Journal of Pediatric Psychology - recent issues

Introduction to the Special Issue: Psychological Aspects of Genomics and Child Health

Tercyak, K. P. — 2009-06-19

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

Kral, T. V. E., Faith, M. S. — 2009-06-19

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.

Incorporating the Family as a Critical Context in Genetic Studies of Children: Implications for Understanding Pathways to Risky Behavior and Substance Use

Rende, R., Slomkowski, C. — 2009-06-19

The availability of candidate gene markers for biobehavioral traits will undoubtedly result in increasing attention to genetic influences in studies of childhood risk factors for health behaviors. However, a strict emphasis on genomics without consideration of the social contexts that give rise to risky behaviors will miss opportunities to understand more fully the powerful effect of the family on childhood development. This article discusses the rationale for using the family as a critical context for studying the translation of genetic propensity for risky behavior into developmental pathways that span childhood and adolescence. Attention is given to the importance of family environmental factors; the emerging literature on genetic influences on potential intermediate phenotypes; the need for rich and detailed characterizations of both phenotypes and environmental risk factors embedded within genomic studies of children; and implications for interventions and preventions aimed at risky behaviors. Via discussion of these issues, pragmatic considerations of how studying families as a context may facilitate the thoughtful inclusion of children into genetic paradigms are emphasized.

Adolescent Medical Providers' Willingness to Recommend Genetic Susceptibility Testing for Nicotine Addiction and Lung Cancer Risk to Adolescents

2009-06-19

Objective To examine the influences of disease, lifestyle, and other factors on adolescent medical providers’ willingness to recommend genetic susceptibility testing (GST). Method Providers attending a national conference completed a self-report survey (n = 232) about their willingness to recommend hypothetical GSTs, differentiated by disease (nicotine addiction/lung cancer), patient lifestyle (nonsmoker/smoker), and other contextual factors. Results Compared to recommending GST unconditionally, providers were more willing to recommend GST with parental/patient consent/assent, and in the presence of a preexisting illness and substance abuse history. Compared to offering nicotine addiction GST to a nonsmoker, providers were more willing to offer this type of testing to a smoker and were more willing to offer GST for lung cancer regardless of patient lifestyle. Conclusions Providers’ willingness to recommend GSTs is sensitive to many factors. Efforts to integrate GST into adolescent preventive care likely will need to address these and other influences on provider behavior.

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)

2009-06-19

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.

From Genetics to Genomics: Ethics, Policy, and Parental Decision-making

Wilfond, B., Ross, L. F. — 2009-06-19

Objective Ethical evaluation of genetic testing in children is traditionally based on balancing clinical benefits and risks. However, this focus can be inconsistent with the general practice of respecting parental decision-making about their children's health care. We argue that respect for parental decision-making should play a larger role in shaping pediatric genetic testing practices, and play a similar role regarding decisions to use emerging genomic technologies. Methods Genomic testing involves the examination of thousands of DNA markers spanning genes throughout the genome and their interrelationships, yielding virtually limitless interpretations. We presume that parents and providers should proceed cautiously in applying genomic testing in children, as we explore how genomic testing will stress the fault lines of the traditional ethical analysis. Results Empirical data about the psychosocial risks and benefits of genetic testing of children do not reveal serious harms, yet virtually no such data exist yet about genomic testing. Unless empirical social and behavioral data indicate that genomic testing is highly likely to cause serious harms to the children, parental decisions to obtain comprehensive genomic testing in their children should be respected. Once comprehensive genomic testing of children becomes routine, resultant information may be more easily integrated by families than anticipated. Conclusions Research on the social and behavioral impact of comprehensive genomic testing on children and their families is needed to further inform parents, clinicians, and policy makers.

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. — 2009-06-19

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.

