Journal of Pediatric Psychology - Advance Access

Brief Report: The Relationship of Parental Support and Conflict to Physical Activity in Preadolescents with Type 1 Diabetes

Mackey, E. R., Streisand, R. — 2008-05-13

Objective To use structural equation modeling to provide a preliminary examination of the relationship between parental support and conflict regarding physical activity behaviors in preadolescents with type 1 diabetes. Method Parent–child dyads (n = 85, M child age = 10.8) completed physical activity items from the Diabetes Family Behavior Scale, Diabetes Related Conflict Scale, and Self-Care Inventory. Children completed physical activity items from the Center for Disease Control's Youth Risk Behavior Surveillance System, and activity was further measured via 24 hr recall interviews assessing physical activity behavior on a typical day. Results Parental conflict was related to less frequent physical activity, whereas parental support was related to more frequent physical activity. Conclusions In this exploratory study, parental conflict and support for physical activity were related to physical activity in preadolescents with type 1 diabetes. Further research and development of interventions aimed at improving parental support and decreasing conflict around physical activity are warranted.

Chronic Maternal Depression and Children's Injury Risk

Schwebel, D. C., Brezausek, C. M. — 2008-05-12

Objective A substantial number of mothers of young children suffer from depression. One understudied consequence of maternal depression is how it affects toddlers’ injury risk. This study examined links between chronic maternal depression and child injury. Methods A national sample of 1,364 American children was studied. Results Chronic levels of severe maternal depression placed children at increased risk of concurrent injury from birth to age 3. The relation between chronic, severe maternal depression and child injury risk held even after controlling for variance from family SES, child sex, child temperament and externalizing behavior, and parenting. Chronic maternal depression during infancy and toddlerhood did not influence children's subsequent risk for injury, between age 3 and first grade. Less severe symptoms of chronic maternal depression were unrelated to concurrent or future child injury. Conclusions Chronic, severe levels of maternal depression are linked to concurrent child injury risk during infancy and toddlerhood.

Toward Conceptual Clarity in a Critical Parenting Construct: Parental Monitoring in Youth with Chronic Illness

Ellis, D. A., Templin, T. N., Naar-King, S., Frey, M. A. — 2008-05-08

Parental monitoring has been defined as "a set of correlated parenting behaviors involving attention to and tracking of the child's whereabouts, activities, and adaptations." This construct is of significant interest due to its relatedness to a broad range of youth risk behaviors, including risky sexual behavior, substance abuse, and poor adherence. However, to date, measures of parental monitoring are largely absent from the chronic illness literature. The present article focuses upon two key problems in the operationalization of the monitoring construct to date: (a) poor conceptual specificity in parenting constructs such as monitoring, overprotection, and over-involvement when used to date among youth with chronic conditions and (b) the confounding of existing measures of parental monitoring with items evaluating parental knowledge of youth activities, which has resulted in a lack of data regarding the mechanisms by which parents obtain their information. Recommendations for the future development of monitoring measures are discussed.

Examining Short-term Stability of the Mealtime Interaction Coding System (MICS)

Mitchell, M., Piazza-Waggoner, C., Modi, A., Janicke, D. — 2008-05-08

Objective This study assessed the stability of ratings on the McMaster Mealtime Interaction Coding System (MICS), an observational measure of family functioning, across three typical evening meals. Methods Participants included families of infants and toddlers with cystic fibrosis (n = 33) and with no chronic illness (n = 33). Three meals were videotaped across a 3-week period (M = 17.4 days) and involved a secondary data analysis from a larger study. Results Across both groups, test–retest reliability (paired correlation coefficients) was generally moderate, but significant, for all scales at each time point comparison. Analyses revealed no significant within-or between-group differences across time periods on healthy versus unhealthy ratings. Conclusions This study highlights the limitations of coding a single mealtime observation or interpreting multiple observations using the MICS. Findings highlight that family, meal, illness, and assessment factors may impact variability in ratings over time.

Attributions of Teacher Reactions to Diabetes Self-care Behaviors

2008-04-29

Objective This study had two objectives: examine relationships among negative attributions of teacher reactions, anticipated adherence difficulties, teacher support, diabetes stress, and metabolic control; and develop questionnaires to test these relationships. Methods One hundred and two youths with type 1 insulin-dependent diabetes completed instruments measuring attribution of teacher reactions, anticipated adherence, teacher support, and diabetes stress. Metabolic control was measured by percentage of hemoglobin A_1c. Results Structural equation modeling demonstrated that negative attributions had direct effects on anticipated adherence difficulties and diabetes stress. Diabetes stress had a direct effect on metabolic control. Negative attributions had a significant indirect effect on metabolic control through associations with diabetes stress. Teacher support moderated the path between negative attributions and anticipated adherence difficulties. Conclusions Youths making negative attributions about teacher's reactions are likely to find adherence difficult in school situations and have increased stress. Results are discussed in terms of a social information processing model of adjustment and practical applications.

Brief Report: Illness Factors and Child Behavior Before and During Pediatric Hospitalization

Levy, M. C., Kronenberger, W. G., Carter, B. D. — 2008-04-29

Objective Little is known about factors predicting in-hospital adjustment in children with chronic illnesses or about risk/protective factors for in-hospital behavior compared to out-of-hospital behavior. This study investigated the relationship between illness factors (chronicity and severity) and child adjustment in and out of the hospital. Methods Parents and nurses completed questionnaires about in-hospital and home behavior for a sample of 85 hospitalized children. Results In the hospital, children with acute illnesses demonstrated more internalizing behavior problems than children with chronic illnesses. Children with life-threatening illnesses had more internalizing and externalizing problems than children with non-life-threatening illnesses. Out of the hospital, children with chronic illnesses demonstrated more internalizing problems and a trend toward more externalizing problems than healthy children who later developed acute illnesses. Out of hospital behavior problems were unrelated to illness severity. Conclusions Results suggest that different illness factors may predict in-hospital as compared to out-of-hospital behavioral adjustment.

Commentary: Adopting to a Broad Perspective on Posttraumatic Stress Disorders, Childhood Medical Illness and Injury

Manne, S. — 2008-04-25

Predictors of Psychological Morbidity in Parents of Children with Intellectual Disabilities

Gallagher, S., Phillips, A. C., Oliver, C., Carroll, D. — 2008-04-22

Objective This study examined predictors of excess psychological morbidity in parents of children with intellectual disabilities. Methods Thirty-two parents of children with intellectual disabilities and 29 parents of typically developing children completed the Hospital Depression and Anxiety Scale, and measures of social support, child problem behaviors, sleep quality, and perceived caregiver burden. Results Parents of children with intellectual disabilities registered high depression and anxiety scores, and the majority met the criteria for possible clinical depression and/or anxiety. The strongest predictor of psychological morbidity was caregiver burden. Analyses of its component dimensions indicated that feelings of guilt held the greatest consequence for depression and anxiety. Conclusions Caregiver burden, in general, and its guilt component, in particular, predicted symptoms of depression and anxiety in parents of children with intellectual disabilities. Assisting such parents to resolve their feelings of guilt should benefit their psychological status.

