Showing papers in "Journal of Pediatric Psychology in 2010"

Long-term Physical Health Consequences of Childhood Sexual Abuse: A Meta-Analytic Review

Abstract: Objective The purpose of the present article was to systematically review the literature investigating the long-term physical health consequences of childhood sexual abuse (CSA). Methods Literature searches yielded 31 studies comparing individuals with and without a history of CSA on six health outcomes: general health, gastrointestinal (GI) health, gynecologic or reproductive health, pain, cardiopulmonary symptoms, and obesity. Exploratory subgroup analyses were conducted to identify potential methodological moderators. Results Results suggested that a history of CSA was associated with small to moderate group differences on almost all health outcomes assessed, such that individuals with a history of CSA reported more complaints for each health outcome. Suggestive trends in moderating variables of study design and methodology are presented. Conclusions Results highlight the long-term physical health consequences of CSA and identify potential moderators to aid in the design of future research.

History of Maltreatment and Mental Health Problems in Foster Children: A Review of the Literature

Abstract: Objective Foster children often experience compromising situations such as neglect, physical abuse, or sexual abuse before out-of-home placement. This article aims to give a literature review related to the development and mental health of foster children with special consideration of trauma history. Methods A computer-based literature search was conducted in the databases Medline, PsycINFO, PSYNDEXplus, and SCOPUS. We determined a time frame from 1998 to 2009. Results The literature search resulted in 32 articles reporting empirical data about development and mental health in foster children. Very high rates of exposure to maltreatment, developmental delays and mental disorders were found. A broad spectrum of externalizing as well as internalizing symptoms and a high prevalence of comorbid mental disorders were found. Conclusions Foster children exhibit a broad pattern of developmental problems and psychopathology. The etiology of these disorders is discussed in the context of multiple risk factors, especially that of persistent maltreatment.

Co-occurrence of Victimization from Five Subtypes of Bullying: Physical, Verbal, Social Exclusion, Spreading Rumors, and Cyber

Abstract: Objective To examine co-occurrence of five subtypes of peer victimization. Methods Data were obtained from a national sample of 7,475 US adolescents in grades 6 through 10 in the 2005/2006 Health Behavior in School-Aged Children (HBSC) study. Latent class analyses (LCA) were conducted on victimization by physical, verbal, social exclusion, spreading rumors, and cyber bullying. Results Three latent classes were identified, including an all-types victims class (9.7% of males and 6.2% of females), a verbal/ relational victims class (28.1% of males and 35.1% of females), and a nonvictim class (62.2% of males and 58.7% of females). Males were more likely to be all-type victims. There was a graded relationship between the three latent classes and level of depression, frequency of medically attended injuries, and medicine use, especially among females. Conclusions Increased co-occurrence of victimization types put adolescents at greater risks for poorer physical and psychological outcomes.

A Meta-analytic Review of the Psychosocial Adjustment of Youth with Inflammatory Bowel Disease

Abstract: Objective To conduct a meta-analytic review of psychosocial adjustment of youth with inflammatory bowel disease (IBD). Methods Nineteen studies with a total of 1167 youth with IBD (M age = 14.33, 50% female) were included. Effect size (ES) estimates were calculated for anxiety symptoms & disorders, depressive symptoms & disorders, internalizing symptoms & disorders, externalizing symptoms, quality of life (QOL), social functioning, and self-esteem. Separate ESs were calculated for comparisons between IBD and youth with chronic illnesses versus healthy youth. Results Youth with IBD had higher rates of depressive disorders and internalizing disorders than youth with other chronic conditions. Youth with IBD had higher parent-reported internalizing symptoms, lower parent- and youth-reported QOL, and lower youth-reported social functioning compared to healthy youth. Conclusions Clinical attention to depressive disorders, QOL, and social functioning may be particularly salient in the context of pediatric IBD.

Anxiety Symptoms in Adolescents with Type 1 Diabetes: Association with Blood Glucose Monitoring and Glycemic Control

Abstract: Objective To examine the prevalence of anxiety symptoms and their association with blood glucose monitoring (BGM) and glycemic control in adolescents with type 1 diabetes. Methods 276 adolescents and their caregivers completed measures of anxiety symptoms. Adolescents completed a measure of depressive symptoms. Demographic and family characteristics were obtained from caregiver report. Diabetes duration, regimen type, BGM frequency, and glycemic control were also collected. Results Trait anxiety symptoms that suggest further clinical assessment is needed were present in 17% of adolescents; the rate was 13% for state anxiety symptoms. Higher levels of state anxiety symptoms were associated with less frequent BGM F(14, 261) ¼6.35, p<.0001, R 2 ¼.25, and suboptimal glycemic control, F(15, 260) ¼7.97, p<.0001, R 2 ¼.32. State anxiety symptoms were correlates of BGM frequency and glycemic control independent of depressive symptoms. Conclusions State anxiety symptoms are associated with less frequent BGM and suboptimal glycemic control in adolescents with type 1 diabetes.

