Journal of Pediatric Psychology - current issue

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

Lescano, C. M., Brown, L. K., Raffaelli, M., Lima, L.-A. — Thu, 05 Nov 2009 05:48:20 PST

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.

Parental HIV/AIDS and Psychosocial Adjustment among Rural Chinese Children

Thu, 05 Nov 2009 05:48:20 PST

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.

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. — Thu, 05 Nov 2009 05:48:20 PST

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.

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

Thu, 05 Nov 2009 05:48:20 PST

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: Don't Kiss a Sleeping Dog: The First Assessment of "The Blue Dog" Bite Prevention Program

Meints, K., de Keuster, T. — Thu, 05 Nov 2009 05:48:21 PST

Objective The authors attempted to remedy the current lack of empirically evaluated dog-bite prevention programs for children under 7 by assessing children's learning success with the "Blue Dog" CD. Methods Ninety-six 3-, 4-, 5-, and 6-year-old children used the interactive CD in an initial exposure phase, a training and a testing phase. Half received verbal feedback, and the other half additional practice with parents. All children were re-tested after 2 weeks. Results There were significant increases in safe choices after the training phase at all ages, with older children performing better than younger children. Children still retained their ability to make safe choices after 2 weeks. Interestingly, children practicing with parents performed better than others when under 6 years. Verbal feedback did not play a role, the CD is equally effective without. Conclusions Children learned successfully about safe behavior with dogs; thus, the CD can help educate children about dog-bite prevention.

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

Lemanek, K. L., Ranalli, M., Lukens, C. — Thu, 05 Nov 2009 05:48:21 PST

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.

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

Harris, M. A., Freeman, K. A., Beers, M. — Thu, 05 Nov 2009 05:48:21 PST

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.

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

Barrera, M., Schulte, F. — Thu, 05 Nov 2009 05:48:21 PST

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.

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. — Thu, 05 Nov 2009 05:48:21 PST

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

Currier, J. M., Hermes, S., Phipps, S. — Thu, 05 Nov 2009 05:48:21 PST

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.

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

Thu, 05 Nov 2009 05:48:21 PST

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.

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

Thu, 05 Nov 2009 05:48:21 PST

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.

Increasing Parent-Pediatrician Communication about Children's Psychosocial Problems

Hayutin, L. G., Reed-Knight, B., Blount, R. L., Lewis, J., McCormick, M. L. — Thu, 05 Nov 2009 05:48:21 PST

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.

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

Kuhl, E. S., Felt, B. T., Patton, S. R. — Thu, 05 Nov 2009 05:48:21 PST

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.

Brief Report: Psychosocial Factors and Pediatric Noncardiac Chest Pain

Thu, 05 Nov 2009 05:48:21 PST

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.

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

Thu, 05 Nov 2009 05:48:21 PST

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.