Medicina (Kaunas) 2004; 40(7)
663
VISUOMENĖS SVEIKATA
Psychological adjustment of children with congenital hypothyroidism
and phenylketonuria as related to parental psychological adjustment
Roma Jusienė, Vaidutis Kučinskas1
Department of Psychology, Faculty of Social Sciences, Law University of Lithuania,
1
Department of Human and Medical Genetics, Faculty of Medicine, Vilnius University, Lithuania
Key words: congenital hypothyroidism, phenylketonuria, psychological adjustment.
Summary. Phenylketonuria and congenital hypothyroidism are the inherited metabolic diseases that can be diagnosed and successfully treated early from birth. Nevertheless, children
with phenylketonuria and congenital hypothyroidism are found to be in the risk for psychological maladjustment. Parental adjustment – as significant condition for child’s psychological adjustment – and related factors are explored in this study. Parents of 63 children with congenital
hypothyroidism and phenylketonuria (age 2 to 14 years) answered the Child Behavior Checklist,
Coping Strategies Questionnaire and the questionnaire on reactions to child’s disease, relations
with a sick child, with the spouse and other people. Severity of the disease and child’s age are
considered as well. Results of the study show that parental emotional (maladaptive) coping and
indulgence of a sick child account for the higher rates of internalizing problems of children with
phenylketonuria and congenital hypothyroidism. In addition, the higher rates of children’s psychological problems are related to parental feelings of guilt as a reaction to child’s disease.
Introduction
Due to modern technologies of biomedicine many
chronic pediatric conditions have become treatable
and their impact on the individual’s physical health is
controlled as much as possible. Thus, another question
gained importance: how chronic conditions influence
the patients’ mental health, their psychological adjustment?
Many psychological studies conclude that children
with different chronic diseases are at higher risk for
child and adolescent psychopathology (1–6). More
precisely, children with chronic diseases have less behavioral and emotional disturbances, if compared to
clinical sample, but the number of emotional problems
is almost as twice as in general population (4, 6). Hence, it is necessary to identify the highest risk group of
sick children, and to find risk and protective factors
to prevent maladjustment and to help those who encounter problems (5).
Mass neonatal screening recently prosecuted in Lithuania allows early identification of two inherited
diseases: phenylketonuria (since 1975) and congenital
hypothyroidism (since the second half of 1993).
Phenylketonuria (PKU) is an inherited metabolic
disorder, which is caused by the absence or inactivity
of phenylalanine hydroxylase, the enzyme that converts the amino acid phenylalanine (Phe) to tyrosine
(7). Accumulation of phenylalanine and its metabolites
in organism is particularly harmful for the development of central nervous system (8). A lifelong low
protein dietary treatment is recommended for all patients with PKU early from birth to avoid mental retardation and other somatic and neurological symptoms.
Congenital hypothyroidism (CH) is an inherited
metabolic disorder, which is characterized by the scarcity of thyroid hormones starting in a fetus during
pregnancy and continuing after birth (9). Thyroid hormones are vital for the growth of the whole organism,
particularly for the development of central nervous
system. The lifelong treatment with L-thyroxin is
recommended early from birth to prevent retardation
of mental and physical development.
Regular blood controls of thyroid hormones (in
the case of CH) and phenylanine (in the case of PKU)
are performed monthly during the first year of life
and every three months later on to evaluate effecti-
Correspondence to V. Kučinskas, Medical Genetics Center, Santariškių 2, 08406 Vilnius, Lithuania
E-mail: [email protected]
664
Roma Jusienė, Vaidutis Kučinskas
veness of the treatment. Physical and mental development of these children is monitored.
Children early and continuously treated for PKU
and CH usually have normal intellectual abilities, thus
slightly lower than that of normal peers and siblings
(10). Some neuropsychological deficiencies, which
manifest themselves as worse academic abilities or
learning difficulties, are also observed. The relation
between intelligence and severity of PKU and CH are
documented by several researchers (10).
The studies of psychological adjustment of children affected by these diseases reveal that they have
more internalizing problems, which tend to increase
with the sick children’s age (11–13). There is no agreement whether psychological adjustment of children
with PKU can be related to the severity of illness or
elevated Phe levels in patient’s blood (12). In addition,
the studies of children with PKU reveal that stress
evoked by the treatment requirements of the illness,
psychological impact of the illness on the entire family
and other psychological reasons have a determining
significance on children’s psychological adjustment
(14). Our previous studies reveal that Lithuanian
children with treated PKU have lower intellectual
quotient (IQ) than healthy controls, and higher rates
for emotional and behavioral problems, especially in
school age (15). Higher Phe levels were found to
correlate with children’s IQ but not with the psychological problems. However, the lower IQ is related to
the higher rates of psychological problems (15).
