Understanding Family Dynamics Through a Neurocognitive Lens

The present paper deals with behavioral assessment of social interaction in natural settings. The design of observational systems that allow the identification of the direction, contents, quality and social agents involved in a social interchange is an aim of social interaction assessment and research. In the first part a description of a system of behavioral observation of social interaction is presented. This system permits the identification of the above mentioned aspects. Secondly a strategy for the behavioral assessment of social skills is described. This strategy is based on the consequences and effects of social interaction, and it is supported by three basic processes: social effectiveness, social responsiveness and reciprocity.

Agreement among reporters on features of family life, whether family members or outside observers, is considered to be low. This study, which involved a national sample of 720 families comprised of identical and fraternal twins, full siblings, half siblings, and biologically unrelated stepsiblings, examined the issue of low interrater agreement by decomposing the common and unique variance among parent, child, and observer reports of parenting behaviors (warmth and negativity) into genetic and environmental factors. Quantitative genetic analyses were employed to decompose the "Social" level of perception (common variance among parents, children, observers), the level of "Family" subculture (common variance only among parents and children), and the unique "Individual" level into genetic and environmental components. It was predicted that genetic factors would account for substantial portions of the variance at the Social and Family levels; nonshared environmental factors were expected to influence variance unique to child reports; and shared environmental factors were expected to influence variance unique to parent reports. A second and related aim of the study was to examine the subjective-objective dimension of genetic effects on measures of the environment. Results of model-fitting analyses generally supported the predictions for parental warmth and negativity at the Family and Individual levels. At the Social level, genetic factors were predominant for parental negativity and shared environmental factors for parental warmth. The findings are discussed in terms of genetically influenced child effects on parenting and methodological difficulties in constructing latent variables.

Peer interaction can be challenging in autism spectrum disorder, but naturalistic peer-observation scales for preschoolers are scarce. This study examined psychometric qualities of the newly developed Autism Peer Interaction Observation Scale. We tested the Autism Peer Interaction Observation Scale to (a) characterize peer interactions of preschoolers with autism spectrum disorder who were cognitively able versus typical age-mates, (b) explore each group’s hierarchical pattern of peer interaction behaviors, and (c) identify Autism Peer Interaction Observation Scale’s links with standard reports for assessing social-communication functioning (Vineland Behavior Scales, 2nd ed.), social impairment (Social Responsiveness Scale, 2nd ed.), autism severity (Autism Diagnostic Observation Schedule, 2nd ed.), and intelligence quotient (Mullen) in the cognitively able preschoolers with autism spectrum disorder group. Participants comprised 85 preschoolers (50 cognitively able preschoolers with autism spectrum disorder, intelligence quotient > 75; 35 typical). Groups were matched for age, intelligence quotient, and maternal education. Significant group differences emerged on all Autism Peer Interaction Observation Scale categories, in favor of typical. In cognitively able preschoolers with autism spectrum disorder, correlation analyses indicated that more typical peer relations on Autism Peer Interaction Observation Scale were linked with better adaptive and socialization skills (Vineland Behavior Scales, 2nd ed.) and fewer social atypicalities (Social Responsiveness Scale, 2nd ed.). Higher intelligence quotient scores were linked with better Autism Peer Interaction Observation Scale social-communication functioning. Only a few Autism Peer Interaction Observation Scale social-communication categories significantly correlated with the Autism Diagnostic Observation Schedule, 2nd ed. Findings highlight the Autism Peer Interaction Observation Scale as differentiating between groups and providing knowledge about peer interaction in natural settings. This new tool can help personalize social-communication programs and evaluations of early intervention outcomes.Lay abstractPeer interaction can be challenging in autism spectrum disorder, but naturalistic peer-observation scales for preschoolers are limited. This study examined the newly developed Autism Peer Interaction Observation Scale, with 17 subcategories, which evaluate naturalistic peer interaction processes in preschoolers with autism spectrum disorder and typical development. We tested the Autism Peer Interaction Observation Scale to (a) characterize peer interactions of preschoolers with autism spectrum disorder who were cognitively able versus typical age-mates, (b) explore each group’s hierarchical pattern of peer interaction behaviors, and (c) identify Autism Peer Interaction Observation Scale’s links with standard reports for assessing social-communication functioning (Vineland Behavior Scales, 2nd ed.), social impairment (Social Responsiveness Scale, 2nd ed.), autism severity (Autism Diagnostic Observation Schedule, 2nd ed.), and intelligence quotient (Mullen) in the cognitively able preschoolers with autism spectrum disorder group. Participants comprised 85 preschoolers (50 cognitively able preschoolers with autism spectrum disorder, intelligence quotient > 75; 35 typical). Groups were matched according to age, intelligence quotient, and maternal education. Significant group differences emerged on all Autism Peer Interaction Observation Scale categories, with the typical group showing better social-communication functioning as compared to the cognitively able preschoolers with autism spectrum disorder group. Also, in cognitively able preschoolers with autism spectrum disorder that observed as demonstrating more typical peer relations on the Autism Peer Interaction Observation Scale showed better adaptive and socialization skills on the Vineland (Vineland Behavior Scales, 2nd ed.) and fewer social atypicalities on the Social Responsiveness Scale, 2nd ed. Higher intelligence quotient scores were linked with better observed social-communication functioning (on Autism Peer Interaction Observation Scale). Few Autism Peer Interaction Observation Scale social-communicative categories significantly correlated with the Autism Diagnostic Observation Schedule, 2nd ed. Findings highlight the Autism Peer Interaction Observation Scale as differentiating the two preschooler groups and providing additional knowledge about socially communicative peer interaction in natural settings. This new tool can help personalize social-communication programs and evaluations of early intervention outcomes, thereby leading to a fuller picture of these young children’s functioning.

