Stress management in mothers of children with Autism Spectrum Disorder : psychological characteristics, coping strategies and biological correlates

Un figlio con un Disturbo dello Spettro Autistico, caratterizzato da gravi difficoltà nelle relazioni, nei comportamenti e nella comunicazione, costringe tutto il sistema familiare a gestire un notevole stress dovuto alla gestione quotidiana di una patologia così complessa. Per questi motivi, i genitori necessitano di un sostegno il più possibile personalizzato rispetto alle caratteristiche del loro contesto familiare. Per fare questo sarebbe importante individuare quali siano i parametri correlati ai livelli di stress nei familiari di pazienti con autismo e che potrebbero avere un’influenza sul benessere familiare. Lo scopo di questo studio è quello di valutare quali caratteristiche di personalità, stili di coping e capacità di gestire le emozioni possano essere in relazione con la reattività individuale alle situazioni di stress, valutata attraverso alcuni correlati biologici, quali il livello di cortisolo (l’ormone dello stress) e la variabilità della frequenza cardiaca. L’ottica di ricerca applicata fa sì che gli obiettivi ultimi di questo lavoro siano anche quelli di diminuire l’accesso ai servizi per questi soggetti, considerando il fatto che progetti individualizzati di sostegno genitoriale costituiscono un fattore protettivo rispetto a conseguenze fisiche e psicologiche di disagio se implementati tenendo conto della variabilità individuale rispetto alle caratteristiche sopra citate.

MANIFESTAÇÕES PSICOSSOMÁTICAS EM UNIVERSITÁRIOS PORTUGUESES, A PARTIR DA IDENTIFICAÇÃO DE SINTOMAS DE ANSIEDADE, DEPRESSÃO E STRESS

O presente trabalho teve como objetivos investigar a presença de manifestações psicossomáticas em estudantes universitários, a partir da identificação e da prevalência de sintomas de ansiedade, depressão e stress entre outros transtornos; identificar sinais e sintomas de ansiedade, depressão e stress em universitários portugueses; e correlacionar os sinais e sintomas entre si. Utilizou-se o método quantitativo descritivo de corte transversal. Como meio de investigação, foram utilizados três instrumentos: O Inventário de Ansiedade Traço-Estado de Spilberber IDATE, a Escala de Ansiedade, Depressão e Stress EADS-21 (DASS) e o Inventário de Sintomas de Stress para Adultos de Lipp ISSL. A amostra resultou em 147 universitários de primeiro ingresso na universidade com idade variando entre 18 e 26 anos da Universidade do Algarve Ualg (Portugal), em seus diversos cursos. Os dados obtidos foram analisados e correlacionados com o auxilio do software estatístico SPSS - Statistical Package for Social Science (SPSS), versão 19.0 para Windows, utilizando a análise estatística descritiva de frequência e média, Teste T de Student e ANOVA. Os resultados apontaram uma amostra em sua maioria de mulheres, solteiras, que saíram da casa dos pais para estudar e que no momento da coleta dos dados não exerciam atividades de trabalho, apenas estudavam. Houve presença de indicadores de ansiedade, depressão e stress, sendo o nível de ansiedade encontrado moderado e vinculado à probabilidade de depressão associada. Em relação a manifestações psicossomáticas, foi identificada uma dificuldade em auto-avaliação da presença destas, porém entendeu-se que há associação de manifestações psicossomáticas em relação aos sintomas de stress, ansiedade e depressão, encontrados. Levantou-se a hipótese de associação desses sintomas com a situação atual de crise econômica que passa a sociedade portuguesa, principalmente no período de coleta desses dados. Assim, verificou-se um possível estado de vulnerabilidade nesta população com alguma dificuldade em se adaptar às novas exigências de vida, necessitando então de medidas preventivas que auxiliem a adaptação e reestruturação do estilo de vida desses estudantes.

