Showing papers in "Journal of Pediatric Psychology in 2006"

An Integrative Model of Pediatric Medical Traumatic Stress

Abstract: Objective To guide assessment and intervention for patients and families, a model for assessing and treating pediatric medical traumatic stress (PMTS) is presented that integrates the literature across pediatric conditions. Methods A model with three general phases is outlined--I, peritrauma; II, early, ongoing, and evolving responses; and III, longer-term PMTS. Relevant literature for each is reviewed and discussed with respect to implications for intervention for patients and families. Results Commonalities across conditions, the range of normative responses to potentially traumatic events (PTEs), the importance of preexisting psychological well-being, developmental considerations, and a social ecological orientation are highlighted. Conclusions Growing empirical support exists to guide the development of assessment and intervention related to PMTS for patients with pediatric illness and their parents. The need for interventions across the course of pediatric illness and injury that target patients, families, and/or healthcare teams is apparent. The model provides a basis for further development of evidence-based treatments.

Posttraumatic Growth in Adolescent Survivors of Cancer and Their Mothers and Fathers

Abstract: Objective To describe posttraumatic growth (PTG) following childhood cancer survival and its association with demographic and disease/treatment variables, perceived treatment severity and life threat, and posttraumatic stress symptoms (PTSS). Method Adolescent survivors of cancer (N = 150, ages 11-19), at least 1 year after treatment, and their mothers (N = 146) and fathers (N = 107) completed self-report measures of perceived treatment intensity and PTSS and a semistructured interview designed to identify posttraumatic responses and indicators of PTG including perceived positive changes for self, relationships, and life goals. Results A majority of adolescents and their mothers and fathers reported PTG. Greater perceived treatment severity and life threat, but not objective disease severity, was associated with PTG. PTG and PTSS were positively associated for the adolescent cancer survivors. Diagnosis after age 5 resulted in more perceived benefit and greater PTSS for adolescent survivors. Conclusion Clarification of the concept and measurement of PTG after childhood cancer is warranted, as are prospective studies of the association of PTG and PTSS and the role of demographic variables and illness-specific appraisals.

Peer Victimization, Psychosocial Adjustment, and Physical Activity in Overweight and At-Risk-For-Overweight Youth

Abstract: OBJECTIVE: To examine the relationship between peer victimization and child and parent reports of psychosocial adjustment and physical activity in a clinical sample of at-risk-for-overweight and overweight children and adolescents. METHODS: The Schwartz Peer Victimization Scale, Children's Depression Inventory-Short Form, Multidimensional Anxiety Scale for Children, Social Physique Anxiety Scale, PACE+ Adolescent Physical Activity Measure, and Asher Loneliness Scale were administered to 92 children and adolescents (54 females) aged 8-18 years. The youth's parent/guardian completed the Child Behavior Checklist. RESULTS: Peer victimization was positively related to child-reported depression, anxiety, social physique anxiety, and loneliness, and parent-reported internalizing and externalizing symptoms. Peer victimization was negatively related to physical activity. Depressive symptoms and loneliness mediated the relations between peer victimization and physical activity. CONCLUSION: Recognition of the magnitude of the problem and the means of evaluating for peer victimization is important for clinicians who work with overweight youth. Assessing peer experiences may assist in understanding rates of physical activity and/or past nonadherence to clinician recommendations. Language: en

Psychological and cognitive functioning in children and adolescents with congenital heart disease: a meta-analysis.

Abstract: Objective Findings in the literature are inconsistent on the impact of congenital heart disease (CHD) on the psychological and cognitive functioning of children and adolescents. The aim of the present study was to systematically review this empirical body of literature. Methods We conducted a meta-analysis to review studies on behavior problems and cognitive functioning in CHD. Results Only older children and adolescents with CHD displayed an increased risk of overall, internalizing, and to a lesser extent externalizing behavior problems. In addition, patients with severe CHD exhibited lower cognitive functioning than patients with less severe CHD, specifically with respect to performance intelligence. Moreover, decreased cognitive functioning remained relatively stable across different age groups. Conclusions Children with severe heart disease may benefit from interventions specifically targeting perceptual organizational abilities, such as visual-spatial abilities. Moreover, older children and adolescents with CHD may benefit from psychological interventions reducing anxiety symptoms and depression.