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Objective To explore the effects of family dynamics on lymphedema postoperative rehabilitation, positivity and the quality of life (QOL) in breast cancer patients after surgery. Methods A total of 130 breast cancer patients who received rehabilitation therapy were investigated by family dynamics questionnaire, positive and negative affect scales, and QOL questionnaire. The patients are followed up for 8 weeks, and the clinical features of patients with different family dynamics, the difference in the positive rate of rehabilitation patients, the improvement degree of obstructive lymphedema after treatment and their QOL were compared. The effects of family dynamics on lymphedema rehabilitation and QOL in breast cancer patients after surgery was explored on the basis of logistic regression and multivariate linear regression methods. Results After rehabilitation, the improvement degree of lymphedema in patients with high family dynamics was apparently higher than those patients with low dynamics (P<0.05). Multiariable logistic regression analysis showed that: high family dynamics, the positivity before rehabilitation treatment, divorced or widowed, high-grade pathology and elder were independent factors of improving the lymphedema. Multiple linear regressions analysis showed that: high family dynamics, age, marital status, positivity before rehabilitation and family annual income were independent factors of QOL. There was a positive correlation between the family dynamics score and the improvement degree of positivity of rehabilitation (r=0.241, P<0.01) as well as QOL (r=0.358, P<0.01). Conclusions The positivity of breast cancer patients in lymphedema rehabilitation is low. The family dynamics still need to be improved and family dynamics is an influencing factor of positivity in rehabilitation. Family dynamics provides a new way for improving the positivity of rehabilitation. Key words: Breast neoplasms; Lymphedema; Quality of life; Rehabilitation therapy; Family dynamics

In geriatric oncology, family members frequently accompany patients during medical consultations, providing emotional and practical support while participating in shared decision-making (SDM). Family involvement in SDM can facilitate the decision-making process but also pose challenges for healthcare professionals. Additionally, much of the SDM deliberation occurs outside the clinical setting, making it important to understand family dynamics to ensure treatment decisions align with the patient's values and preferences. Therefore this study aims to explore the experiences and perspectives of family members regarding their involvement in decision-making processes for older patients with cancer, and the subsequent impact on roles and family dynamics. Qualitative open in-depth interviews were conducted with 16 family members of 11 patients with cancer of 70 years and older in the Netherlands. Qualitative data analysis was conducted using a thematic analysis approach. Four interconnected themes emerged. The first theme, "Roles" revealed that family members often provide both practical and informational support, and sometimes act as advocates for the patient. The second theme, "Family Values and Beliefs," highlighted a strong sense of unconditional and reciprocal support within families, emphasizing the core value of caring for one another. Third, "Family Dynamics," encompasses: keeping everyone informed, dividing caregiver tasks, dealing with disappointment and sadness, managing different opinions, and coping with uncertainty. Finally, "Dilemma's" describes: family members balancing their own opinions with the patient's preferences, reconciling hope and fear, weighing trust in medical professionals against their own judgment, and balancing caregiving responsibilities with their personal lives. These dilemmas were shaped by roles the family members assumed, the underlying values and beliefs, and family dynamics. The findings of this interview study provide valuable insights into the complex roles that family members of older patients with cancer play in medical consultations and treatment decision-making and their dilemma's. These roles are deeply influenced by family values and dynamics, which can significantly shape decision-making processes and outcomes. Understanding these factors can help healthcare professionals as it highlights the evolving responsibilities of family caregivers and the importance of supporting them in navigating the intricacies of treatment decisions while maintaining respect for patient autonomy.

