health and psychosocial functioning of caregivers of …introduction children with...
Post on 08-Sep-2020
12 Views
Preview:
TRANSCRIPT
Health and Psychosocial Functioning of Health and Psychosocial Functioning of Caregivers of Children with Caregivers of Children with
Neurodevelopmental Disorders: Neurodevelopmental Disorders: Preliminary Results from the NLSCYPreliminary Results from the NLSCY
Lach, L.M., Kohen, D.E., Garner, R.E., Miller, Lach, L.M., Kohen, D.E., Garner, R.E., Miller, A.R., Brehaut, J.C., Klassen, A.F., & A.R., Brehaut, J.C., Klassen, A.F., &
Rosenbaum, P.Rosenbaum, P.
Research Seminar – Centre for Research on Research Seminar – Centre for Research on Children and Families, McGill UniversityChildren and Families, McGill University
April 18, 2007April 18, 2007
Funded by CIHR 2005-2007
IntroductionIntroduction Children and adolescents with Children and adolescents with
neurodevelopmental disordersneurodevelopmental disorders– motor, cognitive, behavioural and/or language motor, cognitive, behavioural and/or language
impairmentimpairment– up to 9.3% of youth <18 years of age (CDCP, up to 9.3% of youth <18 years of age (CDCP,
2005)2005) prevalence rates for individual disorders:prevalence rates for individual disorders:
– CP (0.18% to 0.25%; Johnson, 2002; Missiuna et al., CP (0.18% to 0.25%; Johnson, 2002; Missiuna et al., 2001; Newacheck & Taylor, 1992)2001; Newacheck & Taylor, 1992)
– Epilepsy (0.68% to 0.9%; Silanpaa, 1992; Pless & Epilepsy (0.68% to 0.9%; Silanpaa, 1992; Pless & Graham, 1970; McDermott et al., 1995)Graham, 1970; McDermott et al., 1995)
– Developmental delay (4%; Boyle, 1994)Developmental delay (4%; Boyle, 1994)
IntroductionIntroduction
Children with emotional/behavioural Children with emotional/behavioural problems:problems:– Prevalence rates vary from 6.13% (Boyle, Prevalence rates vary from 6.13% (Boyle,
1994) to 18.1% (Offord, et al., 1987)1994) to 18.1% (Offord, et al., 1987) Emotional disorders rates vary from 5% in 12-16 Emotional disorders rates vary from 5% in 12-16
year old males to 10.7% in 4-11 year old females year old males to 10.7% in 4-11 year old females (Links et al., 1989)(Links et al., 1989)
Externalizing behaviour rates vary from 3.8% for Externalizing behaviour rates vary from 3.8% for girls in the UK to 7.0% for boys in the US girls in the UK to 7.0% for boys in the US (McCulloch, Wiggins, Joshi, & Sachdev, 2000)(McCulloch, Wiggins, Joshi, & Sachdev, 2000)
IntroductionIntroduction Children and adolescents who have a chronic health condition Children and adolescents who have a chronic health condition
accompanied by a disability are at increased risk for compromised accompanied by a disability are at increased risk for compromised emotional, behavioural and social outcomes (Cadman et al., 1986emotional, behavioural and social outcomes (Cadman et al., 198611; ; McDermott et al., 1996McDermott et al., 199622))– O.R. 3.4 for psychiatric disorderO.R. 3.4 for psychiatric disorder11
– O.R. 5.4 for social isolationO.R. 5.4 for social isolation11 – aOR 2.5 for behaviour problemsaOR 2.5 for behaviour problems22
Odds risk ratio varies depending on gender and age groupOdds risk ratio varies depending on gender and age group
25%-32% of youth with neuro-epileptic disorders have problematic 25%-32% of youth with neuro-epileptic disorders have problematic behaviour (Rutter, Graham, & Yule, 1970)behaviour (Rutter, Graham, & Yule, 1970)– 31.4% of children with epilepsy have behaviour problems (McDermott 31.4% of children with epilepsy have behaviour problems (McDermott
et al., 1995)et al., 1995)– 25.5% of children with cerebral palsy have behaviour problems 25.5% of children with cerebral palsy have behaviour problems
(McDermott et al., 1996)(McDermott et al., 1996)
IntroductionIntroduction Caregivers of children and adolescents with CHCCaregivers of children and adolescents with CHC
- Compromised physical and psychological healthCompromised physical and psychological health- Increased rates of tx for ‘nerves’ (OR 2.1 for mothers and 1.9 for Increased rates of tx for ‘nerves’ (OR 2.1 for mothers and 1.9 for
fathers) and significantly higher maternal negative affect scores fathers) and significantly higher maternal negative affect scores (Cadman et al., 1991)(Cadman et al., 1991)
