Family Routines Research Articles

Promoting Social Support as a Protective Factor for Parental Stress and Child Behavior Problems During the COVID-19 Pandemic

Child and family routines were significantly disrupted by the COVID-19 pandemic stay-at-home orders, leaving individuals isolated from school, work, and peer networks. This work examines how social support from family/friends and systems was connected to associations between parental stress and child behavior problems. Data was collected between January and March of 2021 from 195 parents of children in elementary school who were primarily in remote learning due to the pandemic. Hierarchical linear regression models indicated that younger child age and child gender were associated with parental stress in step 1; only child age remained significant when child behavior problems were added. Support from family, but not external systems, attenuated associations between child characteristics and behavior on parental stress, though child behavior problems remained consistent with parental stress even when support was present. Exploring parental stressors and investing in support networks may protect children and families from immediate and ongoing challenges.

Parents working as health professionals during the pandemic

PurposeTo evaluate family routines, stress, and burnout levels of health professionals who were also parents during the pandemic process. Design and methodsThis study is a quantitative descriptive study. A total of 380 parents who were working as health professionals in a training and research hospital participated in this study. Data were collected using a data collection form. Percentage distribution, mean, Kolmogorov–Smirnov, Shapiro–Wilk, one-way MANOVA, and McNemar tests were used to evaluate the data. ResultsIn this study, 64.7% of the participants were women. The rate of participants whose children were in preschool was 31.8%. A total of 82.4% of participants indicated that their role of parenting was affected during the pandemic. A statistically significant difference was found between the Parental Stress Scale, the Emotional Exhaustion, and the Personal Achievement scores according to (p < 0.05). A statistically significant difference was found between the mean scores of depersonalizations of the participants who had infant children, during the play period, and in the preschool period (p < 0.05). ConclusionsIt was determined that family routines of health professionals who were parents during the pandemic were affected, and they experienced stress and burnout due to these altered routines. It was observed that health professionals who had children, especially in preschool, experienced greater stress, because the children were young and more dependent on their parents. Implications to practiceHealth professionals needed to be provided with support, taking necessary precautions for their family life and family routines during the pandemic process.

Integrating a child into an adoptive family in times of COVID-19: Lessons learned from adopters’ and professionals’ views

COVID-19 pandemic has brought multiple challenges for families and child welfare professionals, but also represent a unique psico-socio-ecological context to re-think fundamental working practices. The present work had two main aims: (1) to understand the impact of COVID-19 pandemic on the child’s transition to an adoptive family, in terms of challenges and adjustments made to adoption practice, perceived difficulties as well as benefits, from the views of adopters and adoption professionals, and (2) to identify promising practices to be maintained in pandemic and free-pandemic situations. Semi-structured interviews were conducted online with 13 Portuguese adopter families who received a child during the first wave of COVID-19 (March-June 2020) and 4 dyads of adoption professionals who followed and supported those families. Thematic analysis showed that adopters and professionals highlighted predominantly benefits for different phases of the transition as a result of the COVID-19 pandemic tough some difficulties were experienced. Delays and uncertainties of child’s placements caused anxiety for most children and adopters. However, the strategies undertaken during this waiting time (e.g., recorded video, reflection activities) were viewed as beneficial for parent–child mutual knowledge and preparation for parenthood. The impossibility of adopters to visit the child’s residential care setting and the inconsistency of practices between services were consensually perceived as major difficulties. Confinement and telework were consistently viewed as an opportunity for both adopters to be concurrently at home with the child, which facilitated establishing family bonds and routines. However, adopters reported mixed opinions towards social distancing. Among the several benefits perceived from the adjustments made to adoption practice, virtual (e.g., videoconferences) and informal (e.g., through WhatsApp groups) communication consistently emerged as the most relevant ones. Lessons relevant for adoption policy and practice over the transition to adoptive parenthood are discussed, including suggestions for future research.

