PURPOSEChildren with cancer experience low quality of life (QOL), yet heterogeneity underscores a need to understand how risk and resilience factors interact. This study evaluated if family ...functioning relates to QOL differentially depending on diagnosis and treatment intensity.METHODSParticipants included children (ages 8-14) who completed treatment within six months for either brain tumor (BT; n = 42) or non-central nervous system solid tumor (ST; n = 29). Caregivers and children rated QOL and family functioning. Treatment intensity was categorized as low, moderate, or high. Cross-informant moderation models tested hypothesized interactions.RESULTSChild-reported family functioning significantly interacted with diagnosis and treatment intensity in models of caregiver-reported QOL. More maladaptive family functioning was associated with reduced QOL for children with BT and moderately-intense treatments.CONCLUSIONSChildren with BT and moderate treatment intensities are sensitive to family functioning, highlighting an at-risk group to target for family-level intervention. Future work should evaluate these associations longitudinally.
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To examine the impact of early traumatic brain injury (TBI) on effortful control (EC) over time and the relationship of EC and executive functioning (EF) to long-term functional and social outcomes.
...Parents of children (
= 206, ages 3-7) with moderate-to-severe TBI or orthopedic injuries (OIs) rated EC using the Child Behavior Questionnaire at 1 (pre-injury), 6, 12, and 18 months post-injury. Child functioning and social competence were assessed at 7 years post-injury. Mixed models examined the effects of injury, time since injury, and their interaction on EC. General linear models examined the associations of pre-injury EC and EC at 18 months with long-term functional and social outcomes. Models controlled for EF to assess the unique contribution of EC to outcomes.
Children with severe TBI had significantly lower EC than both the OI and moderate TBI groups at each post-injury time point. Both pre-injury and 18-month EC were associated with long-term outcomes. Among those with low EC at baseline, children with moderate and severe TBI had more functional impairment than those with OI; however, no group differences were noted at high levels of EC. EC had main effects on parent-reported social competence that did not vary by injury type.
Findings suggest that EC is sensitive to TBI effects and is a unique predictor of functional outcomes, independent of EF. High EC could serve as a protective factor, and as such measures of EC could be used to identify children for more intensive intervention.
Changes in daily life created by the novel coronavirus (COVID-19) pandemic have resulted in a largely unprecedented situation for millions of families worldwide. Families are under considerable ...stress, and parents may experience greater psychological distress and disruptions in the parent-child relationship. Some parents may be particularly vulnerable to recent stressors, including those with preexisting psychological disorders and family dysfunction. In the United States, military veterans are one such at-risk population. Recent challenges may exacerbate preexisting conditions and heighten parenting stress, thereby negatively impacting child and family functioning. In this article, we share our experiences developing and piloting a telepsychotherapy parenting skills program for military veterans. The intervention, Online Parenting Pro-Tips (OPPT), combined web-based educational modules addressing child development and positive parenting with live coaching (via videoconferencing link) of parenting skills. Forty-one veterans with a child between the ages of 3 and 9 years enrolled in this trial and 22 completed the 6-session intervention. Veterans who completed the intervention experienced significant reductions in depression, parenting stress, and family dysfunction, with medium to large effect sizes (Cohen's d ranged from .53 to .98). Veterans also reported significant improvements in their child's behaviors. These findings have important implications pertaining to the feasibility and effectiveness of telepsychotherapy interventions to support at-risk families and promote positive parent-child interactions and family functioning during the COVID-19 crisis and beyond. At a practical level, OPPT and similar telepsychotherapy interventions for families could be modified to be delivered via smartphone to increase accessibility and cost-effectiveness for families worldwide.
