The relation between maternal locus of control and coping styles of pediatric leukemia patients during treatment.

The present study focuses on the relation between coping strategies of children with leukemia during treatment and locus of control of their mothers. In particular, the study aims to determine whether maternal locus of control can influence sick children's coping styles, and if this relation can be used to predict maladjustments. The study analyzed a cohort of 60 pediatric leukemia patients undergoing treatment and a group formed by their mothers. The participants were recruited from two Pediatric Onco- Hematology Units in Italy. The Child Behavioral Style Scale (CBSS) was used to assess children's coping strategies, whereas the Parental Health Locus of Control Scale (PHLCS) was employed to analyze maternal locus of control. A linear regression model was applied to verify a possible interdependent relationship between children's coping styles and maternal locus of control. The differences in mean CBSS scores were analyzed by K-S test. Multivariate analysis of variance was performed to assess any potential effect of child's gender, hospital context and maternal socio-cultural status on children's coping strategies. Our results show a significant relationship between children's coping strategies and maternal locus of control. In particular, the scales mass media, fate and healthcare professionals display a predictive effect on children's monitoring coping style, given the positive correlation observed (F=3.28, P=0.008). In contrast, the same scales negatively correlate with blunting coping style (F=3.5, P=0.005). Our results reveal several interesting resources having a profound impact on the psychological functioning of children with leukemia undergoing treatment as well as their mothers. Furthermore, with regard to the central hypothesis of the study, our findings show both positive and negative correlations between specific scales of maternal locus of control and children's coping style, which could be used to predict children at risk of emotional maladjustment.

From Adjustment to Thriving: Exploring Well-Being in Young Adult Survivors of Childhood Cancer and Their Siblings.

PURPOSE: Few studies have addressed the adaptive mental health status of young adult (YA) survivors of childhood cancer (SCCs) and the siblings (SIBs) of the same families. This article explores the existence of different psychological well-being (PWB) profiles and verifies their relationship with life satisfaction, resilience, and mental adjustment among Italian YA survivors of childhood leukemia or lymphoma and their own SIBs. METHODS: YA SCCs (n = 35) who had been off primary treatment for at least 5 years and their SIBs (n = 47) completed anonymous self-report questionnaires for PWB, life satisfaction, resilience, and mental adjustment. The survivors at the time of the survey had an average age of 27 years (SD 3.37) and they were an average age of 12 years (SD 1.93) at diagnosis. Their own SIBs had an average age of 29 years (SD ±5.25). RESULTS: No significant differences were found between SCCs and their SIBs in all considered dimensions. Only 12% of the sample showed evidence of clinically significant mental health disorders, 51% manifested medium levels of resilience, and 49% fit a functional PWB profile. By means of cluster analysis, three PWB statuses could be derived: self-devaluing (25.5%), fatalist (25.5%), and eudaimonic (49%). Each of these PWB statuses exhibited a significant distinct profile in terms of life satisfaction, resilience, and mental adjustment. CONCLUSIONS: There is a need to establish psychosocial services that offer follow-up examinations aimed to not only prevent mental disorders but also to promote PWB.

Coping Strategies and Locus of Control in Childhood Leukemia: A Multi-Center Research.

Acute lymphoblastic leukemia (ALL) is a very distressing experience for children and requires a special effort of adjustment. Therefore, it seems to be crucial to explore coping resources for the experienced risk condition. In this sense, the study focuses on coping strategies and locus of control in children with ALL during the treatment phase, and on their possible relation. The correlation between children and maternal coping strategies is also investigated. The participants involved were an experimental group of 40 children with ALL and their mothers, and 30 healthy children as the control group. The tools used were: the Child Behavioral Style Scale and the Monitor-Blunter Style Scale to assess the coping strategies of children and mothers; the locus of Control Scale for Children to analyze the children's perception of controlling the events. Both children with ALL and their mothers resorted to monitoring coping strategies with a statistically significant rate of occurrence (children: M=17.8, SD=3.8; mothers: M=10.48, SD=3.4). The data concerning the locus of control show this tendency towards internal causes (M=53.1, SD=4.7). There were statistically significant correlations between monitoring coping strategies and external locus of control (r=0.400, P<0.05). The results gained from the control group are almost equivalent. The outcomes show several interesting resources of the psychological functioning of children as well as of their mothers.

Enzymatic replacement therapy for Hunter disease: Up to 9 years experience with 17 patients.

Hunter disease is an X-linked lysosomal storage disorder characterized by progressive storage of glycosaminoglycans (GAGs) and multi-organ impairment. The central nervous system (CNS) is involved in at least 50% of cases. Since 2006, the enzymatic replacement therapy (ERT) is available but with no effect on the cognitive impairment, as the present formulation does not cross the blood-brain barrier. Here we report the outcome of 17 Hunter patients treated in a single center. Most of them (11) started ERT in 2006, 3 had started it earlier in 2004, enrolled in the phase III trial, and 3 after 2006, as soon as the diagnosis was made. The liver and spleen sizes and urinary GAGs significantly decreased and normalized throughout the treatment. Heart parameters improved, in particular the left ventricular mass index/m(2) decreased significantly. Amelioration of hearing was seen in many patients. Joint range of motion improved in all patients. However, no improvement on respiratory function, eye, skeletal and CNS disease was found. The developmental quotient of patients with a CNS involvement showed a fast decline. These patients were no more testable after 6 years of age and, albeit the benefits drawn from ERT, their quality of life worsened throughout the years. The whole group of patients showed a consistent residual disease burden mainly represented by persistent skeletal disease and frequent need of surgery. This study suggests that early diagnosis and treatment and other different therapies which are able to cross the blood-brain barrier, might in the future improve the MPS II outcome.