- Population-based studies suggest that there are no differences Population-based studies suggest that there are no differences in rates of social isolation or family functioning of caregivers in rates of social isolation or family functioning of caregivers (Cadman et al., 1991)(Cadman et al., 1991)
- However, clinical studies provide evidence for and against a However, clinical studies provide evidence for and against a difference between health and psychosocial adjustment of difference between health and psychosocial adjustment of caregivers of children with CHC and caregivers of children who caregivers of children with CHC and caregivers of children who do not have CHC (Brehaut et al., 2004; Dunst & Trivette, 1986)do not have CHC (Brehaut et al., 2004; Dunst & Trivette, 1986)
IntroductionIntroduction
One of the factors that predicts caregiver health One of the factors that predicts caregiver health is that of child behaviour problemsis that of child behaviour problems– in parents of children with non-progressive in parents of children with non-progressive
neurodevelopmental disorders (King, King, neurodevelopmental disorders (King, King, Rosenbaum, & Goffin, 1999)Rosenbaum, & Goffin, 1999) Pathway coefficient = 0.60Pathway coefficient = 0.60
– in caregivers of children with cerebral palsy (Raina, in caregivers of children with cerebral palsy (Raina, O’Donnell, Rosenbaum, Brehaut, Walter, & Rusell et O’Donnell, Rosenbaum, Brehaut, Walter, & Rusell et al., 2005)al., 2005) Beta coefficient = -0.22 for psychological healthBeta coefficient = -0.22 for psychological health Beta coefficient = -0.18 for physical healthBeta coefficient = -0.18 for physical health
IntroductionIntroduction Limitations in existing studies:Limitations in existing studies:
– Epidemiological studies are limited in their Epidemiological studies are limited in their generalizability to this population:generalizability to this population: Categorical listings of that which constitutes a chronic health Categorical listings of that which constitutes a chronic health
condition or a special care need are inconsistently defined condition or a special care need are inconsistently defined from study to study and is a more inclusive groupfrom study to study and is a more inclusive group
range in severity from asthma/allergies to severe mobility range in severity from asthma/allergies to severe mobility and cognitive problemsand cognitive problems
Focus on children and adolescents with specific Focus on children and adolescents with specific neurodevelopmental disorders such as epilepsy, CP or neurodevelopmental disorders such as epilepsy, CP or developmental delay developmental delay
Co-morbidity insofar as a proportion of each population-Co-morbidity insofar as a proportion of each population-based sample will have one or two of the other conditionsbased sample will have one or two of the other conditions
IntroductionIntroduction
Limitations in existing studies:Limitations in existing studies:– Clinical studies are also limited in their Clinical studies are also limited in their
generalizability as the samples are:generalizability as the samples are: Recruited from acute care tertiary centres or Recruited from acute care tertiary centres or
rehabilitation-based sitesrehabilitation-based sites Comprised of small convenience samples (non-Comprised of small convenience samples (non-
random)random) Also categorical in natureAlso categorical in nature
Objective of This StudyObjective of This Study To describe and compare the health and To describe and compare the health and
psychosocial adjustment of caregivers of children psychosocial adjustment of caregivers of children who have a neurodevelopmental diagnosis or who have a neurodevelopmental diagnosis or symptoms indicative of a neurodevelopmental symptoms indicative of a neurodevelopmental condition (hereinafter referred to as condition (hereinafter referred to as neurodevelopmental disorder) to those who do not neurodevelopmental disorder) to those who do not have a child with a neurodevelopmental disorder.have a child with a neurodevelopmental disorder.
– What is their physical and emotional health?What is their physical and emotional health?– What is their family functioning?What is their family functioning?– What is their social support?What is their social support?– What is their marital satisfaction?What is their marital satisfaction?
