulation.     

Counseling Parents of Retarded Children

Recently pediatricians have become more interested in the retarded child and his family and have come to realize that they have been ill-prepared to face the many problems that continually arise. A basic understanding of the role of parents and their aspirations, coupled with a knowledge of interviewing, techniques will enable them to face these problems with greater assurance. In addition, a knowledge of the community facilities and resources is necessary. This will entail direct contact with schools, parent groups, state hospitals for the retarded as well as state and local agencies which deal with the retarded.     

Participation of Children with Disabilities in Taiwan: The Gap between Independence and Frequency

Background

Independence and frequency are two distinct dimensions of participation in daily life. The gap between independence and frequency may reflect the role of the environment on participation, but this distinction has not been fully explored.

Methods

A total of 18,119 parents or primary caregivers of children with disabilities aged 6.0-17.9 years were interviewed in a cross-sectional nationwide survey with the Functioning Scale of the Disability Evaluation System - Child version (FUNDES-Child). A section consisting of 20 items measured the children’s daily participation in 4 environmental settings: home, neighborhood/community, school, and home/community. Higher independence and frequency restriction scores indicated greater limitation of participation in daily activities. Scores for independence, frequency and independence-frequency gaps were examined across ages along with trend analysis. ANOVA was used to compare the gaps across settings and diagnoses for children with mild levels of severity of impairment.

Findings

A negative independence-frequency gap (restriction of frequency was greater than that of independence) was found for children with mild to severe levels of impairment. A positive gap (restriction of independence was greater than that of frequency) was found for children with profound levels of severity. The gaps became wider with age in most settings of children with mild impairment and different diagnoses. Widest negative gaps were found for the neighborhood/community settings than for the other three settings for children with mild to severe impairment.

Conclusions

Children’s participation and independence-frequency gaps depend not only on the severity of their impairments or diagnoses, but also on their age, the setting and the support provided by their environment. In Taiwan, more frequency restrictions than ability restrictions were found for children with mild to moderate severity, especially in the neighborhood/community setting, and increased with age. Further identification of environmental opportunities that positively impact frequency of participation is needed.     

Defects and Disabilities of Thalidomide Children

The range of defects and disabilities in thalidomide children is very much wider than is generally realized. The defects of 154 children are described and classified. Their disabilities range from incapacitating to negligible.     

Long-Term Effectiveness of Dolphin-Assisted Therapy for Children with Severe Disabilities

ABSTRACT

Long-term effectiveness of dolphin assisted therapy, as practiced by Dolphin Human Therapy, was analyzed via a 15 item closed form, ratio scale parent questionnaire (n=71). Children with severe disabilities of many etiologies, from eight countries, received either one or two weeks of therapy in the multidisciplinary, behavior modification program. Results on three clinical issues were analyzed. First, children maintained or improved skills acquired in therapy about 50% of the time even after 12 months away from therapy. Second, no difference in long-term effects occurred as a function of differences in three categories (genetic, brain damage, unknown causes) of etiology (ANOVA, F_(2,39)=2.79, p>0.05). Third, two weeks of therapy produced significantly better long-term results than did one week of therapy (t=3.105, df=28, p<0.01).     

Effectiveness of Short-Term Dolphin-Assisted Therapy for Children with Severe Disabilities

ABSTRACT

The effectiveness of two week dolphin-assisted therapy was compared to the effectiveness of six month conventional physical and speech-language therapy. Data were analyzed using a multiple baseline single subject across settings design, for 47 children with severe disabilities (20 females, 27 males), of multiple etiologies. Children were placed in a physical therapy group (n = 17, mean age = 6 years, 8 months) and a speech language group (n = 30, mean age = 6 years 5 months). Standardized charting procedures were used to measure acquisition of independent motor and speech-language skills. Use of t tests for nonindependent samples indicates that relative to conventional long-term therapy, dolphin-assisted therapy, as practiced by Dolphin Human Therapy, achieves positive results more quickly and is also more cost effective.     