Evidence-based Assessment of Health-related Quality of Life and Functional Impairment in Pediatric Psychology

2008-04-22

Objective To provide an evidence-based review of measures of health-related quality of life (HRQOL) and functional impairment, with a specific focus on their use in the field of pediatric psychology. Methods As part of a larger survey of pediatric psychologists from the Society of Pediatric Psychology e-mail listserv (American Psychological Association, APA, Division 54), 16 measures were selected for this psychometric review. Measures that qualified for the review fell into one of the following three categories: (a) generic HRQOL scales, (b) disease-specific quality of life scales, and (c) functional impairment rating scales. Results Psychometric characteristics (i.e., three types of reliability, two types of validity) were strong for the majority of measures reviewed, with 12 of the 16 measures meeting "well-established" evidence-based assessment criteria. Strengths and weaknesses of existing measures were noted. Conclusions Recommendations for future work in this area of assessment are presented, including suggestions that further validation and exploration of measure properties such as factor analysis and changes in HRQOL over time be conducted.

Influences on Child Eating and Weight Development from a Behavioral Genetics Perspective

Kral, T. V. E., Faith, M. S. — 2008-04-10

Childhood obesity is a strong risk factor for associated comorbidities such as type 2 diabetes, cardiovascular disease, and orthopedic abnormalities in youth and its increasing incidents thus represents a major public health concern. The following review provides evidence for a familial association between parental and child weight status, eating behaviors, and food preferences. It further draws the link between environmental influences, such as parent feeding practices, and the development of child eating behaviors and thereby elucidates how genetic and nongenetic influences can contribute to the familial transmission of obesity. We use eating in the absence of hunger, an eating trait which refers to children's susceptibility to eating in response to the presence of palatable foods in the absence of hunger, as an example to illustrate these associations. The review concludes with an outlook on possibilities for future research efforts in the field.

Validity of the Pediatric Quality of Life Inventory for Youth with Sickle Cell Disease

McClellan, C. B., Schatz, J., Sanchez, C., Roberts, C. W. — 2008-04-09

Objective Evaluate the validity of the Pediatric Quality of Life Inventory (PedsQL) for sickle cell disease (SCD). Methods Sixty-eight parent–child dyads (children 5–18 years) completed the PedsQL. Medical record review assessed history of specific morbidities. Results Internal consistency of the scales varied. The strongest reliability was for parent proxy-report for specific domains or for global functioning scores with either informant. Modest internal consistency was found for specific domains with child informants, particularly for younger children. Moderate convergent validity was found between informants. History of neurologic problems or major pain episodes indicated criterion validity for specific scales. Conclusions The PedsQL appears to validly assess quality of life in youth with SCD. Domain-specific measurement of quality of life was limited by (a) low reliability for youth-report and (b) lack of discriminant validity. Choice of informant may be important when evaluating quality of life effects from pain or neurologic problems in SCD.

Social Functioning and Facial Expression Recognition in Survivors of Pediatric Brain Tumors

2008-04-05

Objective To assess social functioning and facial expression recognition skill in survivors of pediatric brain tumors (BT) as compared to children with juvenile rheumatoid arthritis (JRA). Methods The social functioning of 51 survivors of BT and 31 children with JRA was assessed using a facial expression recognition task, questionnaire ratings of social functioning, and an IQ screener. Results After controlling for estimated IQ, survivors of BT made significantly more errors interpreting adult facial expressions as compared to children with JRA. Additionally, history of therapy and diagnosis age predicted performance on the child portion of the facial recognition task. Finally, survivors of BT demonstrated significantly impaired social functioning across multiple measures when compared to children with JRA. Conclusions Survivors of pediatric BT showed significant deficits in social functioning as compared to an illness comparison group. Errors in facial expression recognition represent another method for evaluating deficits that contribute to social outcomes.

A National Longitudinal Study of the Association Between Hours of TV Viewing and the Trajectory of BMI Growth Among US Children

Danner, F. W. — 2008-04-04

Objectives To assess the association between hours of TV viewing and the trajectory of BMI growth from Kindergarten to Grade 5 among a national longitudinal cohort of 7,334 US children. Methods Multilevel growth curve modeling was used to estimate children's BMI growth trajectories as a function of hours of TV viewing over time while controlling for gender, race/ethnicity, SES, birth weight, and baseline age. Results Hours of TV viewing were significantly positively associated with the acceleration of BMI growth from Kindergarten to Grade 5. Conclusions Hours spent watching TV may be contributing to the recent dramatic increase in the prevalence of overweight and obesity among children.

A systematic review of randomized controlled trials examining psychological interventions for needle-related procedural pain and distress in children and adolescents: An abbreviated Cochrane Review

Uman, L. S., Chambers, C. T., McGrath, P. J., Kisely, S. — 2008-04-02

Objective To report the results of a systematic review of randomized controlled trials (RCTs) of psychological interventions for children and adolescents undergoing needle-related procedures. Methods A variety of cognitive-behavioral psychological interventions for managing procedural pain and distress in children and adolescents between 2 and 19 years of age were examined. Outcome measures included pain and distress as assessed by self-report, observer report, behavioral/observational measures, and physiological correlates. Results Twenty-eight trials met the criteria for inclusion in the review and provided the data necessary for pooling the results. Together, the trials included 1,039 participants in treatment conditions and 951 in control conditions. The largest effect sizes for treatment improvement over control conditions were found for distraction, combined cognitive-behavioral interventions, and hypnosis, with promising but limited evidence for several other psychological interventions. Conclusions Recommendations for conducting future RCTs are provided, and particular attention to the quality of trial design and reporting is highlighted.

Brief Assessment of Parents' Attitudes Toward Testing Minor Children for Hereditary Breast/Ovarian Cancer Genes: Development and Validation of the Pediatric BRCA1/2 Testing Attitudes Scale (P-TAS)

2008-04-01

Objective Predictive genetic testing for hereditary breast/ovarian cancer risk (BRCA1/2 testing) is not recommended for minor children due to its lack of immediate medical benefit and potential psychological risk. Yet, tested mothers are often interested in learning about their children's cancer risks via pediatric BRCA1/2 testing, raising a host of bioethical concerns. However, no reliable or valid tool exists to formally gauge parents’ interest in such testing. The aim of this study was to develop and evaluate a new measure for use in genetic research and consultation, known as the Pediatric BRCA1/2 Testing Attitudes Scale (P-TAS). Methods After pretest genetic counseling and provision of a blood sample for BRCA1/2 testing, the P-TAS was administered to 187 mothers of children between 8- and 21-years-old. The measure was also given to 96 of the mothers’ nontested co-parents. Analyses of the factor structure and psychometric properties of the measure were performed in mothers and confirmed in their co-parents. Results The two factors of the P-TAS, labeled Attitudes and Beliefs (Factor 1) and Decision Making and Communication (Factor 2), accounted for 62.9% of the variance and were reliable (Cronbach's coefficient s = .70 and .90, respectively); the structure and properties were largely confirmed among co-parents. Validity was indicated through its convergence with related constructs. Conclusions This new tool may be integrated into genetic counseling research to better assess parents’ attitudes and interests in pediatric BRCA1/2 testing. Such information may help guide ongoing discussions about the appropriateness of testing in adolescent or young adult children.

Supporting Family Adaptation to Presymptomatic and "Untreatable" Conditions in an Era of Expanded Newborn Screening

Bailey, D. B., Armstrong, F. D., Kemper, A. R., Skinner, D., Warren, S. F. — 2008-03-30

Objective As technology advances, newborn screening will be possible for conditions not screened today. With an expansion of screening, strategies will be needed to support family adaptation to unexpected and possibly uncertain genetic information provided shortly after birth. Method Although candidate conditions for expanded newborn screening will typically be associated with increased morbidity or mortality, for most there is no proven medical treatment that must be implemented quickly. Many will have clinical features that gradually emerge and for which the severity of impact is not predictable. Parents will seek guidance on information, support, and treatment possibilities. This article summarizes issues evoked by expanded newborn screening and suggests strategies for supporting families of identified children. Results We propose four components necessary to support family adaptation to pre-symptomatic and "untreatable" conditions in an era of expanded newborn screening: (1) accurate and understandable information; (2) formal and informal support; (3) active surveillance; and (4) general and targeted interventions. We argue that no condition is "untreatable" and that a well-designed program of prevention and support has the potential to maximize benefit and minimize harm. Conclusions Pediatric psychologists can play important roles in an era of expanded newborn screening by helping families understand genetic information, make informed decisions about genetic testing, and cope with the potential psychosocial consequences of genetic information.

