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Parenting a Child with Phenylketonuria: An Investigation into the Factors That Contribute to Parental Distress

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Part of the book series: JIMD Reports ((JIMD,volume 41))

Abstract

Phenylketonuria (PKU) is an inherited metabolic condition that can lead to the onset of intellectual disabilities if not strictly managed through a low-protein diet. Parents are responsible for supervising their child’s treatment for PKU, which may impact on their experience of distress. This cross-sectional study aimed to identify the factors that contribute to distress in parents who care for a child with PKU, distinct from parents in the general population. Thirty-eight parents of children and adolescents with PKU and 32 parents in the general population completed the questionnaires measuring parental psychological resilience, child behaviour problems, perceived social support and distress. Parents of children with PKU also completed measures of their child’s care dependency and behaviour related to developmental and intellectual disabilities. The findings revealed no statistically significant differences in distress between the groups, but parents of children with PKU reported more child behaviour problems. Multiple regression analysis identified that parental psychological resilience and child anxious behaviour explained 35% of the variance in distress for parents of children with PKU. By comparison, parental psychological resilience and generic child behaviour only accounted for 19% of the variance in distress for parents in the general population. This has implications for developing interventions in clinical settings that aim to reduce parents’ distress by enhancing their psychological resilience and supporting them to manage child behaviour difficulties, particularly anxious behaviour. Future research should include larger, more diverse samples and use longitudinal study designs.

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References

  • Ambler ORS, Hare DJ (2018) A systematic review of the factors associated with well-being in parents of children with PKU. J Inherit Metab Dis Rep. (in press)

    Google Scholar 

  • Blackledge JT, Hayes SC (2006) Using acceptance and commitment training in the support of parents of children diagnosed with autism. Child Family Behav Ther 28:1–18

    Article  Google Scholar 

  • Bland JM, Altman DG (1996) Measurement error. Br Med J 4:744

    Article  Google Scholar 

  • Blau N, Van Spronsen FJ, Levy HL (2010) Phenylketonuria. Lancet 376:1417–1427

    Article  CAS  Google Scholar 

  • Bosch AM, Burlina A, Cunningham A et al (2015) Assessment of the impact of Phenylketonuria and its treatment on quality of life of patients and parents from seven European countries. Orphanet J Rare Dis 10:80

    Article  Google Scholar 

  • Brumm VL, Bilder D, Waisbren SE (2010) Psychiatric symptoms and disorders in phenylketonuria. Mol Genet Metab 99:59–63

    Article  Google Scholar 

  • Cappelletti S, Cotugno G, Goffredo BM et al (2013) Cognitive findings and behavior in children and adolescents with Phenylketonuria. J Dev Behav Pediatr 34:392–398

    Article  Google Scholar 

  • Carpenter K, Medford E, Wittkowski A, Hare DJ, Rust S, Jones S, Smith DM (2018) Parenting a child with Phenylketonuria (PKU): an interpretative phenomenological analysis (IPA) of the experience of parents. J Genet Couns. https://doi.org/10.1007/s10897-018-0227-7

    Article  Google Scholar 

  • Christ SE, Steiner RD, Grange DK, Abrams RA, White DA (2006) Inhibitory control in children with phenylketonuria. Dev Neuropsychol 30:845–864

    Article  Google Scholar 

  • Cleary MA (2015) Phenylketonuria. Paediatr Child Health 25:108–112

    Article  Google Scholar 

  • Craig F, Operto FF, De Giacomo AD et al (2016) Parenting stress among parents of children with neurodevelopmental disorders. Psychiatry Res 242:121–129

    Article  Google Scholar 

  • Einfeld SL, Tonge BJ (1995) The developmental behavior checklist: the development and validation of an instrument to assess behavioral and emotional disturbance in children and adolescents with mental retardation. J Autism Dev Disord 25:81–104

    Article  CAS  Google Scholar 

  • Einfeld SL, Tonge BJ (2002) Manual for the developmental behaviour checklist: primary carer version (DBC-P) & teacher version (DBC-T). Monash University Centre for Developmental Psychiatry and Psychology, Clayton

    Google Scholar 

  • Eyberg SM, Ross AW (1978) Assessment of child behavior problems: the validation of a new inventory. J Clin Child Psychol 7:113–116

    Article  Google Scholar 

  • Field A (2013) Discovering statistics using SPSS, 4th edn. Sage, London

    Google Scholar 

  • Goldberg DP, Williams P (1988) The user’s guide to the general health questionnaire. NFER-Nelson, Windsor

    Google Scholar 

  • Goldberg DP, Gater R, Sartorius N et al (1997) The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychol Med 27:191–197

    Article  CAS  Google Scholar 

  • Hall HR, Graff JC (2012) Maladaptive behaviours of children with autism: parent support, stress and coping. Issues Compr Pediatr Nurs 35:194–214

    Article  Google Scholar 

  • Hankins M (2008) The reliability of the twelve item general health questionnaire (GHQ-12) under realistic assumptions. BMC Public Health 8:355

    Article  Google Scholar 

  • Hilliard ME, Monaghan M, Cogen FR, Streisand R (2010) Parent stress and child behaviour among young children with type 1 diabetes. Child Care Health Dev 37:224–232

    Article  Google Scholar 

  • Jahja R, Huijbregts SCJ, de Sonneville LMJ et al (2013) Mental health and social functioning in early treated Phenylketonuria: the PKU-COBESCO study. Mol Genet Metab 110:57–61

    Article  Google Scholar 

  • Kazak AE, Reber M, Snitzer L (1988) Childhood chronic disease and family functioning: a study of phenylketonuria. Pediatrics 81:224–230

    CAS  PubMed  Google Scholar 

  • King G, King S, Rosenbaum P, Goffin R (1999) Family-centred caregiving and well-being of parents of children with disabilities: linking process with outcome. J Pediatr Psychol 24:41–53

