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Efficacy of Psychosocial Group Intervention for Children With Chronic Illness and Their Parents
Abstract and Figures
Objective:
To investigate the efficacy of a cognitive-behavioral group intervention for children with chronic illnesses and to test the effect of an added parent component.
Methods:
Children (n = 194) and their parents participated in a multicenter randomized clinical trial comparing a child-only intervention and a parent-child intervention to a wait-list control group. Primary outcomes were parent- and self-reported internalizing and externalizing problems; secondary outcomes were child disease-related coping skills (information seeking, relaxation, social competence, medical compliance, and positive thinking). Assessments took place at baseline and at 6- and 12-month follow-ups. Intention-to-treat mixed-model analyses were performed to test the difference in change in outcomes.
Results:
The intervention had a positive effect on changes in parent-reported internalizing problems, child-reported externalizing problems, information seeking, social competence, and positive thinking. The additional effect of parental involvement was observed on parent-reported internalizing problems, child-reported externalizing problems, information seeking, and social competence. Illness severity and illness type did not moderate the effects. There were no intervention effects on child-reported internalizing problems, parent-reported externalizing problems, relaxation, or medical compliance. Of the families in the wait-list control group, 74% sought alternative psychological support during the intervention period.
Conclusions:
This RCT supports the efficacy of a protocol-based group intervention for children with chronic illnesses and their parents. Adding a parental component to the intervention contributed to the persistence of the effects. Future research should focus on moderating and mediating effects of the intervention.
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... During the intervention, children learn five active coping skills: information seeking, relaxation, social competence, positive thinking, and medical compliance. A randomized control trial (RCT) revealed that OK was efficacious in reducing child internalizing problems and increasing the use of information seeking, positive thinking, and social competence (Scholten et al. 2013). The effects were even more persistent at follow-up if parents followed a parallel intervention "Samen Op Koers" (SOK) (in English: "Together on Track"). ...
... Therefore, both parentreported and self-reported internalizing problem scores were used as outcomes in the current study. Children with CI were randomized to three conditions: child-only intervention (OK), parent-child intervention (SOK), and a waitlist control (Scholten et al. 2013). The present study focused on the first two conditions. ...
... This study was approved by the Medical Ethics Committees of the Academic Medical Centre Amsterdam and of the participating hospitals. Additional details of the inclusion criteria, procedures, randomization, and flow-chart were reported by Scholten et al. (2013). Individual participants were randomized per center into three conditions: (1) child only (n = 71), (2) parent-child (n = 49), and (3) waitlist control (n = 74). ...
Children with chronic illness (CI) are at risk for internalizing problems, which reduce their quality of life, hamper treatment, and increase family stress. Accordingly, behavioral interventions are provided at the family level. However, the effects of parental involvement on child outcomes are not consistently beneficial. Therefore, it is relevant to study the working mechanisms. In the present study, we tested child coping and parenting stress as underlying mechanisms of the effect of an intervention for children and an additional group intervention for parents. Data were analyzed from a randomized controlled trial. Families of children with chronic illness ( N = 120, child M age = 12.11 years, range 7.98–18.07) participated in a cognitive-behavioral-based group intervention and were randomized in the child-only intervention or parent–child intervention. Primary outcomes were parent- and child-reported internalizing problems, whereas the mediators were the use of child active coping skills and parenting stress. The causal model was tested with multilevel mediation analysis. Active coping skills and parenting stress stood out as significant mediators of the effect of the intervention on parent- and child-reported internalizing behavior (Cohen’s d effect size range 0.29–1.57). When parents were involved in the intervention, children increased their use of active coping skills and parents decreased in parenting stress, which in turn improved child internalizing problems. Knowing that coping skills and parenting stress underlie the benefit of involving parents can be used for optimizing interventions for children with CI and addressing the risk of internalizing problems.
... The intervention in the current study, Op Koers Online (English: On Track Online) is an online CBT group intervention (chat, without use of video) for adolescents with different types of CI based on the already existing face-to-face interventions Op Koers for children, adolescents and parents (Last et al., 2007;Scholten et al., 2013). Op Koers face-to-face showed positive results on improving psychosocial functioning (parent-reported internalizing problems and child-reported externalizing problems) and on use of the coping skills information seeking, social competence and positive thinking (Scholten et al., 2013). ...
