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Parent-Child Communication after Parental Exposure to Potentially Traumatic Events: A Systematic Review.

Intergenerational traumatization poses a risk for the well-being of children whose parents have been exposed to potentially traumatic events (PTEs). Previous research has implied that parent-child communication may significantly contribute to the transmission of trauma across generations, but findings remain limited and inconclusive, particularly regarding the mechanisms and factors that could underlie this process. Therefore, the present paper performed a mixed methods systematic literature review to methodically map how PTE-exposed parents communicate with their children-both in general and about parental PTEs-and how such communication may contribute to trauma transmission. Five electronic databases were accessed to conduct keyword-led searches, yielding a final inclusion of 31 peer-reviewed, empirical studies that investigated parent-child communication among PTE-exposed parents and/or their nonexposed children. Parental PTE exposure was found to have a negative impact on general parent-child communication, often due to the presence of parental anger, irritability, and withdrawal. Conversations about parental PTEs showed substantial diversity in their frequency, content and style, with strategies of partial/modulated disclosure appearing most common. How parents approached PTE communication frequently stemmed from a desire to keep their children safe and unburdened by their previous experiences. Finally, both general communication and PTE communication were implied to contribute to trauma transmission, revealing a significant impact of parent-child communication on child functioning, identity, and well-being. Based on these key findings, the authors discuss meaningful implications for future research (i.e., prospective directions, addressing methodological concerns) and formulate suggestions for clinicians and policymakers surrounding the treatment of PTE-exposed parents and their offspring.

Humans

Parent-to-child and child-to-parent kidney transplants. Experience with 101 transplants at one centre.

101 first transplants were done in patients with end-stage renal disease using kidneys from parents or offspring. All patients were followed up for at least two years, and the absolute two-year patient-survival rate was 88% and the two-year functional-kidney rate was 79%. Actuarial statistics at four years were 82% for survival and 67% for function in the parent-to-child group. In the child-to-parent group absolute patient survival was 83% and transplant function was 79% at two years; these results were unchanged at four years. Thus, transplants from parents to children or from children to parents are much the same despite differences in age. There is some advantage in parent-to-child transplants from being female but no advantage in being diabetic, receiving higher or lower doses of antilymphocyte globulin, or sharing more than two HLA antigens with the donor. Mismatched sibling transplants survived approximately as well as did grafts from parents to children and children to parents. These results, taken in concert with the poor results of cadaver transplantation, the relative safety of donation, the high personal motivation to donate in these groups, and the personal satisfaction derived by the donor, strongly support the policy of informing potential recipients of the benefits of parental or offspring kidney donation.

Adolescent

Grief response of parents to neonatal death and parent participation in deciding care.

We determined the grief response to neonatal death of 50 mother-father pairs by administering a questionnaire and conducting a semistructured interview during the infant postmortem review. As measured by a parent grief score, maternal grief significantly exceeded paternal grief (t = 5.89, P less than .0001). Parent grief was not significantly related to birth weight, duration of life, extent of parent-infant contact, previous perinatal loss, parent age, or distance from the hospital of birth to the regional center (Pearson product-moment correlation coefficients). However, the attitudes and behavior of family, friends, and health care personnel in the hospital of birth often adversely influenced parent grieving. Of 39 mother-father pairs whose infants required respirator support, 18 participated in a group decision with their physician to withdraw respirator support when the prospects of infant survival seemed hopeless (limited respirator care group). No significant differences in parent grief scores were found (t tests) when the limited respirator care group was compared to those parents of infants who died despite uninterrupted respirator care. Our data suggest that informed parents can participate as partners with their physician in difficult infant care decision, even when death results, and adjust to their loss with healthy grieving.

Attitude to Death

Restricted helper function of F1 hybrid T cells positively selected to heterologous erythrocytes in irradiated parental strain mice. I. Failure to collaborate with B cells of the opposite parental strain not associated with active suppression.