Commentary: Trailblazing a Research Agenda at the Interface of Pediatrics and Genomic Discovery--a Commentary on the Psychological Aspects of Genomics and Child Health

McBride, C. M., Guttmacher, A. E. — 2009-06-19

Unprecedented advances in human genome science are underway with potential to benefit public health. For example, it is estimated that within a decade, geneticists and epidemiologists will complete a catalog of the majority of genes associated with common chronic diseases. Such rapid advances create possibilities, if not the mandate, for translational research in how best to apply these and other anticipated discoveries for both individual and population health benefit. Driving these discoveries are rapid advances in infrastructure (e.g., the International HapMap Project to catalog human genetic variation; http://www.hapmap.org), analytical methods, and technology. This expansion in capabilities quickly has taken us from a genetics paradigm—where the influence of individual genes on health outcomes is paramount, to a genomics paradigm—where the complex influence of individual genes is considered in concert with each other and with environmental exposures on health outcomes. We discuss these and similar groundbreaking discoveries with an eye toward understanding their importance to child health and human development, and the role of behavioral science research conducted at the interface of pediatrics and genomic discovery.

Sleep in Children with Chronic Illness, and the Relation to Emotional and Behavioral Problems--A Population-Based Study

Hysing, M., Sivertsen, B., Stormark, K. M., Elgen, I., Lundervold, A. J. — 2009-06-19

Objective To examine sleep and sleep problems in children with chronic illness, and the potential effect of emotional and behavioral problems. Methods The Bergen Child Study is a total population study. Based on data from the second wave, information about sleep was given by 5,781 children and their parents, of which 496 children (8.6%) had a chronic illness. Results There were no differences in time in bed between children with a chronic illness and their healthy peers. However, the chronic illness group reported more problems falling asleep and had more nighttime awakenings. The increased risk for sleep problems was reduced to a nonsignificant level when adjusting for emotional and behavioral problems. Conclusions The elevated rate of sleep problems and association with emotional and behavioral problems in children with chronic illness underline the importance of early detection and intervention in this group.

Parental Reactions Following the Diagnosis of Cerebral Palsy in Their Young Child

Rentinck, I., Ketelaar, M., Jongmans, M., Lindeman, E., Gorter, J. W. — 2009-06-19

Objective To investigate parental reactions following the diagnosis of cerebral palsy (CP) in their young children. Methods In this cross-sectional study, 51 parents of children with CP (mean age = 18.5 months, SD = 1.5) completed the Reaction to Diagnosis Interview, assessing their personal reactions to their children's diagnosis. Relationships between these reactions and the severity of CP in terms of motor abilities and the child's cognitive functioning, as well as coping of parents and perceived social support, were investigated using univariate and multivariate logistic regression analyses. Results Thirty-nine parents (77%) were classified as "resolved." Multivariate regression analysis revealed that severity of CP was associated with an "unresolved" status. Conclusion The majority of parents of children with CP have come to terms with this diagnosis by the time their children is 18 months old. The child's gross motor limitations seem to represent an important factor explaining negative parental reactions at this time.

Brief Report: A Qualitative Analysis of Discussions about HIV in Families of Parents with HIV

2009-06-19

Objective To explore communication about HIV prevention, risk behaviors, and transmission in families affected by HIV. Methods Semi-structured interviews were conducted with 33 parents with HIV, 27 children (9- to 17-years old), and 19 adult children (≥18-years old) across the U.S. Coders reviewed transcripts, identified themes, and coded transcripts. Results Youth felt uncomfortable discussing HIV with their parent who has HIV because they worried about upsetting and reminding the parent of his/her illness. Adult children reported learning about HIV prevention by watching how the illness affected their parents. Few siblings reported talking with one another about HIV because they worried about upsetting their brother/sister and about their sibling unintentionally disclosing the parent's illness to others. Conclusions Discussions between youth and their parent with HIV and their siblings vary, highlighting the need for further research in this area.