Associations between Family Routines, Family Relationships, and Children’s Behavior

Consistent daily routines are associated with children’s well-being. Family routines provide both a predictable structure to guide behavior and an emotional environment that supports development. Enforcing family routines, improving family relationships, and creating a healthy home environment are necessary to maintain children’s psychosocial health. This study examined the associations between family routines, family relationships, and elementary school children’s behavior. Parents of 1515 third-grade students (8–9 years old) completed a self-administered questionnaire in Japan in 2017. We conducted a path analysis to examine the associations between the predictor variable of family routines, the mediating variable of family relationships, and the criterion variable of children’s behavior. A total of 717 valid responses were included in the analysis. The results showed that family routines were significantly related to children’s behavior (internalizing problem behaviors, externalizing problem behaviors, and prosocial behaviors) through family relationships (cohesiveness, expressiveness, and conflict). Family routines were positively associated with cohesiveness and expressiveness, and negatively associated with conflict. Cohesiveness was negatively associated with externalizing problem behaviors. While expressiveness was negatively associated with internalizing and externalizing problem behaviors, it was positively associated with prosocial behaviors. Conversely, conflict was positively associated with internalizing and externalizing problem behaviors, and negatively associated with prosocial behaviors. Our findings indicate that family routines may protect children’s mental health from the stressors of daily life and foster interpersonal and social competence. Moreover, family routines may stabilize family relationships, reduce children’s problem behaviors, and improve social competence.

The Impact of the COVID-19 Pandemic on the Educational Process of Children with Autism Spectrum Disorder and Effects on the Parental Quality of Life

Background: After the pandemic period, the daily routines changed, and this caused a significant decrease in families’ quality of life. We aimed to show how the pandemic period and closure of educational institutions influenced children with autism spectrum disorder (ASD) and their families’ quality of life. Method: The study is a descriptive type of research. The study population consists of families of children aged between 3 and 16 diagnosed with ASD who attended special education and rehabilitation centers and educational practice schools in Trabzon for at least 6 months before the pandemic, registered with the Trabzon Autism Association, and were followed at the Karadeniz Technical University Faculty of Medicine Child and Adolescent Mental Health and Pediatric Neurology Polyclinic. Families were asked to complete the questionnaire we designed. The data was collected face-to-face prospectively. The questionnaire consisted of six parts: sociodemographic and personal characteristics of children and parents; education problems during the pandemic period; the effect of daily routines during the pandemic period on both children and families; the Quality of Life in Autism Questionnaire-Parent Version; and the Parental Burnout Scale. Results: We contacted 169 parents. Mothers were more likely than fathers to complete the questionnaire (73.1% vs. 26.9%). School attendance decreased by 11.9%, while regular education availability fell by 8.1%. The pandemic has caused changes in the daily routines of families and children in many areas of life, such as decreased physical activity, changes in sleep duration and time, and deterioration in regular eating habits (p = 0.035; 0.001; 0.004; 0.001, respectively). The QoL of parents whose daily schedules changed decreased as a result. Our study found that their levels of burnout significantly increased, and the PBS total score and the QoLA scores had a moderately significant correlation (rs = 0.411, p&amp;lt;0.001). Conclusions: In this study, we showed that the COVID-19 epidemic negatively affected the education process of children with ASD. In order to improve the QoL of families and reduce burnout levels, we suggest providing additional service opportunities (parks, playgrounds, hobby centers, etc.) and special psychiatric services for children with ASD during pandemic periods.

Family Accommodation in Children and Adolescents With Misophonia

Family accommodation (e.g., reassurance, modifying routines, assisting avoidance) has not been explored among youth with misophonia but may have important clinical and intervention implications. We examined family accommodation in 102 children and adolescents with interview-confirmed misophonia and compared its frequency and content to family accommodation in 95 children and adolescents with anxiety disorders. Findings showed that family accommodation was ubiquitous in pediatric misophonia and may be even more frequent than in youth with anxiety disorders. Assisting the child, participating in misophonia-related behaviors, and modifying family routines were endorsed by more than 70% of parents of children with misophonia. Further, compared to parents of children with anxiety disorders, parents of children with misophonia more frequently reported child distress and anger when they did not accommodate. Family accommodation was moderately to strongly associated with misophonia severity even when accounting for co-occurring internalizing and externalizing symptoms and sociodemographic factors. This first study of family accommodation in pediatric misophonia suggests accommodation may be an important clinical feature. A notable study limitation is that the measure of misophonia did not delineate between adaptive versus maladaptive accommodations. Excessive and maladaptive accommodation may be one potential candidate to target in interventions when considered within a broader treatment plan. Importantly, adaptive accommodations should also be considered in day-to-day management if they improve functioning and quality of life.