Barriers to Treatment Adherence for Children with Cystic Fibrosis and Asthma: What Gets in the Way?

Abstract: Objectives The purpose of this study was to systematically identify barriers to treatment adherence for children with cystic fibrosis (CF) and asthma, as well as to examine the relationship between the number of barriers and adherence. Methods Participants included 73 children with CF or asthma and their parents. The mean age of the sample was 9.9 years, and 58% were males. Results Results indicated that barriers were quite similar by illness and informant (e.g., parent and child) for the same treatments, but unique barriers were identified for disease-specific treatments. Frequently mentioned barriers across diseases included forgetting, oppositional behaviors, and difficulties with time management. Trends were identified between adherence and barriers, suggesting that a greater number of barriers were related to poorer adherence. Conclusion Overall, this study provided evidence that patients and their parents experience specific barriers within the context of their own illness and highlights the need for disease-specific measures and interventions.

Effects of Behavioral Family Systems Therapy for Diabetes on Adolescents’ Family Relationships, Treatment Adherence, and Metabolic Control

Abstract: Background Behavioral family systems therapy (BFST) for adolescents with diabetes has improved family relationships and communication, but effects on adherence and metabolic control were weak We evaluated a revised intervention, BFST for diabetes (BFST-D) Methods One hundred and four families were randomized to standard care (SC) or to 12 sessions of either an educational support group (ES) or a BFST-D over 6 months Family relationships, adherence, glycosylated hemoglobin (HbA1c), and health care utilization were measured at baseline and after treatment Results BFST-D significantly improved family conflict and adherence compared to SC and ES, especially among those with baseline HbA1c ≥90% BFST-D and ES significantly improved HbA1c compared to SC among those with baseline HbA1c ≥90% Conclusions The revised intervention (BFST-D) improved family conflict and treatment adherence significantly, while both ES and BFST-D reduced HbA1c significantly, particularly among adolescents with poor metabolic control Clinical translation of BFST-D requires further study

The Relation Between Family Factors and Metabolic Control: The Role of Diabetes Adherence

Abstract: Objectives To examine family factors as predictors of metabolic control in children with type 1 diabetes and determine whether adherence behaviors mediate this relationship. Method Participants were 109 children (ages 8-18) and a parent. Measures of diabetes-specific family functioning and an adherence interview were completed. Glycosylated hemoglobin (HbA1c) was the index of metabolic control. Results Family functioning and adherence were strongly associated with metabolic control. Combined with demographic information, these constructs accounted for 49% of the variance in metabolic control. Age moderated the relation between aspects of family functioning and HbA1c. Path analyses suggest that adherence mediates the relationship between family functioning and metabolic control. Conclusions Family functioning and adherence behaviors are strongly related to a child's health status. Assessment of diabetes-specific family functioning, in addition to adherence, is an important factor in understanding metabolic control.

Catastrophic Thinking About Pain is Independently Associated with Pain Severity, Disability, and Somatic Complaints in School Children and Children with Chronic Pain

Abstract: Objective To investigate the value of pain catastrophizing in explaining pain, disability, and somatic complaints, beyond negative affectivity (NA). Method Two cross-sectional studies, one in a sample of school children (n = 193) and a second in a clinical sample of children with recurrent or chronic pain (n = 43), were conducted. In both studies, measures of pain catastrophizing and NA were examined for their ability to explain pain, disability, and somatic complaints. Results In both studies, pain catastrophizing significantly accounted for the variance of pain, disability, and somatic complaints, beyond the effects of age, sex, and NA. Furthermore, pain catastrophizing significantly mediated the relationship between NA and somatic complaints in both studies and between NA and functional disability in study 1. Conclusions Results suggest the importance of assessing for pain catastrophizing in children. Pain catastrophizing is further discussed in terms of communicating distress to significant others.

Parent and Family Factors Associated with Child Adjustment to Pediatric Cancer

Abstract: Objective To identify factors that influence the association between parent and child distress among families of children with cancer and comparison peers. Methods Parent and child distress, social support, and family environment were assessed among families of 95 children with cancer (94 mothers, 67 fathers) and 98 comparison peers (97 mothers, 77 fathers). Results Significant associations were found between parent and child distress. For models examining the impact of fathers’ distress on children, several moderators were identified (i.e., family environment, child age and gender, a cancer diagnosis, and treatment severity). Family environment also partially mediated father and child distress. Conclusions Children whose parents were distressed were more likely to be distressed themselves. Subgroups of children were particularly vulnerable, indicating a need to identify further mechanisms of risk and resilience and to develop family-based interventions. Support was found for including fathers as independent sources of information in pediatric psychology research and clinical practice.