WHAT IS KNOWN ON THE SUBJECT?: Several studies explore and describe the role of family dynamics in dementia care. However, few focus specifically on the diversity of family relationships that influence family caregivers' experiences of providing care to a relative with dementia. The role of family caregivers engaging in unpaid care of relatives with dementia is becoming more and more critical as the numbers of people living with dementia increase across the globe. Family caregivers are a diverse group of people as there are different categories of kinship relations and thus cannot be viewed as a single collective. They are linked intricately to their family and social support systems, however, they often experience limited family support, and tensions between family members can be a major source of stress. Hence, health professionals need to deepen their understanding of family relationships to enable them to provide effective advocacy and clinical support to family caregivers. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study is unique in that it focuses on a range of family relationships in which a person with dementia finds themselves. It highlights that this network of complex connections influences the caregiving process. The study demonstrates the important role that siblings can play in sharing the caregiving load. However, this sharing is rarely balanced or fair and there is always someone in the family who carries the heaviest load. Communication between family members is frequently a challenge, with family members experiencing denial or an inability to understand the challenges encountered by the family caregiver. Most studies focus on the relationship between the family caregiver and the relative with dementia alone, rather than the family network of the family caregiver and how it influences the caregiving process. This study is unique as it focuses on family dynamics and the family network, particularly the range of family relationships in which family caregivers and their relative with dementia find themselves. Other studies tend to focus on a specific kinship category and the family network, such as an adult child, caring for their parent, but this study presents a wide variety of kinship categories to demonstrate the diversity of family caregiving contexts. The family caregivers in this study all highlighted the need or desire for effective support from the family network. Challenges of communication between family members and the caregiver were also evident and were framed within the existing family dynamic of each family. WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING?: The findings suggest the need for communication (training and therapeutic) interventions between family caregivers and other family members (secondary caregivers). Mental health nurses are often well positioned to offer the family caregiver the option to undertake such an intervention. The findings emphasize the diversity of family caregiving situations and argue that mental health nurses can assess the nature of the care situations and work with families on how best to address the needs of the relative with dementia and the main caregiver. However, tensions frequently exist between family members, some of which existed prior to the relative acquiring dementia and other tensions as a consequence of the relative acquiring dementia. Mental health nurses could assist as a mediator between family members in order to assist families to become more cohesive. ABSTRACT: Introduction This article explores the diverse nature of family caregivers, focusing on the different categories of kinship relations. Family caregivers are linked intricately to their families, but often experience limited family support, causing stress and tension between family members. Aim The article aims to explore the family relationships of family members caring for relatives with dementia in order to provide an insight into the role of such relationships on the caregiver relative with dementia dyad. Method A phenomenological, exploratory-descriptive design was used. Eight participants took part and data were obtained using collages and semi-structured interviews. Results A range of family relationship patterns was highlighted including sibling involvement in the caregiving process; spousal involvement in supporting a caregiver of a parent; and spousal involvement in caring for their spouse. Discussion The family caregivers highlighted the need or desire for effective support from the family network. Challenges of communication between family members and the caregiver were also evident and were framed within the existing family dynamic of each family. Implications for Practice Mental health nurses need to deepen their understanding of family relationships to enable them to provide effective advocacy and clinical support to family caregivers and assist families to become more cohesive.

Session 8 is again focused primarily on family communication and dynamics for the purposes of identifying and addressing parenting behaviors and parent–teen dynamics that may unwittingly undermining teen confidence in becoming more independent in managing their illness and lifestyle. The clinician engages the family in a discussion of parental and teen roles within the family system and an examination of the impact of the teen’s illness on family members’ roles. Behavioral family systems concepts of “misguided support” and “strong beliefs” that family members hold, but that inadvertently may be serving to maintain a dependent or even overprotective/enmeshed family dynamic, are introduced and applied to the family situation, along with strategies for moving these dynamics in a more independence-engendering direction.

In this article, I use the concept of the dividual to analyze the dynamics at stake in a family caring for a member with early‐onset dementia. Drawing on anthropological fieldwork in the Netherlands, I argue that using a dividual framework reveals family dynamics that are overlooked when using an individual framework, and it allows one to better understand the emotional pain that family members experience during the care process. Approaching family members as fractal persons shows how their identity is composed of other family members and how this can lead to dilemmas and conflicts in the care situation. The majority of articles on dementia focus on dyadic relationships. This article advocates a systemic approach encompassing the whole family. Moreover, it underlines the importance of taking the historicity of family relations into account and not limiting the analysis to situational dynamics.

