Exposure to violence, coping resources, and psychological adjustment of South African children.

The effects of exposure to direct and vicarious political, family, and community violence on the adjustment of 625 six-year-old black South African children was examined. Ambient community violence was most consistently related to children's psychosocial outcomes. Resources in the form of individual child resilience, maternal coping, and positive family relationships were found to mitigate the adverse impact in all the assessed domains of children's functioning.

Adversity and psychosocial competence of South African children.

Black children in South Africa commonly experience low socioeconomic status and community violence. Parents (N = 625) in a longitudinal study of urbanization responded to structured questionnaires related to resilience, affability, maturity, and school readiness of their six-year olds. SES was found to have an inverse and linear relation to competence at age six; the relationship to violence was curvilinear, with children from moderately safe communities achieving better outcomes than those from very safe or very unsafe ones.

Social risks and psychological adjustment: a comparison of African American and South African children.

In the United States, race is highly associated with social risk factors such as poverty and family structure that may account by themselves for developmental outcomes often attributed to race alone. This cross-national study assesses the effects of social risks on adjustment of racially similar groups of 306 African American and 625 South African 6-year-olds. Poverty and gender were confirmed as risk factors but single female headship was not. Moreover, poverty and gender posed less risk for South African than for African American children. Poverty placed children at risk for immaturity, hyperactivity, and difficulty in peer relations. Boys were more likely to have behavior problems than were girls. African Americans exhibited higher rates of emotional symptoms but lower rates of bullying, destructiveness, and social rejection than did South Africans. African Americans, particularly the males, scored higher on the opposition and hyperactivity scales than did South Africans. Distinctive social contexts and cultural resources may account for differences in adjustment.

Sibling Adaptation to Childhood Cancer Collaborative Study: the association of sibling adaptation with maternal well-being, physical health, and resource use.

This multi-institutional study investigated the association of behavioral/emotional adaptation among siblings of children with cancer with maternal general well-being, physical health, and resource use. One hundred seventy siblings and mothers completed standardized interviews and self-report measures 6 to 42 months after the cancer was diagnosed. As a group, mothers of children with cancer reported significantly lower levels of well-being than matched controls. When stratified according to the level of the sibling's behavioral/emotional adaptation, mothers of siblings in the Dysfunctional group (1) reported the lowest levels of well-being; (2) during the preceding year, were more likely to have sought professional services than mothers of children in the Resilient group; and (3) were least likely to have found social support helpful. Our results support an association between maternal well-being and sibling adjustment but show it is unlikely that nonspecific social support will improve adjustment. The rationale for problem-solving training for mothers is provided.

Sibling adaptation to childhood cancer collaborative study: health outcomes of siblings of children with cancer.

OBJECTIVE: This seven-site study examined the overall health status, healthcare utilization, somatization, and health-risk behaviors of siblings of children with cancer compared to these factors in matched controls or normative data. The study also examined whether informants (i.e., siblings, parents, physicians) differed in their assessments of the above health domains. DESIGN: Subjects were 254 siblings of children with cancer from seven different pediatric oncology treatment centers that participated in the Sibling Adaptation to Childhood Cancer Collaborative study group. Predictors of the siblings' health status, healthcare utilization, somatization, and health-risk behaviors were identified, and the relationship between these health domains and the siblings' resiliency vs. dysfunctionality were explored via interviews. RESULTS: Overall, siblings were found to be moderately healthy, although siblings report significant problems with sleeping and eating. Healthcare utilization appears to be reduced for siblings. Most importantly, the parents of these siblings are less likely to seek medical help for a variety of conditions for which parents of control children would bring their children to a doctor. A pattern emerged of parental underreporting of sibling health variables when compared to what the siblings themselves reported. When the relationship between health outcomes and the siblings' adaptation to their sick sibling's illness was examined, the resilient and dysfunctional groups significantly differed from each other. It appears that health outcomes are related to sibling adaptation to the changes brought about by their sick sibling's cancer diagnosis and treatment. CONCLUSIONS: The focus of care for families of children with cancer is often limited to the child with cancer. As indicated in this study, the "healthy" siblings may be overlooked in the process. While parents appear to recognize that their "healthy" children are complaining more about aches and pains, they may have little energy or time to attend to the needs of these other family members. It is the intent of this study to document what clinicians may expect and to highlight the need for evaluation of this otherwise neglected group.

Gender differences in parenting a child with cancer.

This study of 124 parents of children diagnosed with cancer investigates parents' perceptions of their role in the illness situation. The study found that mothers and fathers differ in their experience of and response to parenting a child with cancer. These differences appear to reflect traditional parenting roles characterized by a gender-based division of labor. Sex-role socialization theory is discussed as an explanatory model of the parenting experience. Practice recommendations are offered to medical social workers and other health care professionals concerned about the long term psychosocial adjustment of parents with chronically ill children.

Sibling adaptation to childhood cancer collaborative study: prevalence of sibling distress and definition of adaptation levels.

A multisite collaborative study assessed the frequency and intensity of emotional/behavioral distress in siblings of children with cancer. A sample of 254 siblings, aged 4 to 18 years, and their parents completed interviews and self-report measures 6 to 42 (average 22.5) months after diagnosis of cancer in a brother or sister. Matched controls were obtained from respondents to the Child Health Supplement of the National Health Interview Survey administered in 1988 (CHS88). Before diagnosis, the prevalence of parent-reported emotional/behavioral problems among siblings was similar to that in the general population (7.7% vs 6.3%; p = not significant). After diagnosis, prevalence rose to 18% among siblings. When siblings were grouped according to the presence or absence of problems exacerbated by and/or arising after diagnosis, four levels of adaptation, consistent with scores on the Behavior Problem Scales from the CHS88, emerged. This differentiation may help explain inconsistencies in sibling response reported previously and provides a framework for investigating factors that enhance adaptation.

