Showing papers in "Journal of Pediatric Psychology in 2007"
TL;DR: Future research must use conceptually based outcome measures in prospective, longitudinal, and community-based studies to determine which pharmacologic, behavioral, and educational interventions can improve academic and educational outcomes of children with ADHD.
Abstract: Attention-deficit/hyperactivity disorder (ADHD) is associated with poor grades, poor reading and math standardized test scores, and increased grade retention. ADHD is also associated with increased use of school-based services, increased rates of detention and expulsion, and ultimately with relatively low rates of high school graduation and postsecondary education. Children in community samples who show symptoms of inattention, hyperactivity, and impulsivity with or without formal diagnoses of ADHD also show poor academic and educational outcomes. Pharmacologic treatment and behavior management are associated with reduction of the core symptoms of ADHD and increased academic productivity, but not with improved standardized test scores or ultimate educational attainment. Future research must use conceptually based outcome measures in prospective, longitudinal, and community-based studies to determine which pharmacologic, behavioral, and educational interventions can improve academic and educational outcomes of children with ADHD.
937 citations
TL;DR: An evidence-based overview of attention-deficit/hyperactivity disorder (ADHD), including diagnosis, prevalence, developmental expression of symptoms, persistence, the heterogeneity of functional outcome, impairment in afflicted adults, psychiatric comorbidity, pathophysiology, genetics, psychosocial and biologic risk factors, and neurobiology is provided.
Abstract: In this report, we provide an evidence-based overview of attention-deficit/hyperactivity disorder (ADHD), including diagnosis, prevalence, developmental expression of symptoms, persistence, the heterogeneity of functional outcome, impairment in afflicted adults, psychiatric comorbidity, pathophysiology, genetics, psychosocial and biologic risk factors, and neurobiology. Attention-deficit/hyperactivity disorder is an early-onset, highly prevalent neurobehavioral disorder, with genetic, environmental, and biologic etiologies, that persists into adolescence and adulthood in a sizable majority of afflicted children of both sexes. It is characterized by behavioral symptoms of inattention, hyperactivity, and impulsivity across the life cycle and is associated with considerable morbidity and disability. Comorbidity is a distinct clinical feature of both childhood and adult ADHD. Although its etiology remains unclear, emerging evidence documents its strong neurobiologic and genetic underpinnings. Despite the high diagnostic reliability and the robust evidence of the validity of ADHD, there are many underlying issues that remain to be resolved. These include establishing developmentally appropriate diagnostic criteria at older ages, further elaborating the impact of gender on symptom expression, and examining risk and protective factors in relationship to prevention or amelioration of ADHD as well as related functional impairments.
685 citations
TL;DR: Researchers, clinicians, and health educators might use this measure to better understand how parents feed their children, the factors that contribute to these practices, and the implications of these practices on children's eating behaviors.
Abstract: Objective Measures of parents’ feeding practices have focused primarily on parental control of feeding and have not sufficiently measured other potentially important practices. The current study validates a new measure of feeding practices, the Comprehensive Feeding Practices Questionnaire (CFPQ). Method The first study validated a 9-factor feeding practice scale for mothers and fathers. In the second study, open-ended questions solicited feeding practices from parents to develop a more comprehensive measure of parental feeding. The third study validated an expanded 12-factor feeding practices measure with mothers of children from 2 to 8 years of age. Results The CFPQ appears to be an adequate tool for measuring the feeding practices of parents of young children. Conclusions Researchers, clinicians, and health educators might use this measure to better understand how parents feed their children, the factors that contribute to these practices, and the implications of these practices on children’s eating behaviors.
607 citations
TL;DR: Given the limited improvement typically obtained in treatment studies that use peer report measures as outcomes with ADHD samples and the well-documented predictive validity of peer reports for later adjustment, the need for more intensive interventions and novel approaches to address the peer problems of children with ADHD is emphasized.
Abstract: This article describes what is currently known about the peer relationships of children with attention-deficit/hyperactivity disorder (ADHD). This topic is addressed both from the perspective of how ADHD initially contributes to problematic relationships with peers, and also from the perspective of how peers' reactions to these problems may serve to maintain them. Given the limited improvement typically obtained in treatment studies that use peer report measures as outcomes with ADHD samples and the well-documented predictive validity of peer reports for later adjustment, the need for more intensive interventions and novel approaches to address the peer problems of children with ADHD is emphasized.
512 citations
TL;DR: The review of published literature identified 13 studies, most conducted on existing databases by using diagnostic and medical procedure codes and focused on health care costs, which estimated annual COI of ADHD in children and adolescents at $14,576 per individual (2005 dollars).
