Journal of Pediatric Psychology - Advance Access

Concurrent Associations among Sleep Problems, Indicators of Inadequate Sleep, Psychopathology, and Shared Risk Factors in a Population-based Sample of Healthy Ontario Children

Coulombe, J. A., Reid, G. J, Boyle, M. H, Racine, Y. — Wed, 18 Nov 2009 07:09:33 PST

Objectives Examine the contribution of sleep problems and indicators of inadequate sleep to psychopathology among children after accounting for shared risk and comorbid psychopathology. Methods Secondary analyses of cross-sectional data on 4- to 11-year-old (N = 1,550) children without chronic illness or developmental delay or disability. Parents provided information about sleep problems, indicators of inadequate sleep, symptoms of psychopathology, and risk factors for psychopathology. Teachers provided information about indicators of inadequate sleep and symptoms of psychopathology. Results Adjusting for risk factors and comorbid psychopathology, sleeping more than other children was related to parent-rated aggression. Nightmares and trouble sleeping were related to parent-rated anxious/depressed mood. Sleep problems were not related to attention problems. Being overtired was related to parent- and teacher-rated psychopathology. Conclusions Relations among sleep problems, indicators of inadequate sleep, and psychopathology are complex; accounting for potential confounding variables and considering sleep variables separately may clarify these relations.

Parenting an Adolescent with Chronic Pain: An Investigation of How a Taxonomy of Adolescent Functioning Relates to Parent Distress

Cohen, L. L, Vowles, K. E, Eccleston, C. — Fri, 13 Nov 2009 04:37:26 PST

Objective Cluster analyses allow health professionals to classify adolescents with chronic pain into subgroups, which might allow efficient tailoring of treatment. Given the nature of family relationships when a child has chronic pain, we aimed to evaluate whether an adolescent-disability-derived cluster formula would appropriately classify their parents via parenting stress, anxiety, and depression. Methods A patient-report data-derived cluster formula sorted 204 parents of adolescents with chronic pain into 4 groups. Parents completed measures of distress, anxiety, and depression. Results The 4-group solution generally sorted parents accurately, with parents of the least disabled adolescents functioning well and parents of the most disabled adolescents reporting clinically significant levels of stress, anxiety, and depression. Conclusions Findings suggest the patient-derived 4-group cluster solution might be an efficient method of distinguishing subgroups of parents with varying levels of stress, anxiety, and depression, which can be used to guide family-oriented treatment efforts.

Editorial: Assessing and Enhancing Clinical Significance/Social Validity of Intervention Research in Pediatric Psychology

Rapoff, M. A — Fri, 13 Nov 2009 04:37:26 PST

Using Basic Behavior Research on Children's Emotions to Inform Prevention Research: A Commentary on Pooley and Fiddick Social Referencing "Mr. Yuk"

Duncan, C. L, Dempsey, A. G — Wed, 11 Nov 2009 07:19:46 PST

A Randomized Controlled Trial of a Web-Based Early Intervention for Children and their Parents Following Unintentional Injury

Cox, C. M, Kenardy, J. A, Hendrikz, J. K — Wed, 11 Nov 2009 07:19:46 PST

Objective The aim of this article was to evaluate the effectiveness of an information provision web-based early intervention via a randomized controlled trial for children and their parents following pediatric unintentional injury. Method Participants were randomly assigned to an intervention (n = 29) or a control group (n = 27) following baseline measurements. Further assessment was taken at 4–6 weeks and 6 months post-trauma event. Results Analyses revealed that children within the intervention group reported improved anxiety, in comparison to a worsening of symptoms for children in the control group. Furthermore, children who had higher baseline trauma scores reported the intervention to be helpful. Conclusions The intervention showed promising results in its ability to aid child recovery.

The Impact of Pediatric Chronic Pain on Parents' Health-Related Quality of Life and Family Functioning: Reliability and Validity of the PedsQL 4.0 Family Impact Module

Mano, K. E., Khan, K. A., Ladwig, R. J, Weisman, S. J — Tue, 10 Nov 2009 04:50:34 PST

Objective To evaluate the psychometric properties of the Family Impact Module (FIM), a parent self-report measure of health-related quality of life (HRQOL) and family functioning, among parents of youth with chronic pain. Methods Parents (N = 458) completed the FIM (Total Impact, HRQOL, and Family Functioning scales); parents and youth (N = 332) completed measures of pain catastrophizing, pediatric quality of life, and emotional/behavioral functioning. Results The FIM demonstrated strong internal consistency and item-total correlations. All FIM scales were positively associated with pain catastrophizing, functional disability, and emotional/behavioral problems; and inversely related to pediatric quality of life. Mothers reported significantly worse HRQOL than fathers. Mothers and fathers did not differ on reports of Family Functioning. HRQOL and Family Functioning did not differ as a function of pain diagnosis. Conclusion The FIM appears to be a suitable measure of parent self-reported HRQOL and family functioning in pediatric chronic pain.

Commentary: The Application of Quality Improvement in Pediatric Psychology: Observations and Applications

Kotagal, U., Nolan, T. — Mon, 09 Nov 2009 03:12:37 PST

A Pilot Study of Observed Parenting and Adjustment in Adolescents with Type 1 Diabetes and their Mothers

Jaser, S. S., Grey, M. — Wed, 04 Nov 2009 04:21:47 PST

Objectives The purpose of this pilot study was to determine the association of observed parenting behaviors with adjustment in adolescents with type 1 diabetes (T1D) and their mothers. Methods Adolescents with T1D (n = 30) and their mothers provided data on psychosocial adjustment and engaged in a discussion task about diabetes stress, which was coded for parenting behavior. Clinical data (i.e., HbA1c) was obtained from adolescents’ medical records. Results Mothers’ symptoms of anxiety and depression were related to lower levels of child-centered parenting. Higher levels of observed child-centered parenting and positive reinforcement and lower levels of maternal hostility and parental influence were related to better psychosocial adjustment in adolescents (i.e., fewer depressive symptoms, better quality of life) and better metabolic control. Conclusions Results support the use of observational data in this population and provide estimates of effect sizes between parenting variables, maternal and adolescent psychosocial adjustment, and metabolic control.

Children's Memory for Painful Procedures: The Relationship of Pain Intensity, Anxiety, and Adult Behaviors to Subsequent Recall

Noel, M., McMurtry, C. M., Chambers, C. T., McGrath, P. J. — Wed, 04 Nov 2009 04:21:46 PST

Objective To examine whether children's experience of pain intensity and anxiety, and adult behaviors during venepuncture, were related to children's memories of the procedure. Methods Participants were 48 children (24 males, 24 females) between the ages of 5 and 10 years who underwent venepuncture. The venepunctures were videotaped and adult behaviors were coded. Children self-reported their pain intensity and anxiety immediately and 2 weeks following venepuncture and answered contextual questions at follow-up. Results Children who initially reported higher levels of pain tended to over-estimate their anxiety at follow-up, whereas children who reported lower levels of pain accurately- or under-estimated their anxiety. Staff coping-promoting behaviors predicted the accuracy of children's contextual memories. Staff and parent behaviors did not predict children's recalled pain intensity and anxiety. Conclusions Results indicate that children's direct experience of pain intensity and staff behaviors during venepuncture are related to their memories. These data highlight the importance of effective pain management during medical procedures.

Correlates of Depressive and Anxiety Symptoms in Young Adults with Spina Bifida

Fri, 30 Oct 2009 04:47:58 PDT

Objective Based on social ecological theory, this study was designed to examine the unique relationships between multi-level ecological factors and psychological symptoms in young adults with spina bifida (SB). Method A sample of 61 individuals with SB, 18–25 years of age, completed standardized self-report measures of attitude toward SB, satisfaction with family functioning, Chronic Care Model (CCM) services, and depressive and anxiety symptoms. A chart review yielded SB clinical data. Results High rates of depressive and anxiety symptoms were found. Hierarchical regression analysis identified the proximal individual (attitude toward SB) and family (satisfaction with family functioning) factors as more strongly related to depressive symptoms than the distal healthcare system factor (CCM services). Self-reported pain was the only ecological factor associated with anxiety symptoms. Conclusions Study findings provide a potential foundation for multi-factor screening of young adults with SB at risk for psychological symptoms.