A Meta-Analytic Review of eHealth Interventions for Pediatric Health Promoting and Maintaining Behaviors

Abstract: Objective The current study quantitatively evaluated the impact of eHealth interventions on pediatric health promoting and maintaining behaviors believed to impact the development or worsening of a physical disease and their associated outcomes. Method PsycINFO, PUBMED/MEDLINE, Educational Resources Information Center (ERIC), and reference sections of identified articles were searched. Results An omnibus weighted mean effect size for all identified eHealth interventions revealed a small, but significant, effect (mean d = .118, 95% confidence interval [CI] = .066-.171). However, when considered independently, educational interventions demonstrated no significant effect on pediatric health behavior or health outcomes. Behavioral eHealth interventions produced relatively homogeneous effects that were small but significantly different from zero (mean d = .354, 95% CI = .232-.475). Conclusion eHealth interventions that incorporate behavioral methods (e.g., self-monitoring, goal setting, immediate feedback, contingency management) produce larger effect sizes for health behaviors and their associated outcomes than interventions that rely solely on education.

Brief Report: Parenting Styles and Obesity in Mexican American Children: A Longitudinal Study

Abstract: Childhood obesity is a significant and growing health problem associated with multiple health disorders including metabolic syndrome, type 2 diabetes, sleep apnea, diseases of the bones and joints, as well as psychosocial dysfunction (Barlow, 2007). Childhood obesity rates are particularly high in low-income minority populations, including low-income Mexican Americans (Ogden et al., 2006). The increasing rates of childhood obesity appear to be the consequence of a range of factors involving families (e.g., sedentary lifestyles; high caloric meals and snacks; soft drink consumption; extensive TV and computer use; eating out; insufficient sleep), neighborhoods (e.g., limited safe places to play outdoors; pedestrian unfriendly neighborhoods), schools (e.g., high caloric school meals; reduced time in recess and physical education classes), the food industry (e.g., high caloric, prepackaged foods; larger individual portion sizes; high fruit and vegetable prices), and the larger culture (e.g., dieting and eating disorders resulting from attempts to achieve an unattainable “thinness ideal”) (Gorin & Crane, 2008; Hawkins & Law, 2006). Because parents have a significant impact on the food consumption, physical activity, and sedentary behavior of their young children, researchers have examined how general parenting styles may be associated with child obesity. Using the parenting styles first identified by Baumrind (1966), and elaborated on by Maccoby and Martin (1983), researchers have found that the authoritative parenting (high nurturance and high control) is associated with higher levels of fruit consumption (Kremers, Brug, de Vries, & Engels, 2003), physical activity (Schmitz et al., 2002), and the lowest risk for child obesity (Rhee, Lumeng, Appugliese, Kaciroti, & Bradley, 2006; Wake, Nicholson, Hardy, & Smith, 2007). These findings extend the results of numerous studies confirming the relation between authoritative parenting and positive child outcomes (see Maccoby & Martin, 1983; Mandara, 2003 for reviews). Studies differ, however, on the parenting styles associated with the highest obesity risk. Rhee and colleagues (2006) found that children of authoritarian parents (low nurturance and high control) were at the greatest risk. In contrast, Wake and colleagues (2007) found that children of indulgent (high nurturance and low control) and uninvolved (low nurturance and low control) parents showed the greatest risk. Because parents’ attitudes toward child rearing are influenced by cultural norms and contextual factors, the effects of different parenting styles often vary across ethnic groups (Roche, Ensminger, & Cherlin, 2007; Steinberg, Dornbusch, & Brown, 1992). Few studies have examined parenting styles in Latino parents, particularly related to child weight (Ward, 2008). Most studies of general parenting practices in Latino parents have focused on individual parenting dimensions (not styles) and have usually characterized them as showing high levels of parental control (Cardona, Nicholson, & Fox, 2000; Chao & Kanatsu, 2008; Hill, Bush, & Roosa, 2003; MacPhee, Fritz, & Miller-Heyl, 1996; Varela et al., 2004). Such findings are interpreted to reflect the importance of respect for authority in Latino cultures (Knight, Virdin, & Roosa, 1994). Consistent with this interpretation, Mogro-Wilson (2008) found that for Latino parents, in contrast to other populations, high levels of parental control were associated with low levels of adolescent alcohol use. The purpose of the current study was to examine in a low-income, Mexican American sample, the relations between parenting style and the development of child weight status 3 years later. Based upon previous research, we predicted that children with authoritative and authoritarian parents would be at the lowest risk for developing obesity, whereas children with indulgent or uninvolved parents would be at the highest risk. We considered that indulgent and uninvolved parenting styles would predict the development of child obesity in this population given the potentially beneficial effects of parental control in Mexican American families.

