Adjustment of Mothers of Children With Obstetrical Brachial Plexus Injuries: Testing a Risk and Resistance Model

Objective: To investigate direct and moderating effects of risk and resistance factors on the adjustment of mothers of children with obstetrical brachial plexus injuries (OBPI). Participants: Fifty-three mothers of children with OBPI recruited from an OBPI clinic in an Australian pediatric hospital. Measures: OBPI Severity Scale, Parents of Children With Disabilities Inventory, Family APGAR, Short Form Social Support Questionnaire-6, Life Orientation Test—Revised, Perceived Control of Internal States Scale, General Health Questionnaire–12. Results: The factors explained 30% of maternal adjustment variation. Resistance factors explained a unique 18%. Optimism was the only significant moderator. Conclusions: Findings confirm the importance of risk and resistance factors in maternal adjustment and enhance understanding by identifying optimism as a moderator of the risk/adjustment relationship. Interventions promoting optimism may facilitate maternal adjustment. Obstetrical brachial plexus injuries (OBPI) are estimated to occur in 0.3 to 2.0 of every 1,000 live births. Damage to the nerves of the brachial plexus is thought to occur during birth when the infant’s neck and shoulders are stretched too far apart (Laurent & Lee, 1994). Children affected by OBPI are left with permanent deficits that range from subtle functional impairment to complete paralysis and lack of sensation in the affected arm (Michelow et al., 1994). Nerve damage can also extend to the face and cause pupil constriction, eyeball recession into the orbit, and lack of facial sweating on the injured side (Clarke & Curtis, 1995). Very little is known about the effects of this condition on the psychological adjustment of the children and their families. Parents of children with OBPI are confronted with a number of possible stressors associated with their child’s condition. These can include primary surgery (nerve graft surgery) on infants as young as 6 months old, secondary surgery (shoulder, hand, or

[1]  G. Holmbeck.  Post-hoc probing of significant moderational and mediational effects in studies of pediatric populations. , 2002, Journal of pediatric psychology.

[2]  J. Weisz,et al.  Changing the world and changing the self: A two-process model of perceived control. , 1982 .

[3]  Y. Seifu,et al.  The natural history of obstetrical brachial plexus palsy. , 1994, Plastic and reconstructive surgery.

[4]  G. McCain.  Family functioning 2 to 4 years after preterm birth. , 1990, Journal of pediatric nursing.

[5]  K. Stovel,et al.  Functioning among mothers and fathers of children with juvenile rheumatic disease: a longitudinal study. , 1992, Journal of pediatric psychology.

[6]  R. Lambert,et al.  Family functioning and social support in the adaptation of caregivers of children with sickle cell syndromes. , 1998, Journal of pediatric psychology.

[7]  J. Mallet.  [Obstetrical paralysis of the brachial plexus. II. Therapeutics. Treatment of sequelae. Priority for the treatment of the shoulder. Method for the expression of results]. , 1972, Revue de chirurgie orthopedique et reparatrice de l'appareil moteur.

[8]  I. Sarason,et al.  Assessing Social Support: The Social Support Questionnaire. , 1983 .

[9]  W. Kamps,et al.  Psychological adaptation and social support of parents of pediatric cancer patients: a prospective longitudinal study. , 2001, Journal of pediatric psychology.

[10]  J. Wallander,et al.  Development and evaluation of a measure of concerns related to raising a child with a physical disability. , 1996, Journal of pediatric psychology.

[11]  G. Holmbeck.  Toward terminological, conceptual, and statistical clarity in the study of mediators and moderators: examples from the child-clinical and pediatric psychology literatures. , 1997, Journal of consulting and clinical psychology.

[12]  D. S. Glenwick,et al.  Stress, coping, and perceptions of child behavior in parents of preschoolers with cerebral palsy. , 1998 .

[13]  S Donath,et al.  The Validity of the 12-Item General Health Questionnaire in Australia: A Comparison Between Three Scoring Methods , 2001, The Australian and New Zealand journal of psychiatry.

[14]  Michael W. Bridges,et al.  Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): a reevaluation of the Life Orientation Test. , 1994, Journal of personality and social psychology.

[15]  B. Melamed,et al.  Optimism and coping as determinants of psychosocial adjustment to rheumatoid arthritis , 1994, Journal of Clinical Psychology in Medical Settings.

[16]  S. Folkman,et al.  Stress, appraisal, and coping , 1974 .

[17]  J. Zabora,et al.  Psychological distress among adult patients being evaluated for bone marrow transplantation. , 1997, Psychosomatics.

[18]  S. West,et al.  Multiple Regression: Testing and Interpreting Interactions. , 1994 .