Quality of life, stress and mental health in parents of children with parentally diagnosed food allergy compared to medically diagnosed and healthy controls

Background. Food allergy is related to poorer quality of life (QoL) and mental health of caregivers. Many parents diagnose food allergy in their child without seeking medical care and there is limited research on this group. This study investigated parental QoL and mental health in parents of children with parent-diagnosed food allergy (PA), medically diagnosed food allergy (MA), and a control group with no allergy (NA). Methods. One hundred and fifty parents from a general population completed validated measures of QoL, anxiety, depression, and stress. Results. Parents of children with food allergy (PA or MA) reported higher stress, anxiety, and depression than the control group (all ). Parents of children with MA reported poorer food allergy related QoL compared to parents of children with PA (); parents of children with PA reported poorer general QoL compared to parents of children with MA (). Conclusion. Parents of children with food allergy have significantly poorer mental health compared to healthy controls, irrespective of whether food allergy is medically diagnosed or not. It is important to encourage parents to have their child medically tested for food allergy and to recognise and refer for psychological support where needed.

Impact of peanut allergy on quality of life, stress and anxiety in the family

Background: Peanut allergy (PA) is known to impact on quality of life (QoL) of the sufferer, but little research has focused on all family members. We therefore sought to establish the impact of PA on QoL and reported anxiety of children with clinically confirmed PA, their parents and older siblings. Methods: Forty-six families, who had a child with PA, completed QoL (PedsQLTM or WHOQOL-BREF), anxiety (SCAS or STAI) and perceived stress (PSS) scales. PA children completed a PA specific QoL questionnaire (Pediatr Allergy Immunol 2003;14:378). Parents and sibling also completed QoL proxy questionnaires for the PA child (PedsQLTM, Pediatr Allergy Immunol 2003;14:378). Results: Mothers rated their own psychological (P < 0.01) and physical (P < 0.05) QoL significantly worse than fathers rated theirs, and had higher scores than fathers for anxiety (P < 0.05) and stress (P < 0.001). Children with PA had significantly poorer physical health-related QoL (P < 0.05), QoL within school (P < 0.01) and general QoL (P < 0.05) than their siblings did, and greater separation anxiety (P < 0.05). The majority of differences were between girls with PA and female siblings. Mothers felt that there was a greater impact on QoL for their PA child, compared with that reported by siblings, fathers or the PA children themselves (P < 0.01). Conclusions: Mothers report that they have significantly poorer QoL and suffer more anxiety and stress than fathers do; this inter-parental difference may be an important feature of family stress caused by PA. Siblings have a similar view of how QoL affects the PA child as the PA child does, while mothers may possibly overestimate this impact.

Parental influences on children's eating behaviour and characteristics of successful parent-focussed interventions

Parental reports suggest that difficulties related to child-feeding and children's eating behaviour are extremely common. While 'fussy eating' does not pose an immediate threat to health, over the long-term, consumption of a poor diet can contribute to the development of a range of otherwise preventable diseases. In addition, the stress and anxiety that can surround difficult mealtimes can have a detrimental impact upon both child and parental psychological wellbeing. Since parents have a great influence over what, when, and how much food is offered, feeding difficulties may be preventable by better parental awareness. The aim of this review is to describe how parental factors contribute to the development of common feeding problems, and to discuss the merits of existing interventions aimed at parents/primary caregivers to improve child-feeding and children's eating behaviour. The potential for different technologies to be harnessed in order to deliver interventions in new ways will also be discussed. © 2012 Elsevier Ltd.

Parental diet, pregnancy outcomes and offspring health:metabolic determinants in developing oocytes and embryos