MethodMethod SurveySurvey
– NLSCY (Statistics Canada and Social Development NLSCY (Statistics Canada and Social Development Canada)Canada)
– Started in 1994 and biennially repeatedStarted in 1994 and biennially repeated– Person most knowledgeable (PMK) provides Person most knowledgeable (PMK) provides
information on the child as well as information about information on the child as well as information about him/herself and his/her spouse or partnerhim/herself and his/her spouse or partner
– 90% of cases, the PMK is the child’s biological mother90% of cases, the PMK is the child’s biological mother– n=22,831 0-11 year old children were interviewed in n=22,831 0-11 year old children were interviewed in
1994/95 1994/95 – Sample was taken from all areas of the country Sample was taken from all areas of the country
proportionate to regional population (except Yukon, proportionate to regional population (except Yukon, Northwest Territories, and Nunavut)Northwest Territories, and Nunavut)
MethodMethod
SampleSample– All children age 4 and older from cycle 1 of All children age 4 and older from cycle 1 of
the NLSCY (n=14,226)the NLSCY (n=14,226)– 4 groups4 groups
Neurodevelopmental disorderNeurodevelopmental disorder Neurodevelopmental disorder + externalizing Neurodevelopmental disorder + externalizing
behaviour problembehaviour problem Externalizing behaviour problemExternalizing behaviour problem NeitherNeither
Method - SampleMethod - Sample
Locating caregivers of children with Locating caregivers of children with neurodevelopmental disorders in the neurodevelopmental disorders in the database:database:– Categorical listing of diagnoses: cerebral palsy, epilepsy, Categorical listing of diagnoses: cerebral palsy, epilepsy,
mental handicap, learning disability (6-11 year old group mental handicap, learning disability (6-11 year old group only)only)
– Health Utilities Index (Feeny et al., 1995)Health Utilities Index (Feeny et al., 1995) Speech (score 3-5)Speech (score 3-5) Ambulation (3-6)Ambulation (3-6) Dexterity (2-6)Dexterity (2-6) Cognitive (4-6)Cognitive (4-6)
HUI Domain Scores for Those HUI Domain Scores for Those Identified Using Categorical ListIdentified Using Categorical List
1.50 (1.21)2.44 (1.50)1.25 (1.00)3.38 (2.03)Cerebral Palsy (n=16)
0.28 (0.83)2.88 (1.49)1.09 (0.56)1.11 (0.65)Learning Disability (n=371)
2.81 (1.52)4.21 (1.54)1.77 (1.66)1.81 (1.68)Mental Handicap (n=43)
1.93 (1.54)2.84 (1.82)1.36 (1.19)1.56 (1.42)Epilepsy (n=45)
Speech (3-5)
Cognition (4-6)
Dexterity(2-6)
Mobility (3-6)
Mean (S.D.) Scores on Health Utilities Index (HUI) Functional Domains
Method - SampleMethod - Sample Locating caregivers of children with Locating caregivers of children with
externalizing behaviour problems in the externalizing behaviour problems in the database:database:– 5 subscales derived using factor analysis on a 37-5 subscales derived using factor analysis on a 37-
item parent-reported measureitem parent-reported measure Hyperactivity/inattention*Hyperactivity/inattention* Emotional disorder/anxietyEmotional disorder/anxiety Conduct disorder/physical aggression*Conduct disorder/physical aggression* Indirect aggression*Indirect aggression* Absence of prosocial behavioursAbsence of prosocial behaviours
– Included children whose scores were 2 S.D. above Included children whose scores were 2 S.D. above the mean on 3 of these subscalesthe mean on 3 of these subscales
* Subscales used in this study
Method - SampleMethod - Sample
94678303 1164 (12.3)Total
79867236 (76.43)
750 (7.92)No
1481 (15.64)
1067 (11.27)
414 (4.37)Yes
Externalizing Behaviour Problem
TotalNoYes
Neurodevelopmental Disorder
N=313 had missing information required to identify neurodevelopmental disorderand/or behaviour problemRemaining 13,913 children were represented by 9,467 caregivers and so one child was selected per household for inclusion
Method - MeasuresMethod - Measures Measurement of Physical Health - Checklist
