RESUMEN

Youngsters with diabetes face numerous, daily challenges associated with their treatment. Previous research has examined coping in relation to global medical adjustment. However, the role that coping with diabetes-specific stressors plays in adherence to different treatment components, and child responsibility for these components, is not well understood. The present study examined the contribution of coping strategies to medical adjustment (i.e., metabolic control, treatment adherence) and level of child responsibility for treatment among children (n = 27) and adolescents (n = 29) with diabetes. Youngsters reported coping strategies in response to three diabetes-related situations (social, diet, fingerprick). Coping strategies accounted for a significant proportion of the variance in predicting most adjustment and responsibility variables, above and beyond the effects of relevant background variables (i.e., age, duration of diabetes, diabetes knowledge). Higher levels of approach-coping strategies related to better adherence to diet. Higher levels of avoidance-coping strategies related to poorer metabolic control and adherence to fingerpricks and higher levels of child responsibility for diet. These findings suggest that the role that coping strategies play in youngsters' medical adjustment is best understood within the context of diabetes-specific situations.

Asunto(s)

RESUMEN

A lack of knowledge has been linked to increased stress for caregivers. Educational programs are an inexpensive intervention with potential to improve caregivers' provision of care and to reduce the associated stress. The present description is of a Huntington's disease caregiver's participation in a training program for at-home care of a physically dependent, demented person. Care knowledge was deficient prior to participation and increased with participation. Collaterally, confidence in providing assistance increased and stressfulness of care fell. While increased knowledge remained at follow-up, confidence and stressfulness returned to pre-intervention levels. Measures of affect mirrored the pattern of change in confidence and stressfulness. This suggests that education increased knowledge but this gain was not associated with longer term improvement in the caregiver's affect, stressfulness of continuing to provide care, and confidence in providing care. Implications for such programs are discussed.

Asunto(s)

RESUMEN

This article describes and illustrates a treatment program aimed at addressing intermittent extremely dangerous aggressive behavior in an 11-year-old girl who was blind, multiply handicapped, and profoundly mentally retarded. In the month preceding treatment she had injured a peer, a paid careprovider, and her mother. Functional analysis produced no clear antecedents to aggression. Punishment was used to introduce a superordinate contingency. Differential reinforcement of alternative behavior combined with contingent restraint reduced, then eliminated aggression. Follow-up at an age equivalent of 4 years, 6 months indicated a continued absence of aggression. Results are discussed in regards to the balance between research methodology, agency policy, right to effective treatment, and social validity.

Asunto(s)

RESUMEN

Current and lifetime rates of disorders outlined in the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev., DSM-III-R) were compared in 78 adult children caring for a parent with a progressive dementia and 78 control subjects. The frequencies of depressive and anxiety disorders did not differ between groups in the years prior to caregiving, and there were no differences between groups in first-degree relatives' incidence of psychiatric disorder. During the years they had been providing care, 34% of caregivers met DSM-III-R criteria: 24% for a depressive disorder and 10% for an anxiety disorder. In contrast, 8% of the matched controls met criteria during the same time period for depressive or anxiety disorders. Results support the chronic strains of caregiving being linked to the onset of both depressive and anxiety disorders in adult children caring for a demented parent.

Asunto(s)

RESUMEN

Providing long-term care for a demented relative profoundly affects caregivers' lives. We assessed changes in depression, immune function, and health in 69 spousal caregivers who had already been caregiving for an average of five years and 69 sociodemographically matched control subjects. Between the initial sample ("intake") and the follow-up data collected an average of 13 months later, caregivers showed decrements relative to controls on three measures of cellular immunity. Caregivers also reported significantly more days of infectious illness, primarily upper respiratory tract infections. Caregivers had a much greater incidence of depressive disorders than controls, with 25% of caregivers meeting syndromal criteria at intake and 32% at follow-up, compared with no cases among controls at intake and 6% at follow-up. Caregivers who reported lower levels of social support at intake and who were most distressed by dementia-related behaviors showed the greatest and most uniformly negative changes in immune function at follow-up.

Asunto(s)

RESUMEN

Research has consistently supported facial screening as an effective treatment technique capable of reducing a plethora of aberrant behaviors. As yet few data are available, suggesting less than enthusiastic support for this behavioral consequence. The present investigation found facial screening accelerated the rate of stereotypy after prior reports of effective reduction of the rate of stereotypy with this individual. The advantages of rapid evaluation strategies and the need for publication of negative results are discussed.

