Different, difficult or distinct? Mothers' and fathers' perceptions of temperament in children with and without intellectual disabilities.

BACKGROUND: Can ratings of temperament be a way of identifying young children with intellectual disabilities (ID) who are at risk for being experienced as difficult? We aimed to explore parents' reports of temperament in their young children with or without ID, as well as positive and negative impact of the child on parents. METHOD: Mothers and fathers of 55 children recently diagnosed with ID and 183 age-matched typically developing (TD) children completed the EASI Temperamental Survey and two scales of the Family Impact Questionnaire measuring positive and negative impact of the child on parents. RESULTS: Parents rated children with mixed ID/DD (developmental delay) as shyer and more impulsive, and less active and sociable when compared with TD children. Children with mixed ID/DD were also reported to have more negative and less positive impact on the family compared with the TD group. In subgroup analyses, children with Down syndrome and cerebral palsy/motor impairment were described as having less negative impact on parents and were described as low in negative emotionality. Children with autism spectrum disorder (ASD), ID/DD nos and other less common diagnoses had a similar pattern of temperament with high emotionality, shyness and impulsivity, and low activity and sociability. Parents of children with ASD and ID/DD reported the highest level of negative impact. CONCLUSIONS: Temperamental characteristics such as high negative emotionality and impulsivity, which can be identified earlier than behavioural problems, could be indicators of negative impact on parents of young children with ID. Despite great variability in temperament among children with mixed ID/DD, results indicated common temperamental characteristics among children with ASD, ID/DD and other diagnosis.

Socioeconomic and psychological variables as risk and protective factors for parental well-being in families of children with intellectual disabilities.

BACKGROUND: The first aim of the present study was to estimate the extent to which differences in well-being in parents of children with and without intellectual disability (ID) in Sweden can be accounted for by differences in the presence of the risk factors: (1) child disability; (2) socioeconomic disadvantage; (3) household composition; and (4) parental characteristics. The second aim was concerned with individual variation in well-being within the group of parents of children with ID. The aim was to estimate if protective factors such as parental personality characteristics (sense of coherence), perceived positive impact of the child and satisfaction with participation in different arenas of life explained variation in well-being in mothers and fathers of children with ID over and above that explained by the risk factors. METHOD: Parents of children with ID (62 mothers and 49 fathers) and control children (183 mothers and 141 fathers) completed postal surveys on well-being, socioeconomic situation, health, sense of coherence, satisfaction with participation in different arenas of life and the child's impact on the family. RESULTS: The results showed that mothers of children with ID had lower levels of well-being than fathers and control parents, but the presence of a child with ID did not in itself predict poorer maternal well-being. Rather, differences in economic hardship and self-rated health were the strongest predictors for well-being. It was further found that 67.7% of the mothers of children with ID scored within the high well-being group. The predictive power of the model increased significantly for both fathers and mothers when protective factors were added to the model (42 and 78% explained variance compared with 25% with only risk factors). CONCLUSIONS: Well-being of parents with a child with ID is dependent upon the interplay of risk and protective factors and research needs to address these variables simultaneously.

Well-being, involvement in paid work and division of child-care in parents of children with intellectual disabilities in Sweden.

BACKGROUND: The aim of the study was to compare mothers' and fathers' involvement in paid work and child-care in families of children with intellectual disability (ID) and control families and to test if differences in well-being between mothers and fathers of children with ID can be explained by differences in involvement in paid work and child-care. METHODS: Mothers and fathers of 179 children with ID and 196 typically developing children answered mailed surveys on their involvement in paid work, child-care tasks and well-being. Only two-parent families were included. RESULTS: The results show main effects for gender of the parent and presence of a child with ID on involvement in paid work and well-being. Interaction effects indicate that mothers of children with ID are more affected than fathers in their participation in paid work and well-being. A positive relation between level of participation in paid work and well-being was found for both mothers and fathers. No difference in division of child-care tasks was found between families of children with ID and control families. Differences in involvement in paid work and child-care in families of children with ID only explained 5% of the variance in the difference between mothers' and fathers' well-being. CONCLUSIONS: Families with children with ID differ from control families in that the parents are less involved in paid work and have lower levels of well-being. A positive relation between involvement in paid work and well-being was found.

Sense of coherence in parents of children with different developmental disabilities.

BACKGROUND: The aim of the present study was to test if Antonovsky's theory of sense of coherence can facilitate understanding: (1). individual differences in psychological adaptation in parents of children with intellectual disability (ID); and (2). why parents of children with ID generally experience higher levels of stress and depression than parents of children who develop normally. METHODS: Sense of coherence (SoC) and depression were assessed using the short SoC scale (13 items) and the Beck Depression Inventory in 216 families of children with ID and/or autism, and in 213 control families. RESULTS: It is argued that: (1). parents of children with ID with low SoC are at increased risk for developing depression compared to control parents with low SoC not experiencing this stressor; and (2). the life situation of parenting a child with ID may have a negative impact on parents' SoC levels that, in turn, will make them more vulnerable to experiencing stress and depression. CONCLUSION: The SoC theory is valuable in understanding individual differences in psychological adaptation in parents of children with ID.