Profiles of Service Utilization and the Resultant Economic Impact in Preschoolers With Attention Deficit/Hyperactivity Disorder

2009-06-19

Objective To examine whether preschool children with Attention deficit/hyperactivity disorder (ADHD) utilize more speech and language therapy (ST), occupational therapy (OT), and physical therapy (PT) services and are more likely to be placed in special education (SPED) classrooms as compared to their peers. Corresponding financial consequences were also examined. Methods The amount of ST, OT, and PT, as well as SPED placements, was examined in 3- and 4-year-old children with and without ADHD (n = 109 and n = 97, respectively) during the baseline portion of an ongoing, 5-year longitudinal study. Costs for individual services and aggregate cost were determined per child and compared across groups. Results Preschool children with ADHD were more likely to receive individual and multiple services. Higher rates of service utilization translated into increased costs for each individual service with the exception of PT. Conclusions A comprehensive understanding of service utilization in the early years of development is important in addressing the increased service use in the preschool years and assist in guiding allocation of resources.

Special Acknowledgment of Reviewers

2009-06-19

Introduction to the Special Issue: eHealth in Pediatric Psychology

Ritterband, L. M., Palermo, T. M. — 2009-05-19

Association of Multiple Behavioral Risk Factors with Adolescents' Willingness to Engage in eHealth Promotion

Tercyak, K. P., Abraham, A. A., Graham, A. L., Wilson, L. D., Walker, L. R. — 2009-05-19

Objective This study examines adolescents’ willingness to use the internet and other forms of technology for health promotion purposes (i.e., "eHealth promotion" willingness) and determines if a relationship exists between adolescents’ behavioral risks and their eHealth promotion willingness. Methods A total of 332 adolescents provided data at a routine medical check-up, including assessments of technology access, eHealth promotion willingness, and multiple behavioral risk factors for child- and adult-onset disease (body mass index, physical activity, smoking, sun protection, depression). Results The level of access to technology among the sample was high, with moderate willingness to engage in eHealth promotion. After adjusting for adolescents’ access to technology, the presence of multiple behavioral risk factors was positively associated with willingness to use technology for health promotion purposes (β =.12, p =.03). Conclusions Adolescents with both single and multiple behavioral risk factors are in need of health promotion to prevent the onset of disease later in life. eHealth appears to be an acceptable and promising intervention approach with this population.

Commentary: Interest in Internet Interventions--an Infant Sleep Program as Illustration

Thorndike, F. P. — 2009-05-19

The Efficacy of an Internet-Based Cognitive-Behavioral Therapy Intervention for Child Anxiety Disorders

March, S., Spence, S. H., Donovan, C. L. — 2009-05-19

Objective To evaluate the efficacy of an Internet-based cognitive-behavioral therapy (CBT) approach to the treatment of child anxiety disorders. Methods Seventy-three children with anxiety disorders, aged 7–12 years, and their parents were randomly assigned to either an Internet-based CBT (NET) or wait-list (WL) condition. Clinical diagnostic assessment and parent and child questionnaires were completed before and after treatment. The NET condition was reassessed at 6-month follow-up. Results At posttreatment assessment, children in the NET condition showed small but significantly greater reductions in anxiety symptoms and increases in functioning than WL participants. These improvements were enhanced during the 6-month follow-up period, with 75% of NET children free of their primary diagnosis. Conclusions Internet delivery of CBT for child anxiety offers promise as a way of increasing access to treatment for this population. Future research is needed to examine ways to increase treatment compliance and further enhance the impact of treatment.

Brief Report: A Web-Based Mental Health Program: Reaching Parents at Work

Deitz, D. K., Cook, R. F., Billings, D. W., Hendrickson, A. — 2009-05-19

Objective The purpose of the project was to test a web-based program providing working parents with the knowledge and skills necessary for prevention and early intervention of mental health problems in youth. Method Study sample consisted of 99 parents who were randomized into either an experimental (program use) or waitlist control condition. Analysis of covariance and paired t-tests were used to compare response outcomes for the two groups. Results Parents receiving the intervention had greater knowledge of youth mental health issues and greater self-efficacy in handling these issues compared to controls. Conclusions Findings suggest that referring parents to a multimedia web-based program can improve parents’ knowledge of children's’ mental health and their confidence in addressing mental health issues. Web-based programs can be offered to individuals in multiple settings, including the workplace, thereby reaching large numbers of parents.