Online Psychological Treatment for Pediatric Recurrent Pain: A Randomized Evaluation

Abstract: Objective To evaluate the efficacy of a distance treatment delivered through Internet and telephone for pediatric recurrent pain. Methods Forty-seven participants (9–16 years of age) were randomly assigned to either an Internet-based treatment or a standard medical care waitlist. Treatment employed a Web-based manual for children and parents with weekly therapist contact by telephone or e-mail. At 1- and 3-month follow-ups, participants were assessed on the outcome variables of pain and quality of life. A 50% reduction in diary pain scores was considered clinically significant. Results Significant between-group differences were found: 71 and 72% of the treatment group achieved clinically significant improvement at the 1- and 3-month follow-ups, respectively, whereas only 19 and 14% of the control group achieved the criterion. No significant differences were found on the quality of life variable. Conclusions Distance methods have considerable potential for making effective treatments more accessible with lower associated costs.

Sleep Disturbances and Childhood Sexual Abuse

Abstract: OBJECTIVE: This longitudinal, prospective study examined the relationship between childhood sexual abuse and later sleep problems in adolescence while taking into account cooccurring psychopathology that is closely related to sleep disruption e.g., depression and posttraumatic stress disorder (PTSD). METHOD: Sleep disturbances in 147 females (78 sexually abused; 69 comparison) were assessed 10 years after disclosure of substantiated abuse. The follow-up protocol included self-report questions regarding typical sleeping patterns and sleep disturbances as well as measures of depression, PTSD, and lifetime victimization histories. RESULTS: Sleep disturbances correlated significantly with both depression and PTSD. Hierarchical regression analysis showed that sexually abused participants reported significantly greater rates of sleep disturbances than comparison participants above and beyond depression and PTSD. Sleep disturbances were related to revictimization rates independent of sexual abuse, depression, and PTSD. CONCLUSIONS: Assessments of sleep disturbances should be integrated into standard of care for adolescents who have experienced sexual abuse. Language: en

Supportive Relationships and Sexual Risk Behavior in Adolescence: An Ecological-Transactional Approach

Abstract: OBJECTIVE: To examine the longitudinal associations between supportive relationships with friends and parents and sexual risk behavior in adolescence based on an ecological-transactional perspective. METHODS: Analyses were conducted on 2,652 sexually active adolescents from the first two waves of the National Longitudinal Study of Adolescent Health (Add Health). RESULTS: African-American adolescents had lower risk for sexual risk behavior. Supportive friendships and parent connectedness interacted in predicting decreased likelihood of sexual risk behavior. Mother-child communication about sex contributed to decreased likelihood of sexual risk only for girls. There were also small reciprocal effects of sexual risk behavior on decreased relationship quality over time. CONCLUSION: To better understand the parents' role in adolescent sexual risk behavior, multiple facets of parenting, the social contexts of parenting and adolescents' peers, and the effects of adolescents' behavior on these relationships should be taken into consideration. Language: en

Prenatal Alcohol Exposure and Ability, Academic Achievement, and School Functioning in Adolescence: A Longitudinal Follow-Up

Abstract: BACKGROUND: Prenatal alcohol exposure is associated with learning, behavioral, and academic problems even in children without the fetal alcohol syndrome (FAS). OBJECTIVE: To examine the prenatal alcohol exposure and ability, academic achievement, and school functioning in adolescence. METHODS: In a longitudinal cohort, intelligence, academic performance, and school functioning were evaluated in 265 low socioeconomic status (SES) adolescents (M age = 15.1 years), 128 prenatally exposed to alcohol, 53 controls, and 84 special education students by using the Wechsler Intelligence Scale for Children, 3rd edition (WISC-III) and the Wechsler Individual Achievement Test (WIAT). School records were abstracted for grade point averages (GPA), standardized achievement test scores, conduct, attendance, and special education placement. RESULTS: Alcohol-affected youth had significantly lower IQs than those in the other three groups. CONCLUSION: Although academic achievement (WIAT scores) was most impaired in the special education group who showed lower performance over all as well as in reading and spelling, alcohol-affected youth showed significant deficits on mathematics subtests. There was no increased incidence of conduct problems in school records related to alcohol exposure.

