Journal of Pediatric Psychology - current issue

Treating Oppositional Defiant Disorder in Primary Care: A Comparison of Three Models

2008-05-02

Objective To determine if a nurse-led or psychologist-led parent-training program was more successful than a minimal intervention in treating early childhood Oppositional Defiant Disorder (ODD) in pediatric primary care. Methods Twenty-four practices were randomized to conditions in which parents of 117, 3- to 6.11-year-olds with ODD received the 12-session Webster-Stratton Incredible Years program led by primary care nurses or clinical psychologists, or to a minimal intervention group in which parents received only the companion book to the treatment program. Results There was improvement across posttreatment and 12-month follow-up for all groups, but no overall treatment group effects. There was a dose effect, with a reliable, clinically significant gain after seven sessions on the Eyberg intensity scale, and nine sessions on the Child Behavior Checklist externalizing scale. Conclusions There is little advantage to the therapist-led treatment over bibliotherapy unless parents attend a significant number of sessions.

Predictor and Moderator Effects in the Treatment of Oppositional Defiant Disorder in Pediatric Primary Care

2008-05-02

Objective To examine predictors and moderators of parent-training outcomes for treatment of Oppositional Defiant Disorder (ODD) in pediatric primary care. Methods Parents of 117 children with ODD, ages 3–6 years, seen in primary care received either a minimal intervention bibliotherapy treatment (MIT), or a 12-session parenting program led by a nurse or psychologist. Results More initial total life stress, parenting distress, internalizing problems, functional impairment, and difficult temperament were associated with more improvement, but families scoring lower on those variables had fewer behavior problems at posttreatment and follow-up. Gender was a significant moderator, with more improvement for girls than boys in the nurse-led group but more improvement for boys than girls in the MIT group. Less well-educated mothers treated by psychologists showed the greatest change. Conclusions Predictors and moderators may play a role in deciding, which families receive a particular form of treatment for ODD in primary care.

A Randomized Controlled Trial of a Mother-Infant or Toddler Parenting Program: Demonstrating Effectiveness in Practice

Hayes, L., Matthews, J., Copley, A., Welsh, D. — 2008-05-02

Objective Describes outcomes of an intervention aimed to improve infant or toddler care and reduce parental distress. Methods A randomized controlled trial method was used with 118 mothers. Participants were allocated to an intervention group (n = 65) or an enhanced waitlist group (n = 53). Measures were taken at pre-, post-, and 6-weeks follow-up. Results Results demonstrated that mothers who attended the program reported improvement in depression, anxiety, stress, parental satisfaction, and decreases in problematic child behavior. Improvements were maintained at the 6-week follow up. Intention-to-treat analysis replicated the results, although with smaller effect sizes. Conclusions The results of this study demonstrate that delivery of a 1 day intervention for distressed mothers can contribute to lower levels of parental distress and child problem behavior. Given the importance of early mother–child relationships and the limited number of well-controlled studies on brief interventions this result is of significance to researchers and the service community.

Body Size Stigmatization: An Examination of Attitudes of African American Preschool-Age Children Attending Head Start

Margulies, A. S., Floyd, R. G., Hojnoski, R. L. — 2008-05-02

Objective To assess body size stigmatization attitudes (BSSA), their effect on friendship selection, and controllability beliefs in a sample of African American preschool-age children of low socioeconomic status. Methods Participants included 76 children attending Head Start. Children completed an adjective task, a friendship selection task, and a controllability task. Results On the adjective task, the Overweight figure received significantly more negative mean ratings than the Underweight figure; however, there were no significant differences between the mean ratings for the Overweight and Average figures or the Average and Underweight figures. On the friendship selection task, children preferred the Average or Underweight figures as playmates and friends. On the controllability task, greater control was associated with the Overweight figure than the Underweight figure. Conclusion Results suggest that BSSA may be present in a sample of African American preschool-age children of low socioeconomic status. These attitudes may influence friendship selection and controllability beliefs.