Parental stress is associated with poor sleep quality in parents caring for children with developmental disabilities

Gallagher, S., Phillips, A. C., Carroll, D. — Thu, 29 Oct 2009 04:24:56 PDT

Objective This study examined the psychosocial predictors of poor sleep quality in parents caring for children with developmental disabilities. Methods Sixty-seven parents of children with developmental disabilities and 42 parents of typically developing children completed the Pittsburgh Sleep Quality Index, and measures of parental stress, child problem behaviors, and social support. Results Parents of children with developmental disabilities reported poorer sleep quality. Further, the majority of these parents met the established ‘poor sleepers’ criterion. The strongest predictor of poor sleep quality was parental stress. This finding withstood adjustment for a number of potential confounders. Conclusions Parental stress is associated with poor sleep quality in parents of children with developmental disabilities. The monitoring and management of sleep issues in these parental caregivers should be a priority for health professionals.

Adherence and Glycemic Control among Hispanic Youth with Type 1 Diabetes: Role of Family Involvement and Acculturation

Hsin, O., La Greca, A. M., Valenzuela, J., Taylor Moine, C., Delamater, A. — Mon, 26 Oct 2009 04:32:13 PDT

Objective To assess whether family involvement and acculturation were related to adherence and glycemic control among Hispanic youth with type 1 diabetes (T1D). Methods Hispanic youth with T1D (n = 111; M age = 13.33; 53% female) and parents completed questionnaires that assessed diabetes-related family involvement (distribution of responsibility for diabetes, family support for diabetes), acculturation (linguistic acculturation, generational status), and adherence. HbA1c levels indexed glycemic control. Results Better adherence was associated with less adolescent independent responsibility, more family support for diabetes, and more recent immigration (fewer generations of the family living in US). Family support mediated the relationship between responsibility and adherence. Better glycemic control was associated with higher levels of parental education and adherence. Conclusions Family support for diabetes is important for adherence among Hispanic youth with T1D. Research should examine aspects of recent immigration that contribute to better adherence and the impact of supportive interventions on diabetes care.

Prospective Relationship between Maternal Depressive Symptoms and Asthma Morbidity among Inner-City African American Children

Thu, 22 Oct 2009 08:01:23 PDT

Objective To examine prospective relationships between caregiver's depressive symptoms and child asthma morbidity among inner-city African American families. Methods Phone surveys were conducted 6 months apart with 262 African American mothers of children with asthma. Cross-lagged structural path analysis was used for data analyses. Results Using goodness-of-fit indices, the final model for asthma symptoms had a good fit to the data. Time 1 (T1) maternal depressive symptoms predicted T2 child asthma symptoms (β = .16, p < .01); however, T1 asthma symptoms did not predict T2 maternal depressive symptoms (β = .03, non-significant). In contrast, in the final model for emergency department (ED) visits there was no predictive association between maternal depressive symptoms and ED visits. Conclusion Maternal depressive symptoms may have a detrimental effect on child asthma morbidity among inner-city African American families, rather than vice versa. Ameliorating maternal depressive symptoms may result in better asthma outcomes for inner-city children.

Response to the Commentary: A Worldwide Call for Multimodal Inpatient Treatment for Children and Adolescents Suffering from Chronic Pain and Pain-related Disability

Maynard, C. S, Amari, A., Wieczorek, B., Christensen, J. R, Slifer, K. J — Thu, 22 Oct 2009 08:01:16 PDT

Brief Report: Mothers' Long-term Posttraumatic Stress Symptoms Following a Burn Event of Their Child

Bakker, A., Van Loey, N. E. E., Van Son, M. J. M., Van der Heijden, P. G. M. — Wed, 21 Oct 2009 07:12:10 PDT

Objective This prospective longitudinal study examines the course of posttraumatic stress symptoms (PTSS) in mothers of children with burns between 1 and 11 years after the burn event and the role of burn severity and feelings of guilt on this course. Method Self-reported PTSS of 48 mothers were measured with the Impact of Event Scale. Guilt feelings were assessed during an in-depth interview 2 years after the burn event. Eleven years after the burn event, mothers marked their child's scars at the present time on a drawing. Results Over a period of 10 years, maternal PTSS decreased. Multiple regression analysis showed that the interaction between guilt and burn severity predicted the course of PTSS. Conclusions Although PTSS substantially decreases through the years, a subset of mothers, in particular mothers who feel guilty about the burn event and whose children have more extensive permanent scarring seem at risk for longer term PTSS.

Parent Ratings of Behavioral Functioning After Traumatic Brain Injury in Very Young Children

Wetherington, C. E, Hooper, S. R, Keenan, H. T, Nocera, M., Runyan, D. — Fri, 09 Oct 2009 09:16:44 PDT

Objective The behavioral ratings of preschoolers who sustained traumatic brain injury (TBI) prior to the age of 2 years and a typically developing group were compared; predictors of behavioral functioning were examined. Methods Eighty-two 3-year-olds comprised mild TBI (n = 31), moderate/severe TBI (n = 20), and typically developing (n = 31) groups, with Child Behavior Checklist (CBCL) as the primary outcome measure. Results Groups differed on the CBCL Withdrawal Scale. No differences emerged in the proportion of children demonstrating clinical elevations, with average mean scores for each group. Exploratory analyses yielded no differences between inflicted, non-inflicted, and typical groups. Glasgow Coma Scale and Self-Report Family Inventory Leadership predicted Externalizing Problems; developmental level predicted Internalizing Problems. Conclusions After early TBI, preschoolers did not differ from one another or a matched comparison group in behavioral ratings; however, it may be premature to infer that preschoolers do not evidence behavioral dysfunction after early TBI.

Case Study: Multisystemic Therapy for Adolescents Who Engage in HIV Transmission Risk Behaviors

Letourneau, E. J, Ellis, D. A, Naar-King, S., Cunningham, P. B, Fowler, S. L — Thu, 08 Oct 2009 07:54:37 PDT

Objective To present a case study using multisystemic therapy (MST), an intensive family focused psychotherapy. For the clinical trial from which this case was drawn, MST was adapted to address multiple human immunodeficiency virus (HIV) transmission risk behaviors in HIV-infected youth. Targeted behaviors included medication nonadherence, risky sexual behaviors, and substance use. Method One young woman's transmission risk behaviors are described, followed by a description of the MST procedures used to identify and treat the primary drivers of these risk behaviors. Outcome measures were self-report, urine screens, and blood draws. Results At discharge, the young woman showed significant improvements in medication adherence and related health status (e.g., reduced HIV viral load), healthier sexual behaviors, and reduced substance use. Importantly, neither her boyfriend nor her newborn tested positive for HIV. Conclusions Findings from this case study suggest that MST has the potential to reduce transmission risk behaviors among teens with HIV.

Introduction to the Special Issue: Quality Improvement in Pediatric Psychology

Stark, L. J — Thu, 01 Oct 2009 05:28:26 PDT

Child Maltreatment and Pediatric Health Outcomes: A Longitudinal Study of Low-income Children

Lanier, P., Jonson-Reid, M., Stahlschmidt, M. J., Drake, B., Constantino, J. — Thu, 01 Oct 2009 05:28:26 PDT

Objective To examine if maltreatment predicted increased risk of hospital-based treatment prior to age 18 years for asthma, cardio-respiratory, and non-sexually transmitted infectious disease in a sample of low-income children. Methods This study used administrative data from multiple systems to follow children for 12–18 years (N = 6,282). Cox regression was used to explore the risk of first hospital treatment by disease category. Negative binomial regression was used to explore the relationship between recurrent maltreatment and total hospital care episodes. Results Controlling for individual, family, and community factors, children with maltreatment reports had a 74–100% higher risk of hospital treatment. Recurrent reports predicted a higher count of hospital care episodes. Conclusions The negative health impact of maltreatment prior to adulthood supports the need for early prevention and intervention to prevent initial and recurrent child abuse and improve capacity to meet healthcare needs of maltreated children.