Prueba piloto de una intervención de habilidades de crianza por telepsicoterapia para familias veteranas: Implicaciones para el manejo de estrés parental durante COVID-19
Los cambios en la vida diaria creados por la nueva pandemia del virus corona (COVID-19) han resultado en una situación en gran medida sin precedentes para millones de familias en todo el mundo. Familias están bajo un estrés considerable y los padres pueden experimentar mayor angustia psicológica e rupturas en la relación padre-hijo. Algunos padres pueden ser particularmente vulnerable a estresores recientes, incluidos aquellos con preexistencia de trastornos psicológicos y disfunción familiar. En los Estados Unidos, veteranos militares son una de esas poblaciones en riesgo. Los desafíos recientes pueden exacerbar condiciones preexistentes y aumentar el estrés de los padres, lo que afecta negativamente al niño y funciones familiares. En este artículo, compartimos nuestras experiencias desarrollando y poniendo a prueba un programa de habilidades para padres de telepsicoterapia para veteranos militares. La intervención, consejos para padres en línea (OPPT), combinaron módulos educativos basados en la web que abordandan el desarrollo infantil y la crianza positiva, con coaching en vivo (a través de enlace de videoconferencia) de habilidades parentales. Cuarenta y un veteranos con un niño entre las edades de 3 y 9 años se inscribieron en este ensayo y 22 completaron la intervención de 6 sesiones. Los veteranos que completaron la intervención experimentaron reducciones significativas en depresión, estrés parental y disfunción familiar con efectos de tamaño medio a grande (El valor de Cohen oscilaba entre .53 y .98). Los veteranos también reportaron mejoras significativas en los comportamientos de sus hijos. Estos hallazgos tienen implicaciones importantes relacionadas con la viabilidad y efectividad de las intervenciones de telepsicoterapia para apoyar a familias en riesgo y promover interacciones positivas entre padres e hijos y el funcionamiento familiar durante la COVID-19 crisis y más allá. A nivel práctico, OPPT e intervenciones similares de telepsicoterapia para las familias podrían modificarse para ser entregadas a través de teléfonos inteligentes para aumentar accesibilidad y rentabilidad para familias de todo el mundo.
针对退役老兵家庭之育儿技巧干预远程咨询的试行：关于冠状病毒流行期间管理育儿压力的暗示
由新冠病毒流行病所导致的日常生活变化应激导致全世界百万家庭陷入几乎前所未有的境况。 家庭们正在经受着巨大的压力, 而且家长们可能经受着更大的心理痛苦和来自亲子关系中的扰乱。 部分家长可能更易受近期压力源影响，其中包括那些已经遭受先前存在心理障碍和家庭不协调的家长。在美国, 退役老兵就属于这类处于危险中的群体。最近的挑战可能会恶化已经存在的境况并且增加了育儿压力, 因此会对孩子与家庭的运作产生消极影响。在本文中, 关于发展和测试一个针对退役老兵家庭育儿技巧远程心理咨询项目, 我们分享了的经验。这个干预项目, 名为在线家教专业贴士 （OPPT), 将以网络为基础并以儿童发展和积极正面育儿为任务的教育模块与通过视频会议进行的在线育儿技巧辅导结合起来。41个老兵以及他们3-9岁间的孩子参与了此次试运行试验, 其中22人完成了时长为6期的干预治疗。那些完成了干预治疗的老兵感受到了抑郁，育儿的精神压力, 和家庭失衡方面的显著性降低以及中等到较大的效应值（科恩维处于0.53 到0.98). 老兵们也报道孩子的行为有了显著的改善。这些发现, 在关于在疫情期间支持高危家庭并且推进积极的亲子互动以及家庭运转的远程心理治疗干预的可行性和有效性, 有着重要的借鉴意义。在现实操作的层面, OPPT和针对家庭的其他远程心理治疗干预可以被改进从而可以通过智能手机传达来增加对全世界家庭的可及性和成本效益。
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It is challenging to provide supportive intensive care to infants in the neonatal intensive care unit (NICU), giving them every chance for survival, while also trying to minimize suffering for both ...the infant and parents. Parents who believe their infant is suffering may alter treatment goals based on their perceptions; however, it is unknown how parents come to believe that their infant may be suffering.
To examine bereaved parents' perceptions of infant suffering in the NICU.
Parents completed a qualitative interview exploring their perceptions of the level of suffering that their infant experienced at the end of life. Parents whose infant died in a large Midwestern Level IV regional referral NICU from July 2009 to July 2014 were invited to participate. Thirty mothers and 16 fathers from 31 families (31 of 249) participated in telephone interviews between three months and five years after their infant's death.
Four themes emerged from the qualitative analysis: 1) the presence/absence of suffering, 2) indicators of suffering, 3) temporal components of suffering (trajectory), and 4) influence of perceived suffering on parents, infants, and clinical decision making.
