Journal of Pediatric Psychology - Advance Access

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

Greenley, R. N., Doughty, A., Stephens, M., Kugathasan, S. — 2009-06-29

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. — 2009-06-25

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

2009-06-19

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. — 2009-06-19

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. — 2009-06-17

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

2009-06-09

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. — 2009-06-08

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.

Relationships Among Sleepiness, Sleep Time, and Psychological Functioning in Adolescents

2009-06-03

Objective This study examined associations among adolescent sleepiness, sleep duration, variability in sleep duration, and psychological functioning (symptoms of anxiety, depression, externalizing behaviors, and perceived health). Methods This was a cross-sectional analysis of data from a community-based cohort study of sleep and health. Participants were 247 adolescents (48.6% female, 54.3% ethnic minority, mean age of 13.7 years). Sleep duration and variability in sleep duration were measured by actigraphy and sleepiness was measured by adolescent questionnaire. Primary outcomes were measured by parent, teacher, and adolescent questionnaires. Results Sleepiness was associated with higher scores on measures of anxiety (Adjusted partial r² = .28, p < .001), depression (Adjusted partial r² = .23, p < .001), and perceived health (indicating more negative outcomes) (Adjusted partial r² = .19, p < .01). Significant associations between sleep duration or variability in sleep duration with psychological variables were not found. Conclusions Findings highlight the inter-relationships between sleepiness and psychological functioning and the potential importance of addressing sleepiness in health and psychological evaluations of adolescents.

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. — 2009-06-02

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.

Editorial: An Author's Checklist for Measure Development and Validation Manuscripts

Holmbeck, G. N., Devine, K. A. — 2009-05-31

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. — 2009-05-25

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

2009-05-22

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. — 2009-05-22

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.

The Role of Coping and Temperament in the Adjustment of Children with Cancer

2009-05-18

Objective To examine the extent to which stress, coping, and temperament accounted for variability in adjustment among children with cancer. Methods Seventy-five mothers of children with cancer (ages 5–17) completed questionnaires regarding their child's cancer-related stress; coping; temperament characteristics including positive affect (PA), negative affect (NA), and effortful control (EC); and symptoms of anxiety and depression. Assessments occurred within one year of initial diagnosis or relapse (M = 5.74 months; SD = 4.72). Results Cancer-related stress was positively associated with symptoms of depression in children. NA was positively associated with symptoms of anxiety and depression. Primary control coping moderated the association between NA and depression, and primary and secondary control coping mediated this association. Conclusion Results partially support the utility of an integrated model including cancer-related stress, coping, and NA in identifying children at risk for internalizing symptoms during treatment. Additional research is needed to inform interventions for this population.

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

Karazsia, B. T., van Dulmen, M. H. M. — 2009-05-18

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

2009-05-18

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. — 2009-05-15

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. — 2009-05-13

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

2009-05-11

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.

Validity and Reliability of an Adolescent and Parent Rating Scale of Type 1 Diabetes Adherence Behaviors: The Self-Care Inventory (SCI)

2009-05-07

Objective Accurate assessment of diabetes regimen adherence behaviors in youth is a challenging endeavor and is limited by a paucity of empirically supported measures. The purpose of this research is to further demonstrate the validity and reliability of the Self-Care Inventory (SCI), a youth and parent report measure of adherence with diabetes self-care behaviors. The SCI was chosen given its ease of implementation, applicability to multiple diabetes regimens, and dual parent/youth formats. Methods Participants were 164 youth with type 1 diabetes and a parent. Measures were administered at regular office visits to a tertiary care diabetes clinic. Results The SCI has strong psychometric properties, including adequate internal consistency, parent–youth agreement, and test-retest agreement. Relations between the SCI and a structured interview of diabetes adherence (the Diabetes Self-Management Profile; DSMP) and hemoglobin A1c (HbA1c) were strong. Conclusions In addition to demonstrating strong psychometrics, this research provides independent support for the SCI. Thus, the SCI is consistent with recent criteria proposed by Quittner et al. (Journal of Pediatric Psychology, 33, 916–936) for an empirically supported measure of regimen adherence. Although other methods of accessing adherence may provide more comprehensive assessments, the brevity, ease-of-implementation, and robustness for multiple regimens makes the SCI an ideal tool for clinicians and researchers.

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

2009-05-06

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

2009-05-06

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.

The Role of Parental Monitoring in Metabolic Control: Effect on Adherence and Externalizing Behaviors During Adolescence

Horton, D., Berg, C. A., Butner, J., Wiebe, D. J. — 2009-05-06

Objective We examined the role of parental monitoring (general and diabetes specific) on metabolic control through better adherence and lower externalizing behaviors for adolescents with type 1 diabetes. Methods Adolescents aged 10–14 (n = 252) completed assessments of general and diabetes-specific mothers’ and fathers’ monitoring, adherence, and the Youth Self Report (YSR). Glycosylated hemoglobin (HbA1c) indexed diabetes control. Results Path analyses revealed that perceived mothers’ general monitoring was indirectly associated with lower HbA1c through lower externalizing behaviors and higher adherence. Perceived fathers’ general monitoring was associated with HbA1c differently at the extremes: low fathers’ monitoring was associated with higher HbA1c through higher externalizing behaviors; high fathers’ monitoring was associated with HbA1c through higher adherence. Diabetes-specific monitoring was not associated with externalizing behaviors. Conclusion Perceived mothers’ and fathers’ general parental monitoring facilitates metabolic control through a similar process, with parental differences largely seen at the extremes.

Brief Report: Unintentional Injury Risk among Children with Sensory Impairments

Schwebel, D. C., Brezausek, C. M. — 2009-04-22

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

2009-04-22

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.

A Mediation Analysis of the ATHENA Intervention for Female Athletes: Prevention of Athletic-Enhancing Substance Use and Unhealthy Weight Loss Behaviors

2009-04-22

Objective To explain, through mediation analyses, the mechanisms by which ATHENA (Athletes Targeting Healthy Exercise and Nutrition Alternatives), a primary prevention and health promotion intervention designed to deter unhealthy body shaping behaviors among female high school athletes, produced immediate changes in intentions for unhealthy weight loss and steroid/creatine use, and to examine the link to long-term follow-up intentions and behaviors. Methods In a randomized trial of 1668 athletes, intervention participants completed coach-led peer-facilitated sessions during their sport season. Participants provided pre-test, immediate post-test, and 9-month follow-up assessments. Results ATHENA decreased intentions for steroid/creatine use and intentions for unhealthy weight loss behaviors at post-test. These effects were most strongly mediated by social norms and self-efficacy for healthy eating. Low post-test intentions were maintained 9 months later and predicted subsequent behavior. Conclusions ATHENA successfully modified mediators that in turn related to athletic-enhancing substance use and unhealthy weight loss practices. Mediation analyses aid in the understanding of health promotion interventions and inform program development.