The periconceptional period, embracing the terminal stages of oocyte growth and post-fertilisation development up to implantation, is sensitive to parental nutrition. Deficiencies or excesses in a range of macro- and micronutrients during this period can lead to impairments in fertility, fetal development and long-term offspring health. Obesity and genotype-related differences in regional adiposity are associated with impaired liver function and insulin resistance, and contribute to fatty acid-mediated impairments in sperm viability and oocyte and embryo quality, all of which are associated with endoplasmic reticulum stress and compromised fertility. Disturbances to maternal protein metabolism can elevate ammonium concentrations in reproductive tissues and disturb embryo and fetal development. Associated with this are disturbances to one-carbon metabolism, which can lead to epigenetic modifications to DNA and associated proteins in offspring that are both insulin resistant and hypertensive. Many enzymes involved in epigenetic gene regulation use metabolic cosubstrates (e.g. acetyl CoA and S-adenosyl methionine) to modify DNA and associated proteins, and so act as 'metabolic sensors' providing a link between parental nutritional status and gene regulation. Separate to their genomic contribution, spermatozoa can also influence embryo development via direct interactions with the egg and by seminal plasma components that act on oviductal and uterine tissues. © IETS 2014.

Teaching our children when to eat:how parental feeding practices inform the development of emotional eating-a longitudinal experimental design

Background: Emotional eating in children has been related to the consumption of energy-dense foods and obesity, but the development of emotional eating in young children is poorly understood. Objectives: We evaluated whether emotional eating can be induced in 5-7-y-old children in the laboratory and assessed whether parental use of overly controlling feeding practices at 3-5 y of age predicts a greater subsequent tendency for children to eat under conditions of mild stress at ages 5-7 y. Design: Forty-one parent-child dyads were recruited to participate in this longitudinal study, which involved parents and children being observed consuming a standard lunch, completing questionnaire measures of parental feeding practices, participating in a research procedure to induce child emotion (or a control procedure), and observing children's consumption of snack foods. Results: Children at ages 5-7 y who were exposed to a mild emotional stressor consumed significantly more calories from snack foods in the absence of hunger than did children in a control group. Parents who reported the use of more food as a reward and restriction of food for health reasons with their children at ages 3-5 y were more likely to have children who ate more under conditions of negative emotion at ages 5-7 y. Conclusions: Parents who overly control children's food intake may unintentionally teach children to rely on palatable foods to cope with negative emotions. Additional research is needed to evaluate the implications of these findings for children's food intake and weight outside of the laboratory setting. This trial was registered at clinicaltrials.gov as NCT01122290.

Hispanic adolescents with severe substance abuse problems: Parental involvement, acculturation-related factors, and attachment

The main objective of the study was to investigate the relationship between parent-related, acculturation-related, and substance use-related variables found within individual, familial/parental, peer and school adolescent ecological domains, in a clinical sample (i.e. adolescents who met criteria for a Diagnostic Statistical Manual-IV [DSMIV] clinical diagnosis of substance abuse/dependence) of Hispanic adolescents from Miami, Florida. ^ The sample for this study consisted of 94 adolescent-mother pairs. The adolescent sample was 65% male, and 35% female, with a mean age of 15 years. More than half of the adolescents were born in the United States (60%) and had resided in the U.S. for an average of 12 years; 80% of the caregivers (primarily mothers) were foreign-born and lived in the U.S. for an average of 21 years. ^ Correlation and hierarchical regression were used to answer the research questions. The findings indicate that the hypothesized model and corresponding anticipated effect of the relationship between parental school and peer involvement on adolescents’ frequency of alcohol, marijuana and cocaine use was not supported by the data. Parental “acculturation-related” variables did not explain any of the variance in adolescent substance use frequency in this sample. Mediation and moderation models were not supported either. However, some interesting relationships were found: ^ The larger the acculturation gap, the lower the parental involvement in school tended to be (r = -.21, p < .05). Adolescents who experienced a greater acculturation gap with their parents (-.81, p >.01) had an earlier onset of marijuana (-.33, p < .01) and cocaine use (r = -.24, p <.01). The less acculturated parents experienced more parenting stress (r = -.31, p = < .01). Attachment was positively associated with parental peer involvement (r = .24, p < .05) and inversely associated with parenting acculturative stress (r = -.24, p < .05). Attachment was also positively associated with marijuana (r = .39, p < .01) and cocaine use (r = .33, p < .01). Adolescent males reported being more attached to their mothers when compared to adolescent females (r = .22, p >.05), they also reported using marijuana more frequently than females (.21, p >.05). ^