Cognition before and after chemotherapy alone in children with chiasmatic-hypothalamic tumors.

Studies on adults with cancer, with or without CNS involvement, have shown that chemotherapy (CT) can affect cognitive functions. Two studies on children with optic pathway gliomas, involving the hypothalamus in some cases, and treated with CT according to various protocols reported the children maintaining a good IQ (no other cognitive abilities were tested). Among 18 children with chiasmatic-hypothalamic tumors (CHT) given front-line CT treatment at our institute using the same protocol (cisplatin and etoposide), we screened eight children for cognitive sequelae, correlating their test performance with several clinical variables (age at diagnosis and at time of treatment, time elapsing since treatment, and tumor volume reduction). The neuropsychological evaluation involved measuring IQ in all eight children and cognitive flexibility in three before CT (T1), then testing IQ, attention, memory and executive functions after CT (T2). The group as a whole showed no signs of any decline in IQ from T1 to T2, except for some WISC items, but IQ deteriorated severely in three patients with NF1 (only suspected in one case). At T2, the whole sample performed within normal range, except for two children showing a significantly worse result in two specific tests. The parents of the other 10 children, reported no substantial changes in their children's behavior and intellectual vivacity in a semistructured telephone interview conducted in cooperation with the children's teachers. CT alone as front-line treatment for CHT does not appear to have a negative effect on IQ and numerous neuropsychological tests. Some skills were more affected than others in our sample (albeit with a very low statistical significance of the impairment), and some patients seemed to be more vulnerable than others after CT. The multifactorial origin of such cognitive impairments is discussed. This type of study needs to be repeated in larger, but nonetheless carefully selected groups of patients.

Age-related trends in Stroop and conflicting motor response task findings.

Inhibition problems are reportedly at the heart of several childhood pathologies and learning disorders, but few instruments are available for their in-depth investigation. The main aim of the present study was to investigate the development of a capacity to inhibit automatic responses in young and middle childhood. For this purpose, 100 children between 6 and 11 years old were administered two tests that measure executive inhibition: an animal Stroop task (in a paper-and-pencil version of the computerized original proposed by Wright and colleagues in 2003) and a conflicting motor response task. Our results indicate that performance clearly improves in both tests during the course of a child's development and the data obtained with the paper-and-pencil animal Stroop task overlap with those obtained with the computerized version. When the task calls for a stronger inhibitory control (the incongruent situation in the Stroop task and in the opposite condition in the conflicting motor response test) the trend of the response times is less homogeneous, peaking in the youngest and oldest age brackets considered. The positivity and significance of the correlation coefficients between the two tests also suggest that the two measures are tapping cognitive abilities that are developing in a parallel fashion.

Verbal dichotic listening and manual performance in children with congenital unilateral brain lesions.

The authors assessed manual performance and verbal dichotic listening performance in 16 epilepsy-free children with congenital unilateral brain lesions and normal IQ to investigate cerebral reorganization. In all children, the paretic hand had fair grip function, but reaction times were impaired, and cerebral reorganization of hand function in those with right hemiplegia was shown by the high incidence of pathological left-handedness. The dichotic listening results showed that most children with left lesions had a left ear advantage significantly related to the extent of brain damage. This finding suggests that extent of cortical damage and presence of thalamic involvement, irrespective of neuropathology, are the primary factors inducing rightward cerebral language reorganization in children with unilateral congenital brain lesions.

Neuropsychologic effects of frontal lobe epilepsy in children.

Most published neuropsychologic studies on frontal lobe epilepsy have been performed on mixed groups of adults and adolescents with epilepsies of varying etiology. The cognitive profile of frontal lobe epilepsy in children has not been defined. The purpose of this study was to assess neuropsychologic performance in children with frontal lobe epilepsy. Intelligence and executive functions were examined in eight children (age 6 7/12 years to 13 11/12 years) with frontal lobe epilepsy. Performance was related to the focus side, seizure frequency, and age of epilepsy onset. Frontal lobe epilepsy was associated with a range of frontal dysfunctions, but IQ was generally spared. Left focus was associated with deficits in categorization, verbal long-term memory, and detailed visuospatial analysis. Frequent seizures correlated with attention difficulties and inability to inhibit impulsive responses. Children whose epilepsy appeared before age 6 years had reduced ability to change behavioral strategies. Frontal epileptic activity alone can cause selective frontal deficits, the severity and nature of which are related to side, seizure frequency, and age of epilepsy onset. These findings require confirmation on larger series of selected children.