• Food allergies• Other allergies• Asthma• Back problems• High blood pressure• Migraine headaches• Bronchitis• Sinusitis
• Diabetes• Epilepsy • Heart disease• Cancer• Ulcers• Urinary incontinence• Cataracts • Glaucoma• Other Chronic Condition
Method - MeasuresMethod - Measures
Measurement of Physical HealthMeasurement of Physical Health
– Question regarding whether caregiver is Question regarding whether caregiver is limited in at least one domain of activity at limited in at least one domain of activity at home, school, in caring for children, or in home, school, in caring for children, or in other activities such as transportation or other activities such as transportation or leisure (Yes/No)leisure (Yes/No)
– Ranking of general health on a scale of 1 to 5 Ranking of general health on a scale of 1 to 5 (dichotomized into excellent/very good and (dichotomized into excellent/very good and good/fair/poor health)good/fair/poor health)
Method - MeasuresMethod - Measures
Measurement of Psychological Health
– Centre for Epidemiological Studies Depression Scale (CES-D; Radloff et al., 1977)
– 12 item, 4 point scale focused on frequency of occurrence of symptoms in the last week
– Scores range from 0 to 36; higher scores indicate presence of depressive symptoms
– alpha = 0.82
Method - MeasuresMethod - Measures Measurement of Family FunctioningMeasurement of Family Functioning
– General Family Functioning subscale of the Family Assessment General Family Functioning subscale of the Family Assessment Device (FAD; Epstein et al., 1981)Device (FAD; Epstein et al., 1981)
– 12 item; 4 point Likert response scale12 item; 4 point Likert response scale– Score from 0 to 36; higher scores mean more problematic Score from 0 to 36; higher scores mean more problematic
functioningfunctioning– Clinical cut-off of 15 (functional/problematic functioning)Clinical cut-off of 15 (functional/problematic functioning)– Cronbach alpha = 0.88Cronbach alpha = 0.88
Measurement of Marital SatisfactionMeasurement of Marital Satisfaction
– Caregivers rated their marital satisfaction on a scale of 1 to 11 Caregivers rated their marital satisfaction on a scale of 1 to 11 where 1 is completely dissatisfied and 11 is completed satisfiedwhere 1 is completely dissatisfied and 11 is completed satisfied
Method - MeasuresMethod - Measures Measurement of Social SupportMeasurement of Social Support
– 6 item; 4 point Likert-type response scale6 item; 4 point Likert-type response scale– Scores from 0 to 18; higher scores indicate higher levels of Scores from 0 to 18; higher scores indicate higher levels of
perceived social supportperceived social support– Chronbach Alpha = 0.82Chronbach Alpha = 0.82
– Question regarding whether caregivers received help from any Question regarding whether caregivers received help from any of the following over the last 12 months: of the following over the last 12 months: Community or social servicesCommunity or social services Health professionalsHealth professionals Religious or spiritual leaders or communitiesReligious or spiritual leaders or communities Books or magazinesBooks or magazines
– Scores range from 0 to 4; higher scores indicate endorsement of Scores range from 0 to 4; higher scores indicate endorsement of more sources of social supportmore sources of social support
AnalysisAnalysis Basic descriptive statistics for sociodemographic Basic descriptive statistics for sociodemographic
characteristics as well as for each of the outcome measures characteristics as well as for each of the outcome measures of caregiver healthof caregiver health
Chi-square and ANOVA for between group comparison Chi-square and ANOVA for between group comparison adjusted using Bonferroni methodadjusted using Bonferroni method
Multivariate regression models:Multivariate regression models:– To assess independent effects of having a child with a To assess independent effects of having a child with a