The Impact of Adult Behaviors and Vocalizations on Infant Distress during Immunizations

Blount, R. L., Devine, K. A., Cheng, P. S., Simons, L. E., Hayutin, L. — 2008-03-28

Objective The Child–Adult Medical Procedure Interaction Scale-Infant Version (CAMPIS-IV) was used to examine the influence of adult and infant behaviors on infant distress following injections. Methods In this naturalistic observation study, videotaped interactions of 49 infants, parents, and nurses were coded using the CAMPIS-IV. A series of three lag sequential analyses were used to examine the immediate and delayed effects of each of the CAMPIS-IV criterion behaviors, as well as the effects of the onset of each behavior, on infant distress. Results Strong support was found for beneficial effects of the infants playing with an object and sucking, and for adults’ belly-to-belly contact and nonprocedural talk to infant. Some benefit was found for bouncing, patting, and rocking the infant. Apologizing, empathizing, and reassuring the infant received no support, with some indication of detrimental effects. Conclusions The CAMPIS-IV was useful for identifying modifiable risk and protective factors for infants undergoing injections.

Chronic Pain in Adolescence: Parental Responses, Adolescent Coping, and their Impact on Adolescent's Pain Behaviors

Simons, L. E., Claar, R. L., Logan, D. L. — 2008-03-28

Objectives The aim of this study was to examine relations among parental responses, adolescent pain coping, and pain behaviors in adolescents with chronic pain. Methods This study included 217 adolescents (12–17 years) evaluated at a multidisciplinary pain clinic and their parents. Adolescents completed measures assessing their pain, pain coping responses, functional disability, and somatic symptoms. Parents reported on their responses to their adolescent's pain. Results Passive and active coping interacted with parental protective behavior to predict adolescents’ pain behaviors. Contrary to expectations, among adolescents who reported infrequent use of passive or active coping strategies, higher levels of parental protective behavior were associated with higher levels of disability and somatic symptoms. Discussion Among adolescents who report infrequent use of passive and active coping responses, parental protective responses to pain may inadvertently promote greater disability and symptom complaints. Parental responses to pain may be an important target to treat adolescent chronic pain.

Commentary: Evidence-based Assessment of Pediatric Pain

Tsao, J. C. I., Zeltzer, L. K. — 2008-03-28

Effects of Videogame Distraction using a Virtual Reality Type Head-Mounted Display Helmet on Cold Pressor Pain in Children

2008-03-26

Objective To test whether a head-mounted display helmet enhances the effectiveness of videogame distraction for children experiencing cold pressor pain. Method Forty-one children, aged 6–14 years, underwent one or two baseline cold pressor trials followed by two distraction trials in which they played the same videogame with and without the helmet in counterbalanced order. Pain threshold (elapsed time until the child reported pain) and pain tolerance (total time the child kept the hand submerged in the cold water) were measured for each cold pressor trial. Results Both distraction conditions resulted in improved pain tolerance relative to baseline. Older children appeared to experience additional benefits from using the helmet, whereas younger children benefited equally from both conditions. The findings suggest that virtual reality technology can enhance the effects of distraction for some children. Research is needed to identify the characteristics of children for whom this technology is best suited.

A Cumulative Risk Model Predicting Caregiver Quality of Life in Pediatric Asthma

Everhart, R. S., Fiese, B. H., Smyth, J. M. — 2008-03-20

Objective To examine the relationship between a cumulative risk model and caregiver quality of life (QOL) in pediatric asthma and determine whether caregiver QOL is predicted by a linear or quadratic model of cumulative risk. Methods One hundred and ninety-three families of children between the ages of 5 and 12 years with mild to severe asthma completed a background questionnaire and measures of QOL, asthma severity, family burden, and family stress. A cumulative risk model based on risk factors from these measures was calculated for each caregiver. Results The cumulative risk model significantly predicted caregiver QOL as a quadratic function. Caregivers with numerous risk factors experienced a dramatic worsening of QOL. Conclusions Findings suggest that caregiver QOL is best predicted by the interaction and not the summation of these factors. Interventions focused on one area of family risk may be effective in reducing poor QOL in caregivers of children with asthma.

Differences in Family Mealtime Interactions between Young Children with Type 1 Diabetes and Controls: Implications for Behavioral Intervention

Patton, S. R., Dolan, L. M., Powers, S. W. — 2008-03-20

Objective We examine clinically relevant differences in family mealtime behaviors for young children with type 1 diabetes mellitus (T1DM) and matched controls. Methods One hundred and eighteen families (46% boys; M age = 5.0, SD = 1.5 years) had at least three home meals videotaped and coded for family behaviors. Analyses had adequate statistical power to detect medium effects. Results Parents of children with TIDM offered a higher rate and frequency of commands to eat than controls. As the meal progressed, all parents worked harder at controlling mealtimes, while children ate less. Behaviors associated with lower dietary adherence and poorer glycemic control occurred on average 9 min of a typical 19 min meal for children with TIDM. Conclusions When differences in family mealtime behaviors have been found in other pediatric groups (e.g., cystic fibrosis), the results have directly informed the development of effective interventions. The clinically relevant results of this study can be used to inform interventions for young children with TIDM.

Exposure to Cigarette Advertising and Adolescents' Intentions to Smoke: The Moderating Role of the Developing Self-Concept

Shadel, W. G., Tharp-Taylor, S., Fryer, C. S. — 2008-03-20

Objective Increased exposure to cigarette advertisements is associated with increases in adolescent smoking but the reasons for this association are not known. This study evaluated whether the developmental maturity of the self-concept, operationalized as self-conflict, moderated smoking intentions following exposure to cigarette advertisements among adolescents who have never smoked. Methods Eighty-seven adolescents (ages 11–17): (a) completed measures of self-conflict; (b) were exposed to 30 contemporary cigarette advertisements; and (c) rated their intentions to smoke following exposure to each ad. Results Younger adolescents with higher numbers of self-conflicts who also said that cigarette advertising was relevant to them had stronger smoking intentions compared to younger adolescents with lower numbers of self-conflicts after exposure to cigarette advertising. Self-conflict did not play as strong a role with older adolescents. Conclusions Younger adolescents (i.e., middle school aged) who are having the most difficulty figuring out "who they are" are most susceptible to the effects of cigarette advertising.

Diabetes Problem Solving by Youths with Type 1 Diabetes and their Caregivers: Measurement, Validation, and Longitudinal Associations with Glycemic Control

2008-03-17

Objectives This article introduces a new measure of problem-solving skills of youths with type 1 diabetes (T1DM) and adult caregivers in correcting glycemic fluctuations. Methods The Diabetes Problem Solving Interview (DPSI), a structured interview, was validated during a pilot study of a behavioral intervention. DPSI data and measures of diabetes management were obtained at baseline from 114 youths (ages 9–14.5) and 109 caregivers. Glycosylated hemoglobin (HbA_1c) was measured quarterly over 9 months. Results Results confirmed the psychometric adequacy of the DPSI. For caregivers, but not youths, low DPSI scores (indicating poor problem-solving skills) were significantly associated with worse HbA_1c over 9 months. Conclusions The DPSI has clinical and research utility as a measure of diabetes problem-solving skills. Identification and targeted remediation of caregivers’ deficient diabetes problem-solving skills or promotion of youths’ utilization of these skills could possibly enhance glycemic control in youths with T1DM.