Depression in mothers and fathers of children with intellectual disability.

Parental depression was assessed using the Beck Depression Inventory (BDI) in 216 families with children with autism and/or intellectual disability (ID), and in 214 control families. Mothers with children with autism had higher depression scores (mean = 11.8) than mothers of children with ID without autism (mean = 9.2), who in turn, had higher depression scores than fathers of children with autism (mean = 6.2), fathers of children with ID without autism (mean = 5.0), and control mothers (mean = 5.0) and fathers (mean = 4.1). Forty-five per cent of mothers with children with ID without autism and 50% of mothers with children with autism had elevated depression scores (BDI > 9), compared to 15-21% in the other groups. Single mothers of children with disabilities were found to be more vulnerable to severe depression than mothers living with a partner.

The protective effect of niacinamide on ischemia-reperfusion-induced liver injury.

Reperfusion of ischemic liver results in the generation of oxygen radicals, nitric oxide (NO) and their reaction product peroxynitrite, all of which may cause strand breaks in DNA, which activate the nuclear enzyme poly(ADP ribose)synthase (PARS). This results in rapid depletion of intracellular nicotinamide adenine dinucleotide and adenosine 5'-triphosphate (ATP) and eventually induces irreversible cytotoxicity. In this study, we demonstrated that niacinamide, a PARS inhibitor, attenuated ischemia/reperfusion (I/R)-induced liver injury. Ischemia was induced by clamping the common hepatic artery and portal vein of rats for 40 min. Thereafter, flow was restored and the liver was reperfused for 90 min. Blood samples collected prior to I and after R were analyzed for methyl guanidine (MG), NO, tumor necrosis factor (TNF-alpha) and ATP. Blood levels of aspartate transferase (AST), alanine transferase (ALT) and lactate dehydrogenase (LDH) which served as indexes of liver injury were measured. This protocol resulted in elevation of the blood NO level (p < 0.01). Inflammation was apparent, as TNF-alpha and MG levels were significantly increased (p < 0.05 and p < 0.001). AST, ALT and LDH were elevated 4- to 5-fold (p < 0.001), while ATP was significantly diminished (p < 0.01). After administration of niacinamide (10 mM), liver injury was significantly attenuated, while blood ATP content was reversed. In addition, MG, TNF-alpha and NO release was attenuated. These results indicate that niacinamide, presumably by acting with multiple functions, exerts potent anti-inflammatory effects in I/R-induced liver injury.

Modulatory effect of blood cells on hypoxic vasoconstriction response and nitric oxide release in rat lungs.

In this study, we investigated the modulatory effects of different types of blood cells on hypoxic pulmonary vasoconstrictive (HPV) response and nitric oxide (NO) release in isolated rat lungs. The lungs were perfused at a constant flow with physiologic saline solution (PSS). The changes in pulmonary arterial pressure (PAP) and NO release were observed. Two hypoxic challenges with a 5% CO2-95% N2 gas mixture were carried out in each experiment. Hypoxia induced pulmonary vasoconstriction, as reflected by an increase in PAP (0.88 +/- 0.22 cmH2O). At the same time, NO (342.9 +/- 78.3 mv) release from the lungs was also increased. Addition of white blood cells (WBCs, 0.70 to 0.88 x 10(5)/mL), platelets (1.48 to 1.96 x 10(5)/mL), or red blood cells (RBCs, 4.6 to 6.6 x 10(5)/mL) into the perfusate produced different effects on PAP and NO changes. WBCs decreased the pulmonary vasoconstriction response and this was accompanied by an increase in NO release. Platelets had no significant effects on either PAP or NO. RBCs significantly potentiated the PAP increase and attenuated the NO release. The results indicate that NO release during hypoxia tends to offset pulmonary vasoconstriction and that NO release and HPV response are modulated by different cell elements.

Ethanol modulates induction of nitric oxide synthase in glial cells by endotoxin.

