The
Huntington's Scene In New Zealand |
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Key NZ Site Resources :Young Peoples Camp & Research |
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Part I: Camp Overview [back to the top] Introduction In 1993, members of the Wellington Huntington's Disease Association agreed that it would be a good idea to run camps for young people from families with Huntington's Disease. With the encouragement of parents, the Association organised the first camp over a long weekend in January 1994. A six-day camp was held in 1995 and a four-day camp in 1996. Another camp will be held in April 1997. All three camps have had the following objectives:
Each camp has included a range of outdoor activities as well as discussion groups run by an experienced counsellor/facilitator. Some camps have had visits from speakers who have talked to young people about various aspects of the disease. In 1996, the Association decided to review the camps to see whether the children and their parents find them of value and to identify any positive or negative effects. Aims of the review The aims of the review were to:
Who took part in the review Participants in the camps came from all over New Zealand, including Auckland, Hamilton, Wanganui, Wellington, Nelson, Ashburton, Greymouth and Invercargill. Numbers attending each of the camps varied, with the second camp being the largest: Camp one 18 participants ranging in age from 6 to 16, including four family groups Camp two 34 participants ranging in age from 6 to 16, including nine family groups Camp three 21 participants ranging in age from 8 to 18, including four family groups Altogether 37 young people from 23 families have attended at least one of the three camps and most have attended more than one. All 37 young people and their parents or caregivers were invited to take part in the survey. Interviews were completed with 22 children and 16 parents or caregivers from 16 families, that is, with 60% of the young people and 70% of parents. One family with three children had moved to Australia; two families did not want to take part and four families could not be contacted. (The interviews took place over the summer holidays and some children or families were away during that time). Ten young people and their parents were interviewed in person; the remainder were interviewed by telephone because they lived too far away to visit. The young people interviewed included 13 girls and 9 boys. As 20 girls and 17 boys have attended the camps, girls are over-represented in the sample. The ages of the young people at the time of interview ranged from 9 to 19. All would have been younger when they first began attending camps.
Age at time of interview
Fifteen of the 22 had a parent or step-parent with the disease; 7 had a grandparent with Huntingtons. All but two of the children are at risk of the disease themselves. Eleven female and five male parents or caregivers were interviewed; six were in their 30s, eight in their 40s and one each in their 50s and 60s. Four parents are at risk of or have been diagnosed with the disease, 12 are not at risk. This report looks first at the young peoples experience, then at their parents responses. It concludes with a discussion of the camps and where the camps might go in the future.
Part II : The Young Peoples Views [back to the top] Going to camp Nine young people had attended all three camps. Nine young people had attended two camps. Five attended the two most recent camps; four the two earlier camps. The cost of travel meant three of the four could not attend the last camp; and one person was not living at home at the time of the latest camp. Four young people had attended only one camp, two the most recent one reviewed (1996) and two the year before (1995). The two who first attended in 1996 had only recently learned that Huntington's Disease was in their family. Of the two who went to the 1995 but not the 1996 camp, both had family commitments at the time of the second camp. All but one of the young people said they would like to go to another camp if they could; one person who is not at risk of the disease, was unsure Which camp was best? Ten of the 18 young people who went to more than one camp said that although they enjoyed all the camps, the second camp was easier than the first because they "knew people and what to expect". On the other hand, four enjoyed the first camp best because they "learned more and met a lot of new people". Others enjoyed all the camps. Who decided you would go? Eighteen of the 22 young people said they had a choice about whether or not they attended the camps. Two made the decision jointly with their parents and two said their parents decided they would go to the first camp but they decided to go back to subsequent camps themselves. One girl, now 17, commented:
The young people were keen to learn more about Huntington's Disease. Eleven of the 18 who had a choice about going to the camp said that wanting to learn more about the disease was one of the main reasons for going. Six mentioned it as the only reason. The 11 included six girls and five boys aged from 13 to 17. A 14 year-old boy who has been to all three camps said:
Eight young people thought the camp sounded fun and were attracted by the activities. (Three also wanted to learn more about Huntington's Disease.) Five were aged 14 or under and the group included five boys and three girls. A 16 year-old boy said: I decided jointly with my mother and father (that I would go), I thought the activities would be really fun. An 11 year-old girl was told about the camps by her mother "and when I saw what they did I wanted to go." The third reason children wanted to go was to meet people in a similar situation. Seven gave this as one reason why they wanted to go; five of the seven were girls; the youngest in the group was 13 and the oldest is now 19. Comments from 14 year-old and 16 year-old girls were: I didnt really know what Huntington's Disease was and I wanted to meet other people in the same situation. I wanted to go. I read about the camp in the newsletter. I thought Id learn more and meet people. Learning about Huntington's Disease All the young people learned more about Huntington's Disease at the camps. Some already had a reasonable knowledge of the disease, others came with little information about it or understanding of it. They said they learned about the various stages of the disease including the emotional aspects and the fact that everybody is different, as well as the hereditary and genetic aspects of it and what they might expect in the future. All appreciated what they had learned, including a 17 year-old girl who said:
A 16 year-old girl made a similar comment:
Even the youngest person interviewed found the information helpful:
Several young people commented that they learned more at the first camp than at subsequent camps, which is understandable. Two said they found the scientific explanations by the geneticist at the most recent camp difficult to follow. (Participation in the session was voluntary and a number of younger people did not attend.) The camp also provided the first opportunity for some young people to see someone with advanced Huntington's Disease when family members visited for one day. One young man who had little direct experience of Huntington's Disease found the experience challenging: I have more understanding but its pretty frightening. I was pretty worried - a bit for myself, seeing how much you have to be looked after.
All the young people interviewed said that they had a greater understanding of Huntington's Disease from going to the camps. The seven who had a grandparent with the disease said they understood their grandparents behaviour better. Those who saw their grandparent regularly coped better. Fifteen of the young people had a parent or step-parent with the disease. The mother of two young respondents had died from Huntington's Disease before they came to the camp. They still found the information helpful: It was helpful - I didnt understand at all before I went. I learned how it developed and what happens. It made me feel much better. They were also aware that they knew more than some of the other young people at the camp which was sometimes a problem:
Eight of the other 13 young people said that being at the camp had changed the way they felt about their affected parent, making them more tolerant, sympathetic or understanding and helping them cope better. Five said the camp made no difference because they had always got on well with that parent. Neither age nor gender seemed to make any difference to the way young people responded to the information they received. One 16 year-old boy commented that the camp was:
A 17 year-old girl said:
A 16 year-old boy said the camps had helped him on an everyday basis: It didnt change the way I feel about it although I got more understanding about it. I cope better with my Dad. We used to have lots of fights. We still have them but I understand more about them and they taught us how to cope, like walking away so thats got better. Friends and teachers Girls were more likely than boys to have talked to their friends or teachers about Huntington's Disease. Ten of the 13 girls had talked to friends but only two of the nine boys had done so. Very few had talked to teachers although four said their teachers know that Huntington's Disease was in the family. One person told her science teacher when the class was doing genetics to make it easier for me. Both boys and girls who talked to friends said they did not talk about Huntington's Disease unless the friends asked and in most cases the friends did not really understand - its not very real to them. One chose to talk to a friend whose mother has multiple sclerosis. Another compared her own experience with friends in a similar situation:
Both girls and boys said that going to the camp made it easier to talk about the disease and to explain it to friends but there lack of experience was still a barrier to understanding. One had explained to friends that she is at risk. Thats hard on my friends, Im not sure if they understand it.