neurodevelopmental disorder or externalizing behaviour problem neurodevelopmental disorder or externalizing behaviour problem while controlling for sociodemographic characteristics; interaction while controlling for sociodemographic characteristics; interaction term included in order to determine if both different from additive term included in order to determine if both different from additive modelmodel
– Linear models for continuous outcomesLinear models for continuous outcomes– Poisson models for count outcomesPoisson models for count outcomes– Logistic models for binary outcomesLogistic models for binary outcomes– Bootstrapped to account for complex survey design (INSET RAO Bootstrapped to account for complex survey design (INSET RAO
REF)REF)
F(3) = 10.46, p < .0001
4.18 (1.13)
4.33 (1.20)
4.35 (1.34)
4.11 (1.13)
Family size, mean (sd)
F(3) = 22.28, p < .0001
$53,223($38,251)
$48,978($33,690)
$49,104($34,454)
$39,448($27,519)
Household income, mean (sd)
X2 = 102.91, p < .0001
84.0575.6578.3969.12% Two-parent families
Family Characteristics
X2 = 11.30, p<.0194.4696.7095.6093.77% born in Canada
X2 = 96.33, p < .0001
49.9651.7861.9470.15% male
F(3) = 56.31, p < .0001
7.38 (2.38)
7.51 (2.22)
8.21 (2.16)
8.53 (1.93)
Age, mean (sd)
Child Characteristics
Neither(n=7236)
Ext. Only (n=1067)
Neuro.Only
(n=750)Both
(n=414)
Comparison
Caregiver of Child With…
Characteristics
Preliminary FindingsPreliminary Findings
ComparisonNeither(n=7236)
Ext. Only(n=1067)
Neuro. Only
(n=750)Both
(n=414)
24.7733.3933.2953.67Daily smoker4.743.784.233.58Occasional smoker
X2 = 199.29, p < .0001
70.4962.8362.4542.75Non-smoker, incl. former smoker
Smoking status (%)
10.6017.3716.9219.96Divorced, separated or widowed
84.4676.1378.3570.28Married, incl. common-law X2 = 110.53, p < .0001
4.946.504.739.76Single, never-married
PMK marital status (%)
X2 = 66.17, p < .000184.8979.8981.0071.67% with at least a high school
education
X2 = 12.65, p =.00689.5389.8092.9392.81% female
F(3) = 12.65, p < .0001
36.00 (5.83)
35.12 (5.31)
35.32 (5.16)
34.98 (4.87)Age, mean (sd)
Caregiver Characteristics
X2(3) = 31.95, p<.00011.81A,C3.95D2.504.67D Bronchitis
X2(3) = 68.21, p<.00019.21A,B,C14.85D14.36D17.70D Migraine
X2(3) = 14.32, p=0.0032.58C4.36B,D1.78C2.25 High blood pressure
X2(3) = 83.11, p<.000110.24A,C14.66A,D11.93A23.77B,C,D Back problems
X2(3) = 51.42, p<.00014.77A,B,C7.50D7.97D11.48D Arthritis
X2(3) = 39.19, p<.00015.64A,C8.10A,D6.09A12.58B,C,D Asthma
X2(3) = 16.67, p=.000817.36A,C20.80D18.7323.66D Other allergies
X2(3) = 30.49, p<.00015.31B,C7.75D9.52A,D4.46B Food allergies
Chronic conditions, % yes
X2(3) = 97.38, p<.000141.60A,B,C50.95A,D52.27D59.29C,DHas at least one chronic
condition, % yes
D: Neither(n=7236)
C: Ext. Only
(n=1067)
B: Neuro. Only
(n=750)A: Both(n=414)
Comparison
Caregiver of Child With…Physical and Psychological Health Indicators
X2(3) = 33.93, p<.00015.42A,B7.06A8.14D11.49C,D Other chronic
condition
X2(3) = 2.08, ns0.490.61…… Urinary incontinence
X2(3) = 9.19, p=.032.23A2.533.224.28D Ulcers
X2(3) = 13.97, p=.0030.43C1.25D…… Cancer
X2(3) = 8.29, p=.040.640.801.171.72 Heart disease
X2(3) = 20.55, p<.00010.29B0.651.38D… Epilepsy
X2(3) = 4.41, ns0.941.231.301.88 Diabetes
X2(3) = 21.25, p<.00013.98A,C6.59D4.696.93D Sinusitis
Chronic conditions, % yes
D: Neither(n=7236)
C: Ext. Only
(n=1067)
B: Neuro. Only
(n=750)A: Both(n=414)
Comparison
Caregiver of Child With…Physical and Psychological Health Indicators
F(3) = 140.42, p<.0001
4.26 (5.03)ABC
6.65 (6.75)ABD
5.85 (6.55)ACD
8.74 (7.25)BCDDepression, mean (SD)
X2(3) = 120.61, p<.000175.70A,B,C68.37A,D68.10A,D54.31B,C,D
General health status is excellent/very good, % yes1
X2(3) = 85.91, p<.00019.19A,B,C13.10A,D15.02A,D21.13B,C,D
Is limited in at least one domain of activity, % yes
7.3613.358.4318.563+
10.6413.6415.4416.062
23.6023.9728.4124.671 X2(9) = 164.26, p<.0001
58.4049.0547.7340.710
A,B,CB,DA,C,DB,DNumber of conditions, %
D: Neither(n=7236)
C: Ext. Only