The Efficacy of Adherence Interventions for Chronically Ill Children: A Meta-Analytic Review

Abstract: Objectives To provide quantitative information about the overall effectiveness of adherence interventions to improve adherence and health outcomes for children with chronic illnesses. To evaluate statistically the potential moderators. Methods A meta-analysis was performed on 71 adherence intervention studies. Results Weighted-mean effect size (ES) across all the adherence outcomes for group design studies was in the medium range (mean d ¼ 0.58) and for single-subject design studies was in the large range (mean d ¼ 1.44). The weighted mean ES across all health outcome measures for studies using group designs was in the medium range (mean d ¼ 0.40) and for studies using single-subject designs was in the large range (mean d ¼ 0.74). Conclusions Adherence interventions for children with chronic illnesses effectively increase adherence and result in some positive health benefits. Intervention and methodological variables had significant impact on ESs. High levels of heterogeneity characterized the data.

Reduced Hippocampal Activity in Youth with Posttraumatic Stress Symptoms: An fMRI Study

Abstract: Objective Youth who experience interpersonal trauma and have posttraumatic stress symptoms (PTSS) develop cognitive deficits that impact their development. Our goal is to investigate the function of the hippocampus in adolescents with PTSS during a memory processing task. Methods Twenty-seven adolescents between the ages of 10–17 years (16 with PTSS and 11 healthy controls) encoded and retrieved visually presented nouns (Verbal Declarative Memory Task) while undergoing fMRI scanning. Results The PTSS group demonstrated reduced activation of the right hippocampus during the retrieval component of the task. Further, severity of symptoms of avoidance and numbing correlated with reduced left hippocampal activation during retrieval. Conclusions Decreased activity of the hippocampus during a verbal memory task may be a neurofunctional marker of PTSS in youth with history of interpersonal trauma. The results of this study may facilitate the development of focused treatments and may be of utility when assessing treatment outcome for PTSS.

Child Maltreatment and Pediatric Health Outcomes: A Longitudinal Study of Low-income Children

Abstract: In 2007, nearly six million American children were alleged victims of child maltreatment [US Department of Health and Human Services (DHHS), 2009]. While <25% receive a state-level designation of “victim,” research has consistently found that children with investigated but unsubstantiated reports face similar risk of ongoing maltreatment and untoward outcomes (Hussey et al., 2005; Kohl, Jonson-Reid, & Drake, 2008). National estimates using the “victim” designation for whether or not maltreatment was present therefore understate the number of children at risk for later negative outcomes. A recent estimate of the annual cost of abuse and neglect in the USA exceeded $103 billion, with <1% attributed to health (excluding injury) and mental healthcare (Wang & Holton, 2007). This, however, is likely a substantial underestimate for several reasons. First, analyses were restricted to those associated with children who suffered “demonstrable harm” from maltreatment according to the 1996 National Incidence Study, a high standard. Second, studies of adult healthcare use were used to help estimate prevalence of non-injury health problems. Little work has been done linking maltreatment to health problems in childhood or adolescence outside of obesity and eating disorders (Gilbert et al., 2009). We do not know if, or what type of, negative health outcomes among maltreated children appear prior to adulthood. The present article adds to our understanding of whether or not adverse health outcomes are higher during childhood for children reported for maltreatment by using longitudinal data, health outcomes taken from medical records rather than parent ratings of child health, and controls for other risk factors. Health conditions (asthma, other cardio-respiratory illness, and non-sexually transmitted infection) were selected as outcomes because of their high prevalence, cost, and potential sensitivity to external stressors. Consistency of findings with cumulative stress and allostatic load theories was explored and elaborated.

The Psychosocial Impact of Completing Childhood Cancer Treatment: A Systematic Review of the Literature

Abstract: Objective To review the results of any published research study examining the psychosocial functioning of children who have recently completed cancer treatment. Methods Five electronic databases were searched (from 1978 to 2008). Of 1,734 identified articles, 19 met all inclusion criteria. Four articles utilized a qualitative methodology, thirteen utilized a quantitative methodology, and two used mixed methods. Results Children may experience positive psychosocial outcomes on treatment completion, including high self-worth, good behavioral conduct, and improved mental health and social behavior. However, they may also experience significant negative outcomes, including lower levels of psychological well-being, mood, liveliness, self-esteem, and motor and physical functioning, as well as increased anxiety, problem behaviors, and sleeping difficulties. Conclusions Completing treatment can be a psychologically complex time for children as they wait to make the transition from ‘‘cancer patient’’ to long-term ‘‘cancer survivor.’’ Further high-quality research targeting the needs of these children is warranted. Despite the large numbers of children surviving cancer worldwide (Dickerman, 2007), surprisingly little research describes the psychological and social issues of children who have recently completed cancer treatment. In addition, it is a disparate literature varying across disciplines from medicine to nursing and allied health (e.g., psychology and social work). Not only does this make it difficult for clinicians and researchers to quickly appraise the content and quality of the evidence but there are also few guidelines available to support the ever increasing population of children through the first years after treatment. To address this gap, the present paper comprises a systematic review of studies exploring the psychosocial issues faced by children who have recently (i.e., within the last 5 years) completed cancer treatment. The review was justified because despite the large and growing bodies of psychosocial research documenting the impact of being on cancer treatment as well as the impact of long-term