Being at risk Twenty of the 22 children were at risk and one had already taken the predictive test. Nine of the 20, including seven girls and two boys aged between 11 and 17, said they knew they were at risk but rarely thought about it. Some thought the matter would become more relevant later when they had to make decisions about their future. A 17 year-old girl was typical of young peoples response to being at risk:
Two 15 year-old girls commented: We talked about being at risk - I dont worry because Dads old and he hasnt got it yet. I feel OK about it. Dad hasnt taken the test so I dont worry. I would take the test if Dad gets it so I would know about having children. Seven were still unhappy at being at risk, although again they could do little about it till they became eligible for the test. Even then they were unsure whether they would take the test or not. These comments are from two 16 year-old boys.
Four said the discussions at the camp made them feel better about being at risk. A 17 year-old girl was typical of other girls who said they would consider predictive testing should they become pregnant or want to start a family. She said being at the camp:
A 14 year-old girl was philosophical:
None had made any specific plans or done anything differently as a result of knowing they were at risk. Even the person who had taken the predictive test had, within a few months of getting the results, settled back into her former life.
All the young people said they got enough support from others at the camp, and for many , being with others in a similar situation was clearly the best part. It is hard in a written report to convey their enthusiasm on this topic. Their comments included:
Knowing about Huntington's Disease Every one of the 22 young people interviewed was glad they knew about Huntington's Disease. All said they would rather know than not know. One who first found out about the disease at 15 thought she should have known much earlier. They also agreed that children should be told "as soon as they are old enough to understand." Estimates of when that might be ranged from five to 13 or 14 but were always at least two years younger than when the young people themselves had first heard about the disease. Hiding it from people makes it harder to take - like basically tell the truth, especially if its their parent whos got it and especially if theyve got symptoms. Three people qualified their comments: Being told youre at risk might be scary for younger children - you need to be 13-14 onwards to talk about it If the parent is not showing symptoms maybe you dont need to know - it depends on the symptoms and on the child. Tell them when theyre 13 or 14 when they understand. I noticed the younger ones handled it really well so you could tell them early. I guess it depends on the situation. The camps themselves All the young people wanted the camps at least once a year because a larger gap would mean "youd lose touch". Two would like to have them more often while one thought that if the numbers dropped it would be appropriate to have them every two years but he hoped that would not happen. All wanted national camps rather than separate camps for the North and South Islands and none wanted parents to be involved. They saw the camps as an opportunity for families to have time away from each other and for young people to have the opportunity to talk freely about things they could not talk about at home.
Activities between camps Only the Wellington Huntington's Disease Association offers activities for young people in between the camps. These have ranged from visits to a fast food restaurant to sleepovers at a local house. The young people were very positive about these gatherings and several who lived out of Wellington wanted to hear more about the Wellington activities in case they were able to attend. While some of the young people wanted adventure activities like bungy-jumping, others wanted less activity and more time to talk, particularly during an overnight stay. All wanted some kind of activity in each of the main school holidays. I dont want to go horse-riding or to Pizza Hut. I want more time to talk rather than doing things. We went to somebodys place once and that was really good - it was casual rather than organised. All but two of those who lived out of Wellington also wanted local activities but none had access to them at present. They acknowledged problems of cost, difficulties in organising activities and shyness as inhibiting factors. As one person said
I would like local activities. I think there are about 11 families here but I dont know them. I dont mind what we do. Age-mixing All but one of the young people wanted the age groups to remain mixed as they are now. One person, who is now 19, wanted the age groups split, with separate camps for 10 to 15 year-olds and 16 year-olds and over. Those who supported age-mixing said it was good to have the younger ones there, even though they could be annoying at time. They suggested that any problems could be solved by having some split time within the camp, perhaps including an overnight camp for older children. They also suggested there could be separate discussion groups: All in one camp but certain activities for 10 and up and 9 and under; some of the stuff we talk about is pretty scary - intimidating for small children - you could have some spilt discussion groups
Age mixing was fine and there was an age limit to the activities we did and separate dormitories. You felt you could be with people you wanted to be with. Discussion time Thirteen of the 22 young people thought the amount of time they had for discussions was about right; nine thought some of the discussions were too long. Two girls aged 14 and 15 said that they had learned most of what they needed to know at the first camp which made later discussions somewhat repetitive but both were happy to accommodate that:
The nine who thought that some of the discussions were too long included four girls and four boys aged between 11 and 16. All felt that individual sessions were too long and would have preferred more shorter sessions possibly during the day rather than in the evening when people are getting tired. A few suggested having more separate sessions for older children but the youngest person disagreed with this:
The young people particularly liked being able to ask questions and to put them in writing so that they are anonymous. They felt they had plenty of chance to have a say and none could think of any topics they wanted to talk about that were not covered. Some found the talk by the geneticist at the latest camp too long and technical but generally the format and content of discussions was acceptable. Two people specifically said they liked the craft activities such as building a sculpture or model of a place where they feel safe from Huntington's Disease but two others said they found these activities boring and unhelpful. The format of introductions and the counselling activities caused some comment. Three young people wanted different introductory games - "we do the same things every year - and they did not want to have to wear name tags. Others made no comment.