Estilos Educativos Parentais (EMBU-A), Sintomatologia Depressiva/Ansiosa, Stress e Autoestima, numa Amostra de Adolescentes

Introdução. Os estilos educativos parentais enquanto clima educativo geral apresentam um forte impacto em diferentes resultados desenvolvimentais (e.g., sintomatologia depressiva/ansiosa e auto estima) da criança/jovem. Podem ser estudados de um ponto de vista dimensional, considerando, por exemplo, as dimensões Controlo/Sobreproteção e Suporte, ou categorial, seguindo, por exemplo, a abordagem de Baumrind, e Maccoby e Martin. Neste estudo pretendemos: verificar se existem diferenças por género e idade, nas dimensões Suporte Emocional, Sobreproteção e Rejeição (EMBU-A) (cada progenitor separadamente), na sintomatologia depressiva/ansiosa e na auto estima; avaliar se existem diferenças nas dimensões do EMBU-A, entre progenitores, na amostra total e por género; explorar associações entre as variáveis centrais do estudo (estilos educativos, sintomatologias e auto estima) e variáveis sociodemográficas, também nas três amostras; explorar diferenças entre quatro grupos criados (Pai-Filho, Pai-Filha; Mãe-Filho e Mãe-Filha) nas dimensões do EMBU-A; combinando a Sobreproteção e o Suporte Emocional (EMBU-A), e definindo os estilos educativos parentais autoritário, autoritativo, permissivo e negligente, calcular a prevalência dos mesmos na nossa amostra (por Pai e por Mãe) e explorar as suas associações com as sintomatologias e com a auto estima (separadamente, por progenitor). Metodologia. A nossa amostra é constituída por 284 adolescentes (idade média = 14,5; DP = 1,68; raparigas, n = 171, 60,2%). Todos preencheram um protocolo composto por um questionário sociodemográfico, pela Rosenberg Self- Esteem Scale (RSES), pelo DASS-21 e pelo Parental Rearing Style Questionnaire for use with Adolescents (EMBU-A/A). Resultados. De salientar o facto de os adolescentes percecionarem a mãe como apresentando valores mais elevados em todas as dimensões do EMBU-A, por comparação com o pai. Da mesma forma, ainda que com diferentes padrões de associação conforme o género, é de salientar a associação entre níveis maiores de Suporte emocional e níveis mais baixos de sintomatologia depressiva/ansiosa e stress, e a associação entre as dimensões Sobreproteção e Rejeição e níveis superiores desses resultados. Uma mais baixa escolaridade do pai associa-se a menor Suporte emocional e uma maior escolaridade da mãe a maior Sobreproteção. Uma díade constituída por progenitor e adolescente do género masculino apresenta resultados inferiores em todas as dimensões do EMBU-A, por comparação com díades formadas por mãe-filho/filha. O estilo Autoritativo é o mais prevalente na nossa amostra (em ambos os progenitores) e o estilo Autoritário é aquele que se associa a pontuações mais elevadas de psicopatologia e a uma menor auto estima. Discussão. De uma forma, genérica os resultados seguem de perto a literatura e revelam a associação entre valores mais elevados na dimensão Suporte emocional e níveis mais baixos de psicopatologia e stress, e a associação entre as dimensões Sobreproteção e Rejeição e níveis superiores desses resultados. Igualmente, o estilo educativo Autoritário está claramente associado a piores resultados nessas mesmas variáveis. São discutidas algumas implicações, no que toca a programas psicoeducativos/educação parental. / Introduction. As a general educational environment, parental rearing styles have a strong impact in different outcomes of development of the child or teenager (e.g. symptoms of depression/ anxiety and self-esteem). These can be studied from a dimensional point of view considering for example the dimensions Control/Overprotection and Support or from a categorical point of view following for example the approach of Baumrind and Maccoby and Martin. This study aims at checking whether there are differences of gender and age in the dimensions of Emotional Support, Overprotection and Rejection (EMBU-A) (each parent separately) in depressive symptoms/anxiety and self esteem; assessing whether there are differences in the dimensions of the EMBU-A, between parents in the total sample and by gender; exploring associations between the study’s main variables (rearing styles, symptomatology and self esteem) and sociodemographic variables, also in the three samples; exploring differences between the four groups created (Father-Son, Father-Daughter, Mother-Son and Mother-Daughter) in the dimensions of the EMBU-A, combining Overprotection and Emotional Support(EMBU-A) and defining the authoritarian, authoritative, indulgent, and neglectful parental rearing styles. The aim is also to estimate the prevalence of these in our sample (by Father and Mother) and explore their associations to the symptomatology and self esteem (separately, per parent). Methodology. Our sample is composed of 284 teenagers (average age = 14,5; DP = 1,68; girls, n = 171, 60,2%). All participants filled in a protocol of questionnaires consisting of a set of socio demographic questions by Rosenberg Self- Esteem Scale (RSES), by DASS-21 and by Parental Rearing Style Questionnaire for use with Adolescents (EMBU-A/A). Outcomes. It is important to emphasize the fact that teenagers perceive their mother as having higher values in all the EMBU-A dimensions compared to their father. In the same way, though with different patterns of association according to gender, it is important to emphasize the association of higher levels of Emotional Support and lower levels of depressive/anxious symptomathology and stress and the association of Overprotection and Rejection and higher levels of those outcomes. A father’s lower level of education is associated to a lower Emotional Support while a mother’s higher level of education is associated to a greater Overprotection. A dyad composed of male parent and male teenager presents lower outcomes in all EMBU-A dimensions if compared to dyads composed of mother-son/daughter. The authoritative style is the most prevalent in our sample (in both parents) and the authoritarian style is the one associated to higher scores of psychopathology and lower levels of self esteem. Debate. In general, the outcomes closely follow the literature review and reveal the association of higher values in the Emotional Support dimension and lower levels of psychopathology and stress and also the association of the dimensions of Overprotection and Rejection and higher levels of those outcomes. Equally, the authoritarian rearing style is clearly associated to the worst outcomes in those same variables. Some implications are discussed as far as psychoeducational programmes and parental rearing are concerned.

