Predicting Behavior Problems in Children with Epilepsy - Essay Example

Appraisal Predicting Behavior Problems in Children with Epilepsy: Child Factors, Disease Factors, Family Stress, and Child-Mother Interaction. By Robert C.Pianta and Deborah J.Lothman This is a very informative and analytical study done by Pianta and Lothman, which examines the symptoms, effects and management of Epilepsy in children. This study examines the relative role of parent-child relationship, family stress and disease factors in predicting behaviour problems in children with epilepsy. It is paper of great interest as it concentrates on the biological risk factors which are the result of influences from home and parental role in the management of the disease. This paper has provided insightful research and information in the analysis of the factors influencing epilepsy. Epilepsy and behavioural problem is very tightly connected, and the paper has been very innovative in the context of information on this issue, emphasizing that "childhood epilepsy is a biologically based risk factor that is associated with child behaviour problems and family adjustment problems" (Pianta and Lothman,1994) This has been a very critical problem, predicting adjustment problems in children with epilepsy has been difficult, as the medical and disease related factors such as seizure type and frequency, age of onset and medical toxicity have not proven to be significant useful predictors. The paper is very relevant and appropriate from the point of information which the literature provides with the focus on the parent-child relationship and behaviour problems by examining the children with biological risk. The information is significant and valuable, as child-parent relationship predict the development of behaviour problems over and above the influence of disease-related factors, even for children at considerable biological risk. The references made in the literature to the wide variety of sources and literature makes the paper very credible and authentic. The references are very in-depth and substantial. The importance given to the mother-child relationship in the management and the control of the seizure is highly contributory. The focus and introduction ic very clear and precise with good outline of the issue in very clear and direct terms. The focus of the paper has been very clearly outlined in the treatment of the subject. The theoretical approach is very comprehensive and systematic. Information is very well backed by sound reason and good figures. The theory clearly revolves around the fact that "the features of epilepsy directly affect the child-parent relationships by increasing parents overprotective responses, anxiety and intrusive interactions"(Chavez,1985; Ritchie,1981; Seidenberg & Behrent,1992)(Pianta and Lothman,1994) The problem of epilepsy is treated in very logical scientific and methodical manner. Epilepsy is unique in its treatment as a form of disease as even when seizures are well under control, parental fears and expectations, and stigma associated with the disease, and the recurring anxiety of the parents and the children regarding the possibility of the reoccurrence of the seizures contribute to a long term process of adjustment to the . The threat of continued and unpredictable seizures and the experience during the seizure of being out of control which is reported by the parents and the children are some of the unique features of the disease compared to some other chronic illnesses. The methodology of developmental research in the determination of the extent to which the biologically based risk factors like temperament play a role in the development of the behavior problems is very effectively analyzed with good comparative analysis of the factors which affect other similar diseases ad the critical role played by the parental authority, home factor and the mother-child relationship. Even in the studies conducted over children without chronic diseases indicate that measures of the child-parent relationship plays a very significant predictor of child behaviour problems and psychiatric symptoms. The relationship systems regulate the behaviour of the children across a wide range of biological dispositions. The methodology used is the research development of the parent-child relationship, which is the key predictor of the extent to which this interaction affects the determination of the behavioural problem. The importance of the presence of the biological risk is again a very important factor for understanding the role parent-child relationships in overriding the effects of chronic illness and the risk and for intervening with children with epilepsy and their families. A wide range of psychological and social problems have been associated with childhood epilepsy, in which studies reveal that boys show the problem outcomes with more frequency than the girls. Negative effects reported in the paper which has been soundly supported by research and new developments in the field are academic performance below expected levels, increased psychiatric and behavioural disturbance, poor self-esteem and excessive dependency. The uniqueness of the disease has been very compared with many other childhood diseases, enhancing the justification of the research developed. "Compared with the children with diabetes, children with epilepsy perceive events in their world as out of control, are reported to be immature, emotionally distressed, and rejected by others.(Matthews, Barabas, &Ferrari 1982). In comparison to the children with learning disabilities, children with epilepsy are more anxious and dissatisfied (Margalit &Heiman,1983), and they have lower self concepts and more depression and behaviour problems than children with asthma(Austin,1988)" )(Pianta and Lothman,1994) The most crucial and critical information is the comparative result and methodology of comparative assessment of the literature with whole approach which evaluates the information from the disease, environmental factors , social factors and the parental factors backed by the temperament. The report give very insightful analysis of the factors which contribute to the problem of epilepsy in light of biological and the psychological point of view. "The incidence of the psychiatric problems for children with epilepsy is 28.6%; higher than for children with other chronic physical condition which is 11.6% and that had tendency to go up to 53% in case of children with complicated epilepsy(epilepsy and other neurological problems) have psychiatric problem." )(Pianta and Lothman,1994) Parent-child relationship seems to be the focus of the research development taking into consideration other factors like biological, social and clinical, the over and under regulation by the parents is a form of the relationship disorder that predictably leads to behaviour problems in the children, suggesting a possible link between epilepsy and child behaviour problems. Clinical reports and research directly points at the child-mother relationship as the important factor in the adjustment to epilepsy. Parent child relationship and parent child communication has been important predictors of the outcomes of self esteem, dependency and academic achievement in children with epilepsy. It has been evaluated and confirmed that the mothers restrictive, overprotective and intrusive behavior has been important in children's lack of competence. Recent studies also indicate that both mother's emotional support and the degree of restrictiveness are strongly related to children's autonomy, confidence, task involvement and flexibility in a problem