The Roles of Age, Gender, Inhibitory Control, and Parental Supervision in Children's Pedestrian Safety

Abstract: OBJECTIVE: Thousands of American children are injured or killed each year as pedestrians, but behavioral factors in pedestrian injury etiology remain poorly understood. We examined the roles of children's individual differences (age, gender, and inhibitory control) and parental supervision in children's pedestrian behaviors. METHODS: Using the pretend road method, a sample of 85 children and 26 adults crossed a pretend crosswalk set adjacent to a real road. Safety of crossing the pretend road was determined based on actual traffic on the real road. Adults also crossed the real road. RESULTS: Adults' behavior on the real road paralleled that on the pretend road, supporting validity of the method. On the pretend road, younger children, boys, and children with less behavioral control engaged in riskier pedestrian behaviors. Children with less behavioral control responded more noticeably to increases in parental supervision. CONCLUSION: Results are discussed in relation to children's development and injury prevention. Language: en

Adolescent Male Bullies, Victims, and Bully-Victims: A Comparison of Psychosocial and Behavioral Characteristics

Abstract: Objective To determine among male adolescents whether bully-victims would report the poorest psychosocial health, the worst attitudes toward school, more problem behavior (delinquency, weapons possession, and substance use), and more physical injury compared with bullies, victims, and neutral students. We also assessed ethnic differences in bullying category membership. Methods Employing multisample latent variable models, we contrasted 1,312 males in grades 7-12 classified as bullies (n = 299), victims (n = 180), bully-victims (n = 195), and neutral (n = 638) on school attitudes, psychosocial health, problem behaviors, and physical injury. Results Hypotheses were generally confirmed, especially contrasts between bully-victims and neutrals. However, bullies did not have better school attitudes than bully-victims, and victims only marginally reported better psychological health than bully-victims. The boys of mixed ethnicity were more likely to be victims. Conclusions Greater awareness of the problems associated with boys who both bully and are victimized is necessary for improved intervention. Language: en

Predictors of Youth Diabetes Care Behaviors and Metabolic Control: A Structural Equation Modeling Approach

Abstract: Objective To empirically test a biopsychosocial model of predictors of youth diabetes care behaviors and metabolic control. Methods A cross-sectional multisite study of youths (N = 222) with T1D (mean age = 12.6) used structural equation modeling to examine interrelations among predictors, with follow-up analyses of covariance (ANCOVAs). Results Youths' memory skills related to diabetes knowledge which, along with self-efficacy and age, was associated with greater youth responsibility that in turn predicted poorer self-care behaviors. Less frequent/briefer exercise and less frequent blood glucose monitoring/eating were found; the latter directly related to poorer metabolic control. Behavior problems also were associated directly with poorer metabolic control. A parsimonious model found memory directly related to blood glucose testing. Conclusions Continued parental supervision of adolescents, along with monitoring diabetes knowledge and efficacy, may help optimize transfer of diabetes care from parents to youths. Behavior problems warrant immediate attention because of their direct and adverse relation to metabolic control.

Long-term Parental and Family Adaptation Following Pediatric Brain Injury

Abstract: Objective To determine whether parents of children with traumatic brain injuries (TBI) report increased injury-related burden, distress, and family dysfunction and to examine the effects of attrition on the results. Methods Children with severe TBI, moderate TBI, and orthopedic injuries were followed at six time points from baseline to 6 years after injury. Parents completed measures of injury-related burden, psychological distress, and family functioning at each assessment. Mixed model analysis was used to examine long-term changes. Results Attrition was higher among families in the severe TBI group with lower burden thereby amplifying group differences. The severe TBI group reported higher injury-related burden over time after injury than the other groups. Family functioning was moderated by social resources. Families of children with severe TBI and low resources reporting deteriorating functioning over the follow-up interval. Conclusions Although environmental advantages moderate long-term effects on family functioning, families of children with severe TBI experience long-standing injury-related burden.

