Pediatric Psychology Research Papers - Academia.edu (original) (raw)

2025

Background Post-traumatic stress disorder is a common occurrence in children that can affect their overall physical and mental functioning and quality of life. Early intervention can have significant health benefits for children. The purpose of this study was to investigate the effects of parents’ web-based training on the level of post-traumatic stress symptoms in children. Methods This study was a quasi-experimental one with two groups that is intervention and control group. 110 children aged 10 to 18 with traumatic stress symptoms and one of their parents were selected through available sampling. Data were collected by a researcher-made demographic questionnaire and the Child Revised Impact of Events Scale (CRIES-8). The control group received routine care, but the experimental group received a 4-week training course through a researcher-designed website. Two weeks after the intervention, the child stress level was measured and compared within both groups. Data were analyzed usin...

2025, Pediatric Health, Medicine and Therapeutics

Health care transition, or HCT, is the process of adolescents and young adults moving from a child/family-centered model of health care to an adult/patient-centered model of health care. Healthcare providers have an essential role in this process which can be especially challenging for individuals with medical or special healthcare needs. Neurofibromatosis type 1 (NF1) is a complex multisystem disorder requiring lifelong medical surveillance, education, and psychosocial support. This review highlights the transition needs of NF1 patients and provides resources for both clinicians and families to facilitate HCT in this population. The authors propose a framework for the development of an effective NF1 transition program by using the Six Core Elements model of the Got Transition program, reviewing existing literature, and incorporating author experiences in the care and transition of NF1 patients.

2025, Journal of Pediatric Psychology

ance concept is particularly important in severe, chronic illness, where regular contact, ongoing symptom assessment, and mutual decision making are necessary between the patient and his or her physician. Within asthma management, the central role of treatment alliance is emphasized in the recently revised Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma (NHLBI, 1997). Indeed, the need for an effective partnership between the patient and care provider is cited as one of the four primary components of optimal treat-

2025, Journal of Pediatric Psychology

Background Body satisfaction is an important issue for youth. Youth with more severe asthma may have experiences and emotions associated with less body satisfaction; however, this has not been studied. Objective To identify correlates of body dissatisfaction in youth with asthma. Methods Sixty-three females and 60 males, ages 8-18 years with asthma, completed measures of body dissatisfaction, anxiety, depression, asthma symptoms, and behaviors. Parents completed measures of asthma limitations; clinicians rated asthma severity. Results Anxiety, depression, and body mass index (BMI) accounted for 21 and 15% of the variance in body dissatisfaction for females and males, respectively. Physical activity added 13% variance to the above model for females. Asthma symptoms added 14% for males. Of note, neither parent ratings of asthma limitations nor clinician ratings of asthma severity contributed additional variance. Conclusion This study increases our understanding of youth with asthma and provides future research directions.

2025, Journal of Pediatric Psychology

Objectives To evaluate the feasibility and efficacy of a handheld personal digital assistant (PDA)-based supplement for maternal Problem-Solving Skills Training (PSST) and to explore Spanish-speaking mothers' experiences with it. Methods Mothers (n ¼ 197) of children with newly diagnosed cancer were randomized to traditional PSST or PSST þ PDA 8-week programs. Participants completed the Social Problem-Solving Inventory-Revised, Beck Depression Inventory-II, Profile of Mood States, and Impact of Event Scale-Revised pre-, post-treatment, and 3 months after completion of the intervention. Mothers also rated optimism, logic, and confidence in the intervention and technology. Results Both groups demonstrated significant positive change over time on all psychosocial measures. No between-group differences emerged. Despite technological ''glitches,'' mothers expressed moderately high optimism, appreciation for logic, and confidence in both interventions and rated the PDA-based program favorably. Technology appealed to all Spanish-speaking mothers, with younger mothers showing greater proficiency. Conclusions Well-designed, supported technology holds promise for enhancing psychological interventions.

2025, Journal of Pediatric Psychology

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

2025, Journal of Developmental & Behavioral Pediatrics

Objective To compare parental adjustment, social support, and family functioning between families of children with neurofibromatosis 1 (NF1) and a group of demographically similar comparison families, and to examine the impact of disease severity. Methods Questionnaires were completed at home by parents of 54 children with NF1 (54 mothers and 42 fathers) and 51 comparison children (49 mothers and 32 fathers). Results Few differences between groups were identified for parental distress, social support, or family environment. Greater neurological impairment in children with NF1 was associated with greater distress, more family conflict, less positive mealtime interactions, and less social support from the perspectives of mothers. Conclusions Overall, parents of children with NF1 appear similar to parents of comparison children. Mothers who have children with NF1 characterized by greater neurological impairment may be at risk for more difficulties. Future work exploring long-term adjustment for these mothers as well as interventions to ameliorate any potential difficulties may be appropriate.