Implications of Resolving the Diagnosis of PKU for Parents and Children

Lord, B., Ungerer, J., Wastell, C. — 2008-03-13

Objective To examine resolution of the diagnosis among parents of children with phenylketonuria (PKU) as a mechanism of adjustment for parents and children. Methods Reaction to diagnosis interviews were conducted with 52 mothers and 47 fathers of 55 children with PKU aged 2–12 years. The parents also completed questionnaires assessing their personal adjustment (stress symptoms), their child's adjustment (behavior problems), and coping variables (personal hopefulness and coping strategies). Results Most mothers (69%) and fathers (77%) were resolved to their child's diagnosis. Lower levels of parent stress were explained by higher personal hopefulness (14% of the variance for mothers and 21% for fathers) and resolution of the diagnosis (15% of the variance for mothers and 6% for fathers) after taking account of demographic variables and severity of the child's PKU. Parent resolution, however, did not contribute independently to the variance explained in child behavior problems after taking account of coping variables and severity of PKU. Conclusions Resolution of the diagnosis of PKU is a strong indicator of parent adjustment, and assessment of parent reactions should be considered an integral component of clinical care. Further research is warranted in relation to the implications of parent resolution for the child's response to PKU through different development stages and the effectiveness of interventions in aiding parent resolution.

Medication Adherence and Quality of Life in Pediatric Inflammatory Bowel Disease

Hommel, K. A., Davis, C. M., Baldassano, R. N. — 2008-03-11

Objective To examine the relationship between medication adherence and quality of life (QOL) in adolescent patients with inflammatory bowel disease (IBD) utilizing a multimethod adherence assessment approach. Methods Medication adherence in 36 adolescents with IBD was assessed via interviews, pill counts, and biological assays. QOL was assessed via patient and parent report. Pediatric gastroenterologists provided disease severity assessments. Results Hierarchical multiple regression analyses revealed that adherence contributed significant variance to patient-reported QOL but not parent-reported QOL. Nonadherence to 6-MP/azathioprine was related to poorer patient-reported physical health QOL. Greater self-reported 5-ASA adherence was related to poorer overall psychological health QOL, and particularly social functioning QOL. Conclusions Results provide preliminary support for the negative effects of 6-MP/azathioprine nonadherence on QOL and an inverse relationship between 5-ASA adherence and QOL in this population. Adherence burden in patients and the utility of multimethod adherence assessment in research are discussed.

Supervising Children During Parental Distractions

Boles, R. E., Roberts, M. C. — 2008-03-10

Objective To examine the effects of parenting distractions on supervising behaviors in relation to child risky behaviors. Methods Forty preschool-aged children and their parents were randomly assigned to occupy a simulated home living room for 45 min with the parent involved in either (a) no planned distraction, (b) a telephone call distraction, (c) a TV show distraction, or (d) a computer assignment distraction. Parent and child behaviors were recorded and coded. Results Parent supervising behaviors were significantly intercorrelated but revealed no relation to risky child behavior. Children showed higher risky behavior during parental distractions and steadily over time when parent distractions occurred. Additionally, younger children were more likely to engage in risky behavior when compared to older children. Conclusions Parents showed significant reductions in their ability to supervise children during distractions, limiting the ability to provide education or to take immediate action necessary to prevent or minimize possible injuries.

Child versus Parent Report of Parental Influences on Children's Weight-related Attitudes and Behaviors

Haines, J., Neumark-Sztainer, D., Hannan, P., Robinson-O'Brien, R. — 2008-02-27

Objective To compare parent and child report of parental weight-related behaviors and examine their respective associations with child's weight-related outcomes. Methods Seventy-three parent–child dyads completed self-administered surveys that assessed parent and child report of parental direct weight-related behaviors (comments to child about weight, encourage child to diet) and indirect behaviors (dieting, comments about own weight/appearance). Outcome variables included child's body dissatisfaction, weight concerns, and dieting. Results Considerable disagreement (21–30%) was found between parent and child report of parental weight-related behaviors. Both the parent and child report of direct parental behaviors were associated with child's outcomes. Child report of parental indirect behaviors was more consistently associated with child's outcomes than parent report. Conclusion Parent weight-related behaviors, both direct and indirect, are positively associated with child's weight-related attitudes and behaviors.

Psychosocial Functioning in Youth with Glycogen Storage Disease Type I

Storch, E., Keeley, M., Merlo, L., Jacob, M., Correia, C., Weinstein, D. — 2008-02-23

Objective To assess the quality of life and psychosocial functioning among pediatric patients with Glycogen Storage Disease (GSD) types Ia and Ib. Methods Thirty-one youth with GSD types Ia and Ib and 42 healthy controls participated. Quality of life ratings from the GSD types Ia and Ib sample were compared with a previously reported clinical comparison sample. Children completed measures of quality of life, loneliness, family functioning, and sibling relationship quality (e.g., warmth, conflict). Parents completed measures of parental distress, parenting stress, child adaptive behavior, and child emotional and behavioral functioning. Results Quality of life was generally lower in youth with GSD relative to healthy controls but similar to those with a chronic illness. Children with GSD were rated as having more internalizing symptoms, social problems, and lower independent functioning relative to healthy controls. Parents reported greater distress and parenting stress relative to healthy controls. Conclusions The presence of GSD types Ia and Ib are associated with reduced quality of life and independent functioning, and elevated levels of internalizing distress and parental stress relative to healthy peers. Relative to their children, parents generally reported that their child was more impaired, which suggests the need for multiple informants during assessment and active parental involvement during psychological treatment. These points should be kept in mind when assessing and treating youth with this disease and their families as psychological interventions that target areas of concern (e.g., adherence, coping with having a chronic disease) may be helpful for improving child and family outcomes.

Glycemic Control in Youth with Type 1 Diabetes: Family Predictors and Mediators

2008-02-23

Objective This study examined predictive and mediated relationships among youth perception of critical parenting, Child Behavior Checklist Externalizing Subscale (CBCL) externalizing problem scores, adherence, and (hemoglobin A_1c HbA_1c), in youth with type 1 diabetes from low socioeconomic status families. Methods Caregiver/youth dyads (n = 120) completed diabetes specific measures of family functioning regarding diabetes management and structured adherence interviews. Parents completed the CBCL, while assays of youth HbA_1c were performed. Analyses were conducted using hierarchical linear regression. Results Combined measures predicted 44% of the variance in HbA_1c. Adherence partially mediated critical parenting and HbA_1c, while critical parenting and adherence mediated CBCL externalizing problem scores and HbA_1c. CBCL externalizing problem scores did not mediate critical parenting and HbA1_c. Conclusions The presence of youth perceptions of critical parenting and youth externalizing behavior problems may interfere with adherence, leading to increases in HbA_1c.