A Systematic Review of Internet-based Self-Management Interventions for Youth with Health Conditions

Stinson, J., Wilson, R., Gill, N., Yamada, J., Holt, J. — 2009-05-19

Objective Critically appraise research evidence on effectiveness of internet self-management interventions on health outcomes in youth with health conditions. Methods Published studies of internet interventions in youth with health conditions were evaluated. Electronic searches were conducted in EBM Reviews-Cochrane Central Register of Controlled Trials, Medline, EMBASE, CINAHL and PsychINFO. Two reviewers independently selected articles for review and assessed methodological quality. Of 29 published articles on internet interventions; only nine met the inclusion criteria and were included in analysis. Results While outcomes varied greatly between studies, symptoms improved in internet interventions compared to control conditions in seven of nine studies. There was conflicting evidence regarding disease-specific knowledge and quality of life, and evidence was limited regarding decreases in health care utilization. Conclusions There are the beginnings of an evidence base that self-management interventions delivered via the internet improve selected outcomes in certain childhood illnesses.

Brief Report: Web-based Management of Adolescent Chronic Pain: Development and Usability Testing of an Online Family Cognitive Behavioral Therapy Program

Long, A. C., Palermo, T. M. — 2009-05-19

Objectives This study evaluates the usability and feasibility of a Web-based intervention (Web-MAP) to deliver cognitive behavioral therapy (CBT) to adolescents with chronic pain and their parents. Methods The Web site was evaluated in two stages. In stage one, recovered adolescents and parents (n = 5 dyads), who had completed office-based CBT through a pediatric pain management clinic, completed ratings of Web site content, usability, appearance, and theme. In stage two, treatment-seeking adolescents and their parents (n = 6 dyads) completed the full-length Web program. Program usage data were obtained to assess interaction with the Web site. Results Participants rated moderate to strong acceptability of the program. Usage data indicated that participants interacted with the site and used communication features. Conclusions Feedback from usability testing provided important information in the process of designing a feasible Web-based treatment for adolescents with chronic pain for use in a randomized controlled trial.

Brief Report: Description of Feasibility and Satisfaction Findings from an Innovative Online Family Problem-solving Intervention for Adolescents following Traumatic Brain Injury

Wade, S. L., Walz, N. C., Carey, J. C., Williams, K. M. — 2009-05-19

Objective To describe feasibility and satisfaction findings from an innovative online family problem-solving intervention for adolescents with traumatic brain injury (TBI). Methods Nine adolescents who sustained a moderate to severe TBI in the previous 24 months and their families participated in a novel, online, manualized treatment program (Teen Online Problem Solving, TOPS) consisting of 10 web-based sessions providing information and interactive exercises on cognitive, social, and behavioral skills typically affected by TBI. Web-based sessions were followed by synchronous video conferences with a therapist to review target skills and apply the problem-solving process to family goals. Results All teens and consenting parents completed at least 10 sessions. The website and videoconferences received moderate to high ratings on helpfulness and ease of use. Parents and teens reported increased knowledge regarding targeted knowledge and skills. Conclusions Findings support the acceptability of TOPS for adolescent TBI.