Children's Memory for Painful Procedures: The Relationship of Pain Intensity, Anxiety, and Adult Behaviors to Subsequent Recall

Abstract: Objective To examine whether children’s experience of pain intensity and anxiety, and adult behaviors during venepuncture, were related to children’s memories of the procedure. Methods Participants were 48 children (24 males, 24 females) between the ages of 5 and 10 years who underwent venepuncture. The venepunctures were videotaped and adult behaviors were coded. Children self-reported their pain intensity and anxiety immediately and 2 weeks following venepuncture and answered contextual questions at follow-up. Results Children who initially reported higher levels of pain tended to over-estimate their anxiety at follow-up, whereas children who reported lower levels of pain accurately- or under-estimated their anxiety. Staff coping-promoting behaviors predicted the accuracy of children’s contextual memories. Staff and parent behaviors did not predict children’s recalled pain intensity and anxiety. Conclusions Results indicate that children’s direct experience of pain intensity and staff behaviors during venepuncture are related to their memories. These data highlight the importance of effective pain management during medical procedures.

Factors Influencing Familial Decision-Making Regarding Human Papillomavirus Vaccination

Abstract: Objective The purpose of this review is to summarize the research regarding Human Papillomavirus (HPV)vaccination uptake among families with adolescent/preadolescent daughters. Methods Literature searches(utilizing PubMed and PsychInfo databases) were conducted and research examining psychological and envi-ronmental factors which relate to HPV vaccine uptake and intentions was reviewed. Results Factors such asphysician recommendations, perceptions of the beliefs of peers and significant others, history of childhoodimmunizations, and communication with adolescents regarding sexual topics appear to influence HPVvaccination outcomes. Conclusions Although primary prevention of cervical and other cancers isavailable for preadolescent and adolescent girls, rates of HPV vaccine uptake are low. Future interventionsshould target vaccine intent and physician/family communication as a means to increasing HPV vaccination.Key words cancer and oncology; health promotion and prevention; parent–adolescent communication;sexually transmitted diseases.

The Course of Posttraumatic Stress in Children: Examination of Recovery Trajectories Following Traumatic Injury

Abstract: Objective Group-based trajectory modeling was used to identify patterns of posttraumatic stress symptom (PTSS) in children 6-16 years following accidental injury. The aims were to: (a) identify probable groups of children following distinct trajectories, and (b) identify risk factors affecting the probability of group membership. Method Children's Impact of Events Scale (n = 190) was used to assess PTSS up to 2 years post injury. Age, gender, type of injury, and preinjury behavior were assessed as risk factors. Results Three distinct trajectory groups were identified: resilient (57%), elevated stress symptoms which recovered quickly (33%), and chronic (10%). Younger children were more likely to be in the recovery group. Those with serious injuries were more likely to be in the chronic group. Preinjury child behavior problems were predictive of recovery and high chronic symptoms. Conclusion Identification of distinct PTSS trajectory groups has implications for understanding the course and treatment of PTSS in children.

Parental stress is associated with poor sleep quality in parents caring for children with developmental disabilities

Abstract: Objective This study examined the psychosocial predictors of poor sleep quality in parents caring for children with developmental disabilities. Methods Sixty-seven parents of children with developmental disabilities and 42 parents of typically developing children completed the Pittsburgh Sleep Quality Index, and measures of parental stress, child problem behaviors, and social support. Results Parents of children with developmental disabilities reported poorer sleep quality. Further, the majority of these parents met the established ‘poor sleepers’ criterion. The strongest predictor of poor sleep quality was parental stress. This finding withstood adjustment for a number of potential confounders. Conclusions Parental stress is associated with poor sleep quality in parents of children with developmental disabilities. The monitoring and management of sleep issues in these parental caregivers should be a priority for health professionals.