Math intervention targeting family routines increases parental math talk and math activities

Previous interventions have seldom promoted family math engagement across family routines, tailored the intervention content to each family's typical routines, or provided videos of real families doing math. This feasibility study examines the effects of Math Made for Me (MM4M), a six-week program fostering math engagement across family routines via videos tailored to each family's typical routines. Participants were 76 parents and their 4-year-old children (M = 53.26 months; 47% female) from mostly middle-income, White backgrounds. Families were randomized into MM4M or a business-as-usual control condition. Parents' math talk, home math activities, and children's math skills were assessed at pre- and post-test. MM4M had positive, moderate-to-large effects on parents' math talk (d = 0.95) and home math activities (d = 0.55) but no effects on children's math skills. Promoting math across routines and tailoring the intervention content is a promising way through which family math engagement can be increased.

Cognitive Testing of Items Measuring Movement Behaviours in Young Children Aged Zero to Five Years: Development of the Movement Behaviour Questionnaires for -Baby (MBQ-B) and -Child (MBQ-C).

This paper describes the cognitive interview phase of the development of two brief surveys, the Movement Behaviour Questionnaire-Baby (MBQ-B) and Movement Behaviour Questionnaire-Child (MBQ-C), which measure the duration of physical activity, screen time, and sleep of children aged 0-5 years. The aims were (1) review the format, content, and clarity of questionnaire items and response options, (2) understand how parents retrieve, encode, and formulate responses when asked about their child's movement behaviours, and (3) identify potential sources of response error and make appropriate modifications. Interviews with parents of children aged 0-5 years were conducted using concurrent think-aloud techniques and probing questions. Parents reviewed the MBQ-B and/or MBQ-C depending on the developmental stage of their child(ren). Twenty-nine interviews were conducted with 20 parents, over four iterative rounds. Participants recalled usual family routines and rules when estimating the duration/frequency of behaviours. To estimate active play, parents referred to the child's daily routine considering wake and bedtimes, naps, and mealtimes. Participants were influenced by the examples provided, being unable to interpret these as exemplars only. Decomposing general items into specific questions with examples was well received. Use of numeracy skills when estimating duration was evident. Interviews informed revisions to item wording, examples, and recall prompts, which will be taken forward into the MBQ-B and MBQ-C validation studies. Utilising cognitive interviewing can enhance confidence that questionnaire items are correctly interpreted and understood by participants.

Development and Psychometric Evaluation of the Children's Illness-Related Concerns Scale.

Despite the effect of maternal breast cancer on many children, there is no valid or reliable quantitative measure of the concern that children attribute to their mothers' disease, which constrains both science and clinical practice. This study aimed to develop and psychometrically evaluate the initial measures of child-reported, illness-related concerns associated with maternal cancer. The study was conducted in three phases: scoping review, item extraction from a battery of items obtained from school-aged children about general issues related to their mothers' breast cancer, and testing of the three proposed structural models of these extracted items using confirmatory factor analysis. The scoping review yielded five categories of illness-related concerns: altered family routines, uncertainty, concerns about illness contagion, maternal death, and maternal well-being. To reflect these five categories, 18 items were extracted from a 93-item questionnaire completed by 202 school-aged children regarding their mothers' breast cancer. Next, three structural models were hypothesized to assess the construct validity of illness-related concerns: five-, three-, and one-factor models. Confirmatory factor analysis was used to test and compare the models. The five-factor model best fit the data, and each factor showed adequate internal consistency reliability. These findings align with the a priori five-factor model informed by the scoping review. The results provide initial evidence of the construct validity of the 18-item Children's Illness-Related Concerns Scale, which can be used to assess children's concerns and inform future intervention studies.

