Special Families

Robert D. Wells , Martin T. Stein , in Encounters with Children (Fourth Edition), 2006

Determination

The needs of children living in specific forms of special families (stepfamilies; single-parent, adoptive, foster intendance, and homeless families; and families with gay or lesbian parents) have been described. Other types of special families in which a child'due south development may be affected in unique means are increasing in contemporary America. These include children living with a grandmother equally a master parent and low-income families. Openness, respect and a want to talk near the effect of these special family environments on the development of children should exist the goal of the kid's clinician. Helping parents guide the development of children who live in special families is an appropriate goal—and challenge—in a developmentally focused clinical practice. The fundamental, shared functions of all family units must be kept clearly in mind when the circumstances in which a child lives, no matter how "special" they seem, are evaluated.

In the introduction to a recent report from the American University of Pediatrics on "Family Pediatrics," the instance is made for making an effort to anticipate the part of the family in the provision of kid wellness intendance: "The practice of pediatrics is unique amid medical specialists in many ways…. Regardless of whether parents or other family unit members are physically nowadays, their influence is pervasive. Families are the most central and enduring influence in children'south lives. Parents are also central in pediatric intendance. The health and well-existence of children are inextricably linked to their parents' physical, emotional and social health, social circumstances, and child-rearing practices." By including nonparental caretakers who care for children in special families, the significance of this statement for pediatric practise is expanded.

HEADS UP—SPECIAL FAMILIES

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Sensitivity to the family unit constellation at each pediatric meet enhances the quality of communication among clinicians, parents and children. Don't assume that each child comes with a biological set of parents living at home.

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An private child or parent'south response to loss is subjective; ask about their sense of the severity of loss or upheaval rather than rely on one's ain impression.

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Don't underestimate the value of supportive care when working with special families, including asking empathic questions almost the family constellation, discovering and commenting on family and child developmental strengths and informing families about community resource that volition support the family and child'south developmental needs.

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After a separation, divorce, adoption or entry into a new stepfamily, continue to enquire about the effects of change on the kid'southward development and behavior. List the change in family pattern as a dissever trouble in the medical record encourages continuous follow-up.

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Children who accept lived through a divorce but still have significant behavioral concerns later on one twelvemonth demand a mental health referral.

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All children in foster care need a comprehensive developmental cess and behavioral evaluation.

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When separated parents remain in disharmonize with each other and about child rearing, clarify who has physical and legal custody, attempt to involve both parents in care decisions and avoid inappropriate support of one parent over the other.

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Recognize the enormous stress placed on parents who enhance children every bit a single parent or alive in a homeless environs or in significant economic poverty. When appointments are cleaved or arrival to the function is late, when anxiety levels are heightened or when payment for medical service is delayed, the kid's clinician should be sensitive to these added stresses.

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Children are resilient. Be attentive to the characteristics of children raised in special families that promote educational, psychological and social resiliency when developmental expectations are challenged. Support parents with positive feedback when these attributes are discovered.

QUICK CHECK—SPECIAL FAMILIES

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Simply 42% of children currently live in a traditional nuclear family and 22% live in a 2d union, two-parent family. By the fourth dimension children reach their 18th birthday, 50% to lx% of them will be affected by divorce.

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The emotional experience of loss is a primal theme that guides children in many "special families." The sense of loss is especially important later a divorce, disease or death of a parent (or other close relative), entering a new stepfamily and frequent changes in foster families.

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Prediction of the developmental outcome of a detail kid reared in ane type of special family is not usually possible.

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Failure to Thrive

Susan Feigelman , Virginia Keane , in Nelson Pediatric Symptom-Based Diagnosis, 2018

Social History

Many cases of FTT practise not have a principal medical etiology, and thus the social history is vital. The examiner should start with the family constellation and who takes care of the child. What is the relationship of the adults in the household, and how practise they get along? Are the parents working, and if they work simultaneously, who cares for the child? Are food stores accessible? Do the parents have adequate storage, refrigeration, and food grooming space? Are there adequate eating facilities and implements? Are in that location siblings who might eat the child's food? Is the child enrolled in the Women, Infants, and Children (WIC) program? Families should be screened for food insecurity. What is the cultural context of food selection and eating behavior?

More than difficult social issues must be approached carefully, with a statement to the family unit that all patients with this problem are asked these routine questions. Is there any substance abuse in the home that might result in utilise of food money for tobacco, alcohol, or drugs? Have the child protection authorities e'er been involved with the family?