Abstract: Using a cost of illness (COI) framework, this article examines the economic impact of attention-deficit/ hyperactivity disorder (ADHD) in childhood and adolescence. Our review of published literature identified 13 studies, most conducted on existing databases by using diagnostic and medical procedure codes and focused on health care costs. Two were longitudinal studies of identified children with ADHD followed into adolescence. Costs were examined for ADHD treatment-related and other health care costs (all but 1 study addressed some aspect of health care), education (special education, 2 studies; disciplinary costs: 1 study), parental work loss (2 studies), and juvenile justice (2 studies). Based on this small and as yet incomplete evidence base, we estimated annual COI of ADHD in children and adolescents at $14,576 per individual (2005 dollars). Given the variability of estimates across studies on which that number is based, a reasonable range is between $12,005 and $17,458 per individual. Using a prevalence rate of 5%, a conservative estimate of the annual societal COI for ADHD in childhood and adolescence is $42.5 billion, with a range between $36 billion and $52.4 billion. Estimates are preliminary because the literature is incomplete; many potential costs have not been assessed in extant studies. Limitations of the review and suggestions for future research on COI of ADHD are provided.
331 citations
TL;DR: Research should cross manifold levels of causation so that programs will be more effective at promoting adolescents' adoption and maintenance of STD/HIV preventive behaviors, and has been implemented in Brazil and was shown to be effective.
Abstract: Objective Behavioral intervention programs to reduce adolescent sexual risk behaviors have shown statistically significant reductions in the short-term; however, longer-term follow-up has demonstrated that effects diminish. One criticism has been the reliance on individual-level models. We review the research that has shaped this narrow perspective and propose that a broader, ecological perspective is needed to amplify and extend the efficacy of sexual risk reduction interventions. Methods We summarize adolescent sexual risk research and outline intervention research that is suggestive of an ecological perspective. Examples from the published literature that have investigated antecedents or conceptualized preventive interventions using a multilevel approach are provided. Results Adolescents are exposed to diverse sources of influence transecting different levels of causation. To adequately prevent, reduce, and maintain the likelihood of adolescents’ adopting sexual risk behaviors, intervention programs should be designed to address these myriad levels of causation. This approach has been implemented in Brazil and was shown to be effective. Conclusion Research should cross manifold levels of causation so that programs will be more effective at promoting adolescents’ adoption and maintenance of STD/HIV preventive behaviors.
271 citations
TL;DR: Close parental monitoring of care completion can contribute to better adherence in adolescents with diabetes, and general warmth and support in the absence of careful parental supervision may be insufficient to help youth achieve adequate levels of adherence.
Abstract: Objective To determine if parental monitoring of adolescent behavior was related to regimen adherence and metabolic control among adolescents with type 1 diabetes. An additional objective was to compare the relative importance of instrumental parenting behaviors such as monitoring to affective behaviors such as parental support as predictors of regimen adherence. Method Ninety-nine adolescents aged 12-18 years and their primary caregiver completed self-report questionnaires. Path analysis was used to test a model where diabetes-specific parental monitoring and support were predicted to have direct effects on regimen adherence and indirect effects on metabolic control via regimen adherence and an alternative model where parental support moderated the effects of monitoring on adherence. Results Diabetes-specific, but not general, monitoring was found to be associated with regimen adherence based on both parent and youth report. Monitoring had an indirect effect on metabolic control through regimen adherence. Although adolescent-reported parental support was significantly associated with regimen adherence in bivariate analyses, multivariate analyses indicated that parental support was not a significant independent predictor of health outcomes when parental monitoring was considered simultaneously. Modest support was also found for parental support as a moderator of the relationship between monitoring and adherence. Conclusions Close parental monitoring of care completion can contribute to better adherence in adolescents with diabetes. General warmth and support in the absence of careful parental supervision may be insufficient to help youth achieve adequate levels of adherence.
237 citations
TL;DR: Although the groups did not differ in self-reported sleep habits, multiple concerns were reported by parents of overweight participants, including daytime sleepiness, parasomnias, and inadequate sleep.