Oral Health Behaviors for Young Low-Income Urban Children during the COVID-19 Pandemic: A Mixed Methods Analysis.

This research assessed oral health behaviors changes in urban families with young children during the stay-at-home period of the COVID-19 pandemic (Nov 2020-August 2021). Survey data on oral health behaviors were collected in homes at three points before COVID-19, and via phone during COVID-19. A subset of parents and key informants from clinics and social service agencies completed in-depth interviews via video/phone. Of the 387 parents invited, 254 completed surveys in English or Spanish (65.6%) during COVID-19. Fifteen key informant interviews (25 participants) and 21 family interviews were conducted. The mean child age was 4.3 years. Children identified as mainly Hispanic (57%) and Black race (38%). Parents reported increased child tooth brushing frequency during the pandemic. Family interviews highlighted changes in family routines that impacted oral health behaviors and eating patterns, suggesting less optimal brushing and nutrition. This was linked to changed home routines and social presentability. Key informants described major disruptions in oral health services, family fear, and stress. In conclusion, the stay-at-home period of the COVID-19 pandemic was a time of extreme routine change and stress for families. Oral health interventions that target family routines and social presentability are important for families during times of extreme crisis.

Positive Early Childhood Experiences and School Readiness among US Preschoolers

To characterize the relationship between positive early childhood experiences (PECEs) and school readiness, and assess whether the PECEs-school readiness relationship was robust to and/or differed across levels of adverse childhood experiences (ACEs). We analyzed national data on children ages 3-5 from 2016 to 2020 (n=26 871) to examine associations between key PECE domains (nurturing relationships, home learning opportunities, safe and stable environments, and family routines) with being on track for school readiness, defined using a pilot, multidimensional measure called "healthy and ready to learn". Weighted univariate, bivariate, and multivariable analyses were conducted to generate nationally representative estimates. Multivariable models adjusted for sociodemographic factors and were assessed both with and without cumulative ACE exposure. Two-fifths of children were healthy and ready to learn. Exposure to PECEs was associated with higher school readiness, irrespective of relative ACE exposure. Compared with those with low PECEs, children with moderate (aOR, 2.19; 95% CI, 1.86-2.58) and high (aOR, 4.37; 95% CI, 3.58-5.34) PECEs had greater odds for being healthy and ready to learn, net of both sociodemographic factors and ACE exposure. Significant associations were robust across demographic groups (eg, race and ethnicity), ACE levels, and ACE types (eg, parental incarceration). Increasing PECEs correspond with greater likelihood of possessing capacities key for school functioning, even amidst ACEs. In concert with efforts to ameliorate early life trauma, caregivers, health care providers, educators, and systems can consider boosting PECEs to foster healthy development in childhood and beyond.

Living With an Advanced Cancer While Parenting Minor Children: A Needs Assessment Study.

Evidence-based interventions addressing the needs of couples co-parenting young children while facing an advanced cancer diagnosis are lacking. Thus, this study seeks to identify parenting-related intervention needs and delivery preferences of advanced cancer patients and their spouses/co-parents. Twenty-one couples completed quantitative measures of cancer-related parenting concerns, relationship and family functioning, and service needs along with individual semi-structured interviews. Patients (mean age=44 years, 48% female, 91% White) and spouses (mean age=45 years, 52% female, 91% White) reported family distress (62% of couples) and marital distress (29% of couples). Parenting concerns were generally high with patients revealing concerns particularly regarding the practical impact of the cancer on the child(ren). Spouses rated concerns about the co-parent significantly higher (P<.001) than patients. Parenting concerns were inversely associated with relationship (P<.001 for patients; P=.03 for spouses) and family functioning (P<.001 for patients). Themes identified through qualitative interviews include needs related to maintenance of family routines and traditions, childcare, transportation, meals, home maintenance, and finances. Couples who endorsed marital distress also indicated a need for conflict resolution skills. All patients and 89% of spouses would like to receive parenting-related education/services; up to 50% of couples preferred targeted, self-led readings without therapist support; and up to 50% desired counseling sessions indicating a preference towards dyadic and video conferenced intervention delivery. The delivery of optimal supportive care involves a family-focused perspective such as screening for parenting status and referrals to social work services to address the need of tangible resources and manage parenting-related distress.