Unprimed (CBA X C57BL/6)F1 lymph node T cells were transferred with sheep erythrocytes (SRC) into heavily irradiated F1 or parental strain mice and recovered from thoracic duct lymph or spleens of the recipients 5 days later. To study their helper function, the harvested F1 T cells were transferred with antigen into irradiated F1 mice plus B cells from either the two parental strains or from F1 mice. F1 T cells activated in F1 mice gave high IgM and IgG anti-SRC responses with all three populations of B cells. By contrast, F1 T cells activated in mice of one parental strain collaborated well with B cells of this strain, but poorly with B cells of the opposite strain. Active suppression was considered an unlikely explanation for this result since (a) good responses were found with F1 B cells, and (b) addition experiments showed that the poor response with B cells of the opposite parental strain (which was equivalent to that produced by unprimed F1 T cells) could be converted to a high response by a supplemental injection of F1 T cells activated in F1 mice. The phenomenon (a) was specific for the antigen used for activation (criss-cross experiments were performed with horse erythrocytes), (b) was reflected in levels of serum hemagglutinins as well as in numbers of splenic plaque-forming cells, (c) applied also to comparable activation of (DBA/2 X C57BL/6)F1 T cells, and (d) could be prevented by activating F1 T cells in mice of one parental strain in the presence of peritoneal exudate cells of the opposite parental strain. The hypothesis was advanced that F1 T cells contain two discrete subpopulations of antigen-reactive cells, each subject to restrictions acting at two different levels: (a) during T-macrophage interactions and (b) during T-B collaboration. It was suggested that when F1 T cells are activated to antigen in a parental strain environment, radioresistant macrophages activate only one of the two subgroups of T cells, and this subgroup is able to collaborate with B cells of the strain used for activation (and with F1 B cells) but not with B cells of the opposite parental strain. The other subgroup of T cells remains in an unprimed (nonactivated) state.

Animals

Responsive parenting: an approach to training parents of problem children.

Two behavior modification groups for parents of problem children between the ages of two and ten were conducted along the lines of the Responsive Teaching Model. The two groups met for 10 and 8 weeks, respectively, with six families represented in each group. In Responsive Parenting (RP), parents are taught to observe and measure their children's problematic behavior. Subsequently, each parent develops a home project designed to modify this behavior; 11 of the 12 parents developed a successful home project. In addition, the attendance was approximately 90% and the completion of weekly assignments was close to 100%. Paper-and-pencil measures revealed that the parents were very satisfied with the parent-training group and rated their children as improved on a bipolar adjective checklist. These results are discussed with regard to implications for the delivery of mental health services for children. Future research directions are delineated.

Adult

Adaptive differentiation of murine lymphocytes. I. Both T and B lymphocytes differentiating in F1 transplanted to parental chimeras manifest preferential cooperative activity for partner lymphocytes derived from the same parental type corresponding to the chimeric host.

The concept of adaptive (selective) differentiation preducts that early differentiation of lymphocytes is conditioned by the environment in which such differentiation takes place. These processes appear to involve selection of lymphocytes according to their self-recognition between interacting lymphocytes is, at least in part, controlled by major histocompatibility complex-linked genes, then adaptive differentiation is also controlled by these genes. In these studies, we have tested the capacities of helper T lymphocytes and hapten-specific B lymphocytes primed in the environments of various combinations of bone marrow chimeras prepared between two parental strains (i.e. A/J and BALB/c) and their corresponding F1 hybrid (CAF1) to interact with primed B and T lymphocytes derived from conventional parent and F1 donors as well as all of the corresponding bone marrow chimera combinations. The results demonstrate clearly that (a) F1 transplanted to F1 chimeric lymphocytes display no restriction in terms of cooperative activity with all of the various partner cell combinations; (b) parent transplanted to F1 chimeric lymphocytes manifest effective cooperative activity only for partner cells from F) or parental donors corresponding to the haplotype of the original bone marrow donor, thereby behaving phenotypically just like conventional parental lymphocytes; and (c) F1 transplanted to parent chimeric lymphocytes display restricted haplotype preference in cooperating best with partner lymphocytes sharing the H-2 haplotype, either entirely or codomimantly, of the parental chimeric host. The implications of these findings for understanding certain controlling mechanisms for lymphocyte differentiation are discussed.

Animals

Parental needs and professional responses: a parental perspective.

Parental needs are discussed as they have been revealed during a six-year period in a Boston parents' group, Prescription Parents, Inc. In addition, professional responses at various stressful periods during cleft palate rehabilitation are examined and certain responses suggested. Emphasis is given to the professional-parent partnership in developing the child's self-image and also to the relationship between professionals and the patient, particularly from age six through adolescence. The role of the peer group as it interacts with the home environment is also stressed. Specific suggestions are offered concerning the influence of a parents' group and the specific services such groups can provide.

