Post on 02-May-2023
Psychology and Psychiatry
EMOTIONAL AND BEHAVIOURAL PROBLEMS IN CHILDREN AND
ADOLESCENTS WITH HIV: A STUDY WITH THE YOUTH SELF REPORT
AND THE CHILD BEHAVIOUR CHECKLIST
Assist. Prof. Dr. Lisete dos Santos Mendes Mónico1
Assist. Prof. Dr. Luiza Nobre-Lima1
Dr. Diana Arraiol1
Dr. Francisco Rafael de Araújo Rodrigues2
Dr. Hélder Meireles Cardeira3
1 Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal
2 Institute of Biomedical Sciences Abel Salazar, University of Porto, Portugal
3 University of Extremadura, Spain
ABSTRACT
Children and adolescents with HIV are prone to neurological and psychological
problems, not only due to the drugs they take, but also because of stigma, prejudice and
discrimination that this disease frequently involves (New, Lee, & Elliot, 2007). Studies
show that they present more behavioural and learning problems and reveal attention
deficit (Armstrong et al., 1993; Brouwers et al., 1998). The main goal of this study was
to assess emotional and behavioural problems of children and adolescents infected with
HIV, those perceived by themselves and by their parents. The sample is composed of 15
children and adolescents with HIV (8 to 17 years old; 11 boys and 4 girls; M = 11.73
years old; SD = 3.43), recruited from the Infectious Diseases Consultation of the
Portuguese Pediatric Hospital. Their parents completed the Child Behaviour Checklist
(Achenbach, 1991) and adolescents answered the Youth Self Report (Achenbach &
Edelbrock, 1991). Among the domains assessed (behaviour, opposition/immaturity,
aggressiveness, hyperactivity/attention, social problems, depression, somatic
complaints, withdrawal, anxiety and obsessive/schizoid), and comparing with normative
data, only 26.7% present behavioural problems, particularly in the
opposition/immaturity domain. The lowest score was in the anxiety domain. When
assessed by parents, adolescents ' behaviour did not significantly differ from childrens’
behaviour. Results are discussed considering prevention and intervention in the mental
health of children and adolescents with HIV, since emotional and behavioural problems
can affect adaptation to the disease.
Keywords: HIV, children, adolescents, emotional problems, behavioural problems
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INTRODUCTION
Currently a large number of children infected by HIV through vertical transmission
reach adolescence and adulthood. The prolongation of their lives thus raises issues of a
biomedical order and also of a psychosocial nature, such as revelation of the diagnosis,
treatment adherence, fear of stigma and the quality of life in general [3], [5], [15].
Living with HIV generates much suffering largely due to issues such as the stigma,
prejudice and discrimination this disease involves. These patients also experience
subjective conflicts, such as: the feeling of helplessness in the face of disease, the lack
of skills to deal with the situation, the sense of guilt and shame that permeate this
experience and accompany the daily lives of thousands of people with the HIV virus
[1].
AIDS is a stigmatized disease, and patients with HIV are often victims of discrimination
and prejudice [15], which may entail postponing the revelation. Thus, a vicious circle:
the stigma tends to lead to more suffering, which in turn results in silence on the subject.
And the secret can lead to stigma gaining ground [7].
For children and adolescents with HIV, the disease represents more than a physical
pain. It represents, above all, a change in terms of their daily routine. These changes
become more evident when hospitalization occurs, because they are subject to
coexistence with unknown people and painful procedures. This situation can cause a
pain greater than the disease itself, because the child is deprived of play, seeing their
friends, talking, jumping and running, and can enter into a state of depression and
isolation [11].
If, on the one hand, treatment through antiretroviral drugs increasingly offers a better
quality of life, on the other hand children and adolescents living with HIV are subject to
neurological and psychological problems due to the variety of pharmaceuticals they
consume per day [14]. Empirical studies on the prevalence of mental health problems in
children with HIV [14] are, however, still scarce. Some studies indicate that children
and adolescents with HIV have more learning problems, attention difficulties [6],
behavioural problems and cognitive deficits [2].
It is essential to examine the mental health needs of children and young people with
HIV, since emotional and behavioural problems can affect the level of adaptation of this
population to the disease itself [10].
Aims
The main goal of this research is to understand if children and adolescents with HIV
present emotional and behavioural problems and what kind of problems. More
specifically, it is intended to characterize the behaviour of these children and
adolescents according to their own perspective and that of parents (caregivers).
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MATERIALS AND METHODS
Sample
The sample consists of 15 children and adolescents infected with HIV, 11 males and 4
females, aged between 8 and 17 years (M = 11.73; SD = 3.42 years). Most children
(66.6 percent) attended the first cycle of schooling (1st – 4
th years), 13.4% attended the
second cycle (5th – 6
th years) and 20% were in the third cycle (7
th – 9
th years).