Emotional and behavioral problems of children
with CH can be related to severity of the disease (11).
Psychological adjustment of children with CH as well
as psychological related variables have not been studied in Lithuania and other countries thoroughly.
Parental psychological adjustment can be essential
factor of chronically ill child’s psychological adjustment. As it is asserted in many studies of children
with disabilities and chronic conditions, child’s psychological adjustment reflects parental psychological
adjustment (1, 4, 16). Parental psychological adjustment can influence children’s psychological adjustment indirectly through efficacy of the treatment that
is affecting as an organic factor, as the parents of very
young chronically ill children are mostly responsible
for the treatment compliance. Parental psychological
adjustment, that is coping abilities, emotional state
and attitudes toward a sick child and the illness, can
also directly influence children’s psychological adjustment through relations with a child. Parental overprotection and indulgence as well as the absence of feedback about inappropriate behavior in the case of child’s
chronic conditions can determine the lack of social
skills (3). Furthermore, lack of social skills can manifest itself as other emotional and behavioral problems
(17).
On the other hand, the care of a child with chronic
conditions increases probability of parental maladjustment (18). In addition to the usual strain with a newborn child, parents of children with disabilities or other
chronic conditions have to deal with additional demands, as for example, the grievance and disappointment of having given birth to a sick child, and the
management of the special treatment requirements.
The aim of the study
The aim of the present study is to find out the
variables related to the psychological maladjustment
of children treated for phenylketonuria and congenital
hypothyroidism and of their parents.
The following main hypothesis have been formulated in this study:
Parental psychological maladjustment can predict
children’s psychological maladjustment: i. e. parental
coping styles and reactions to a child’s illness and the
quality of relations with a child is related to child’s
emotional and behavioral problems.
Methods
Participants of the study are 63 children (ages 2–
14 years) with early and continuously treated PKU
and CH and their parents. These children are patients
at Medical Genetics Center of Vilnius University Hospital “Santariškių klinikos”. Forty-six (22 girls, 24
boys, ages 2–14 years) of them are children with phenylketonuria. Seventeen sick children are children
with congenital hypothyroidism (9 girls, 8 boys; 2–6
years old, because the screening program for CH was
started in late 1993 in Lithuania). The inclusion criteria for participation in the study were parental agreement, the absence of mental retardation in the child,
and treatment started early and continued without interruption.
Measures. Psychological adjustment of children
with PKU and CH was assessed by their parents’
ratings on Child Behavior Checklist (19, 20). CBCL
4/18 for assessment of children aged 4–18 years and
CBCL 2/3 for assessment of children aged 2–3 years
were used in our study. CBCL 4/18 measures emotional and behavioral problems on eight syndrome scales: withdrawn, somatic complaints, anxious/depressed (these three comprise internalizing problems),
delinquent and aggressive behavior (these two comprise externalizing problems), social problems, thought
Medicina (Kaunas) 2004; 40(7)
Psychological adjustment of children with congenital hypothyroidism
problems and attention problems. Total problems are
the score derived from all eight scales. CBCL 2/3 measures emotional and behavioral problems on six syndrome scales: withdrawn, somatic complaints, anxious/
depressed (these three comprise internalizing problems), destructive and aggressive behavior (these two
comprise externalizing problems) and sleep problems.
Total problems are the score derived from all six
scales.
The Coping Strategies Questionnaire (CSQ) (21)
was used for assessment of parental everyday stress
coping styles. CSQ measures four coping styles: rational, detachment (these two comprise adaptive coping), emotional and avoidance (these two comprise
maladaptive coping).
The structured questionnaire was used to assess
the parental reactions to child’s disease and relations
in the family, social relations and relations with a sick
child as affected/changed by child’s disease. Parents
answered “yes” or “no” to the statements such as:
“When I learned about child’s disease, I felt confused”,
“I blamed myself”, “I often argue with the child”, “I
make connivance to a sick child”, etc.
The severity of illness of the children with PKU
and CH was assessed by ratings of the medical
geneticians in Medical Genetics Center. The severity
of PKU was assessed according the biochemical
phenotype and genotype; the severity of CH was assessed according the functionality of thyroid tissue.