Brief Report: Nature and Implications of Personal Projects Among Adolescents With and Without Diabetes

Helgeson, V. S., Takeda, A. — 2009-04-16

Objective We examined the relation of adolescent goals to psychological well-being and diabetes health. Method We used personal project analysis to elicit the goals that adolescents with (n = 110) and without type 1 diabetes (n = 117) have. Adolescents evaluated several project dimensions (progress, stress, typicality, happiness, extent desired by others). Psychological well-being and diabetes health were assessed. Results Adolescents with and without diabetes described similar projects, with academic projects being most frequently named. Adolescents with diabetes were more likely to identify appearance projects, and healthy adolescents were more likely to identify self-improvement projects. Among the project dimensions, project progress was associated with better psychological and diabetes health, and project stress was associated with poorer psychological and diabetes health. Conclusion Results suggest that aspects of the general goals that adolescents set for themselves may have implications for their psychological well-being as well as how they care for their diabetes.

Self-perception and Body Image Associations with Body Mass Index among 8-10-year-old African American Girls

2009-04-14

Objectives The purpose of this study was to examine relationships among body mass index (BMI), self-perceptions, and body image discrepancy in African American (AA) girls. Methods Baseline self-perception and BMI data were collected by trained staff from 303 preadolescent AA girls participating in the girls health enrichment multi-site studies. Correlations and multivariable logistic regression analyses were performed to identify relationships of BMI with self-perception factors. Results Girls with a BMI at or above the 85th percentile were more likely to have greater body image discrepancy and participate in weight control behaviors than girls with a BMI below the 85th percentile. Body image discrepancy was not related to self-esteem, but was positively correlated with physical activity self-concept and self-efficacy, and diet self-efficacy. Conclusion Girls with higher BMI had greater body image discrepancy and were less confident in abilities to be active and eat healthy. Findings may inform the development of obesity interventions for preadolescents.

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

2009-04-14

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.

Children's Response to Serious Illness: Perceptions of Benefit and Burden in a Pediatric Cancer Population

Currier, J. M., Hermes, S., Phipps, S. — 2009-04-02

Objective To examine a revised measure of benefit finding for children, in relation to perceptions of illness-related burden, and other measures of child psychological functioning. Methods A sample of 78 children with cancer completed the newly revised Benefit/Burden Scale for Children (BBSC) and measures of optimism/pessimism, positive/negative affect, anxiety and defensiveness. Results Factor analysis of the BBSC revealed a clear two-factor solution, with benefit finding and illness-related burden representing orthogonal factors. Both scales were internally consistent and demonstrated different patterns of correlation with the other measures assessed in the study. Conclusion The BBSC is internally reliable and preliminary data supports the validity of separate benefit and burden constructs. Children report positive and negative aspects of their illness simultaneously, and perceptions of benefit and burden function as independent constructs. The BBSC is a useful measure for pediatric cancer patients that could be applied to children experiencing other significant life events.

Trajectories and Predictors of the Development of Very Young Boys with Fragile X Syndrome

2009-04-02

Objective To describe the development of young boys with fragile X syndrome (FXS). Methods Fifty-five boys (aged 8–48 months at study entry) with the full mutation FXS received multiple developmental assessments. Results As expected, the boys’ rate of development was significantly lower than chronological age expectations. No evidence of slowing in the rate of development was found. Autistic behavior was negatively associated with development, but maternal IQ was not. Developmental delays were evident in some domains as early as 9 months; however, initial detection of delays is complicated by measures and criteria used. Developmental age scores at 31 months of age were related to scores obtained at 61 months of age only in the global composite and visual reception domain. Conclusions Developmental delays are evident in some infants with FXS as young as 9 months of age. Pediatric psychologists need to be informed about the developmental profiles in young children with FXS to accurately diagnose, treat, and support these children and their families.

Survivors of Childhood Cancer and Comparison Peers: The Influence of Peer Factors on Later Externalizing Behavior in Emerging Adulthood

Thompson, A. L., Gerhardt, C. A., Miller, K. S., Vannatta, K., Noll, R. B. — 2009-03-26

Objective To examine group differences and predictors of externalizing behavior and substance use during the transition to emerging adulthood (i.e., ages 18–25) among survivors of childhood cancer and comparison peers. Methods Peer acceptance and social behavior were assessed in classrooms of 55 children (ages 8–15) during cancer treatment. Children with cancer, comparison peers (n = 60), and parents completed measures of externalizing behavior and/or substance use during an initial home visit and soon after participants turned 18. Results At follow-up, survivors and peers exhibited similar externalizing behaviors and substance use, except peers were more likely to use marijuana. Substance use was associated with earlier peer acceptance and social behavior. Survivors who were older at diagnosis were at greater risk for later externalizing behavior and substance use. Conclusions Mean externalizing behaviors and substance use generally fell within normative ranges for both survivors and peers. Some survivors may benefit from interventions to reduce risk behavior.

Brief Report: Psychosocial Factors and Pediatric Noncardiac Chest Pain

2009-03-25

Objective To investigate the associations between children's perceived chest pain severity, somatization symptoms, depressive symptoms, anxiety sensitivity, and maternal somatization symptoms in children and adolescents with noncardiac chest pain (NCCP). Methods Measures of chest pain and psychosocial functioning were collected from 35 participants (M age = 12.5 years, 54% female) with NCCP and their parents during evaluation at cardiology clinics. Results Among children presenting for cardiac evaluations, wide variation in ranges of pain severity, episode frequency, and history were observed. Children's somatic symptoms and fear of physiological arousal predicted significant variance in children's chest pain severity. Additionally, children's depressive symptoms and maternal somatization were both significant predictors of children's somatic symptoms. Conclusions These results suggest NCCP may be part of a broader pattern of somatic responding and sensitivity to physiological arousal. This pattern is associated with both child and maternal functioning. Suggestions for future research are provided.

