We piloted a novel parent-targeted intervention, Take A Breath (TAB), for parents of children diagnosed with a life-threatening illness (LTI) with the aim of reducing parental distress. Parents were assisted to adapt to their child's diagnosis, treatment, and recovery via TAB's combined acceptance and commitment therapy (ACT) and problem-solving skills training (PSST) approach. Participants were 11 parents of children with a diagnosis of cancer, or who had life-saving cardiac surgery at least 4 months prior. Parents completed questionnaires at pre, post, and 6-month follow-up assessing parent posttraumatic stress symptoms (PTSS), the emotional impact of the child's LTI (e.g., feelings of uncertainty, guilt and sorrow, emotional resources), and psychological elements targeted by the intervention (parental psychological flexibility and mindfulness). Parents reported significant reductions in PTSS and emotional impact from their child's LTI, along with significant improvements in parental psychological flexibility and mindfulness. Effect sizes were medium to large, and improvements were maintained at 6-month follow-up. Our pilot indicates the TAB intervention has promise for preventing or reducing parental distress associated with child LTI and warrants more rigorous evaluation. Although preliminary, these findings suggest that targeting parents' subjective perceptions of their child's LTI may be an effective approach to reducing parental distress. Our results also indicate the potential for such an approach to be adopted across diverse child diagnoses in the acute pediatric setting. Further, our findings provide early indications that ACT combined with PSST is an appropriate therapeutic approach within this context.

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Research in contextParents of children with life threatening illness or injuries are at elevated risk of distress reactions, involving symptoms of acute stress disorder, depression and anxiety. Currently, the impact of child illness factors is unclear, and to date research systematically examining the prevalence of these psychological reactions across different illness groups with an acute life threat is sparse. This is important to explore given that studies show that parent functioning impacts on the psychological adjustment and recovery of the ill child.What does this study add?At four weeks following a child's diagnosis of a serious illness, 49–54% of parents met DSM-IV criteria for acute stress disorder, across a number of illness groups, whereas 15–27% of parents were in the moderate/severe range for depression and anxiety, and 25–31% for stress. Results from this study demonstrate that rates and severity of these psychological reactions in parents of seriously ill children do not vary according to illness type.BackgroundA life threatening childhood illness/injury can lead to significant distress reactions in parents, with independent studies finding such reactions in several different illness groups. To date, there is limited research systematically comparing the prevalence of adverse parental psychological reactions across different childhood illness groups with an acute life threat. This study aimed to investigate the frequency and severity of symptoms of acute traumatic stress, depression, anxiety and general stress in parents, following admission of their child to hospital for a life threatening illness. The study also aimed to explore the relationship between these symptoms, and to determine whether they differ according to illness/injury.MethodsCross-sectional data from a prospective, longitudinal study are reported. Participants were 194 parents of 145 children (49 couples), admitted to cardiology (n = 53), oncology (n = 40) and pediatric intensive care units (n = 52), for serious illnesses/injuries. Parents completed self-report questionnaires within four weeks of hospital admission.ResultsRates of acute traumatic stress (P = 0.262), depression (P = 0.525), anxiety (P = 0.453) and general stress symptoms (P = 0.720) in parents were comparable across illness type, with 49–54% reaching criteria for acute stress disorder, 15–27% having clinical levels of depression and anxiety, and 25–31% for general stress. Anxiety was most strongly associated with acute traumatic stress (r = 0.56), closely followed by stress (r = 0.52) and depression (r = 0.49), with all correlations highly significant (P < 0.001).ConclusionsThese findings provide evidence that the child's medical condition is not associated with parents’ experience of clinically significant psychological symptoms, and emphasize the importance for health care providers to be aware of these potential psychological reactions in parents, regardless of the type of illness.

Findings indicate that, although the majority of parents adapt to the acute stress of surgery for a serious cardiac illness in their infant, the remaining 38.5% report an increased psychosocial risk associated with higher rates of emotional distress, which may impact on the parental quality of life and capacity for optimal parenting. The distribution of psychosocial risk in parents of children undergoing surgery for a congenital heart disease is consistent with that described for parents of children with other serious paediatric diagnoses.

There is debate regarding the relationship between executive function and social outcome following paediatric traumatic brain injury (TBI), due to inconsistent findings in the literature. It has been suggested that these contradictory results may reflect the absence of an established mechanism to explain this relationship. Yeates and colleagues (2004) proposed a possible model in which the maturity of social problem‐solving skills mediates the relationship between executive function and social outcome. The current study aimed to explore this model and determine whether social problem solving mediates the relationship between executive function and social outcome in a TBI population. The sample consisted of 36 adolescents and young adults who sustained a TBI between 8 and 12 years of age. They ranged between 16 and 22 years of age and were 7–10 years post‐injury. Findings indicated that a higher level of executive dysfunction was associated with less sophisticated social problem‐solving skills and poorer social outcome. Further, the maturity of social problem‐solving skills was found to mediate the relationship between executive function and social outcome in this group.