Results
Severity of the illnesses
The comparison of children’s with CH behavior
problems according severity of the illness is complicated as only 4 cases are diagnosed as severe form of
CH and 12 cases – as moderate and 1 case as mild
form of CH. Those with severe CH have more total,
externalizing and particularly internalizing problems
than the children with moderate and mild form of CH,
though differences do not reach significant level (as
compared with Mann-Whitney U test, Z=1.934,
665
p=0.053, for internalizing problems).
The comparison of CBCL scores according severity of the illness is complicated in PKU-affected
children as in the case of CH. 40 children with PKU
are diagnosed with severe form of disease and only 5
as moderate and 1 as mild. Results revealed the nonsignificant tendency for severity of illness to relate to
internalizing problems. The latter may also be related
to age, because mean age of children with different
severity of illness differs significantly.
Parental coping strategies as related to children’s
behavioral problems
Coping strategies of parents with PKU and CH
children do not differ significantly between these two
groups.
Correlation analysis of coping strategies as related
to CBCL scores reveal significant relations. As Table
1 shows parental total maladaptive coping and especially emotional coping are related to children’s internalizing and total problems.
Parents’ with PKU and CH children response to
the child’s disease
Most of parents (95%) accepted the medical diagnosis believing that the disease can be treated and
controlled. Nevertheless, they have other emotional
reactions as well. For 68% of parents it took long time
to get use to thought about child’s disease; 95% felt
confused and puzzled, because of uncertainty about
the future, and 77% stated they were afraid because
had no knowledge about the illness. One third of parents (32%) blamed themselves and felt guilty, and
42% felt anger toward themselves / others / God.
Responses to child’s illness do not differ significantly while comparing responses of parents of children with PKU and CH. As for example 25% parents
who have a child with CH blamed themselves and
35% parents of PKU-affected child did. Feelings of
anger were indicated by 27% of parents with CH child
and by 44% of parents with PKU child (these differences are not significant as compared with Pearson’s
Chi-square).
Table 1. Correlations between parental coping strategies and CBCL scores
Parental coping strategies
Total maladaptive coping
Emotional coping
Avoidant coping
Total adaptive coping
* p<0.05; ** p<0.01
Medicina (Kaunas) 2004; 40(7)
Internalizing problems
Externalizing problems
Total problems
0.325*
0.382**
0.146
–0.075
0.154
0.236
0.022
0.076
0.275*
0.356**
0.094
–0.034
Roma Jusienė, Vaidutis Kučinskas
666
The comparisons of CBCL scores with MannWhitney U test according to the parental reactions to
child’s disease do show several significant differences
(Table 2). Parents who blamed themselves also rated
their sick children as having more internalizing and
total problems. Parental feelings of anger are also
related to higher CBCL scores, though these differences are not significant.
The results also show that parental feelings of guilt
and anger are related to their emotional and total maladaptive coping (Table 2). As compared with MannWhitney U test parents who felt anger also tend to
use more emotional stress coping strategies (Z=2.783,
p<0.01) and maladaptive coping (Z=2.449, p<0.05),
than those who did not feel anger. Parents who felt
guilt use more emotional coping strategies (Z=2.063,
p<0.05) than those who did not feel guilt. There where
no significant differences found in groups of parents
who blamed / felt anger according their education,
children’s age and severity of illness.
Parental relations with a sick child and with
a spouse
More than half of parents (53%) are indulging their
sick child. Thirty percent of parents answered they
do not require discipline from a sick child and 20%
parents often have quarrels with a sick child. Parents
of children with PKU and CH differ according their
relations with a child. Parents of children with PKU
are more often indulging their child (Pearson c2=4.560,
p<0.05), more of them do not require discipline
(Pearson c2=5.640, p<0.05) and do quarrel with a sick
child (Pearson c2=5.312, p<0.05). Two latter peculiarities of the relations are also related to a child’s
age: parents require no discipline and quarrel with
the older children.
The between groups comparison of CBCL scores
according the parental connivance to a sick child with
Mann-Whitney U test reveal several significant differences. Children with PKU and CH who are indulged
by their parents have more internalizing and total
problems than those who are not indulged (Table 2).
The mean children’s age does not differ significantly
between two groups.
