Research Article
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The Self-Concept, Family Functioning, Psychological and Emotional Symptoms, in Children and Adolescents with Neurofibromatosis Type 1

Year 2024, Issue: Early Access
https://doi.org/10.18678/dtfd.1509447

Abstract

Aim: This study aimed to examine the self-concept and related psychological factors in children and adolescents with neurofibromatosis type 1 (NF1).
Material and Methods: A total of 71 participants (35 patients and 36 controls) were included in this study. As measurement tools the Piers-Harris children’s self-concept scale (PHSCS), family assessment device (FAD), Turgay DSM-IV-based screening and rating scale for disruptive behavior disorders (T-DSM-IV-S), children's depression inventory (CDI), Beck depression inventory (BDI), state-trait anxiety inventory (STAI), children’s sleep habits questionnaire (CSHQ), and autism spectrum quotient-adolescent (AQ-adolescent) were used.
Results: NF1 patients had lower intellectual functioning/academic achievement (p=0.002) and popularity/social appreciation (p<0.001) subscale scores in addition to total self-esteem (p=0.002) scores compared to the control group. Inattentiveness (p=0.024), state anxiety (p=0.028), and trait anxiety (p=0.012) symptoms were more common in these patients, and autistic features were more conspicuous in adolescents (p<0.001). Mother’s depression (p=0.045), and state and trait anxiety (p=0.016, and p=0.006, respectively) levels were higher in the NF1 group. Depression, state anxiety, and hyperactivity were found predictors of self-concept in children and adolescents with NF1 (p<0.001, p=0.036, and p=0.016, respectively).
Conclusion: Turkish children and adolescents with NF1 face substantial challenges related to their self-concept and psychological health, particularly in academic and social domains, compared to their peers. It seems important to be aware of poor self-concept and related psychological factors in NF patients early in life and to develop intervention programs to address this issue.

Thanks

One of the authors of our article, Prof. Dr. Elvan Çağlar Çıtak passed away shortly after the completion of being written the article. We are grateful to him for his precious contribution to the article.