Brief report: A Pilot Study of a Web-based Resource for Families of Children with Cancer

Ewing, L. J., Long, K., Rotondi, A., Howe, C., Bill, L., Marsland, A. L. — 2009-05-19

Objective To develop a Web-based resource for families of children newly diagnosed with cancer and examine the viability of this modality of providing support. Methods Twenty-one children (8–17 years) newly diagnosed with cancer and their families were enrolled. Quantitative data on Web site utilization and frequency of accessing specific sections and qualitative data on participant satisfaction are reported. Results Twenty-one families comprising 51 participants (children with cancer, parents, and siblings) had access to the Web site. Utilization was lower than anticipated, with members of only nine families accessing the site. The majority of these hits were on peer discussion groups. Conclusion Further research is warranted to examine whether the Internet is a viable method of delivering support to families affected by childhood cancer. The current pattern of results suggests that the timing of its introduction and the method used to train families may affect utilization.

Exploring the Relationship between Parental Worry about their Children's Health and Usage of an Internet Intervention for Pediatric Encopresis

Magee, J. C., Ritterband, L. M., Thorndike, F. P., Cox, D. J., Borowitz, S. M. — 2009-05-19

Objective To investigate whether parental worry about their children's health predicts usage of a pediatric Internet intervention for encopresis. Methods Thirty-nine families with a child diagnosed with encopresis completed a national clinical trial of an Internet-based intervention for encopresis (www.ucanpooptoo.com). Parents rated worry about their children's health, encopresis severity, current parent treatment for depression, and parent comfort with the Internet. Usage indicators were collected while participants utilized the intervention. Results Regression analyses showed that parents who reported higher baseline levels of worry about their children's health showed greater subsequent intervention use (β =.52, p =.002), even after accounting for other plausible predictors. Exploratory analyses indicated that this effect may be stronger for families with younger children. Conclusions Characteristics of individuals using Internet-based treatment programs, such as parental worry about their children's health, can influence intervention usage, and should be considered by developers of Internet interventions.

Using a Website to Build Community and Enhance Outcomes in a Group, Multi-Component Intervention Promoting Healthy Diet and Exercise in Adolescents

2009-05-19

Objective This article describes website use and behavioral outcomes in a multi-component lifestyle intervention promoting healthy diet and exercise. Methods A 2-year randomized clinical trial to improve bone density in 228 adolescent girls, the intervention included a website designed to enhance intervention adherence, retention of participants, and behavioral outcomes. Measures included diet and exercise recalls, surveys, and web-usage data. Results Website use was associated with increases in calcium intake (ß = 69.72, p =.01, ES = 0.15) and high-impact activity (ß = 10.93, p =.04, ES =.13). Use of web pages related to behavioral feedback and communications was not significantly associated with behavioral outcomes. The most visited website pages had content related to incentive points, caption contests, and fun facts. Conclusions Web elements of a multi-component intervention may promote retention and engagement in target behaviors. Such websites may be most acceptable to adolescent participants if they blend fun and behavioral elements, rather than exclusively focusing on behavioral changes.

Report from a Multi-Institutional Randomized Clinical Trial Examining Computer-Assisted Problem-Solving Skills Training for English- and Spanish-Speaking Mothers of Children with Newly Diagnosed Cancer

2009-05-19

Objectives To evaluate the feasibility and efficacy of a handheld personal digital assistant (PDA)-based supplement for maternal Problem-Solving Skills Training (PSST) and to explore Spanish-speaking mothers’ experiences with it. Methods Mothers (n = 197) of children with newly diagnosed cancer were randomized to traditional PSST or PSST + PDA 8-week programs. Participants completed the Social Problem-Solving Inventory-Revised, Beck Depression Inventory-II, Profile of Mood States, and Impact of Event Scale-Revised pre-, post-treatment, and 3 months after completion of the intervention. Mothers also rated optimism, logic, and confidence in the intervention and technology. Results Both groups demonstrated significant positive change over time on all psychosocial measures. No between-group differences emerged. Despite technological "glitches," mothers expressed moderately high optimism, appreciation for logic, and confidence in both interventions and rated the PDA-based program favorably. Technology appealed to all Spanish-speaking mothers, with younger mothers showing greater proficiency. Conclusions Well-designed, supported technology holds promise for enhancing psychological interventions.

