Parents of children with cystic fibrosis: how they hope, cope and despair.

BACKGROUND: Cystic fibrosis is a chronic, life-threatening illness. Coping, vicarious hope and vicarious despair are constructs that may explain why some children and parents adjust well to cystic fibrosis, while others adjust poorly. Vicarious hope refers to parent expectations that desirable things will occur in their child's future, whereas vicarious despair refers to parent expectations that undesirable things will occur in their child's future. The aims of this study were: (1) to examine parent coping strategies and associations with child and parent adjustment to cystic fibrosis; (2) to investigate the effects of vicarious hope and vicarious despair on coping, parent adjustment and child adjustment; and (3) to examine distinctions between coping, vicarious hope and vicarious despair. METHODS: Participants were 35 parents of children with cystic fibrosis. RESULTS: Self-blame and behavioural disengagement were coping strategies associated with child and parent maladjustment. Social support predicted less parental emotional impact. Vicarious hope and vicarious despair predicted child mental health, parent anxiety and parent emotional impact. CONCLUSIONS: Results indicate that vicarious hope and vicarious despair are distinct constructs from coping. Interventions directed at parent coping, vicarious hope and vicarious despair are implicated.

Critical influences affecting response to various treatments in young children with ADHD: a case series.

BACKGROUND: While the use of stimulant medication as a treatment for children with attention deficit hyperactivity disorder (ADHD) has been the most studied therapy in child psychiatry, there is debate about its use with young children. This study describes a series of cases seen in a normal clinical context, treated with one of four different treatment programmes. METHODS: Sixteen pre-school children diagnosed with ADHD and their parents were randomly assigned to receive one of four treatments: (1) 0.3 mg/kg methylphenidate, parent training programme; (2) 0.3 mg/kg methylphenidate, parent support programme; (3) placebo medication, parent training; and (4) placebo medication, parent support. Changes were assessed at the individual level, using clinical observations, parent and teacher rating scales and measures of parenting and family factors. RESULTS: Children were more likely to improve when the treatment involved at least one active component (medication or parent training). However, there was notable variability in individual parental and child participants' responses to all treatment conditions, indicating the importance of interactions between treatment variables and other factors. CONCLUSIONS: Findings are discussed within the framework of a transactional model, and inferences are drawn about the limitations of the idea that there is a 'best treatment' that is universally applicable.