Results of analysis of the association between
child-parent relations and parental responses to illness
show that indulgence significantly relates to feelings
of guilt (Pearson c2=8.744, p<0.01) and anger (Pearson c2=4.659, p<0.05, Fig. 1). Parents who indulge
their child also tend to use significantly more emotional (Mann-Whitney U test’s Z=2.642, p<0.01) and
maladaptive (Z=2.518, p<0.05) coping (Table 2).
Fifty-seven percent of parents upbringing children
with PKU and CH indicated that the child’s disease
consolidated/strengthened the relations with a spouse;
53% said the relations did not change; 14% of parents
said the child’s disease caused the conflicts with a
Table 2. Comparison of CBCL scores and coping styles between parents who indulge and do not
indulge a sick child and who feel guilty and angry and do not feel guilty and angry
Mean (SD)
Problems and
coping styles
Indulging a child
“Yes”
N=33
“No”
N=28
Total problems
42.3
(16.3)
29.9
(15.2)
Internalizing
problems
15.3
(7.1)
Externalizing
problems
Mean (SD)
p value
Feeling guilty
“Yes”
N=20
“No”
N=41
p<0.01
40.9
(19.5)
35.6
(15.3)
9.07
(5.3)
p<0.01
14.6
(8.1)
15
(6.7)
13.6
(7.3)
ns
Total maladaptive
coping
23
(6.6)
19.7
(4)
Emotional coping
8.9
(3.4)
Avoidant coping
Total adaptive
coping
Mean (SD)
p value
Feeling angry
p value
“Yes”
N=26
“No”
N=36
p<0.05
39.6
(19.7)
34.3
(14)
ns
11.4
(6.3)
p<0.05
13.9
(7.8)
11.6
(6.4)
ns
15.9
(8.5)
13.6
(6.1)
ns
14.9
(7.8)
13.7
(6.4)
ns
p<0.05
22.3
(5)
21.1
(6.2)
ns
23.8
(5.2)
19.7
(5.7)
p<0.05
6.7
(3)
p<0.01
9.2
(2.8)
7.3
(3.5)
p<0.05
9.4
(2.7)
6.7
(3.5)
p<0.01
14.1
(4.9)
13
(2.6)
ns
13.1
(3.4)
13.8
(4.3)
ns
14.4
(4)
13
(3.9)
ns
23.7
(5.8)
23.5
(7.2)
ns
24.2
(4.5)
23.3
(7.2)
ns
23.7
(6.1)
23.7
(6.6)
ns
Medicina (Kaunas) 2004; 40(7)
Psychological adjustment of children with congenital hypothyroidism
667
100%
4
80%
8
24
20
60%
not indulging
Not
indulging
40%
18
Indulging
indulging aa child
child
16
17
15
No feelings
of guilt
No feelings
of anger
20%
0%
Felt guilty
Felt angry
Fig. 1. The number and proportion of parents indulging a child and feeling guilty and angry
spouse and 5% divorced as a result. The comparison
of CBCL scores according the marital relations of parents show the tendency that incidence of conflicts
and divorce relates to higher rates of children’s total,
internalizing and externalizing problems, though the
differences are not significant. Results of analysis of
relations with a spouse show significant relation with
parental education: high-educated parents indicated
more negative affects of child’s disease on the family.
Other difficulties of families with children with
PKU and CH
Parents of children with PKU indicated negative
influence of child’s disease on social relations and
parental employment, but did not parents of children
with CH. Eleven percent of mothers of children with
PKU have changed the job and 20% have quited the
job because of child’s disease. Twenty-nine percent
of parents of children with PKU indicated that they
go out (from home) less after the child with PKU was
born. Nonparametric Spearman correlations reveal
that negative effect on parental social relations and
employment relates to parental response to child’s
disease (rho=0.436, p<0.01) and to relations with a
sick child (rho=0.488, p<0.01). Analysis of the results
also shows significant correlations between financial
embarrassment (as indicated by parents) and negative
influence of disease on social relations and/or employment and with parental requirement for psychological and social help.
Analysis of interaction between psychological
adjustment of children with PKU and CH and of their
parents
Multiple regression analysis was applied to explore
the variables predicting the emotional and behavioral
Medicina (Kaunas) 2004; 40(7)
problems of children with PKU and CH. Results show,
that children’s total problems can be predicted by
parental emotional coping and indulgence (Model’s
F=7.383, p<0.01; coefficient of determination R2=0.20,
Table 3).
Parental emotional coping and indulgence account
also for 28% of variance of the children with PKU
and CH internalizing problems (Model’s F=11.054,
p<0.001; Table 4).