The following criteria were used for inclusion in the sample: between the ages of 8 and
18 years; parental consent for a child collaborating in the study. Preferably, participants
would be those caregivers who devote more of their time to caring for the child, or who
spend more time with them.
Children and adolescents in this sample were recruited from the Infectious Diseases
Consultation of the Portuguese Pediatric Hospital.
Measures
Portuguese versions of the Youth Self Report (YSR; of Achenbach & Edelbrock, 1991:
[8]), version for teens, and the Child Behaviour Checklist (Achenbach, 1991; from
GENETIC: [9]) version for parents were used. Completion of a demographic data sheet
was also requested, with relevant information on children and adolescents and their
caregivers.
The YSR aims to describe and evaluate the social skills and behaviour problems of
adolescents of 11 to 18 years of age, as they are perceived by themselves. It consists of
two parts, the first with items that assess the competencies, activities and social interests
of the adolescent, and the second whose items assess socially desirable behaviours.
Overall, the items are grouped in 8 factors: aggressive behaviour, delinquency,
anxiety/depression, thinking problems, attention problems, somatic complaints,
isolation and social problems. The results are interpreted through the overall result and
the 8 factors. There are standards for the Portuguese population by gender and age
brackets.
The GENETIC evaluates the social skills and behavioural problems of children and
adolescents, from 7 to 16 years of age, as they are perceived by their parents. It consists
of two parts, the first consisting of 20 matters relating to the powers of the
child/adolescent in different areas (participation in sports, hobbies, jobs, social
interactions, school performance, etc) and the second consisting of 120 items relating to
various behavioural problems. The items are grouped into 9 factors:
opposition/immaturity, aggressiveness, hyperactivity/attention problems, social
problems, depression, somatic complaints, isolation, anxiety, and obsessive schizoid/.
The results are also interpreted through the overall outcome and factors, with standards
existing for the Portuguese population by gender, years of schooling and age brackets.
Procedures and data analysis
Formal authorization to carry out this study was requested, consent having been
obtained from the hospital. The request for participants’ collaboration was made after
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presentation of the research objectives, with informed consent being signed by parents,
guaranteeing total anonymity and confidentiality of responses.
Statistical analyses were performed with the SPSS program, version 21.0. Non-
parametric statistics were used, due to the reduced size of the sample.
RESULTS
Table 1 presents the mean (M) and the standard deviation (SD) of the behaviour
reported by parents in relation to their children with HIV, and by teenagers themselves.
Table 1. Behaviour of adolescents with HIV reported by themselves (YSR) and by parents (CBCL): Mean (M), standard-deviation (SD) and comparison of averages by Wilcoxon test
CBCL – Parents
YSR - Adolescents
Differences between
adolescents and parents
of children and adolescents
(n = 15)
of adolescents (n = 8)
n = 8 Wilcoxon (n = 8)
Behaviour: M SD M SD M SD z p
General Behaviour 48.13 28.44 51.88 34.87 50.75 24.21 -0.14 .889
Opposition/Immaturity 8.67 6.24 7.75 6.78 7.13 3.09 -0.07 .944
Aggression 4.33 3.75 4.38 3.70 4.88 3.23 -0.36 .719
Hyperactivity/Attention 6.80 4.99 6.50 5.83 3.13 2.75 -1.76 .079
Depression 4.47 4.36 5.25 5.63 5.13 5.03 -0.14 .888
Social Problems 4.40 2.53 5.00 2.83 4.00 2.98 -0.95 .340
Somatic Complaints 1.40 2.38 1.75 3.06 .88 2.10 -0.55 .581
Isolation 4.60 2.56 4.38 2.92 4.00 2.71 -0.43 .670
Anxiety 3.60 2.41 3.75 2.55 3.29 2.43 -0.11 .916
Obsessive/Schizoid 3.93 2.94 4.25 3.37 2.86 1.68 -1.02 .306
Considering the average General Behaviour from the perspective of the parents of
children and adolescents, and comparing with data of existing normative nature in
Portugal (given the age variable) [8], [9], it turns out that 60% of children presented
average results (n = 9 cases). Only 2 have above-average scores in 1 SD normative
(13.3%) and higher than average results obtained 4 regulations in 2 SD (26.7 percent).
Analyzing each domain, according to parents’ evaluation, it turns out that behaviours of
opposition and immaturity are the most mentioned and anxiogenic behaviours the least
perceived.
Considering the average scores obtained by adolescents (n = 8), and compared to the
normative data (given the age variable), it turns out that 50% have average results (n = 4
Psychology and Psychiatry
cases). Only 2 have above-average scores in 1 SD normative (13.3%) and higher than
average results obtained 2 regulations in 2 SD (13.3 percent).