... The intervention in the current study, Op Koers Online (English: On Track Online) is an online CBT group intervention (chat, without use of video) for adolescents with different types of CI based on the already existing face-to-face interventions Op Koers for children, adolescents and parents (Last et al., 2007;Scholten et al., 2013). Op Koers face-to-face showed positive results on improving psychosocial functioning (parent-reported internalizing problems and child-reported externalizing problems) and on use of the coping skills information seeking, social competence and positive thinking (Scholten et al., 2013). A pilot study of Op Koers Online for adolescent survivors of childhood cancer showed promising results on feasibility (Maurice-Stam et al., 2014). ...
... The results of this RCT indicate a positive effect of Op Koers Online for adolescents, an online psychosocial group intervention for adolescents with different types of CI: the intervention had a positive effect on disease-related coping skills (use of relaxation, social competence and information seeking) and on HRQoL (social, school, psychosocial and total). The effect sizes were medium with standardized regression coefficient β's between 0.52 and 0.68, which was in line with earlier studies on the efficacy of psychosocial interventions for youth with a CI (Scholten et al., 2013;Barakat et al., 2010). ...
Objective
The present study aimed to evaluate the efficacy of Op Koers Online, a protocolled online psychosocial group intervention for adolescents with a chronic illness (CI).
Methods
Adolescents (12–18 years) with different types of CI (N = 59; Mean age = 15.1 years, SD = 1.7; 54% female) participated in a parallel multicenter randomized controlled trial comparing Op Koers Online (N = 35) with a waitlist control group (N = 24). Assessments (online questionnaires) took place at baseline (T0), 6-months (T1) and 12-months follow-up (T2). Primary outcomes were internalizing and externalizing behavioral problems and disease-related coping skills. Health-Related Quality of Life was secondary. Efficacy was tested with linear mixed models.
Results
Compared to the control group, the intervention had a significant positive effect (p < .05) on disease-related coping skills T1 vs T0 (use of relaxation, β = 0.68; social competence, β = 0.57) and T2 vs T0 (information seeking, β = 0.61), and on HRQoL (social-, school-, psychosocial functioning and total HRQoL) T1 vs T0 (β = 0.52 to β = 0.60). No intervention effects on internalizing and externalizing behavioral problems were found.
Conclusion
The results of this randomized controlled trial indicate a positive effect of Op Koers Online. The intervention had beneficial effects on disease-related coping skills and HRQoL.
Practice implications
The next step is to implement Op Koers Online for adolescents in clinical practice.
... Initiating a conversation about stress and stress communication within the parentchild relationship can be beneficial, for example using conversation tools based on positive health [30]. Coping interventions designed to facilitate communication between parents and children regarding disease-related stressors, may further strengthen the parent-child relationship and promote healthy dyadic coping [31,32]. ...
... Together with the individual (neuro)psychological profile, a treatment plan can be determined focussing on training or compensating for underlying (social) cognitive defects (Roelofs et al., 2017), or strengthening social communicative skills and/or enhancing selfesteem and emotion-regulation (e.g. Scholten et al., 2013). ...
Objective
Classical galactosemia (CG) is an inborn error of galactose metabolism. Many CG-patients suffer from long-term complications including poor cognitive functioning. There are indications of social dysfunction but limited evidence in the literature. Therefore, this study aims to improve our understanding of social competence in CG by investigating social cognition, neurocognition and emotion-regulation.
Methods
A comprehensive (neuro)psychological test battery including self- and proxy questionnaires was administered to CG-patients without intellectual disability. Social cognition was assessed by facial emotion recognition, Theory of Mind and self-reported empathy. Standardized results were compared to normative data of the general population.
Results
Data of 23 patients (aged 8–52) were included in the study. On a group-level, CG-patients reported satisfaction with social roles and no social dysfunction despite the self-report of lower social skills. They showed deficits on all aspects of social cognition on both performance tests (emotion-recognition and Theory of Mind) and self-report questionnaires (empathy). Adults had a lower social participation than the general population. Parents reported lower social functioning, less adaptive emotion-regulation and communication difficulties in their children. Individual differences in scores were present.
Conclusion
This study shows that CG patients without intellectual disability are satisfied with their social competence, especially social functioning. Nevertheless, deficits in social cognition are present in a large proportion of CG-patients. Due to the large variability in scores and discrepancies between self- and proxy-report, an individually tailored, comprehensive neuropsychological assessment including social cognition is advised in all CG-patients. Treatment plans need to be customized to the individual patient.