(n=1067)
B: Neuro. Only
(n=750)A: Both(n=414)
Comparison
Caregiver of Child With…Physical and Psychological Health Indicators
F(3) = 7.51, p<.0001
9.43 (1.96)C
9.11 (1.94)D
9.27 (2.01)
9.22(2.02)
Marital Satisfaction, mean (sd)3
F(3) = 42.06, p<.0001
0.75 (1.03)A,B,C
1.00 (1.13)A,D
1.01(1.14)D
1.16 (1.27)C,D
# of Sources of Helpful Support, mean (sd)
F(3) = 11.32, p<.0001
14.54(2.82)A,C
14.19 (3.06)D
14.35 (2.99)A
13.86 (2.72)B,D
Social Support Scale, mean (sd)2
F(3) = 56.87, p<.0001
7.72 (5.08)A,B,C
9.14 (5.38)A,D
8.58 (5.32)A,D10.41 (5.42)B,C,D
Family Functioning Scale, mean (sd)1
D: Neith
er(n=7236)
C: Ext. Only
(n=1067)
B: Neuro. Only
(n=750)A: Both(n=414)
Comparison
Caregiver of Child With…
Psychosocial Functioning
Preliminary Findings - PsychosocialPreliminary Findings - Psychosocial
ns0.15-0.18General health status is excellent/very good,% yes (n=9379)
ns0.170.25Any activity limitation (n=9379)ns0.180.19Any chronic condition (n=9378)
Logistic Regression
ns0.240.24Number of sources of helpful support (n=9347)
ns0.340.21Number of chronic conditions (n= )
Poisson Regression0.33-0.32-0.15 (ns)Marital satisfaction (n=7764)ns-0.28nsSocial support (n=9324)ns1.320.82Family functioning (n=9287)ns2.061.38Depression (n=9248)
Linear RegressionInteractionAny Ext.Any Neuro.
Regression coefficientsOutcomes
Marital Satisfaction
9.17
9.49
9.34 9.35
9
9.1
9.2
9.3
9.4
9.5
9.6
No External Externalizing
Scal
e ra
nge
0-11
No Neuro Neuro Disorder
Preliminary Findings – Marital Preliminary Findings – Marital SatisfactionSatisfaction
DiscussionDiscussion
What is the take home message?What is the take home message?– Caregivers of children with Caregivers of children with
neurodevelopmental disabilities and neurodevelopmental disabilities and externalizing behaviour problems are more externalizing behaviour problems are more likely to have….likely to have….
ConclusionConclusion
Implications for PracticeImplications for Practice– Need to assess for caregiver health and problematic Need to assess for caregiver health and problematic
family functioningfamily functioning– Need for prevention programsNeed for prevention programs
Implications for Future ResearchImplications for Future Research– What is it about the family functioning that is What is it about the family functioning that is
problematic?problematic?– What kind of support impacts on caregiver health?What kind of support impacts on caregiver health?
Implications for PolicyImplications for Policy– Need for services to be family-centredNeed for services to be family-centred
ReferencesReferences Brehaut, J.C., Kohen, D.E., Raina, P., Walter, S.D., Russell, D., & Swinton, M. et al. (2004). The Brehaut, J.C., Kohen, D.E., Raina, P., Walter, S.D., Russell, D., & Swinton, M. et al. (2004). The
health of primary caregivers of children with cerebral palsy: How does it compare with that of health of primary caregivers of children with cerebral palsy: How does it compare with that of other Canadian caregivers? other Canadian caregivers? Pediatrics, 114(2), Pediatrics, 114(2), e182-e190.e182-e190.
Cadman, D., Boyle, M.H., Offord, D.R., Szatmari, P., Rae-Grant, N., Crawford, J., & Byles, J. Cadman, D., Boyle, M.H., Offord, D.R., Szatmari, P., Rae-Grant, N., Crawford, J., & Byles, J. (1986). Chronic illnesses, functional conditions and limitations in Ontario children: Findings of (1986). Chronic illnesses, functional conditions and limitations in Ontario children: Findings of the Ontario Child Health Study. the Ontario Child Health Study. CMAJ, 135, CMAJ, 135, 761-767.761-767.
Cadman, D., Rosenbaum, P., Boyle, M., & Offord, D.R. (1991). Children with chronic illness: Cadman, D., Rosenbaum, P., Boyle, M., & Offord, D.R. (1991). Children with chronic illness: Family and parent demographic characteristics and psychosocial adjustment. Family and parent demographic characteristics and psychosocial adjustment. Pediatrics, 87(6), Pediatrics, 87(6), 884-895.884-895.