Abstract: Objective To document the sleep of overweight adolescents and to explore the degree to which weight-related sleep pathology might account for diminished psychosocial outcome. Methods Sixty children aged 10–16.9 from a weight-management clinic were compared to 22 healthy controls using comprehensive actigraphic, polysomnographic, and parentand self-report questionnaire assessments. Results Overweight participants averaged more symptoms of sleep-disordered breathing, later sleep onset, shorter sleep time, and more disrupted sleep than controls. Although the groups did not differ in self-reported sleep habits, multiple concerns were reported by parents of overweight participants, including daytime sleepiness, parasomnias, and inadequate sleep. Group differences in academic grades and depressive symptoms were at least partially accounted for by short sleep and daytime sleepiness. Conclusions Excessive weight is associated with an increased risk of sleep problems. There is a need for further research in this area and for clinicians who work with overweight children to evaluate their sleep.
214 citations
TL;DR: Bridging the gap between these literatures should provide further insights into the etiologies of these disorders, increase symptom detection, and improve the clinical care of children and their families.
Abstract: Objective To review and critically evaluate the association between sleep, anxiety, and depression in children and provide recommendations for future research. Methods A literature search was conducted using MEDLINE and PsychINFO computerized databases and bibliographies of relevant articles. Results A surprisingly small but growing research base exists on the relation between sleep disturbance, anxiety, and depression in pediatric populations. Existing research indicates a significant symptom overlap between anxiety, depression, and sleep. This overlap may complicate proper assessment and treatment of children with these disorders. Conclusions Future research should ensure adequate assessment for symptoms of anxiety and depression when examining sleep disturbance in children. Likewise, research on anxiety and depression should include assessment for symptoms of disturbed sleep. Bridging the gap between these literatures should provide further insights into the etiologies of these disorders, increase symptom detection, and improve the clinical care of children and their families.
204 citations
TL;DR: Overweight, treatment-seeking adolescents with BED are clearly distinguishable from teens without the disorder on measures of eating-related psychopathology, mood, and anxiety.
Abstract: Binge eating disorder (BED), a provisional diagnostic category in DSM-IV-TR (American Psychiatric Association [APA], 2000), is characterized by recurrent binge eating episodes in the absence of inappropriate compensatory behaviors and is often associated with obesity (de Zwaan et al., 1994). When compared with non-binge-eating adults, those with BED suffer from greater eating-disordered cognitions (Crow, Stewart Agras, Halmi, Mitchell, & Kraemer, 2002; Masheb & Grilo, 2000; Striegel-Moore et al., 2001; Wilfley, Schwartz, Spurrell, & Fairburn, 2000), increased general psychopathology (Mussell et al., 1996; Wilfley, Friedman, et al., 2000; Yanovski, Nelson, Dubbert, & Spitzer, 1993), and more health problems (Johnson, Spitzer, & Williams, 2001; de Zwaan et al., 2002).
The DSM-IV-TR description of BED identifies frequency and duration criteria that must be met to receive a diagnosis. The frequency criterion is binge eating (eating an objectively large quantity of food during which a loss of control [LOC] is experienced) on average at least twice per week; the duration criterion is that binge eating occurs consistently over a 6-month period (APA, 2000). However, there are few data demonstrating these thresholds identify the majority of individuals having significant difficulties with binge eating. Investigations comparing adults with BED to those with subthreshold BED (characterized by recurrent episodes of binge eating with an average frequency of once per week during the past 6 months) have found few differences between groups on measures of psychiatric distress, body weight, dieting, weight history, or body image disturbance (Striegel-Moore et al., 2000; Striegel-Moore, Wilson, Wilfley, Elder, & Brownell, 1998). A study employing an even less stringent frequency criterion for subthresh-old BED (binge eating at least once per month during the past 6 months) also found few differences on measures of eating-related and general psychopathology between women with diagnostic and subthreshold BED (Crow et al., 2002). These data suggest that binge eating, even at lower frequencies, is a clinically significant problem. Moreover, the significance of objectively large overeating as an important characteristic of BED in adults has been questioned, suggesting that the experience of LOC may be the most salient factor associated with emotional distress (Niego, Pratt, & Agras, 1997; Pratt, Niego, & Agras, 1998).