Asunto(s)

RESUMEN

Data on subject selection biases in research with older adults are limited. We conducted two sample bias studies that assessed primary caregivers for dementia patients. The first study compared 46 caregivers, who required home interviews, with 63 caregivers willing to travel to the university hospital for assessment; all subjects had been offered free taxi service. Caregivers interviewed at home were helping more hours per day and were more depressed than those assessed at the university; in addition, the patients of caregivers assessed at home were more impaired and had greater personality changes. The second study compared available information from respite care users who chose to participate in our caregiver research project with those who chose not to participate. Nonparticipants provided care for more impaired patients. No demographic differences were found between groups in either study, and there were no differences in the chronicity of caregiving. The implications of these data for aging research are discussed.

Asunto(s)

RESUMEN

Current and lifetime rates of Diagnostic and Statistical Manual (rev. 3rd ed.) disorders were compared in 86 older adults caring for a spouse with a progressive dementia and 86 sociodemographically matched control subjects. Dementia caregivers were significantly more dysphoric than non-care givers. The frequencies of depressive disorders did not differ between groups in the years before care giving, and there were no group differences in first-degree relatives' incidence of psychiatric disorder. During the years they had been providing care, 30% of care givers experienced a depressive disorder (major depression, dysthymia, or depression not otherwise specified) versus 1% of their matched controls in the same time period. Only two care givers who met criteria during care giving had met criteria for a depressive disorder before care giving, and family history was not even weakly related to the identification of at-risk care givers. In contrast to these group differences in depressive disorders, there were no significant differences in other Axis I disorders either before or during care giving. Thus, the chronic strains of care giving appear to be linked to the onset of depressive disorders in older adults with no prior evidence of vulnerability.

Asunto(s)

RESUMEN

Dementia occurs as a primary component of Senile Dementia of the Alzheimer's type (SDAT) and as a secondary component of Parkinson's Disease (PD) in a subset of PD patients. We compared caregiver distress subsequent to the unique features of these dementing illnesses. Self- and other-rated depression was compared in spousal caregivers for 23 SDAT patients, 23 PD with dementia patients, and 23 control subjects. The two caregiving groups were similar in the length of time they had been providing assistance and in caregiver distress, and both caregiver groups were more depressed than comparison subjects.

Asunto(s)

RESUMEN

Anorexia nervosa is a multidimensional syndrome in which perfectionistic striving appears as a common component of the symptom cluster. Multiple studies have linked this character trait to attempts to achieve a "perfect" weight. In contrast, no empirical data are available that document perfectionistic striving outside of food and weight themes. The present study (N = 20) looked for evidence of perfectionistic striving in school behavior by comparing school achievement and IQ scores. School achievement was found to be significantly greater than would be predicted by IQ scores. This finding and directions for future research are discussed.

Asunto(s)

RESUMEN

Dental patients with severe and profound mental impairments may engage in behaviors that adversely affect their oral health. Based on experience in a residential care facility, this report sensitizes dental practitioners, who are unfamiliar with the problems of these patients, to consequences of these behaviors.

Asunto(s)

RESUMEN

PIP: In order to identify the needs and expectations of pregnant women, a questionnaire was applied to 500 out-patients at the National Institute of Perinatology, Mexico, of which 458 are reported. 2/3 of the patients had had prior obstetric experiences and more than 1/2 remembered them as unpleasant. The predominant impression concerning birth was that it is a painful, dangerous event accompanied by suffering. Information concerning pregnancy and birth had most frequently been provided by family members and less often by members of the health team. More than 1/2 of the patients showed some degree of anxiety, especially those who had had prior obstetric experiences and who had not taken the course in gestational education. The majority of the patients were worried about the future birth, especially with respect to pain, how they would be treated and condition of the newborn. 2/3 of the women were inclined to take an active role during delivery, walking and or doing exercies and preferring that anesthetic be used only if necessary. A large majority expressed their desire to be accompained by their husband or companion. Practically all the patients considered it necessary to take a course in gestational education. (author's)^ieng

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

The prevalence of multiple classes of stereotypic behavior was assessed in a large sample of nonambulatory profoundly mentally retarded people. Implications for programming efforts were discussed.

Asunto(s)

Asunto(s)

RESUMEN

There are 16 items in the standard MMPI group forms which are included twice. It was found that a number of computerized scoring services use only the first occurrence of repeated items in scoring the MMPI scales, whereas the handscoring templates use an arbitrary combination of the first and second occurrence of these items. Comparison of these conventions suggested a potential for significant differences in score, particularly on the Sc scale. Scoring a set of 126 MMPIs of chronic pain patients by both of these scoring conventions revealed differences of up to 10 T points on the Sc scale. It is recommended that a single scoring convention for the MMPI be adopted by psychologists. For several reasons we suggest that only the first occurrence of repeated items should be used for scoring purposes. In the absence of a single convention, comparisons between Sc scores on different protocols should not be made without first insuring that the protocols were scored in the same manner.

Asunto(s)