References

  • Elbeltagy M, Abbassy M. Neurofibromatosis type1, type 2, tuberous sclerosis and Von Hippel-Lindau disease. Childs Nerv Syst. 2023;39(10):2791-806.
  • Brar KS, Trivedi C, Kaur N, Adnan M, Patel H, Beg U, et al. Prevalence of psychiatric comorbidities in patients with neurofibromatosis. Prim Care Companion CNS Disord. 2023;25(5):23m03514.
  • National Institute of Neurological Disorders and Stroke. Neurofibromatosis. Bethesda, MD: NINDS Publication; 2023.
  • Lee TJ, Chopra M, Kim RH, Parkin PC, Barnett-Tapia C. Incidence and prevalence of neurofibromatosis type 1 and 2: a systematic review and meta-analysis. Orphanet J Rare Dis. 2023;18(1):292.
  • Friedman JM. Neurofibromatosis 1. In: Adam MP, Feldman J, Mirzaa GM, Pagon RA, Wallace SE, Bean LJH, et al., editors. GeneReviews®. Seattle (WA): University of Washington, Seattle; 2018.
  • Beaussart ML, Barbarot S, Mauger C, Roy A. Systematic review and meta-analysis of executive functions in preschool and school-age children with neurofibromatosis type 1. J Int Neuropsychol Soc. 2018;24(9):977-94.
  • Molosh AI, Shekhar A. Neurofibromatosis type 1 as a model system to study molecular mechanisms of autism spectrum disorder symptoms. Prog Brain Res. 2018;241:37-62.
  • Sánchez Marco SB, López Pisón J, Calvo Escribano C, González Viejo I, Miramar Gallart MD, Samper Villagrasa P. Neurological manifestations of neurofibromatosis type 1: our experience. Neurologia (Engl Ed). 2022;37(5):325-33.
  • Torres Nupan MM, Velez Van Meerbeke A, López Cabra CA, Herrera Gomez PM. Cognitive and behavioral disorders in children with neurofibromatosis type 1. Front Pediatr. 2017;5:227.
  • Smith TF, Kaczorowski JA, Acosta MT. An executive functioning perspective in neurofibromatosis type 1: from ADHD and autism spectrum disorder to research domains. Childs Nerv Syst. 2020;36(10):2321-32.
  • Barton B, North K. The self-concept of children and adolescents with neurofibromatosis type 1. Child Care Health Dev. 2007;33(4):401-8.
  • Gore JS, Cross SE. Defining and measuring self-concept change. Psychol Stud. 2011;56(1):135-41.
  • Elliott GC. Dimensions of the self-concept: a source of further distinctions in the nature of self-consciousness. J Youth Adolesc. 1984;13(4):285-307.
  • Cole DA, Maxwell SE, Martin JM, Peeke LG, Seroczynski AD, Tram JM, et al. The development of multiple domains of child and adolescent self-concept: a cohort sequential longitudinal design. Child Dev. 2001;72(6):1723-46.
  • Ahn JA, Lee S. Peer attachment, perceived parenting style, self-concept, and school adjustments in adolescents with chronic illness. Asian Nurs Res (Korean Soc Nurs Sci). 2016;10(4):300-4.
  • Krab LC, Oostenbrink R, de Goede-Bolder A, Aarsen FK, Elgersma Y, Moll HA. Health-related quality of life in children with neurofibromatosis type 1: contribution of demographic factors, disease-related factors, and behavior. J Pediatr. 2009;154(3):420-5.
  • Ejerskov C, Lasgaard M, Østergaard JR. Teenagers and young adults with neurofibromatosis type 1 are more likely to experience loneliness than siblings without the illness. Acta Paediatr. 2015;104(6):604-9.
  • Hummelvoll G, Antonsen KM. Young adults' experience of living with neurofibromatosis type 1. J Genet Couns. 2013;22(2):188-99.
  • Rosnau K, Hashmi SS, Northrup H, Slopis J, Noblin S, Ashfaq M. Knowledge and self-esteem of individuals with neurofibromatosis type 1 (NF1). J Genet Couns. 2017;26(3):620-7.
  • Aksu B. Rare disease and orphan drug situations in Turkey and around the world. A J Health Sci. 2019;1(2):95-109.
  • Demir Gündoğan B, Tuğ Bozdoğan S, Ayhan YS, Müjde C, Bişgin A, Çitak EÇ. Clinical findings and mutational spectrum of neurofibromatosis type 1 patients in a single center of south part of Turkey. Turk J Med Sci. 2021;[Epub ahead of print]. doi: 10.3906/sag-2101-401.
  • Gonca Kaçar A, Kılınc Oktay B, Çınar Özel S, Ocak S, Güneş N, Uludağ Alkaya D, et al. Neurofibromatosis type 1 in children: a single-center experience. Turk Arch Pediatr. 2021;56(4):339-43.