The Relationship of Hope and Illness-Related Uncertainty to Emotional Adjustment and Adherence Among Pediatric Renal and Liver Transplant Recipients

Abstract: Objective To examine, using partial least squares (PLS) modeling, the associations among hope, illness-related uncertainty, anxiety, depression, and adherence in a sample of children with renal and liver transplantations. Methods Seventy pediatric renal and liver transplant recipients and their caregivers participated in a 3-month study which involved completing questionnaires and monitoring adherence via self-report and electronic monitoring (MEMS™ caps). A PLS estimation procedure was used to examine the associations among constructs in the theoretical model. Results Hope and uncertainty were associated with both depressive symptoms and anxiety, and depressive symptoms were associated with treatment adherence. The association of hope and adherence to treatment was fully mediated by depressive symptoms. Conclusions Findings suggest mechanisms for identifying patients that may be at risk for nonadherence and components for intervention programs to improve adherence rates among pediatric transplant recipients.

Paternal Involvement in the Management of Pediatric Chronic Diseases: Associations with Adherence, Quality of Life, and Health Status

Abstract: Objectives This article reports associations among paternal involvement in pediatric chronic disease management and child outcomes. Methods The Dads’ Active Disease Support scale (DADS) and measures of treatment adherence, quality of life, health status, and health care utilization were obtained for youths with six chronic diseases, with complete data sets obtained from 190 couples. Results Paternal involvement was not associated with these outcomes among younger children. Among adolescents, mother-reported and father-reported DADS scores indicating more paternal involvement were associated with maintenance, rather than deterioration, of treatment adherence and more favorable quality of life. Youths’ health status and health care utilization were not related significantly to paternal involvement. Conclusions More paternal involvement was associated with more favorable adherence and quality of life among adolescents but not associated with health status or health care utilization. Longitudinal studies could verify whether paternal involvement merits clinical intervention.

Children’s Attentional Skills 5 Years Post-TBI

Abstract: Objective While a small number of research papers have reported findings on attentional deficits following pediatric traumatic brain injury (TBI), no study to date has reported findings in this area at 5 years post-TBI in very young children. This study examined attentional skills in a group of children who had sustained a mild, moderate, or severe TBI between the ages of 2 and 7 years. Methods The sample comprised 70 children, 54 of these had sustained a TBI and 16 the non-injured control group. Children were assessed 5 years post-TBI, with focus on tests of attentional ability. Results Attentional and processing speed (PS) deficits do occur and persist up to 5 years post-TBI, particularly following severe TBI in early childhood. Predictors of attentional outcomes varied depending on the component of attention investigated. Conclusions Those skills developing or emerging at time of injury (e.g., sustained attention, shifting attention, divided attention, PS) are more compromised and may not develop at a normal rate of post-injury.

A Meta-Analysis of the Effects of Psychological Interventions in Pediatric Oncology on Outcomes of Psychological Distress and Adjustment

Abstract: Objective To estimate the effectiveness of psychological interventions in pediatric oncology on decreasing psychological distress and increasing psychological adjustment using meta-analytic methods. Methods A meta-analysis was conducted on 12 psychological intervention studies in pediatric oncology using a weighted least squares (WLS) approach and random effect models. Results Effect sizes significantly different from zero were found for parent distress (mean = 0.35, 95% CI = 0.20–0.49, n = 7) and parent adjustment (mean = 0.23, 95% CI = 0.07–0.40, n = 5). Effect sizes for child distress, child adjustment, parent-reported child distress, and parent-reported child adjustment were not significantly different from zero. Conclusions Psychological interventions in pediatric oncology show promise in decreasing distress and improving the adjustment of parents of children with cancer but may have minimal effects for child outcomes. Methodological issues of intervention research are discussed.

Posttraumatic Stress Symptoms in Parents of Children with Acute Burns

Abstract: OBJECTIVE To develop a model of risk factors for posttraumatic stress disorder (PTSD) symptoms in parents of children with burns. METHODS Immediately following the burn and 3 months later, parents reported on their children's and their own psychological functioning and traumatic stress responses. RESULTS Approximately 47% of the parents reported experiencing significant posttraumatic stress symptoms 3 months after the burn. Our model indicates three independent pathways to PTSD symptoms (i.e., parent-child conflict, parents' dissociation, and children's PTSD symptoms). Additionally, parents' anxiety predicted increased parent-child conflict, conflict with extended family and size of the burn predicted parents' dissociation, and size of the burn and children's dissociation predicted children's PTSD symptoms. CONCLUSIONS This study suggests that many parents of children with burns suffer from posttraumatic stress symptoms. Interventions that target factors such as family conflict, children's symptoms, and parents' acute anxiety and dissociation may diminish the risk for PTSD.