Course and Predictors of Posttraumatic Stress Disorder in Parents after Pediatric Intensive Care Treatment of their Child

Abstract: Objective To study posttraumatic stress disorder (PTSD) in parents after unexpected pediatric intensive care unit (PICU) treatment of their child and to identify risk factors for its development. Method Parents completed PTSD questionnaires 3 and 9 months (N ¼190) after PICU treatment. Risk factors included pretrauma data, medical data, social demographics and posttraumatic stress responses at 3 months. Results In total, 30.3% of parents met criteria for subclinical PTSD and 12.6% for clinical PTSD at 3 months. Clinical PTSD prevalence rates did not change over time. At 9 months, 10.5% of parents still met criteria for PTSD. Number of earlier stressful life events, earlier psychosocial care and posttraumatic stress responses at 3 months predicted persistent subclinical and clinical PTSD. Conclusions PICU admission is a stressful event associated with persistent parental PTSD. Assessment of risk factors can facilitate detection of persistent PTSD for early intervention.

Skin Conductance Reactivity and Respiratory Sinus Arrhythmia Among Maltreated and Comparison Youth: Relations with Aggressive Behavior

Abstract: Objective The goal of this study was to examine respiratory sinus arrhythmia (RSA), an indicator of parasympathetic nervous system-linked cardiac activity, and skin conductance level (SCL), a sympathetic indicator, as moderators of the link between child maltreatment and adolescent aggression. Method Participants were 234 maltreated (48.3% male) and 128 (57.8% male) comparison youth aged 9–16 years participating in wave 2 of a longitudinal study. Results Regression analyses suggest that among boys, high RSA may be protective against the effects of maltreatment on aggressive behavior. Among girls, the moderating effect of RSA was further moderated by SCL reactivity such that low levels of both baseline RSA and SCL reactivity, or conversely high levels of both baseline RSA and SCL reactivity, exacerbated the link between maltreatment and aggression. Conclusions High RSA may protect against the effects of maltreatment on aggressive behavior, though this effect may be moderated by SCL reactivity among girls.

Relationship between School Absenteeism and Depressive Symptoms among Adolescents with Juvenile Fibromyalgia

Abstract: Objective To describe school absences in adolescents with Juvenile Primary Fibromyalgia Syndrome (JPFS) and examine the relationship between school absenteeism, pain, psychiatric symptoms, and maternal pain history. Methods Adolescents with JPFS (N ¼ 102; mean age 14.96 years) completed measures of pain and depressive symptoms, and completed a psychiatric interview. Parents provided information about the adolescents’ school absences, type of schooling, and parental pain history. School attendance reports were obtained directly from schools. Results Over 12% of adolescents with JPFS were homeschooled. Those enrolled in regular school missed 2.9 days per month on average, with one-third of participants missing more than 3 days per month. Pain and maternal pain history were not related to school absenteeism. However, depressive symptoms were significantly associated with school absences. Conclusion Many adolescents with JPFS experience difficulties with regular school attendance. Long-term risks associated with school absenteeism and the importance of addressing psychological factors are discussed.

Cultural Issues in Eating Pathology and Body Image Among Children and Adolescents

Abstract: Eating pathology and body image issues are now recognized as affecting all racial and ethnic groups. This article reviews eating pathology and body image concerns in four diverse groups in the U.S. (African Americans, Latino/as, Asians, and Native Americans). The major conclusion based on this review is that eating disturbances and body dissatisfaction occur to some degree in children and adolescents from all four major ethnic groups in the U.S; however, there is substantial variability across studies. Future directions include the need for studies of prevalence, prevention and treatment research, and investigations of neurobiological and genetic variables.

Infant Sleep and Paternal Involvement in Infant Caregiving During the First 6 Months of Life

Abstract: Objectives The goals of this study were to assess: (a) the involvement of fathers and mothers in overall and nighttime infant caregiving; (b) the links between paternal involvement in infant care and infant sleep patterns during the first 6 months. Methods Fifty-six couples recruited during their first pregnancy, participated in the study. After delivery (1 and 6 months), both parents completed a questionnaire assessing the involvement of fathers relative to mothers in infant caregiving. Infant sleep was assessed using actigraphy and sleep diaries. Results Mothers were significantly more involved than fathers in daytime and nighttime caregiving. A higher involvement of fathers in overall infant care predicted and was associated with fewer infant night-wakings and with shorter total sleep time after controlling for breastfeeding. Conclusions The findings highlight the importance of including fathers in developmental sleep research. Future studies should explore mechanisms underlying the relations between paternal involvement and infant sleep.