solving task and to the teacher's report of competence in the school. The methodology used is in different categories of assessment subjects, data collection, measures, mothers support for task completion, child's self reliance, coordination effect, life events scale, child behaviour checklist-teacher report form, child behaviour checklist-parent report form, and data analysis. Subject: The subjects for this study were 51children between 7-13 years of age. with diagnosis of epilepsy or seizure disorder, and their mothers. The children were school going, with average intelligence and of varied class and cultural backgrounds. The average age of the children participating was 9 years and the average age of the mothers was 38years. The mothers had varying educational qualification. The family size was 1t0 7. Mothers were primary caregivers in most cases. The focus of the research was cild-mother relationship. Measures: "Observational measures of the child mother interaction in a dyadic problem solving situation-where mothers and children were involved in two videotaped tasks." The mothers and the children's behavior in the two tasks was rated using a series of seven point rating scales. Three seven point global scales were used to rate the mother/child interaction tasks determining mothers support for task completion, the child's self-reliance and coordination of affect. The quality of the interactive behaviour was evaluated. Mother's support of task completion: This scale reflected the mother's awareness and understanding of the child's skills relative to the task and her sensitivity in structuring the task emotionally and instructionally to promote her child's success. Child's self reliance: This scale, although based on child's behaviour, reflects the child's skills in effectively using his or her own resources and the resources available from the mother to remain organized and focused in the task completion. Self reliance in children did not mean total independence from mother. Coordination of affect (dyadic scale) This scale reflected the expression of emotion in the mother/ child dyad. This dimension reflects the extent to which the mother and child made their emotions known to one another and responded in manner indicating acceptance and acknowledgement. A pair scoring high on this scale reflected open expression and acceptance of the feelings within the session, there would be expression of both warmth and frustration, with indications that both the ends of the dyad were affected by the others feelings. Life events scale: The family life events scale lists 25 items describing changes in the family which may have occurred over preceding 12 months. Child Behaviour checklist-teacher report form: This was developed to measure child's behaviour in the school setting. Child behaviour checklist-Parent report form: This was to be completed by the parents during the time of data collection. Data Analysis: The relations between the mother-child interaction and parent reported and teacher reported child behaviour problems were examined using Pearson correlation. This was designed specifically to isolate the predictive effects of the child-mother interaction measures and interaction terms, independent of demographics, disease and other social context. The methodology provides clear and structured research development and analysis with credible and ethical process in implementation. The sample is very justified and the data collection is very valid. The method applied is appropriate(Pianta and Lothman,1994) There is very convincing analysis of the several significant relations between the six ratings of mother-child interaction, the two factor scores, and child behaviour problems at home and school. The results are very systematically and logically presented in the form of charts and the tables reflecting the different categories of evaluation. The use of visual data analysis report, the equation for analysis and interpretation, the consideration of the variables and the, the interaction effect, the regression analysis, the predictor variables are very lucidly taken into consideration. Table 1 which evaluates the results of the correlations between child-mother interaction measures ad child behaviour problems are evaluated under maternal support , self reliance sand child self reliance factors taking into consideration the Parent CBCL externalizing and internalizing factor and Teacher CBCL externalizing and internalizing factor. Table 2 shows predicting teachers rating of externalizing behaviour from child characteristics, epilepsy factors, family stress and child-mother interaction taking into account the gender, IQ percentile, age, medical risk, stress, maternal support/ affect factor, child self reliance factor and maternal support/affect factor along with child gender. Similarly Table 3 and 4 were drawn to analyze data categories for complete evaluation of the varying categories and factors. (Pianta and Lothman,1994) The results support the hypothesis that child-parent relationships play a significant role in predicting behaviour problems in children with considerable biological risk, specifically epilepsy. The findings confirm the work of other investigations that parenting process plays a significant role in the development of children with epilepsy. The role of the mother-child relation dyad in the ratings of the child's self reliance is highly valuable. Childs self reliance was the aspect of interaction with strongest overall relation with the behaviour problems, especially parent reported problems. Self reliance reflects child's persistence in the face of frustration and effective use of maternal resources when they are needed. The family stress as an important factor contributing to regression was also confirmed after data analysis. Mother role in the positive regulation of child's behaviour can significantly control the behaviour problems in the child (boy) with epilepsy. The data is effectively processed; the categories and the themes derived from data are relevant and informative. Sufficient data is presented taking into consideration the contradictory data. The paper effectively describes with evidence the pathways linking to childhood epilepsy with behaviour problems and psychopathology in adolescence and adulthood involve parent-child relationships, as well as neurophysiologic processes.(Hermann & Whitman, 1984)(Pianta and Lothman,1994) Though there are limitations to the present evaluation of this paper, which should be considered in the future. One of the most serious limitation is the fact that fathers were not included in the present study, and there direct and indirect role should be considered especially in the preadolescent. The age range of 7to 13 is fairly large to analyze a complete behaviour. The clinical and the practical implications are clear and effective. The literature very comprehensively evaluates the theme and justifies it with evidence showing light to future control of the behaviour problems in the children with epilepsy. Works Cited Pianta & Lothman, Robert C.& Deborah J. (1994).Predicting Behavior Problems in Children with Epilepsy: Child Factors, Disease Factors, Family Stress, and Child-Mother Interaction. Child Development. Vol.65No.5, 1415-1428. ( Pianta & Lothman, 1994) www.jstor.org/view/00093920/ap030278/03a00120/11searchUrl=http%3a//www.jstor.org/search/BasicResults%3fhp%3d25%26si%3d1%26gw%3djtx%26jtxsi%3d1%26jcpsi%3d1%26artsi%3d1%26Query%3dEpilepsia%26wc%3don&frame=noframe¤tResult=00093920%2bap030278%2b03a00120%2b12%2c0060&userID=aes@aes.ac.in/01cc99331600501bfb8a8&dpi=3&config=jstor Read More