[19]  C. Romaña.  La paralysie obstétricale du plexus brachial , 2009 .

[20]  J. Manuel.  Risk and resistance factors in the adaptation in mothers of children with juvenile rheumatoid arthritis. , 2001, Journal of pediatric psychology.

[21]  J. Wallander,et al.  Perceived Problem-Solving Ability, Stress, and Coping in Mothers of Children with physical disabilities: Potential cognitive influences on adjustment , 1997, International journal of behavioral medicine.

[22]  J. A. Linney,et al.  Optimism, appraisals, and coping in the adjustment of mothers and their children with spina bifida , 1995 .

[23]  C. Carver,et al.  Optimism, coping, and health: assessment and implications of generalized outcome expectancies. , 2009, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[24]  K. Kelleher,et al.  Functional limitations of school-aged children seen in primary care. , 2002, Child: care, health and development.

[25]  R. Bakeman,et al.  Psychological adaptation and adjustment of mothers of children with congenital heart disease: stress, coping, and family functioning. , 1998, Journal of pediatric psychology.

[26]  D. Jackson,et al.  Chronic parenting stress: moderating versus mediating effects of social support. , 1990, Journal of personality and social psychology.

[27]  S. Thompson,et al.  Primary versus secondary and central versus consequence-related control in HIV-positive men. , 1994, Journal of personality and social psychology.

[28]  M. Liang,et al.  Psychosocial adjustment in juvenile arthritis. , 1992, Journal of pediatric psychology.

[29]  J. Laurent,et al.  Topical Review: Birth-Related Upper Brachial Plexus Injuries in Infants: Operative and Nonoperative Approaches , 1994, Journal of child neurology.

[30]  Gillian King,et al.  Family-centered caregiving and well-being of parents of children with disabilities:linking process with outcome , 1999 .

[31]  J. Varni,et al.  Effects of pediatric chronic physical disorders on child and family adjustment. , 1998, Journal of child psychology and psychiatry, and allied disciplines.

[32]  H. Clarke,et al.  An approach to obstetrical brachial plexus injuries. , 1995, Hand clinics.

[33]  B. Tabachnick,et al.  Using Multivariate Statistics , 1983 .

[34]  M. Järvelin,et al.  Cohesion and parents' social relations in families with a child with disability or chronic illness. , 1999, International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation.

[35]  H. Ireys,et al.  Mental health of mothers of children with juvenile rheumatoid arthritis: appraisal as a mediator. , 1996, Journal of pediatric psychology.

[36]  Edgar Erdfelder,et al.  GPOWER: a priori, post-hoc, and compromise power analyses for MS-DOS [Computer Program] , 2004 .

[37]  J. Wallander,et al.  Hope and social support as resilience factors against psychological distress of mothers who care for children with chronic physical conditions. , 2001 .

[38]  J. Varni,et al.  Disability parameters, chronic strain, and adaptation of physically handicapped children and their mothers. , 1989, Journal of pediatric psychology.

[39]  L. George,et al.  Stability and change in the psychological adjustment of mothers of children and adolescents with cystic fibrosis and sickle cell disease. , 1994, Journal of pediatric psychology.

[40]  Paul D. Williams,et al.  A user's guide to the General Health Questionnaire , 1988 .

[41]  Maintaining perceptions of control: finding perceived control in low-control circumstances. , 1993 .

[42]  Colton Cl.  5,000 years of the treatment of fractures , 1998 .

[43]  G. Smilkstein,et al.  The family APGAR: a proposal for a family function test and its use by physicians. , 1978, The Journal of family practice.

[44]  C. Gerhardt,et al.  Comparing parental distress, family functioning, and the role of social support for caregivers with and without a child with juvenile rheumatoid arthritis. , 2003, Journal of pediatric psychology.

[45]  J. Wallander.  Special Section Editorial: Current Research on Pediatric Chronic Illness , 1993 .

[46]  J. Pallant,et al.  Development and Validation of a Scale to Measure Perceived Control of Internal States , 2000, Journal of personality assessment.

[47]  D. Montaño,et al.  Validity and reliability of the family APGAR as a test of family function. , 1982, The Journal of family practice.

[48]  J. Wallander,et al.  Perceived role restriction and adjustment of mothers of children with chronic physical disability. , 1995, Journal of pediatric psychology.

[49]  Irwin G. Sarason,et al.  A Brief Measure of Social Support: Practical and Theoretical Implications , 1987 .

[50]  R. J. Thompson,et al.  Stress, coping, and family functioning in the psychological adjustment of mothers of children and adolescents with cystic fibrosis. , 1992, Journal of pediatric psychology.