Is the child in group daycare, or has the family traveled to an area where a chronic infection such every bit a parasite might accept been caused? Although the social history can be the most revealing part of the history, it can be the most difficult to elicit. Often the clinician must establish trust with the family before they can reveal the source of their disability to meet their child'due south nutritional needs.

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CRITICAL FAMILY EVENTS

William I. Cohen (1947-2009) , in Developmental-Behavioral Pediatrics (Fourth Edition), 2009

Part of the Physician

Most medical care is provided in response to the family'due south initiative. The connexion of chief intendance providers to their customs ofttimes leads to cognition of changes in the family unit constellation before the patient becomes symptomatic, giving the practitioner the opportunity to provide guidance. A sympathetic card following the expiry of a family unit fellow member can express condolences and offer availability for counseling and support of the child and family equally they move through the grieving procedure. In a similar style, awareness of the return of separated parents, parents returning from military service, or the arrival of grandparents into the household may allow the practitioner to express willingness to support the family during these transitions.

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2B or Not 2B?

David Goldman , in Our Genes, Our Choices, 2012

Validating a Human Impulsivity Gene in a Mouse Model

An obvious trouble with human behavioral genetics, and the human genetic study that enabled us to discover the HTR2B stop codon, is that scientists cannot readily perform controlled experiments. Human geneticists study the individuals, family constellations and populations that exist, and ordinarily cannot manipulate environmental exposures. People who have the end codon and who as a result are severely impulsive might for several reasons exist underrepresented in epidemiological samples. This is one reason why it was of import that we had bachelor a sample of severely impulsive Finnish criminals and matched controls. The criminals could take declined to have part in our study, but few did. As nosotros will discuss at more than length, the Finnish men we studied choose their environments or have them thrust upon them, and some of their environments are very different. As well, if we are interested in the action of a gene such as HTR2B we have to be concerned with the effects of genetic background. What are the other 25,000 genes doing? On the other hand, what we care most deeply about may be the human beliefs, and the genetic variant that alters behavior in the human might be rare or not-existent in an beast model.

Fortunately for the HTR2B cease codon story, we were able to evaluate the behavior of a relevant animate being model, and thereby evidence that the discovery we had made in people had predictive validity in some other species where we could control both surround and genetic background. Luc Maroteaux, a scientist who has long studied the HTR2B gene, had used recombinant Dna methods to target and disrupt the gene in mice. In these mice, other genetic and environmental factors are held constant, just the HTR2B gene has been knocked out. Fundamental to the study of such an brute model is that impulsive behavior, novelty seeking and responses to novelty are measurable and correspond to homo behavior. Another advantage is that we did non have to worry about underascertainment of mice that happened to be impulsive, because the mice, in contrast to people, could not wander off or turn down to take part in our studies.

We will hash out the definition and measurement of impulsivity in people in more depth later. For now, it is sufficient to say that impulsivity of these mice was measured experimentally and in several ways, as illustrated past the "2B" and "not 2B" mice in the yin-yang clock confront shown in Figure iii.two, credit for which goes to Luc and his lab. The patient "2B" mouse bides its time in exploring a new environs, even to seek food when hungry. Information technology fears a novel object that is placed in its muzzle and takes its time to touch on and explore this new thing that could be dangerous. Although hungry, the "2B" mouse charily lurks at the edges of a box biding its time before venturing to the center where it knows it is likely to find a food pellet, just where information technology is also more exposed to harm. In contrast, the impulsive "not 2B" mouse with its htr2b factor knocked out is less inhibited by fright, and intolerant to delay. When placed in a novel environment it rapidly explores information technology. When a novel object is placed in its surround it more readily touches information technology. Perhaps it is something tasty! If it is hungry it does not await long earlier sallying into open spaces that mice fear and, at least this fourth dimension, information technology finds a food pellet waiting. Later nosotros volition discuss that the "non 2B" mouse actually is different in how information technology discounts reward versus the amount of time information technology has to expect for a larger payoff. The "non 2B" mouse and the people who carry the HTR2B stop codon are not stupid but, as we were able to measure, the "non 2B" mouse is too impatient to wait a long fourth dimension even though it has learned that the delayed reward would ultimately exist greater.

Effigy iii.2. Impulsivity in mice, and the consequence of a knockout of the HTR2B serotonin receptor, also missing in some people.

