Introduction 1 2 3 4 5 6 7 8 9 To our knowledge, no studies have reported on the effect of different temperament dimensions on the functioning of children of parents who have been diagnosed with cancer. The aim of the current study was to investigate the effects of temperament on prevalence of problems in these children, beyond the possible effects of socio-demographics (age, gender, educational level), illness-related variables (recurrent disease and time since diagnosis) and the number of negative life events that children experienced during the year before assessment. Materials and methods Procedure Between January 2001 and February 2003, written information on this study was offered to all cancer patients who were consecutively hospitalised or who visited the outpatient’s clinic at the University Medical Centre Groningen by their physicians or oncology nurses. In addition, information was sent to patients and their family members who had contacted the researchers in response to media attention because they wished to participate in the study. Families were eligible if patients had been diagnosed between 1 to 5 years before study entry and if they had children between 4 to 18 years of age. Participants had to be fluent in Dutch. Patients discussed study participation with their partners (if present) and children. Informed consent was obtained according to the regulations of the Medical Ethical Committee of the University Medical Centre Groningen. After informed consent was received, questionnaires and prepaid return envelopes were provided. Participants were guaranteed that answers were treated absolutely confident and will be described completely anonymous. Participants The current study is part of a larger study in which 476 families with children aged 4 to 18 years were approached, and information was mailed to 110 families who had contacted us for information about participation. Of these, 205 families from the first group and 89 families from the second group consented to participate (response: 43 and 81%, respectively). Ill parents who did not participate did not significantly differ from those who participated with respect to gender, tumour type and time since diagnosis. The current study focused on the responses of children of 11 years of age and older, as they completed the questionnaires themselves. The sample for the present study consisted of 340 adolescent children (149 sons and 191 daughters), between the ages of 11 and 18 years (mean age=14.9 years, SD=2.3) and their 212 ill parents (80% mothers, mean age=45.4 years, SD=4.7). Twenty-one percent of the children were receiving education in primary school, 9% at the lower vocational level, 17% in lower general secondary education, 12% in intermediate vocational education, 38% in high school and 3% in higher vocational education or university. Nine percent of the children were from single-parent families. Parents (43 fathers; 169 mothers, mean age=45.4 years, SD=4.7) had been diagnosed with various types of cancer: breast (55%), haematological (9%), skin (9%), gynaecological (9%), urological (5%), bone tumours (4%), gastrointestinal (5%) or other cancers, such as cancer of the central nervous system or head and neck cancer (6%). The mean time since diagnosis was 2.6 years (SD=1.2). Twenty-nine percent of the parents had suffered relapses. t p Measures Temperament 10 12 α α 13 α α r r Internalising and externalising problems 14 16 α Life events 17 Analyses Factor analyses of the EATQ-R were executed using Simultaneous Confirmatory Analysis (SCA) and Exploratory Principal Component Analysis (PCA) to investigate factor validity. t t t 18 19 13 20 p Results Preliminary analyses 21 effortful control perceptual sensitivity pleasure sensitivity pleasure intensity shyness frustration α α r r 1 Table 1 Cronbach’s alpha EATQ-R dimensions of children in the current study and a control study Dimensions Current study Control Cronbach’s alpha Mean inter-item correlations Cronbach’s alpha Mean inter-item correlations Number of items Effortful control 0.75 0.26 0.74 0.25 9 Pleasure sensitivity 0.79 0.36 0.83 0.56 4 Shyness 0.69 0.30 0.63 0.25 5 Frustration 0.61 0.21 0.69 