Use of Handheld Wireless Technology for a Home-based Sickle Cell Pain Management Protocol

2009-05-19

Purpose To evaluate use of a handheld electronic wireless device to implement a pain management protocol for participants with sickle cell disease (SCD). Methods Participants were 19 patients with SCD aged 9–20 who experienced vaso-occlusive pain. A single-session training on the use of cognitive–behavioral coping skills was followed by instruction on how to practice these skills and monitor daily pain experience using the device. Daily pain experience and practice of coping skills were collected for the 8-week intervention period using wireless technology. Results High rates of participation, daily diary completion and consumer satisfaction support the use of handheld wireless devices to implement this protocol. A comparison of the rates of self and device-recorded skills practice provides important information about the use of electronic monitoring for behavioral interventions. Conclusion Wireless data transfer technology has significant potential to become a practical method to improve symptom monitoring and communication between patients and providers.

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

2009-05-19

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.

Commentary: Electronic Communication in the Pediatric Setting--Dilemmas Associated with Patient Blogs

Tunick, R., Mednick, L. — 2009-05-19

Editorial: How to Write an Effective Results and Discussion for the Journal of Pediatric Psychology

Drotar, D. — 2009-04-22

Relation of Caregiver Alcohol Use to Unintentional Childhood Injury

Damashek, A., Williams, N. A., Sher, K., Peterson, L. — 2009-04-22

Objective The present study used a case-crossover design to investigate the association of caregiver alcohol consumption and supervision to children's injury occurrence and severity. Method A community sample of 170 mothers of toddlers was interviewed biweekly about their children's daily injuries for a period of 6 months. Results Proximal caregiver-reported alcohol use predicted higher likelihood of injury occurrence and higher injury severity, whereas caregiver-reported supervision predicted lower likelihood of injury occurrence and lower injury severity. Conclusion Even at low levels, proximal caregiver alcohol use may contribute to higher risk for childhood injuries and more severe injuries. The combined effect of supervision and drinking on injury likelihood warrants further exploration.

A Token Economy for Exercise Adherence in Pediatric Cystic Fibrosis: A Single-Subject Analysis

Bernard, R. S., Cohen, L. L., Moffett, K. — 2009-04-22

Objective In cystic fibrosis (CF), adherence to airway clearance techniques (e.g., chest physiotherapy and exercise) is poor. Exercise is important because pulmonary difficulties are associated with the highest mortality rate. Despite this, very little research has focused on exercise adherence in CF. This study examined a token economy for increasing exercise in children with CF. Methods An ABAB single-subject design evaluated a token economy for increasing and maintaining exercise in three children with CF. Patient report, parent report, and physiological measures were used to assess treatment integrity, medical stability, and changes in exercise. Results Measures suggested that treatment integrity was strong. Results indicated strong treatment effects for all participants without negative medical side effects. Follow-up of 1 and 3 months supported continued exercise for all participants. Conclusions A token economy effectively increased exercise in children with CF, and the single-subject design highlighted some of the intricacies of individualized treatment of adherence. Implications and recommendations for further research are discussed.

Childhood Sexual Abuse and Adolescent Pregnancy: A Meta-analytic Update

Noll, J. G., Shenk, C. E., Putnam, K. T. — 2009-04-22

Objective Recent increases in adolescent pregnancies have sparked a renewed impetus to identify risk factors, such as childhood sexual abuse (CSA), associated with adolescent pregnancy. Given mixed evidence regarding the strength of the relationship between CSA and adolescent pregnancy (Blinn-Pike, Berger, Dixon, Kuschel, & Kaplan, 2002), our objective was to provide an estimate of the effect size of this relationship using updated literature and meta-analytic techniques. Methods Meta-analyses of 21 studies were conducted using a random effects model of binary outcomes to determine aggregate effect-size estimates controlling for study heterogeneity. Results CSA significantly increased the odds of experiencing an adolescent pregnancy by 2.21-fold (95% CI: 1.94–2.51). A supplemental analysis suggested that 4.5 out of 10 pregnant adolescents may have a prior history of CSA. Conclusions CSA places females at increased risk for subsequent adolescent pregnancy. Addressing conditions associated with CSA might impact the overall adolescent pregnancy rate.