Outcome and Predictors of Functional Recovery 5 Years Following Pediatric Traumatic Brain Injury (TBI)

Catroppa, C., Anderson, V. A., Morse, S. A., Haritou, F., Rosenfeld, J. V. — 2008-02-23

Objectives The aim was to examine functional outcomes following traumatic brain injury (TBI) during early childhood, to investigate impairments up to 5 years postinjury and identify predictors of outcome. Methods The study compared three groups of children (mild = 11, moderate = 22, severe = 15), aged 2.0–6.11 years at injury, to a healthy control group (n = 17). Using a prospective, longitudinal design, adaptive abilities, behavior, and family functioning were investigated acutely, 6, 30 months and 5 years postinjury, with educational progress investigated at 30 months and 5 years postinjury. Results A strong association was suggested between injury severity and outcomes across all domains. Further, 5-year outcomes in adaptive and behavioral domains were best predicted by preinjury levels of child function, and educational performance by injury severity. Conclusion Children who sustain a severe TBI in early childhood are at greatest risk of long-term impairment in day-to-day skills in the long-term postinjury.

"Practice What You Preach": Induced Hypocrisy as an Intervention Strategy to Reduce Children's Intentions to Risk Take on Playgrounds

Morrongiello, B. A., Mark, L. — 2008-02-21

Objective An intervention based on induced hypocrisy was conducted to reduce children's intentions to show fall-risk behaviors on playground equipment. Methods To induce hypocrisy participants (7–12 years) advocated for safe-play behaviors while being made mindful about past failures to play safely on playgrounds. To measure the impact of the intervention, children created posters indicating which playground behaviors they Would Do and Would Not Do; children believed they would have to demonstrate the behaviors endorsed on their posters. Results The intervention resulted in significant reductions in the risk behaviors children endorsed both for risk behaviors targeted (specific effects) and nontargeted risk behaviors (generalized effects). Assessing the mechanism by which the intervention produced changes in behavioral intentions revealed it yielded changes in cognitions that predicted subsequent reductions in risk-taking intentions. Conclusions The present intervention was successful in reducing children's intentions to engage in risky playground behaviors and it did so by changing cognitions.

A Meta-analysis of Interventions to Increase Adherence to Medication Regimens for Pediatric Otitis Media and Streptococcal Pharyngitis

Wu, Y. P., Roberts, M. C. — 2008-02-21

Objective The current study quantitatively synthesized the adherence intervention literature for two common acute childhood illnesses and examined the magnitude of change in adherence as indicated by different outcome measures and the relationship between type of intervention and adherence outcome. Methods Meta-analysis was used to synthesize the results of 12 interventions to increase medication adherence in pediatric otitis media and streptococcal pharyngitis. Effect sizes were analyzed using homogeneity tests and an analog to the analysis of variance. Results Combination interventions were more effective than single strategy interventions. However, families receiving educational interventions alone did not demonstrate better adherence than control groups. Indirect measures of adherence showed more change in adherence than direct measures. Conclusions Further work is needed to develop effective interventions for improving adherence for the medication regimens required for short-term illness and for optimizing health outcomes.

An Integration of Parents' and Best Friends' Smoking, Smoking-Specific Cognitions, and Nicotine Dependence in Relation to Readiness to Quit Smoking: A Comparison between Adolescents with and without Asthma

2008-02-19

Objective To study the impact of parents’ and best friends’ smoking, nicotine dependence, and craving on smoking-specific cognitions, and readiness to quit in adolescents with and without asthma. Methods Structural equation analyses were applied to data from a sample of 1,120 daily smoking adolescents, 83 of whom had asthma. Results Adolescents with asthma felt more ready to quit, and cognitions were more strongly related to readiness to quit among adolescents with asthma than among adolescents without asthma. Moreover, best friends’ smoking seemed more relevant to the cognitions of adolescents with asthma. Nicotine dependence and craving were strongly related to cognitions, and to readiness to quit in both groups. The relation between craving and readiness to quit, however, was stronger among participants with asthma. Conclusions Reduction of nicotine dependence and craving is essential for both groups. Youth with asthma may benefit even more from cognitive-based cessation services than healthy youth. The finding that adolescents with asthma are relatively more ready to quit, and that their cognitions are more easily affected can be turned into advantages in asthma-specific cessation services.

Assessment of Parental Psychological Stress in Pediatric Cancer: A Review

2008-02-19

Objectives We present an overview of the literature between 1997 and 2007 on parental stress reactions following the diagnosis of childhood cancer and we evaluate methodological strengths and weaknesses of the studies. Methods PubMed, PsychInfo, and Cinahl databases were used. Sixty-seven were included in the review. Results The conceptualization of parental stress and timing of assessment varies considerably between the studies, which makes comparison difficult. Most emotional stress reactions are seen around the time of diagnosis, with mothers reporting more symptoms than fathers. As a group, parents seem relatively resilient, although a subset of parents reports continuing stress even up to 5 years or more postdiagnosis. Conclusions The authors recommend clear definitions of parental stress, fixed points in time to assess parental stress, and an approach that highlights both parental strengths and weaknesses. Improved assessment can contribute to tailoring psychological care to those parents most in need.

Early Childhood Risk Factors Associated with Daytime Wetting and Soiling in School-age Children

Joinson, C., Heron, J., von Gontard, A., Butler, U., Golding, J., Emond, A. — 2008-02-07

Objective To examine the impact of a range of early childhood factors on the risk for daytime wetting and soiling. Methods This is a longitudinal study based on a UK population of over 10,000 children from age 4 to 9 years. Parents completed questionnaires on child development (at 18 months); child temperament (24 months); maternal depression/anxiety (21 months), and parenting behaviors (24 months). The analysis examined whether these risk factors distinguish between children with normal development of daytime bladder and bowel control and those with delayed acquisition of daytime continence; persistent daytime wetting/soiling, and relapse in wetting/soiling. Results Delayed development, difficult temperament, and maternal depression/anxiety were associated with an increase in the odds of experiencing problems with bladder and bowel control. Conclusions The current findings provide evidence that risk factors in early childhood are associated with a subsequent increase in the odds of children experiencing daytime wetting and soiling at school age.

Mental Health of Early Adolescents from High-risk Neighborhoods: The Role of Maternal HIV and Other Contextual, Self-Regulation, and Family Factors

2008-02-04

Objectives To examine the effect of maternal HIV infection, as well as other individual, family, and contextual factors on the mental health of inner-city, ethnic minority early adolescents. Methods Participants included 220 HIV-negative early adolescents (10–14 years) and their mothers, half of whom were HIV-infected. Individual interviews were conducted regarding youth depression, anxiety, externalizing and internalizing behaviour problems, as well as a range of correlates of youth mental health guided by a modified version of Social Action Theory, a theoretical model of behavioral health. Results Although the HIV status of mothers alone did not predict youth mental health, youth knowledge of mother's HIV infection and mother's overall health were associated with worse youth mental health outcomes, as were contextual, self-regulation, and family interaction factors from our theoretical model. Conclusions There is a need for family-based mental health interventions for this population, particularly focusing on parent–child relationships, disclosure, and youth self-esteem.

Associations Among the Perceived Parent-Child Relationship, Eating Behavior, and Body Weight in Preadolescents: Results from a Community-based Sample

Schuetzmann, M., Richter-Appelt, H., Schulte-Markwort, M., Schimmelmann, B. G. — 2008-01-31

Objective Data on associations between the parent–child relationship, eating behavior, and body weight in a community-based sample of preadolescent children are presented. The aim of our study was to replicate the finding from clinical samples that families of overweight children demonstrate adverse characteristics of the parent–child relationship. Methods A community-based sample of 373 fourth-grade students was given self-report questionnaires on the perceived parent–child relationship and on eating behavior, and each child's height and weight was measured. Results No meaningful associations between children's body weight and the parent–child relationship were apparent. Deviant eating behavior was strongly linked to an adverse parent–child relationship irrespective of children's body weight. Conclusions It is suggested that previous findings from clinical samples of overweight children cannot simply be generalized to the population of overweight children and that deviant eating behavior, not overweight itself, is linked to an adverse parent–child relationship in preadolescent children.

