A confirmative clinimetric analysis of the 36-item Family Assessment Device.

BACKGROUND: The Family Assessment Device (FAD) is a 60-item questionnaire widely used to evaluate self-reported family functioning. However, the factor structure as well as the number of items has been questioned. A shorter and more user-friendly version of the original FAD-scale, the 36-item FAD, has therefore previously been proposed, based on findings in a nonclinical population of adults. AIMS: We aimed in this study to evaluate the brief 36-item version of the FAD in a clinical population. METHODS: Data from a European multinational study, examining factors associated with levels of family functioning in adult cancer patients' families, were used. Both healthy and ill parents completed the 60-item version FAD. The psychometric analyses conducted were Principal Component Analysis and Mokken-analysis. RESULTS: A total of 564 participants were included. Based on the psychometric analysis we confirmed that the 36-item version of the FAD has robust psychometric properties and can be used in clinical populations. CONCLUSIONS: The present analysis confirmed that the 36-item version of the FAD (18 items assessing 'well-being' and 18 items assessing 'dysfunctional' family function) is a brief scale where the summed total score is a valid measure of the dimensions of family functioning. This shorter version of the FAD is, in accordance with the concept of 'measurement-based care', an easy to use scale that could be considered when the aim is to evaluate self-reported family functioning.

Prevalence and predictors of emotional and behavioural functioning of children where a parent has cancer: a multinational study.

BACKGROUND: This study aimed to evaluate prevalence and risk factors for emotional and behavioral problems in dependent children of cancer patients using a multinational research design. METHODS: The sample comprised 350 ill parents, 250 healthy partners, and 352 children. Parents assessed the child's psychological functioning using the Child Behavior Checklist, parental depression using the Beck Depression Inventory, family functioning using the General Functioning subscale of the Family Assessment Device, quality of life using short-form questionnaire, and adolescents (N = 168) self-reported psychological functioning using the Youth Self Report. RESULTS: Children and adolescents, in particular latency-aged boys and adolescent girls, were of higher risk of psychosocial problems than norms. There was a higher risk of problems when the father was ill than when the mother was ill, but it remains unclear whether this difference was due to the different diagnoses of fathers and mothers, gender or other factors. The best predictor of internalizing problems in children and adolescents was parental depression, and the best predictor of externalizing problems in children and adolescents was family dysfunction. CONCLUSIONS: The results indicate the need for a family-oriented approach to psychological support of cancer patients.

Multinational study of cancer patients and their children: factors associated with family functioning.

PURPOSE: This study examined factors associated with family functioning in cancer patients' families with dependent children. PATIENTS AND METHODS: A sample of 381 families (639 parents and 489 children) was recruited simultaneously in six European countries. Patients and family members completed a background questionnaire, the Family Assessment Device (FAD), the Beck Depression Inventory, and the short form version of the Medical Outcomes Health Survey. Descriptive statistics and a multilevel model that allowed a multi-informant design were used. Analyses were carried out with all participants, and separately with parent-rated and children-rated FAD scores. RESULTS: In descriptive analyses, children reported more impairment in family functioning than parents, but the difference was not significant. Depression prevalence was 35% for ill mothers and 28% for ill fathers. In the multilevel analyses with all participants (ie, adults and children) the ill parent's depression was significantly associated with impaired family functioning on five of seven FAD subscales. In analyses with only children, the perception of impairment of family functioning was not associated with parental depression. Additionally, poorer physical status of the ill parent was significantly associated with impairment on roles and communication. CONCLUSION: The ill parent's depression was the most significant factor associated with impairment in family functioning. Screening for depression, active diagnostics, and appropriate treatment of cancer patient's and partner's depression may be important to protect their children from mental disorders. Therefore, support systems need to be more family-oriented and child-centered in their approaches to cancer psychosocial care.

[Psychoanalytic psychotherapy and the ADHD-triad (impulsivity, hyperactivity and attention deficit disorder)]. / Psychoanalytische Psychotherapie und ADHD-trias (Impulsivität, Hypermotorik und Aufmerksamkeitsstörungen).

A brief survey of the psychoanalytically oriented literature regarding the symptom triad of ADHD is followed by the discussion of frequently found disturbances in infantile development, attachment, object relations (regulation of drives and affects, ego functions) of the role of infantile trauma (object loss) and psychic conflict. In the analytic-psychotherapeutic process with a child, the ADHD-symptom-triad may manifest itself e.g. as intrapsychic conflict on the level of the self-representation or of the representation of central self-object-relations (characterized by an insufficient containing-/holding-function), as impairment of self-regulative functions, as inconsistent symbolizing capacity or as deficient regulating and controlling capacity of the ego. The multitude of factors involved does not allow a generalisation of neither the etiology or the pathogenesis of this symptom triad. This is particularly evident in a therapeutic procedure which is relation oriented. In a first interview the authors illustrate the capacity of a ten year old boy (diagnosed as ADHD patient) to make use of the analytic therapeutic dialogue and to present his intrapsychic experiences and problems in a figurative and narrative performance. Finally some specific technical features of low or high frequent analytic psychotherapy with ADHD children are shown: according to the foremost pregenital form of relations--manifested mostly by intensive self esteem problems, narcissistic aggressiveness and motor impulsivity--the transference and counter-transference movements proceed predominantly by projective and introjective identifications. Containment of the difficulties by the therapist is often paralleled for a long period of time by assistance in regulation and by limit setting for the child. Translation of action into language and transformation of intrapsychic processes within the psyche of the therapist into helpful interventions for the child require a continuous adjustment to the inconsistent ego functions and the fragile self esteem of the child. The additional use of stimulant drugs, the work within the family and/or the social context and the high need for research in the analytical field are briefly discussed at the end.

Mental health problems in children of somatically ill parents, e.g. multiple sclerosis.

OBJECTIVES: Based on the investigation of 144 families (144 patients affected by Multiple Sclerosis (MS), 109 partners, and 192 children) examined in three different European child and adolescent psychiatric University centres by means of questionnaires, we evaluated the prevalence of psychological symptoms in the offspring and associated risk factors such as duration and severity of the disease as well as depression of the ill and the healthy parent. RESULTS: Indicate that the severe disease of MS is associated with depression of the ill and healthy parent. Ill parents, especially ill mothers, as well as depressed ill, or depressed healthy parents evaluate their children's mental health problems with a higher prevalence within the internalizing spectrum. Healthy parents report normal psychological adjustment of their children. If two parents present a depressive state, the prevalence of relevant psychological internalizing symptoms is twice or three times as high as the age norms. CONCLUSION: Children in families with a parent affected by MS and associated depression of the parental couple are at high risk of mental health problems, especially internalizing disorders. In focusing on the mental health of children one must also be aware of the potential opportunities to address the parents' own psychological needs.