 (Figure courtesy of Arnauld Belmer)

What does the discovery of genetic variations with a function in impulsive behaviors mean, and what does it mean that we can even create a controlled model in the mouse that validates genetic effects observed in people? Starting time, that the question of whether impulsivity and its resulting deleterious behaviors are in part inherited is settled. In retrospect, it could not be otherwise: behavior is the product of brain and the building blocks of the brain are subject to genetic variation. We are all neurochemically individual. Second, we've learned something almost the nature of the inherited variations that alter impulsivity. With the genes discovered we can country that the genes that make some people more than or less susceptible to behavioral dyscontrol work in different ways. Looking forward, we will see that some variants, such as Han Brunner'due south MAOA stop codon, are rare – the vulnerability genotype existence plant in but 1 Dutch family. Others, such as a dissimilar variant at MAOA, are common – someone in every gathering of people probably has the vulnerability genotype. Some, such as the HTR2B stop codon, are found in multiple families, but are restricted or relatively restricted to only ane population. Several of the variants, and perhaps all, are strongly dependent in their action on contexts, for example beingness male person, having a high testosterone level and having experienced an early-life stress. The genetic variant may be a necessary part of the behavioral syndrome, but alone it is not sufficient.

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Birth Order

D.L. Paulhus , in Encyclopedia of Infant and Early on Babyhood Evolution, 2008

Confluence Model

Proposed by Zajonc, this theory explains the firstborn advantage in terms of the intellectual environment evolving within the family. With just two propositions, the theory was able to explain birth-lodge effects every bit well as intellectual deficits deriving from five other family unit constellation effects: family size, close child spacing, multiple births, and being lastborn or an merely child.

The first proposition of the model is simply that intellectual stimulation of children has enduring benefits for their later intellectual success. But firstborns take a menstruation of time where they receive 100% of their parents' attention. For secondborns, the maximum quality time involves sharing the parents' attention with the firstborn. With each successive child, the available parental attention gets watered down fifty-fifty farther. In add-on, the linguistic environment becomes increasingly less mature as more children enter the family. The second proposition of the confluence model was that lastborns miss out on the intellectual stimulation involved in teaching younger siblings. We consider that second proposition in the department below on lastborns.

Zajonc'southward first proposition does non seem radical or specially controversial: in hindsight, information technology seems more than like commonsense. But he spelled out the various consequences and quantified them in a simple but persusive arithmetic formula. To represent the quality of the intellectual atmosphere at any point in a child's development, one simply has to calculate the electric current mean mental historic period in the family. Integrated over the childhood years, this hateful is college for firstborns: they receive the near intellectual stimulation because they spend a larger portion of their time in a loftier-quality temper. This stimulation stays with them in the form of superior cognitive abilities.

Intellectual deficits due to family size also follow from this watering-down mechanism. Increasing the spacing betwixt children helps modulate this watering down issue by allowing the mental ages of the older children to increase earlier adding the new contributor of zero mental age. Finally, the actress deficit seen in children of multiple births follows from the actress drop in average mental historic period due to the add-on of several zeros to the equation.

Although they are seldom spelled out, implications for social development can also be derived from the Confluence Model. Differential parental attending, even out of practical necessity, should impact the nature of the parent–child relationship across the birth social club. Firstborns should be more attuned to their parents' aspirations for their children, more needy of their parents' approval, and expect to maintain the special status they enjoyed as children in time to come social settings. Together, these sequelae could eventuate in the different personality trait and value profiles typically found across the birth orders.

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Complications in Stroke Patients

Louis R. Caplan Md , in Caplan's Stroke (Fourth Edition), 2009

Caregivers and their Reactions to the Stroke Patient

Strokes and stroke patients practice non live in a vacuum. Strokes crusade of import ramifications that impact all those who interact with the individual stroke survivor, but about of the burden falls on the family and principal caregiver. Stroke is a affliction that hits the whole family constellation, not merely the stroke patient.

Stroke patients who take severe deficits often get dependent on caregivers for daily activities and concrete and emotional support. Members of the family must deal with the physical handicaps and, often, new personality traits. If the patient is dependent on family members for care, the main caregiver can develop feelings of entrapment, isolation, anger, and depression. In some families, it seems every bit if a new dependent child has been thrust on them. Physicians should remember that caregivers are often old and sick and take their own concrete and emotional issues.