    Article  Google Scholar 

  • Kolb B, Whishaw IQ (2003) Fundamentals of human neuropsychology. Worth Publishers, New York

    Google Scholar 

  • Lord B, Wastell C, Ungerer J (2005) Parent reactions to children with PKU. Families Syst Health 23:204–219

    Article  Google Scholar 

  • Lord B, Ungerer J, Wastell C (2008) Implications of resolving the diagnosis of PKU for parents and children. J Pediatr Psychol 33:855–856

    Article  Google Scholar 

  • Mahmoudi-Gharaei J, Mostafavi S, Alirezaei N (2011) Quality of life and the associated psychological factors in caregivers of children with PKU. Iran J Psychiatry 6:66–69

    PubMed  PubMed Central  Google Scholar 

  • Medford E, Carpenter K, Wittkowski A, Rust S, Jones S, Hare DJ (2017a) Treatment adherence and psychological wellbeing in maternal carers of children with Phenylketonuria (PKU). J Inherit Metab Dis Rep 37:107–114

    Google Scholar 

  • Medford E, Hare DJ, Wittkowski A (2017b) Demographic and psychosocial influences on treatment adherence for children and adolescents with PKU: a systematic review. J Inherit Metab Dis. https://doi.org/10.1007/8904_2017_52. E-pub ahead of print

    Google Scholar 

  • Morote R, Hjemdal O, Uribe PM, Corveleyn J (2017) Psychometric properties of the Resilience Scale for Adults (RSA) and its relationship with life-stress, anxiety and depression in a Hispanic Latin-American community sample. PLoS One 12(11):e0187954

    Article  Google Scholar 

  • Nakagawa S (2004) A farewell to Bonferroni: the problems of low statistical power and publication bias. Behav Ecol 15:1044–1045

    Article  Google Scholar 

  • Roohafza HR, Afshar H, Keshteli AH, Mohammadi N, Feizi A, Taslimi M, Adibi P (2014) What’s the role of perceived social support and coping styles in depression and anxiety? J Res Med Sci 19(10):944–949

    PubMed  PubMed Central  Google Scholar 

  • Smith I, Knowles J (2000) Behaviour in early treated phenylketonuria: a systematic review. Eur J Pediatr 159:89–93

    Article  Google Scholar 

  • Ten Hoedt AE, de Sonneville LM, Francois B et al (2011a) High phenylalanine levels directly affect mood and sustained attention in adults with phenylketonuria: a randomised, double-blind, placebo-controlled, crossover trial. J Inherit Metab Dis 34:165–171

    Article  CAS  Google Scholar 

  • Ten Hoedt AE, Maurice-Stam H, Boelen CCA et al (2011b) Parenting a child with phenylketonuria or galactosemia: implications for health-related quality of life. J Inherit Metab Dis 34:391–398

    Article  Google Scholar 

  • Waisbren SE, Noel K, Fahrbach K et al (2004) Phenylalanine blood levels and clinical outcomes in Phenylketonuria: a systematic literature review and meta-analysis. Mol Genet Metab 92:63–70

    Article  Google Scholar 

  • Weeland J, van Aar J, Overbeek G (2017) Dutch norms for the Eyberg child behavior inventory: comparisons with other western countries. J Psychopathol Behav Assess. https://doi.org/10.1007/s10862-017-9639-1

    Article  Google Scholar 

  • Windle G, Bennett KM, Noyes J (2011) A methodological review of resilience measurement scales. Health Qual Life Outcomes 9:8

    Article  Google Scholar 

  • Zimet GD, Dahlem NW, Zimet SG, Farley GK (1988) The multidimensional scale of perceived social support. J Pers Assess 52:30–41

    Article  Google Scholar 

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Authors and Affiliations

Authors

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Correspondence to Dougal J. Hare .

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Additional information

Communicated by: John Christodoulou, MB BS PhD FRACP FRCPA

Appendices

Synopsis

This research study identified that child anxious behaviour and parents’ psychological resilience explained 35% of the variance in parents’ distress in families affected by PKU, whereas child behaviour problems and parents’ resilience explained 19% of the variance for parents in the general population.

Details of the Contributions of Individual Authors

Dr. Olivia Ambler contributed to planning the research design, carrying out all aspects of the method and statistical analysis and writing the majority of the manuscript.

Dr. Emma Medford contributed to planning the research design and planning the method.

Dr. Dougal Julian Hare contributed to planning the research design, method, interpretation of the findings and preparation of manuscript.

Corresponding Author

Dr. Dougal Julian Hare.

Conflict of Interest

The authors declare that there was no conflict of interest.

Details of Funding and Ethics Approval

This study was funded by Cardiff University as part of the South Wales Doctorate Programme in Clinical Psychology.

Ethical approval was obtained from Cardiff University School of Psychology Ethics committee (EC.16.07.12.4554A2).

Informed Consent

Informed consent was obtained from the participants as part of the remit of ethical approval from Cardiff University School of Psychology Ethics Committee (EC.16.07.12.4554A2).

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© 2018 Society for the Study of Inborn Errors of Metabolism (SSIEM)

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Ambler, O., Medford, E., Hare, D.J. (2018). Parenting a Child with Phenylketonuria: An Investigation into the Factors That Contribute to Parental Distress. In: Morava, E., Baumgartner, M., Patterson, M., Rahman, S., Zschocke, J., Peters, V. (eds) JIMD Reports, Volume 41. JIMD Reports, vol 41. Springer, Berlin, Heidelberg. https://doi.org/10.1007/8904_2018_105

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  • DOI: https://doi.org/10.1007/8904_2018_105

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-58080-6

  • Online ISBN: 978-3-662-58081-3

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