Parents used signs exhibited by infants, as well as information they received from the health care team to form their perceptions of suffering. Perceived suffering followed different trajectories and influenced the decisions that parents made for their infant. Soliciting parent perspectives may lead to improvements in the understanding of infant well-being, particularly suffering, as well as how parents rely on these perceptions to make treatment decisions for their infant.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
To assess the feasibility and acceptability of an online parenting-skills program for caregivers of young children with traumatic brain injury (TBI). Positive parenting contributes to recovery ...following early TBI and social and emotional development in typically developing children. Yet, few interventions have been designed to support psychosocial recovery and subsequent development after early TBI.
This study protocol was registered with clinicaltrials.gov (NCT05160194). We utilized an academic hospital's Trauma Registry to recruit caregivers of children, ages 0-4 years, previously hospitalized for TBI. The GROW intervention integrated six online learning modules with videoconference meetings with a coach to review and practice skills while receiving in vivo coaching and feedback. Interactive modules addressed strategies for responsive parenting, stimulating cognition, and managing parenting stress. Enrollment and retention rates served as feasibility metrics and satisfaction surveys assessed acceptability.
18 of 72 families contacted (25%) consented, and 11 of 18 (61%) completed the intervention and follow-up assessments. All participants rated the intervention as helpful and indicated that they would recommend the intervention to others. All endorsed a better understanding of brain injury and how to optimize their child's recovery and development. Both coaches rated intervention delivery as comparable to traditional face-to-face treatment.
Low levels of uptake and initial engagement underscore the challenges of intervening with caregivers following early TBI, which likely were exacerbated due to the COVID-19 pandemic. High levels of acceptability and perceived benefit support the potential utility of GROW while highlighting the need to improve accessibility and early engagement.
Purpose: Technological advances have made the delivery of psychological interventions via web-based platforms increasingly feasible. In recent years, there has been growth in the delivery of ...psychological interventions through web-based modalities, that is, telepsychology. Although there is evidence supporting the usability and feasibility of telepsychology for a range of populations, there is limited literature on clinician perceptions delivering telepsychology, particularly to pediatric rehabilitation populations. In this mixed-methods study, we report on clinician perspectives and experiences delivering telepsychology to children/families impacted by pediatric traumatic brain injury. Method: Seventeen clinicians (psychologists and advanced psychology doctoral students) who delivered telepsychology interventions to children/families impacted by pediatric brain injuries completed surveys and interviews. Results: Overall, clinicians reported that telepsychology was equivalent to face-to-face treatment in many regards (e.g., therapeutic alliance, weekly progress, child/family engagement, and establishing rapport). Clinicians reported a number of advantages of telepsychology over face-to-face interventions for this pediatric population including greater ease of scheduling, increased understanding of the family and home environments, and less caregiver stigma of behavioral health care. Disadvantages of telepsychology included difficulties reading nonverbal cues, logistical/technological issues, and greater disruptions during sessions. Conclusions: Findings provide an important foundation for future investigations examining the merits of telepsychology versus traditional treatment for both pediatric rehabilitation populations.
Impact and Implications
This study elucidates several advantages and disadvantages of utilizing telepsychology in comparison with face-to-face therapy for family-centered treatment of pediatric traumatic brain injury from a clinician perspective. Overall, clinicians reported that telepsychology was superior to face-to-face therapy in terms of scheduling/attendance, understanding the family and home environments, and reducing behavioral health stigma. Clinicians reported several challenges with utilizing telepsychology; the most prominent including distractions and reading nonverbal cues. Findings from this study provide an important foundation for future investigations examining the merits of telepsychology versus traditional treatment for pediatric populations.
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Purpose:To understand child and family needs following TBI in early childhood, 22 caregivers of children who were hospitalized for a moderate to severe TBI between the ages of 0 and 4 within the past ...10 years (M = 3.27 years; Range = 3 months to 8 years) participated in a needs assessment.
Methods: Through a convergent study design, including focus groups (FG), key informant interviews (KII), and standardized questionnaires, caregivers discussed challenges and changes in their child's behaviors and functioning in addition to resources that would be helpful post-injury. Standardized questionnaires assessing current psychological distress and parenting stress in addition to open-ended questions about their general experience were completed.
Results: Results indicated some families continue to experience unresolved concerns relating to the child's injury, caregiver wellbeing, and the family system after early TBI, including notable variation in caregiver reported psychological distress and parenting stress. Caregivers noted unmet needs post-injury, such as child behavior management and caregiver stress and coping.