... Parents are usually the ones who interact the most with children and adolescents. Offering group interventions to parents may be an effective way to support them and their children by sharing experiences in a similar situation [19] and learning how to support their child in managing psychological symptoms [20][21][22]. The World Health Organization (WHO) advises parents to communicate with their children in an honest and age-appropriate way that addresses children's concerns and eases their anxiety. ...
Background
The first aim of this study is to test the effectiveness of school-based psychosocial interventions for improving mental health in rural Chinese children with traumatic experiences. The second aim is to examine which individual, family and school related factors could explain the effectiveness of school-based psychosocial interventions. Third, we will investigate whether individual, family, and school related conditions play a moderator role on the effectiveness of school-based psychosocial interventions.
Methods
This study will conduct a cluster randomized controlled trial (RCT) in a large sample of Chinese rural children. Four rural counties in Shandong (Central China), Henan (Central China), Inner Mongolia (Northern China), and Xinjiang (Western China) will be selected as study settings from which schools will be sampled. Each sampled school will be randomly allocated either the intervention groups or a control group. Randomization will be performed by the research member who is not involved in the intervention stage. In each school students in grade 5 or higher will be recruited to ensure that approximately 50 children aged 10 to 18 years will be included. In each county, one high school, one middle school, and one primary school will be randomly chosen as the intervention group, and the other three similar schools will be chosen as control (waiting list) groups. A standardized and uniform research protocol will be applied in all intervention schools. All school social workers and psychological teachers would receive one week of in-person training following procedures. School-based psychosocial interventions included 14 group sessions for 14 consecutive weeks.
Discussion
This study would develop school-based mental health promotion policy recommendations to improve Chinese rural children’s mental health. This study can provide solid evidence for the promotion of school-based intervention in general.
Trial registration
ChiCTR2300069405, Registered on 15 March 2023.
... Stimulating patients and survivors to join in activities with peers is important for their psychosocial functioning. Group programs based on cognitive behavioralbased therapy (CBT) [40] or acceptance and commitment therapy (ACT) [41] could be helpful in stimulating coping with the consequences of childhood cancer and could prevent and diminish psychosocial problems in patients, survivors, and parents [42,43]. ...
Purpose
The study aimed to compare the psychosocial development of young adult survivors of childhood cancer (YACCS) with a norm group of young adults from the general population.
Methods
From 2017 to 2020, 558 YACCS (18–30 years, 51% female, 10.9% CNS cancer) who participated in the Dutch Childhood Cancer Survivor Study (DCCSS) LATER cohort (diagnosed 1963–2001) part 2 completed the Course of Life Questionnaire ( CoLQ ), assessing the achievement of milestones. Items were grouped into the scales autonomy, psychosexual, and social development. Differences between YACCS and norm group were examined with ANOVA and Cohen’s d ( CoLQ scales) and with logistic regression analysis and odds ratio ( OR ) ( CoLQ items), for the total group and YACCS of CNS cancer.
Results
The total group of YACCS did not report a less favorable psychosocial development than the norm group. YACCS of CNS cancer scored lower than the norm group ( p < 0.001) on the scales autonomy ( d = − 0.36) and psychosexual ( d = − 0.46). Additionally, on half of the items of autonomy (0.25 ≤ OR ≤ 0.34), psychosexual (0.30 ≤ OR ≤ 0.48), and social (0.23 ≤ OR ≤ 0.47) development, YACCS of CNS cancer were less likely ( p < 0.01) than the norm group to have achieved the milestones.
Conclusion
Overall, psychosocial development of YACCS was as favorable as the norm, but YACCS of CNS cancer were at risk of an unfavorable psychosocial development in all domains. Monitoring psychosocial development should be included in the standards of psychosocial care, especially for CNS cancer patients and survivors, to be able to trace delay. Personalized interventions should be offered to improve the psychosocial development in an early stage.
... Previous research with CF children has revealed that appropriate support strategies such as talking to the child, describing their behaviours, valuing the child's verbalisations, and praising their performance positively contribute to the child's compliance and adherence to treatment (Butcher & Nasr, 2015). Behavioural control strategies are also related to positive developmental outcomes in chronically ill children, such as more positive affective expressiveness, communication skills, social responsiveness (Tluczek et al., 2015), social competence, and fewer incidences of internalising and externalising problems (Scholten et al., 2013). On the other hand, overprotection and critical control are related to problematic mealtime behaviours (Driscoll et al., 2015), poor psychosocial functioning (Cappelli et al., 1989) and a lower adherence to treatment (Butcher & Nasr, 2015) in CF children. ...