Although few adolescents meet the criteria for full-syndrome BED (Johnson, Grieve, Adams, & Sandy, 1999; Stice, Killen, Hayward, & Taylor, 1998; Stice, Presnell, & Bearman, 2001), the prevalence of sub-threshold binge eating, particularly among overweight adolescents, appears to be substantial (Johnson, Rohan, & Kirk, 2002), with estimates ranging from 20% (Isnard et al., 2003) to ~30% (Decaluwe, Braet, & Fairburn, 2003) in weight loss treatment-seeking samples. Consistent with the adult literature (Striegel-Moore et al., 1998, 2000), studies in adolescents seeking weight loss treatment have found that those who report subthresh-old binge eating have greater eating-related distress and depressive symptomatology than those who do not report any binge eating (Berkowitz, Stunkard, & Stallings, 1993; Decaluwe et al., 2003; Isnard et al., 2003; Johnson et al., 1999). Nevertheless, the implications of sub-threshold binge eating as compared with full-syndrome BED in adolescents are unclear. In a community sample of 10- to 18-year-olds, Johnson et al. (1999) found that children meeting full diagnostic criteria for BED by questionnaire reported significantly more depressive symptomatology and greater disturbed eating-related cognitions than children describing subthreshold binge eating. By contrast, another study of middle and high school students with BED and subthreshold BED found no substantial differences in depressed mood, self-esteem, or body dissatisfaction (Ackard, Neumark-Sztainer, Story, & Perry, 2003). Although full-syndrome BED in childhood is rare, children reporting LOC episodes regardless of the amount of food eaten have greater adiposity and psychological distress than those with no LOC episodes (Morgan et al., 2002; Tanofsky-Kraff et al., 2004). In a study using structured clinical interviews, overweight children (6–13 years) who endorsed experiencing as few as one episode of LOC eating in their lifetime reported greater eating-disordered and general psychopathology compared with overweight children who reported no such episodes (Tanofsky-Kraff, Faden, Yanovski, Wilfley, & Yanovski, 2005).
A notable limitation of most prior studies examining binge eating among adolescents is the lack of interview methodology to assess eating-disordered behaviors and cognitions (Ackard et al., 2003; Decaluwe et al., 2003; Isnard et al., 2003; Johnson et al., 1999; Morgan et al., 2002). To investigate the potential association of frequency and recency of binge eating episodes with eating-related cognitions and general psychopathology, we used an interview method to assess eating-disordered pathology in a cohort of overweight, treatment-seeking adolescents. We posited that the frequency and recency of binge eating would be related to higher levels of depressive and anxious symptomatology. Specifically, we hypothesized that (a) teens meeting DSM-IV-TR criteria for BED (high frequency and high recency) would report the highest levels of eating-related and general psychopathology and that (b) participants endorsing recent subthreshold binge eating in the 3 months before assessment (low frequency but high recency) would report more emotional disturbance than adolescents who reportedly had never experienced binge or LOC eating. Given the findings of Tanofsky-Kraff et al. (2005), we also expected adolescents who reported the experience of LOC eating ever in the past (low frequency and low recency) would report higher levels of eating-related, depressive and anxious symptomatology than adolescents who reportedly had never experienced binge or LOC eating.
202 citations
TL;DR: In both cross-sectional and longitudinal analyses, multilevel modeling showed that shared responsibility was consistently associated with better psychological health, good self-care behavior, and good metabolic control, whereas child and parent responsibility were not.
Abstract: Objective To examine the relation of adolescent and parent responsibility distribution for diabetes self-care to psychological and physical health. Methods We interviewed children (mean age 12 years) annually for 3 years and asked parents to complete a questionnaire. Both reported how diabetes self-care was distributed in the family. Amount of responsibility held by the child only, the parent only, and shared between child and parent was calculated. Psychological distress, competence, and diabetes outcomes were assessed at each wave. Results In both cross-sectional and longitudinal (lagged) analyses, multilevel modeling showed that shared responsibility was consistently associated with better psychological health, good self-care behavior, and good metabolic control, whereas child and parent responsibility were not. In some cases, links of shared responsibility to health outcomes were stronger among older adolescents. Conclusions These findings highlight the importance of shared responsibility for diabetes self-care through early to middle adolescence.
TL;DR: Perceived physical environmental factors indirectly influenced self-reported physical activity, and perceived social environmental factors both directly and indirectly influencedSelf- reported physical activity in this sample of older adolescent girls was influenced by both parental education and body mass index.
Abstract: Objective This cross-sectional study examined the direct and indirect effects of perceived equipment accessibility, neighborhood safety, and social support on self-reported physical activity among older adolescent girls. Methods Adolescent girls (n = 1,655) who were in the 12th grade completed a battery of questionnaires that included self-report measures of the perceived physical environment, social support, barriers self-efficacy, and physical activity. Results Perceived neighborhood safety did not exhibit direct or indirect effects on self-reported physical activity. Perceived equipment accessibility exhibited an indirect effect on self-reported physical activity that was accounted for by barriers self-efficacy. Perceived social support exhibited direct and indirect effects on self-reported physical activity; the indirect effect was accounted for by barriers self-efficacy. The relationships were independent of parental education and body mass index (BMI). Conclusions Perceived physical environmental factors indirectly influenced self-reported physical activity, and perceived social environmental factors both directly and indirectly influenced self-reported physical activity in this sample of older adolescent girls.