  • Aydin S, Kurtcan S, Alkan A, Guler S, Filiz M, Yilmaz TF, et al. Relationship between the corpus callosum and neurocognitive disabilities in children with NF-1: diffusion tensor imaging features. Clin Imaging. 2016;40(6):1092-5.
  • Terzi YK, Oğuzkan-Balci S, Anlar B, Erdoğan-Bakar E, Ayter S. Learning disability and oligodendrocyte myelin glycoprotein (OMGP) gene in neurofibromatosis type 1. Turk J Pediatr. 2011;53(1):75-8.
  • Erdoğan-Bakar E, Cinbiş M, Ozyürek H, Kiriş N, Altunbaşak S, Anlar B. Cognitive functions in neurofibromatosis type 1 patients and unaffected siblings. Turk J Pediatr. 2009;51(6):565-71.
  • Legius E, Messiaen L, Wolkenstein P, Pancza P, Avery RA, Berman Y, et al. Revised diagnostic criteria for neurofibromatosis type 1 and Legius syndrome: an international consensus recommendation. Genet Med. 2021;23(8):1506-13.
  • American Psychiatric Association (APA). Diagnostic and statistical manual of mental disorders, 5th ed. Washington, DC: APA; 2013.
  • Piers EV. Revised manual for the Piers-Harris Children’s Self Concept Scale, 2nd ed. Los Angeles, CA: Western Psychological Services; 1984.
  • Öner N. Manual of the Piers-Harris children’s self-concept scale, 1st ed. Ankara: Turkish Psychologists Association Publications; 1996. Turkish.
  • Epstein NB, Baldwin LM, Bishop DS. The McMaster family assessment device. J Marital Fam Ther. 1983;9(2):171-80.
  • Bulut I. Handbook of family assessment device, 1st ed. Ankara: Özgüzeliş Matbaası; 1990. Turkish.
  • Ercan ES, Amado S, Somer O, Cıkoglu S. Development of a test battery for the assessment of attention deficit hyperactivity disorder. Turk J Child Adolesc Ment Health. 2001;8(3):132-44. Turkish.
  • Kovacs M. The children's depression inventory (CDI). Psychopharmacol Bull. 1985;21(4):995-8.
  • Oy B. Reliability and validity study of the children’s depression inventory. Turk J Psychiatry. 1991;2(2):137-40. Turkish.
  • Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561-71.
  • Hisli N. Validity and reliability of Beck Depression Inventory in university students. Turk J Psychol. 1989;7(23):3-13. Turkish.
  • Gaudry E, Vagg P, Spielberger CD. Validation of the state-trait distinction in anxiety research. Multivariate Behav Res. 1975;10(3):331-41.
  • Öner N, Le Compte A. Handbook of state-trait anxiety inventory. İstanbul: Boğaziçi University Press; 1998.
  • Owens JA, Spirito A, McGuinn M. The children’s sleep habits questionnaire (CSHQ): psychometric properties of a survey instrument for school-aged children. Sleep. 2000;23(8):1043-51.
  • Perdahlı Fiş N, Arman A, Ay P, Topuzoglu A, Guler AS, Gökçe Imren S, et al. The validity and the reliability of Turkish Version of Children’s Sleep Habits Questionnaire. Anatolian J Psychiatry. 2010;11(2):151-60.
  • Baron-Cohen S, Hoekstra RA, Knickmeyer R, Wheelwright S. The autism-spectrum quotient (AQ)-adolescent version. J Autism Dev Disord. 2006;36(3):343-50.
  • Cetinoglu E, Aras S. The autism-spectrum quotient (AQ) adolescent’s version in Turkey: factor structure, reliability and validity. J Autism Dev Disord. 2022;52(7):3260-70. Turkish.
  • Wang DL, Smith KB, Esparza S, Leigh FA, Muzikansky A, Park ER, et al. Emotional functioning of patients with neurofibromatosis tumor suppressor syndrome. Genet Med. 2012;14(12):977-82.
  • Ünal F, Öktem F, Çetin Çuhadaroğlu F, Çengel Kültür SE, Akdemir D, Foto Özdemir D, et al. Reliability and validity of the schedule for affective disorders and schizophrenia for school-age children-present and lifetime version, DSM-5 November 2016-Turkish adaptation (K-SADS-PL-DSM-5-T). Turk J Psychiatry. 2019;30(1):42-50. Turkish.
  • Descheemaeker MJ, Ghesquière P, Symons H, Fryns JP, Legius E. Behavioural, academic and neuropsychological profile of normally gifted Neurofibromatosis type 1 children. J Intellect Disabil Res. 2005;49(Pt 1):33-46.
  • Cavallo ND, Maggi G, Ferraiuolo F, Sorrentino A, Perrotta S, Carotenuto M, et al. Neuropsychiatric manifestations, reduced self-esteem and poor quality of life in children and adolescents with neurofibromatosis type 1 (NF1): the impact of symptom visibility and bullying behavior. Children (Basel). 2023;10(2):330.