Conclusion: Early TBI can have a long-term impact on the child, caregivers, and family system. Addressing the needs of the whole family system in intervention and rehabilitation efforts may optimize outcomes following early TBI. Study results will inform intervention development to facilitate post-injury coping and positive parenting.
IMPLICATIONS FOR REHABILITATION
Early TBI can result in unmet needs that have a lingering impact on the child, caregiver, and family.
Caregivers need information and resources that address their own distress and stressors related to changes in the child post-injury.
Our study suggests that stress management and self-care skills are possible targets of intervention for caregivers of children who experienced an early TBI.
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Purpose/Objective: Existing evidence suggests that the relationship between adolescent behavior problems following traumatic brain injury (TBI) and injury-related family burden may be bidirectional, ...with increased child behavior problems contributing to greater family burden over the first year postinjury and vice versa. We extended existing evidence by prospectively examining reciprocal influences between parent-adolescent interactions and adolescent behavior problems over the initial 2 years postinjury. Research Method/Design: Participants included 117 adolescents ages 12-17 with moderate-to-severe TBIs and their parents who participated in a randomized controlled trial. At baseline, adolescent-parent dyads completed a videotaped problem-solving task that yielded composites of negativity, effective communication, and warmth. Parents also completed a structured interview and problem checklists. Families repeated assessments at 6, 12, and 18 months postbaseline. Bidirectional associations between observed parenting behavior and adolescent behavior were examined with autoregressive cross-lagged panel analyses collapsed across the trial arms. Results: One cross-lagged model was significant, with higher observed effective communication predicting fewer externalizing behavior problems at subsequent time points, and fewer externalizing behavior problems predicting more effective communication. Other models indicated that effects were unidirectional, with observed parenting behaviors predicting externalizing behavior and everyday functioning. Conclusions/Implications: The bidirectional relationship between effective communication and adolescent externalizing behavior suggests a transactional model in pediatric TBI in which effective communication leads to reduced adolescent behavior problems and reduced behavior problems lead to improved communication over time. Findings yielded stronger evidence for parenting effects as compared to adolescent behavior effects, providing further support for clinical interventions targeting parent-adolescent interactions following TBI.
Impact and ImplicationsThe results support the influence of parents in adolescent recovery following traumatic brain injury (TBI). This is the first study to examine bidirectional effects between parenting behaviors and adolescent outcomes following TBI, and thus extend a theoretical transactional model from developmental psychology to a neurological population. The results provide support for the hypothesized negative spiral that may occur following injury in which ineffective parent-adolescent communication following injury can exacerbate behavioral difficulties, which in turn further corrode communication. This study provides evidence supporting interventions directed towards improving parent-adolescent communication in order to reduce morbidity following injury.
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To examine the frequency of behavioral problems after childhood traumatic brain injury (TBI) and their associations with injury severity, sex, and social environmental factors.
Children's hospitals ...in the Midwestern/Western United States.
381 boys and 210 girls with moderate (n = 359) and severe (n = 227) TBI, with an average age at injury of 11.7 years (range 0.3-18) who were injured ≤3 years ago.
Secondary data analysis of a multistudy cohort.
Child Behavior Checklist (CBCL) administered pretreatment.
Thirty-seven percent had borderline/clinical elevations on the CBCL Total Problem Scale, with comparable rates of Internalizing and Externalizing problems (33% and 31%, respectively). Less parental education was associated with higher rates of internalizing, externalizing, and total problems. Time since injury had a linear association with internalizing symptoms, with greater symptoms at longer postinjury intervals. Younger boys had significantly higher levels of oppositional defiant symptoms than girls, whereas older girls had significantly greater attention-deficit hyperactivity disorder symptoms than boys.
Pediatric TBI is associated with high rates of behavior problems, with lower socioeconomic status predicting substantially elevated risk. Associations of higher levels of internalizing symptoms with greater time since injury highlight the importance of tracking children over time.