TL;DR: Self-reports and observations provide complementary information on how parents interact with their overweight children and family-based treatment programs should include discussions on the adequate amount of parental control and support.
Abstract: Objective To examine differences between families of children with and without overweight on parental control and support. Methods Twenty-eight families with an overweight child and a control group of 28 families with a normal weight child (age range 7–13 years) participated in the study. Observations and self-reports of mealtime family functioning were administered and analyzed. Results Parents of children with overweight reported to exert more control on their children’s feeding behavior and an equal amount of parental support in comparison with parents of children without overweight. However, observations at mealtime indicated that in families with an overweight child, maladaptive control strategies were twice as prevalent, and less parental support was displayed. Conclusions Self-reports and observations provide complementary information on how parents interact with their overweight children. Familybased treatment programs should include discussions on the adequate amount of parental control and support.
TL;DR: In this paper, the translation of psychological research into clinical services in pediatric oncology, based on two decades of research and clinical services at The Children's Hospital of Philadelphia (CHOP), is described.
Abstract: Objective This paper describes the translation of psychological research into clinical services in pediatric oncology, based on two decades of research and clinical services in the Division of Oncology at The Children’s Hospital of Philadelphia (CHOP). Method Two models helpful in conceptualizing clinical care underlying intervention work at CHOP are summarized: The Pediatric Psychosocial Preventative Health Model (PPPHM; Kazak, 2006) and the Medical Traumatic Stress Model, specific to pediatric illness and injury (Kazak, Kassam-Adams et al., 2006). Results Integration of these two models offers a ‘‘blueprint’’ for development and evaluation of services to children with cancer and their families relevant for all families across the complete spectrum of disease and treatment. Conclusion The dissemination of evidence-based psychosocial practice in pediatric oncology remains a large and challenging goal. The proposed blueprint may facilitate collaborative work to help assure that children with cancer and their families have access to evidence-based care.
TL;DR: These findings highlight considerable resilience among mothers facing the stress of childhood cancer and suggest intervention efforts aimed at reducing maternal distress might best be targeted towards the subgroup of mothers who may be predicted to exhibit the highest level of distress.
Abstract: Objectives The objectives of this study were (a) to assess negative affectivity and posttraumatic symptomatology in mothers following the diagnosis of cancer in their children; (b) to examine sociodemographic and psychosocial variables associated with change in distress over time; and (c) to identify distinct subgroups of mothers whose patterns and trajectories of adjustment can be distinguished according to available predictor data. Methods Two hundred and twelve mothers at seven sites were assessed just following their child's diagnosis, and again 3 months and 6 months later. Primary outcomes included measures of mood disturbance, depressive symptoms, and symptoms of posttraumatic stress. Results Overall, mothers demonstrated a pattern of mildly elevated negative affectivity and posttraumatic symptomatology initially, with steady improvements evident at 3- and 6-month follow-up. Distinct adjustment trajectories were evident within the sample as a whole, indicating subgroups of mothers with high-declining, moderate-stable, and low-stable distress levels. Conclusions These findings highlight considerable resilience among mothers facing the stress of childhood cancer. Intervention efforts aimed at reducing maternal distress might best be targeted towards the subgroup of mothers who may be predicted to exhibit the highest level of distress.
TL;DR: In this article, the authors examined risky driving behaviors and negative driving outcomes in a large sample of adolescents and adults diagnosed in childhood with Attention Deficit Hyperactivity Disorder (ADHD) compared with demographically similar controls without ADHD.
Abstract: OBJECTIVE: To examine risky driving behaviors and negative driving outcomes in a large sample of adolescents and adults diagnosed in childhood with Attention Deficit Hyperactivity Disorder (ADHD) compared with demographically similar controls without ADHD. METHODS: 355 adolescents and young adults of the Pittsburgh ADHD Longitudinal Study (PALS) (n = 203 probands; n = 152 controls) were administered the Young Adult Driving Questionnaire. Parent and self-report of current ADHD symptoms and conduct problems were tested as potential mediators of the association between childhood ADHD and negative driving outcomes. RESULTS: ADHD group differences, of small to medium effect size, were found for number of tickets and accidents, and hyperactivity-impulsivity at follow-up emerged as a significant mediator of this association. Current conduct problems were associated with both risky and alcohol-impaired driving. CONCLUSIONS: Childhood ADHD elevates risk for driving-related problems, especially when symptoms persist. Co-occurring conduct problems capture some of this risk. Language: en
TL;DR: Caregiver stress, child mealtime behaviors, weight, and caloric intake improved significantly following treatment in the intensive feeding program, regardless of category placement.