Indirect Effects of Parental Coping on Children’s Psychosocial Adjustment in the Context of Pediatric Cancer

Thesis (Ph.D.)--University of Washington, 2016-08

Parental exposure to the herbicide diuron results in oxidative DNA damage to germinal cells of the Pacific oyster Crassostrea gigas

Chemical pollution by pesticides has been identified as a possible contributing factor to the massive mortality outbreaks observed in Crassostrea gigas for several years. A previous study demonstrated the vertical transmission of DNA damage by subjecting oyster genitors to the herbicide diuron at environmental concentrations during gametogenesis. This trans-generational effect occurs through damage to genitor-exposed gametes, as measured by the comet-assay. The presence of DNA damage in gametes could be linked to the formation of DNA damage in other germ cells. In order to explore this question, the levels and cell distribution of the oxidized base lesion 8-oxodGuo were studied in the gonads of exposed genitors. High-performance liquid chromatography coupled with UV and electrochemical detection analysis showed an increase in 8-oxodGuo levels in both male and female gonads after exposure to diuron. Immunohistochemistry analysis showed the presence of 8-oxodGuo at all stages of male germ cells, from early to mature stages. Conversely, the oxidized base was only present in early germ cell stages in female gonads. These results indicate that male and female genitors underwent oxidative stress following exposure to diuron, resulting in DNA oxidation in both early germ cells and gametes, such as spermatozoa, which could explain the transmission of diuron-induced DNA damage to offspring. Furthermore, immunostaining of early germ cells seems indicates that damages caused by exposure to diuron on germ line not only affect the current sexual cycle but also could affect future gametogenesis.