Table 3. Results of multiple reggression analysis
predicting children’s total problems
Predictor
Indulging
Emotional coping
Total maladaptive
coping
Feeling guilty
Feeling angry
b
t
p
0.287
0.261
0.182
2.285
2.076
1.445
0.026
0.042
0.154
0.052
0.069
0.395
0.546
0.694
0.587
Note. Multiple R=0.447, R2=0.20.
Table 4. Results of multiple reggression analysis
predicting children’s internalizing problems
Predictor
Indulging
Emotional coping
Total maladaptive
coping
Feeling guilty
Feeling angry
b
t
p
0.354
0.292
0.226
2.968
2.453
1.889
0.004
0.017
0.064
0.0677
0.060
0.550
0.476
0.584
0.636
Note. Multiple R=0.529, R2=0.28.
Roma Jusienė, Vaidutis Kučinskas
668
Parental emotional
coping
Parental feelings of guilt
and / or anger
Indulgence of a
sick child
Children’s psychological
maladjustment
(emotional and behavioral
problems)
Fig. 2. Summary of relations between children’s with PKU and CH psychological maladjustment
and parental emotional coping, feelings of guilt/anger and indulgence
Results of regression analysis and previous correlation and comparative analysis between parental and
children’s psychological maladjustment are summarized in Figure 2.
Discussion
The results of the study confirm hypothesis that
parental psychological maladjustment predicts the
psychological maladjustment of children with congenital hypothyroidism and phenylketonuria. Parents
who tend to use more emotion-oriented coping in
everyday stress situations and who indulge their sick
children also rate them as having more psychological
problems. The relationship between parental and
children’s psychological adjustment is documented in
studies of depressed families and families with disabled children as well (1, 16, 22, 23). There are also
considerations that parenting style and ability to solve
problems are related to children’s with phenylketonuria psychological adjustment (12).
Parental feelings of guilt and anger, though relate
to the adjustment problems of children with PKU and
CH in our study, do not have a predictive value. Thus,
we assume that children’s psychological adjustment
or, more precisely, mental and physical health, also
may have influence on parental responses and relations
with a sick child. As for example when a child has
more emotional and behavioral problems (as conditioned by severe form of illness or other organic and
intrapersonal factors), his parents may blame themselves and to overindulge the child.
Additionally, there is a possibility that poorly ad-
justed parents may be prone to detect more psychological problems in their children (5, 24, 25). The
evaluations of children’s behavior problems obtained
from other informants (teachers, psychologists, older
children themselves) could help answer this question
in future studies.
However even keeping in mind the limitations of
the present study we can conclude that parental adjustment – their reactions to child’s disease, coping
abilities, interpersonal relations and social environments – is of utmost importance to consider when
dealing with child’s inherited disorders. On the one
hand, children learn to adjust and cope from their parents (26). On the other hand, depressed parental mood
can restrict their ability to satisfy children’s social and
emotional needs (22). Moreover, parental distress and
depression can negatively affect adherence to treatment requirements. The indulgence of the sick child
thus implies not only inadequate parental-child relationship, which can disturb development of child’s
social relations, but also implies “making excuses”
from the low protein diet in the case of PKU. Increase
of the concentration of phenylalanine in child’s organism, as a result, may directly influence child’s
mental health, that is cognitive and emotional functioning.
According to our results, social environments interact with parental-child relationships and parental
psychological adjustment. Additional requirements of
PKU versus CH treatment indicate also more negative
impact on social environments. Thus, the social supports are essential for families of children with pheMedicina (Kaunas) 2004; 40(7)
Psychological adjustment of children with congenital hypothyroidism
nylketonuria and other diseases with additional treatment requirements.
Finally, we suggest that children with phenylketonuria, congenital hypothyroidism and other inherited or chronic conditions can be protected from psychopathology by collaborative efforts of medical staff,
psychologists and social workers and, most importantly, parents and children themselves. First, it is
necessary to assure that parents and children would
be active participants in creating their own psychological well being; secondly, that they always would
have a possibility to get professional help.
Conclusions
Emotional and total maladaptive stress coping strategies of parents, who have children with phenylketonuria and congenital hypothyroidism, are related to
children’s total and internalizing problems. Parents
who felt guilty as a response to child’s disease and
who indulged a sick child also rate their children with
phenylketonuria and congenital hypothyroidism as
669
having more internalizing and total behavioral problems. Parental feelings of guilt and anger and parental
indulgence of a sick child are related to parental emotional and total maladaptive coping. Parental reactions
to a child’s illness and interactions with a child are
related to the influence of the illness on parental social
relations and/or employment. The influence of phenylketonuria on social relations and/or employment is
more negative than that of congenital hypothyroidism.