Free time Seventeen young people thought the amount of free time they had at the camps was about right. They had time to socialise, to prepare skits and to write their diaries. Two people thought there was too much free time at the last camp but that was because there was not a lot to do at the site. They preferred sites with scope for some leisure activities they organised themselves. Three would like more free time but did not feel strongly about the issue.
Activities The young people were most enthusiastic about the activities. Their eyes and voices lit up in discussing these. They were most enthusiastic about the high adrenalin activities such as bridge-swinging, abseiling and white water rafting. The latter was especially popular because it meant the whole group was together having fun. The least popular activity was caving. The young people were aware that the range of activities depended on the camp site They preferred outdoor to indoor activities although two 15 and 16 year-old boys were enthusiastic about the video parlour visit. One girl summed up the group feelings by describing the activities as wicked. Comments from two boys are typical:
Loved the bridge-swinging, the adrenalin stuff, caving is boring but I liked rafting - the whole group having fun, I liked the golf, liked different things each time. Liked caving and tramping least. The best were the physical and group activities - rafting, canoeing, bridge-swinging, abseiling. Would like small overnight camp with a subgroup of the main group. Only two new activities were suggested - four-wheel motorbike riding and an overnight camp with small groups of older children.
Child with Huntington's Disease As part of the interview, the young people were asked how they would feel about having a child with advanced Huntington's Disease at the camp. Only one person answered a clear Yes to this question and even those who said they would not mind were cautious. Ten of the 22 said they would not mind having a child with Huntington's Disease at the camp although one added that he had not seen anyone like that. Two acknowledged that "it would be a bit scary" and a reminder of what could happen to them Eleven were unsure or thought the child should not come. One girl familiar with the advanced stages of the disease said:
One girl thought the camps were for children at risk and that having a child already showing symptoms would be too upsetting. Another suggested the child could visit rather than stay the whole time. It would be difficult to include them in the activities, although the environment may be supportive.
Dislikes Very few people had any dislikes about the camps. Three did not like the food at one particular camp; one did not like having to travel a long distance to the camp and two of the younger members did not like having to go to bed early. One of the 14 year-olds who had been to all three camps had noticed a difference as the young people became teenagers and the nature of their relationships changed. Some are more distant now, moving apart and less interested in Huntington's Disease. He added that the changes were not enough to stop him looking forward to the next camp. For one girl, the worst thing was going home. They had few suggestions for improvements. Some would like the camps held out of the Wellington area, but that would require other Associations to become involved in the organisation. They generally preferred longer camps with five days rather than three, even if we only had organised activities on three of the days, we could spend time round the camp.