Family Burden and Parental Distress Following Mild Traumatic Brain Injury in Children and its Relationship to Post-concussive Symptoms

2008-01-28

Objective

To examine the relationship of mild traumatic brain injuries (TBI) and post-concussive symptoms (PCS) to post injury family burden and parental distress, using data from a prospective, longitudinal study.

Methods

Participants included 71 children with mild TBI with loss of consciousness (LOC), 110 with mild TBI without LOC, and 97 controls with orthopedic injuries not involving the head (OI), and their parents. Shortly after injury, parents and children completed a PCS interview and questionnaire, and parents rated premorbid family functioning. Parents also rated family burden and parental distress shortly after injury and at 3 months post injury.

Results

Mild TBI with LOC was associated with greater family burden at 3 months than OI, independent of socioeconomic status and premorbid family functioning. Higher PCS shortly after injury was related to higher ratings of family burden and distress at 3 months.

Conclusions

Mild TBI are associated with family burden and distress more than mild injuries not involving the head, although PCS may influence post injury family burden and distress more than the injury per se. Clinical implications of the current findings are noted in the Discussion section.

Parental Functioning in the Context of Adolescent Chronic Pain: A Review of Previously used Measures

Jordan, A., Eccleston, C., Crombez, G. — 2008-01-18

Objective To examine the use of instruments which assess the functioning of individuals who parent an adolescent with chronic pain. The study will focus on examining the population in which measures were developed, content, length, psychometric evaluation, and published use with this specific chronic pain population. Methods A systematic search of the literature identified 4,225 articles, generating a total of 73 eligible studies. Examination of these studies revealed the existence of 68 instruments. All measures underwent comprehensive content analysis. Results The majority of instruments were in the psychological (N = 32) or social domain (N = 25). Median frequency of usage was 1. While 27 instruments demonstrated evidence of psychometric evaluation in a sample of parents of adolescents with chronic pain, in 20 instances, this evaluation involved only assessment of internal consistency. Conclusions Clinically relevant psychometric data were missing for many instruments. Results identified a diversity of instrumentation with little consistency in instrument usage.

Commentary: Evidence-based Assessment Strength in Numbers

Mash, E. J., Hunsley, J. — 2008-01-13

Evidence-based Assessment of Cognitive Functioning in Pediatric Psychology

Campbell, J. M., Brown, R. T., Cavanagh, S. E., Vess, S. F., Segall, M. J. — 2008-01-13

Objective To review the evidence base for measures of cognitive functioning frequently used within the field of pediatric psychology. Methods From a list of 47 measures identified by the Society of Pediatric Psychology (Division 54) Evidence-Based Assessment Task Force Workgroup, 27 measures were included in the review. Measures were organized, reviewed, and evaluated according to general domains of functioning (e.g., attention/executive functioning, memory). Results Twenty-two of 27 measures reviewed demonstrated psychometric properties that met "Well-established" criteria as set forth by the Assessment Task Force. Psychometric properties were strongest for measures of general cognitive ability and weakest for measures of visual-motor functioning and attention. Conclusions We report use of "Well-established" measures of overall cognitive functioning, nonverbal intelligence, academic achievement, language, and memory and learning. For several specific tests in the domains of visual-motor functioning and attention, additional psychometric data are needed for measures to meet criteria as "Well established."

Commentary: Integrating Lessons from Evidence-Based Assessment of Adherence into Clinical Practice

McQuaid, E. L. — 2008-01-11

Meta-Analysis of Psychological Interventions to Promote Adherence to Treatment in Pediatric Chronic Health Conditions

Kahana, S., Drotar, D., Frazier, T. — 2008-01-11

Objective To estimate the effectiveness of adherence-promoting psychological interventions for pediatric populations with chronic health conditions. Methods A meta-analysis was conducted on 70 adherence-promoting psychological intervention studies among chronically ill youth using a weighted least squares approach and random effect model. Results Medium effects sizes were found for the behavioral (mean d =.54, 95% confidence interval [CI] = 0.34–0.73, n = 10) and multi-component interventions (mean d =.51, 95% CI = 0.45–0.57, n = 46), while educational interventions displayed a small effect size with adherence (mean d =.16, 95% CI = 0.10–0.22, n = 23). Study designs incorporating pre–post comparisons yielded effect sizes approaching the medium range (mean d =.42, 95% CI = 0.36–0.48, n = 30). Conclusions Behavioral and multi-component interventions appear to be relatively potent in promoting adherence among chronically ill youth. Recommendations for future research and methodological issues are presented.

Brief Report: Using Actigraphy to Compare Physical Activity Levels in Adolescents with Chronic Pain and Healthy Adolescents

Long, A. C., Palermo, T. M., Manees, A. M. — 2008-01-07

Objectives This study compared activity levels of adolescents with chronic pain and healthy adolescents, and investigated relations between actigraphy and subjective measures of activity limitations and depression. Methods Forty adolescents (n = 20 with chronic pain, n = 20 otherwise healthy; 12–17 years; 72.5% females) participated. Adolescents completed questionnaires regarding pain, activity limitations, and depression. Activity levels were assessed for 7 days using the Actiwatch 64® device, yielding mean and peak activity levels, and time spent in moderate and sedentary activity. Results Physical activity was lower in adolescents with chronic pain than in healthy peers. Adolescents with chronic pain reported significantly higher levels of activity limitations and depression. Age and gender were related to activity. Higher activity was inversely correlated with pain frequency and depression. Peak activity was also significantly inversely related to self-reported pain intensity and activity limitations. Conclusions Actigraphy may be useful for examining physical activity outcomes in adolescents with chronic pain.

Factorial Invariance of Child Self-report Across Healthy and Chronic Health Condition Groups: A Confirmatory Factor Analysis Utilizing the PedsQLTM 4.0 Generic Core Scales

Limbers, C. A., Newman, D. A., Varni, J. W. — 2007-12-27

Objectives The objective of the present study was to examine the factorial invariance of the PedsQL^TM 4.0 Generic Core Scales for child self-report across 11,433 children ages 5–18 with chronic health conditions and healthy children. Methods Multigroup Confirmatory Factor Analysis was performed specifying a five-factor model. Two multigroup structural equation models, one with constrained parameters and the other with unconstrained parameters, were proposed in order to compare the factor loadings across children with chronic health conditions and healthy children. Results Metric invariance (i.e., equal factor loadings) was demonstrated based on stability of the Comparative Fit Index (CFI) between the two models, and several additional indices of practical fit including the root mean squared error of approximation, the Non-normed Fit Index, and the Parsimony Normed Fit Index. Conclusions The findings support an equivalent five-factor structure on the PedsQL^TM 4.0 Generic Core Scales across healthy and chronic health condition groups. These findings suggest that when differences are found across chronic health condition and healthy groups when utilizing the PedsQL^TM, these differences are more likely real differences in self-perceived health-related quality of life, rather than differences in interpretation of the PedsQL^TM items as a function of health status.

Brief Report: Reporting Practices of Methodological Information in Four Journals of Pediatric and Child Psychology

Raad, J. M., Bellinger, S., McCormick, E., Roberts, M. C., Steele, R. G. — 2007-12-27

Objective To replicate Sifers, Puddy, Warren, and Roberts (2002) examining reporting rates of demographic, methodological, and ethical information in articles published during 1997, and to compare these rates to those found in articles published during 2005, in order to determine whether and how reporting practices of these variables have changed over time. Methods We examined reporting demographic, methodological, and ethical information in articles in four journals: Journal of Pediatric Psychology, Journal of Clinical Child and Adolescent Psychology, Journal of Abnormal Child Psychology, and Child Development. Reporting rates during 2005 were compared to articles published during 1997. Results These four journals improved on many of the 23 variables compared to Sifers et al. including increases in the reporting of ethnicity, attrition, child assent procedures, socioeconomic status, reliability, and reward/incentive offered to participants. Conclusions Improvements in descriptive information have implications for interpretation, replication, and generalizability of research findings.

