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SOCIAL, EMOTIONAL, AND BEHAVIORAL FUNCTIONING OF CHILDREN EXPOSED TO MEDICAL TRAUMA: A THEORY OF HARDINESS

SOCIAL, EMOTIONAL, AND BEHAVIORAL FUNCTIONING OF CHILDREN EXPOSED TO MEDICAL TRAUMA: A THEORY OF HARDINESS. Robert B. Noll, Ph.D. Director, Child Development Unit Medical Director for Behavioral Health. ACKNOWLEDGEMENTS. Vannatta, Gerhardt, Sheeber, Zeller, Reiter-Purtill

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SOCIAL, EMOTIONAL, AND BEHAVIORAL FUNCTIONING OF CHILDREN EXPOSED TO MEDICAL TRAUMA: A THEORY OF HARDINESS

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  1. SOCIAL, EMOTIONAL, AND BEHAVIORAL FUNCTIONING OF CHILDREN EXPOSED TO MEDICAL TRAUMA: A THEORY OF HARDINESS Robert B. Noll, Ph.D. Director, Child Development Unit Medical Director for Behavioral Health

  2. ACKNOWLEDGEMENTS • Vannatta, Gerhardt, Sheeber, Zeller, Reiter-Purtill • Staff--UC Friendship Study • Dahl, Szigethy, Rofey, Finder • National Institute of Health • American Cancer Society • National Arthritis Foundation

  3. RESEARCH RATIONALE • Improve clinical care • Theory – Stress and trauma

  4. STRESSFUL/TRAUMATIC LIFE EVENTS • Random versus non-random • Uncontrollable versus controllable GREATEST HARM • Uncontrollable, randomly occurring stressful/traumatic life events

  5. IMPACT ON CHILDREN • Social functioning • Emotional well being • Externalizing behavior (acting out)

  6. IMPACT ON PARENTS AND FAMILIES • Parental mental health • Child-rearing • Family functioning • Time management • Siblings • Economic issues

  7. STRESS / TRAUMA MODELEvolutionary Behavioral Health • Illness Parameters • Trauma to the CNS Childhood Chronic Illness Child Dysfunction • Family Parameters • Extreme Family Deprivation

  8. METHODOLOGY PROBLEMS • Comparison groups • Sampling • Contextual factors • Source of information • Lack of longitudinal data

  9. SELECTION CRITERIA FOR COMPARISONS • Classmate at school • Race • Gender • Closest date of birth

  10. FAMILY DEMOGRAPHIC VARIABLES • Family social prestige • Family income • Age of parents • Number of children living at home • Education of parents • Marital status

  11. CHILD DEMOGRAPHIC VARIABLES • Age • Gender • Race • IQ

  12. PRIMARY DIMENSIONS OF SOCIAL FUNCTIONING • What is the child like? • Is the child liked?

  13. REVISED CLASS PLAYWhat is the child like? • Popular/Leader • Prosocial • Aggressive/Disruptive • Sensitive/Isolated

  14. ILLNESS ROLES Someone who is sick a lot Someone who misses a lot of school Someone who is tired a lot

  15. SOCIAL ACCEPTANCE Is the child liked? Three Best Friends • Number of nominations • Reciprocated friendships Like Rating Scale • Overall social acceptance

  16. CHILDREN’S EMOTIONAL WELL-BEING CHILDREN’S REPORT (objective and projective) • depression/anxiety • loneliness • self concept PARENT’S REPORT • depression/anxiety

  17. EVALUATION OF CHILD FUNCTIONING • PERSPECTIVE OF MEDICAL CHART • PERSPECTIVE OF OTHERS • teachers • peers • parents (mothers and fathers) • PERSPECTIVE OF SELF • questionnaires • projectives

  18. DATA ANALYSIS • Comparison of group means • Disease severity • Age and gender as moderators

  19. GENERAL SELECTION CRITERIA • 8-15 years of age • No full time special education • Treated at CCHMC

  20. CHILDREN WITH CHRONIC ILLNESS • Neurofibromatosis (Type 1) • Cancer (no primary CNS involvement)

  21. NF1 • 72 identified (medical records) • 66 located and agreed to participate • 60 schools participated • 54 children with NF and 53 COMPs participate in home-based assessment

  22. NF1: DISEASE SEVERITY • Overall medical severity • Visibility/cosmetic involvement • Neurologic involvement

  23. RCP: TEACHER NOMINATIONS

  24. RCP ILLNESS ROLES: PEERS ***p < .001

  25. RCP: PEER NOMINATIONS

  26. SOCIAL ACCEPTANCE: NF1

  27. DEPRESSION AND LONELINESS

  28. SELF PERCEPTIONS

  29. SELF PERCEPTIONS

  30. MOTHER REPORTS ** *

  31. FATHER REPORTS

  32. DISEASE SEVERITY: NF1 OVERALL MEDICAL SEVERITY • Sick a lot (peers) • Attention (mothers and fathers) VISIBILITY/COSMETIC INVOLVEMENT • RA rating

  33. NEUROLOGIC DISEASE SEVERITY:PEER REPORTS • Social behavior • Popular-Leader [r = -.32] • Sensitive-Isolated [r = .28] • Social acceptance • Reciprocated friendships [r = -.28] • Like Ratings [r = -.32]

  34. NEUROLOGIC DISEASE SEVERITY: PARENT REPORTS • Externalizing symptoms (M & F) • Attention (M) • Rhythmicity (M & F)

  35. NEUROLOGIC DISEASE SEVERITY:CHILD REPORTS • Depression [r = .43] • Self concept: Behavior [r = .30]

  36. CONCLUSIONS: CHILDREN WITH NF • Social functioning • Emotional well being • Behavior (acting out) • DISEASE SEVERITY • Major role: Neurological severity

  37. SELECTION CRITERIA: CANCER • No primary CNS involvement • On chemotherapy • 11 months since diagnosis

  38. PRIMARY DISEASE leukemias lymphomas solid tumors # OF PATIENTS 34 21 17 DISEASE STATUS

  39. CHILDHOOD CANCER: ILLNESS SEVERITY • Protocols • Response to treatment

  40. RCP: TEACHER NOMINATIONS

  41. RCP ILLNESS ROLES: PEERS

  42. RCP: PEER NOMINATIONS

  43. SOCIAL ACCEPTANCE: CANCER

  44. SOCIAL ACCEPTANCE: NF1

  45. DEPRESSION AND LONELINESS

  46. SELF PERCEPTIONS

  47. SELF PERCEPTIONS

  48. MOTHER REPORTS

  49. FATHER REPORTS

  50. DISEASE SEVERITY: CANCER • Peer reports: Aggressive-Disruptive • Peer reports: Like Ratings • Teacher reports: Sensitive-Isolated

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