Researchers have begun to analyze and quantitate burdens perceived past those caring for stroke patients. Researchers take as well begun to describe and quantify the emotional and physical consequences of caregiving. 143–147 A Dutch study analyzed the burden of caregiving among 121 partners of patients who were living at habitation. 145 The investigators interviewed the caregivers 3 years after stroke affected their loved ones. Caregivers reported feeling overwhelmed with responsibility, uncertainty, and worry. They establish it difficult to handle the restraints placed on their own social lives and interests. 145 Analysis showed that higher levels of burden were explained by the stroke patient's degree of inability and the corporeality of care needed. The caregiver's emotional distress, loneliness, and perception of his or her ability to care for the stroke patient shaped the burden the caregiver felt. 145

The emotional event of stroke on caregivers was analyzed in a Scottish study of 231 stroke patients and their caregivers. 146 Severe emotional distress and depression were common amidst caregivers. Caregivers were more probable to be depressed if the stroke patient was dependent or emotionally distressed. The caregivers' emotional country in terms of anxiety and depression highly correlated with the emotional land of the stroke patient. Women who cared for male person stroke patients had more feet and depression than male caregivers. Older caregivers were more depressed than young caregivers. 146 In another study, the proportion of caregivers that were depressed did non diminish over time. 143

Conspicuously, intendance, education, and concern must exist addressed to the caregivers and their families, likewise as the stroke patients.

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Grandparents Raising Grandchildren

Oliver W. Edwards , in Handbook of Diversity in Parent Education, 2001

Groundwork

The phenomenon of grandchildren raised past their grandparents is hardly new (Burton, 1992; Doucette-Dudman & LaCure, 1996; Fuller-Thomson, Minkler, & Commuter, 1997; Strom & Strom, 1993), simply not until recently have researchers begun to investigate what impact this altered family constellation has on grandchildren and their school functioning (Dubowltz & Sawyer, 1994; Edwards, 1998a, b, 1996a, b). Recent findings suggest both negative and positive weather condition occur when grandparents raise their grandchildren (Edwards, 1998; Minkler & Roe, 1993; Poe, 1992; Sawyer & Dubowitz, 1994).

In many cases, grandparents must raise their grandchildren because of negative life events (Poe, 1992). While assuasive grandchildren to remain part of their biological family unit and retain a connection to their family history, the altered family constellation can be quite stressful for both grandparents and grandchildren. Raising children for a second time is doubly difficult for grandparents who have non bargained on childrearing during what should be a fourth dimension of peace and quiet.

Many grandparents believe they take no right to influence the rearing of their grandchildren when the children's parents are bachelor (Cherlin & Furstenberg, 1986). This suggests that grandparents, unless explicitly supported by their children, neither want nor are expected to take an active role in the parenting of their minor grandchildren. Obliged to assume the surrogate parenting role, grandparents may experience adverse emotional and physical reactions.

Grandchildren are also nether stress and may experience home and school problems every bit a result. The negative life events that are a precursor to grandchildren existence raised past grandparents, along with the concomitant childhood trauma, and difficulty with attachment may cause grandchildren to have problems in the surface area of psychosocial functioning. This chapter volition accost the bug experienced by both grandparents and grandchildren involved in this altered family unit situation and will nowadays potential solutions to assist the family function more effectively.

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Heterosexism and/in Linguistic communication

R. Queen , in Encyclopedia of Language & Linguistics (2d Edition), 2006

Heterosexism in Language: Kinship Terminology

As an example of how people can adjust linguistic conventions, some lesbians and gay men in the English-speaking world take reconfigured the English kinship system to assistance create new understandings of family relationships. Nigh kinship systems are centrally founded on heterosexual, procreative relationships and the (assumed) biogenetic ties that result. Although systems of kinship may differ in terms of how those biogenetic ties are conceived and ordered, most, if not all, encode some kind of gender binarism that at the very to the lowest degree locates a given private (an 'ego') in terms of a web of relations organized according to gender distinctiveness. The English terms mother/father, brother/sister, and aunt/uncle are expert examples of this binarism. English has a few gender-neutral kinship terms, for example, cousin or spouse , but in full general the kinship arrangement remains staunchly heterosexist even as family constellations have evolved to include a diversity of groups of adults in myriad child-raising and nonchild-raising situations.

A look at the utilize of kinship terminology in some of these new family constellations reveals surprising patterns. For instance, work on kinship amongst gay men and lesbians in San Francisco, California, showed that gay men and lesbians who live in 'called' families (families consisting of shut friends and romantic partners rather than kin) constitute those families in relation to their families of origin. Within such chosen families, traditional kinship terminology helps sustain nontraditional familial bonds. Thus, gay male and lesbian couples may reclaim spousal terms such 'wife' or 'husband' to refer to each other and in so doing disrupt the very gender binary traditionally encoded therein. Gay men and lesbians who utilise this terminology typically leave the gender specificity of the term intact (e.m., a lesbian will refer to her 'wife' and a gay man to his 'hubby'), whereas homophobic discourses that use this terminology typically maintain the encoded binarism (e.g., deridingly asking a lesbian couple, "Who'due south the married man?"). Distinctions such as these illustrate the difficulties with trying to specify heterosexism within linguistic communication itself. Fifty-fifty the blatantly heterosexist kinship system can exist reinterpreted to capture nonheterosexist meanings.