Understanding Unintentional Injury Risk in Young Children II. The Contribution of Caregiver Supervision, Child Attributes, and Parent Attributes

Abstract: Objective: To identify child and parent attributes that relate to caregiver supervision and examine how these factors influence child-injury risk. Methods: Mothers completed diary records about supervision of their young child (2-5 years) when at home. Standardized questionnaires provided information about child attributes, maternal attributes, and children's history of injuries. Results: Correlations revealed that child attributes and parent attributes related both to actual maternal supervision and child-injury scores. Regression analyses to predict injury scores revealed child-temperament factors alone predicted all levels of severity (minor, moderately severe, and medically attended), but parent supervision also contributed to predict medically attended injuries. Conclusions: Both child and parent factors influenced caregiver's supervision of young children at home and related to child-injury risk. For medically attended injuries, child attributes and parent supervision both predicted risk, whereas for less serious injuries, child factors alone determined risk.

Attention and Memory Functioning Among Pediatric Patients with Medulloblastoma

Abstract: OBJECTIVE To test the hypotheses that memory and attention deficits are prevalent in survivors of childhood medulloblastoma (MB) and that these deficits are associated with problems with academic achievement. METHODS The medical charts of 38 child survivors of MB, who were administered the California Verbal Learning Test, Child Version (CVLT-C), Conners' Continuous Performance Test (CPT), and the Wechsler Individual Achievement Test (WIAT) as part of a comprehensive neurocognitive test battery, were retrospectively reviewed. RESULTS Although no significant verbal memory deficits were found, 8 of 11 CPT variables were significantly below the standardization mean (p < or = .01). Additionally, stepwise regression analyses found that increased omission errors were significantly associated with lower reading and math performance (p < or = .01). CONCLUSIONS These findings confirm previous reports of attention deficits among survivors of MB and provide a better understanding of how the dysfunction of particular attentional substrates (e.g., perceptual sensitivity, response bias) may result in learning problems in this population.

Mental Health Outcomes of Cocaine-Exposed Children at 6 Years of Age

Abstract: Objective To assess 6-year-old cocaine- and noncocaine-exposed children’s mental health outcomes controlling for potential confounders. Methods The sample consisted of 322 children [169 cocaine exposed (CE) and 153 noncocaine exposed (NCE)] enrolled in a longitudinal study since birth. At age 6, children were assessed for mental health symptoms using the Dominic Interactive (DI), a child self-report measure, and the Child Behavior Checklist (CBCL), a caregiver report of behavioral problems. Results CE children were more likely to self-report symptoms in the probable clinical range for oppositional defiant disorder (ODD) and attention deficit hyperactivity disorder (ADHD). In contrast, prenatal cocaine exposure was not related to child behavior based on the CBCL. After control for exposure, CE children in adoptive or foster care were rated as having more problems with aggression, externalizing behaviors, and total behavioral problems than NCE children and CE children in maternal or relative care. Also, CE children in adoptive or foster care self-reported more externalizing symptoms than CE children in maternal or relative care and NCE children. Findings could not be attributed to caregiver intelligence or depressive symptoms, or to the quality of the home environment. Conclusions CE children report more symptoms of ODD and ADHD than nonexposed children. Adoptive or foster caregivers rated their CE children as having more behavioral problems than did maternal or relative caregivers of CE children or parents of NCE children. Although further studies are needed to understand the basis for the more negative ratings by adoptive or foster caregivers of their CE children, the self-report of CE children indicates a need for psychological interventions.

Posttraumatic Stress and Related Impairment in Survivors of Childhood Cancer in Early Adulthood Compared to Healthy Peers

Abstract: OBJECTIVE To compare rates of posttraumatic stress disorder (PTSD) and related impairment between childhood cancer survivors in early adulthood and healthy peers. METHODS Cancer survivors (n = 57) and comparison group (n = 83) completed measures of PTSD, depression, health-related quality of life (HRQOL), mood, and satisfaction with life (SWL). RESULTS The cancer survivor group was more likely to have PTSD than the control group (odds ratio = 4.67, p < .05) but was not more likely to experience subclinical PTSD symptoms. The groups differed on physical HRQOL, F(1, 140) = 15.02, p < .001, and positive affect, F(1, 140) = 7.03, p < .01, but did not differ on depression, SWL, psychosocial HRQOL, and negative mood. Those in the survivor group with PTSD (n = 10) experienced more depression and negative affect, worse HRQOL and SWL, perceived their cancer to impact developmental tasks more, and were older at the time of diagnosis compared with those without PTSD (n = 47). CONCLUSIONS Although most are well adjusted, childhood cancer survivors in early adulthood are more likely to have PTSD and to experience significant impairment compared with healthy peers.