Exploring health behaviors and the role of pet dogs in households with autistic children: the DANE study.

Autism spectrum disorder (ASD) often presents a unique set of risk factors that impact healthy eating and physical activity. Animal-assisted interventions (AAI) are a promising approach for autistic children. There is growing evidence for the positive impact of AAIs on self-regulation, which is necessary for initiating and maintaining behavioral changes. Pet dogs offer several potential advantages as a vehicle for an AAI focused on health behaviors. However, little is known about the experiences of autistic children and their families with respect to dog ownership and the mechanisms through which such an AAI might operate. We conducted interviews with ten parent-child dyads to explore the role of pet dogs in the lives and lifestyle habits of families with an autistic child. Interview guides were designed to explore the relationship between the autistic child and the pet dog and the role of the dog in family life; attitudes and practices related to physical activity and nutrition; and thoughts about intervention strategies. We used a directed qualitative content analysis approach for analysis. Themes indicate a strong bond between the child and the dog, the child's enjoyment in caring for their dog, and successful integration of dogs within family routines. In contrast, minor themes emerged around the challenges that owning a pet dog posed for families with an autistic child. In terms of nutrition and physical activity, a major theme among children was that healthy eating and exercise were important for both them and their dogs. However, minor themes suggest challenges with healthy eating and exercise and room for improvement for these behaviors. Parents held favorable views toward an intervention that would incorporate the family dog to teach children about nutrition and physical activity, although they expressed some concerns about feasibility. This exploratory work suggests that AAIs to improve nutrition and physical activity could build on the strong bond that children have with their pet dogs, but should consider the specific needs of each family, including the needs of the pet dog.

Family Life &amp; Autistic Children With Sensory Processing Differences: A Qualitative Evidence Synthesis of Occupational Participation

Abstract Date Presented 04/21/2023 This study aimed to conduct a qualitative evidence synthesis to explore the gap identified in understanding successful occupational experiences of family participation and routines when supporting autistic children with sensory processing needs. Primary Author and Speaker: Gina Daly Contributing Authors: Jeanne Jackson, Helen Lynch

Barriers and facilitators of family rules and routines during pediatric cancer treatment

ObjectivePediatric nurses work closely with families of children with new cancer diagnoses and can provide essential supports to promote coping and adjustment. This cross-sectional qualitative study aimed to gather caregiver perspectives on barriers and facilitators to adaptive family functioning during the early phases of cancer treatment, with a focus on family rules and routines. MethodsCaregivers (N = 44) of a child diagnosed with cancer and receiving active treatment completed a semi-structured interview about their engagement in family rules and routines. Time since diagnosis was abstracted from the medical record. A multi-pass inductive coding strategy was utilized to extract themes identifying caregiver-reported facilitators and barriers to maintaining consistent family rules and routines during the first year of pediatric treatment. ResultsCaregivers identified three primary contexts that presented barriers and facilitators to engagement in family rules and routines: the hospital setting (n = 40), the family system (n = 36), and the broader social and community setting (n = 26). Caregivers reported barriers primarily related to the demands of their child's treatment, additional caregiving needs, and needing to prioritize basic daily tasks (e.g., food, rest, household needs). Caregivers reported that different networks of support across contexts facilitated family rules and routines by expanding caregiver capacity in distinctive ways. ConclusionsFindings provided insight into the importance of having multiple networks of support to extend caregiving capacity in the context of cancer treatment demands. Practice implicationsProviding nurses with training to facilitate problem-solving skills in the context of competing demands may provide a new avenue of clinical intervention at the bedside.

Frequency, facilitators, and barriers for range of motion to prevent shoulder contracture in brachial plexus birth injury: A pilot study.