0.27 6 Perceptual sensitivity 0.62 0.25 0.70 0.31 5 Pleasure intensity 0.71 0.37 0.74 0.42 4 Fear/worry 0.61 0.34 0.61 0.35 3 Cross validity 1 Internalising and externalising problems in children T 2 Table 2 t   Sons Norm group boys t Daughters Norm group girls t Mean SD Mean SD Mean SD Mean SD Internalising problems YSR 9.6 7.3 8.6 5.8 1.6 13.9 9.9 10.8 7.1 4.3* Externalising problems YSR 11.4 6.2 11.5 6.7 −0.2 10.8 6.2 10.0 6.1 1.7 Internalising problems CBCL 6.1 6.2 5.7 5.7 0.8 8.4 7.2 6.5 6.0 3.5* Externalising problems CBCL 6.6 6.1 7.1 7.1 −0.9 5.9 6.0 5.5 5.8 0.9 p Children’s problems and socio-demographics, illness-related variables and life events Socio-demographics t p t p Illness-related variables Life events r p r p r p Children’s temperament and socio-demographics, illness-related variables and life events Socio-demographics t p t p r p Illness-related variables t p Life events r p r p r p r p Relationships between temperament and problems in children 3 Table 3 Descriptive statistics of the temperament dimensions and correlations of these variables with internalising and externalising problems Temperament Mean SD Children Ill parents Internalising Externalising Internalising Externalising r r r r Effortful  control 27.8 6.2 −0.25** −0.44** −0.05 −0.24** Pleasure sensitivity 11.2 4.0 22** 0.03 0.13 −0.04 Shyness 12.0 3.8 0.30** 0.00 0.19** −0.13 Frustration 18.4 3.8 0.29** 0.36** 0.10 0.14* Perceptual sensitivity 16.4 3.5 0.15* 0.07 −0.01 −0.09 Pleasure intensity 14.7 3.7 −0.18** −0.02 −0.19** 0.10 Fear/worry 7.4 2.7 0.46** 0.29** 0.23** 0.16* p p Predictors of internalising and externalising problems Internalising problems R 2 R 2 R 2 R 2 R 2 R 2 4 Table 4 Regression analyses examining temperament as a predictor of internalising problems reported by children an ill parents   Children Ill parents Internalising problems Internalising problems Beta R 2 R 2 FCh Beta R 2 R 2 FCh Step 1  0.10  17.1**  0.08  13.5**  Child’s gender −0.25**    −0.18**     Recurrent disease 0.20**    0.22**    Step 2  0.20 0.10 40.6**  0.15 0.07 24.4**  Negative life events 0.33**    0.26**    Step 3  0.48 0.27 22.8**  0.19 0.04 5.3**  Effortful control −0.10    –     Pleasure sensitivity 0.09    –     Shyness 0.31**    0.10     Frustration 0.15**    –     Perceptual sensitivity 0.12*    –     Pleasure intensity 0.02    −0.09     Fear/worry 0.25**    0.13    The dashes indicate that variables were not entered into the model because no significant univariate relationship was found. p p Externalising problems R 2 R 2 R 2 5 Table 5 Regression analyses examining temperament as a predictor of externalising problems as reported by children and ill parents   Children Ill parents Externalising problems Externalising problems Beta R 2 R 2 FCh Beta R 2 R 2 FCh Step 1  07  22.6**      Negative life events 0.26**    –    Step 2  29 0.22 33.7**  0.07  7.9**  Effortful control −0.33**    −0.21**     Frustration 0.23**    0.06     Fear/worry 0.10    0.10    The dash indicates that the variable was not entered into the model because no significant univariate relationship was found. p p Discussion and conclusion 22 23 9 9 24 26 9 11 26 29 27 25 26 30 30 26 26 19 31 Another interesting result from this study is that, four of the seven temperament dimensions were related to the number of negative life events experienced. This is consistent with Rothbert’s theory, which suggests that, despite its biological base, temperament is influenced by experiences. The influence of stressful environmental factors on the development of temperament is an interesting phenomenon. Because the current study uses a cross-sectional design, no causal statements can be derived from the results. 26 26 32 33 34 The fact that temperament of children can have an impact on the prevention of problems by children is important information. Health care providers can use this knowledge to assist parents to take the individual characteristics of the child into account and by means of this to understand their children’s behaviour better. Additionally, parents might be supported to improve the ‘fit’ between the temperament of the child and the consequences of having a parent with cancer.