Deirdre Logan | Harvard Medical School (original) (raw)

Papers by Deirdre Logan

Teacher Responses to Children's Symptoms Scale

PsycTESTS Dataset, 2020

The impact of chronic pain on school functioning in young people

Work and pain, 2019

School plays a central role in young people’s lives, offering a developmental environment that fo... more School plays a central role in young people’s lives, offering a developmental environment that fosters crucial academic, emotional, cognitive, and social milestones. This chapter presents a critical discussion of how a young person’s school functioning can be negatively affected by chronic pain. We highlight how the impact of chronic pain, and associated psychosocial factors, goes beyond school absenteeism to influence school engagement, executive functioning skills, and social skills development. Furthermore, the challenges teachers face to provide an inclusive school environment for young people with chronic pain will be discussed in depth. The chapter ends with suggestions of how to overcome the barriers to implementing a comprehensive approach towards school functioning within both research and clinical practice, including reviewing standardized tools to assess school impairment and offering guidance for biopsychosocially informed approaches to foster adaptive school functioning...

Gastroenterology, 2018

repeat admissions with a mean of 1.52±0.18 admissions and 3.26±0.55 nights. 16% (n= 25) had addit... more repeat admissions with a mean of 1.52±0.18 admissions and 3.26±0.55 nights. 16% (n= 25) had additional repeat ED visits. 39% had at least one related clinic visit. There was one patient death from unexplained causes during follow-up. Conclusions: Infants with BRUE continue to be frequently admitted. Diagnostic testing remains common and of those tested for oropharyngeal dysphagia, 50% have abnormal swallow study results and 100% of those with aspiration have silent aspiration. BRUE symptoms are frequently blamed on reflux and many children are discharged on acid suppression. With the current approach, BRUE patients remain symptomatic and frequently represent to medical care.

Challenges Conducting Child-Robot Interaction Research in a Pediatric Inpatient Care Context

In this paper, we present challenges that arise when conducting child-robot interaction research ... more In this paper, we present challenges that arise when conducting child-robot interaction research in a pediatric inpatient care setting, and practical solutions for balancing scientific validity while prioritizing medical care for patients. In the Huggable project, we learned that our experimental setup needs to be minimally obtrusive, easy to deploy, and quick to remove in the event of a medical emergency. When administering questionnaires, we also learned that we needed to be sensitive to the physical and mental state of pediatric patients to reduce added burden and minimize incomplete study measures. In sum, being flexible and sensitive to dynamic changes in the pediatric care context is key to performing successful child-robot interaction research in this complex, real-world setting.

Pediatric Anesthesia, 2019

Variables such as age, anxiety, and temperament have been shown to affect pediatric procedural pa... more Variables such as age, anxiety, and temperament have been shown to affect pediatric procedural pain and distress behaviors. Temperamental predisposition for high activity level and low mood are most consistently related to pediatric pain behaviors. Relatedly, proneness to anger and fear have been found to predict pain-related distress.

The Clinical Journal of Pain, 2017

Objectives: Adverse childhood experiences (ACEs) in youth have been found to be frequently associ... more Objectives: Adverse childhood experiences (ACEs) in youth have been found to be frequently associated with several chronic illnesses, including chronic pain. However, this relationship remains poorly understood. Previous research has examined the association between ACEs and chronic pain, but these have primarily been examined in the context of adults with limited assessment of ACEs and individual pain conditions. The primary objectives of this study were to examine the incidence and psychological/pain-related correlates of ACEs in a sample of youth with chronic pain. Exploratory analyses were also examined using primary pain diagnosis and number of pain locations. Methods: Data were gathered using retrospective data from a clinical databank. Participants were 141 youth ages 9-19 with chronic pain who presented for evaluation at a multidisciplinary pain clinic. Information on ACEs exposure, pain diagnostic information, pain-related impairment, and psychosocial functioning were gathered via self-report and retrospective review of the medical record. Results: Results revealed that over 80% of youth with chronic pain reported at least one ACE in their lifetime. Further, multiple and univariate analyses of variance revealed that ACEs exposure is significantly associated with greater symptoms of anxiety, depression, and fear of pain, with 3 or more ACEs associated with greatest impairment in functioning. No relationships were found between ACEs and increased pain-related disability or pain intensity. Discussion: ACEs exposure in youth with chronic pain occurs frequently and can be associated with increased psychosocial but not functional impairment. Future research is needed to further examine the relationship between ACEs and chronic pain in youth in a prospective fashion.