Nörofibromatozis Tip 1 Tanılı Çocuk ve Ergenlerde Benlik Kavramı, Aile İşlevleri, Ruhsal ve Emosyonel Semptomlar

Year 2024, Issue: Early Access
https://doi.org/10.18678/dtfd.1509447

Abstract

Amaç: Bu çalışma, nörofibromatozis tip 1 (NF1) tanısı olan çocuk ve ergenlerde benlik kavramını ve ilişkili psikolojik faktörleri incelemeyi amaçlamaktadır.
Gereç ve Yöntemler: Bu çalışmaya toplam 71 katılımcı (35 hasta ve 36 kontrol) dahil edildi. Ölçme aracı olarak Piers-Harris çocuklar için benlik kavramı ölçeği (PHBKÖ), aile değerlendirme ölçeği (ADÖ), Turgay yıkıcı davranım bozuklukları için DSM-IV’e dayalı tarama ve değerlendirme ölçeği (YDB- TDÖ), çocuklar için depresyon ölçeği (ÇDÖ), Beck depresyon envanteri (BDE), durumluk-sürekli kaygı envanteri (DSKE), çocuk uyku alışkanlıkları anketi (ÇUAA) ve otizm spektrum anketi-ergen formu (OSA-ergen) uygulandı.
Bulgular: NF1 hastaları, kontrol grubuna kıyasla daha düşük toplam benlik kavramı puanlarının (p=0,002) yanı sıra daha düşük zihinsel işlevsellik/akademik başarı (p=0,002) ve popülerlik/sosyal beğeni (p<0,001) alt ölçek puanlarına sahipti. Dikkat eksikliği (p=0,024), durumluk anksiyete (p=0,028) ve sürekli anksiyete (p=0,012) semptomları bu hastalarda daha sıktı ve ergenlerde otistik özellikler (p<0,001) daha belirgindi. Annelerin depresyon (p=0,045) ve durumluk ve sürekli kaygı (sırasıyla p=0,016 ve p=0,006) düzeyleri NF1 grubunda daha yüksekti. NF1 tanılı çocuk ve ergenlerde depresyon, durumluk anksiyete ve hiperaktivite, benlik kavramının yordayıcıları olduğunu gösterdi (sırasıyla, p<0,001, p=0,036 ve p=0,016).
Sonuç: NF1 tanısı olan Türk çocuk ve ergenler, akranlarına kıyasla, özellikle akademik ve sosyal alanlarda olmak üzere benlik kavramları ve psikolojik sağlıkları ile ilgili önemli zorluklarla karşılaşmaktadır. NF hastalarındaki zayıf benlik kavramının ve ilişkili psikolojik faktörlerin yaşamın erken dönemlerinde farkında olmak ve buna yönelik müdahale programları geliştirmek önemli görünmektedir.