A Group Social Skills Intervention Program for Survivors of Childhood Brain Tumors

Barrera, M., Schulte, F. — 2009-03-25

Objective The purpose of this study was to evaluate the feasibility and preliminary outcomes of a social skills group intervention program for child brain tumor survivors. Methods Participants were 32 survivors (14 females) aged 8–18 years. Medulloblastoma (28%) was the main diagnosis. The intervention consisted of eight 2-hr weekly sessions focused on social skills including friendship making and assertion. Survivors and parents completed measures of social skills, quality of life, behavior and depression, at baseline, pre- and post-intervention, and 6 months later. Results Feasibility analyses revealed promising acceptability, retention, recruitment, and treatment fidelity. Significant improvement was found after intervention based on parents’ reports of self-control [F(1,27) = 5.97, p <.05], social skills [F(1,28) = 5.70, p <.05], and quality of life [F(1,15) = 17.98, p <.01]. Conclusions The intervention is feasible and outcomes based on parental reports provide preliminary support for the efficacy of the program.

Brief Report: Adherence to Fluid Recommendations in Children Receiving Treatment for Retentive Encopresis

Kuhl, E. S., Felt, B. T., Patton, S. R. — 2009-03-20

Objective Limited data are available regarding whether children being treated for retentive encopresis are adherent to recommendations to increase their daily fluid intake. The purpose of this study was to examine fluid adherence in children who received treatment for retentive encopresis. Methods A retrospective chart review was performed using diet diary data for 26 children (ages 3–12) who completed a group behavioral intervention for retentive encopresis. Results Mean daily intake of clear fluid increased significantly during treatment and children relied primarily on water and juice to make this dietary change. However, adherence rates to clear fluid goals were <50%. Conclusions Children's increased clear fluid intake did not equate to high fluid adherence. Children's high juice consumption is concerning as it could place them at risk for other negative health consequences. Future research should examine whether enhanced fluid education and use of behavior change strategies yield higher fluid adherence.

Exploring Psychophysiological Markers of Vulnerability to Somatic Illnesses in Females

Hipwell, A. E., Keenan, K., Marsland, A. — 2009-03-13

Objective To examine the association between biological stress regulation and somatic complaints in young girls prior to the onset of clear psychopathology such as somatization disorder. Methods Salivary cortisol, heart rate variability (HRV), and negative mood were assessed in 48 12-year-old girls in response to the Trier Social Stress Test for Children (TSST-C). Parent and child report on the Children's Somatization Inventory was used to identify girls with high and low somatic complaints. Results Girls with high levels of somatic complaints had significantly higher initial levels of cortisol, which decreased over time, and showed a trend for a more limited HRV in response to the TSST-C than girls with low levels of somatic complaints. Conclusions High levels of cortisol and possibly low HRV among girls with somatic complaints may interfere with flexibility in responding to typical psychosocial stressors, which may increase vulnerability to the onset of somatic illnesses in females.

A Randomized Controlled Trial of Massage Therapy in Children with Sickle Cell Disease

Lemanek, K. L., Ranalli, M., Lukens, C. — 2009-03-12

Objective This randomized controlled trial investigated the short-term effects of massage therapy on youth with SCD and their parents. Methods Thirty-four children and adolescents, and their parents were assigned to a massage therapy or an attention control group. Parents were trained in massage in their homes once a week for 4 weeks, with instructions to provide nightly massages. Families in the control group were visited weekly by a research assistant. Participants completed measures of depression and anxiety, functional status, pain intensity, medication use, and service utilization. Results Parents in the massage therapy group reported higher levels of depression and anxiety following the intervention. Youth in this group showed higher levels of functional status, and lower levels of depression, anxiety, and pain. Health service utilization rates were unchanged from pre- to post-intervention. Conclusions These results offer preliminary support for parent-delivered massage therapy as an intervention for SCD pain.

Brief Report: Young Children's Risk of Unintentional Injury: A Comparison of Mothers' and Fathers' Supervision Beliefs and Reported Practices

Morrongiello, B. A., Walpole, B., McArthur, B. A. — 2009-03-10

Objective There is increasing interest in understanding how parent supervision influences young children's risk of injury, but nearly all of this research has been conducted with mothers. The present study compared first-time mothers’ and fathers’ supervisory beliefs and reported practices, and related these scores to parental reports of their child's history of injuries. Methods Mothers and fathers of children 2–5 years each independently completed a telephone interview and previously validated questionnaires about their supervisory beliefs and practices and their child's history of injuries. Results Mothers and fathers provided similar reports of their child's injuries (minor, medically attended) and scored similarly on various supervision indices. Despite these similarities, the way mothers’ and fathers’ supervision indices related to children's injury history scores differed. Children's frequency of minor and medically attended injuries was predicted from maternal supervisory scores but not from paternal scores. Conclusions Maternal supervision has more impact on children's risk of injury than paternal supervision, possibly because mothers spend more time with children than fathers.

Increasing Parent-Pediatrician Communication about Children's Psychosocial Problems

Hayutin, L. G., Reed-Knight, B., Blount, R. L., Lewis, J., McCormick, M. L. — 2009-03-06

Objective To examine the differential effects of two scoring procedures for a parent-completed measure, the Pediatric Symptom Checklist (PSC), designed to assess children's behavioral and emotional functioning, on parent–pediatrician communication concerning psychosocial issues. Methods Prior to their medical appointment, 174 parents of children aged 4–16 were assigned to one of three experimental conditions: (1) typical medical care control, (2) Staff-Scored PSC administration, or (3) Parent-Scored PSC administration. Following the appointment, parent perception of parent–pediatrician communication was assessed. Results For children with more emotional and behavioral problems, participants in the Parent-Scored group and the Staff-Scored group had better parent–pediatrician communication scores than those in the control group. Conclusions Both the Staff-Scored and Parent-Scored administrations of the PSC improved parent–pediatrician communication on psychosocial issues. The Parent-Scored PSC removed the scoring burden on the medical personnel.

Generic and Diabetes-specific Parent-Child Behaviors and Quality of Life Among Youth with Type 1 Diabetes

2009-03-06

Objective To evaluate associations among parent–child behaviors and generic and diabetes-specific health-related quality of life (HRQOL) in a multi-site sample of youth with type 1 diabetes. Method One hundred and twenty-one youth and their primary caregivers completed measures of parent–child behaviors, child HRQOL, and participated in an observed family interaction task. Results Diabetes-specific parent–child variables were associated significantly with both generic and diabetes-specific HRQOL above and beyond the contributions of demographic and generic parent-child variables, accounting for between 13% and 31% of the variance in HRQOL. Diabetes-specific family conflict and negative diabetes-specific family communication were associated with lower HRQOL. Collaborative parent involvement in diabetes care was associated with higher levels of HRQOL. Conclusions Interventions that target diabetes-specific family interactions will be beneficial to the quality of life of children with type 1 diabetes.