Regional anesthesia and pain medicine, Jan 10, 2017

Evidence supports treatment of pediatric complex regional pain syndromes (CRPS) with physical and... more Evidence supports treatment of pediatric complex regional pain syndromes (CRPS) with physical and occupational therapy and cognitive-behavioral therapy. Some patients have persistent pain and/or limb dysfunction despite these treatments. We performed a retrospective study of pediatric patients with CRPS treated by continuous epidural or peripheral perineural local anesthetic infusions along with inpatient rehabilitation at Boston Children's Hospital. After approval from the institutional review board, electronic medical records were reviewed for patients treated between September 2003 and September 2014. Primary outcomes were pain and functional scores. Data were collected at the first encounter, at follow-up visits between 4 months before and after admission, and daily while inpatient. Changes over time were assessed using Wilcoxon tests with Dunn corrections. Clinical significance of benefit or harm was assessed by the method of Jacobson and Truax. Response predictors were ana...

Journal of Pediatric Psychology, 2016

Objective To adapt problem-solving skills training (PSST) for parents of children receiving inten... more Objective To adapt problem-solving skills training (PSST) for parents of children receiving intensive pain rehabilitation and evaluate treatment feasibility, acceptability, and satisfaction. Methods Using a prospective single-arm case series design, we evaluated the feasibility of delivering PSST to 26 parents (84.6% female) from one of three pediatric pain rehabilitation programs. Parents completed four to six sessions of PSST delivered during a 2-4-week period. A mixed-methods approach was used to assess treatment acceptability and satisfaction. We also assessed changes in parent mental health and behavior outcomes from pretreatment to immediate posttreatment and 3-month follow-up. Results Parents demonstrated excellent treatment adherence and rated the intervention as highly acceptable and satisfactory. Preliminary analyses indicated improvements in domains of mental health, parenting behaviors, health status, and problem-solving skills. Conclusions Findings demonstrate the potential role of psychological interventions directed at reducing parent distress in the context of intensive pediatric pain rehabilitation.

Gastroenterology, 2015

Patient: A 77-year-old male patient who was undergone hemi-maxillectomy including removal of the ... more Patient: A 77-year-old male patient who was undergone hemi-maxillectomy including removal of the zygomatic bone, orbit and eyeball on his right side due to cancer. His chief complaint was to gain the stable orbital prosthesis at the first examination. The fabrication of an upper complete denture, a lower removal partial denture and an orbital prosthesis were planned for functional and esthetic rehabilitation. At first, intraoral prostheses were fabricated, then, an orbital prosthesis was completed through the facial impression, sculpture, transfer the silicone material and coloration as following the conventional method. Discussion: It was confirmed that the oral function was improved with the hollow obturator on the upper jaw, while some problems for the orbital prosthesis such as the difficulty in daily handling have remained. Conclusion: In fabrication of maxillofacial prostheses, ever y clinical steps should be carefully done depending on rather complicated clinical conditions of individual patient.

Pain, 2015

Although pain and function improve at immediate post-treatment for youth receiving cognitivebehav... more Although pain and function improve at immediate post-treatment for youth receiving cognitivebehavioral therapy for chronic pain, limited data are available to understand changes that youth make during psychological treatment. We sought to characterize distinct trajectory patterns of change in pain and function in order to understand the temporal association of these changes during internet-delivered cognitive-behavioral treatment. Weekly repeated assessments of pain and function were conducted during eight weeks of treatment among 135 adolescents, ages 11 to 17 years, with chronic pain who were randomized to the cognitive-behavioral intervention (CBT) arm of an ongoing trial of internet-delivered CBT (Web-Based Management of Adolescent Pain; Web-MAP2). Using random effects growth mixture models we characterized pain and functional disability trajectories finding distinct trajectory groups indicating patterns of both linear as well as quadratic effects. Trajectories of change showed that some patients' pain and functional disability was improving, others worsened, or changed minimally. Paired t-tests compared the withinsubject relative change rate in pain and function demonstrating similar change range for pain and function during the treatment period. There was no support for improvements in either pain or function to precede changes in the other domain. Findings may be useful in informing future studies of psychosocial treatments for pediatric chronic pain to consider how to target treatment strategies to distinct patient response profiles. This may lead to the development of intervention strategies that can both more effectively target children's pain and function during treatment, and lead to sustained changes following treatment.