Estimating rates of psychosocial problems in urban and poor children with sickle cell anemia.

The risk of adjustment problems increases when a child has a serious life-threatening illness. This article estimates the frequency of adjustment problems across multiple domains for children and adolescents with sickle cell anemia (SCA). Parents provided information on the social, emotional, academic, and family adjustment of 327 children with SCA who were being treated at a comprehensive sickle cell clinic serving a predominantly poor and urban population. More than 25 percent of these children had emotional adjustment problems in the form of internalizing symptoms such as anxiety and depression. In addition, at least one child in five had problems related to social functioning and academic performance. These impairments were related significantly to the frequency of serious pain episodes but not to absolute family income. No significant differences in the data were found based on family income. The data also showed that the disruptive effects of the illness were related to gender and age.

Risk and resilience in adjustment to sickle cell disease: integrating focus groups, case reviews, and quantitative methods.

Case reviews and focus groups were used to develop clinical profiles of poorly adjusted and psychologically resilient children with sickle cell anemia. The convergence of these clinical profiles with quantitative data was examined by drawing upon objective information in the case records derived from physical and structured psychosocial assessments. Regression analyses were used to test the predictors of psychological, academic, and social adjustment identified in the clinical discourse. The results provide a basis for speculating about the process of adjustment to illness and the value of a family approach to psychosocial intervention.

Does "telling" less protect more? Relationships among age, information disclosure, and what children with cancer see and feel.

Parents report telling young children less about the diagnosis, treatment, and prognosis of cancer than older children and adolescents. This is often based on the desire to spare children from being overwhelmed. 43 children diagnosed with cancer reported on information disclosed to them at diagnosis, their causal attributions, illness-related stress, and coping strategies. Consistent with parental reports, children under 9 years (n = 18) were told less than children 9-14 years (n = 15) and adolescents (n = 10). Young children's reports of illness impact differed from older children and adolescents only with respect to school and social domains. Younger children reported fewer cognitive strategies than older children and adolescents. Even though young children were told much less than older children they reported similar levels of distress. This suggests that nondisclosure fails to mask the salient and distressing aspects of the illness.

The medical context of parental coping with childhood cancer.

This research assessed the extent to which contextual factors, especially the medical context, are related to the use of specific coping strategies by 74 parents of surviving children with cancer. Parents reported that they coped reasonably well by using information-seeking, problem-solving, help-seeking, maintaining emotional balance, relying on religion, being optimistic, denying, and accepting. More highly educated parents tended to use problem solving, optimism, and information seeking significantly more and denial significantly less than well-educated parents. However, gender and income were unrelated to coping. The use of specific coping strategies was not related to severity of the child's medical condition, stress level, or parents' own evaluations of their coping effectiveness. However, the quality of relations with the medical staff was strongly related to coping strategies. Use of passive coping strategies was positively related to good relations with the medical staff.

Relating to the medical staff: how parents of children with cancer see the issues.

Interviews with seventy-five parents of surviving children with cancer provide information on their relations with medical staff. The major issues that concern parents in regard to staff members include the staff's empathy with the child and their acceptance of parental participation in care. Discussion centers on how these and other issues affect parent-staff relations.

Relationships with the medical staff and aspects of satisfaction with care expressed by parents of children with cancer.

Seventy-four parents of children with cancer were asked to characterize the behavior of medical staff members with whom they interacted. Seven empirically distinct dimensions of staff behavior relevant to their relationships with parents were identified, including information transmission, clarity and honesty of communication, acceptance of parental efficacy, resolution of conflicts, personal contact with parents, empathy with the child, and staff competence. With respect to their experiences with the treatment of their child, parents also were asked to indicate their satisfaction with the medical staff in terms of changes in their respect and/or anger for the medical staff, changes in feelings about doctors, support received from doctors and nurses, and stress resulting from tense relations with the staff. The seven dimensions of parent-staff relationships were used as predictors in a series of multiple regressions employing these satisfaction measures as criteria. The overall quality of the parent-staff relationship was best predicted by positive personal contact. The strongest predictor of whether or not parents felt increased anger was staff empathy with child. Increased respect for the medical staff was predicted by a combination of information transmission and perception of staff competence. Experience of support by parents was best predicted by information transmission and staff acceptance of parental efficacy in treatment and decision making. This complex pattern supports the usefulness of disaggregating measures of staff behavior and parent satisfaction when examining the relations between medical consumers and service providers.

Enhancement of individual and community competence: the older adult as community worker.

This paper presents an evaluation of a primary prevention program designed to enhance individual and community competence in older adult community workers and in community residents with whom they worked. A total of 22 community workers and 97 community residents participated in the study; 30 residents constituted as posttest-only control group. Pre-post changes included increased knowledge of community services among all participants, as well as increased number of community information channels and increased life satisfaction for the workers. Residents, particularly black residents, became more internal, and their increased sense of personal control was related to their increased knowledge of services. Thus, the helper-therapy principle was supported for these older adult, mostly female, community workers, and their helping role had a net empowering effect.