This pilot study investigated the efficacy of passive range of motion (PROM) during the first year of life to prevent development of shoulder contractures in children with brachial plexus birth injury (BPBI) and identified facilitators and barriers to caregiver adherence with daily PROM. Five caregivers of children with upper trunk BPBI participated in retrospective interviews about the frequency with which they performed PROM during their child's first year of life including facilitators and barriers to daily adherence. Medical records were reviewed for documentation of caregiver-reported adherence and documented evidence of shoulder contracture by age one. Three of the five children had documented shoulder contractures; all three had delayed initiation or inconsistent PROM in the first year of life. Two without shoulder contractures received consistent PROM throughout the first year of life. Making PROM part of the daily routine was a facilitator to adherence while family contextual factors were barriers. Absence of shoulder contracture may be related to consistent PROM throughout the first year of life; decreased frequency of PROM after the first month of life did not increase the risk of shoulder contracture. Consideration of family routines and context may facilitate adherence with PROM.

Impact of Daily Family Routine on a Child’s Development

Impact of Daily Family Routine on a Child’s Development

Caregivers' anxiety and perception of their children's wellbeing: a year into the COVID-19 pandemic.

The COVID-19 pandemic and related social restrictions disrupted family routines affecting millions of youths and their caregivers worldwide. This study explored the relationship between caregivers' anxiety and their children's emotional states 1 year after COVID-19, as well as differences between caregivers' perceptions of their children's emotional states and reality. Sixty-eight caregiver-child pairs completed an online survey between March 31 and May 31, 2021. Our analysis showed positive correlations between caregivers' anxiety and children's wellbeing, worries about children's use of time, and a variety of negative emotional states in their children. Caregivers' anxiety about their children's wellbeing was negatively correlated with their children's perceptions of self-control. Caregivers' anxiety about their personal wellbeing was negatively correlated with children's feelings of busyness and positively associated to their children's fear. Caregivers' perception of COVID-19 as a challenging experience was positively associated with some of their children's negative emotions. Overall, caregivers were accurate about children's emotional experiences in the previous 3 months with some exceptions: their children felt lonelier and more worried about schoolwork and grades than their caregivers realized. These findings will help researchers and practitioners further explore the sources of caregivers' anxiety and their relationship with children's emotions and stress management as countries move toward a new normal.

Assessment of Sensory Integration in Early Childhood: A Systematic Review to Identify Tools Compatible with Family-Centred Approach and Daily Routines

ABSTRACT This systematic review aims to verify whether tools designed to assess Ayres Sensory Integration constructs take into account the basic principles of current early childhood intervention approaches, namely the family-centered approach, child and family routines, and natural contexts. This systematic review was based on a standard protocol constructed according to the Preferred Reporting Items for Systematic Reviews (PRISMA) statement and included 323 publications. From these publications, we identified seven sensory integration assessment instruments for children up to 6 years old which are compatible with recommended early intervention practice. This study identified the instruments for sensory integration assessment in young children and related them with current principles of early childhood approaches. The findings may help researchers and clinicians choose instruments.

Palliative Care Needs of Families of Adults With Advanced Cancer.

Diagnosis and treatment of a terminal illness can significantly impact patients and their families, as well as their functionality and daily routines. This study aimed to understand the palliative care needs of a group of families with an adult relative with advanced cancer receiving palliative care. A qualitative approach was used to conduct a content analysis. Fourteen semistructured interviews were carried out with family members in Cundinamarca (Colombia) between March and April 2022. The information was analyzed by coding and categorizing the emerging themes using NVivo. Three main categories emerged: the diagnosis' harsh surprise, the family's coping with the disease, and the palliative care needs of families. Identifying the resources available to families to care for relatives with advanced cancer can facilitate the work of palliative care teams. It is necessary to prevent the family from giving up on caring, which can result from exhaustion due to various causes. Families who have an adult relative with advanced cancer in palliative care face significant challenges. Their situation involves accepting the diagnosis, changing family routines, dealing with the disease and the health care system, and coping with circumstances that create needs of different kinds.