Fear of Pain Questionnaire--Child Report

PsycTESTS Dataset, 2011

Pain Management Nursing, 2014

PAIN, 2012

The importance of willingness to adopt a self-management approach to chronic pain has been demons... more The importance of willingness to adopt a self-management approach to chronic pain has been demonstrated in the context of cognitive-behaviorally oriented interdisciplinary pain treatment programs for adults, both as a treatment outcome and as a process that facilitates functional improvements. Willingness to self-manage pain has not been studied in pediatric interdisciplinary pain treatment settings. Study aims were (1) to investigate willingness to self-manage pain among children and parents undergoing intensive interdisciplinary pain treatment and (2) to determine whether increased willingness to self-manage pain influenced functional treatment outcomes. 157 children ages 10-18 and their parents enrolled in a pediatric pain rehabilitation program completed the Pain Stages of Change Questionnaire (PSOCQ youth and parent versions) at pre-treatment, post-treatment, and short-term follow up. They also reported on pain, functional disability, depressive symptoms, fear of pain, and use of passive and accommodative coping strategies. Results show that willingness to self-manage pain increased during treatment among both children and parents, with gains maintained at follow-up. Increases in children's readiness to self-manage pain from pre-to post-treatment were associated with decreases in functional disability, depressive symptoms, fear of pain, and use of adaptive coping strategies. Increases in parents' readiness to adopt a pain-self management approach were associated with changes in parent-reported fear of pain but not with other child outcomes. Few associations emerged between pre-treatment willingness to self-manage pain and post-treatment outcomes. Findings suggest that interdisciplinary pediatric pain rehabilitation may facilitate increased willingness to self-manage pain, which is associated with improvements in function and psychological well-being.

Parental Identification of Depression and Mental Health Service Use Among Depressed Adolescents

Journal of the American Academy of Child & Adolescent Psychiatry, 2002

To examine a proposed pathway to service use among depressed adolescents, this study assessed the... more To examine a proposed pathway to service use among depressed adolescents, this study assessed the effects of (1) parental perceptions of family burden due to adolescents&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;depression, (2) adolescent-parent communication, (3) parents&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; depressive symptomatology, and (4) comorbid substance use disorders on parental identification of adolescent depression and use of mental health services. A two-stage screening process was used to recruit 44 depressed adolescents and their parents from pediatrics clinics between 1997 and 1999. Measures included structured diagnostic interviews with adolescents, the Child and Adolescent Services Assessment, the Child and Adolescent Functional Assessment Scale, the Beck Depression Inventory (for parents), and the Communication subscale of the Inventory of Parent and Peer Attachment. When history of service use was controlled, two predictors--parental perceptions of family burden and presence of a substance use disorder in the adolescent--were most strongly related to parental depression-identification. The data support the role of parental identification of depression as a mediator between the parent/adolescent characteristics and reports of mental health service use. Enhancing parents&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; abilities to identify and understand signs of depression may facilitate service use among depressed adolescents.

Journal of the American Academy of Child & Adolescent Psychiatry, 2000

Journal of Pediatric Psychology, 2003

Objective To develop a self-report measure of barriers to adherence and to evaluate its reliabili... more Objective To develop a self-report measure of barriers to adherence and to evaluate its reliability and validity in a sample of adolescents with asthma. Methods The Illness Management Survey (IMS) was developed through item generation, expert panel review, and focus group administration. Adolescents with asthma (N = 152) completed the measure. Participants reported on perceived drawbacks to medication, risk-taking behavior, and social desirability tendencies. Providers rated adolescents' illness severity and adherence. Reliability and validity of the IMS were assessed, and factor structure was examined. Results The 27-item IMS shows high internal consistency (alpha =.87). Scores correlate with perceived medication drawbacks, risk taking, and self-and provider reports of adherence. Principal-components analysis indicates five domains of barriers, accounting for 52.4% of the variance: disease/regimen issues, cognitive difficulties, lack of social support/lack of self-efficacy, denial/distrust, and peer/family issues. Conclusions Preliminary data indicate that the IMS reliably and validly assesses perceived barriers to adherence within this sample of adolescents with asthma. It shows promise as a tool for identifying subgroups of nonadherent adolescents.