Brief Report: Weight Dissatisfaction, Weight Status, and Weight Loss in Mexican-American Children

Dalton, W. T., Johnston, C. A., Foreyt, J. P., Tyler, C. — 2007-12-11

Objective To assess the association between weight dissatisfaction, weight status, and weight loss in Mexican-American children participating in a weight management program. Methods Participants included 265 Mexican American children recruited for a school-based weight management program. All children completed baseline assessments and changes in standardized body mass index (zBMI) were monitored in at-risk for overweight and overweight children (i.e., >85th BMI percentile) who had been randomized to receive the weight loss intervention (n = 101). Results Participants classified as at-risk for overweight or overweight reported greater weight dissatisfaction than normal weight children. Lower weight dissatisfaction at baseline was associated with greater changes in zBMI at 6 months. Weight dissatisfaction did not change across the course of treatment. Conclusions Mexican-American children whose weight status is greater than normal have greater weight dissatisfaction. Children with greater weight dissatisfaction are less likely to lose weight in a weight management program and weight dissatisfaction remains stable over the course of treatment.

Identifying the Classics: An Examination of Articles Published in the Journal of Pediatric Psychology from 1976 2006

Aylward, B. S., Roberts, M. C., Colombo, J., Steele, R. G. — 2007-12-11

Objectives The purpose of the present investigation was to identify the top 100 most highly cited "classic" articles in the Journal of Pediatric Psychology, from 1976 to 2006. Methods The Cited Reference search option of the Web of Science® was used, which allows for identification of variations in citations. Results One-hundred and four classic articles ranging in citations from 46 to 192 (M = 71.66, SD = 31.15) were identified. These articles were found to be mostly applied research that focused predominantly on children across several age groups with chronic illness. Citation trends among the classics revealed an inverted-u shape relationship between year since publication and citations per year, which peaked around seven years after publication. Conclusions The current findings highlight some of the influential works in the field, which have contributed to important advances not only the field of pediatric psychology but other fields as well.

Symptoms of Posttraumatic Stress in Parents of Children with Cancer: Are they Elevated Relative to Parents of Healthy Children?

Jurbergs, N., Long, A., Ticona, L., Phipps, S. — 2007-12-11

Objective To examine posttraumatic stress symptoms (PTSS) in parents of children with cancer as a function of time since diagnosis, treatment status, and relapse history, and as compared to parents of healthy children. Method Participants included parents of 199 children with cancer, comprising a cross-sectional sample of diagnoses and treatment phases, ranging from currently on therapy to long-term survivors, and 108 parents of healthy children obtained via acquaintance control methods. Parents completed a standardized self-report measure of PTSS. Results Within the cancer group, parental report of PTSS differed as a function of treatment status and time since diagnosis. Parents of children on active treatment endorsed similar levels of PTSS as control parents, whereas parents of children off treatment reported significantly lower levels of PTSS than did controls. Similarly, parents of long-term survivors reported significantly lower levels of PTSS than did controls, while parents of recently diagnosed children did not differ from controls on PTSS. In contrast, parents of children who had suffered a relapse reported significantly higher levels of PTSS, and were much more likely to be identified as a posttraumatic stress disorder (PTSD) case. Conclusions As a group, parents of children with cancer did not demonstrate any evidence of increased PTSS relative to parents of healthy children. Time since diagnosis, child treatment status, and relapse history are significant determinants of parent PTSS. Only parents of children who experienced a relapse appear to be at increased risk of PTSD. The current results appear discrepant from the existing literature, and possible explanations for these discrepancies are examined.

Caregiver Stress and Outcomes of Children with Pediatric Feeding Disorders Treated in an Intensive Interdisciplinary Program

Greer, A. J., Gulotta, C. S., Masler, E. A., Laud, R. B. — 2007-12-03

Objective This study investigated the impact of an intensive interdisciplinary feeding program on caregiver stress and child outcomes of children with feeding disorders across three categories. Methods Children were categorized into either tube dependent, liquid dependent, or food selective groups. Outcomes for caregiver stress levels, child mealtime behaviors, weight, and calories were examined at admission and discharge for 121 children. Repeated measures ANOVAs were used to examine differences pre- and post-treatment and across feeding categories. Results Caregiver stress, child mealtime behaviors, weight, and caloric intake improved significantly following treatment in the intensive feeding program, regardless of category placement. Conclusions Few studies have examined the impact of an intensive interdisciplinary approach on caregiver stress, as well as on child outcome variables with such a diverse population. This study provides support that regardless of a child's medical and feeding history, an intensive interdisciplinary approach significantly improves caregiver stress and child outcomes.

Lifestyle Factors, Body Mass Index, and Lipid Profile in Adolescents

2007-11-17

Objective and methods A model specifying body mass index (BMI) as mediating the relationship between lifestyle factors (aerobic fitness determined by peak oxygen consumption; physical activity by 7-day physical activity recall; diet by 24 hr dietary recall), and lipid profile were tested in a sample of 205 adolescents (73% boys), who were on average at risk of overweight, aerobically unfit, and from ethnic minority groups. Results In this well-fitting model, consuming a diet low in fat and cholesterol, and being aerobically fit predicted lower BMI, which together resulted in increases in high-density lipoprotein cholesterol and decreases in triglycerides and low-density lipoprotein cholesterol. Being physically active, predicted greater aerobic fitness. Conclusions In addition to furthering understanding of the interrelationships among predisposing, major, and conditional coronary heart disease risk factors in adolescents, these data suggest that improving diet and aerobic fitness will reduce BMI and result in a better lipid profile.

Evidence-based Assessment of Pediatric Pain

2007-11-17

Objective To conduct an evidence-based review of pediatric pain measures. Methods Seventeen measures were examined, spanning pain intensity self-report, questionnaires and diaries, and behavioral observations. Measures were classified as "Well-established," "Approaching well-established," or "Promising" according to established criteria. Information was highlighted to help professionals evaluate the instruments for particular purposes (e.g., research, clinical work). Results Eleven measures met criteria for "Well-established," six "Approaching well-established," and zero were classified as "Promising." Conclusions There are a number of strong measures for assessing children's pain, which allows professionals options to meet their particular needs. Future directions in pain assessment are identified, such as highlighting culture and the impact of pain on functioning. This review examines the research and characteristics of some of the commonly used pain tools in hopes that the reader will be able to use this evidence-based approach and the information in future selection of assessment devices for pediatric pain.

Structural Equation Modeling in Pediatric Psychology: Overview and Review of Applications

Nelson, T. D., Aylward, B. S., Steele, R. G. — 2007-10-31

Objective To describe the use of structural equation modeling (SEM) in the Journal of Pediatric Psychology (JPP) and to discuss the usefulness of SEM applications in pediatric psychology research. Method The use of SEM in JPP between 1997 and 2006 was examined and compared to leading journals in clinical psychology, clinical child psychology, and child development. Results SEM techniques were used in <4% of the empirical articles appearing in JPP between 1997 and 2006. SEM was used less frequently in JPP than in other clinically relevant journals over the past 10 years. However, results indicated a recent increase in JPP studies employing SEM techniques. Conclusions SEM is an under-utilized class of techniques within pediatric psychology research, although investigations employing these methods are becoming more prevalent. Despite its infrequent use to date, SEM is a potentially useful tool for advancing pediatric psychology research with a number of advantages over traditional statistical methods.