This study aimed to comprehensively describe parental control strategies (appropriate support, critical control or overprotection) in the distinct living contexts of paediatric cystic fibrosis patients (namely daily routine and peer interaction). Fourteen mothers and two fathers of children with cystic fibrosis participated in the study. Children’s ages ranged from 5 to 12 years old (M=7.00; SD=2.25). Participants answered the Interview on Childrearing Practices and The New Friends Vignettes and provided socio-demographic information concerning the family and clinical details about the child’s illness. Descriptive statistical analyses were performed. Appropriate support was the most frequently reported strategy in both contexts, with 83.9% in daily routine and 44.37% in peer interaction. In the daily routine context, reports of critical control were infrequent (15.68%), especially regarding the treatment for cystic fibrosis. In the peer interaction context, reports of overprotection were more frequent (38.48%) than reports of critical control (17.15%). Parents may be more flexible and responsive to children’s difficulties associated with treatments than to other types of disturbing behaviours in their daily routine, while problems in peer interactions tend to evoke overprotective strategies.
Objective
Parents of children with cancer are at risk for developing psychosocial problems. The present study aims to evaluate the effect of an online group intervention (Op Koers Online, in English: On Track Online) on psychosocial wellbeing and coping skills.
Methods
Parents of a child with cancer (diagnosis <5 years ago) participated in a randomized controlled trial. In six consecutive (and one booster‐) protocolled sessions in an online chatroom, trained psychologists and social workers taught coping skills using cognitive behavioral and acceptance and commitment techniques. Questionnaires assessed anxiety, depression, distress, situation‐specific emotional reactions and coping skills (Op Koers Questionnaire/Cognitive Coping Strategies Scale Parent Form) and evaluated the intervention. Linear mixed‐model analyses were performed to detect differences between the conditions in changes over time; T0–T1 and T0–T2 (6‐week and 6‐month follow‐up), and to detect changes in scores T2–T3 (12‐month follow‐up) for the intervention group only.
Results
89 parents were included in analyses (mean age 41.9 years, 86% female, 62%/38% post/during treatment of their child). Beneficial intervention effects ( p < 0.05) were found at T1 for anxiety, depression, distress, loneliness and relaxation, and at T2 for anxiety, uncertainty and relaxation. In the intervention condition, scores did not change from T2 to T3, except loneliness that decreased and relaxation that improved. All effect sizes were small to medium ( β = −0.21 to 0.46). Parents were generally positive about the intervention.
Conclusions
Op Koers Online for parents of children with cancer has a positive effect on psychosocial wellbeing and the coping skill relaxation. Implementation is recommended to prevent psychosocial problems.
Clinical Trial Registration
Dutch Trial Register https://onderzoekmetmensen.nl/en NL73763.041.20.
Objective:
The aim of this study is to evaluate the effect of 'peer-assisted video-based education programme' (VTPA) and counselling to reduce anxiety in children newly diagnosed with cancer.
Methods:
A non-randomised controlled trial design with repeated measures was conducted. The sample of the study consisted of 50 children between the ages of 9 and 18 who were newly diagnosed with cancer in the hospital. Intervention and control groups were created. Children in the intervention group received both VTPA training and counselling practice 3 days a week for 2 months. Data were collected with the State-Trait Anxiety Inventory for Children. The basal assessment in the research was the first meeting with the child, with interval assessments 1 month after, 2 months after and 3 months after the education.
Results:
In the study, it was determined that the state anxiety mean scores of the children in the PAVEP and control groups differed over time (p < 0.05). However, it was determined that there was no difference between the trait anxiety mean scores of the children (p > 0.05).
Conclusion:
VTPA with peer assistance and counselling application supported the reduction of state anxiety in children newly diagnosed with cancer over time.
Objective
To develop and test a brief Composite Intervention Module for Pre-adolescents with Acute Lymphoblastic Leukemia (CIMPALL).
Design
Single-center randomized controlled design.
Setting
A tertiary care center of national importance
Participants
A total of 36 children with acute lymphoblastic leukemia in the maintenance phase of the treatment.
Intervention
A five-session (540 min) brief, multidomain, audiovisually aided, therapist-facilitated conjoint intervention module for children with cancer and their parents.
