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The state of the literature on the psychosocial adjustment of children and adolescents with cancer is primed for novel contributions to the promotion of quality of life and depletion of negative psychosocial outcomes. Many recent studies indicate that this population may be at increased risk for depressed and anxious symptomatology; however, there is a large degree of individual variation. Coping responses have been demonstrated as significant predictors of adjustment outcomes with these patients. Research focusing upon coping with childhood chronic illness is progressing toward levels of greater specificity of construct and application; therefore, it is timely to target specific coping mechanisms in response to specified stressors. Health psychology has examined the role of spirituality as promoting positive health outcomes in adult populations. However, the pediatric literature has not empirically addressed this potential coping mechanism for child populations. The current study sought to: (a) develop a preliminary child measure of spiritual coping, and (b) to employ this assessment tool in an empirical investigation of the relationship between spiritual coping and psychosocial adjustment in the childhood cancer population. This investigation included 55 child participants recruited from three hospital settings across the southeastern, Midwestern, and western United States. During the measure development phase, 22 children were interviewed regarding their use of coping strategies (specifically spirituality) to target illness-related stress. The spiritual coping measure was based upon the response set obtained during this phase, and incorporated items into two subscales: existential and religious coping. The rest of the sample (N=33) participated in an individual interview that assessed coping (approach, avoidant, and spiritual) as well as depression, anxiety, and quality of life. A pilot factor analysis was employed to examine the structure of the new spiritual coping measure. Additionally, hierarchical regression analyses were employed to examine the contributions of each coping variable to the prediction of child adjustment outcomes. The results indicated that depression is significantly predicted by the full coping model; however, the analyses for anxiety and quality of life were not significant. Furthermore, spiritual coping was not demonstrated to add significantly to the prediction of child adjustment in the full coping model. Post-hoc analyses revealed a mediation effect for social functioning upon the relationship of existential coping and depression. Additionally, religious coping was found to mediate the effect of emergency room utilization upon perceived efficacy of avoidant coping. The factor analysis for the measure, while preliminary in nature, reflected a two-factor solution with strong loadings that closely approximated the theoretical delineation of the subscales. / Ph. D.

Research from the U.S. suggests that maternal HIV-infection negatively impacts children's psychosocial functioning and that resources (e.g., the parent-child relationship) positively influence their adjustment to maternal HIV-infection. Although HIV-infection in South Africa is most prevalent among Black South African women, there is limited research examining its impact on their children. In addition, as these children are exposed to numerous socio-cultural stressors beyond those associated with HIV-infection, they are at particular risk for psychosocial difficulties. This study had two aims: 1) to evaluate whether maternal HIV-infection confers risk for psychosocial difficulties (i.e., internalizing and externalizing behaviors) among Black South African children; and, 2) to examine potential protective resources for children of HIV-infected mothers that could ideally be addressed through appropriate community-level interventions. Three categories of resources were considered: material (familial economic stability); maternal (maternal psychological functioning; maternal social support); and, caregiving (the parent-child relationship; quality of the caregiver - co-caregiver relationship). Participants included women who self-identified as HIV-infected or non-infected and who were the biological mother of a child aged 11-16. Results indicated that there were no psychosocial adjustment differences between the two groups of children. The lack of differences suggests that in the context of the constellation of stressors Black South African children face, maternal HIV-infection may not serve as a unique stressor for psychosocial adjustment difficulties. However, the lack of differences should not be construed to mean that a child whose mother is HIV-infected is not affected his/her mother's diagnosis. Maternal HIV-infection is a complex phenomenon that warrants further study among Black South African children. The results did not illuminate any resources that were particularly salient to the children of HIV-infected mothers; rather, variables salient to all children were identified, notably economic stability, maternal depression, family social support, the parent-child relationship, and conflict in the mother- co-caregiver relationship. Given the overall risk present in the lives of Black South African children beyond maternal HIV-infection, it appears important to address the needs of all children. This study provides important information about individual and family-level variables that could be emphasized in family interventions with the population as a whole.

Interventions which ameliorate the late effects of cancer treatment, and promote adjustment for children coping with cancer are needed (Kazak, 2005). The Beads of Courage® (BOC) Program (Baruch, 2002), is an arts-in-health program developed to strengthen resilience and alleviate suffering in children receiving treatment for cancer. Through the BOC Program, children receive different colored beads that serve as visible symbols of the many procedures they experience during cancer treatment. Despite the wide use of the BOC Program by more than 70 children's hospitals, the BOC Program has never been formally evaluated.The purpose of this study was to evaluate the BOC Program using qualitative descriptive methods. The specific aims of the program evaluation were to: 1) Describe the BOC Program process; 2) Describe how the BOC Program is implemented; and 3) Describe the potential outcomes of the BOC Program.Data collection methods with four BOC Program stakeholders included: Semi-structured interviews with children (N=6); focus groups with clinicians (N=10) and parents (N=5); and open-ended surveys with clinicians (N=9), parents (N=8) and bead artists (N=6). Findings indicate that the BOC Program is operating according to design (process and implementation), and the overall satisfaction and perceived worth of the BOC Program is high. Emerging categories from the content analysis describe the BOC Program as a form of narrative medicine that provides a reflective tool, a symbol of accomplishment, and joy and encouragement for children receiving treatment for cancer. Preliminary data support the BOC Program theory, with resilience-based protective factors (positive coping, derived meaning, social support) supported, and risk factors (uncertainty in illness, defensive coping) decreased in children who received the BOC Program. Future studies should include quantitative measures of factors of resilience to determine change over time in children receiving the BOC Program during cancer treatment. Findings from this study support theory development to further strengthen the body of knowledge on psychosocial adjustment issues for children coping with cancer. The findings also provide evidence to support the role that arts-in-health programs have in alleviating the experience of suffering in children coping with cancer.