Although ethanol has long been recognized as an immunosuppressant, the effects of ethanol on immune functions in the central nervous system (CNS) have not been well characterized. Glial cells function as immune effector cells within the CNS. Nitric oxide (NO), generated by inducible NO synthase (iNOS) of activated glial cells, appears to participate in the immune defense and the pathogenesis of brain injury and several neurologic diseases. The goal of the present study was to examine the effects of ethanol on NO production and mRNA expression of iNOS following its induction by bacterial endotoxin lipopolysaccharide (LPS) in cultured glial cells. After incubation of mixed glia with LPS for 24 hr, the levels of nitrite in the culture medium were assayed by Griess reaction. We found that LPS (10-500 ng/ml) induced a concentration-dependent increase in the production of NO which was abolished by the selective iNOS inhibitor aminoguanidine. While ethanol treatment (25 to 400 mM, 24 hr exposure) had no direct effect on basal NO production, it significantly suppressed the LPS-induced increase of nitrite levels in a concentration-dependent manner. Using a semiquantitative reverse transcriptase polymerase chain reaction, we found that while ethanol by itself was unable to induce iNOS mRNA, it nevertheless suppressed LPS-induced iNOS mRNA expression. Our results that ethanol had no direct effect on NO production but inhibited LPS-induced NO, indicated an immunomodulatory role by ethanol. These findings suggest that ethanol may ameliorate the consequences of overwhelming NO generation through iNOS induction in glial cells following infection, inflammation or CNS injuries.

Effects of day care on the development of cognitive abilities in 8-year-olds: a longitudinal study.

In Göteborg, Sweden, 146 children (72 girls) were enrolled in a longitudinal study when they averaged 16 months of age. None of the children had experienced regular out-of-home care yet, but within 3 months, 54 entered center care and 33 entered family day care. Quality of home and out-of-home care environments, child temperament, and the development of verbal abilities were assessed regularly during preschool years. When they were 8 years old (2nd grade), cognitive ability tests were administered to the 123 children (65 girls) still in the study. Tested ability was related to the number of months children had spent in center-based day care before 3.5 years of age. Child care quality predicted cognitive abilities among children who had spent at least 36 months in out-of-home care during their preschool years. Both tested and rated cognitive abilities in 2nd grade were related to earlier measures of verbal ability and to paternal involvement during preschool years.

Screening for postnatal depression in a population-based Swedish sample.

This study surveyed the prevalence of postnatal depression and demographic factors associated with it in a Swedish population. A community sample of 1,584 women was screened at 8 and 12 weeks postpartum using the Edinburgh Postnatal Depression Scale (EPDS). The point prevalence of depression, using a threshold of 11/12 on the EPDS, was 12.5% at 8 weeks and 8.3% at 12 weeks postpartum. The period prevalence for 8 to 12 weeks postpartum was 4.5%. A significantly increased risk of postnatal depression was found for single women. Parity, maternal age and occupational status were not found to be related to postnatal depression. The findings suggest that screening for postnatal depression is feasible at the time of postnatal checks on the baby, and that it can aid in the identification of women at risk for depression. A two-stage screening procedure will identify women at risk for more persistent postnatal depression.

The Edinburgh Postnatal Depression Scale: validation on a Swedish community sample.

The Edinburgh Postnatal Depression Scale (EPDS) was designed to be used by community health workers to screen for postnatal depression. We report data from a population-based sample of 1655 women who completed the EPDS at 2 months and 3 months postpartum. A total of 128 women were interviewed with the Montgomery Asberg Depression Rating Scale (MADRS) and assessed according to DSM-III-R criteria for major depression. A cut-off score of 11.5 on the EPDS identified all but two women with major depression, giving it a sensitivity of 96%, a specificity of 49% and a positive predictive value of 59%. This study supports the validity of the EPDS shown in earlier studies, and indicates that the scale is a useful screening instrument for identifying postnatal depression in primary health care in Sweden.

Counselling of postnatal depression: a controlled study on a population based Swedish sample.

In a two-stage screening procedure using the Edinburgh Postnatal Depression Scale (EPDS) at 8 and 12 weeks postpartum and the Montgomery-Asberg Depression Rating Scale (MADRS) and DSM-III-R at about 13 weeks postpartum, 41 women identified as depressed were randomly allocated to a study and a control group. The women in the study group received 6 weekly, counselling visits by the Child Health Clinic nurse and the control group received routine primary care. Twelve (80%) of 15 women with major depression in the study group were fully recovered after the intervention compared to 4 (25%) of 16 in the control group. Counselling by health nurses is helpful in managing postnatal depression and seems to work well within the Swedish Primary Health Care system.

Effects of various nitric oxide synthase inhibitors on NMDA-induced neuronal injury in rat cortical neurons.