Social Effects of a Dog's Presence on Children with Disabilities

ABSTRACT

Productive and positive interactions between dogs and humans have been documented in studies using dogs trained as companion animals and as assistants for people with disabilities. In this study, the effects of the presence of a dog on social interactions between three 5–9-year-old children with developmental disabilities and their teacher at an elementary school were analyzed. A single-case experimental design with repeated measures and with replicated effects across participants was employed to assess changes in interactions from baseline to an intervention condition. During baseline, interactions were assessed in the social environment of a room adjacent to the classroom, which had a toy dog and other play materials, during time with the teacher. The experimental change introduced sequentially and systematically across the participants was the additional presence of an obedience-trained dog, a German Shepherd/Labrador Retriever cross. Interactions between the children and their teacher were examined during morning sessions using reliable direct observation interval recording procedures. All participants demonstrated an increase in overall positive initiated behaviors (verbal and non-verbal) toward both the teacher and the dog. The children also showed an overall decrease in negative initiated behaviors. In addition, observational ratings showed positive generalization of improved social responsiveness by the children in their classroom following the completion of the experimental sessions. This study supports the position that children with developmental disabilities benefit from the use of skilled dogs as teaching assistants and therapeutic adjuncts.     

Th17 Immunity in Children with Allergic Asthma and Rhinitis: A Pharmacological Approach

Th17 cells and IL-17A play a role in the development and progression of allergic diseases. We analyzed the IL-17A levels in sputum supernatants (Ss), nasal wash (NW) and plasma (P) from Healthy Controls (HC) and children with Asthma/Rhinitis. We tested the expression of IL-17A, RORγ(t) and FOXP3 in peripheral blood T-lymphocytes from intermittent and mild-moderate asthma. The effect of Budesonide and Formoterol was tested “in vitro” on IL-17A, RORγ(t) and FOXP3 expression in cultured T-lymphocytes from mild-moderate asthma/persistent rhinitis patients, and on nasal and bronchial epithelial cells stimulated with NW and Ss from mild-moderate asthma/persistent rhinitis. Further, the effect of 12 weeks of treatment with Budesonide and Formoterol was tested “in vivo” in T-lymphocytes from mild-moderate asthma/persistent rhinitis patients. IL-17A was increased in Ss, NW and P from children with mild-moderate asthma compared with intermittent and HC. In cultured T-lymphocytes IL-17A and RORγ(t) expression were higher in mild-moderate asthma/persistent rhinitis than in mild-moderate asthma/intermittent rhinitis, while FOXP3 was reduced. Budesonide with Formoterol reduced IL-17A and RORγ(t), while increased FOXP3 in cultured T-lymphocytes from mild-moderate asthma/persistent rhinitis, and reduced the IL-8 release mediated by IL-17A present in NW and Ss from mild-moderate asthma/persistent rhinitis in nasal and bronchial epithelial cells. Finally, Budesonide with Formoterol reduced IL-17A levels in P and Ss, CD4⁺IL-17A⁺T-cells, in naïve children with mild-moderate asthma/persistent rhinitis after 12 weeks of treatment. Th17 mediated immunity may be involved in the airway disease of children with allergic asthma and allergic rhinitis. Budesonide with Formoterol might be a useful tool for its therapeutic control.     

Towards Measuring the Informal City: A Societal Metabolism Approach

The rapid growth of urban informal settlements, or slums, poses a particular challenge for balancing developmental and environmental goals. In South Africa, high levels of inequality, poverty, and unemployment contribute to widespread migration. The influx of migrant workers to cities, however, is rarely matched with adequate housing and infrastructure, resulting in the formation and growth of urban informal settlements. Despite the persistence of the slum phenomenon, very few studies provide an in‐depth understanding of the metabolic processes that link these spaces, and informal economies, to the broader urban environment and economy. This article therefore utilized a multiscale integrated assessment of the societal and ecosystem metabolism approach to examine human activity and land use in Enkanini, an urban informal settlement in Stellenbosch, South Africa. The results highlight a number of issues to be addressed through spatial, developmental, and local economic policy, such as the need for improved transport linkages. The time‐use results show that Enkanini is a net provider of labor to the surrounding area. Further, geographical mapping indicates Enkanini as a small, but vibrant, informal economy, while being grossly underserviced in terms of water, waste, and sanitation infrastructure. Key implications are discussed in terms of the theoretical, methodological, societal, and policy impact of the study, including the need for city observatories that conduct regular data collection and analysis.     