Background: Mild Cognitive Impairment (MCI) is a clinical construct reputed to represent an intermediate stage on a continuum between normal aging and cognitive decline. Conceptual and prognostic ambiguity can lead to significant diagnostic challenges and there is a need for accurate screening tests which can assist clinicians with decision-making. A diagnosis of MCI is also associated with considerable uncertainty for patients who may be adjusting to cognitive difficulties along with an increased risk of developing dementia. Beliefs about MCI may influence psychosocial adjustment, and individual differences in ‘psychological flexibility (PF)’, as conceptualised by the Acceptance and Commitment Therapy (ACT) model, may also be involved in this process. Objectives: In order to evaluate the accuracy and clinical utility of a recently developed screening tool for MCI, the Montreal Cognitive Assessment (MoCA), a systematic review of validation and diagnostic test accuracy (DTA) studies for this measure was conducted. Psychosocial adjustment to a diagnosis of MCI was also a key focus. An empirical study was therefore carried out with the aim of evaluating the possible relationships between cognitive impairment, illness representations about MCI, psychological wellbeing and quality of life (QoL), and to assess the potential involvement of PF. Method: Following a systematic search of relevant electronic databases and reference lists, validation and DTA studies of the MoCA were identified and evaluated for methodological quality. For the empirical study, patients recently diagnosed with MCI were recruited from local NHS memory clinic services and completed the MoCA and a questionnaire pack assessing illness representations, PF, mood, anxiety and QoL. Results: The systematic review identified 18 validation and DTA studies. Few of the studies achieved high ratings for methodological quality and problems with representativeness and generalisability were identified. Nevertheless, sensitivity levels appeared robust across studies, though specificity was variable. For the present empirical study, participants reported a spectrum of positive and negative beliefs about MCI. Distress attributed to MCI was associated with anxiety, along with perceptions of more serious illness consequences, while higher PF was associated with higher perceived QoL and mood. Lived experience of MCI appeared to have more relevance to psychosocial adjustment than objective cognitive impairment. Conclusions: The results of the systematic review indicate that while the MoCA is a robust tool overall in the identification of cognitive impairment, estimates of accuracy may be exaggerated by inter-study variation and bias. More rigorous validation studies are therefore needed. Implications for clinical decision-making regarding MCI are discussed and recommendations for future accuracy studies are outlined. The empirical study supported the findings of previous studies of the relevance of illness representations to psychosocial adjustment in MCI and added to the evidence base by providing preliminary support for the possible involvement of PF. The results suggest that both cognitive content and PF may represent possible vehicles for therapeutic change in patients with adjustment difficulties, and indicate that further investigation of these factors is warranted. Conclusions are limited, however, by small sample size and low statistical power. Replication of these findings with a larger and more representative sample is therefore recommended.

The psychosocial needs of couples impacted by aphasia are often unmet. Sixty-one marriage and family therapists' (MFTs) experiences, perceived knowledge, confidence, comfort, and barriers in working with couples impacted by aphasia, and their interactions with speech-language pathologists (SLPs) were investigated using survey methodology. All MFTs were licensed, practicing in the US, and had at least 3 years of experience. Participants completed the following in order: (a) a pre-intervention survey, (b) one of two intervention conditions, and (c) a post-intervention survey. Twenty-eight respondents were randomly assigned to an education-alone intervention and 33 respondents were assigned to an education plus Relationship-Centered Communication Partner Training program (RC-CPT). The results of the present study suggest that MFTs who participated in this survey consider providing therapy to couples impacted by aphasia to fall within their scope of practice and already feel comfortable with various skills needed to provide therapy to this population. Aphasia education alone and education plus RC-CPT can both improve MFTs' knowledge, confidence, and comfort in working with couples impacted by aphasia but being shown a model of RC-CPT likely helped MFTs better visualize therapy, which bolstered changes in respondents' perceptions. Future development of RC-CPT should prioritize MFT involvement as collaborators and consultants. Continuing education courses and interprofessional collaboration are needed to better address the psychosocial needs of people with aphasia (PWA) from an interdisciplinary perspective.