Sleep and Napping Patterns in 3-to-5-year old Children Attending Full-Day Childcare Centers

Ward, T. M., Gay, C., Anders, T. F., Alkon, A., Lee, K. A. — 2007-10-23

Objective To describe daytime naps and nighttime sleep–wake patterns in children attending full-day childcare centers. Methods A descriptive cross-sectional study of sleep and daytime nap patterns in 52 healthy children 3–5 years of age. Sleep and nap data were obtained over 3 days and nights (Tuesday, Wednesday, and Thursday) with continuous ankle actigraphy recording on children attending two university-affiliated childcare centers. Results Children averaged about 10 hr (610 min ± 38 SD) of total sleep in 24 hr, as estimated by actigraphy. For the 41 children who napped, average nap duration was 75.8 min (±20 SD). Nocturnal sleep was less for children who napped (9.0 hr ± 0.71 SD) compared to those who did not nap (9.8 hr ± 0.53 SD). Conclusions Findings indicate that the majority of 3-to-5-year-old children nap when given an opportunity. Preschool children's sleep and napping patterns on weekends and in other types of childcare environments warrant further research to assess health effects and impact on growth and development.

Effects of Inattention and Hyperactivity/Impulsivity Symptoms on Development of Nicotine Dependence from Mid Adolescence to Young Adulthood

Rodriguez, D., Tercyak, K. P., Audrain-McGovern, J. — 2007-10-23

Objective The relationship of Attention-Deficit/Hyperactivity Disorder (ADHD) and smoking is well documented. However, it is unclear whether ADHD symptoms relate to nicotine dependence (ND) symptoms from adolescence to young adulthood. We sought to assess the relationship of ADHD Hyperactivity–Impulsivity (H/I) and Inattention (I) symptoms with ND symptoms in a community sample from adolescence to young adulthood (ages 18–21). Methods Participants were adolescents (n = 672) smoking at least one whole cigarette in their lifetime. Participants are members of a prospective cohort study (ages 14–22) evaluating the bio-behavioral predictors of smoking. Data were analyzed with a two-piece latent growth curve model. Results ADHD-I symptoms were associated with ND symptoms acceleration in adolescence, but slowing acceleration in young adulthood, whereas ADHD-H/I symptoms were associated with ND symptoms acceleration in young adulthood. Conclusions The results suggest the relationship of ADHD and ND symptoms may differ by symptom type, and the developmental period assessed.

Evidence-based Assessment of Coping and Stress in Pediatric Psychology

2007-10-15

Objective To review selected measures of stress and coping in pediatric populations. Stress and coping are presented within a risk and resiliency framework. Methods The Society of Pediatric Psychology (SPP) surveyed the membership to identify the most frequently used assessment instruments. Twelve measures of coping and three measures of stress were reviewed. These instruments were evaluated using the Stress and Coping workgroup's modification of the criteria developed by the SPP Assessment Task Force (SPP-ATF). Results One of the three measures of stress and five of the 12 measures of coping were Well-established measures that broaden understanding. Additionally, one of the coping measures was categorized as a Well-established measure that guides treatment. Merits of the individual measures are discussed. Conclusions Recommendations for future research are provided, including suggestions for the construction and use of measures to inform treatment research.

Evidence-based Assessment in Pediatric Psychology: Family Measures

2007-09-28

Objective To provide a review of the evidence base of family measures relevant to pediatric psychology. Method Twenty-nine family measures were selected based upon endorsement by Division 54 listserv members, expert judgment, and literature review. Spanning observational and self-report methods, the measures fell into three broad assessment categories: Family functioning, Dyadic family relationships, and Family functioning in the context of childhood chronic health conditions. Measures were categorized as: "Well-established", "Approaching well-established", or "Promising." Results Nineteen measures met "well-established" criteria and the remaining ten were "approaching well-established." "Well-established" measures were documented for each of the broad assessment categories named above. Conclusions Many measures deemed "well-established" in the general population are proving to be reliable and useful in pediatric samples. More evidence of the validity of family measures is needed in this context. This review should prove helpful to clinicians and researchers as they strive to make evidence-based decisions regarding family measures.

Brief Report: Quality of Life Is Impaired in Pediatric Burn Survivors with Posttraumatic Stress Disorder

Landolt, M. A., Buehlmann, C., Maag, T., Schiestl, C. — 2007-09-21

Objective This study assessed health-related quality of life (HRQOL) and posttraumatic stress disorder (PTSD) in pediatric burn survivors and examined associations between PTSD and HRQOL. Methods Forty-three burn survivors, ages 7–16 years, were interviewed at an average of 4.4 years after their accident using the Clinician-Administered PTSD Scale for Children and Adolescents and the TNO-AZL Child Quality of Life Questionnaire. Results Eight children (18.6%) met DSM-IV criteria for current PTSD. While most dimensions of HRQOL were within normal limits, social functioning was impaired. Severity of PTSD was significantly associated with physical, cognitive, and emotional dimensions of HRQOL. Children with PTSD reported an impaired overall HRQOL and limited physical (e.g., more bodily complaints) and emotional functioning (e.g., more feelings of sadness). Conclusions This study provides tentative evidence for a considerably high prevalence of PTSD in pediatric burn survivors and for a negative association between PTSD and HRQOL.

Evidence-based Assessment of Adherence to Medical Treatments in Pediatric Psychology

2007-09-10

Objectives Adherence to medical regimens for children and adolescents with chronic conditions is generally below 50% and is considered the single, greatest cause of treatment failure. As the prevalence of chronic illnesses in pediatric populations increases and awareness of the negative consequences of poor adherence become clearer, the need for reliable and valid measures of adherence has grown. Methods This review evaluated empirical evidence for 18 measures utilizing three assessment methods: (a) self-report or structured interviews, (b) daily diary methods, and (c) electronic monitors. Results Ten measures met the "well-established" evidence-based (EBA) criteria. Conclusions Several recommendations for improving adherence assessment were made. In particular, consideration should be given to the use of innovative technologies that provide a window into the "real time" behaviors of patients and families. Providing written treatment plans, identifying barriers to good adherence, and examining racial and ethnic differences in attitudes, beliefs and behaviors affecting adherence were strongly recommended.

Evidence-Based Assessment in Pediatric Psychology: Measures of Psychosocial Adjustment and Psychopathology

2007-08-28

Objective To provide an evidence-based review of measures of psychosocial adjustment and psychopathology, with a specific focus on their use in the field of pediatric psychology. MethodsAs part of a larger survey of pediatric psychologists from the Society of Pediatric Psychology e-mail listserv (American Psychological Association, APA, Division 54), 37 measures were selected for this psychometric review. Measures that qualified for the review fell into one of the following three categories: (a) internalizing or externalizing rating scales, (b) broad-band rating scales, and (c) self-related rating scales. ResultsPsychometric characteristics (i.e., three types of reliability, two types of validity) were strong for the majority of measures reviewed, with 34 of the 37 measures meeting "well-established" evidence-based assessment (EBA) criteria. Strengths and weaknesses of existing measures were noted. ConclusionsRecommendations for future work in this area of assessment are presented, including suggestions that more fine-grained EBA criteria be developed and that evidence-based "profiles" be devised for each measure.

Introduction to Special Issue: Evidence-Based Assessment in Pediatric Psychology

2006-05-04