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

2009-03-06

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.

Family Therapy for Adolescents with Poorly Controlled Diabetes: Initial Test of Clinical Significance

Harris, M. A., Freeman, K. A., Beers, M. — 2009-03-05

Objective We examined a structured family therapy approach in promoting clinically meaningful improvements in parent–adolescent conflict in adolescents with poorly controlled diabetes. Method Eighteen adolescents with poorly controlled diabetes and their parent(s) participated in 10 sessions of home-based Behavioral Family Systems Therapy (BFST). Outcome comparisons were made using a sample of adolescents with poorly controlled diabetes (n = 40) from a previous study. Clinically significant improvements were determined by calculating SD differences between treatment and comparison groups on measures of diabetes-related and general parent–adolescent conflict. Results Home-based BFST produced change in diabetes-related family conflict ranging from 1/3 to 1/2 SD and general family conflict ranging from 1/3 to 3/4 SD. Conclusions BFST produced change in family conflict, a variable shown through previous research to relate to treatment adherence in adolescents with diabetes. The test of clinical significance represents an example of a method useful for pediatric research.

Assessment of Somatic Symptoms in British Secondary School Children Using the Children's Somatization Inventory (CSI)

2009-02-17

Objective To present normative and psychometric data on somatic symptoms using the Children's Somatization Inventory (CSI) in a nonclinical sample of British young people, and to assess associations with stress and functional impairment. Methods A total of 1,173 students (11- to 16-years old) completed the CSI and self-report psychopathology measures. Results The median CSI total score was 12 (5, 23). Headaches, feeling low in energy, sore muscles, faintness, and nausea were most frequent. Girls scored higher than boys, and respondents aged 13–14 years lower than younger children. The CSI showed good internal consistency and exploratory factor analysis yielded three factors: pain/weakness, gastrointestinal, and pseudoneurological. A quarter of respondents reported somatic symptoms were made worse by stress. CSI scores were moderately significantly correlated with impairment and emotional symptoms. Conclusions The CSI, complemented by information on functional impairment and stress is an appropriate measure of recent somatic symptoms and somatization risk in young people for use in the UK.

Exercise Effects on Depressive Symptoms and Self-Worth in Overweight Children: A Randomized Controlled Trial

Petty, K. H., Davis, C. L., Tkacz, J., Young-Hyman, D., Waller, J. L. — 2009-02-16

Objective To test the dose–response effects of an exercise program on depressive symptoms and self-worth in children. Method Overweight, sedentary children (N = 207, 7–11 years, 58% male, 59% Black) were randomly assigned to low or high dose (20 or 40 min/day) aerobic exercise programs (13 ± 1.6 weeks), or control group. Children completed the Reynolds Child Depression Scale and Self-Perception Profile for Children at baseline and posttest. Results A dose–response benefit of exercise was detected for depressive symptoms. A race x group interaction showed only White children's global self-worth (GSW) improved. There was some evidence that increased self-worth mediated the effect on depressive symptoms. Conclusions This study shows dose–response benefits of exercise on depressive symptoms and self-worth in children. However, Blacks did not show increased GSW in response to the intervention. Results provide some support for mediation of the effect of exercise on depressive symptoms via self-worth.

How to Select, Calculate, and Interpret Effect Sizes

Durlak, J. A. — 2009-02-16

The objective of this article is to offer guidelines regarding the selection, calculation, and interpretation of effect sizes (ESs). To accomplish this goal, ESs are first defined and their important contribution to research is emphasized. Then different types of ESs commonly used in group and correlational studies are discussed. Several useful resources are provided for distinguishing among different types of effects and what modifications might be required in their calculation depending on a study's purpose and methods. This article should assist producers and consumers of research in understanding the role, importance, and meaning of ESs in research reports.

Brief Report: Factors Associated with Asthma Management Self-Efficacy Among 7th and 8th Grade Students

Ayala, G. X., Yeatts, K., Carpenter, D. M. — 2009-02-11

Objective Examine correlates of asthma self-management among 12,154 adolescents with physician-diagnosed asthma. Methods All 7th and 8th grade students in North Carolina completed a survey to assess asthma prevalence and self-management behaviors among those with asthma. Results Adolescents who were allowed to carry their inhaled medication at school, shown how to use a peak flow meter, and had access to more asthma care resources were more confident that they could prevent an asthma exacerbation. Adolescents who were allowed to carry their inhaled medication at school and who had a private doctor were more confident that they could control their symptoms. Adolescents taking anti-inflammatory medicine were less confident that they could prevent an exacerbation and control their symptoms. Conclusions Various indicators of autonomy and control were associated with greater self-efficacy for managing asthma. Adolescents who require anti-inflammatory medicines would benefit from additional intervention efforts to improve their asthma management self-efficacy.

Parental HIV/AIDS and Psychosocial Adjustment among Rural Chinese Children

2009-02-10

Objective To assess the relationship between parental HIV/AIDS and psychosocial adjustment of children in rural central China. Methods Participants included 296 double AIDS orphans (children who had lost both their parents to AIDS), 459 single orphans (children who had lost one parent to AIDS), 466 vulnerable children who lived with HIV-infected parents, and 404 comparison children who did not experience HIV/AIDS-related illness and death in their families. The measures included depressive symptoms, loneliness, self-esteem, future expectations, hopefulness about the future, and perceived control over the future. Results AIDS orphans and vulnerable children consistently demonstrated poorer psychosocial adjustment than comparison children in the same community. The level of psychosocial adjustment was similar between single orphans and double orphans, but differed by care arrangement among double orphans. Conclusion The findings underscore the urgency and importance of culturally and developmentally appropriate intervention efforts targeting psychosocial problems among children affected by AIDS and call for more exploration of risk and resilience factors, both individual and contextual, affecting the psychosocial wellbeing of these children.