Understanding Collective Discontents: A Psychological Approach to Measuring Zeitgeist

Over the last decade, several countries around the world developed a collective sense of doom and gloom: Their Zeitgeist could be characterized as one of decline. Paradoxically, in some countries, such as the Netherlands, this collective discontent with society seems to exist despite high levels of individual well-being. Current psychological research informs us about why individuals would feel unduly optimistic, but does not account for a collective sense of decline. The present research develops a novel operationalization of Zeitgeist, referred to as a general factor Z. We conceptualize Zeitgeist as a collective global-level evaluation of the state (and future) of society. Three studies confirm that perceptions of the same societal problems at the personal and collective level differed strongly. Across these studies we found support for a hypothesized latent factor Z, underlying collective-level perceptions of society. This Z-factor predicted people’s interpretation of new information about society that was presented through news stories. These results provide a first step in operationalizing and (ultimately) understanding the concept of Zeitgeist: collectively shared ideas about society. Implications for policy are discussed.     

Parents and Vehicle Purchases for Their Children: A Surprising Source of Weight Bias

According to current estimates, 68% of the population in United States is considered either overweight or obese. Despite its relative frequency, prejudice and discrimination against overweight and obese Americans is a common occurrence. This study seeks to build on previous findings that overweight individuals are more likely than their skinnier peers to rely on themselves, rather than family, to fund their education. We examined whether this trend continued in car‐buying practices. Results suggest that overweight and obese individuals differentially rely on their own sources of income to finance a car, even after controlling for socioeconomic differences. Possible explanations and implications are discussed.     

Behavior of Children with Learning Disabilities Interacting With a Therapy Dog

ABSTRACT

Therapy using animals is now a widespread phenomenon, but some authorities have argued that there is insufficient evidence either to justify or to guide animal-assisted therapy. This reflects a paucity of adequate quantitative methodology for investigations in this area. The little research that has been carried out suggests that animal presence may increase general social behavior. Our study aimed to develop a methodology to investigate the effects of a dog on the behavior of children with severe learning disabilities. A repeated measures design was used to observe eight children with Down's syndrome in controlled sessions, under the direction of an adult. Each session consisted of seven minutes of interaction with a real dog, and seven minutes with an imitation dog. Differences in visual attending, and verbal and non-verbal initiation and response behaviors indicated that the real dog provided a more sustained focus for positive and co-operative interactions with itself and the adult, than did the imitation dog.     

Coping with Breast Cancer: A Meta-Analysis

Objective

The primary aim of this study was to examine the associations between different types of coping and psychological well-being and physical health among women with breast cancer. A second aim was to explore the potential moderating influences of situational and measurement factors on the associations between coping and psychological well-being and physical health.

Methods

On 14 February 2011, a literature search was made for articles published in the PubMed and PsycINFO databases before January 2010. On 5 September 2013, a repeated literature search was made for articles published before May 2013. In the final analyses, 78 studies with 11 948 participants were included.

Results

Efforts to facilitate adaptation to stress, such as Acceptance and Positive Reappraisal, were related to higher well-being and health. Disengagement and avoidance types of coping were associated with lower well-being and health. The analyses indicated that, in several circumstances, coping effectiveness was dependent on cancer stage, treatment, disease duration, and type of coping measure.

Conclusions

Use of coping targeting adjustment and avoiding use of disengagement forms of coping were related to better psychological well-being and physical health. Adaptive strategies and avoiding disengagement forms of coping seemed particularly beneficial for women undergoing treatment.     

Posttraumatic Stress Reactions in Parents of Children Esophageal Atresia

Objective

The aim of this study was to investigate psychological stress in parents of children with esophageal atresia and to explore factors associated with the development of Posttraumatic Stress disorder (PTSD).

