Oct. 6, 2005 -- When a parent has a stroke, what's the best way to help children cope?
Researchers offer four suggestions in the journal Stroke:
- Check how well (or not) kids cope when the parent's stroke rehabilitation starts.
- Tend to the mental health of the parent who didn't have a stroke.
- Watch how the healthy parent feels about the marriage.
- Involve families in stroke rehabilitation.
"Based on our findings, we advise a family-centered approach in stroke care in which attention should be given to children's adjustment," write the researchers.
They included Anne Visser-Meily, MD. She works in Utrecht, the Netherlands at the Rehabilitation Center De Hoogstraat and the Rudolf Magnus Institute of Neuroscience.
In a news release, Visser-Meily adds some more tips. "Health care providers should give these children information, including names of web sites about young caretakers, books, etc.," she says.
"Give the parents -- both the healthy parent and the patient -- advice to deal with the children's feelings. And advise school teachers of how they might better deal with these children," says Visser-Meily.
The researchers interviewed 82 children (aged 4-18 years) and their parents (55 stroke patients and 55 spouses).
The stroke patients were about 46 years old, on average. They were moderately disabled by stroke and got inpatient stroke rehab. The kids were 13 years old, on average, and half were girls.
Interviews were done three times: soon after inpatient stroke rehabilitation started, two months after rehabilitation ended, and a year after the stroke.
Early Impact Important
The best way to predict how well the kids functioned a year after their parent's stroke was to see how well those children were doing soon after the stroke.
"This result may suggest an enduring impact of parental stroke on a child's functioning," write the researchers.
"Identification of children at risk for long-term problems can best be done by screening children in the early phases, when they are visiting their parents in rehab and it is relatively easy to speak, interview, or assess them," says Visser-Meily, in the news release.
Some kids coped better as time passed.
About half of the kids (54%) showed one or more behavior problems or depression in the first interview. That figure dropped to 23% when rehabilitation ended and then notched up a bit to 29% by the stroke's anniversary.
Handling Kids' Reactions
It might help to teach kids what to expect after a parent's stroke, the researchers note.
"Ensuring that these children obtain information about the consequences of stroke and its impact on the family and advice about how to deal with their feelings might support the adjustment process," they write.
"At a later stage, children with persisting adjustment problems can be given professional help if needed," the researchers continue.
Spouse, Marriage Also Big Influences
The healthy parent's reaction to their partner's stroke was a big deal to the kids, who all came from two-parent families.
Apart from the kids' coping skills soon after the stroke, "depression of the healthy parent was clearly the most important early predictor of children's adjustment," the researchers write.
In other words, if the healthy parent got depressed, the kids tended to have a harder time coping.
The healthy parent's view of his or her marriage also mattered. If the healthy parent felt that the marriage was faltering, kids may have picked up on that and had a rougher time, the study shows.
How the kids and the healthy parent handled the stroke seemed to matter even more than the extent of the stroke.
"The seriousness of the stroke appears to be of minor importance," write the researchers.
Finding a New Balance
The study was small and the first of its kind, so expect more research on the topic.
Meanwhile, kids may have a tough time when stroke rehab ends, the researchers note.
While the stroke patient is away in rehab, "the family tries to find a new balance," the researchers write.
When the stroke patient comes home, that new balance may get unsettled.
Kids' problems may rise while the family realizes "that at least some of the changes will be permanent and that they have to reorganize family routines," write the researchers.
"We can expect, but need to prove in future studies, that better outcomes will occur when stroke rehabilitation is organized as family-centered care in which assessment of family functioning, marital relationship, health situation, and coping style of all family members is included," says Visser-Meily, in the news release.