ADHD and Anger Contexts: Electronic Diary Mood Reports from Mothers and Children

2009-02-05

Objective Using electronic diaries (eDiaries), this study examined temporal links between child and maternal anger, as well as positive mood and perceived stress, in children with attention–deficit/hyperactivity disorder (ADHD) versus comparison peers. Methods Across 7 days, half-hourly eDiaries were completed independently by mothers and their 8–12-year-old children (51 receiving medication for ADHD and 58 comparison peers). Results Cross-informant analyses revealed systematic patterns of negative maternal moods in relation to child anger in both groups along with evidence of slower recovery in the ADHD group. Analogously, for both groups, children's anger reports increased and good-mood reports decreased in relation to maternal anger, whereas elevated stress in relation to maternal anger was restricted to children with ADHD. Conclusions The findings indicate that a negative affective climate is more likely to persist in ADHD than in comparison families. They also affirm the utility of child as well as parent eDiary reports and suggest that children may be willing to report low positive mood when reluctant to report negative mood. The promise of incorporating real-time data on mood patterning into tailored treatments for children with ADHD and their families is discussed.

Adherence to Treatment in Adolescents with Cystic Fibrosis: The Role of Illness Perceptions and Treatment Beliefs

Bucks, R. S, Hawkins, K., Skinner, T. C., Horn, S., Seddon, P., Horne, R. — 2009-02-05

Objectives This study was conducted to explore the relationships between illness perceptions, emotional representations, treatment beliefs and reported adherence in adolescents with cystic fibrosis (CF). Methods Thirty-eight adolescents completed questionnaires assessing their perceptions of CF, beliefs about prescribed treatments and reported adherence to chest physiotherapy, enzyme supplements, and antibiotics. Results Reported non-adherence to chest physiotherapy was associated with the way in which patients judged their personal need for treatment relative to their concerns about potential adverse effects. Patients reported strong doubts about the necessity of chest physiotherapy. Reported non-adherence to antibiotics was related to doubts about the necessity of antibiotics, believing that CF is not amenable to treatment control. Despite these beliefs about treatment, participants perceived CF as a chronic condition. Conclusions The findings provide preliminary support for the self-regulatory model, using the necessity-concerns framework to operationalize treatment beliefs, in explaining adherence to treatment in adolescents with CF.

Cultural Factors and Family-Based HIV Prevention Intervention for Latino Youth

Lescano, C. M., Brown, L. K., Raffaelli, M., Lima, L.-A. — 2009-01-30

Latino youth are the fastest growing ethnic group in the United States and are at considerable risk for HIV and other sexually transmitted infections (STIs), given that they have an earlier onset of sexual activity and use condoms less consistently than European American adolescents. Theorists and scholars have emphasized the importance of taking culture into account in sexuality interventions with Latino adolescents, yet few culturally tailored interventions have been developed for this population. Given the emphasis on familismo and collectivism among Latinos, family-based programs are likely to be well received and could contribute to long-term maintenance of adolescent safety. In this synthesis of the relevant literature, cultural factors that have been identified as relevant to Latino sexuality are reviewed and implications for family-based intervention with Latinos are addressed.

School Functioning in Adolescents With Chronic Pain: The Role of Depressive Symptoms in School Impairment

Logan, D. E., Simons, L. E., Kaczynski, K. J. — 2009-01-30

Objective To explore associations between depressive symptoms and school functioning, including school attendance, academic performance, self-perceived academic competence, and teacher-rated school adjustment among predominantly Caucasian and female adolescent chronic pain patients. Methods A total of 217 clinically referred adolescents (aged 12–17 years) and their parents completed measures of pain characteristics, depression, and school functioning. Additional data were collected from school records and teacher reports. Results Depressive symptoms strongly correlated with school functioning indicators. In linear regression analyses, higher levels of depressive symptoms predicted more school impairment. A model testing whether depressive symptoms mediated the association between current pain intensity and parent perceptions of the interference of pain on school functioning was supported by the data. Conclusions Depressive symptoms play a key role in influencing the extent of school impairment in adolescents with chronic pain. Interventions to alleviate depressive symptoms may enhance treatments designed to improve school functioning in this population.

Development and Initial Validation of a Pictorial Quality of Life Measure for Young Children with Asthma

Everhart, R. S., Fiese, B. H. — 2009-01-23

Objective To develop and assess the psychometric properties of a pictorial version of the Pediatric Asthma Quality of Life Questionnaire (PAQLQ). Methods A pictorial PAQLQ was administered to 101 children with mild to severe asthma between 5 and 7 years of age. A subgroup of 48 children followed longitudinally completed the established version of the PAQLQ. Results A confirmatory factor analysis with modifications supported the factor structure of the established PAQLQ. The pictorial measure exhibited internal consistency reliability and convergent, discriminant, and predictive validity. Conclusions Results suggest that the pictorial version of the PAQLQ has an underlying factor structure that is similar to that of the established PAQLQ. Future research with larger and diverse samples is needed to confirm the factor structure of the pictorial PAQLQ.

Health-Related Hindrance of Personal Goal Pursuit and Well-Being of Young Adults with Cystic Fibrosis, Pediatric Cancer Survivors, and Peers without a History of Chronic Illness

Schwartz, L. A., Drotar, D. — 2009-01-23

Objective Study examined content of personal goals, health-related hindrance (HRH; i.e., impact of health on goals), and relationship of HRH to health status and psychological well-being in young adults with cystic fibrosis (CF; n = 48), who survived childhood cancer (n = 57), and without history of chronic illness (n = 105). Methods Participants completed measures of life events, quality of life, psychological well-being, and goals. Results No group differences were found on goal content. HRH significantly related to subjective well-being and distress after controlling for demographics, negative life events, physical health-related quality of life, disease status, and self-efficacy. HRH related to health status variables. Cancer survivors without cancer late effects had significantly less HRH than the other groups. Conclusions Health status may affect pursuit of personal goals and relate to well-being of young adults. The assessment of HRH has potential clinical utility for targeting interventions and warrants further research.