Dunst, C., & Trivette, C. . (1986). Mediating influences in social support: Personal, family, and Dunst, C., & Trivette, C. . (1986). Mediating influences in social support: Personal, family, and child outcomes. child outcomes. American Journal of Mental Deficiency, 90, American Journal of Mental Deficiency, 90, 403-417.403-417.
Feeny D., Furlong, W., Boyle, M., & Torrance, G.W. (1995). Mutliattribute health-status Feeny D., Furlong, W., Boyle, M., & Torrance, G.W. (1995). Mutliattribute health-status classification systems – Health Utilities Index. classification systems – Health Utilities Index. Pharmacoeconomics, 7, Pharmacoeconomics, 7, 490-502.490-502.
Johnson, A. (2002). Prevalence and characteristics of children with cerebral palsy in Europe. Johnson, A. (2002). Prevalence and characteristics of children with cerebral palsy in Europe. Developmental Medicine and Child Neurology, 44, Developmental Medicine and Child Neurology, 44, 633-640.633-640.
Links, P.S., Boyle, M.H., & Offord, D.R. (1989). The prevalence of emotional disorder in children. Links, P.S., Boyle, M.H., & Offord, D.R. (1989). The prevalence of emotional disorder in children. The Journal of Nervous and Mental Disease, 177(2), The Journal of Nervous and Mental Disease, 177(2), 85-91.85-91.
ReferencesReferences McCulloch, A., Wiggins, R.D., Joshi, H.E., & Sachdev, D. (2000). Internalising and externalising McCulloch, A., Wiggins, R.D., Joshi, H.E., & Sachdev, D. (2000). Internalising and externalising
children’s children’s
McDermott, S., Mani, S., & Krishnaswami, S. (1995). A population based analysis of specific McDermott, S., Mani, S., & Krishnaswami, S. (1995). A population based analysis of specific behavior problems associated with childhood seizuresbehavior problems associated with childhood seizures. Journal of Epilepsy, 8,. Journal of Epilepsy, 8, 110-118. 110-118.
Missiuna, C., Smits, C., Rosenbaum, P., Woodside, J., & Law, M. (2001). Report to the Ministry Missiuna, C., Smits, C., Rosenbaum, P., Woodside, J., & Law, M. (2001). Report to the Ministry of Health on the indicence and prevalence of childhood disability. of Health on the indicence and prevalence of childhood disability. CanChild, CanChild, 26-27.26-27.
Newacheck, P.W., & Taylor, W.R. (1992). Childhood chronic illness: Prevalence, severity, and Newacheck, P.W., & Taylor, W.R. (1992). Childhood chronic illness: Prevalence, severity, and impact. impact. American Journal of Public Health, 82(3), American Journal of Public Health, 82(3), 364-371.364-371.
Offord, D.R., Boyle, M.H., Szatmari, P., Rae-Grant, N.I., Links. P.S., & Cadman, D. et al. (1987). Offord, D.R., Boyle, M.H., Szatmari, P., Rae-Grant, N.I., Links. P.S., & Cadman, D. et al. (1987). Ontario Child Health Study II. Six month prevalence of disorder and rates of service utilization. Ontario Child Health Study II. Six month prevalence of disorder and rates of service utilization. Archives of General Psychiatry, 44, 832-836.Archives of General Psychiatry, 44, 832-836.
Pless, I.B., & Graham, P. (1970). Epidemiology of physical disorder. In M. Rutter, J. Tizard, & Pless, I.B., & Graham, P. (1970). Epidemiology of physical disorder. In M. Rutter, J. Tizard, & K. Whitmore (Eds.), K. Whitmore (Eds.), Education, Health and BehaviourEducation, Health and Behaviour (pp. 285-296). Huntington, New York: (pp. 285-296). Huntington, New York: Robert E. Brieber Publishing Company.Robert E. Brieber Publishing Company.
Silanpaa, M. (1992). Epilepsy in childhood: Prevalence, disability and handicap. Silanpaa, M. (1992). Epilepsy in childhood: Prevalence, disability and handicap. Epilepsia, Epilepsia, 33(3),33(3), 444-449. 444-449.
top related