Optimism and Pessimism in Children with Cancer and Healthy Children: Confirmatory Factor Analysis of the Youth Life Orientation Test and Relations with Health-Related Quality of Life

Williams, N. A, Davis, G., Hancock, M., Phipps, S. — Thu, 01 Oct 2009 05:28:25 PDT

Objective To test the measurement equivalence of the Youth Life Orientation Test (YLOT) in children with cancer (N = 199) and healthy controls (N = 108), and to examine optimism and pessimism as predictors of children's health-related quality of life (HRQL). Methods Confirmatory factor analysis (CFA) was conducted to establish the two factor structure of the YLOT and to test for metric invariance. Results A two-factor structure for the YLOT was confirmed and found to be stable across our study groups. There were no differences in mean levels of optimism and pessimism between cancer patients and controls after controlling for race/ethnicity. Higher optimism was associated with lower self-reports of pain and better emotional/behavioral functioning, whereas pessimism was related to poorer mental health and general behavior, and greater impact on the family. Conclusions Optimism and pessimism appear to be differentially related to certain aspects of children's HRQL, and should be investigated separately in relation to these outcomes.

Effects of Videogame Distraction and a Virtual Reality Type Head-Mounted Display Helmet on Cold Pressor Pain in Young Elementary School-Aged Children

Mon, 28 Sep 2009 05:31:16 PDT

Objective This study examined the effects of videogame distraction and a virtual reality (VR) type head-mounted display helmet for children undergoing cold pressor pain. Methods Fifty children between the ages of 6 and 10 years underwent a baseline cold pressor trial followed by two cold pressor trials in which interactive videogame distraction was delivered via a VR helmet or without a VR helmet in counterbalanced order. Results As expected, children demonstrated significant improvements in pain threshold and pain tolerance during both distraction conditions. However, the two distraction conditions did not differ in effectiveness. Conclusions Using the VR helmet did not result in improved pain tolerance over and above the effects of interactive videogame distraction without VR technology. Clinical implications and possible developmental differences in elementary school-aged children's ability to use VR technology are discussed.

Interaction of Child Maltreatment and 5-HTT Polymorphisms: Suicidal Ideation among Children from low-SES Backgrounds

Cicchetti, D., Rogosch, F. A., Sturge-Apple, M., Toth, S. L. — Thu, 24 Sep 2009 07:40:35 PDT

Objective To investigate whether genotypic variation of the serotonin transporter gene-linked promoter region (5-HTTLPR) moderates the effect of maltreatment on suicidal ideation in school-aged children. Methods Eight hundred and fifty low-income children (478 maltreated; 372 non-maltreated) provided DNA samples and self-reported depressive and suicidal symptoms. Genotypes of 5-HTTLPR (s/s or s/l vs. l/l) were determined by fragment analyses. Results Higher suicidal ideation was found among maltreated than non-maltreated children; the groups did not differ in 5-HTTLPR genotype frequencies. Children with one to two maltreatment subtypes and s/s or s/l genotypes had higher suicidal ideation than those with the l/l genotype; suicidal ideation did not differ in non-maltreated children or children with three to four maltreatment subtypes based on 5-HTTLPR variation. The results were applicable to emotionally maltreated/neglected and to physically/sexually abused children. Gene–environment interaction was not found for depressive symptoms. Conclusion The protective effect of the 5-HTTLPR l/l genotype on suicidal ideation was limited to maltreated children experiencing fewer subtypes.

Barriers to Oral Medication Adherence for Adolescents with Inflammatory Bowel Disease

Ingerski, L. M, Baldassano, R. N, Denson, L. A, Hommel, K. A — Wed, 23 Sep 2009 08:54:00 PDT

Objective To identify family-reported, adherence-related barriers for adolescents with inflammatory bowel disease (IBD) and examine their relationship to 6-MP/azathioprine and 5-ASA medication adherence. Methods Participants included 74 adolescents, aged 13–17 years, diagnosed with IBD and their caregivers. Adolescents and caregivers jointly completed a measure of barriers to medication adherence. Adherence to medication was measured by family-report, pill-count, and serum assay. Results Families endorsed one to seven total barriers to medication adherence. The most commonly reported barriers included forgetting, being away from home, and interference with an activity. Neither demographic nor disease severity variables were related to the total number of reported barriers. Fewer total reported barriers was related to better adherence by adolescent and maternal report. Conclusion Most families experience at least one barrier to treatment adherence. Effective problem-solving around these barriers and its integration into future treatment protocols may help improve medication adherence in the pediatric IBD population.

Validity of the Family Asthma Management System Scale with an Urban African-American Sample

Celano, M., Klinnert, M. D, Holsey, C. N., McQuaid, E. L — Wed, 23 Sep 2009 08:54:00 PDT

Objective To examine the reliability and validity of the Family Asthma Management System Scale for low-income African-American children with poor asthma control and caregivers under stress. The FAMSS assesses eight aspects of asthma management from a family systems perspective. Methods Forty-three children, ages 8–13, and caregivers were interviewed with the FAMSS; caregivers completed measures of primary care quality, family functioning, parenting stress, and psychological distress. Children rated their relatedness with the caregiver, and demonstrated inhaler technique. Medical records were reviewed for dates of outpatient visits for asthma. Results The FAMSS demonstrated good internal consistency. Higher scores were associated with adequate inhaler technique, recent outpatient care, less parenting stress and better family functioning. Higher scores on the Collaborative Relationship with Provider subscale were associated with greater perceived primary care quality. Conclusions The FAMSS demonstrated relevant associations with asthma management criteria and family functioning for a low-income, African-American sample.

Predictors of Medication Adherence in High Risk Youth of Color Living with HIV

MacDonell, K. E, Naar-King, S., Murphy, D. A, Parsons, J. T, Harper, G. W — Tue, 15 Sep 2009 07:50:58 PDT

Objective To test predictors of medication adherence in high-risk racial or ethnic minority youth living with HIV (YLH) using a conceptual model of social cognitive predictors including a continuous measure of motivational readiness. Methods Youth were participants in a multi-site clinical trial examining the efficacy of a motivational intervention. Racial-minority YLH (primarily African American) who were prescribed antiretroviral medication were included (N = 104). Data were collected using computer-assisted personal interviewing method via an Internet-based application and questionnaires. Results Using path analysis with bootstrapping, most youth reported suboptimal adherence, which predicted higher viral load. Higher motivational readiness predicted optimal adherence, and higher social support predicted readiness. Decisional balance was indirectly related to adherence. Conclusions The model provided a plausible framework for understanding adherence in this population. Culturally competent interventions focused on readiness and social support may be helpful for improving adherence in YLH.

Commentary: Environmental Influences: Issues of Timing and Type

Aylward, G. P. — Tue, 15 Sep 2009 07:50:57 PDT

Brief Report: Parent's Health Literacy among High-Risk Adolescents with Insulin Dependent Diabetes

Janisse, H. C, Naar-King, S., Ellis, D. — Tue, 15 Sep 2009 07:50:57 PDT

Objective To describe the health literacy of parents of high-risk adolescents with insulin dependent diabetes and to examine the relation of parent's health literacy with treatment adherence. Methods Participants were 93 adolescents in poor metabolic control diagnosed with insulin dependent diabetes and their primary caregivers. Results All parents had adequate health literacy as defined by the S-TOFHLA. Better parent reading comprehension scores were significantly related to family structure, race, and treatment regimen. Reading comprehension in turn significantly predicted adherence for adolescents on an intensive insulin regimen but not for those on conventional regimens. Conclusions Parents with low health literacy may struggle to help their children adhere to the increasingly complex diabetes regimens being used at present. Such families may benefit from more intensive diabetes education or different approaches to teaching diabetes management skills.

The Effectiveness of a Bicycle Safety Program for Improving Safety-Related Knowledge and Behavior in Young Elementary Students

McLaughlin, K. A, Glang, A. — Tue, 15 Sep 2009 07:50:56 PDT

Objective The purpose of this study was to evaluate the "Bike Smart" program, an eHealth software program that teaches bicycle safety behaviors to young children. Methods Participants were 206 elementary students in grades kindergarten to 3. A random control design was employed to evaluate the program, with students assigned to either the treatment condition (Bike Smart) or the control condition (a video on childhood safety). Outcome measures included computer-based knowledge items (safety rules, helmet placement, hazard discrimination) and a behavioral measure of helmet placement. Results Results demonstrated that regardless of gender, cohort, and grade the participants in the treatment group showed greater gains than control participants in both the computer-presented knowledge items (p > .01) and the observational helmet measure (p > .05). Conclusions Findings suggest that the Bike Smart program can be a low cost, effective component of safety training packages that include both skills-based and experiential training.

