Behavioral adjustment and self-esteem of school-age children of women with breast cancer.

PURPOSE/OBJECTIVES: To describe children's psychosocial adjustment to their mother's breast cancer and to compare their level of adjustment with normative data and with the level of adjustment of children of women with fibrocystic breast disease or diabetes. Hypotheses tested were (a) children of women with breast cancer would be most negatively affected and (b) families of mothers with fibrocystic breast disease would require less family adaptation than families of women with breast cancer or diabetes. DESIGN: One component of a larger longitudinal survey. SETTING: University-based physician clinic in a metropolitan area in the Northwestern United States. SAMPLE: Mothers, predominantly Caucasian, with medically controlled diabetes mellitus (n = 18), nonmetastatic breast cancer (n = 13), or biopsy-proven fibrocystic breast disease (n = 17) and their children (N = 48), who ranged in age from 6 to 12. METHODS: Five in-home interviews conducted at four-month intervals. MAIN OUTCOME MEASURES: Behavioral adjustment using the Louisville Behavior Checklist (maternal report) and the Zeitlin Coping Inventory (nurse-observer report) and self-esteem using the Personal Attribute Inventory for Children (children's self-report). FINDINGS: Children of women with breast cancer scored better than average on behavioral adjustment (mothers' ratings) and were judged by nurse observers to be better behaviorally adjusted than children in the noncancer illness groups. Children of women with breast cancer and of women with diabetes tended to score significantly lower on self-esteem than the comparative sample. CONCLUSIONS: Measures of childhood adjustment to chronic medical illness in mothers need to distinguish between behavioral adjustment and self-esteem. Discrepancies between child ratings and mother and nurse-observer ratings suggest that differences exist. IMPLICATIONS FOR NURSING PRACTICE: Findings are preliminary in nature, and other explanations for findings must be ruled out. However, if a child's self-appraisal is affected negatively by the mother's illness, it would be appropriate to identify ways to increase emotional and physical exchange with the child and to interpret inaccessibility in ways that protect the child's positive self-appraisal.

The child's adaptation to parental medical illness: theory and clinical implications.

Few resource papers are available to health care providers that address in detail the issues faced by children in adapting to serious parental illness. The current paper offers a developmental approach to understanding the responses and problems of school-age and adolescent children coping with parental medical illness. Four developmental issues are considered: security and separation anxiety, interpersonal understanding, conceptualizations of illness and death and the role of fantasy. Based on these considerations, broad guidelines for clinical interaction are suggested for health professionals working with seriously ill parents and their children.

Parent and peer attachment in early adolescent depression.

Insecure attachment relations have been theorized to play a significant role in the development of depressogenic modes of adaptation and to thus form a vulnerability factor for the emergence of depressive disorder in children. This study examined security of parent and peer attachment among four groups of early adolescents: clinically depressed, nondepressed psychiatric controls, nonpsychiatric controls, and adolescents with resolved depression. Depressed adolescents reported significantly less secure parent attachment than either of the control groups, and less secure peer attachment than the nonpsychiatric control group. Attachment security of adolescents with resolved depression was on a par with the nonpsychiatric control group. Among all psychiatric patients, security of attachment to parents was negatively correlated with severity of depression according to interview and self-report ratings. Less secure attachment to parents, but generally not to peers, was also related to more maladaptive attributional styles, presence of separation anxiety disorder, and history of suicidal ideation.

Effects of craniofacial birth defects on maternal functioning postinfancy.

This study examined the relationships between children with craniofacial anomalies (cleft lip and palate, cleft palate only, and sagittal synostosis) and their mothers during late infancy and toddlerhood in an effort to identify early factors leading to the psychosocial problems that have been observed in this population of children at school age. Dyadic interaction was observed in play and teaching situations. Maternal self-reports of psychological/emotional status and the quality of relationships with spouse and others were gathered. As compared with mothers of healthy children matched for age and SES, mothers of children with craniofacial anomalies reported higher levels of stress, lower evaluations of self-competence, and a higher degree of marital conflict. The observational measures revealed no group differences in maternal response to the child or in the behavior and responsiveness of the children themselves. The implications of these findings for longitudinal research with children with craniofacial birth defects are discussed.

The inventory of parent and peer attachment: Individual differences and their relationship to psychological well-being in adolescence.

The results of two studies are reported. Study I involved the development of the Inventory of Parent and Peer Attachment (IPPA), a self-report instrument for use with adolescents. Subject were 179 college students aged 16-20 years. Item content of the instrument was suggested by attachment theory's formulations concerning the nature of feelings toward attachment figures. In Study II, the convergent validity of the IPPA was examined. Also, a hierarchial regression model was employed to investigate the association between quality of attachment and self-esteem, life-satisfaction, and affective status. Respondents were 86 adolescents from the Study I sample. As hypothesized, perceived quality of both parent and peer attachments was significantly related to psychological well-being. Results of the development of a theoretically focused, exploratory classification scheme indicated that adolescents classified as highly securely attached reported greater satisfaction with themselves, a higher likelihood of seeking social support, and less symptomatic response to stressful life events.