References

  • Elbeltagy M, Abbassy M. Neurofibromatosis type1, type 2, tuberous sclerosis and Von Hippel-Lindau disease. Childs Nerv Syst. 2023;39(10):2791-806.
  • Brar KS, Trivedi C, Kaur N, Adnan M, Patel H, Beg U, et al. Prevalence of psychiatric comorbidities in patients with neurofibromatosis. Prim Care Companion CNS Disord. 2023;25(5):23m03514.
  • National Institute of Neurological Disorders and Stroke. Neurofibromatosis. Bethesda, MD: NINDS Publication; 2023.
  • Lee TJ, Chopra M, Kim RH, Parkin PC, Barnett-Tapia C. Incidence and prevalence of neurofibromatosis type 1 and 2: a systematic review and meta-analysis. Orphanet J Rare Dis. 2023;18(1):292.
  • Friedman JM. Neurofibromatosis 1. In: Adam MP, Feldman J, Mirzaa GM, Pagon RA, Wallace SE, Bean LJH, et al., editors. GeneReviews®. Seattle (WA): University of Washington, Seattle; 2018.
  • Beaussart ML, Barbarot S, Mauger C, Roy A. Systematic review and meta-analysis of executive functions in preschool and school-age children with neurofibromatosis type 1. J Int Neuropsychol Soc. 2018;24(9):977-94.
  • Molosh AI, Shekhar A. Neurofibromatosis type 1 as a model system to study molecular mechanisms of autism spectrum disorder symptoms. Prog Brain Res. 2018;241:37-62.
  • Sánchez Marco SB, López Pisón J, Calvo Escribano C, González Viejo I, Miramar Gallart MD, Samper Villagrasa P. Neurological manifestations of neurofibromatosis type 1: our experience. Neurologia (Engl Ed). 2022;37(5):325-33.
  • Torres Nupan MM, Velez Van Meerbeke A, López Cabra CA, Herrera Gomez PM. Cognitive and behavioral disorders in children with neurofibromatosis type 1. Front Pediatr. 2017;5:227.
  • Smith TF, Kaczorowski JA, Acosta MT. An executive functioning perspective in neurofibromatosis type 1: from ADHD and autism spectrum disorder to research domains. Childs Nerv Syst. 2020;36(10):2321-32.
  • Barton B, North K. The self-concept of children and adolescents with neurofibromatosis type 1. Child Care Health Dev. 2007;33(4):401-8.
  • Gore JS, Cross SE. Defining and measuring self-concept change. Psychol Stud. 2011;56(1):135-41.
  • Elliott GC. Dimensions of the self-concept: a source of further distinctions in the nature of self-consciousness. J Youth Adolesc. 1984;13(4):285-307.
  • Cole DA, Maxwell SE, Martin JM, Peeke LG, Seroczynski AD, Tram JM, et al. The development of multiple domains of child and adolescent self-concept: a cohort sequential longitudinal design. Child Dev. 2001;72(6):1723-46.
  • Ahn JA, Lee S. Peer attachment, perceived parenting style, self-concept, and school adjustments in adolescents with chronic illness. Asian Nurs Res (Korean Soc Nurs Sci). 2016;10(4):300-4.
  • Krab LC, Oostenbrink R, de Goede-Bolder A, Aarsen FK, Elgersma Y, Moll HA. Health-related quality of life in children with neurofibromatosis type 1: contribution of demographic factors, disease-related factors, and behavior. J Pediatr. 2009;154(3):420-5.
  • Ejerskov C, Lasgaard M, Østergaard JR. Teenagers and young adults with neurofibromatosis type 1 are more likely to experience loneliness than siblings without the illness. Acta Paediatr. 2015;104(6):604-9.
  • Hummelvoll G, Antonsen KM. Young adults' experience of living with neurofibromatosis type 1. J Genet Couns. 2013;22(2):188-99.
  • Rosnau K, Hashmi SS, Northrup H, Slopis J, Noblin S, Ashfaq M. Knowledge and self-esteem of individuals with neurofibromatosis type 1 (NF1). J Genet Couns. 2017;26(3):620-7.
  • Aksu B. Rare disease and orphan drug situations in Turkey and around the world. A J Health Sci. 2019;1(2):95-109.
  • Demir Gündoğan B, Tuğ Bozdoğan S, Ayhan YS, Müjde C, Bişgin A, Çitak EÇ. Clinical findings and mutational spectrum of neurofibromatosis type 1 patients in a single center of south part of Turkey. Turk J Med Sci. 2021;[Epub ahead of print]. doi: 10.3906/sag-2101-401.
  • Gonca Kaçar A, Kılınc Oktay B, Çınar Özel S, Ocak S, Güneş N, Uludağ Alkaya D, et al. Neurofibromatosis type 1 in children: a single-center experience. Turk Arch Pediatr. 2021;56(4):339-43.