A Review of HIV Prevention Interventions for Juvenile Offenders

Tolou-Shams, M., Stewart, A., Fasciano, J., Brown, L. K — Wed, 09 Sep 2009 07:00:23 PDT

Objective To conduct a critical review of all HIV prevention intervention studies conducted with adolescents in juvenile justice settings to inform future intervention development. Method PubMed and PsycInfo database searches were conducted for peer-reviewed, published HIV prevention intervention studies with juvenile offenders. Results Sixteen studies were identified (N = 3,700 adolescents). Half of the projects utilized rigorous methodologies to determine intervention effect on behavior change, such as conducting a randomized controlled trial (n = 8). Nine studies reported behaviors at least 3 months post-intervention and five out of nine showed decreases in sexual risk behavior. Conclusions Several HIV prevention programs with juvenile offenders have led to sexual risk reduction, although effect sizes are modest. Most existing programs have neglected to address the impact of family, mental health, and substance use on HIV risk. More work is needed to develop evidence-based interventions that include HIV prevention strategies relevant and appropriate for the juvenile justice setting.

Determinants of Somatic Complaints in 18-month-old Children: The Generation R Study

Tue, 08 Sep 2009 05:17:50 PDT

Objective To investigate the effect of child temperament, maternal psychologic symptoms, maternal chronic pain, and parenting stress on children's somatic complaints. Methods The study was embedded in the Generation R Study, a population-based cohort study. Child somatic complaints were assessed via mother-report in 5,171 children of 18 months of age. Questionnaires assessed maternal somatic symptoms, symptoms of depression, anxiety during pregnancy and 2 months after delivery, maternal chronic pain during pregnancy, parenting stress 18 months after birth, and mother-reported child temperament 6 months after birth, as the determinants. Results Fearful temperament, temperamental falling reactivity, maternal somatic symptoms, anxiety symptoms, and parenting stress each independently and prospectively increased the likelihood of children's somatic complaints at 18 months of age. Conclusions In toddlers, temperament, maternal stress, and maternal somatic symptoms seem particularly important for the development of somatic complaints, but long-term research is needed to establish causality and predictive value of these factors.

Longitudinal Evaluation of Externalizing and Internalizing Behavior Problems Following Iron Deficiency in Infancy

Corapci, F., Calatroni, A., Kaciroti, N., Jimenez, E., Lozoff, B. — Mon, 07 Sep 2009 05:03:01 PDT

Objective This study examined externalizing and internalizing behavior problem trajectories as a function of both iron status in infancy and infant characteristics. Methods A sample of 185 healthy Costa Rican children who either had chronic, severe iron deficiency or good iron status in infancy were followed for 19 years. Results Mother ratings of externalizing and internalizing problems from age 5 to 11–14 years were higher for the chronic iron deficiency group compared with those with the good iron status. Iron deficiency in infancy predicted persisting externalizing problems over this time period, especially for those with low physical activity in infancy. Beyond adolescence, youth in the chronic iron deficiency group did not report more problems than those in the good iron group. Conclusions These findings underscore the importance of considering infant iron status along with early behavioral characteristics to better identify those children at greatest risk for persisting long-term behavior problems.

Brief Report: Parenting Styles and Obesity in Mexican American Children: A Longitudinal Study

Olvera, N., Power, T. G — Wed, 02 Sep 2009 07:05:49 PDT

Objective To assess longitudinally the relations between four parenting styles (authoritative, authoritarian, uninvolved, and indulgent) and child weight status in Mexican American families. Methods Sixty-nine low-income Mexican American mothers and their 4- to 8-year-old children participated in a 4-year longitudinal study. Mothers completed demographic and parenting measures. Children's body weight and height were assessed annually. Body mass index was calculated to determine weight status. Results At baseline, 65% of children were found to be normal weight, 14% were overweight, and 21% were obese. Analyses examined how parenting styles at baseline predicted child's weight status 3 years later, controlling for initial weight status. Children of indulgent mothers were more likely to become overweight 3 years later than children of authoritative or authoritarian mothers. Conclusions This study provides longitudinal evidence for the role of indulgent parenting in predicting overweight in Mexican American children. Possible mediating factors that may account for this relationship (e.g., dietary patterns, physical activity patterns, and children's self-regulation) are considered.

Brief Report: A Confirmatory Approach to Exploring the Factor Structure of the Social Consequences of Pain Questionnaire

Wed, 26 Aug 2009 08:29:45 PDT

Objective Confirmatory factor analysis was used to evaluate the factor structure of the Social Consequences of Pain (SCP) questionnaire in youth referred for specialty pain treatment. The existing four-factor structure (i.e., Positive Attention, Negative Attention, Activity Restriction, Privileges) was compared to an alternate three-factor structure merging Positive Attention and Privileges into a single scale (Favorable Consequences). Methods Participants were 373 youth (aged 8–18 years) with chronic pain referred to a tertiary pain clinic. Most participants presented with pain in the head, abdomen, legs, or back. Participants completed the SCP questionnaire at or before an intake appointment. Results Both three-factor and four-factor solutions were acceptable. The three-factor solution emerged as preferable due to stronger internal consistencies. Conclusions Findings support the validity of the SCP for the assessment of social consequences in diverse presentations of pediatric chronic pain.

Adherence to Pediatric Asthma Treatment in Economically Disadvantaged African-American Children and Adolescents: An Application of Growth Curve Analysis

Wed, 26 Aug 2009 08:29:45 PDT

Objectives The primary aims of the study were to: (a) describe the trajectories of adherence to daily inhaled corticosteroid (ICS) medication for a year in economically disadvantaged, African-American youth with asthma based on growth curve modeling; and (b) test the relationship of treatment adherence to symptom control, quick-relief medication, and healthcare utilization. Methods This prospective study measured adherence to daily ICS treatment using electronic monitoring in 92 children and adolescents with moderate to severe asthma for 9–12 months and assessed clinical outcomes, including asthma-related symptoms, quick-relief medication, and healthcare utilization. Results Youth showed a decrement in treatment adherence to less than half of prescribed corticosteroid treatment over the course of the study, which related to increased healthcare utilization (p < .04), but not to asthma symptoms or albuterol use. Conclusion Economically disadvantaged youth with asthma demonstrate high rates of chronic nonadherence that warrant identification and intervention to reduce asthma-related healthcare utilization.

Treatment Adherence Impact: The Systematic Assessment and Quantification of the Impact of Treatment Adherence on Pediatric Medical and Psychological Outcomes

Pai, A. L., Drotar, D. — Wed, 26 Aug 2009 08:29:44 PDT

Objective Treatment adherence impact (TAI) is the quantification of the effects of adherence behaviors on medical or psychological outcomes using systematic assessment and analytic methods. The purpose of this review is to provide a framework for the measurement and analysis of TAI. Methods Specific studies were selected from the treatment adherence literature to illustrate methods to assess TAI. Results There are many methods available to investigators to evaluate TAI and, when possible, multiple impact outcomes should be included in adherence studies. The methods available to assess TAI and barriers to assessing TAI vary across illness group requiring illness-specific applications of the concepts presented. Conclusions Systematically examining TAI in adherence studies could advance the state of the art of treatment adherence science.

The Efficacy of Adherence Interventions for Chronically Ill Children: A Meta-Analytic Review

Graves, M. M, Roberts, M. C., Rapoff, M., Boyer, A. — Wed, 26 Aug 2009 08:29:44 PDT

Objectives To provide quantitative information about the overall effectiveness of adherence interventions to improve adherence and health outcomes for children with chronic illnesses. To evaluate statistically the potential moderators. Methods A meta-analysis was performed on 71 adherence intervention studies. Results Weighted-mean effect size (ES) across all the adherence outcomes for group design studies was in the medium range (mean d = 0.58) and for single-subject design studies was in the large range (mean d = 1.44). The weighted mean ES across all health outcome measures for studies using group designs was in the medium range (mean d = 0.40) and for studies using single-subject designs was in the large range (mean d = 0.74). Conclusions Adherence interventions for children with chronic illnesses effectively increase adherence and result in some positive health benefits. Intervention and methodological variables had significant impact on ESs. High levels of heterogeneity characterized the data.