Main outcome measures
Standardized psychological tools for children including CBCL, CPSS (Child Posttraumatic Stress Disorder Symptoms Scale), PedsQol (Pediatric Quality of Life), and NIMHANS (National Institute of Mental Health and Neurosciences) neuropsychological battery and parents including PTSD CC (Posttraumatic Stress Disorder Civilian Checklist), CHIP (Coping Health Inventory for Parents), CBS (Caregiver Burden Scale), and SRQ (Self-Reporting Questionnaire).
Results
A total of 36 patients were randomized to an experimental or a control group. Over 80% agreement was observed on indices of expert evaluation; 100% of participants found the sessions to be helpful, useful, appropriate in terms of time, duration, and place, and interventionist. The participation rate in the sessions was 94% and the study flow was smooth; 97.3% eligible candidates agreed to participate. Furthermore, 100% agreement on performance of activities was observed and the attrition rate was 5.26%.
Conclusion
This pilot study presents the CIMPALL, which to the best of our knowledge is the first of its kind in India. The data suggest that the CIMPALL intervention is feasibly delivered by a clinical psychologist and that the CIMPALL intervention has an impact on important psychosocial variables for children with acute lymphoblastic leukemia and their parents.
Objective To determine the effectiveness of educational programmes for the self management of asthma in children and adolescents. Data sources Databases of the Cochrane Airways Group, PsychINFO, reference lists of review papers, and eligible studies. Review methods Eligible studies were published randomised controlled trials or controlled clinical trials of educational programmes for the self management of asthma in children and adolescents that reported lung function, morbidity, self perception of asthma control, or utilisation of healthcare services. Eligible studies were abstracted, assessed for methodological quality, and pooled with fixed effects and random effects models. Results 32 of 45 identified trials were eligible, totalling 3706 patients aged 2 to 18 years. Education in asthma was associated with improved lung function (standardised mean difference 0.50, 95% confidence interval 0.25 to 0.75) and self efficacy (0.36, 0.15 to 0.57) and reduced absenteeism from school (–0.14, –0.23 to –0.04), number of days of restricted activity (–0.29, –0.33 to –0.09), and number of visits to an emergency department (–0.21, –0.33 to –0.09). When pooled by the fixed effects model but not by the random effects model, education was also associated with a reduced number of nights disturbed by asthma. The effect on morbidity was greatest among programmes with strategies based on peak flow, interventions targeted at the individual, and participants with severe asthma. Conclusions Educational programmes for the self management of asthma in children and adolescents improve lung function and feelings of self control, reduce absenteeism from school, number of days with restricted activity, number of visits to an emergency department, and possibly number of disturbed nights. Educational programmes should be considered a part of the routine care of young people with asthma.
Outcomes from 42 studies of psychological interventions for children and adolescents with chronic medical conditions were analyzed using meta-analysis. Studies were divided into the four intervention categories suggested by LaGreca and Varni (1993), Disease Management, Emotional/Behavioral Problems, Health Promotion, and Prevention. Results supported overall effectiveness of psychological interventions, with an effect size (ES) of 1.12, as well as maintenance of treatment gains for at least 12 months posttreatment. Psychological interventions directed at disease-related or emotional/behavioral problems were both found to be effective, although too few studies of health promotion or disease prevention interventions were identified to be included in the analysis. Effectiveness of behavioral interventions, which were most heavily represented in the sample, demonstrated similar effects for disease management (ES = 1.20) and emotional/behavioral (ES = 1.03) problems. Although disease type, severity, and duration did not affect intervention effectiveness, some influences of patient age and gender were noted across studies. Recommendations for further intervention studies and improvements in study design are discussed.
To examine the risk of emotional and behavioral problems among children with a chronic physical illness.
Random-effects meta-analysis was computed to integrate the results of 569 studies that used the Child Behavior Checklist, Youth Self Report, and the Teacher Report Form.
Young people with a chronic physical illness have higher levels of internalizing (g = .47 standard mean difference), externalizing (g = .22) and total behavior problems (g = .42) than healthy peers. The largest differences were found in parental ratings and the weakest differences in adolescent self-ratings. Strongest elevations of internalizing problems were found for chronic fatigue syndrome and strongest elevations of externalizing problems were observed for epilepsy and migraine/tension-type headache. Effects also varied by country and, in part, by age, gender, year of publication, and study design.
The results call for regular screens for psychological distress and referrals for mental health services, when needed.