The Wilcoxon test allowed us to compare differences in the lack of behaviour among
teens and their parents. Although in the field of hyperactivity/attention parents indicate
higher values than their children, none of the differences was statistically significant,
indicating that parents and teens are in agreement as to their behaviour (see Table 1).
Table 2 - Behaviour of children and adolescents with HIV reported by parents (CBCL): Mean (M), standard-deviation (SD) and comparison of averages by the Mann-Whitney test
Children (CBCL)
n=8
Adolescents (CBCL)
n=7 Mann-Whitney
Behaviour M SD M SD U p
General Behaviour 43.50 19.19 53.43 37.36 26.0 .817
Opposition/Immaturity 9.25 5.63 8.00 7.28 24.5 .684
Aggression 4.13 3.83 4.57 3.95 24.0 .640
Hyperactivity/Attention 7.00 3.96 6.57 6.29 25.5 .771
Depression 3.63 2.20 5.43 6.05 23.5 .597
Social Problems 4.13 2.30 4.71 2.93 26.0 .816
Somatic Complaints 0.88 1.36 2.00 3.22 26.5 .849
Isolation 4.63 2.20 4.57 3.10 26.0 .815
Anxiety 3.37 2.26 3.86 2.73 26.5 .861
Obsessive/Schizoid 3.50 2.39 4.43 3.60 24.0 .639
The comparison of behaviours of children and adolescents, according to parents’
evaluation, did not show any statistically significant differences (see Table 2, p >. 05).
However, inspection of the values of the averages shows us that the scores in the
General behaviour of adolescents (M = 53.43; DP = 37.36 in CBCL) are higher than
those of children (M = 43.5; DP = 19.19), mainly due to the specific domains of
Depression (absolute average difference of 1.8), Somatic Complaints (absolute average
difference of 1.22) and Obsessive/Schizoid (absolute average difference of 0.93).
However, parents of children evaluate the behaviour of their children in the field of
Opposition/Immaturity higher than parents of teenagers (absolute average difference of
1.24).
DISCUSSION
With this study we intend to assess the emotional and behavioural problems of children
and adolescents infected with HIV, as perceived by themselves and by their parents.
We conclude that both the behaviour of children and adolescents with HIV, reported by
parents (GENETIC), and the behaviours reported by adolescents (YSR) are within the
parameters considered normal.
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Our results corroborate a study with a sample of 41 children with HIV, of which only 3
were identified as having psychosocial dysfunction by the Pediatric Symptom Checklist,
which indicates, in general terms, the lack of psychosocial problems in the HIV group,
as reported by parents [13]. The New study, Lee and Elliot [14] supports our results
regarding the behaviours in this population. However, a series of investigations found
opposing results (e.g., [4]; [6]; [10]; [11]; [12]).
Therefore, we consider that evaluation of the mental health of children and adolescents
with HIV is essential because emotional and behavioural problems can affect the state
of the disease and adaptation to it [10]. Early identification of these problems can offer
opportunities for prevention and intervention, leading to a better quality of life. Recent
data on pediatric acquired immunodeficiency syndrome Clinical Trials Group (PACTG)
concluded that children with HIV are more vulnerable to psychiatric admission than the
General Pediatric population [11]. They reported that the acute and chronic effects of
HIV infection may lead to a neurodevelopment deficit, meaning certain mental
disorders are more likely, and early intervention is essential.
Despite our results tending not to reveal significantly dysfunctional behaviour in
children and adolescents with HIV, higher than average normative results in SD in 2
26.7% of the sample were found according to the assessment made by parents, and in
13.3% according to self-evaluation made by teenagers. The highest score was found in
the area of Opposition/Immaturity and the lowest in relation to Anxiety. In fact,
psychosocial dysfunction and behaviour problems have been identified in school-age
patients with HIV. Other studies indicate that children with HIV are likely to present
problems of learning and attention disorders [6], as well as behavioural problems [4];
[12]. However, some contradictory reports claim that the results of psychological
adjustment are not significantly different in children with HIV, when compared with
healthy children. In some cases, HIV infected children have reported low levels of
depressive symptoms and anxiety, having a generally positive notion of their health
condition [14].
Limitations and further research
Beyond the limitation concerning the method used in the probabilistic sampling, there is
also the limitation of the relatively small size of the sample. It would be relevant to
involve a larger number of subjects in future investigations. Another limitation concerns
the fact there isn´t a control group in the sample.
Conclusion
We conclude that, among the domains assessed, and comparing with normative data,
only 26.7% present behavioural problems, particularly in opposition/immaturity. The
lowest score was in the anxiety domain. When assessed by parents, adolescents'
behaviour did not significantly differ from childrens’ behaviour. Our results suggest that
children and adolescents with HIV are remarkably resilient given the multitude of
challenges they face on a day-to-day basis, due to their HIV- condition.
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SGEM 2014 International Multidisciplinary Scientific Conferences on Social Sciences and Arts
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