The Effects of Parental Depression and Parenting Practices on Depressive Symptoms and Metabolic Control in Urban Youth with Insulin Dependent Diabetes

Eckshtain, D., Ellis, D. A, Kolmodin, K., Naar-King, S. — Wed, 26 Aug 2009 08:29:43 PDT

Objective Examine relationships between parental depressive symptoms, affective and instrumental parenting practices, youth depressive symptoms and glycemic control in a diverse, urban sample of adolescents with diabetes. Methods Sixty-one parents and youth aged 10–17 completed self-report questionnaires. HbA1c assays were obtained to assess metabolic control. Path analysis was used to test a model where parenting variables mediated the relationship between parental and youth depressive symptoms and had effects on metabolic control. Results Parental depressive symptoms had a significant indirect effect on youth depressive symptoms through parental involvement. Youth depressive symptoms were significantly related to metabolic control. While instrumental aspects of parenting such as monitoring or discipline were unrelated to youth depressive symptoms, parental depression had a significant indirect effect on metabolic control through parental monitoring. Conclusions The presence of parental depressive symptoms influences both youth depression and poor metabolic control through problematic parenting practices such as low involvement and monitoring.

Cultural Issues in Eating Pathology and Body Image Among Children and Adolescents

Edwards George, J. B., Franko, D. L. — Mon, 24 Aug 2009 01:40:04 PDT

Eating pathology and body image issues are now recognized as affecting all racial and ethnic groups. This article reviews eating pathology and body image concerns in four diverse groups in the U.S. (African Americans, Latino/as, Asians, and Native Americans). The major conclusion based on this review is that eating disturbances and body dissatisfaction occur to some degree in children and adolescents from all four major ethnic groups in the U.S; however, there is substantial variability across studies. Future directions include the need for studies of prevalence, prevention and treatment research, and investigations of neurobiological and genetic variables.

Experimentally-Induced Learned Helplessness in Adolescents with Type 1 Diabetes

McLaughlin, E., Lefaivre, M.-j., Cummings, E. — Thu, 20 Aug 2009 22:38:07 PDT

Objectives To determine whether adolescents with type 1 diabetes are more at risk for learned helplessness than their healthy peers. Methods Twenty-three adolescents with diabetes and 25 controls completed a solvable or unsolvable concept formation task. All completed pre- and post-task performance and attribution ratings, and later completed an anagram-solving task to determine if perceived helplessness on the first task would negatively impact performance on the second. Results Participants in the unsolvable condition solved fewer anagrams; those with diabetes did not show weaker performance than controls. Participants in the solvable condition (diabetes and controls) showed an increase in internal attributions from before the concept formation task to after. In the unsolvable condition, only participants with diabetes made more external attributions for their failure. Conclusions Contrary to the only other controlled study to use this paradigm in youth with chronic illness, adolescents with diabetes were not more susceptible to learned helplessness.

Social Referencing "Mr. Yuk": The Use of Emotion in a Poison Prevention Program

Pooley, A. J, Fiddick, L. — Tue, 18 Aug 2009 08:09:59 PDT

Objective To assess whether disgust, the emotion depicted on poison control "Mr. Yuk" stickers, conveys an age-appropriate message to young children. Methods Two preliminary studies (both N = 48) were conducted with adults to assess what facial expressions of emotion they associated with child and adult violations of precautionary rules. Subsequently, 20 3-year-olds and 35 4-year-olds were tested on age-appropriate scenarios to determine what facial expressions of emotion they associate with accidental poisonings. Results Adults associated violations of precautionary rules, regardless of whether they involved children or adults and physical injury or accidental poisonings, with facial expressions of fear, not disgust. The study conducted with children indicated that they likewise anticipated facial expressions of fear in response to accidental poisonings. Conclusions The disgust displayed on Mr. Yuk stickers does not appear to convey a valid emotional message, regardless of whether the stickers are used for preventive or educational purposes.

Commentary: A Worldwide Call for Multimodal Inpatient Treatment for Children and Adolescents Suffering from Chronic Pain and Pain-related Disability

Hechler, T., Dobe, M., Zernikow, B. — Fri, 14 Aug 2009 07:18:39 PDT

Anxiety Symptoms in Adolescents with Type 1 Diabetes: Association with Blood Glucose Monitoring and Glycemic Control

Herzer, M., Hood, K. K — Fri, 14 Aug 2009 07:18:39 PDT

Objective To examine the prevalence of anxiety symptoms and their association with blood glucose monitoring (BGM) and glycemic control in adolescents with type 1 diabetes. Methods 276 adolescents and their caregivers completed measures of anxiety symptoms. Adolescents completed a measure of depressive symptoms. Demographic and family characteristics were obtained from caregiver report. Diabetes duration, regimen type, BGM frequency, and glycemic control were also collected. Results Trait anxiety symptoms that suggest further clinical assessment is needed were present in 17% of adolescents; the rate was 13% for state anxiety symptoms. Higher levels of state anxiety symptoms were associated with less frequent BGM F(14, 261) = 6.35, p < .0001, R² = .25, and suboptimal glycemic control, F(15, 260) = 7.97, p < .0001, R² = .32. State anxiety symptoms were correlates of BGM frequency and glycemic control independent of depressive symptoms. Conclusions State anxiety symptoms are associated with less frequent BGM and suboptimal glycemic control in adolescents with type 1 diabetes.

Brief Report: Parents and Nurses' Behaviors Associated with Child Distress during Routine Immunization in a Portuguese Population

Pedro, H., Barros, L., Moleiro, C. — Fri, 14 Aug 2009 07:18:38 PDT

Objectives To explore the behaviors of parents and nurses during the immunization process and their association with children's distress and coping in a sample of Portuguese preschool-aged children; to identify similarities and differences in the behavior of parents, nurses, and children, as well as in the relation between adults’ behaviors and child distress and coping, with those previously identified by the Interactive Model of Acute Child Distress, from Blount et al. (1992). Method A total of nine nurses, 89 children aged 3–6, and their parents participated. Behaviors were videotaped and scored according to CAMPIS-R operational definitions. Measures of parents and nurses’ ratings of children's distress and of child-rated distress were obtained. Results Our results show not only similarities, but also important divergences from previous research. New adult codes were proposed. Only two new codes, and another code previously considered neutral, significantly contributed to explain the association between adult and child behavior. Conclusions Portuguese nurses and parents’ behaviors during immunization show some important cultural differences.

Peer Status and Victimization as Possible Reinforcements of Adolescent Girls' and Boys' Weight-Related Behaviors and Cognitions

Rancourt, D., Prinstein, M. — Mon, 10 Aug 2009 08:51:17 PDT

Objective Reciprocal longitudinal associations among weight-related behaviors and cognitions and peer relations constructs were examined among adolescent males and females. Methods Participants included 576 adolescents aged 10–14 years, in grades 6–8. Measures assessed body dissatisfaction, negative weight-related cognitions, weight management behaviors, muscle-gaining behaviors, body mass index (BMI), likeability, popularity, and victimization at two time points, approximately 11 months apart. Multiple group path analyses were conducted to examine the reciprocal longitudinal associations between the peer relations constructs and weight-related behaviors and cognitions, controlling for participants’ Time 1 BMI, pubertal development, and age. Results Higher levels of body dissatisfaction were associated longitudinally with decreases in popularity. Higher popularity and lower likeability each were associated longitudinally with increases in negative body-related cognitions. Higher popularity was associated longitudinally with muscle-gaining behaviors for boys. Conclusions Findings suggest highly popular and disliked adolescents may be at greater risk of weight-related behaviors and cognitions than other adolescents.

Behavioral Parent Training as an Adjunct to Routine Care in Children with Attention-Deficit/Hyperactivity Disorder: Moderators of Treatment Response

Fri, 24 Jul 2009 05:56:14 PDT

Objective To investigate predictors and moderators of outcome of behavioral parent training (BPT) as adjunct to ongoing routine clinical care (RCC), versus RCC alone. Methods We randomly assigned 94 referred children (4–12 years) with attention-deficit/hyperactivity disorder (ADHD) to BPT plus RCC or RCC alone. Outcome was based on parent-reported behavioral problems and ADHD symptoms. Predictor/moderator variables included children's IQ, age, and comorbidity profile, and maternal ADHD, depression, and parenting self-efficacy. Results Superior BPT treatment effects on behavioral problems and ADHD symptoms were present in children with no or single-type comorbidity—anxiety/depression or oppositional defiant disorder (ODD)/conduct disorder (CD)—and when mothers had high parenting self-efficacy, but absent in children with broad comorbidity (anxiety/depression and ODD/CD) and when mothers had low parenting self-efficacy. In older children ADHD symptoms tended to decrease more through BPT than in younger children. Conclusions Adjunctive BPT is most useful when mothers have high parenting self-efficacy and in children with no or single-type comorbidity.