Good Things The people were clearly the best thing about the camps - making friends, getting to know people in a similar situation and being able to talk to people the same age who feel the same way. All the young people mentioned friendships as one of the best things about the camps. One 15 year-old girl summed up the responses:
A 15 year-old boy made a similar comment: Freely talking about it with the people round, the openness of it and the activities. The activities were also popular. Nine people included them among the best things about the camp. Two of the young people described themselves as lucky for being able to go to the camps:
The social worker who organised the three camps was much appreciated by the young people. They described her as a legend, shes awesome, I trusted her, shes a trouper and as really helpful. She gives us a shoulder to lean on, and helps us try to sort things out ourselves. I want her there again. A comment from a 17 year-old girl summed up peoples feelings about the camps when she described the best thing as:
The whole thing - this great big bond, all the support, I dont feel alone.
Part III : Parents or Caregivers Views [back to the top]
Sixteen parents from 10 families were interviewed. They included 10 mothers, 5 fathers and one other caregiver. Four were at risk of or had the disease themselves; 12 were not at risk. Their children had attended: One camp 3 Two camps 6 Three camps 7 Total 16
Giving permission Eleven of the 16 parents suggested that their child go to the camp; in four cases the suggestion came from the child and one was a mutual decision. The parents were very keen for their children to learn more about Huntington's Disease, particularly from people who knew what they were talking about and could give the children accurate information. One man whose wife had the disease:
They were also eager for their children to meet others in the same situation.
Two parents had some reservations at first about what the children might learn but were prepared to deal with the consequences. In one case the father had been diagnosed with the disease and the mother decided that as they were getting older, the children needed to know about Huntington's Disease. Another worried what he might be getting into: But talking to Dorothy fills me with confidence and they came back so happy I knew it was right. Others had what one described as the usual mother worries about their children being away from home for the first time, travelling on a plane or doing some of the activities rather than any concerns about Huntington's Disease itself. At the same time, every parent thought the children would be safe and well cared for. Although three parents noticed little change in their children after the camps, others said they noticed a considerable difference, with the first camp having a greater impact than later ones, generally because the children learned more at the first camp. Two parents comments were typical:
Noticed a huge difference- the first time it took a few days to get out what theyd received from it; the second trip up they came back full of confidence. One parent found it scary when her children came back from the first camp:
They came back with all the questions and we were not sure that we had all the answers; they wanted their father to take the test but it was his decision; later ones were OK. Arrangements, activities and discussions All parents said they had enough information before and after the camps and thought the camps were well-organised. One would like to know who will be attending the next camp but only to help with transport arrangements. All the parents approved of both the activities at the camp and the discussions. One commented that it was good for the young people to try different activities and while one mother worried about things like abseiling, she added that she knew her child was in capable hands. Parents were generally enthusiastic about the discussions, adding remarks like the more they know the better, I wanted the discussions, and she realised she is not alone, she used to feel alone. One admitted she did not know much about the discussions but trusted Dorothy (the organiser) to do the right thing and put the right knowledge across. Another approved of the fact that the young people could write questions down on paper if they were shy. Knowing about Huntington's Disease All the parents interviewed were very comfortable with their children knowing about Huntington's Disease. One reiterated that it was far better to know than not know; another said, rather ruefully, that although she was very comfortable with her children knowing about Huntington's Disease there were times when she wished that we all didnt know. All parents said their children learned more about Huntington's Disease at the camps and were comfortable with that knowledge. Even those young people who knew quite a lot before they went learned more or had their knowledge confirmed and expanded. One father appreciated the fact that women were involved in the camp:
Eight parents said their children did not change their behaviour either generally or in relation to their family member after going to the camps. Four said their child or children had always been supportive and related well to that person. That behaviour did not change. Two said their children were not living with or living close to a family member with Huntington's Disease and so did not have any particular reason to change their behaviour. The children from two families continued to relate to their family members as they had done before. One, whose mother has the disease, did not talk to her much before the camps because conversation is difficult and that has stayed the same. The other learned a lot but seems to have put it aside. He judges his father as a normal person. He gets the brunt of his fathers anger and doesnt know to keep quiet. The effects of the camp didnt last." The other eight parents or caregivers said their children had become more understanding, more supportive and better able to cope, particularly with a parents or grandparents anger. One gave an example of a practical change:
No parents or caregivers reported any negative outcomes as a result of young people attending the camps, although they acknowledged that their children could experience both sadness and anger.
