Human Flourishing in Adolescents with Cancer: Experiences of Pediatric Oncology Health Care Professionals.

PURPOSE: This study explores human flourishing (HF) in adolescents with cancer (AC) as witnessed by their health care providers, and it develops a list of critical attributes associated with HF to describe the positive outcomes witnessed. DESIGN AND METHODS: Our study used a qualitative descriptive design incorporating data from an open-ended electronic survey and semi-structured individual interviews with 17 pediatric oncology health care providers. RESULTS: We found 3 major themes (positive forward motion, connectedness, and self-character) representing 11 critical attributes of human flourishing in AC: (1) initiative and enterprise, (2) positivity and evocativeness, (3) tranquility and maturity, (4) perseverance and tenacity, (5) compassion and empathy, (6) social engagement and connection, (7) wisdom and translation into life, (8) supportive background, (9) self-awareness and self-agency, (10) transcendence and full potential, and (11) meaning-making. CONCLUSIONS: Understanding the concept of HF as it applies to the needs of AC is a step toward establishing it as a comprehensive health care goal and toward developing care provider guidelines for its promotion. PRACTICE IMPLICATIONS: Given the attributes of HF in AC, nurses can consider HF as an ultimate nursing care outcome and should focus on goals of care beyond disease treatment and symptoms mitigation when providing care for this population. Holistic, individualized assessment, timely care during each phase of treatment, and developmentally tailored intervention should be provided.

Challenges in Shifting Management Responsibility From Parents to Adolescents With Sickle Cell Disease.

This study explored the challenges faced by adolescents with sickle cell disease (SCD) and their parents and the work they engage in to progressively shift from parent management to independent adolescent self-management. DESIGN AND METHODS: A qualitative descriptive focus-group design with semi-structured interviews was used with adolescents (11-18 years) with SCD (HbSS genotype) and their parents/primary caregivers. Interviews were analyzed using content analysis. RESULTS: Two adolescent focus groups, with a total of 14 adolescents, and two parent focus groups, with a total of 15 parents, described adaptive challenges. Adolescents' adaptive challenges included mastering complex symptom management, communicating about SCD and symptoms, and maintaining control. Parents' adaptive challenges included giving over the complex management, communicating the management with the adolescent, balancing protection against risk with fostering independence, changing a comfortable rhythm, and releasing the adolescent into an "SCD-naive" world. Adolescents' adaptive work included pushing back at parents, defaulting back to parental care, stepping up with time, learning how SCD affects them, and educating friends about SCD. Parents' adaptive work included engaging the adolescent in open dialogue and co-managing with the adolescent. CONCLUSIONS: Shifting management responsibility from parents to adolescents imposes adaptive challenges for both. Future research is needed to develop and test interventions that improve adaptive capacity in adolescents and parents. PRACTICE IMPLICATIONS: Health care providers need to assess the parent-child relationship and their progress in shifting the management responsibility, facilitate discussions to arrive at a shared understanding of the challenges, and collaborate on adaptive work to address these challenges.

Immigration, language proficiency, and autobiographical memories: Lifespan distribution and second-language access.

This investigation examined two controversies in the autobiographical literature: how cross-language immigration affects the distribution of autobiographical memories across the lifespan and under what circumstances language-dependent recall is observed. Both Spanish/English bilingual immigrants and English monolingual non-immigrants participated in a cue word study, with the bilingual sample taking part in a within-subject language manipulation. The expected bump in the number of memories from early life was observed for non-immigrants but not immigrants, who reported more memories for events surrounding immigration. Aspects of the methodology addressed possible reasons for past discrepant findings. Language-dependent recall was influenced by second-language proficiency. Results were interpreted as evidence that bilinguals with high second-language proficiency, in contrast to those with lower second-language proficiency, access a single conceptual store through either language. The final multi-level model predicting language-dependent recall, including second-language proficiency, age of immigration, internal language, and cue word language, explained ¾ of the between-person variance and (1)/5 of the within-person variance. We arrive at two conclusions. First, major life transitions influence the distribution of memories. Second, concept representation across multiple languages follows a developmental model. In addition, the results underscore the importance of considering language experience in research involving memory reports.

Childhood remembered: Reports of both unique and repeated events.

To explore the significance of repeated memories for individuals' personal histories, we compared the characteristics of young adults' unique and repeated memories of childhood experiences. Memory type (unique vs. repeated) was a within-participant variable. In Experiment 1, college-age participants generated as many early memories as possible in 4 minutes; in Experiment 2, another sample provided complete reports of five early memories in each condition. In both experiments, participants rated the vividness, biographical importance and personal meaning of each memory and labelled the accompanying emotion. Unique memories were more vivid than repeated memories as well as more likely to include negative emotion, regardless of the method of reporting. Most importantly, college students rated their memories for unique and repeated events as equivalently infused with personal meaning. Analysis of the content of the memories reported in Experiment 2 established that unique and repeated memories did not differ in word count or percentages of perceptual terms or words indicating positive affect, although unique memories contained a greater percentage of negative affect. Additional analyses of content provided evidence for differences in the functions served by unique and repeated memories. The results have implications for the study of autobiographical memory and for identifying over-general memories.

Predicting which childhood memories persist: contributions of memory characteristics.