IMPORTANCE A substantial proportion of parents whose child is diagnosed with a life-threatening illness experience high levels of distress that can lead to long-term mental health difficulties. This can affect the child's recovery. OBJECTIVE To evaluate the efficacy of an acceptance and commitment therapy-based group intervention, delivered using videoconferencing, in reducing posttraumatic stress symptoms (PTSS) in these parents. DESIGN, SETTING, AND PARTICIPANTS This study was a randomized clinical trial of an intervention for parents with elevated acute stress symptoms. It was a single-site study conducted in a tertiary pediatric hospital in Australia. Parents of children aged 0 to 18 years admitted for a lifethreatening illness or injury to the oncology, cardiology, or pediatric intensive care departments were eligible. Participants were screened for eligibility within the first month after diagnosis or admission and then were randomized to the intervention group or the waiting list control group 4 to 10 months after diagnosis or admission. Recruitment commenced January 2014, and final postintervention follow-up was completed in February 2018. Data analysis was performed from July to September 2018. INTERVENTIONS Treatment was a psychological acceptance and commitment therapy-based group therapy program called Take a Breath, which consisted of a 6-session parent-mediated psychological intervention delivered via online videoconferences over the course of 8 weeks. Waiting list control participants received treatment as usual and were offered the intervention 3 months after randomization. MAIN OUTCOMES AND MEASURES The primary outcome was PTSS, as measured by the Posttraumatic Stress Disorder Checklist-Version 5 (total score range, 0-80, with higher scores indicating greater symptom severity). The PTSS was measured both before and immediately after the intervention. Changes in psychological skills taught within the intervention were also evaluated, including acceptance, mindfulness, values-based living, and psychological flexibility. RESULTS Of 1232 parents who were assessed for eligibility, 313 were randomized; 161 were allocated to the waiting list control group, and 152 were allocated to the intervention group. Of those allocated, 44 parents in the waiting list group and 37 in the intervention group completed the postintervention questionnaire and were analyzed (81 participants total; mean [SD] age, 37.17 [6.43] years). Sixtyfive participants (80.2%) were women, 48 participants (59.3%) were married, and 40 participants (49.4%) lived in rural or regional areas, or in a different state. In addition, 24 parents (29.6%) were in (continued) Key Points Question Is an acceptance and commitment therapy-based group intervention, delivered using videoconferencing, effective in reducing posttraumatic stress symptoms in parents of very ill children? Findings This randomized clinical trial found that videoconference-based acceptance and commitment therapy (compared with a waiting list) was effective in reducing posttrauma...

Given that reading, spelling and arithmetic skills are acquired through childhood, their development may be compromised following a childhood traumatic brain injury (TBI). The present study examined educational skills (reading accuracy, spelling and arithmetic) at a mean follow-up interval of 6.8 years post-injury in children who had sustained a mild, moderate, or severe TBI at two ages: 'Young' (age at injury: 3-7 years, n = 48) and 'Old': (age at injury: 8-12 years, n = 36). Comparisons between the young and old TBI groups resulted in inconsistent findings. While a dose-response relationship for severity was evident for the young group, this was not always the case for the old group. Significant predictors of outcome included both severity and acute intellectual function.

A systematic review of the literature investigating the early traumatic stress responses in parents of children diagnosed with a serious illness/injury. A literature review was conducted (September 2013) using Medline, PsycINFO, and CINAHL databases. Twenty-four studies related to parents of children hospitalized due to diagnosis of cancer, type 1 diabetes, meningococcal disease, trauma or serious injury, preterm birth and other serious illnesses requiring admission to intensive care were included. Parents were assessed for early traumatic stress symptoms within 3 months of their child's diagnosis/hospitalization. Prevalence rates of acute stress disorder in parents ranged from 12 to 63%. Prevalence of posttraumatic stress disorder ranged from 8 to 68%. Variability was related to methodological factors including differences in study design, timing of assessments, measurement tools, and scoring protocols. Psychosocial factors rather than medical factors predicted parent distress. This review integrates and compares early traumatic reactions in parents with children suffering a range of serious illnesses. Findings suggest a high prevalence of acute and posttraumatic stress symptoms in parents. Methodological inconsistencies made comparison of early traumatic stress prevalence rates difficult. Risk factors associated with traumatic stress symptoms were identified.