The Relationship of Prenatal Alcohol Exposure and the Postnatal Environment to Child Depressive Symptoms

Abstract: Objective This study examined the association between prenatal alcohol exposure and child depressive symptoms, and the mediating effects of maternal and child characteristics. Methods Participants were 42 children aged 4-5 years and their biological mothers. Prenatal alcohol consumption was assessed by self-report of maximum drinks per drinking occasion. The Pictorial Depression Scale (PDS) measured child depressive symptoms. Mother-child interactions were assessed using the family interaction puzzle task. Results Structural equation modeling indicated that prenatal alcohol exposure was associated with more negative child affect. In turn, mothers of more negative children were less emotionally connected to their children, and those children had higher levels of depressive symptomatology. Results could not be explained by current maternal drinking patterns or maternal depression. Conclusions Study findings highlight the importance of examining prenatal alcohol exposure as a risk factor in the prediction of childhood-onset depression and the environmental mechanisms that may mediate that relationship.

Appraisal and Coping with Daily Stressors by Pediatric Patients with Chronic Abdominal Pain

Abstract: Chronic abdominal pain, defined as long-lasting intermittent or constant abdominal pain (American Academy of Pediatrics and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition, Subcommittee on Chronic Abdominal Pain, 2005), affects 5–20% of youth (Apley & Naish, 1958; Kristjansdottir, 1997; Oster, 1972), is associated with high levels of impairment and pediatric health service utilization (Campo, Comer, Jansen-McWilliams, Gardner, & Kelleher, 2002), and may continue into adolescence and adulthood (Campo et al., 2001; Walker, Guite, Duke, Barnard, & Greene, 1998). It is rarely associated with organic disease, but instead typically reflects a functional gastrointestinal disorder (Boyle, 1997; Walker, et al., 2004). Several investigations have linked chronic abdominal pain to stressful life events. In prospective studies, higher levels of negative life events predicted symptom maintenance 3 months (Walker & Greene, 1991) and 1 year (Walker, Garber, & Greene, 1994) following children’s medical evaluation for abdominal pain. Moreover, results of a diary study showed that the intraindividual relation between daily stressors and somatic symptoms was significantly stronger in abdominal pain patients than in well children (Walker, Smith, Garber, Van Slyke, & Claar, 2001). Investigation of pain patients’ subjective experience and behavioral responses to stress might shed light on the relation between stress and somatic symptoms observed in these patients. Theories of life stress emphasize that the manner in which individuals appraise and cope with stress determine the impact of stress on health (Lazarus & Folkman, 1984; Monroe & Kelly, 1995; Sandler, Wolchik, MacKinnon, Ayers, & Roosa, 1997). This perspective suggests that pediatric abdominal pain patients may differ from well children in the way that they appraise and cope with stress, and, moreover, their particular style of stress appraisal and coping may be associated with high levels of symptoms and disability. Accordingly, this study aimed to (a) examine stress appraisal and coping by pediatric abdominal pain patients in comparison to well children and (b) examine the relation of children’s appraisal and coping with daily stressors to their somatic and depressive symptoms and disability. Our specific predictions were based on the model of stress appraisal and coping advanced by Lazarus & Folkman (1984) (Folkman, Lazarus, Dunkel-Schetter, DeLongis, & Gruen, 1986), which asserts that individuals’ appraisals of stressor severity and their perceived coping potential predict the nature of the coping strategies they use when confronting a particular stressor. Those strategies, in turn, determine the impact of the stressor on their health (Lazarus & Folkman, 1984). Appraisals of coping potential can be differentiated into two major types: problem-focused coping potential (PFCP)—the perceived ability to alter the circumstances to make them more desirable—and emotion-focused coping potential (EFCP)—the perceived ability to handle or adjust to the circumstances, even if they cannot be improved (cf. Lazarus & Folkman, 1984; Smith & Lazarus, 1990; Walker, Smith, Garber, & Claar, 2005). We predicted that abdominal pain patients would appraise both their PFCP and EFCP as lower compared to well children. The particular combination of perceived PFCP and EFCP is thought to predict one’s response to a stressor (Folkman, 1984; Lazarus & Folkman, 1984; Walker et al., 2005), as shown in Fig. 1. Individuals who appraise their PFCP as high are hypothesized to engage in strategies aimed at improving their circumstances—strategies that have been referred to as active coping in some typologies (e.g., Brown & Nicassio, 1987; Walker, Smith, Garber, & Van Slyke, 1997). Individuals who appraise their PFCP as low, in contrast, are hypothesized to engage in either accommodative or passive coping, depending on whether they appraise their EFCP as high or low. If they appraise their EFCP as high, and thus believe that they can accept and adjust to their circumstances, they are expected to engage in accommodative coping strategies such as acceptance and positive reappraisal, which theoretically foster adaptation to unchangeable stressful circumstances (see Lazarus, 1991; Smith & Lazarus, 1990). Conversely, if they appraise their EFCP as low, and thus believe that they cannot adjust to unchangeable stressful circumstances, they are expected to engage in passive coping strategies characterized by negative cognitions and lack of active problem-solving efforts (e.g., Brown & Nicassio, 1987; Walker et al., 1997). Thus, we predicted that, in comparison to well children, pediatric abdominal pain patients would report more passive coping strategies and fewer active and accommodative coping strategies when dealing with daily stressors. Figure 1 Hypothesized relations of appraised problem-focused coping potential (PFCP) and emotion-focused coping potential (EFCP) to active, passive, and accommodative coping. We also examined the relation of children’s appraisal and coping with daily stressors to their symptoms and disability. We expected that appraisals of coping potential would predict the nature of coping strategies and that these strategies, in turn, would predict symptoms and disability. Thus, we hypothesized that coping strategies would mediate the relations between appraisals of coping potential and symptoms and disability. Specifically, we hypothesized that higher levels of passive coping, itself predicted by lower levels of both PFCP and EFCP, would be associated with greater functional disability and higher levels of somatic and depressive symptoms. In contrast, higher levels of active coping (itself predicted by higher levels of appraised PFCP) and higher levels of accommodative coping (itself predicted by higher levels of EFCP) would be associated with less disability and lower levels of somatic and depressive symptoms.