Parental psychological adjustment, their ability to
react to a child’s illness properly, which manifests itself through interactions with a sick child, and the
use of adaptive coping patterns are important factors
of a good psychological adjustment of a chronically
ill child.
Acknowledgements
The authors thank the parents of children with
phenylketonuria and congenital hypothyroidism and
Loreta Cimbalistienė, M.D., Ph.D. and Dalia Juščienė,
M.D., Ph.D for cooperation in this study.
Įgimta hipotiroze ir fenilketonurija sergančių vaikų psichologinių problemų sąsajos
su tėvų psichologiniu prisitaikymu
Roma Jusienė, Vaidutis Kučinskas1
Lietuvos teisės universiteto Socialinio darbo fakulteto Psichologijos katedra
1
Vilniaus universiteto Medicinos fakulteto Žmogaus ir medicininės genetikos katedra
Raktažodžiai: fenilketonurija, įgimta hipotirozė, psichologinis prisitaikymas.
Santrauka. Anksti pradėtas ir tinkamas paveldimų medžiagų apykaitos ligų fenilketonurijos ir įgimtos
hipotirozės gydymas sąlygoja normalią sergančių vaikų psichinę ir fizinę raidą. Tačiau, kai kurių tyrimų
duomenimis, net ir gydant šias ligas, jos kaip ir kitos lėtinės ligos gali lemti vaiko emocinius ar elgesio
sutrikimus, kitus šeimos psichologinius sunkumus. Viena svarbiausių sergančio vaiko psichologinio prisitaikymo
prielaidų yra tėvų psichologinis prisitaikymas, jų reagavimas į vaikui diagnozuotą ligą, streso įveikimo būdai,
santykiai su sergančiu vaiku, santykiai šeimoje bei su kitais žmonėmis.
Šio tyrimo tikslas – išanalizuoti, kaip tėvų psichologinio prisitaikymo ypatybės gali būti susijusios su
vaikų, sergančių fenilketonurija ir įgimta hipotiroze, sunkesniu psichologiniu prisitaikymu.
Tyrime dalyvavo 63 vaikai, sergantys paveldimomis medžiagų apykaitos ligomis ir dėl šių ligų gydomi (2–
14 metų; 46 iš jų serga fenilketonurija, 17 – įgimta hipotiroze), bei jų tėvai. Vaikų psichologiniam prisitaikymui
įvertinti naudojome Vaikų elgesio klausimyną, kurį pildė tėvai (CBCL 2/3 ir CBCL 4/18, Achenbach, 1991).
Tėvų streso įveikimo būdams vertinti naudojome Įveikimo strategijų klausimyną (Elklit, 1996). Tėvai taip pat
pildė klausimyną, kur buvo klausiama apie reagavimą į vaiko ligą, ligos įtaką santykiams su vaiku, sutuoktiniu,
socialiniams santykiams ir užimtumui.
Tyrimo duomenimis, tėvų emocionalūs ir apskritai neadaptyvūs streso įveikimo būdai bei tėvų kaltės jausmas,
nuolaidžiavimas sergančiam vaikui yra susiję su fenilketonurija ir įgimta hipotiroze sergančių vaikų elgesio
bei emocijų sunkumais. Įvertinus tėvų emocinius streso įveikimo būdus ir nuolaidžiavimą sergančiam vaikui,
galima prognozuoti vaikų emocinius sunkumus. Tėvų kaltės jausmas ir pyktis, neadaptyvūs streso įveikimo
būdai bei nuolaidžiavimas sergančiam vaikui yra labai susiję. Manome, jog labiausiai sergančio vaiko
psichologinį prisitaikymą veikia tėvų ir sergančio vaiko tarpusavio santykiai.
Adresas susirašinėjimui: V. Kučinskas, Medicininės genetikos centras, Santariškių 2, 08406 Vilnius
El. paštas: [email protected]
Medicina (Kaunas) 2004; 40(7)
670
Roma Jusienė, Vaidutis Kučinskas
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Received 30 January 2004, accepted 20 April 2004
Straipsnis gautas 2004 01 30, priimtas 2004 04 20
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