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Juvenile rheumatoid arthritic (JRA) children and their mothers : a multi-method comparison with a healthy population Schmirler, Donna M. H.


The main purpose of the present study was to assess the psychological impact of juvenile rheumatoid arthritis (JRA) upon JRA children and their mothers by comparing them to a group of physically healthy children and their mothers in four domains: maternal and child behaviors, maternal perceptions of child adjustment, and maternal personal adjustment. The second purpose was to evaluate the relative strength of each domain to differentiate between the JRA and healthy comparison groups. Lastly, the interrelationships among various measures within the JRA sample were investigated. Eighteen mother-child pairs with a JRA child were compared to eighteen mother-child pairs with a healthy child. The two groups were balanced on a variety of demographic variables. Mothers completed questionnaires which assessed their perceptions of their child's behavior. Self-perception questionnaires were also administered to measure maternal levels of depression, anxiety and marital satisfaction. Then each mother-child pair participated in a series of home observations in which trained observers coded behaviors from the mother-child interaction. Results from the behavioral observations indicated that mothers of JRA children gave less positive attention to their children and that JRA children were less compliant to maternal commands. Mothers of JRA children perceived their children to be more "internalizing" in their behavior (e.g., more depressed, anxious, withdrawn, dependent). Mothers of JRA children also perceived themselves to be experiencing more personal distress than mothers of healthy children. Analyses revealed that, in order of magnitude, maternal depression, maternal positive attention, and maternal perceptions of children's internalizing behaviors were the best discriminators between the two groups. Within the JRA sample, severely ill children were perceived to have more general behavior problems, more internalizing behaviors, and were observed to have higher levels of inappropriate behavior than their less ill peers. Additional analyses indicated that mothers who gave less positive attention tended to have children who were less compliant. Measures of maternal adjustment were not related to any of the other measures within the JRA sample. Results suggested that the psychological adjustment of JRA children and their mothers was similiar to the healthy comparison group in many respects, however they did differ in some important ways. These included an increase in internalizing behaviors and less compliance to maternal commands on the part of the child and increased feelings of personal distress and decreased positive attention towards the JRA child on the part of the mother. Measures related to mothers' behaviors, perceptions and personal adjustment were the strongest discriminators between the two groups, suggesting that maternal rather than child variables are what most separated the JRA from the healthy comparison group. Within the JRA sample, the psychological adjustment of JRA children seemed to be affected by the severity of their illness, but maternal behaviors and personal adjustment were not related to this or any other measures. This suggested the overall strength and ability of mothers to cope with raising their JRA children, even though they may be experiencing increased personal distress as a result.

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