Abstract: Objective This study investigated the impact of an intensive interdisciplinary feeding program on caregiver stress and child outcomes of children with feeding disorders across three categories. Methods Children were categorized into either tube dependent, liquid dependent, or food selective groups. Outcomes for caregiver stress levels, child mealtime behaviors, weight, and calories were examined at admission and discharge for 121 children. Repeated measures ANOVAs were used to examine differences pre- and posttreatment and across feeding categories. Results Caregiver stress, child mealtime behaviors, weight, and caloric intake improved significantly following treatment in the intensive feeding program, regardless of category placement. Conclusions Few studies have examined the impact of an intensive interdisciplinary approach on caregiver stress, as well as on child outcome variables with such a diverse population. This study provides support that regardless of a child’s medical and feeding history, an intensive interdisciplinary approach significantly improves caregiver stress and child outcomes.
TL;DR: The evidence supports including pediatric patients' perspectives in clinical trials when the child is willing and able to provide their perspective, and Parent proxy-report is recommended when pediatric patients are too young, too cognitively impaired, too ill or fatigued to complete a HRQOL instrument.
Abstract: pediatric oncology. Results Data demonstrate that children as young as 5 years of age can reliably and validly self-report their HRQOL when an age-appropriate instrument is utilized. Conclusions The evidence supports including pediatric patients’ perspectives in clinical trials. Parent proxy-report is recommended when pediatric patients are too young, too cognitively impaired, too ill or fatigued to complete a HRQOL instrument, but not as a substitute for child self-report when the child is willing and able to provide their perspective.
TL;DR: Declining IQ and academic struggles may be predated by difficulties with attention, memory, and processing speed in medulloblastoma survivors.
Abstract: Objective Risk-adapted treatment approaches employed within contemporary medulloblastoma treatment protocols aim to reduce the neurotoxicity directed at the central nervous system. Despite these important steps to reduce radiation dose exposure, an overwhelming majority of medulloblastoma survivors continue to experience academic failure and significant learning delays. Methods A review of the current literature is presented. Results Deficits in intellectual function, academic achievement, memory, attention, and processing speed are reported. Finally, intervention programs, including pharmacotherapy and experimental cognitive intervention studies, are discussed. A review of neuroimaging studies shows changes in brain tissue following chemotherapy and radiation treatment. Conclusions Declining IQ and academic struggles may be predated by difficulties with attention, memory, and processing speed. More clinical trials directed at treating and preventing neurocognitive late effects through cognitive rehabilitation are needed.
TL;DR: Treatment research in the future should explicitly consider the exploration of moderator and mediator variables, which can greatly aid the explanatory power of clinical trials and specify the critical next steps for intervention research.
Abstract: Objective To present data on moderators and mediators of treatment response from the Multimodal Treatment Study of Children With ADHD (MTA). Methods Moderator variables (baseline factors that define subgroups with greater vs lesser intervention response) and mediator variables (factors occurring during treatment that explain how interventions ‘‘work’’) are described with specific application to the outcomes of the MTA Study. Results Key moderator variables (comorbid anxiety disorder, public assistance, severity of attention-deficit/hyperactivity disorder, parental depressive symptomatology, IQ) and mediator processes (negative/ineffective parental discipline) are reviewed. Conclusions Treatment research in the future should explicitly consider the exploration of moderator and mediator variables, which can greatly aid the explanatory power of clinical trials and specify the critical next steps for intervention research.
TL;DR: The adaptive style paradigm is described as a heuristic model for understanding the very positive psychosocial adjustment that has been observed in children with cancer, and to integrate findings regarding repressive adaptive style into a broader positive psychology framework.
Abstract: psychosocial adjustment that has been observed in children with cancer, and to integrate findings regarding repressive adaptive style into a broader positive psychology framework. Method A selective review of the literature on adaptive style, and its’ relevance to outcomes of depressive symptoms, posttraumatic stress symptoms, somatic distress, and health-related quality of life in children with cancer. Results Studies have found children with cancer report low levels of psychological distress. Adaptive style is a much stronger predictor of psychosocial outcomes than is health history. Conclusion Children with cancer represent a flourishing population. A repressive adaptive style is one pathway to resilience in this population. Additional constructs from the domain of positive psychology are reviewed, and a positive psychology model is suggested as a framework for guiding future research in this area.