Design

Self-report questionnaires were administered to parents of children with EA. Domains included: (1) sociodemographic data, current personal difficulties, assessment scales for the quality of life and for the global health status of the child (2) French-validated versions of the Perinatal Posttraumatic Stress disorder Questionnaire and of the State-Trait Anxiety Inventory. Associations between PTSD and severity of the neonatal course, presence of severe sequelae at 2 years of age, and quality of life and global health status of children according to their parents’ perception were studied.

Setting

A Tertiary care University Hospital

Results

Among 64 eligible families, 54 parents of 38 children (59%) participated to the study. PTSD was present in 32 (59%) parents; mothers were more frequently affected than fathers (69 vs 46%, p = 0.03). Four mothers (8%) had severe anxiety. PTSD was neither associated with neonatal severity nor with severe sequelae at 2 years. Parents with PTSD rated their child’s quality of life and global health status significantly lower (7.5 vs 8.6; p = 0.01 and 7.4 vs 8.3; p = 0.02 respectively).

Conclusions

PTSD is frequent in parents of children with esophageal atresia, independently of neonatal severity and presence of severe sequelae at 2 years of age. Our results highlight the need for a long-term psychological support of families.     

The Association between GP Consultations for Non-Specific Physical Symptoms in Children and Parents: A Case-Control Study

Background

Non-specific physical symptoms (NSPS) such as abdominal pain, headache and musculoskeletal pain are widespread in the community, and are common reasons for visiting a general practitioner (GP). Causes of NSPS are multifactorial, but may include parental influences.

Objective

To investigate associations between GP consultations for NSPS in parents and their children.

Methods

Matched case-control study using GP consultation data from 12 GP practices in the United Kingdom. Participants were 1328 children who consulted a GP for NSPS in 2009 (cases), 3980 controls who consulted a GP in 2009 but not for NSPS, plus parents of cases and controls (n = 8354). Primary outcome measure: child consultation status for NSPS.

Results

Maternal consultation for NSPS was associated with significantly increased odds of their child consulting for NSPS (odds ratio (OR) 1.51, 95% confidence intervals (CI) 1.33, 1.73); there was no significant association with paternal consultations (OR 0.87, 95% CI 0.71, 1.08). Each additional maternal consultation for NSPS was associated with an increase in the rate ratio for number of consultations for NSPS in the child by 1.03 (95% CI 1.01, 1.05). This overall association was clearest in maternal-child consultations for painful NSPS and for specific bodily systems including gastrointestinal, musculoskeletal and neurologic symptoms.

Conclusions

Maternal GP consultation for NSPS is associated with increased odds of GP consultations for NSPS in children. This study included a large sample of children and parents and used medical records data which is not subject to recall bias. However, analysis was based on medical records, thus the presence of NSPS not leading to consultations is unknown. Medical practitioners managing children with NSPS need to be aware of this association.     

Correlation of Age and Birth Order of Parents with Chromosomal Anomalies in Children*

One hundred children with suspected congenital and/or malformation and their parents who reported to SAT hospital, Medical College, Trivandrum, India formed the test group. Fifty children with no obvious anomalies or abnormalities and their parents formed the control group. The criteria for selection of the control was (1) the maternal age at delivery was below 30 years and (2) the parents belong to first or second birth order. The chromosomal analysis was carried out in all the subjects using peripheral blood lymphocyte microculture to investigate any constitutional chromosomal markers and quantitate the mutagen (bleomycin) sensitivity of the chromosomes. All the subjects were evaluated clinically and a complete family history was recorded. Chromosome anomalies were noted in 41 out of 100 children and in 4 out of 200 parents of the test group. No constitutional aberrations were seen either in the parents or in the children of the control group. Bleomycin sensitivity study revealed a high b/c value in 35 children (24 hypersensitive and 11 sensitive) of the test group whereas in the control group the b/c values were low denoting hyposensitivity and very good DNA repair mechanism. This study reveals that the incidence of chromosome aberrations is higher when the age and birth order of parents are higher. A direct correlation was noted with parental order and b/c value. This was also true with the parental age and birth defects.