The Fear of Pain Questionnaire (FOPQ): Assessment of Pain-Related Fear Among Children and Adolescents With Chronic Pain

The Journal of Pain, 2011

An important construct in understanding pain-related disability is pain-related fear. Heightened ... more An important construct in understanding pain-related disability is pain-related fear. Heightened pain-related fear may result in behavioral avoidance leading to disuse, disability, and depression; whereas confrontation of avoided activities may result in a reduction of fear over time and reengagement with activities of daily living. Although there are several measures to assess pain-related fear among adults with chronic pain, none exist for children and adolescents. The aim of the current study was to develop a new tool to assess avoidance and fear of pain with pediatric chronic pain patients: the Fear of Pain Questionnaire, child report (FOPQ-C), and Fear of Pain Questionnaire, parent proxy report (FOPQ-P). After initial pilot testing, the FOPQ-C and FOPQ-P were administered to 299 youth with chronic pain and their parents at an initial multidisciplinary pain treatment evaluation. The FOPQ demonstrated very strong internal consistency of .92 for the child and parent versions. One-month stability estimates were acceptable and suggested responsivity to change. For construct validity, the FOPQ correlated with generalized anxiety, pain catastrophizing, and somatization. Evidence of criterion-related validity was found with significant associations for the FOPQ with pain, healthcare utilization, and functional disability. These results support the FOPQ as a psychometrically sound measure. Pain-related fear plays an important role in relation to emotional distress and pain-related disability among children and adolescents with chronic pain. Identification of patients with high levels of fear avoidance of pain with the FOPQ will inform how to proceed with psychological and physical therapy interventions for chronic pain.

The Journal of Pain, 2014

Pain-related self-efficacy and pain-related fear have been proposed as opposing predictors of pai... more Pain-related self-efficacy and pain-related fear have been proposed as opposing predictors of painrelated functional outcomes in youth with chronic pain. Self-efficacy is a potential resiliency factor that can mitigate the influence pain-related fear has on outcomes in youth with chronic pain. Drawing from theoretical assertions tested among adults with chronic pain, this study aimed to determine whether pain-related self-efficacy mediates the adverse influence of pain-related fear on functional outcomes in a sample of youth with chronic headache. In a cross-sectional design of 199 youth with headache, self-efficacy was strongly associated with fear, disability, school impairment, and depressive symptoms. Pain intensity and self-efficacy were only modestly related, indicating level of pain has less influence on one's confidence functioning with pain. Selfefficacy partially mediated relationships between pain-related fear and both functional disability and school functioning but did not mediate the relationship between pain-related fear and depressive symptoms. These results suggest that one's confidence in the ability to function despite pain and fear avoidance both uniquely contribute to pain-related outcomes in youth with chronic headache. These results further suggest that treatment for chronic headache in youth must focus on not only decreasing pain-related fear but also on enhancing a patient's pain-related self-efficacy. Perspective-Pain-related self-efficacy is an important resiliency factor impacting the influence of pain-related fear on functional disability and school functioning in youth with headache. Enhancing self-efficacy may be a key mechanism for improving behavioral outcomes. Clinicians

The Clinical Journal of Pain, 2012

Objectives-To examine clinical outcomes of an interdisciplinary day hospital treatment program (c... more Objectives-To examine clinical outcomes of an interdisciplinary day hospital treatment program (comprised of physical, occupational, and cognitive-behavioral therapies with medical and nursing services) for pediatric complex regional pain syndrome (CRPS). Methods-The study is a longitudinal case series of consecutive patients treated in a day hospital pediatric pain rehabilitation program. Participants were 56 children and adolescents ages 8-18 years (median = 14 years) with CRPS spectrum conditions who failed to progress sufficiently with a previous outpatient and/or inpatient treatments. Patients participated in daily physical therapy, occupational therapy and psychological treatment and received nursing and medical care as necessary. The model places equal emphasis on physical and cognitive-behavioral approaches to pain management. Median duration of stay was 3 weeks. Outcome measures included assessments of physical, occupational, and psychological functioning at program admission, discharge, and at post-treatment follow-up at a median of 10 months post-discharge. Scores at discharge and followup were compared with measures on admission by Wilcoxon tests, paired t tests, or ANOVA as appropriate, with corrections for multiple comparisons. Results-Outcomes demonstrate clinically and statistically significant improvements from admission to discharge in pain intensity (p<0.001), functional disability (p<0.001), subjective report of limb function (p<0.001), timed running (p<0.001) occupational performance (p<0.001), medication use (p<0.01), use of assistive devices (p<0.001), and emotional functioning (anxiety, p<0.001; depression, p<0.01). Functional gains were maintained or further improved at follow-up. Discussion-A day-hospital interdisciplinary rehabilitation approach appears effective in reducing disability and improving physical and emotional functioning and occupational performance among children and adolescents with complex regional pain syndromes that have failed to improve with outpatient treatment.

American Journal of Orthopsychiatry, 1999