Parent and Adolescent Distribution of Responsibility for Diabetes Self-care: Links to Health Outcomes

Helgeson, V. S., Reynolds, K. A., Siminerio, L., Escobar, O., Becker, D. — 2008-05-02

Objective To examine the relation of adolescent and parent responsibility distribution for diabetes self-care to psychological and physical health. Methods We interviewed children (mean age 12 years) annually for 3 years and asked parents to complete a questionnaire. Both reported how diabetes self-care was distributed in the family. Amount of responsibility held by the child only, the parent only, and shared between child and parent was calculated. Psychological distress, competence, and diabetes outcomes were assessed at each wave. Results In both cross-sectional and longitudinal (lagged) analyses, multilevel modeling showed that shared responsibility was consistently associated with better psychological health, good self-care behavior, and good metabolic control, whereas child and parent responsibility were not. In some cases, links of shared responsibility to health outcomes were stronger among older adolescents. Conclusions These findings highlight the importance of shared responsibility for diabetes self-care through early to middle adolescence.

Mediators of Depressive Symptoms in Children with Type 1 Diabetes and their Mothers

Jaser, S. S., Whittemore, R., Ambrosino, J. M., Lindemann, E., Grey, M. — 2008-05-02

Objective To examine the relationships among maternal and child depressive symptoms and child and family psychosocial factors. Method Secondary analysis of baseline data for a coping skills intervention for school-age children (ages 8–12) with type 1 diabetes (T1D) and their mothers. Children and mothers completed measures of depressive symptoms, coping, quality of life, and family functioning. Results There was a strong relationship between maternal and child depressive symptoms (r = .44, p < .001). Maternal depressive symptoms were negatively related to child quality of life, perceptions of coping, and family functioning. Impact of diabetes on quality of life, finding coping with diabetes upsetting, and family warmth mediated the relationship between maternal and child depressive symptoms. Conclusions Maternal depression may negatively affect child adjustment through its influence on quality of life, coping, and family functioning. Implications for interventions to improve psychosocial adjustment in children with T1D are discussed.

Psychosocial Adjustment, Health-Related Quality of Life, and Psychosexual Development of Boys with Hypospadias: A Systematic Review

Schonbucher, V. B., Weber, D. M., Landolt, M. A. — 2008-05-02

Objective A systematic review of studies on psychosocial adjustment, HRQoL (health-related quality of life), and psychosexual development of boys with hypospadias. Methods Research was conducted on several online bibliographic databases. Articles were selected on the basis of predefined criteria. Methodological quality was assessed by two independent reviewers who applied a standardized checklist. When possible, data analyses were performed by calculating effect sizes. Results Thirteen studies met the criteria for inclusion, whose methodological standard ranged from low to high quality. None of them has focused on HRQoL. Findings with regard to psychosocial and psychosexual adjustment were inconsistent, though they clearly showed that boys with hypospadias suffer from negative genital appraisal and sexual inhibitions. Overall, medical factors exerted a rather small influence. Psychosocial risk factors have hardly been examined so far. Conclusions The identification of psychosocial risk factors in methodologically sound studies is necessary to guarantee a comprehensive treatment for boys with hypospadias.

Factors Related to Changes in Cognitive, Educational and Visual Motor Integration in Children who Undergo Hematopoietic Stem Cell Transplant

Barrera, M., Atenafu, E., Andrews, G. S., Saunders, F. — 2008-05-02

Objectives Investigate cognitive, educational, and perceptual motor skills up to 2 years posttransplant of pediatric hematopoietic progenitor cell transplantation (HPCT) survivors and their correlates. Methods Survivors were assessed at baseline, 12, and 24 months after transplant. Results Performance IQ improved over time and was negatively related to maternal depression. Full IQ and educational outcomes were positively related to child's age and mother's age. Low depression scores were associated with high Verbal IQ one and 2 years post-HPCT, and with high visual motor scores 2 years post-HPCT. Poor educational outcomes were related to increased time since diagnosis. Two years post-HPCT, Performance IQ and Processing Speed were above the norm values whereas arithmetic and motor scores were below. Conclusions Pediatric HPCT survivors do better cognitively than educationally. Maternal age and depression, child's age, and time since diagnosis are critical factors for these outcomes.

A Developmental Perspective on Functional Somatic Symptoms

Beck, J. E. — 2008-05-02

Objective To provide a new approach for conceptualizing and studying functional somatic symptoms (FSS) in children and adolescence. Methods A developmental model is proposed based on the synthesis of the extant literature and previous theoretical perspectives of FSS in children and adolescents. Results Multiple risk and protective factors from child, familial, social, and environmental domains, the interactions across risk domains, and potential developmental pathways of FSS are identified. Conclusions This article underscores the necessity of taking a broader, developmental view of FSS. The tenets of developmental psychopathology emphasize the utility of viewing FSS on a continuum of severity rather than as a discrete entity or diagnosis. This article concludes with directions for future research and treatment implications.