Using an in vitro primary cell culture model in which cortical neurons undergo a gradual and delayed neuronal death after a brief (5 min) challenge with glutamate receptor agonist N-methyl-D-aspartate (NMDA, 300 microM), the neuroprotective effects of various nitric oxide synthases (NOS) inhibitors were compared with that of the NMDA receptor antagonist dizocilpine maleate (MK-801). Our rat cortical cultures consisted of approximately 80-96% neurons and 5-20% astroglia as determined by immunocytochemical staining with antibodies against glial fibrillary acidic protein (GFAP) or neuron specific enolase (NSE). The delayed type of NMDA-induced neurotoxicity was examined by the morphological estimate of cell injury and was further confirmed by the activity of lactate dehydrogenase (LDH) in the extracellular fluid measured 24 hrs after the 5-min NMDA exposure. The accumulation of nitrite, the stable metabolite of nitric oxide (NO), was also measured 24 hrs after the 5-min NMDA exposure. The brief NMDA exposure caused about 60% neuronal death, as compared with persist (24 hr) NMDA exposure at 24 hr after NMDA exposure. Effects of drugs were studied by pretreating the cultures for 10 mins prior to the induction of NMDA neurotoxicity. Both the nonselective NOS inhibitor N alpha-nitro-L-arginine methyl ester (L-NAME, 100 microM) and the selective neuronal nitric oxide synthase (nNOS) inhibitor 7-nitroindozale (7-NI, 100 microM) suppressed nitrite accumulation and attenuated neuronal damage induced by NMDA. However, the selective inducible nitric oxide synthase (iNOS) inhibitor aminoguanidine (AG, 100 microM) exhibited no neuroprotective effects and no reduction in the nitrite production. The NMDA-induced neurotoxicity and nitrite production was abolished by pretreatment with the NMDA receptor antagonist MK-801 (100 microM). Thus the results indicate that a brief NMDA exposure leads to delayed neuronal damage with concomitant increase in NO production in cortical neuronal cultures. We suggest that the NO may originate primarily from nNOS. The neuroprotective effects of NOS inhibitors are weaker than that of MK-801.

Measurement of nitric oxide release in the isolated perfused rat lung.

In this study we have continuously measured real-time production of nitric oxide (NO) in the isolated, perfused rat lung by using an NO monitor (model NO-501, Inter Medical Co., Nagoya, Japan) with an NO-selective resin microsensor. A stable NO response was obtained when the sensor was placed in the pulmonary artery or the pulmonary vein; in contrast, the tracings obtained from the lung periphery were unstable. Furthermore, the NO release was higher when the isolated lungs were perfused with physiological salt solution rather than whole blood perfusion. Changes in NO production were also monitored in acute hypoxia and reoxygenation. Pretreatment with endotoxin (10 mg/kg) potentiated the NO release observed, and this effect of endotoxin was further potentiated by arginine (1 x 10(-4) M) and acetylcholine (1 x 10(-5) M) and countered by the NO synthase inhibitor, L-NG-nitro-arginine methyl ester (L-NAME; 1 x 10(-3) M).

Validity of the Children's Dental Fear Picture test (CDFP).

The validity of the Children's Dental Fear Picture test (CDFP) was investigated in 146 Swedish children aged 5-12 yr. The CDFP was compared with dental fear scores on Children's Fear Survey Schedule-Dental Subscale (CFSS-DS), selection criteria for testings (dentally fearful/not dentally fearful), and with level of general fear measured by the Short Form of Children's Fear Survey Schedule (CFSS-SF). Dental fear in the CDFP was closely related to high scores on CFSS-DS and CFSS-SF. The CDFP proved to be a valid instrument to diagnose dental fear in children with values of sensitivity up to 98.5%.

Children's dental fear picture test (CDFP): a projective test for the assessment of child dental fear.

A projective method, the Children's Dental Fear Picture test (CDFP), for measuring child dental fear was developed and tested for reliability in 146 Swedish children aged 5 to 12-years-old. The CDFP consists of three subtests: the Dental Setting Pictures (CDFP-DS), the Pointing Pictures (CDFP-PP), and a Sentence Completion test (CDFP-SC). Assessments of dental fear were made in each of the subtests as well as for the complete test (CDFP). Based on the assessments, the children were grouped into three categories: "fearful", "non fearful"c and "uncertain". The proportion of agreements between assessments of subtests and final assessment (CDFP) varied from 77.4 percent to 89.0 percent. Interexaminer reliability was computed from 27 testings assessed separately by two trained dentists. Full agreement in the final assessments (CDFP) was found between the dentists in 88.9 percent of the testings, indicating that the CDFP is a reliable method for measuring child dental fear.

Treatment of infantile colic with surface active substance (simethicone).

The effect of Simethicone on "colicky" (n = 27) infants was tested in a double-blind cross-over study. Three different parameters were used to measure the efficiency of the treatment: interviews, 24-hour records and behavioral observations. No effects of Simethicone on the symptoms of infantile colic could be demonstrated. However, 67% of the infants improved during the treatment, which could be ascribed to a high-grade placebo-effect.