Demographic, Maltreatment, and Neurobiological Correlates of PTSD Symptoms in Children and Adolescents

Abstract: OBJECTIVE: To examine the relationships of demographic, maltreatment, neurostructural and neuropsychological measures with total posttraumatic stress disorder (PTSD) symptoms. METHODS: Participants included 216 children with maltreatment histories (N = 49), maltreatment and PTSD (N = 49), or no maltreatment (N = 118). Participants received diagnostic interviews, brain imaging, and neuropsychological evaluations. RESULTS: We examined a hierarchical regression model comprised of independent variables including demographics, trauma and maltreatment-related variables, and hippocampal volumes and neuropsychological measures to model PTSD symptoms. Important independent contributors to this model were SES, and General Maltreatment and Sexual Abuse Factors. Although hippocampal volumes were not significant, Visual Memory was a significant contributor to this model. CONCLUSIONS: Similar to adult PTSD, pediatric PTSD symptoms are associated with lower Visual Memory performance. It is an important correlate of PTSD beyond established predictors of PTSD symptoms. These results support models of developmental traumatology and suggest that treatments which enhance visual memory may decrease symptoms of PTSD. Language: en

A Pilot Study of Observed Parenting and Adjustment in Adolescents with Type 1 Diabetes and their Mothers

Abstract: Objectives The purpose of this pilot study was to determine the association of observed parenting behaviors with adjustment in adolescents with type 1 diabetes (T1D) and their mothers. Methods Adolescents with T1D (n ¼30) and their mothers provided data on psychosocial adjustment and engaged in a discussion task about diabetes stress, which was coded for parenting behavior. Clinical data (i.e., HbA1c) was obtained from adolescents’ medical records. Results Mothers’ symptoms of anxiety and depression were related to lower levels of child-centered parenting. Higher levels of observed child-centered parenting and positive reinforcement and lower levels of maternal hostility and parental influence were related to better psychosocial adjustment in adolescents (i.e., fewer depressive symptoms, better quality of life) and better metabolic control. Conclusions Results support the use of observational data in this population and provide estimates of effect sizes between parenting variables, maternal and adolescent psychosocial adjustment, and metabolic control.

Social-Cognitive Correlates of Physical Activity in a Multi-Ethnic Cohort of Middle-School Girls: Two-year Prospective Study

Abstract: Insufficient physical activity among adolescent girls is a public health concern in the United States. Large declines in girls’ leisure time physical activity have been reported between ages 9 and 18 (Caspersen, Pereira, Curran, 2000; Kimm et al., 2002), and the rate of decline during high school is nearly twice as great in girls than boys (Grunbaum et al., 2004). It is important to identify mediators and moderators of change in physical activity that can guide successful interventions to increase and maintain physical activity levels as girls develop (Lewis, Marcus, Pate, & Dunn, 2002; Luban, Foster, & Biddle, 2008). Social-cognitive variables (i.e., beliefs that are formed by social learning and reinforcement history) are putative influences on self-initiated change in health behaviors such as physical activity (Bandura, 2004). They may be especially important during early adolescence, when physical activity increasingly becomes a leisure choice. According to self-efficacy theory (Bandura, 1997), a belief in personal capabilities to plan and execute the courses of action required to attain a behavioral goal is the proximal influence on physical activity. Self-regulatory efficacy beliefs about the ease or difficulty of overcoming personal (e.g., sedentary choices or lack of skill) and environmental (e.g., bad weather or securing social support) barriers to participating in physical activity have been related to physical activity among adolescent girls, regardless of outcome-expectancy values (Beets, Pitetti, & Forlaw, 2007; Dishman et al., 2004; Hagger, Chatzisarantis, & Biddle, 2001; Motl et al., 2002; Neumark-Sztainer, Story, Hannan, & Rex, 2003). However, those studies used subjective self-reports (which can be biased by inaccurate recall and socially desirable responses) to assess physical activity, rather than an objective measure, and most used a cross-sectional design or assessed self-efficacy at a single time. Recent reports of longitudinal, cohort studies of adolescent girls suggest that declines in physical activity during the period from late middle-school through high school are mitigated by self-efficacy for overcoming barriers to physical activity and by perceived social support (Dishman, Saunders, Motl, Dowda, & Pate, 2009), especially from family (Dowda, Dishman, Pfeiffer, & Pate, 2007) and friends (Duncan, Duncan, Strycker, & Chaumeton et al., 2007). According to self-efficacy theory (Bandura, 1989; 1997), efficacy beliefs can affect physical activity both directly and indirectly by influencing self-management (e.g., goal setting, self-persuasion, planning, and problem solving) and perceptions about socio-cultural environments that present barriers or, conversely, provide support for physical activity (Bandura 2004). In these ways, beliefs in personal capability to overcome barriers to physical activity would sustain physical activity despite the perception of such barriers or low support of physical activity from family or friends. Similarly, perceptions of social support can have reciprocal relations with self-efficacy and might influence physical activity indirectly through perceived barriers and self-management (Dishman et al., 2002; 2005). Whether self-efficacy and perceived social support act as moderators (e.g., Dishman, Saunders, et al., 2009) or mediators (e.g., Dishman et al., 2004) of change in girls’ physical activity has received little study (Luban et al., 2008) and is as yet unknown. Other evidence indicates that activity levels are lowest among girls of African American or Hispanic/Latino ancestry or who have high body mass index (BMI) (Gordon-Larsen, Adair, & Popkin 2002; Kimm et al., 2002; Sulemana, Smolensky, & Lai, 2006). It is not known whether these potential moderators are related to change in physical activity independently of social-cognitive variables. For example, girls having less social capital or different cultural values about body weight and physical activity might have lower self-efficacy while perceiving more barriers and less social support. Or, they might be less likely to use self-management strategies such as goal setting. We previously found that physical activity and self-efficacy for overcoming barriers to physical activity were each higher among White girls than Black or Hispanic/Latino girls in the 8th grade (Dishman, Saunders, et al., 2009). While declines in those girls’ physical activity and their perceptions of social support during high school were related to each other regardless of race, self-efficacy did not change and was not directly related to the physical activity change. Rather, self-efficacy moderated the activity–social support relation. The stability of these variables and their relations during middle school are not known. Here, we report a longitudinal, observational study of relations of objectively measured physical activity with social-cognitive variables derived from self-efficacy theory among an ethnically diverse cohort of girls who were participants in the control and intervention arms of the Trial of Activity for Adolescent Girls (TAAG) during their 6th through 8th grade school years. The design and primary outcomes of the intervention have been described elsewhere (Stevens et al., 2005; Webber et al., 2008). Although the intervention did not result in an increase in the primary outcome measures among the study cohort, secondary aims of TAAG were to examine whether variations in physical activity would be related to social support of physical activity, self-efficacy for overcoming barriers to physical activity, the use of self-management strategies, and perceived barriers to physical activity (Elder et al., 2007). Our primary goal here was to test hypothesized direct and indirect (i.e., mediated by self-management and perceived barriers) relations of barriers of self-efficacy and perceived social support with physical activity, consistent with self-efficacy theory and previous cross-sectional findings in other 6th and 8th grade girls (Dishman et al., 2005); see Figure 1. We also tested whether barriers self-efficacy moderated the relations of perceived social support with perceived barriers and self-management strategies, and we examined whether the relations were similar in White, Black, and Hispanic/Latino girls. Secondary goals were to determine the stability of the variables between the 6th and 8th grade assessments and whether initial status and change in the variables were related to race/ethnicity. Novel features of the TAAG study were the opportunities to examine putative mediators of objectively measured physical activity in a longitudinal, multi-ethnic cohort of girls from six regions of the United States. Figure 1. Results of the hypothesized model. Variables at the 8th grade were adjusted for initial status in the 6th grade, relations among the variables in the 6th grade, and the change between the 6th and 8th grade. Dotted lines indicate paths that were tested ...