Speakers may also use the available terminological organisation in novel ways. Thus, questions about whether someone is 'family' are sometimes used in the United States to covertly ask whether or not someone is queer. The 'auntie' human relationship among U.S. drag queens captures a close intergenerational bond between an older (often retired) drag queen and a younger protégé, whereas the 'daddy/boy' human relationship denotes a romantic human relationship betwixt an older and younger man. 'Daddy' relationships are besides found in the leather community, where the 'daddy' is the dominant partner (male or female, young or erstwhile, 'meridian' or 'bottom'). These examples further illustrate the discursive flexibility available through language, even in seemingly closed systems like the kinship system.

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Functional Neurologic Disorders

J. Bakery , in Handbook of Clinical Neurology, 2016

Biographic details for individuals with functional voice disorders

There is a surprising paucity of information about the individuals with FVD other than details related to age and gender (Baker, 2008). In the example-control study cited to a higher place (Baker et al., 2013), efforts were fabricated to redress this problem past gathering more comprehensive biographic information most participants. These findings showed that women with FVD in comparison to those with OVD were more probable to be educated to higher levels, and to piece of work total-time in teaching, and in jobs with managerial, professional, or supervisory responsibilities. There were no significant differences betwixt the groups for marital status, family constellation, or family of origin. The majority of women were in some form of conjugal relationship with one to 3 children.

Nevertheless, at that place was a difference between groups for any experience of sexual abuse, violence, or strangulation in their lifetime (FVD 36/73   =   49% vs. OVD 18/55   =   33%). Some of these experiences had occurred during their formative years, others during the 12 months prior to onset of their dysphonia. To the best of our cognition, these are the beginning data related to sexual abuse and violence in a cohort of women with voice disorders. We as well found statistically pregnant differences between the PVD (northward  =   37) and MTVD (northward  =   36) subgroups for age (51 vs. 43 years, p  =   0.004), education (38% vs. 72% third education, p  <   0.011), and any experience of sexual abuse in their lifetime (43% vs. 19%, p  =   0.03).

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BROTHERS AND SISTERS

Perri Klass , in Developmental-Behavioral Pediatrics (Fourth Edition), 2009

CHILDREN WITH SPECIAL NEEDS

When families include children with special needs, the sibling issues can be particularly important. These issues are closely related to notwithstanding sibling questions and tensions discussed previously, but they can be fabricated more complex and more intense, and may require special thought and understanding on the part of parents and providers. Parents' coping abilities and family resilience are important for helping children cope with the stress of sibling disability and illness.

A child with special needs alters the family constellation; a brother or sister may experience the sense that all the parents' attentions and emotions are full-bodied on the more "vulnerable" child and may deeply resent the time that the parents spend taking that child to medical or therapy appointments. Brothers and sisters of children with autistic spectrum disorders reported feeling acrimony at the aggressive behaviors associated with those disorders (Ross and Cuskelly, 2006). At the same time, as a child comes to understand that a blood brother or sister is struggling with affliction or disability, there may be a neat deal of guilt at having escaped the problem and concomitant guilt almost feeling resentment. When there is a child in a family unit who faces extra struggles and extra limitations, other children may come to feel that they are being saddled with an actress weight of parental expectations and may react to this with a mixture of resentment, anxiety, and pride.

On the 1 paw, some children feel astute shame most a brother or sis who is visibly "different"—with obvious concrete anomalies or with astringent autism. This shame is ofttimes accompanied by guilt and a sense that the parents would be angry or disappointed if they knew. On the other hand, many children take on the roles of protector, guide, and major supporter for brothers and sisters with special needs. As with all sibling relationships, these dissimilar emotions and behavior patterns are non rigidly separated: a 9-twelvemonth-former girl who has endless patience at dwelling house for her autistic brother and understands his express communications better than anyone else may find herself hideously embarrassed when he has a meltdown at the mall merely as a few of her classmates come up along; she then may feel guilty and dislocated virtually her own embarrassment.

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