The Role of Asthma Management Beliefs and Behaviors in Childhood Asthma Immune and Clinical Outcomes

Walker, H. A., Chim, L., Chen, E. — 2009-04-22

Objective This study examined associations of asthma management-related beliefs and behaviors with immune markers and clinical outcomes in a sample of 66 children with asthma (ages 9–18 years). Methods Children and parents were interviewed about asthma management beliefs and behaviors. Immune measures included stimulated production of cytokines implicated in asthmatic airway inflammation, eosinophil counts, and IgE levels. Clinical outcomes included pulmonary function, symptoms, β-agonist use, and physician contacts. Results Children's reports of greater conceptual understanding of asthma, parents' reports of quicker responses to asthma symptoms, and children's and parents' reports of more balanced integration of asthma into daily life were all associated with reduced inflammatory profiles. Inflammatory profiles were found to be a statistically significant pathway linking asthma beliefs and behaviors to clinical outcomes. Conclusions These findings suggest that interventions aimed at teaching families better asthma management approaches may have the potential to alter biological profiles in children with asthma.

Brief Report: Diurnal Salivary Cortisol in Youth--Clarifying the Nature of Posttraumatic Stress Dysregulation

Weems, C. F., Carrion, V. G. — 2009-04-22

Objective The purpose of this study was to clarify the nature of diurnal salivary cortisol dysregulation in youth who experience posttraumatic stress (PTS). Method Diurnal trends in salivary cortisol secretion were examined in a sample of 41 youth aged 10–16 years (26 youth exposed to interpersonal traumas and 15 control participants with no PTS) using hierarchical linear modeling. Results Cortisol levels were characterized by curvilinear trends in secretion (i.e., sharp declines from prebreakfast to prelunch followed by smaller decreases from prelunch to predinner with a leveling-off or slight increase from predinner to prebed assessment). Results further indicated that youth with PTS had sharper morning declines and relatively higher evening levels (i.e., a greater curve in the daily trend) than nontraumatized youth. Conclusions Findings help to elucidate the physiological basis for altered arousal patterns in youth with PTS. Traumatized youth showed wider daily fluctuations in cortisol levels when these trends were modeled in a curvilinear fashion. The findings help to describe the nature of stress dysregulation in trauma-exposed youth and may have implications for clarifying some of the apparent inconsistencies in the literature.

Triple Risk: Do Difficult Temperament and Family Conflict Increase the Likelihood of Behavioral Maladjustment in Children Born Low Birth Weight and Preterm?

2009-04-22

Objective This study examined the impact of family conflict on internalizing and externalizing behavior at age 8 for children born low birth weight (LBW) and preterm (PT), with specific attention to the moderating role of early temperament. Methods The sample included 728 families enrolled in the longitudinal study of the Infant Health and Development Program. The study relied on maternal reports of child temperament at age 1, family conflict at age 61/2 years and 8 years, and child behavior at age 8 years. Results Children exposed to high levels of family conflict had more internalizing problems. Child temperament assessed in infancy moderated the impact of family conflict on externalizing but not internalizing problem behavior. Discussion LBW/PT children with a difficult temperament are more at risk for poor developmental outcomes, such as externalizing behavior problems, when exposed to family conflict than children with a less difficult temperament.