Sickle Cell Disease (SCD) is a genetic disorder that affects approximately 1 out of every 600 African-American newborns (NHLBI, 2006). SCD and its associated symptoms can have widespread impact on both the psychological functioning of the individual diagnosed with the illness and their families. The purpose of this study was to apply the illness intrusiveness framework to better understand the relations among vaso-occlusive pain crises (VOC), child age, pediatric health related quality of life (QOL), and parental psychosocial adjustment. Participants included 103 parent-child dyads. Parents completed a background form, the Brief Symptom Inventory-18, and the Illness Intrusiveness Rating Scale. Children completed the Pediatric Quality of Life Inventory. Results revealed that experiencing a greater frequency of VOC’s was related to decrements in QOL across domains. However, this relation was not mediated by parental perceived illness intrusiveness. Further, results revealed that the effect of frequency of vaso-occlusive pain crises in children with SCD on parental psychosocial maladjustment is mediated by parental illness intrusiveness, which is contingent upon child age.

<p>Caregivers of survivors of pediatric cancer face ongoing social, emotional and financial challenges that may result in enduring illness- and caregiving-related distress. After patients complete treatment there are challenges that persist. Indeed, emerging physical and cognitive "late effects," resulting from the disease and treatment, require families to adapt to a new normal state that may require significant long-term follow-up and care by the survivor and their primary caregiver. This study compares the psychological adjustment of caregivers of pediatric cancer survivors with caregivers of healthy children. In addition, this study evaluates individual factors, such as family functioning and coping style, which may be associated with poorer adjustment among caregivers of pediatric cancer survivors. Caregivers of pediatric cancer survivors (n = 64) and caregivers of healthy children (n = 64) were recruited during regularly scheduled clinic visits to complete questionnaires including a demographic and illness questionnaire and measures of psychosocial functioning. A series of multivariate analyses of covariance were conducted to assess for differences in caregiver distress by group. Caregivers of survivors reported significantly more child-specific parenting stress and somatization than caregivers of healthy children. Hierarchical regression modeling revealed that Escape-avoidance coping and Supportive family functioning predicted 25-40% of the variance in parenting-related psychological adjustment among caregivers of survivors. Caregivers of pediatric cancer survivors face unique challenges that contribute to ongoing distress, particularly related to the parenting role. This population may benefit from interventions aimed at reducing avoidance based coping and improving family functioning.</p> / Dissertation

Σκοπός της παρούσας εργασίας ήταν να μελετήσει την ψυχοκοινωνική προσαρμογή και την αυτοεκτίμηση παιδιών με και χωρίς μαθησιακές δυσκολίες (ΜΔ), που φοιτούσαν στην Ε΄και Στ΄τάξη του Δημοτικού. Στη μελέτη έλαβαν μέρος συνολικά 137 μαθητές, εκ των οποίων οι 36 παρουσίαζαν ΜΔ βάσει εκτιμήσεων των εκπαιδευτικών σε αντίθεση με τους υπόλοιπους 101 μαθητές. Σε όλους τους συμμετέχοντες χορηγήθηκε ένα ερωτηματολόγιο αυτοαναφοράς με το οποίο συλλέχθηκαν κάποια δημογραφικά στοιχεία και μετρήθηκε η ψυχοκοινωνική προσαρμογή και οι επιμέρους διαστάσεις της – κοινωνική, σχολική, συναισθηματική επάρκεια, προβλήματα συμπεριφοράς και αυτοαντίληψη – καθώς επίσης η αυτοεκτίμηση. Τα αποτελέσματα των αναλύσεων έδειξαν ότι οι μαθητές με ΜΔ του δείγματος παρουσίαζαν χαμηλότερη ψυχοκοινωνική προσαρμογή και αυτοεκτίμηση από τους τους μαθητές χωρίς ΜΔ. Ακόμη, , τα παιδιά με ΜΔ σημείωσαν χαμηλότερο σκορ στην κοινωνική επάρκεια και την αυτοαντίληψη και υψηλότερο σκορ στα προβλήματα συμπεριφοράς συγκριτικά με τα παιδιά χωρίς ΜΔ. Ωστόσο, δεν υπήρξαν διαφοροποιήσεις μεταξύ των δύο ομάδων συμμετεχόντων ως προς τη σχολική και συναισθηματική επάρκεια. / The purpose of this study was to examine psychosocial adjustment and self-esteem in students with learning disabilities (LD) compared to their normally achieving classmates. The sample of the study consisted of 137 fifth and sixth grade elementary school students. The normally achieving children were 10, whereas the children with LD were 36 and were identified based on teachers' ratings. Self-ratings were used to measure psychosocial adjustment and its dimensions – social competence, school competence, emotional competence, behavioral problems, self-concept ¬– as well as self-esteem. Also, demographic data were obtained. The results of this study showed that children with LD exhibited lower psychosocial adjustment and self-esteem compared to their normally achieving classmates. Also, they had lower scores in social competence and self-concept, whereas they scored in behavioral problems. There was no significant differences found between children with and without LD school and emotional competence.