Psychosocial function in Children with Low Anorectal Malformations

Helena Wigander RN, PhD*,. Margret Nisell RN, PhD., Tomas Wester MD, Professor., Björn Frenckner MD, Professor., Maria Öjmyr-Joelsson RN, PhD.Pediatric Surgery Unit. Department of Women's and Children's Health. Karolinska Institutet. Astrid Lindgren Children’s Hospital, Stockholm ,Sweden

Karolinska InstitutetDepartment of Women’s and Children’s HealthPediatric Surgery UnitKarolinska University HospitalAstrid Lindgren Children’s HospitalSE- 171 76 Stockholm, Sweden

E-mail: helena.wigander@.sll.se Telephone: +468-123 935 17

ConclusionsOverall, children and adolescents with low ARM seem to have good psychosocial function. The severity of the malformation might be related to psychosocial function.

IntroductionAnorectal malformations (ARM) are congenital anomalies that occurs 1 in 3000 births (Svenningsson, Gunnarsdottir, & Wester, 2018). The malformation varies from minor to complex and can be divided in to low, intermediate and high form of ARM. Children treated for ARM often have some degree of functional problems such as constipation or incontinence. Children with poor bowel function with fecal incontinence, have shown to have more behavioral problems compared to children with a good fecal continence (Bai et al., 2000). There are few studies conducted on this matter. Further research is necessary to obtain a better understanding of the complexity of ARM. The aim of this study was to examine psychosocial functioning in children with low ARM.

MethodThe Imperforate Anus Psychosocial Questionnaire (IAPSQ) was used (Nisell, Brodin, Christensson, & Rydelius, 2009). Forty-four patients with ARM were invited to participate. Twenty-three (53%) accepted, 9 (20%) declined, and 12 patients (27%) did not answer. For comparison two control groups were included. Control group 1 consisted 17 of healthy children who had visited the hospital for a minor procedure. Control group 2 consisted of 25 children with high and intermediate ARM who previously had answered the questionnaire.

ResultsSixteen (36%) children and adolescents with low ARM

answered the IAPSQ. Seven boys and 9 girls. Mean age 10.9 (7.3 – 16.8) years. The children and adolescents scored overall high in the psychosocial domains. Compared to healthy controls, similar scores were found in all domains. When comparing the index group to control group 2 no statistical differences were found, except for in the domain COG, where control group 2 scored significantly lower function.

Index groupn= 16

Comparisongroup 1 n=17

Comparisongroup 2 n=25

p-value

COG EMO SELFPSYCHSOC

25.55 (4.86)54.76 (3.13)14.25 (2.41)94.56 (8.47)51.24 (4.47)

25.13 (6.08)53.26 (3.78)13.82 (2.51)92.21 (9.96)49.36 (6.37)

21.61 (5.33)53.54 (3.97)13.11 (2.16)88.25 (8.10)49.86 (4.89)

0.042*0.4600.2950.0760.567

Table Sum score comparison in groups: sub domains emotional cognition (COG) emotional (EMO) self determination (SELF) and the domains psychological (PSYCH) and social (SOC) presented as mean and standard deviation (SD)

Objectives• To measure the participants psychosocial function a

Swedish disease specific questionnaire designed for children with ARM was used

• A comparison with two control groups were included• No differences were found between index group and the

healthy control group. The index group scored significantly higher in the domain COG compared to control group 2

References:Bai, Y., Yuan, Z., Wang, W., Zhao, Y., Wang, H.,& Wang, W. (2000). Quality of life for children with fecal incontinence after surgically corrected

anorectal malformation. Journal of Pediatric Surgery,35(3), 462-464. doi:10.1016/s0022-3468(00)90215-x

Nisell, M., Brodin, U., Christensson, K., & Rydelius, P. (2009). The Imperforate Anus Psychosocial Questionnaire (IAPSQ): Its construction and psychometric properties. Child and Adolescent Psychiatry and Mental Health,3(1). doi:10.1186/1753-2000-3-15

Svenningsson, A., Gunnarsdottir, A., & Wester, T. (2018). Maternal risk factors and perinatal characteristics of anorectal malformations. Journal of Pediatric Surgery,53(11), 2183-2188. doi:10.1016/j.jpedsurg.2018.04.021