The Effects of Parental Depression and Parenting Practices on Depressive Symptoms and Metabolic Control in Urban Youth with Insulin Dependent Diabetes

Abstract: Objective Examine relationships between parental depressive symptoms, affective and instrumental parenting practices, youth depressive symptoms and glycemic control in a diverse, urban sample of adolescents with diabetes. Methods Sixty-one parents and youth aged 10–17 completed self-report questionnaires. HbA1c assays were obtained to assess metabolic control. Path analysis was used to test a model where parenting variables mediated the relationship between parental and youth depressive symptoms and had effects on metabolic control. Results Parental depressive symptoms had a significant indirect effect on youth depressive symptoms through parental involvement. Youth depressive symptoms were significantly related to metabolic control. While instrumental aspects of parenting such as monitoring or discipline were unrelated to youth depressive symptoms, parental depression had a significant indirect effect on metabolic control through parental monitoring. Conclusions The presence of parental depressive symptoms influences both youth depression and poor metabolic control through problematic parenting practices such as low involvement and monitoring.

Parental Mental Health and Early Social-emotional Development of Children Born Very Preterm

Abstract: Objective The aims of this study were to describe the mental health of parents of children born very preterm and examine relations between parental mental health and early social-emotional development in very preterm and term born children. Methods Participants were 177 children born very preterm and 69 children term born and their parents. At 2 year’s corrected age for the children, parental mental health was assessed using the General Health Questionnaire (GHQ-28), and child social-emotional development assessed using the Infant-Toddler Social-Emotional Assessment (ITSEA) and a structured parent–child interaction paradigm. Results Twenty-six per cent of parents of children born very preterm and 12% of parents of term born children reported clinically significant mental health problems. Parental mental health problems were associated with increased risk for dysregulation in very preterm and term children. Conclusions Findings highlight the need to identify and support parents of children born very preterm with mental health difficulties.

Adherence and glycemic control among Hispanic youth with type 1 diabetes: role of family involvement and acculturation.

