Exploring Factors Associated With Parental Acceptance-Rejection Among Parents of Children With Congenital Adrenal...

Children living with congenital adrenal hyperplasia (CAH) are at increased risk of psychosocial adjustment difficulties. Parental acceptance-rejection has been consistently associated with children's psychosocial adjustment across cultures. Understanding factors associated with parental acceptance-rejection in CAH families might help genetic counselors recognize those needing additional psychosocial assessment and support, potentially improving psychosocial adjustment in affected children. To our knowledge, no study has yet examined factors associated with parental acceptance-rejection in this population. This exploratory cross-sectional study aimed to address this gap by examining the associations between parental, child, and contextual stress-related factors and parental acceptance-rejection among families of children with CAH. Data were collected from 60 parents of 45 children with classical CAH using a questionnaire assessing variables of interest, the validated Bahasa Indonesia version of the Parental Acceptance-Rejection Questionnaire (PARQ), and the Parental Burnout Assessment (PBA). Univariable linear mixed-effects models (LMM) were employed to examine these associations while accounting for the non-independence of parental responses clustered within children. Higher levels of parental burnout were associated with greater overall rejection, hostility, and indifference. Fathers reported higher levels of overall rejection and greater coldness/lack of affection toward their children compared to mothers. Compared with university-educated parents, those with senior high school education reported higher overall rejection, emotional coldness, and indifferent behavior toward their child, while those with junior high school education reported higher hostility. Later CAH diagnosis onset was associated with higher parental undifferentiated rejection. Future studies are needed before these findings can inform genetic counseling practice for families of children with CAH.