Case Study: Using a Virtual Reality Computer Game to Teach Fire Safety Skills to Children Diagnosed with Fetal Alcohol Syndrome

Abstract: Objective To assess the effectiveness of a computer-based virtual reality (VR) game in teaching five children diagnosed with fetal alcohol syndrome (FAS) fire safety skills and to generalize these skills to a real world simulation. Method Children participated in a study by using a multiple baseline, multiple probe design. Before the game, no child could correctly describe what actions to take during a home fire. A computerized game allowed them to learn the recommended safety steps in a virtual world. Skill learning and real-world generalization were tested immediately after the intervention and at 1-week post-test. Results All children reached 100% accuracy on the computer intervention, defined as successfully completing each of the safety steps. At the 1-week follow-up, all the children were able to perform the steps correctly in a real world simulation. Conclusions The results suggest that this method of intervention warrants further study as an educational delivery system for children with FAS.

Current Measures of PTSD for Children and Adolescents

Abstract: Objective To review measures of posttraumatic stress disorder (PTSD) and posttraumatic stress symptoms (PSS) for children and adolescents. Methods We reviewed broad-based child mental health journals within the disciplines of pediatrics, child psychology, and trauma, from 1995 to 2004, to identify measures of PTSD and PSS for children and adolescents. The review includes a summary of the psychometric properties and associated features of the measures and the clinical domains and types of studies using each measure. Results Seven measures of PTSD and PSS were identified, including clinician-administered interviews and self-report questionnaires. Sixty-five articles containing the measures were categorized into eight trauma domains. We found there is little consensus over measures used within each trauma domain. Conclusions Few measures of PTSD and PSS have been designed specifically for young people. Further directions for measurement of PTSD in this age group are discussed to prevent under-diagnosis and under-treatment for youth.