This investigation identified memory-level predictors of the survivability of 4- to 13-year-old children's earliest recollections over a 2-year period. Data previously reported by Peterson, Warren, and Short (2011) were coded for inclusion of emotion terms and thematic, chronological, and contextual narrative coherence. In addition, the uniqueness and content of the reported events were classified, and the presence or absence of event reminders was recorded. The use of logistic multilevel modeling indicated that emotion and each dimension of coherence added to the prediction of a memory's survivability over and above age-related variance. In contrast, event uniqueness, content category, reminders, and word count were not associated with retention. The findings help explain why particular early memories endure over time.

Finding the light at the end of the tunnel: age differences in the relation between internal states terms and coping with potential threats to self.

Previous research has examined how adults respond to negative self-evaluations, but has not explored developmental differences in this process. This cross-sectional study investigated linkages between the inclusion of internal states language in narrative accounts of problems in important self-categories and reports of coping responses and troubling thoughts. There were a total of 160 participants at three age levels: late childhood (9-12 years old), early adolescence (12-15 years old) and emerging adulthood (18-28 years old). Age-related changes were found in the density of internal states language and its relation to coping strategies. Among the children, greater usage of positive emotion terms predicted less adaptive use of coping strategies. In contrast, among the adolescents, greater density of positive emotion terms and anxiety terms was associated with more assistance seeking, and greater use of anger terms was related to lower levels of intrusive and avoidant thoughts. Finally, among the emerging adults, a greater density of insight terms was associated with higher levels of intrusive thoughts. The findings are interpreted as indicating unique responses to self-threat at different points in the development of the self-concept. Further, they have implications for understanding inconsistent past findings regarding the relation between internal states language usage and well-being.

Interference Suppression vs. Response Inhibition: An Explanation for the Absence of a Bilingual Advantage in Preschoolers' Stroop Task Performance.

The well-documented advantage that bilingual speakers demonstrate across the lifespan on measures of controlled attention is not observed in preschoolers' performance on Stroop task variations. We examined the role of task demands in explaining this discrepancy. Whereas the Color/Word Stroop used with adult participants requires interference suppression, the Stroop task typically used with preschoolers requires only response inhibition. We developed an age-appropriate conflict task that measures interference suppression. Fifty-one preschool children (26 bilinguals) completed this new Color/Shape task and the Day/Night task used in previous research. Bilingual in comparison to monolingual children performed better on incongruent trials of the Color/Shape task, but did not differ on other measures. The results indicate that the discrepancy between preschoolers and older individuals in performance on Stroop task adaptations results from characteristics of the task rather than developmental differences. Further, the findings provide additional support for the importance of interference suppression as a mechanism underlying the bilingual advantage.

Brief report: making experience personal: internal states language in the memory narratives of children with and without Asperger's disorder.

The development of the personal past is complex, requiring the operation of multiple components of cognitive and social functioning. Because many of these components are affected by autism spectrum disorders, it is likely that autobiographical memory in children with Asperger's Disorder (AD) will be impaired. We predicted that the memory narratives of children with AD, in comparison to typically-developing peers, would reflect less personal interpretation as evidenced by internal states language. Thirty children with AD and 20 typically-developing children aged 6-14 reported their earliest memories and two emotional experiences (one positive and one negative). Consistent with our predictions, children with AD included fewer emotional, cognitive, and perceptual terms than the comparison sample.

Coherence of Personal Narratives across the Lifespan: A Multidimensional Model and Coding Method.

Personal narratives are integral to autobiographical memory and to identity, with coherent personal narratives being linked to positive developmental outcomes across the lifespan. In this article, we review the theoretical and empirical literature that sets the stage for a new lifespan model of personal narrative coherence. This new model integrates context, chronology, and theme as essential dimensions of personal narrative coherence, each of which relies upon different developmental achievements and has a different developmental trajectory across the lifespan. A multidimensional method of coding narrative coherence (the Narrative Coherence Coding Scheme or NaCCS) was derived from the model and is described here. The utility of this approach is demonstrated by its application to 498 narratives that were collected in six laboratories from participants ranging in age from 3 years to adulthood. The value of the model is illustrated further by a discussion of its potential to guide future research on the developmental foundations of narrative coherence and on the benefits of personal narrative coherence for different aspects of psychological functioning.

Fragile but real: children's capacity to use newly acquired words to convey preverbal memories.

There is ongoing debate about children's ability to use subsequently acquired language to describe preverbal experiences. This issue was addressed experimentally in this investigation using a novel paradigm. Two-year-old children who lacked color words were individually taught to activate a bubble machine by selecting a particular color of bubble solution. The children then participated in weekly, experimenter-provided activities that fostered their acquisition of the color labels. After 2 months, their ability to apply the newly acquired words in reporting the original event was assessed. A significant proportion of the children demonstrated verbal recall when prompted in the presence of physical reminders of the event. These findings indicate that some early, preverbal memories are translated into words at a later time.

The influence of prior knowledge and repeated questioning on children's long-term retention of the details of a pediatric examination.

Children's recall of the details of pediatric examinations was examined over the course of a 6-month interval. Although the 83 4- to 7-year-old participants reported a substantial amount of information at each assessment, performance declined over time, dropping sharply over the course of 3 months but then remaining constant out to the final interview at 6 months. As expected, older children provided more total information than younger children did and reported a greater proportion of the event components in response to general rather than specific questions. However, comparable patterns of remembering and forgetting over time were observed at each age level. In addition, no effects of repeated questioning--in the form of an interview at 3 months for half of the children--were observed on performance at the 6-month assessment. Moreover, children's prior knowledge about routine doctor visits was assessed before the checkup for half of the participants at each age and was associated with initial but not delayed recall. Although knowledge increased with age as expected, it nonetheless affected recall over and above the influence of age.