The recent growth in dual-income families has led to new configurations of domestic work distribution among family members. Because working parents are required to spend a great deal of time and energy at their respective jobs outside the home while also managing parenting responsibilities and household tasks, a high premium is placed on how partners negotiate and enact the division of labor inside the home. This paper draws from videotaped interviews and naturally occurring interactions in the home to explore working couples' perspectives on the challenges of managing household work and parenting. Transcripts of these videotapes are presented to examine couples' ongoing negotiation of responsibilities and expectations, with particular reference to the requests that partners make of one another and subsequent responses to these requests. Findings suggest that the degree of ambiguity in the models governing couples' expectations for and performance of housework responsibilities affects the behaviors that working parents exchange. Clear models appear to facilitate efficient management of household tasks, minimize bids for influence, and enable partners to feel effective and respected, while ambiguous models entail continued negotiation of responsibilities, repeated demands and directives, and tension within the dyad. The value of studying marital interaction in natural settings with observational methods, using principles from psychology and anthropology, is emphasized.

Posttraumatic stress disorder (PTSD) among combat veterans remains an urgent and, for some, unmanageable problem for those who have served in war, as well as their family members. This paper focuses on how familial dynamics are deeply affected by veterans returning with PTSD, especially after severe combat exposure. We examined the familial dynamics of PTSD in combat veterans by presenting an autoethnographic case study. One of the authors was a US combat veteran and wrote his personal account of social reintegration with his family after returning from multiple combat deployments. This autoethnographic case study is used to examine the family dynamics of a combat veteran and his family to present this argument. We argue that one of the reasons that combat-related PTSD remains so difficult to treat is due to the limited intervention strategies to treat individuals with PTSD within the family system. Ultimately, there are three contributing factors that currently hinder the ability to successfully treat and reintegrate combat veterans diagnosed with PTSD without alienating them from their family system. The first is a failure to look at family systems theory as a therapeutic intervention to treat the individual with PTSD, as well as those affected by the shift of the family dynamics. The second related issue is the effect of attachment prior, during, and after the deployment and development of PTSD. The third is to look at Moral Injury to understand another face of trauma that can be misdiagnosed as PTSD, affecting morals and values held by the family system.

PROTOCOL: Family Behavior Therapy (FBT) for young people in treatment for non‐opioid drug use

Background. Cancer is a hard challenge for the patient's family that causes changes in family functioning. In the study analyzed manifestations of family anxiety in families with cancer patients, depending on the stage of the disease and the level of adaptation in families. Contingent and research methods. Based on informed consent, a psychological examination of 288 families with a cancer patient was conducted, of which 174 patients were women and 114 were men. The respondents were further divided into subgroups depending on the stage of cancer and the level of adaptability of the family system. In the study used the Family Anxiety Questionnaire and the Family Adaptation and Cohesion Scale (FACES-3), a clinical-psychological interview. Results. Oncology was a powerful stress factor that affected family functioning and potentiated changes in marital relationships, perceptions of family events, attitudes and responsibilities. On the level of family, anxiety influenced the progression of cancer, the adaptability of the family system, the gender of the couple. With continued cancer or relapse, the family responds with increasing family anxiety, guilt and hyper responsibility for the family situation, tension. The progression of cancer in a family member led to increasing manifestations of family anxiety, which expressed in a sense of helplessness, uncontrollability, independence of the situation in the family from their efforts, exaggeration of responsibility for events, failure to fulfil family obligations. Particularly striking was the increased anxiety and guilt in patients' wives. Violations of family adaptability were accompanied by increased family anxiety in all its structural components. Conclusions. Medical-psychological help for a family of cancer patients is an important part of interventions in oncology practice.

Assisted Living Facilities: Benefits, Challenges, and the Importance of Culture

The transition to providing end-of-life (EOL) care to a family member can be challenging for family caregivers as they face difficult decisions regarding medical course of treatment, increasing caregiving responsibilities, and anticipatory grief. Low preparedness for EOL caregiving is associated with higher levels of caregiver strain, increased levels of depression and anxiety, and complicated and prolonged grief after the death of the family member. Despite the breadth of caregiving research, little is known about how family relationships and interactions relate to caregiver preparedness for EOL caregiving. Thus, the purpose of this study was to explore the association between family caregivers’ family dynamics and their perceived preparedness for the transition to EOL caregiving. A sample of 173 family caregivers were recruited to complete an online, self-report survey. A structural equation model was used to analyze the association between family dynamics and caregiving preparedness. Most caregivers reported balanced family cohesion (75.1%) and family flexibility (75.7%), but low family communication and low family satisfaction. In addition, 20.2% of caregivers reported being not at all prepared for the transition to EOL caregiving. Although there was a lack of meaningful association between family dynamics and preparedness for EOL caregiving, it may be that family relationships and interactions grow more complex as families age and individuals take on new and different roles (such as family caregiving) within the family system. This study demonstrates the need for future research to develop new measures to explore how aging family dynamics relate to family caregiver experiences and outcomes.