Brief Report: Normative Data on a Structured Interview for Diabetes Adherence in Childhood

Thu, 09 Jul 2009 05:46:50 PDT

Objective This study provides normative data, divided by age and gender, for the Diabetes Self-Management Profile (DSMP), an empirically supported structured interview that assesses adherence with the type 1 diabetes treatment regimen. Despite wide use, normative data on the DSMP have yet to be reported. Methods The sample included 444 parents and 275 youth with type 1 diabetes. The DSMP was administered by a trained clinician. Results For both child and parent ratings of adherence, means and standard deviations for the overall sample and subdivision by gender and three age groups are presented for normative comparisons. Subscale data (e.g., glucose monitoring, diet, exercise) are similarly presented. Lower adherence scores were reported among older adolescents relative to preadolescents. Conclusions The literature has lacked normative data on pediatric diabetes adherence. These data present means and standard deviations for parent and child ratings of regimen adherence from a relatively large sample of youth with diabetes that can be utilized for normative comparisons for clinical and research purposes.

Neighborhood Influences on the Academic Achievement of Extremely Low Birth Weight Children

Andreias, L., Borawski, E., Schluchter, M., Taylor, H., Klein, N., Hack, M. — Tue, 07 Jul 2009 07:35:34 PDT

Objective To examine neighborhood effects on academic achievement of children with extremely low birth weight (ELBW <1000 g) and normal birth weight (NBW) controls. Methods The study included 183 8-year-old children with ELBW born during 1992–1995 and 176 sociodemographically similar NBW controls. Academic achievement was measured via The Woodcock–Johnson III Academic Skills Cluster. Results Children with ELBW had significantly lower achievement scores (89 ± 16 vs. 97 ± 13). A multilevel estimation of predictors of academic achievement revealed that neighborhood poverty was significantly associated with lower achievement (β = –.17; 95% CI –.3, –.05; p < .01). Additional correlates included birth weight status, male sex, and parent ratings of attention deficit hyperactivity disorder symptoms. Family characteristics included maternal education and parent protection. Conclusions Neighborhood characteristics affect academic achievement of both children with ELBW and NBW controls, over and above individual and family influences. Interventions designed to address family and neighborhood factors may potentially improve these outcomes.

The Psychosocial Impact of Completing Childhood Cancer Treatment: A Systematic Review of the Literature

Fri, 03 Jul 2009 09:23:50 PDT

Objective To review the results of any published research study examining the psychosocial functioning of children who have recently completed cancer treatment. Methods Five electronic databases were searched (from 1978 to 2008). Of 1,734 identified articles, 19 met all inclusion criteria. Four articles utilized a qualitative methodology, thirteen utilized a quantitative methodology, and two used mixed methods. Results Children may experience positive psychosocial outcomes on treatment completion, including high self-worth, good behavioral conduct, and improved mental health and social behavior. However, they may also experience significant negative outcomes, including lower levels of psychological well-being, mood, liveliness, self-esteem, and motor and physical functioning, as well as increased anxiety, problem behaviors, and sleeping difficulties. Conclusions Completing treatment can be a psychologically complex time for children as they wait to make the transition from "cancer patient" to long-term "cancer survivor." Further high-quality research targeting the needs of these children is warranted.

Brief Report: Development of the Inflammatory Bowel Disease Family Responsibility Questionnaire

Greenley, R. N., Doughty, A., Stephens, M., Kugathasan, S. — Mon, 29 Jun 2009 06:37:42 PDT

Objective To present psychometric data on youth and parent versions of the Inflammatory Bowel Disease-Family Responsibility Questionnaire (IBD-FRQ), a measure of family involvement in IBD management. Methods Fifty-eight adolescents with inflammatory bowel disease (IBD), along with 55 mothers and 26 fathers completed the IBD-FRQ, a demographics questionnaire, and a measure of family involvement in decision making in non-IBD domains. Medical information was obtained via chart review. Results Support for the internal consistency of the IBD-FRQ was obtained. Evidence of validity was documented via moderate to high intercorrelations among reporters. Youth involvement increased with youth age, while maternal and paternal involvement decreased with youth age. Across all reporters, maternal involvement was higher than paternal involvement. Conclusions Preliminary analyses offer support for the measure's reliability and validity. The measure shows promise as a means of assessing family involvement in IBD condition management; however, further validation studies are needed.

Medical Adherence in Young Adolescents with Spina Bifida: Longitudinal Associations with Family Functioning

Stepansky, M. A., Roache, C. R., Holmbeck, G. N., Schultz, K. — Thu, 25 Jun 2009 23:25:44 PDT

Objective The purpose of this study was 2-fold: (1) to explore the transfer of responsibility of medical tasks from parent to child during the transition to adolescence, and (2) to examine the associations between family functioning and medical adherence in youth with spina bifida. Methods Seventy families of children with spina bifida participated in this study. Data were collected during family interaction sessions by using questionnaires completed by mothers, fathers, youth, teachers and health professionals. Results Findings suggest that responsibility for medical regimens transfers gradually from parent to child over time. Additionally, family conflict and cohesion were correlated with medical adherence. Finally, family conflict over medical issues was related to a decrease in medical adherence over time. Conclusions Results suggest that as youth take more responsibility over their medical regimens, family conflict regarding medical issues becomes a contributor to their adherence behaviors. Interventions that target family conflict may facilitate adherence behaviors.

Transition to Adult Services among Behaviorally Infected Adolescents with HIV--A Qualitative Study

Fri, 19 Jun 2009 06:11:17 PDT

Objectives The present study aimed to describe the experiences of youth with behaviorally acquired HIV who transitioned to adult care, to identify difficulties encountered, and to explore areas for improvement. Methods Semi-structured interviews were conducted with 10 young adults ranging from 24 to 29 years old. Themes were derived from coding participant interviews. Results Participants experienced adolescent care providers as an important source of support, felt anxiety about transition, provided recommendations for improving the process, and described significant changes associated with adult HIV care. Conclusions Findings support the development of a clear and structured transition process to address patients’ fears and worries through early communication, planning, and coordination for adult healthcare, highlighting the need for future research in this area.

Behavioral Outcome in Children with a History of Neonatal Encephalopathy following Perinatal Asphyxia

van Handel, M., Swaab, H., de Vries, L. S., Jongmans, M. J. — Fri, 19 Jun 2009 06:11:17 PDT

Objective To examine the effects of mild and moderate neonatal encephalopathy (NE) on behavioral functioning, and prevalence of psychiatric diagnoses at 9–10 years. Methods The Child Behavior Checklist (CBCL), Teacher's Report Form (TRF), Diagnostic Interview Schedule for Children IV (DISC-IV), and the Children's Social Behavior Questionnaire (CSBQ) were used to assess behavioral outcome of 34 children with mild NE, 47 children with moderate NE, and 53 typically developing controls. Results Both children with mild and moderate NE showed more problematic behaviors than controls, which are related to a diversity of behavioral domains: elevated rates of social problems, anxiety and depression, attention regulation problems, and thought problems. No group differences were found in percentages of children with a DISC-IV (DSM-IV) classification. Conclusions NE has a mildly negative effect on behavioral functioning, but does not lead to elevated levels or specific patterns of developmental psychopathology.

The Course of Posttraumatic Stress in Children: Examination of Recovery Trajectories Following Traumatic Injury

Le Brocque, R. M, Hendrikz, J., Kenardy, J. A. — Wed, 17 Jun 2009 21:31:47 PDT

Objective Group-based trajectory modeling was used to identify patterns of posttraumatic stress symptom (PTSS) in children 6–16 years following accidental injury. The aims were to: (a) identify probable groups of children following distinct trajectories, and (b) identify risk factors affecting the probability of group membership. Method Children's Impact of Events Scale (n = 190) was used to assess PTSS up to 2 years post injury. Age, gender, type of injury, and preinjury behavior were assessed as risk factors. Results Three distinct trajectory groups were identified: resilient (57%), elevated stress symptoms which recovered quickly (33%), and chronic (10%). Younger children were more likely to be in the recovery group. Those with serious injuries were more likely to be in the chronic group. Preinjury child behavior problems were predictive of recovery and high chronic symptoms. Conclusion Identification of distinct PTSS trajectory groups has implications for understanding the course and treatment of PTSS in children.