The novel coronavirus, COVID-19, has led to sweeping changes in psychological practice and the concomitant rapid uptake of telepsychotherapy. Although telepsychotherapy is new to many clinical ...psychologists, there is considerable research on telepsychotherapy treatments. Nearly 2 decades of clinical research on telepsychotherapy treatments with children with neurological conditions has the potential to inform emerging clinical practice in the age of COVID-19. Toward that end, we synthesized findings from 14 clinical trials of telepsychotherapy problem-solving and parent-training interventions involving more than 800 children and families with diverse diagnoses, including traumatic brain injury, epilepsy, brain tumors, congenital heart disease, and perinatal stroke. We summarize efficacy across studies and clinical populations and report feasibility and acceptability data from the perspectives of parents, children, and psychotherapists. We describe adaptation for international contexts and strategies for troubleshooting technological challenges and working with families of varying socioeconomic strata. The extensive research literature reviewed and synthesized provides considerable support for the utility of telepsychotherapy with children with neurological conditions and their families and underscores its high level of acceptability with both diverse clinical populations and providers. During this period of heightened vulnerability and stress and reduced access to usual supports and services, telepsychotherapy approaches such as online family problem-solving treatment and online parenting skills training may allow psychologists to deliver traditional evidence-based treatments virtually while preserving fidelity and efficacy.
Telepsicoterapia con niños y familias: lecciones extraídas de dos décadas de investigación traslacional
El nuevo coronavirus, COVID-19, ha conducido a cambios radicales en la psicología. práctica y el rápido consumo concomitante de telepsicoterapia. A pesar de que la telepsicoterapia es nueva para muchos psicólogos clínicos, existe una investigación considerable sobre tratamientos de telepsicoterapia. Casi dos décadas de investigación clínica sobre los tratamientos de telepsicoterapia con niños con afecciones neurológicas tienen la potencial para informar la práctica clínica emergente en la edad de COVID-19. Hacia ese fin, sintetizamos los resultados de 14 ensayos clínicos de resolución de problemas de telepsicoterapia e intervenciones de capacitación para padres que involucran a más de 800 niños y familias con diagnósticos diversos que incluyen lesión cerebral traumática, epilepsia, tumores cerebrales, enfermedad cardíaca congénita y accidente cerebrovascular perinatal. Resumimos la eficacia entre los estudios y poblaciones clínicas e reportamos datos de viabilidad y aceptabilidad desde las perspectivas de padres, hijos y psicoterapeutas. Describimos adaptacion para contextos internacionales y estrategias para resolver problemas tecnológicos y trabajar con familias de estratos socioeconómicos variables. La extensa literatura de investigación revisada y sintetizado proporciona un apoyo considerable para la utilidad de la telepsicoterapia con niños con afecciones neurológicas y sus familias y subraya su alto nivel de aceptabilidad con diversas poblaciones clínicas y proveedores. Durante este período de mayor vulnerabilidad y estrés y menor acceso a los apoyos habituales y servicios, enfoques de telepsicoterapia como tratamiento em línea para resolución de problemas familiares y la capacitación en habilidades para padres en línea pueden permitir que los psicólogos brinden tratamientos tradicionales basados en evidencia virtualmente mientras se preserva la fidelidad y la eficacia.
兒童與家庭之遠程心理治療：從20年的轉化研究中汲取之經驗
新型冠狀病毒COVID-19為心理治療實務帶來了徹底的變化，也導致隨後對遠程心理治療的迅速採用。雖然遠程心理治療對許多臨床心理學家來說是新事物，但已有相當多針對遠程心理治療療法的研究。近二十年來針對患有神經系統疾病的兒童進行遠程心理治療療法之相關研究有可能為COVID-19時代的新興臨床實務提供信息。為此，我們綜合了研究發現，分別來自14種問題解決遠程心理治療臨床試驗，以及
包含800多個具有不同診斷的兒童和家庭之家長培訓干預，這些診斷包括顱腦外傷，癲癇，腦瘤，先天性心臟病和產期中風。從不同研究和臨床族群中, 我們總結了療效，並從父母、孩子和心理治療師之觀點報告可行性和可接受性數據。我們描述了對國際情勢之適應、解決技術挑戰之策略，以及與來自不同社會經濟階層的家庭工作之策略。廣泛的研究文獻回顧及綜述為應用於有神經系統疾病的兒童及其家庭之遠程心理療法的實用性提供了相當大的支持，也強調其在不同臨床人群和提供者中的高度可接受性。在這段高度脆弱性、高壓力，並且獲得常規支持和服務的機會減少的期間，遠程心理治療方法，例如在線家庭問題解決治療，以及在線育兒技能培訓，可以使心理學家在虛擬的提供傳統的、基於證據的治療方法時，同時保留真實度和功效。
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