Brief Report: Hope, Perceived Maternal Empathy, Medical Regimen Adherence, and Glycemic Control in Adolescents with Type 1 Diabetes

Lloyd, S. M., Cantell, M., Pacaud, D., Crawford, S., Dewey, D. — 2009-01-23

Objective The relationships among hope, perceived maternal empathy, medical regimen adherence, and glycemic control in adolescents with type 1 diabetes were examined. Method Twenty-nine girls and 21 boys with type 1 diabetes completed measures of hope, perceived maternal empathy, and medical regimen adherence. Each participant's most recent hemoglobin A1c, a measure of glycemic control, was obtained from the diabetes clinic database. Results Significant correlations were found among hope, perceived maternal empathy, and medical regimen adherence. Significant correlations were also found among hope, perceived maternal empathy, and glycemic control. Adolescents’ perceptions of maternal empathy were positively correlated with level of hope. Hope appeared to mediate the relationship between perceived maternal empathy and adherence, as well as between perceived maternal empathy and glycemic control. Conclusions The results of this study affirm the need for longitudinal research that examines the associations among hope, perceived maternal empathy, medical regimen adherence, and glycemic control.

Brief Report: Problem Solving and Maternal Distress at the Time of a Child's Diagnosis of Cancer in Two-Parent Versus Lone-Parent Households

2009-01-07

Objective To examine negative affectivity and problem-solving abilities for lone mothers and those who are married/partnered subsequent to a child's diagnosis with cancer. Methods Negative affectivity and problem-solving strategies were assessed for 464 mothers (87 lone and 377 married/partnered) within 2–16 weeks of their child's diagnosis with cancer. Results The two groups of mothers did not differ significantly on measures of perceived posttraumatic stress or problem-solving; lone mothers reported significantly more symptoms of depression. This difference was no longer significant when maternal education was taken into account. Conclusions Negative affectivity and problem-solving abilities were similar for lone mothers and those that are married/partnered shortly after their child has been diagnosed with cancer. Findings are discussed within the context of contemporary strategies to assess marital status as proxy variable for various underlying constructs.

Collaborative Involvement of Primary and Secondary Caregivers: Associations with Youths' Diabetes Outcomes

2008-12-26

Objective Collaboration between youths with type 1 diabetes (T1D) and their adult caregivers may be central to effective management of T1D. This article includes analysis of cross-sectional associations between T1D outcomes (adherence, glycemic control, quality of life, family conflict, depression, and self-efficacy) and scores on the Collaborative Parent Involvement (CPI) Scale obtained from 309 youths with T1D about their primary and secondary caregivers. Methods MANCOVA, controlling for age, evaluated associations of diabetes outcomes with youths’ CPI scores for each caregiver. Results Diabetes outcomes were poor when both caregivers obtained CPI scores below the median. Diabetes outcomes were more strongly associated with CPI scores of primary, rather than secondary, caregivers. CPI scores at or above the median among primary caregivers were associated with more favorable status on multiple youth outcomes. When both caregivers obtained CPI scores at or above the median, children had significantly lower HbA1C and parents retained more responsibility for diabetes care. Conclusions Higher collaborative involvement, particularly among primary caregivers, was associated with favorable status along a variety of diabetes outcomes. Longitudinal studies could confirm if youth–parent collaboration is a justifiable intervention target.

A Transactional Model of Sleep-Wake Regulation in Infants Born Preterm or Low Birthweight

Schwichtenberg, A.J. M., Poehlmann, J. — 2008-12-19

Objective To test a transactional model of sleep–wake development in infants born preterm or low birthweight (PT LBW), which may inform clinical practice, interventions, and future research in this at risk population. Methods One hundred and twenty-eight mother–infant dyads participated from hospital discharge to 4 months postterm. Assessments of prematurity, infant sleep–wake patterns, maternal interaction quality, depression, feeding route, and sociodemographic factors were conducted. Results Path analyses revealed that maternal interactions directly related to infant sleep patterns and family sociodemographic risks related to less optimal parenting. In addition, bottle fed infants experienced fewer night wakings and more nighttime sleep. Conclusions Two potential pathways to sleep patterns in PT LBW infants were identified. The findings suggest directions for clinical work, such as supporting healthy infant sleep through parenting interventions or supporting interpersonal relations between parents and their PT LBW infants by encouraging more daytime naps. Additionally, clinicians should assess parents’ nighttime sleep concerns within the larger sociodemographic and feeding context.

Putting Research in Context: Understanding Confidence Intervals from One or More Studies

Finch, S., Cumming, G. — 2008-12-18

Objectives To support wider use and higher quality interpretation of confidence intervals (CIs) in psychology. Methods We discuss the meaning and interpretation of CIs in single studies, and illustrate the value of CIs when reviewing and integrating research findings across studies. We demonstrate how to find CIs from summary statistics and published data in some simple situations. Results We provide the ESCI graphical software, which runs under Microsoft Excel, to assist with calculating and plotting CIs. (www.latrobe.edu.au/psy/esci) Conclusions The wider use of CIs in psychology should support quality research communication and integrated interpretation of findings in context.

Brief Report: Body Dissatisfaction, Weight Criticism, and Self-Reported Physical Activity in Preadolescent Children

Jensen, C. D., Steele, R. G. — 2008-12-17

Objective To examine the associations among physical activity, weight criticism during physical activity, and body dissatisfaction in a sample of pre-adolescent children. Methods A community sample of 376 fifth- and sixth-grade students (M age = 10.8, SD = 0.65) completed measures of physical activity, weight criticism during physical activity, and body dissatisfaction. Results Girls who reported experiencing high levels of weight criticism and high body dissatisfaction engaged in significantly fewer vigorous activities than girls who experienced criticism in the absence of body dissatisfaction. These results were not evident among boys. Conclusions These findings highlight the importance of body dissatisfaction in girls' propensity to engage in physical activity, and lend preliminary support to obesity prevention efforts that address body dissatisfaction and weight criticism among girls.

Conducting a Randomized Clinical Trial of an Psychological Intervention for Parents/Caregivers of Children with Cancer Shortly after Diagnosis

2008-12-17

Objective To report acceptability, feasibility, and outcome data from a randomized clinical trial (RCT) of a brief intervention for caregivers of children newly diagnosed with cancer. Method Eighty-one families were randomly assigned following collection of baseline data to Intervention or Treatment as Usual (TAU). Recruitment and retention rates and progression through the protocol were tracked. Measures of state anxiety and posttraumatic stress symptoms served as outcomes. Results Difficulties enrolling participants included a high percentage of newly diagnosed families failing to meet inclusion criteria (40%) and an unexpectedly low participation rate (23%). However, movement through the protocol was generally completed in a timely manner and those completing the intervention provided positive feedback. Outcome data showed no significant differences between the arms of the RCT. Conclusions There are many challenges inherent in conducting a RCT shortly after cancer diagnosis. Consideration of alternative research designs and optimal timing for interventions are essential next steps.