The Risk for Impaired Learning-related Abilities in Childhood and Educational Attainment Among Adults Born Near-term

2009-04-22

Objective To examine whether near-term births (NTB) and small-for-gestational-age (SGA) infants are at high risk for childhood learning-related problems and poor adult educational attainment, and whether poverty amplifies the adverse effects of NTB and SGA on those outcomes. Methods A randomly selected birth cohort (n = 1,619) was followed into adulthood. IQ and learning abilities were measured in childhood and educational attainment was measured in adulthood. Results NTB (n = 226) and SGA (n = 154) were associated with lower educational attainment mediated through learning-related abilities at age 7. Childhood poverty moderated the impact of NTB on educational attainment both directly and mediated through lower learning-related abilities. Poverty did not moderate the effect of SGA. Conclusions Poorer learning-related outcomes and educational attainment were not limited to children born very (<32 weeks) or extremely (<28 weeks) preterm, especially among those living in poverty. Targeted interventions such as remedial learning during childhood among NTB in poor families may yield higher educational attainment.

Parenting a Child with Autism: Contextual Factors Associated with Enhanced Daily Parental Mood

Pottie, C. G., Cohen, J., Ingram, K. M. — 2009-04-22

Objective To examine the extent to which social support, unsupportive interactions, support services, and disruptive child behaviors predict daily positive and negative mood in parents of children with autism. Methods Ninety-three parents of children with autism completed initial measures of disruptive child behaviors, and support services, then biweekly measures of daily stress, received emotional and instrumental social support, unsupportive social interactions, and mood over 3 months. Results Greater levels of daily positive mood were associated with more emotional and instrumental support, and less parenting stress and unsupportive interactions. Greater daily negative mood was associated with less emotional support and more parenting stress, unsupportive interactions, and disruptive child behaviors. Emotional support, unsupportive interactions, and disruptive child behaviors moderated the stress–mood relationship. Conclusions Daily received social support and unsupportive interactions, and disruptive child behaviors are important predictors of daily mood. Identifying interpersonal processes that enhance psychological well-being may inform future parenting interventions.

Children's Somatization Inventory: Psychometric Properties of the Revised Form (CSI-24)

Walker, L. S., Beck, J. E., Garber, J., Lambert, W. — 2009-04-22

Objective To conduct a multimethod psychometric evaluation to refine the Children's Somatization Inventory (CSI) and to investigate its dimensionality. Method The CSI was administered to 876 pediatric patients with chronic abdominal pain at their initial visit to a pediatric gastroenterology clinic. Tools from three psychometric models identified items that most effectively measured the construct of somatization and examined its dimensionality. Results Eleven statistically weak items were identified and removed, creating a 24-item CSI (CSI-24). The CSI-24 showed good psychometrics according to the three measurement models and correlated.99 with the original CSI. The CSI-24 has one dominant general factor but is not strictly unidimensional. Conclusions The CSI-24 is a reliable and psychometrically sound refinement of the original CSI. Findings are consistent with the view that somatization has a strong general factor that represents a continuum of symptom reporting, as well as minor components that represent specific symptom clusters in youth with chronic abdominal pain.

Self-Efficacy Moderates the Relation Between Declines in Physical Activity and Perceived Social Support in High School Girls

Dishman, R. K., Saunders, R. P., Motl, R. W., Dowda, M., Pate, R. R. — 2009-04-22

Objective To test whether self-efficacy for overcoming barriers to physical activity has direct, indirect (i.e., mediated), or moderating relations with naturally occurring change in perceived social support and declines in physical activity during high school. Methods Latent growth modeling was used with measures completed in the 8th, 9th, and 12th grades by a cohort of 195 Black and White girls. Results Self-efficacy was stable and moderated the relation between changes in physical activity and perceived social support. Girls who maintained a perception of strong social support had less of a decline in physical activity if they also had high self-efficacy. However, girls having high self-efficacy had a greater decline in physical activity if they perceived declines in social support. Conclusions Randomized controlled trials of physical activity interventions based on social cognitive theory should consider that the influence of girls’ perceptions of social support on their physical activity may differ according to their efficacy beliefs about barriers to physical activity.

Erratum

2009-04-22