Abstract: Objective To assess whether family involvement and acculturation were related to adherence and glycemic control among Hispanic youth with type 1 diabetes (T1D). Methods Hispanic youth with T1D (n ¼ 111; M age ¼ 13.33; 53% female) and parents completed questionnaires that assessed diabetes-related family involvement (distribution of responsibility for diabetes, family support for diabetes), acculturation (linguistic acculturation, generational status), and adherence. HbA1c levels indexed glycemic control. Results Better adherence was associated with less adolescent independent responsibility, more family support for diabetes, and more recent immigration (fewer generations of the family living in US). Family support mediated the relationship between responsibility and adherence. Better glycemic control was associated with higher levels of parental education and adherence. Conclusions Family support for diabetes is important for adherence among Hispanic youth with T1D. Research should examine aspects of recent immigration that contribute to better adherence and the impact of supportive interventions on diabetes care.

Behavioral Outcome in Children with a History of Neonatal Encephalopathy following Perinatal Asphyxia

Abstract: (CBCL), Teacher’s Report Form (TRF), Diagnostic Interview Schedule for Children IV (DISC-IV), and the Children’s Social Behavior Questionnaire (CSBQ) were used to assess behavioral outcome of 34 children with mild NE, 47 children with moderate NE, and 53 typically developing controls. Results Both children with mild and moderate NE showed more problematic behaviors than controls, which are related to a diversity of behavioral domains: elevated rates of social problems, anxiety and depression, attention regulation problems, and thought problems. No group differences were found in percentages of children with a DISC-IV (DSM-IV) classification. Conclusions NE has a mildly negative effect on behavioral functioning, but does not lead to elevated levels or specific patterns of developmental psychopathology.

Responsibility Sharing between Adolescents with Type 1 Diabetes and Their Caregivers: Importance of Adolescent Perceptions on Diabetes Management and Control

Abstract: Objective To analyze associations between factor scores for caregiver responsibility for direct and indirect diabetes management tasks with glycemic control and blood glucose monitoring (BGM) frequency. Methods Two hundred and sixty one adolescents with type 1 diabetes and their caregivers completed the Diabetes Family Responsibility Questionnaire (DFRQ). Data on diabetes management (e.g., BGM frequency) and glycemic control (e.g., A1c values) were obtained. Results Confirmatory factor analysis of the DFRQ revealed two factors-direct and indirect management tasks. Multivariate analyses demonstrated that adolescent perception of greater responsibility sharing with caregivers on direct management tasks was significantly associated with higher BGM frequency. Conclusions Adolescents who perceive greater caregiver responsibility, particularly around direct management tasks, engage in better diabetes management. Implications of these findings include designing interventions that encourage and sustain caregiver responsibility through adolescence and make explicit the contribution of caregivers.

Does Early Age at Brain Insult Predict Worse Outcome? Neuropsychological Implications

Abstract: Objective Traditionally early brain insult (EBI) has been argued to have better outcome than later injury, consistent with the notion that the young brain is flexible and able to reorganize. This view was investigated by comparing neurobehavioral outcomes of children sustaining EBI at different developmental stages (gestation to late childhood). Methods One hundred and sixty four children who had sustained focal brain insult (confirmed by MRI) formed six groups, based on age at EBI, (a) Congenital; (b) Peri-natal; (c) Infancy; (d) Preschool; (e) Middle Childhood; (f) Late Childhood, and were compared on a range of standardized neurobehavioral measures. Groups were matched for lesion characteristics and demographics. Results Children sustaining EBI before age 2 recorded global deficits, while children with later EBI performed closer to average. Conclusion These results question the advantages of early brain plasticity, demonstrating poorer outcome from very early insults, and increasingly better function with lesions later in childhood.

Interdisciplinary Behavioral Rehabilitation of Pediatric Pain-Associated Disability: Retrospective Review of an Inpatient Treatment Protocol

Abstract: Objective A biopsychosocial model was used to treat pain-associated disability in children and adolescents. We assessed the clinical outcomes of children and adolescents (8–21 years of age) with pain-associated disability who were treated in an interdisciplinary inpatient rehabilitation program which included physical, occupational, and recreational therapy, medicine, nursing, pediatric psychology, neuropsychology, psychiatry, social work, and education. Psychological treatment emphasized cognitive-behavioral intervention for pain and anxiety management, and behavioral shaping to increase functioning. Methods We conducted a retrospective chart review of 41consecutive patients. School attendance, sleep, and medication usage were assessed at admission and discharge; functional disability and physical mobility were assessed at admission, discharge, and 3-month follow-up. Results As a group, significant improvements were observed in school status, sleep, functional ability, physical mobility, and medication usage. Conclusion Findings support the efficacy of an inpatient interdisciplinary behavioral rehabilitation approach to the treatment of pain-associated disability in pediatric