Psychometric Properties of the Chinese Version of the Swanson, Nolan, and Pelham, Version IV Scale-Teacher Form

2008-12-12

Objectives To examine the psychometric properties of the Chinese version of Swanson, Nolan and Pelham IV Scale (SNAP-IV)-Teacher Form. Methods The sample included a representative sample of 3,653 first to eighth graders (boys, 52.3%) and 190 children diagnosed with ADHD (aged 6–15). Teachers completed the Chinese versions of the SNAP-IV, and Strengths and Difficulties Questionnaire. Results The confirmatory factor analysis revealed a four-factor structure (inattention, hyperactivity, impulsivity, and opposition) with an adequate fit (Comparative Fit Index = 0.990; root mean square error of approximation = 0.058). The test–retest reliability (intraclass correlations = 0.60–0.84), internal consistency ( = .88–.95), and concurrent validity (Pearson correlations = 0.61–0.84) were satisfactory. Children with both ADHD and oppositional defiant/conduct disorders had the highest scores, followed by children with ADHD only who had intermediate scores and then school-based participants who had the lowest scores. Conclusions Our findings suggest that the Chinese SNAP-IV-Teacher Form is a reliable and valid instrument for rating ADHD and oppositional symptoms (ClinicalTrials.gov number, NCT00491361).

Mental Health Services for Preschool Children in Primary Care: A Survey of Maternal Attitudes and Beliefs

Harwood, M. D., O'Brien, K. A., Carter, C. G., Eyberg, S. M. — 2008-12-08

Objective This study examined maternal attitudes and practices that may prevent preschoolers from receiving needed mental health services. Methods Mothers of 110 children ages 3–6 completed a survey of maternal attitudes and practices and the Eyberg Child Behavior Inventory (ECBI). Results Mothers wanted pediatrician assistance with child behavior concerns. Mothers of children with elevated ECBI scores reported most often discussing disruptive behaviors with their pediatrician, and preferred clinician-provided services, whereas mothers of children with normal range ECBI scores most often discussed developmental issues with the pediatrician and preferred parenting help from handouts and books. Mothers reported receiving clinician-provided services almost never. Conclusions Mothers were open to psychosocial services for child behavior problems, particularly via primary care, and ratings of barriers were relatively low despite reporting infrequent service use. Mothers’ responses highlight the need for mental health providers in primary care to ensure accessibility of desired services.

Attrition in Randomized Controlled Trials for Pediatric Chronic Conditions

Karlson, C. W., Rapoff, M. A. — 2008-12-08

Objective To examine attrition variables in randomized controlled trials of cognitive behavioral interventions for children with chronic illnesses. Methods We examined attrition rates reported on 40 randomized cognitive behavioral interventions published in six pediatric research journals, during the years 2002–2007. Intervention focus was limited to children with a chronic medical condition, such as asthma, obesity, arthritis, diabetes, cancer, sickle cell disease, and cystic fibrosis. Results Mean rate of enrollment refusal was 37% (range 0–75%). Mean attrition rate was 20% (range 0–54%) for initial follow-up and 32% (range 0–59%) for extended follow-up. Of the reviewed articles, 40% included a CONSORT diagram. Conclusions Strategies that can be used to limit attrition include tailoring recruitment to the study population, providing personalized feedback, maintaining consistent study procedures, providing incentives, and using intensive tracking measures. There is a need for standardized definitions and reporting of attrition rates in randomized cognitive behavioral intervention studies.

Brief Report: The Association Between Peer Victimization, Prosocial Support, and Treatment Adherence in Children and Adolescents with Inflammatory Bowel Disease

2008-12-06

Objective To examine the relationship between peer victimization, prosocial support, and treatment adherence in children and adolescents with Inflammatory Bowel Disease (IBD). Method Thirty-eight children diagnosed with IBD, between the ages of 7–19 years, and their parents were recruited from an outpatient Gastroenterology Clinic. Each child completed the Social Experience Questionnaire. The child, parent, and treating physician completed a one-item measure of child medication adherence. Results Child reported positive social interactions moderated the relationship between child reported peer victimization and self-reported medication adherence (t = –2.09; p = .045). These relationships held when parent report of child adherence was substituted for child reported adherence in this model (t = –2.37; p = .024). Conclusions The findings from this pilot study suggest that prosocial support may buffer children with IBD from experiencing the more negative effects of peer victimization on treatment adherence and highlight the importance of social interactions in youth with IBD. Implications for treatment are discussed.

Cognitive Development of Singletons Conceived by Intracytoplasmic Sperm Injection or In vitro Fertilization at Age 5 and 10 years

Goldbeck, L., Gagsteiger, F., Mindermann, I., Strobele, S., Izat, Y. — 2008-11-26

Objective To investigate the cognitive functioning of low-risk singletons born after intracytoplasmic sperm injection (ICSI) or in vitro fertilization (IVF) at the age of 5 or 10 years. Methods Sixty-nine children (35 ICSI, 34 IVF) participated voluntarily in the study that had been approved by the local IRB. Their intellectual functioning was examined by the Kaufmann Assessment Battery for Children. Results The IQ of the study group fell in the normal range (mean = 98.2; SD = 12.2). ICSI children (IQ = 94.1, SD = 13.8) had statistically lower intellectual abilities compared to IVF children (IQ = 102.0, SD = 9.1; t = –2.81, p = .005), especially in simultaneous mental processing. 23.5% ICSI children, but only 2.9% IVF children (p = .011) had at least borderline delayed cognitive development. Conclusions Most artificially conceived singletons show a normal cognitive development, however the method of fertilization seems to have an impact on their IQ. ICSI might be associated with the risk for a slightly delayed cognitive development compared to IVF.

Testing Gender as a Moderator of Associations Between Psychosocial Variables and Functional Disability in Children and Adolescents with Chronic Pain

Kaczynski, K. J., Claar, R. L., Logan, D. E. — 2008-10-29

Objective To evaluate gender as a moderator of associations between psychosocial variables and functional disability in children and adolescents with chronic pain. Method Participants included 266 patients (177 girls; mean age = 13.3 years) with chronic or recurrent headache or abdominal pain who were evaluated at a pediatric chronic pain clinic. Patients completed measures of pain intensity, anxiety, depression, pain coping, and functional disability. Parents completed a measure of protective behavior. Results Girls and boys reported similar levels of pain intensity. Girls were more likely to endorse depressive symptoms, and internalizing symptoms were associated with disability in girls, not in boys. No gender differences were found in links between coping and protective parenting and disability. Conclusions In general, psychosocial factors influenced functional disability similarly in girls and boys, although some gender differences were found. Findings highlight the importance of considering child gender when evaluating factors that contribute to functional disability.