TL;DR: There is a dearth of studies examining the association between lone parenting and psychosocial functioning among children and adolescents with chronic illnesses.
Abstract: We have attempted to underscore the critical need to conduct long needed research among children with chronic illnesses within the context of the changing family demography in this country. Research should encompass the various types of families that exist in our society, including those families that are headed by single parents. It clearly is not possible within the space limitations to delineate all research possibilities. Rather, our plan was to identify some of the more significant gaps in this important and heretofore neglected area of inquiry. We hope that we have stimulated investigators to consider this issue either as part of their existing research programs or as a new area of inquiry.
TL;DR: Treating both tic and nontic-related impairments concurrently may improve functioning more so than treating the symptoms separately.
Abstract: Objective Tourette's Syndrome (TS) during childhood is linked to varied behavioral and psychological difficulties and functional impairment. The current study was undertaken to examine both tic-related impairment and impairment from other psychological problems in 59 youth (mean age 11.4 years, 69% male) with TS. Methods Caretakers completed a checklist about the impact of tics and other psychological difficulties on family, school, and social functioning. In addition, a clinician administered a measure of tic severity to families. Results Over half of the sample reported one significant problem area due to the presence of tics, with over a third reporting two or more problem areas. Problems were heterogeneous in nature, with no report of a particular problem area in more than 25% of the children. The rate of nontic-related impairment was very high, with 70% of parents reporting at least one problem area. Conclusions Treating both tic and nontic-related impairments concurrently may improve functioning more so than treating the symptoms separately.
TL;DR: The PMBS and AMBS are brief and psychometrically promising scales for assessing perceived barriers to adherence in adolescent transplant recipients.
Abstract: Objective To create Parent and Adolescent Medication Barriers Scales (PMBS and AMBS) for assessing perceived barriers to medication adherence in adolescent transplant recipients. Methods These scales were developed and initially validated with 78 families. Participants responded to questions concerning perceived barriers to medication adherence. To assess validity, data on contextual factors (e.g., family functioning) and adherence measures were collected. Results A principal components factor analysis resulted in the following subscales for the PMBS and AMBS: (a) Disease Frustration/Adolescent Issues, (b) Regimen Adaptation/Cognitive Issues, (c) Ingestion Issues, and (d) Parent Reminder (PMBS only). Significant associations were found between barrier scale scores, contextual factors, and adherence. Conclusions The PMBS and AMBS are brief and psychometrically promising scales for assessing perceived barriers to adherence in adolescent transplant recipients.
TL;DR: How influential friends were in determining one's body image was a unique predictor of body dissatisfaction but only for the overweight and at risk of overweight group.
Abstract: Objective The goal of this study was to evaluate peer-related influences on appearance, body dissatisfaction, eating disturbance, and self-esteem in average weight, at risk of overweight, and overweight adolescent girls. Methods Three hundred twenty-five adolescent girls from high schools in Florida were assessed. Ninety met criteria for being at risk of overweight or overweight. Logistic and multiple regression analyses were used to evaluate group differences on all variables and to assess the amount of variance accounted for by peer-influence variables in the prediction of body dissatisfaction, eating disturbance, and self-esteem. Results Overweight and at risk of overweight girls scored higher than average weight girls on body dissatisfaction, dieting, and a peer measure that assessed negative comments and attributions about appearance. They also scored lower than average weight girls on self-report measures that assessed conversations about appearance and anti-dieting advice. How influential friends were in determining one’s body image was a unique predictor of body dissatisfaction but only for the overweight and at risk of overweight group. Conclusions Possible implications for clinical intervention programs are discussed along with directions for future research.
TL;DR: Specific parenting variables are associated with youth-reported illness uncertainty; however, their relationship varies according to developmental level.
Abstract: Objective To examine the relationship of parent-reported overprotection (OP), perceived child vulnerability (PCV), and parenting stress (PS) to youth-reported illness uncertainty, and to explore potential developmental differences. Method Eighty-two children and 82 adolescents (n ¼164) diagnosed with Type 1 diabetes mellitus (DM1) or asthma, completed a measure of illness uncertainty, while their parents completed measures of OP, PCV, and PS. Results After controlling for demographic and illness parameters, both PCV and PS significantly predicted youth illness uncertainty in the combined sample. Within the child group, only PS significantly predicted illness uncertainty, whereas only PCV significantly predicted uncertainty for adolescents. Conclusion Specific parenting variables are associated with youth-reported illness uncertainty; however, their relationship varies according to developmental level. Although OP has been identified as a predictor of child psychological outcomes in other studies, it does not appear to be associated with illness uncertainty in youth with DM1 or asthma.