The role of oxidative stress as an underlying mechanism in life-history trade-offs

A key aspect underpinning life-history theory is the existence of trade-offs. Trade-offs occur because resources are limited, meaning that individuals cannot invest in all traits simultaneously, leading to costs for traits such as growth and reproduction. Such costs may be the reason for the sub-maximal growth rates that are often observed in nature, though the fitness consequences of these costs would depend on the effects on lifetime reproductive success. Recently, much attention has been given to the physiological mechanism that might underlie these life-history trade-offs, with oxidative stress (OS) playing a key role. OS is characterised by a build-up of oxidative damage to tissues (e.g. protein, lipids and DNA) from attack by reactive species (RS). RS, the majority of which are by-products of metabolism, are usually neutralised by antioxidants, however OS occurs when there is an imbalance between the two. There are two main theories linking OS with growth and reproduction. The first is that traits like growth and reproduction, being metabolically demanding, lead to an increase in RS production. The second involves the diversion of resources away from self-maintenance processes (e.g. the redox system) when individuals are faced with enhanced growth or reproductive expenditure. Previous research investigating trade-offs involving growth or reproduction and self-maintenance has been equivocal. One reason for this could be that associations among redox biomarkers can vary greatly so that the biomarker selected for analysis can influence the conclusion reached about an individual’s oxidative status. Therefore the first aim of my thesis was to explore the strength and pattern of integration of five biomarkers of OS (three antioxidants, one damage and one general oxidation measure) in wild blue tit (Cyanistes caeruleus) adults and nestlings (Chapter 2). In doing so, I established that all five biomarkers should be included in future analyses, thus using this collection of biomarkers I explored my next aims; whether enhanced growth (Chapters 3 and 4) or reproductive effort (Chapter 5) can lead to increased OS levels, if these traits are traded off against self-maintenance. I accomplished these aims using both a meta-analytic and experimental approach, the latter involving manipulation of brood size in wild blue tits in order to experimentally alter growth rate of nestlings and provisioning rate (a proxy for reproductive expenditure) of adults. I also investigated the potential for redox integration to be used as an index of body condition (Chapter 2), allowing predictions about future fitness consequences of changes to oxidative state to be made. A growth – self-maintenance trade off was supported by my meta-analytic results (Chapter 4) which found OS to be a constraint on growth. However, when faced with experimentally enhanced growth, animals were typically not able to adjust this trade-off so that oxidative damage resulted. This might support the idea that energetically expensive growth causes resources to be diverted away from the redox system; however, antioxidants did not show an overall reduction in response to growth in the meta-analysis suggesting that oxidative costs of growth may result from increased RS production due to the greater metabolism needed for enhanced growth. My experimental data (Chapter 3) showed a similar pattern, with raised protein damage levels (protein carbonyls; PCs) in the fastest growing blue tit chicks in a brood, compared with their slower growing sibs. These within-brood differences in OS levels likely resulted from within-brood hierarchies and might have masked any between-brood differences, which were not observed here. Despite evidence for a growth – self-maintenance trade off, my experimental results on blue tits found no support for the hypothesis that self-maintenance is also traded off against reproduction, another energetically demanding trait. There was no link between experimentally altered reproductive expenditure and OS, nor was there a direct correlation between reproductive effort and OS (Chapter 5). However, there are various factors that likely influence whether oxidative costs are observed, including environmental conditions and whether such costs are transient. This emphasises the need for longitudinal studies following the same individuals over multiple years and across a wide range of habitats that differ in quality. This would allow investigation into how key life events interact; it might be that raised OS levels from rapid early growth have the potential to constrain reproduction or that high parental OS levels constrain offspring growth. Any oxidative costs resulting from these life-history trade-offs have the potential to impact on future fitness. Redox integration of certain biomarkers might prove to be a useful tool in making predictions about fitness, as I found in Chapter 2, as well as establishing how the redox system responds, as a whole, to changes to growth and reproduction. Finally, if the tissues measured can tolerate a given level of OS, then the level of oxidative damage might be irrelevant and not impact on future fitness at all.