Reading in Children with Orofacial Clefts versus Controls

Tue, 09 Jun 2009 09:46:05 PDT

Objective To examine reading and related skills in children with and without orofacial clefts. Methods Forty-two children with orofacial clefts were recruited from an urban craniofacial center. A demographically similar sample of 43 children without clefts was recruited using community advertisements and a research registry. Participants completed assessments of basic reading, phonological awareness, phonological memory, reading fluency, and rapid naming. Parents completed a semi-structured interview regarding educational and medical history. Results Children with clefts scored significantly lower than controls on measures of basic reading, phonological memory, and reading fluency. Conclusions This is one of the first studies of reading in children with orofacial clefts to include a control sample. The findings suggest that children with clefts are less adept readers than demographically matched peers without clefts, supporting the need to monitor academic achievement in this population.

Maternal Scaffolding and Preterm Toddlers' Visual-Spatial Processing and Emerging Working Memory

Dilworth-Bart, J., Poehlmann, J., Hilgendorf, A. E, Miller, K., Lambert, H. — Mon, 08 Jun 2009 08:25:20 PDT

Objective We examined longitudinal associations among neonatal and socioeconomic risks, maternal scaffolding behaviors, and 24-month visual-spatial processing and working memory in a sample of 73 toddlers born preterm or low birthweight (PT LBW). Methods Risk data were collected at hospital discharge and dyadic play interactions were observed at 16-months postterm. Abbreviated IQ scores, verbal/nonverbal working memory, and verbal/nonverbal visual-spatial processing data were collected at 24-months postterm. Results Higher attention scaffolding and lower emotion scaffolding during 16-month play were associated with 24-month verbal working memory scores. A joint significance test revealed that maternal attention and emotion scaffolding during 16-month play mediated the relationship between socioeconomic risk and 24-month verbal working memory. Conclusions These findings suggest areas for future research and intervention with children born PT LBW who also experience high socioeconomic risk.

Social-Cognitive Correlates of Physical Activity in a Multi-Ethnic Cohort of Middle-School Girls: Two-year Prospective Study

Dishman, R. K., Dunn, A. L., Sallis, J. F., Vandenberg, R. J., Pratt, C. A. — Mon, 25 May 2009 04:50:42 PDT

Objective The study examined social-cognitive correlates of physical activity in a multi-ethnic cohort of girls from six regions of the United States who participated in the Trial of Activity for Adolescent Girls during their 6th and 8th grade school years. Methods Girls completed validated questionnaires and wore accelerometers that measured weekly physical activity in the spring of 2002 and 2005. Results In 8th grade, self-efficacy and perceived social support had indirect relations with physical activity mediated through perceived barriers, which was inversely related to physical activity. Self-efficacy also had a direct relation with physical activity. Conclusions Correlations were smaller than those obtained in studies that measured physical activity by self-reports, suggesting that previous estimates were inflated by common method artifact. Nonetheless, physical activity trials among girls during early adolescence might focus on increasing self-efficacy for overcoming barriers to physical activity and on ways by which perceived barriers can otherwise be reduced.

Predicting Methylphenidate Response in Long-Term Survivors of Childhood Cancer: A Randomized, Double-Blind, Placebo-Controlled, Crossover Trial

Fri, 22 May 2009 09:08:12 PDT

Objective To investigate the methylphenidate (MPH) response rate among childhood survivors of acute lymphoblastic leukemia (ALL) and brain tumors (BTs) and to identify predictors of positive MPH response. Methods Cancer survivors (N = 106; BT = 51 and ALL = 55) identified as having attention deficits and learning problems participated in a 3-week, double-blind, crossover trial consisting of placebo, low-dose MPH (0.3 mg/kg), and moderate-dose MPH (0.6 mg/kg). Weekly teacher and parent reports on the Conners’ Rating Scales were gathered. Results Following moderate MPH dose, 45.28% of the sample was classified as responders. Findings revealed that more problems endorsed prior to the medication trial on parent and teacher ratings were predictive of positive medication response (p < .05). Conclusions MPH significantly reduces attention problems in a subset of childhood cancer survivors. Parent and teacher ratings may assist in identifying children most likely to respond to MPH so prescribing may be optimally targeted.

Interdisciplinary Behavioral Rehabilitation of Pediatric Pain-Associated Disability: Retrospective Review of an Inpatient Treatment Protocol

Maynard, C. S., Amari, A., Wieczorek, B., Christensen, J. R., Slifer, K. J. — Fri, 22 May 2009 09:08:11 PDT

Objective A biopsychosocial model was used to treat pain-associated disability in children and adolescents. We assessed the clinical outcomes of children and adolescents (8–21 years of age) with pain-associated disability who were treated in an interdisciplinary inpatient rehabilitation program which included physical, occupational, and recreational therapy, medicine, nursing, pediatric psychology, neuropsychology, psychiatry, social work, and education. Psychological treatment emphasized cognitive-behavioral intervention for pain and anxiety management, and behavioral shaping to increase functioning. Methods We conducted a retrospective chart review of 41consecutive patients. School attendance, sleep, and medication usage were assessed at admission and discharge; functional disability and physical mobility were assessed at admission, discharge, and 3-month follow-up. Results As a group, significant improvements were observed in school status, sleep, functional ability, physical mobility, and medication usage. Conclusion Findings support the efficacy of an inpatient interdisciplinary behavioral rehabilitation approach to the treatment of pain-associated disability in pediatric patients.

Assessing Injuries with Proxies: Implications for Understanding Concurrent Relations and Behavioral Antecedents of Pediatric Injuries

Karazsia, B. T., van Dulmen, M. H. M. — Mon, 18 May 2009 02:17:36 PDT

Objective To examine the implications of using proxies of medically attended injuries (minor injuries and close calls) for understanding concurrent relations among—and behavioral antecedents of—pediatric injuries. Methods Participants were 812 children from the NICHD Study of Early Child Care. Measures of externalizing behavior, maternal depression, SES, and the home environment were examined as prospective predictors of minor injuries, close calls, and medically attended injuries. Results Minor injuries and close calls were associated with medically attended injuries concurrently. Regression equations revealed different prospective predictors across the three outcome variables. Conclusions This study was the first to examine concurrent associations among minor injuries, close calls, and medically attended injuries. Prospective antecedents of each injury assessment were also examined. The present findings signify the importance of distinguishing between these different methods of assessing pediatric injury. The study also illustrated that different analytic strategies were needed to represent observed data of each outcome variable.

Assessment of the Psychometric Properties of the Family Management Measure

Mon, 18 May 2009 02:17:35 PDT

Objective This paper reports development of the Family Management Measure (FaMM) of parental perceptions of family management of chronic conditions. Method By telephone interview, 579 parents of children age 3 to 19 with a chronic condition (349 partnered mothers, 165 partners, 65 single mothers) completed the FaMM and measures of child functional status and behavioral problems and family functioning. Analyses addressed reliability, factor structure, and construct validity. Results Exploratory factor analysis yielded six scales: Child's Daily Life, Condition Management Ability, Condition Management Effort, Family Life Difficulty, Parental Mutuality, and View of Condition Impact. Internal consistency reliability ranged from .72 to .91, and test-retest reliability from .71 to .94. Construct validity was supported by significant correlations in hypothesized directions between FaMM scales and established measures. Conclusion Results support FaMM's; reliability and validity, indicating it performs in a theoretically meaningful way and taps distinct aspects of family response to childhood chronic conditions.

Negative Attitudes Toward Physical Activity: Measurement and Role in Predicting Physical Activity Levels Among Preadolescents

Nelson, T. D., Benson, E. R., Jensen, C. D. — Fri, 15 May 2009 05:56:18 PDT

Objectives To describe the development and validation of a measure of negative attitudes toward physical activity and examine the association between these attitudes and self-reported physical activity among preadolescents. Method A school-based sample of 382 fifth and sixth graders (mean age = 10.8) completed measures of attitudes toward physical activity and self-reported physical activity. Body mass index data for the participants was collected as a part of a standard school health assessment. Exploratory factor analysis, confirmatory factor analysis, and structural equation modeling were utilized to test the factor structure and predictive value of attitudes toward physical activity. Results Results supported the reliability and concurrent validity of the negative attitudes measure and found a significant association between negative attitudes and physical activity. Negative attitudes was found to be a stronger predictor of physical activity than positive attitudes, which have been the focus of previous research in this area. Conclusions The results suggest that negative attitudes toward physical activity can be reliably measured and may be an important target for intervention efforts to increase physical activity among children and adolescents.