  • Aydin S, Kurtcan S, Alkan A, Guler S, Filiz M, Yilmaz TF, et al. Relationship between the corpus callosum and neurocognitive disabilities in children with NF-1: diffusion tensor imaging features. Clin Imaging. 2016;40(6):1092-5.
  • Terzi YK, Oğuzkan-Balci S, Anlar B, Erdoğan-Bakar E, Ayter S. Learning disability and oligodendrocyte myelin glycoprotein (OMGP) gene in neurofibromatosis type 1. Turk J Pediatr. 2011;53(1):75-8.
  • Erdoğan-Bakar E, Cinbiş M, Ozyürek H, Kiriş N, Altunbaşak S, Anlar B. Cognitive functions in neurofibromatosis type 1 patients and unaffected siblings. Turk J Pediatr. 2009;51(6):565-71.
  • Legius E, Messiaen L, Wolkenstein P, Pancza P, Avery RA, Berman Y, et al. Revised diagnostic criteria for neurofibromatosis type 1 and Legius syndrome: an international consensus recommendation. Genet Med. 2021;23(8):1506-13.
  • American Psychiatric Association (APA). Diagnostic and statistical manual of mental disorders, 5th ed. Washington, DC: APA; 2013.
  • Piers EV. Revised manual for the Piers-Harris Children’s Self Concept Scale, 2nd ed. Los Angeles, CA: Western Psychological Services; 1984.
  • Öner N. Manual of the Piers-Harris children’s self-concept scale, 1st ed. Ankara: Turkish Psychologists Association Publications; 1996. Turkish.
  • Epstein NB, Baldwin LM, Bishop DS. The McMaster family assessment device. J Marital Fam Ther. 1983;9(2):171-80.
  • Bulut I. Handbook of family assessment device, 1st ed. Ankara: Özgüzeliş Matbaası; 1990. Turkish.
  • Ercan ES, Amado S, Somer O, Cıkoglu S. Development of a test battery for the assessment of attention deficit hyperactivity disorder. Turk J Child Adolesc Ment Health. 2001;8(3):132-44. Turkish.
  • Kovacs M. The children's depression inventory (CDI). Psychopharmacol Bull. 1985;21(4):995-8.
  • Oy B. Reliability and validity study of the children’s depression inventory. Turk J Psychiatry. 1991;2(2):137-40. Turkish.
  • Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561-71.
  • Hisli N. Validity and reliability of Beck Depression Inventory in university students. Turk J Psychol. 1989;7(23):3-13. Turkish.
  • Gaudry E, Vagg P, Spielberger CD. Validation of the state-trait distinction in anxiety research. Multivariate Behav Res. 1975;10(3):331-41.
  • Öner N, Le Compte A. Handbook of state-trait anxiety inventory. İstanbul: Boğaziçi University Press; 1998.
  • Owens JA, Spirito A, McGuinn M. The children’s sleep habits questionnaire (CSHQ): psychometric properties of a survey instrument for school-aged children. Sleep. 2000;23(8):1043-51.
  • Perdahlı Fiş N, Arman A, Ay P, Topuzoglu A, Guler AS, Gökçe Imren S, et al. The validity and the reliability of Turkish Version of Children’s Sleep Habits Questionnaire. Anatolian J Psychiatry. 2010;11(2):151-60.
  • Baron-Cohen S, Hoekstra RA, Knickmeyer R, Wheelwright S. The autism-spectrum quotient (AQ)-adolescent version. J Autism Dev Disord. 2006;36(3):343-50.
  • Cetinoglu E, Aras S. The autism-spectrum quotient (AQ) adolescent’s version in Turkey: factor structure, reliability and validity. J Autism Dev Disord. 2022;52(7):3260-70. Turkish.
  • Wang DL, Smith KB, Esparza S, Leigh FA, Muzikansky A, Park ER, et al. Emotional functioning of patients with neurofibromatosis tumor suppressor syndrome. Genet Med. 2012;14(12):977-82.
  • Ünal F, Öktem F, Çetin Çuhadaroğlu F, Çengel Kültür SE, Akdemir D, Foto Özdemir D, et al. Reliability and validity of the schedule for affective disorders and schizophrenia for school-age children-present and lifetime version, DSM-5 November 2016-Turkish adaptation (K-SADS-PL-DSM-5-T). Turk J Psychiatry. 2019;30(1):42-50. Turkish.
  • Descheemaeker MJ, Ghesquière P, Symons H, Fryns JP, Legius E. Behavioural, academic and neuropsychological profile of normally gifted Neurofibromatosis type 1 children. J Intellect Disabil Res. 2005;49(Pt 1):33-46.
  • Cavallo ND, Maggi G, Ferraiuolo F, Sorrentino A, Perrotta S, Carotenuto M, et al. Neuropsychiatric manifestations, reduced self-esteem and poor quality of life in children and adolescents with neurofibromatosis type 1 (NF1): the impact of symptom visibility and bullying behavior. Children (Basel). 2023;10(2):330.
There are 46 citations in total.