Coping with a chronic illness (CI) challenges children's psychosocial functioning and wellbeing. Cognitive-behavioral intervention programs that focus on teaching the active use of coping strategies may prevent children with CI from developing psychosocial problems. Involvement of parents in the intervention program may enhance the use of learned coping strategies in daily life, especially on the long-term. The primary aim of the present study is to examine the effectiveness of a cognitive behavioral based group intervention (called 'Op Koers') 1 for children with CI and of a parallel intervention for their parents. A secondary objective is to investigate why and for whom this intervention works, in order to understand the underlying mechanisms of the intervention effect.
This study is a multicentre randomized controlled trial. Participants are children (8 to 18 years of age) with a chronic illness, and their parents, recruited from seven participating hospitals in the Netherlands. Participants are randomly allocated to two intervention groups (the child intervention group and the child intervention combined with a parent program) and a wait-list control group. Primary outcomes are child psychosocial functioning, wellbeing and child disease related coping skills. Secondary outcomes are child quality of life, child general coping skills, child self-perception, parental stress, quality of parent-child interaction, and parental perceived vulnerability. Outcomes are evaluated at baseline, after 6 weeks of treatment, and at a 6 and 12-month follow-up period. The analyses will be performed on the basis of an intention-to-treat population.
This study evaluates the effectiveness of a group intervention improving psychosocial functioning in children with CI and their parents. If proven effective, the intervention will be implemented in clinical practice. Strengths and limitations of the study design are discussed.
Current Controlled Trials ISRCTN60919570.
This book discusses the most important techniques available for longitudinal data analysis, from simple techniques such as the paired t-test and summary statistics, to more sophisticated ones such as generalized estimating of equations and mixed model analysis. A distinction is made between longitudinal analysis with continuous, dichotomous and categorical outcome variables. The emphasis of the discussion lies in the interpretation and comparison of the results of the different techniques. The second edition includes new chapters on the role of the time variable and presents new features of longitudinal data analysis. Explanations have been clarified where necessary and several chapters have been completely rewritten. The analysis of data from experimental studies and the problem of missing data in longitudinal studies are discussed. Finally, an extensive overview and comparison of different software packages is provided. This practical guide is essential for non-statisticians and researchers working with longitudinal data from epidemiological and clinical studies.
Since 1991 the BMJ has had a policy of not publishing trials that have not been properly randomised, except in rare cases where this can be justified.1 Why?
The simplest approach to evaluating a new treatment is to compare a single group of patients given the new treatment with a group previously treated with an alternative treatment. Usually such studies compare two consecutive series of patients in the same hospital(s). This approach is seriously flawed. Problems will arise from the mixture of retrospective and prospective studies, and we can never satisfactorily eliminate possible biases due to other factors (apart from treatment) that may have changed over time. Sacks et al compared trials of the same treatments in which randomised or historical controls were used and found a consistent tendency for historically controlled trials to yield more optimistic results than randomised trials.2 The use of historical controls can be justified only in tightly controlled situations of relatively rare conditions, such …
This study examined whether the quality of parent–adolescent interactions moderate the association between stressful life events and internalizing and externalizing problems in referred adolescents (N=101, M age 13.41 years, SD=1.81). Adolescents and their parents reported on psychological problems at the time of referral and 4 years later. At follow-up parents reported on stressful life events and an interaction task was conducted to observe autonomy and relatedness promoting behaviors. For adolescents exposed to stressful events, levels of internalizing and externalizing problems went up except if observed parent–adolescent interactions were characterized by high autonomy and relatedness. The results implied that autonomy and relatedness protect adolescents against the deleterious effects of stressful life events. These findings build on previous research showing for psychologically vulnerable adolescents that parenting that promotes autonomy while maintaining relatedness is associated with resilience in times of stress.
We compared the levels of academic, physical, and social functioning of children and adolescents with chronic physical diseases with those of healthy peers or test norms.
A random effects meta-analysis was computed to integrate the results of 954 studies.
Impairments of physical functioning (g = 0.82 standard deviation units) were stronger than impairments of academic (g = 0.53) and social functioning (g = 0.43). Children with cerebral palsy and spina bifida showed the largest levels of functional impairments. The levels of functional impairments also varied by year of publication, source of information, ethnicity, country, and sociodemographic equivalence of the compared groups.
More efforts are needed to develop and implement measures for the prevention of impaired functioning of children and adolescents with chronic physical illness and for the reduction of already existing impairments of their functioning.