The Association of Pain and Depression in Preadolescent Girls: Moderation by Race and Pubertal Stage

Keenan, K., Hipwell, A. E., Hinze, A. E., Babinski, D. E. — 2008-10-23

Objective To test whether an association between pain response and depression in females is present during preadolescence using a controlled pain stimulus and a clinically relevant assessment of depressive symptoms. Method In a sample of 232 girls, pain threshold and tolerance were assessed at age 10 years using the cold pressor task, and a diagnostic interview was used to assess depression symptoms at 10 and 11 years of age. Results Response to pain at age 10 was associated with depressive symptoms at ages 10 and 11; race and pubertal stage moderated the association. Pain response and depression were more strongly associated among girls who had reached advanced stages of pubertal development and among European American girls. Conclusions The results add to the existing literature on the co-occurrence of depression and pain by demonstrating modest but consistent concurrent and prospective associations between response to pain and depression among girls during preadolescence.

Chronic Tension-Type Headache in Adolescents. Clinical and Psychological Characteristics Analyzed Through Self- and Parent-Report Questionnaires

Battistutta, S., Aliverti, R., Montico, M., Zin, R., Carrozzi, M. — 2008-10-16

Objectives To analyze the relation between the symptoms reported by adolescents with chronic tension-type headache (CTTH) and their perception of their emotional and behavioral functioning. Methods Two groups of adolescents (clinical group, n = 48; control group, n = 135) and their parents (clinical group, n = 42; control group, n = 128) were studied, respectively, with the Youth Self-Report Questionnaire and the Child Behavior Checklist. Moreover, a secondary analysis was performed, identifying another subgroup of adolescents who reported having headaches. Results The clinical group of adolescents obtained higher scores than the control group in Internalizing Syndrome; Aggressive Behavior for Externalizing Syndrome; Social, Thought, and Attention Problems; and in all Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV)-oriented scales (except conduct problems). Differences between the two groups of parents were found in all the scales. The controls reporting headaches obtained interesting intermediate scores. Conclusions Adolescents with CTTH show greater emotional and behavioral problems than their healthy peers. Consequently, clinical approaches for proper diagnosis and treatment need to adopt a multidisciplinary prospective.

Examining the Stress Response and Recovery Among Children With Migraine

Huss, D., Derefinko, K., Milich, R., Farzam, F., Baumann, R. — 2008-10-15

Objective This study compared physiological differences between children diagnosed with migraine and their healthy peers. Method Physiological measures were obtained at baseline, after discussing an emotional stressor, and after a 5-min recovery period in 21 children with pediatric migraine and 32 healthy peers. Comparisons were also made on psychological measures investigating anxiety. Results Children with migraine exhibited a significantly higher pulse rate compared to comparison children at rest, and higher diastolic blood pressure and higher low-frequency/high-frequency ratio after a 5-min recovery from an emotional stressor. Additionally, when anxiety was entered as a covariate, group differences after the 5-min recovery period were no longer significant. Conclusions Results suggest that relative to comparison children, children with migraine exhibit some physiological elevation at rest, as well as a prolonged physiological recovery period after an emotional stressor. Group differences after the 5-min recovery period suggest that children with migraine experience delayed sympathetic hyperarousal and prolonged sympathovagal imbalance. The treatment implications of these findings are discussed.

Maternal Emotional Availability and Infant Pain-related Distress

Din, L., Pillai Riddell, R., Gordner, S. — 2008-10-13

Objectives The current study investigated the relationships between maternal emotional availability and infant pain expressions. Methods A group of 73 mother–infant dyads were recruited prior to their routine immunization appointment and were subsequently filmed. Results Analyses revealed that maternal nonintrusiveness was related to lower infant pain expressions both immediately and 1 min following needle. In addition, maternal sensitivity and overall emotional availability were related to lower infant pain expressions 1 min after needle. Conclusions These results suggest that intrusive caregiving behaviors can increase infant pain reactivity and hinder the regulation of pain-related distress. On the other hand, sensitive and emotionally available caregiving help infants to regulate their pain-related distress. The results support that infant pain expressions are related to the quality of maternal caregiving.

The Cold Pressor Test for the Pediatric Population: Refinement of Procedures, Development of Norms, and Study of Psychological Variables

2008-10-09

Objective The aims of the study were: (a) to propose focal refinements to the cold pressor test (CPT) for the pediatric population, contributing to the development of subjective and behavioral norms; (b) to analyze the influence of personal (gender, age, and skin-fold thickness), and psychological (anxiety, depression, internalization, and externalization) variables on pain perception and its correlation with room temperature. Methods After a phase of adaptation in a water bath (24–27°C), the child immersed one arm in cold water (10°C) and reported pain threshold and tolerance. Results The test was conducted on 141 healthy children. Pain tolerance was reached within the first minute by 50% of the children. Pain intensity affected the children's emotional status. Older children tolerated pain for longer. Gender, psychological, and environmental variables did not influence pain perception. Conclusion This study provides methodological refinements to the CPT contributing to the development of norms for children.

Brief Report: Prediction of Children's Preoperative Anxiety by Mothers and Fathers

Thompson, C., MacLaren, J. E., Harris, A., Kain, Z. — 2008-10-09

Objective To assess the ability of mothers and fathers at predicting children's anxiety at anesthesia induction. Methods Participants were parents and their children aged 2–12 years (n = 159). Parents predicted child anxiety using a Visual Analog Scale. Observed child anxiety was assessed using the Yale Preoperative Anxiety Scale. Results Results of linear regressions indicated that fathers' predictions were significantly related to children's anxiety, whereas mothers’ predictions were not. Baseline anxiety in mothers and fathers did not contribute to a model predicting children's observed anxiety. Child gender did not moderate the relations between fathers’ predictions and children's observed anxiety. Conclusions Fathers’ predictions of children's anxiety were related to children's observed anxiety at anesthesia induction; mothers’ predictions were not. Thus, fathers may be able to more accurately identify a need for intervention. Further research is needed to better explain discrepancies between mothers and fathers.