Adolescent

The children of psychiatrically disturbed parents: differences as a function of the sex of the sick parent.

To examine the effects of the sex of psychiatrically disturbed parent on the offspring, we compared children of a schizophrenic parent, a psychiatrically disturbed but not schizophrenic parent, and a normal parent using behavioral, attentional, and neurological indices. Results of a discriminant analysis indicate that children of psychiatrically disturbed mothers have an increased sensitivity to tactile stimulation, possibly reflecting more labile autonomic nervous system functioning. In addition, children with a schizophrenic parent of either sex show evidence of neurological motor dysfunction.

Adolescent

Hybrid-versus-parental strain reaction. III. Comparative mortality in parental strain mice of the H-2k genotype.

Lethally irradiated parental strain male and female mice were inoculated with marrow from reciprocal hybrid donors of the same sex. Hybrid cells homozygous for the H-2k genotype could recognize the quantitatively greater antigenicity of the parental strain CBA male recipients only. The more severe reaction occurred when the maternal strain of the hybrid donor was allogeneic to the recipient, which indicates the maternal effect on the antigen recognition system. This demonstration of a maternal influence on the expression of paternally derived tissue antigens made it possible to attribute the secondary disease syndrome to a hybrid-versus-parental strain reaction. The apparent differences in mortality between male and female recipients could not be attributable to X or Y chromosome disparity without additional transfers of appropriate marrow from males to females and females to males. In all cases, the parental strain-versus-hybrid reaction resulted in greater mortality than that observed in the hybrid-versus-parental strain reaction.

Animals

[Methodology of parent group therapy (experiences with a social training program for parents of children and adolescents requiring psychotherapy)].

An analysis is made of the socio-psychological status of parents and their problems with regard to intrafamiliar social behavior, and then the aims of parent groups are defined. This is followed by a critical assessment of such methods as information groups, conventional training groups and dynamic group psychotherapy, all of which are unsuitable for this population. Then follows a discussion of the experience gained and results achieved, with a social training program for parents of children needing psychotherapy, where the disturbance in the child is an expression of family-neurotic disturbances. The accent is on the formation of motivations, sensitization to emotional signals, self-experience, feedback exercises and the mastering of partner-oriented conflict management behavior. The aim is to resolve neurotic family arrangements, so that the child is no more needed as a carrier of symptoms. The new attitudes and conflict management behavior should also be available in genuine educational situations. During the third phase of the program of exercises which consists of three parts, concrete problem situations are dealt within psychodramatic manner. As a conclusion special requirements for leading such groups are discussed with a view to therapists treating parents and children at the same time.

Adolescent

Hybrid-versus-parental strain reaction. I. Comparative mortality in allogenetic and parental strain male and female mice.

Lethally irradiated male and female hybrids, parental strains, and the third party strain A mice were inoculated with reciprocal hybrid marrow from donors of the same sex. A graft-versus-host reaction was produced against H-Y antigens of reciprocal hybrids. Although the late mortality in inbred strain males was generally greater than that of females, without further tests this difference was not automatically attributable to an X or a Y chromosome disparity. Hybrids did not recognize the qualitative difference in antigenicity of their reciprocals, but they were able to recognize the quantitatively greater antigenicity of their parental strains, and a hybrid-versus-parental strain reaction occurred. The graft-versus-host reaction in the third party strain A mice was significantly more severe than that produced by hybrid marrow in their reciprocal hybrid recipients, but significantly less severe than that produced in the parental strains. The relationship between antigenicity and responsiveness was such that the severity of the graft-versus-host reactions masked the maternal influences observed with other reciprocal hybrids.

Animals

The questionnaire to parents of children with the Down syndrome: how to inform the parents and psychological responses to counseling.

This study determined the experience of 137 sets of parents when they were informed that their child had Down syndrome and how they would have preferred this matter to have been handled. The survey revealed that the majority of parents would have preferred being told as soon as possible, with both of them present, and that they had suspected something wrong at the birth of the child. This information prompted us to analyze critically the parental experiences and to formulate a positive approach, with sensitive, supportive, and progressive counseling.