Longitudinal Behavioral Effects of a School-Based Fruit and Vegetable Promotion Program

Hoffman, J. A., Franko, D. L., Thompson, D. R., Power, T. J., Stallings, V. A. — Wed, 13 May 2009 09:26:17 PDT

Objective This study examined the longitudinal effects of a school-based program on kindergarten and first grade children's fruit and vegetable (F&V) consumption. Methods The program included lunchroom, classroom, school-wide, and family components. The primary dependent variable, F&V consumed at lunch, was assessed using weighed plate waste. Hierarchical linear models were used to analyze the differences between intervention and control groups and to account for repeated measurements. Results Children in the experimental group consumed more F&V (F = 29 g; V = 6 g; 0.43 portions/lunch; 0.28 servings/lunch) at the end of Year 1 compared with children in the control group. At the end of Year 2, children in the experimental group consumed more fruit (21 g; 0.23 portions/lunch; 0.15 servings/lunch), but not more vegetables compared with children in the control group. Conclusions The intervention resulted in increased F&V consumption, with more pronounced and enduring effects for fruits than vegetables.

Validity of Social-Cognitive Measures for Physical Activity in Middle-School Girls

Mon, 11 May 2009 09:54:09 PDT

Objective The factorial validity and measurement equivalence/invariance of scales used to measure social-cognitive correlates of physical activity among adolescent girls were examined. Methods Confirmatory factor analysis was applied to questionnaire responses obtained from a multi-ethnic sample (N = 4885) of middle-school girls from six regions of the United States. A cohort of 1893 girls completed the scales in both sixth and eighth grades, allowing longitudinal analysis. Results Theoretically and statistically sound models were developed for each scale, supporting the factorial validity of the scales in all groups. Multi-group and longitudinal invariance was confirmed across race/ethnicity groups, age within grade, BMI categories, and the 2-year period between grades. Conclusions The scores from the scales provide valid assessments of social-cognitive variables that are putative mediators or moderators of change in physical activity. The revised scales can be used in observational studies of change or interventions designed to increase physical activity among girls during early adolescence.

Validation of the Chinese version of the Pediatric Quality of Life InventoryTM (PedsQLTM) Cancer Module

Wed, 06 May 2009 09:48:09 PDT

Objective The psychometric properties of the Chinese version of the Pediatric Quality of Life Inventory^TM (PedsQL^TM) Cancer Module were investigated. Methods This instrument and the Generic Core Scales were administered to 359 pediatric patients with cancer (5–18 years) and 413 parents of such patients (2–18 years old). Results Seven and eight factors were, respectively, identified for the patient and parent versions. The Cronbach's alpha coefficients were respectively .89 and .92 for the total scale, and respectively .75–.90 and .76–.93 for the subscales of the patient and parent versions. Test–retest reliability coefficients exceeded .60 for most cases. The total/subscale scores of the Cancer Module significantly correlated with those of the Generic Core Scales. Some of the subscales could distinguish between on-treatment and off-treatment patients. Conclusions The psychometric properties of the patient and parent versions of the Chinese PedsQL^TM Cancer Module were found acceptable.

Description of a standardized nutrition classification plan and its relation to nutritional outcomes in children with cystic fibrosis

Wed, 06 May 2009 09:48:08 PDT

Objective Better nutrition enhances lung function and increases survival for children with cystic fibrosis (CF). Therefore, we developed a standardized strategy to evaluate nutritional status and create individualized treatment plans to ensure that all patients received the same high-quality care in a busy CF Center. Methods A quality improvement approach was undertaken to develop a novel nutrition classification strategy to identify and treat children with subtle manifestations of nutritional deficits in addition to those with obvious nutritional issues. Results During the 15-month study period, the median body mass index (BMI) percentile increased from 35.2 (0–95.9) to 42.0 (0–97.7), p < .005. Additionally, the number of children with a BMI ≥ 50th percentile increased by 11.8%. Conclusions Adoption of a standardized approach to nutritional assessment and treatment led to significant improvement in nutritional outcomes of CF patients, demonstrating that systematic changes in clinical practice can improve clinical outcomes substantially over a short period of time.

Brief Report: Unintentional Injury Risk among Children with Sensory Impairments

Schwebel, D. C., Brezausek, C. M. — Wed, 22 Apr 2009 09:48:33 PDT

Objective Pediatric injuries result from a multifaceted process involving a range of individual, interpersonal, and environmental influences. One risk that remains poorly understood is the role of children's perception and perceptual disabilities. Methods Injury counts (parent-report of injuries requiring professional medical treatment over the past year) in three groups of children were compared: those without vision or hearing sensory impairments, those with deficits who use eyeglasses or hearing aids, and those with deficits who do not use aids as recommended. A national sample of 7391 5-year-olds in the National Head Start/Public School Early Childhood Transition Demonstration Study was studied. Results Injury counts over the past year were higher among children with sensory impairments, and higher still among children with sensory impairments who did not use prescribed sensory aids. Conclusions Awareness of increased injury risk among children with hearing and vision impairment could help professionals protect children from injury.

Enhancing Pain Management in the PICU by Teaching Guided Mental Imagery: A Quality-Improvement Project

Wed, 22 Apr 2009 09:48:32 PDT

Objective This quality-improvement study, following the PDCA methodology, compared the effectiveness of teaching mental imagery (MI) for pain management versus conducting a detailed inquiry (DI) about pain-related experiences with acutely injured PICU patients. Methods Participants included 44 hospitalized children and adolescents assigned to one of two intervention groups, MI (N = 24) or DI (N = 20). Pain was assessed pre- and post-intervention using the Wong-Baker Faces Pain Rating Scale and a 0–10 Likert pain rating scale, and the Pediatric Trauma Score was utilized to assess the severity of each child's injuries. Results Boys in the MI condition exhibited a significant decrease in average pain ratings [t(38) = 3.41, p = .0015]. Girls in the MI condition exhibited a non-significant decrease in average pain ratings. Conclusions Teaching children the use of MI for pain management in an intensive-care setting was supported; the use of DI with boys was not supported.

Using Quality Improvement Science to Implement a Multidisciplinary Behavioral Intervention Targeting Pediatric Inpatient Airway Clearance

Tue, 14 Apr 2009 08:06:27 PDT

Objective The objective of this study was to use quality improvement science methodology to develop a multidisciplinary intervention improving occurrence of best-practice airway clearance therapy (ACT) in inpatient adolescents with cystic fibrosis during routine clinical care. Methods The model for improvement was used to develop and implement interventions. Primary outcomes were quality of ACT (% ACT meeting criteria for best practice) and quantity of ACT (% of hospital days patients received ACT four times/day). Annotated control charts were used to document the impact of the interventions. Results Quality of ACT significantly improved from 21% best practice ACT at baseline to 73%. Quantity of ACT significantly improved from 41% days with ACT four times/day at baseline to 64%. Conclusions A multidisciplinary, evidence-based intervention was effective for improving occurrence of best-practice ACT. Pediatric psychology can make valuable contributions to improving the quality of care provided in the medical setting.

Applying Quality Improvement Methods to Implement a Measurement System for Chronic Pain-Related Disability

Fri, 06 Mar 2009 03:58:02 PST

Objective This article describes the application of quality improvement methodology to implement a measurement tool for the assessment of functional status in pediatric patients with chronic pain referred for behavioral intervention. Methods The Functional Disability Inventory (FDI), a validated instrument for assessment of pain-related disability, was chosen as the primary clinical outcome measure. Using improvement science methodology, PDSA (Plan-Do-Study-Act) cycles were run to evaluate: (a) regular FDI administration, (b) two administration methods, (c) regular patient feedback, and (d) documentation methods. Results Within 1 month, psychologists were administering the FDI at least 80% of the time to patients. A high level of reliability using two administration methods (92.8%) was demonstrated. The FDI was feasible to integrate into clinical practice. Modifications to electronic records further enhanced clinician reliability of documentation. Conclusions Quality improvement methods are an innovative way to make process changes in pediatric psychology settings to dependably gather and document evidence-based patient outcomes.