TL;DR: Parents of youth with chronic illnesses experience sleep disruptions, providing a potential mechanism to explain elevated rates of negative daytime functioning found in previous studies.
Abstract: Objective Provide a comprehensive review of the existing literature on the prevalence, causes, and consequences of sleep disruptions in parents of youth with chronic illnesses. Methods A comprehensive literature search of PsychInfo, MEDLINE, and CINAHL for articles related to sleep in parents of youth with chronic illnesses yielded 59 potential articles, with 19 meeting inclusion criteria. Results Parents of children with eczema were the most commonly studied group. The prevalence of sleep disruptions was 15–86%. Potential causes of parent sleep disruptions included nighttime caregiving, monitoring of the child’s illness, and stress related to the child’s illness. Consequences included poor sleep quality, depression, and anxiety. Conclusions Parents of youth with chronic illnesses experience sleep disruptions, providing a potential mechanism to explain elevated rates of negative daytime functioning found in previous studies. To provide interventions and support for these parents, additional research is needed to address the limitations of the existing literature.
TL;DR: A developmental model is proposed based on the synthesis of the extant literature and previous theoretical perspectives of FSS in children and adolescents to provide a new approach for conceptualizing and studying functional somatic symptoms inChildren and adolescence.
Abstract: Objective To provide a new approach for conceptualizing and studying functional somatic symptoms (FSS) in children and adolescence. Methods A developmental model is proposed based on the synthesis of the extant literature and previous theoretical perspectives of FSS in children and adolescents. Results Multiple risk and protective factors from child, familial, social, and environmental domains, the interactions across risk domains, and potential developmental pathways of FSS are identified. Conclusions This article underscores the necessity of taking a broader, developmental view of FSS. The tenets of developmental psychopathology emphasize the utility of viewing FSS on a continuum of severity rather than as a discrete entity or diagnosis. This article concludes with directions for future research and treatment implications.
TL;DR: The association between retrospectively reported attention deficit hyperactivity disorder (ADHD) symptoms and progression to smoking and the association with nicotine dependence and the development of prevention and treatment modalities are examined.
Abstract: Objective To examine the association between retrospectively reported attention deficit hyperactivity disorder (ADHD) symptoms and progression to smoking and the association with nicotine dependence. Methods Study sample consisted of a nationally representative cohort of U.S. adolescents (n ¼ 13,494). Logistic regression was used to examine ADHD symptoms from both the inattentive (IN) and hyperactive-impulsive (HI) domains and smoking trajectories. Linear regression was used to examine nicotine dependence. Results HI symptoms were associated with progression from nonsmoking to regular smoking (OR ¼ 1.14, 95% CI ¼ 1.07–1.21), and with progression from experimentation to regular smoking (OR ¼ 1.16, 95% CI ¼ 1.08–1.26). IN and HI symptoms were associated with nicotine dependence among current smokers (IN: b ¼ 0.17, SE ¼ 0.03, p < 0.0001; HI: b ¼ 0.10, SE ¼ 0.04., p < .001). Conclusions These results have important implications for the development of prevention and treatment modalities.
TL;DR: The majority of internationally adopted children form secure attachment relationships and function at normative developmental levels shortly after adoption, and temporary residence in a foster home in the country of origin before adoption is related to higher MDI and PDI, whereas disorganized attachment in the adoptive family was related to lower MDI
Abstract: Objective To examine infant attachment and developmental functioning shortly after international adoption. Methods At 14 months, infant–mother attachment and mental (MDI) and psychomotor (PDI) development were assessed in 70 internationally adopted children. Mean age at arrival was 5.5 months, mean stay in the adoptive family 8.7 months. Results Adopted children’s MDI and PDI did not deviate from normative scores. Also, their secure–insecure attachment distribution was comparable with that of normative groups. However, more adoptees were disorganized attached (36 vs. 15% in normative groups). Temporary residence in a foster home in the country of origin before adoption was related to higher MDI and PDI, whereas disorganized attachment in the adoptive family was related to lower MDI and PDI scores. Conclusions The majority of internationally adopted children form secure attachment relationships and function at normative developmental levels shortly after adoption. Residence in a foster family before adoption may partly prevent developmental delays.