Adaptation, Psychological

Relieving parental anxiety a booklet for parents of an infant in NICU.

The transfer of a sick newborn infant to a Newborn Intensive Care Unit evokes an acute emotional crisis for the parents. In order to help the family master this crisis, the authors have developed a parent booklet entitled, "A Sign of Hope." This pamphlet introduces the parents to Newborn Intensive Care even before the transfer of the baby to the regional hospital. By merely changing a few words, telephone numbers, and maps, this brochure can be adapted for use at most Level II or III Newborn Special Care Units.

Anxiety

Parent-parent support in the care of high-risk newborns.

Despite the expertise of professional personnel in supporting parents of high-risk infants, parents with similar previous experiences can play a strong adjunctive role also. One program in which these parents were used as the key resource is described, including organization, actual operation, results, and problems.

Female

Parents' subjective evaluation of a self-help education-exercise program for asthmatic children and their parents.

A self-help education-exercise program for asthmatic children and their parents was evaluated in Denver, Colorado. The objective of the program was to instill better self-care practices in the child which are expected to reduce utilization and cost of medical services and reduce the amount of interference in the child's normal activities. The program was designed to educate the family about the nature of asthma and its treatment, the importance of self-responsibility for the child, and the psychosocial aspects which may affect both the child and the parents in a family with an asthmatic child. The program also included specific lessons pertaining to self-care practices including general health exercises on land and in water, relaxation training, and diaphragmatic breathing. The results of subjective evaluations of the parents indicated that the program was successful in achieving its goals to: Reduce the number of severe attacks, reduce medication usage, improve compliance, reduce days of school missed, increase exercise activity, and control wheezing by the steps taught in the course. While the results are suggestive, a further, controlled evaluation of the program is recommended.

Adolescent

Parent-of-origin specific allelic expression in outbreeding Arabidopsis arenosa identifies antagonistic parental enrichment in protein degradation pathways.

In plants, the epigenetic phenomenon of parent-of-origin allele-specific expression occurs mainly in the triploid endosperm. Although well studied in inbreeding Arabidopsis thaliana, genomic imprinting has been less investigated in outcrossers. In order to investigate a wider role of parental-specific allelic expression, we have analyzed imprinting in whole seeds of the obligate outbreeder Arabidopsis arenosa. High-throughput analysis of imprinting in outbreeding species is hampered by the lack of reference genomes and available sequenced accessions. High degree of allelic variation in outbreeding species may also limit the analysis to loci with less variation. We developed a reference-independent pipeline to detect parental-specific reads. Using different accessions in reciprocal crosses, we detected more than 70 paternally biased imprinted genes and > 500 maternally biased genes. Paternally biased genes showed major enrichment for proteins with ubiquitin protein transferase and ligase activity. Maternally biased genes were enriched for protein pathways directly counteracting paternally enriched genes. Here, we demonstrate an alignment-free protocol to identify imprinted genes that may be successfully applied for imprinting studies in other highly heterozygous outcrossing species. Our results suggest a unique role of genomic imprinting affecting post-transcriptional gene regulation in outbreeding A. arenosa.

Arabidopsis arenosa

Chimaerism in lymph nodes of F1 into irradiated parental recipient chimaeras rejecting skin allografts from the other parent.

Mice of the C57BL strain were irradiated with 800 R over the whole body. The next day they received i.v. a mixture of 50 x 10(6) spleen and bone marrow cells from (C57BL x CBA-T6T6)F1 hybrid mice, and were challenged with CBA-T6T6 skin grafts later on. About 20% of the recipients rejected the CBA-T6T6 skin, whereas the others were completely tolerant for more than 200 days. By using the cytotoxic test, we found that both tolerant and nontolerant recipients were complete chimaeras, i.e., had only (C57BL x CBA-T6T6)F1 cells in their lymph nodes. However, analysis of the same mice by the chromosome marker technique disclosed a proportion of host (C57BL) cells in lymph nodes of both tolerant and nontolerant chimaeras. The percentage of host metaphases in nontolerant chimeras was significantly higher than that in tolerant chimaeras (P less than 0.01). It is possible therefore that the CBA-T6T6 skin grafts were rejected by residual host (C57BL) cells rather than (C57BL x CBA-T6T6)F1 cells reacting against skin-specific transplantation antigen(s) of the parental graft.

Animals