One parent described the experiences of two of her children. Both experiences were related to the camps, but she did see them as negative outcomes . In fact, she believed that attending the camps had helped her children deal with the experiences and with their own feelings about the disease.
The camps themselves Twelve of the 16 parents thought the camps should be help once a year; two would like them more often, to give both the children and themselves a break. Two thought the timing should depend on the numbers and the age mix, or on childrens needs. Parents were very aware of the cost of the camps and recognised the demands of organising them. At the same time one noted that once a year is preferable to allow the young people to keep in touch. Once every two years is too long when youre young. One parent commented:
All thought the camps should be national rather than having separate camps for the North and South Island. All but three agreed with the current system of mixing the age groups. The three suggested that the older children could have some separate activities either as part of the camp or as a separate event. While most parents from out of Wellington wanted local activities for young people they acknowledged that these are hard to organise. One parent suggested that activities need to be organised by someone not directly involved with Huntington's Disease.
It is hard to get back-up for local activities. Huntington's Disease is very emotional. People say Yes, yes then something happens and they want nothing to do with it. You need someone else to do the arrangements, it can all be too close to home. Wellington parents were very appreciative of the local activities; some in other areas wanted to hear about activities in Wellington on the off-chance that they may be able to attend. They stressed that the children need to have time to talk and enough space in between for things to happen. Part IV : Discussion [back to the top]
There is no doubt that the camps have met their objectives and must be judged a success. They are appreciated by young people and parents alike and have had no negative outcomes. The review has highlighted a number of issues. One is the isolation of families with Huntington's Disease. Very few of the young people had others they could or did talk to about the disease. While girls were more likely than boys to talk to their friends about it, they commented that even their best friends did not really understand. Attending the camps not only gave them more information for themselves but also helped them explain their situation to others. Their pleasure in finding others in similar circumstances was obvious. They described the strong bonds that formed between them because of the particular nature of their shared experience. Parents reinforced the comments young people made and noted that many of the young people kept in touch with other either on a regular basis or when a crisis occurred. The importance of this form of mutual support cannot be underestimated. The camps gave the young people a sense of specialness which was highlighted by the remarks of two who described themselves as almost lucky to have Huntington's Disease in the family so they had the opportunity to attend and to take part in the activities. The comments were a reminder that Huntington's Disease families do not always have the resources to offer children opportunities that may be more freely available to other children. Both parents and young people appreciated the knowledge the young people gained about the disease. In some cases young people were able to tell parents things they did not know, in others they passed on information to older siblings who had not had the opportunity to attend. Parents appreciated having impartial, trained facilitators teaching their children. They were confident the information given was accurate and believed their children were more willing and able to learn in a supportive and neutral environment. The children faced the reality of being at risk of the disease with courage and realism. The camps could not change their situation but they did offer information and support and kept young people up to date with the latest research on predictive testing and genetic developments. The format of the camps needs little modification. More attention could be paid to catering for the older children within the existing format rather than having separate events for older and younger children. The timing and length of discussion groups could also be varied so that there is greater flexibility. The young people acknowledged that the discussions would inevitably cover familiar ground as new people came to the camps. Most were tolerant of this. Possibly more use could be made of their knowledge and experience to create bonds with newcomers. The overwhelming message of the review was that knowing about Huntington's Disease is better than not knowing and that children as young as nine and eleven can cope with the knowledge and gain support from others in a similar situation. Both parents and young people benefit from the camps. A week a year cannot solve family problems or change the situation families must deal with on a daily basis. The camps cannot transform children or change their personalities. They are a support not a panacea but they are a support that is highly valued by all participants. The last word should go to a brother and sister who have attended all three camps: If they ever stop, well get mad. |