Details

Primary Language English
Subjects Paediatrics (Other)
Journal Section Research Article
Authors

Gülen Güler Aksu 0000-0001-9555-3916

Özlem Tezol 0000-0001-9994-7832

Meryem Özlem Kütük 0000-0002-2918-7871

Ozan Kayar 0000-0002-1269-3719

Ali Evren Tufan 0000-0001-5207-6240

İrem Kargın 0000-0003-0224-3682

Pelin Dağ 0000-0002-5051-3459

İsmail Dorukhan Erk 0000-0002-9162-5561

Fevziye Toros 0000-0001-5402-9157

Early Pub Date November 30, 2024
Publication Date
Submission Date July 3, 2024
Acceptance Date November 9, 2024
Published in Issue Year 2024 Issue: Early Access

Cite

APA Güler Aksu, G., Tezol, Ö., Kütük, M. Ö., Kayar, O., et al. (2024). The Self-Concept, Family Functioning, Psychological and Emotional Symptoms, in Children and Adolescents with Neurofibromatosis Type 1. Duzce Medical Journal(Early Access). https://doi.org/10.18678/dtfd.1509447
AMA Güler Aksu G, Tezol Ö, Kütük MÖ, Kayar O, Tufan AE, Kargın İ, Dağ P, Erk İD, Toros F. The Self-Concept, Family Functioning, Psychological and Emotional Symptoms, in Children and Adolescents with Neurofibromatosis Type 1. Duzce Med J. November 2024;(Early Access). doi:10.18678/dtfd.1509447
Chicago Güler Aksu, Gülen, Özlem Tezol, Meryem Özlem Kütük, Ozan Kayar, Ali Evren Tufan, İrem Kargın, Pelin Dağ, İsmail Dorukhan Erk, and Fevziye Toros. “The Self-Concept, Family Functioning, Psychological and Emotional Symptoms, in Children and Adolescents With Neurofibromatosis Type 1”. Duzce Medical Journal, no. Early Access (November 2024). https://doi.org/10.18678/dtfd.1509447.
EndNote Güler Aksu G, Tezol Ö, Kütük MÖ, Kayar O, Tufan AE, Kargın İ, Dağ P, Erk İD, Toros F (November 1, 2024) The Self-Concept, Family Functioning, Psychological and Emotional Symptoms, in Children and Adolescents with Neurofibromatosis Type 1. Duzce Medical Journal Early Access
IEEE G. Güler Aksu, Ö. Tezol, M. Ö. Kütük, O. Kayar, A. E. Tufan, İ. Kargın, P. Dağ, İ. D. Erk, and F. Toros, “The Self-Concept, Family Functioning, Psychological and Emotional Symptoms, in Children and Adolescents with Neurofibromatosis Type 1”, Duzce Med J, no. Early Access, November 2024, doi: 10.18678/dtfd.1509447.
ISNAD Güler Aksu, Gülen et al. “The Self-Concept, Family Functioning, Psychological and Emotional Symptoms, in Children and Adolescents With Neurofibromatosis Type 1”. Duzce Medical Journal Early Access (November 2024). https://doi.org/10.18678/dtfd.1509447.
JAMA Güler Aksu G, Tezol Ö, Kütük MÖ, Kayar O, Tufan AE, Kargın İ, Dağ P, Erk İD, Toros F. The Self-Concept, Family Functioning, Psychological and Emotional Symptoms, in Children and Adolescents with Neurofibromatosis Type 1. Duzce Med J. 2024. doi:10.18678/dtfd.1509447.
MLA Güler Aksu, Gülen et al. “The Self-Concept, Family Functioning, Psychological and Emotional Symptoms, in Children and Adolescents With Neurofibromatosis Type 1”. Duzce Medical Journal, no. Early Access, 2024, doi:10.18678/dtfd.1509447.
Vancouver Güler Aksu G, Tezol Ö, Kütük MÖ, Kayar O, Tufan AE, Kargın İ, Dağ P, Erk İD, Toros F. The Self-Concept, Family Functioning, Psychological and Emotional Symptoms, in Children and Adolescents with Neurofibromatosis Type 1. Duzce Med J. 2024(Early Access).