2025, Journal of Developmental & Behavioral Pediatrics

This study compared the social reputation of: (1) childre4, with a cancer which did not involve the central nervous system (N=26); (2) children with a primary meignancy involving the central nervous system (N=15); and (3) children with sickle cell disease (N=33) to matched, same classroom peers using a measure of social reputation, the Revised Class Play (RCP). All children were ages 8 to 15. Each child's classroom teacher completed the RCP, which assesses sociability-leadership, aggressive-disruptive, and sensitive-isolated interpersonal qualities. Analysis showed children with cancer were nominated more often for roles on the sociability-leadership dimension and less often for roles on the aggressive-disruptive factor. Brain tumor survivors were nominated more often for sensitive-isolated roles. Children with sickle cell disease were not significantly different from peers. Results suggest that chronic illness per se does not have a negative impact on children's social reputation. The data demonstrated that the stressful life events associated with cancer or sickle cell disease did not save a significant negative impact on school adjustment for school-aged children with these diseases. Includes 29 references. (DB)

2025, Journal of pediatric psychology

The Psychosocial Assessment Tool (PAT) was developed to screen for psychosocial risk in families of a child diagnosed with cancer. The current study is the first describing the cross-cultural adaptation, reliability, validity, and usability of the PAT in an European country (Dutch translation). METHODS: A total of 117 families (response rate 59%) of newly diagnosed children with cancer completed the PAT2.0 and validation measures. RESULTS: Acceptable reliability was obtained for the PAT total score (α = .72) and majority of subscales (0.50-0.82). Two subscales showed inadequate internal consistency (Social Support α = .19; Family Beliefs α = .20). Validity and usability were adequate. Of the families, 66% scored low (Universal), 29% medium (Targeted), and 5% high (Clinical) risk. CONCLUSIONS: This study confirms the cross-cultural applicability, reliability, and validity of the PAT total score. Reliability left room for improvement on subscale level. Future research should in...

2025, Journal of pediatric psychology

To examine the relation of behavioral autonomy to psychological, behavioral, and physical health among emerging adults with and without type 1 diabetes. High school seniors with (n = 118) and without type 1 diabetes (n = 122) completed online questionnaires for three consecutive years. Behavioral autonomy, psychological health, risk behaviors, and diabetes outcomes were assessed. Regression analyses were conducted to predict Time 2 and 3 outcomes, controlling for Time 1 outcomes. There were no group differences in behavioral autonomy. Behavioral autonomy predicted better psychological health but only for emerging adults without diabetes. Behavioral autonomy was related to increased risk behavior for both groups. Behavioral autonomy was unrelated to self-care but predicted better glycemic control for females. Behavioral autonomy may be beneficial for psychological health, but is related to increased risk behavior. The implications of behavioral autonomy for emerging adults with type ...

2025, Journal of pediatric psychology

To examine whether friendship and romantic relationships of emerging adults with type 1 diabetes differed from those of a comparison group, and to determine whether these relationships were associated with psychological and diabetes health outcomes. METHODS: High school seniors with (n = 122) and without (n = 118) type 1 diabetes were assessed annually for 3 years. Friend and romantic relationship variables, psychological distress, life satisfaction, eating disturbances, and, for those with diabetes, diabetes outcomes were assessed. RESULTS: Those with diabetes reported less friend support but similar friend conflict compared with controls. Aspects of romantic relationships and friend relationships were associated with health outcomes, but there were more effects involving romantic relationships. On some indices, romantic support was more beneficial for controls and romantic conflict was more troublesome for those with diabetes. CONCLUSIONS: Both friendship and romantic relat...

2025, Journal of Pediatric Psychology

Objective To determine whether diabetes is associated with psychosocial difficulties over the transition to adolescence. Methods We compared adolescents with diabetes (n ¼ 132) with a healthy comparison group (n ¼ 131) on indices of psychosocial functioning for 3 years. We interviewed both groups annually and had one parent complete a questionnaire. Results There were no group differences in depressive symptoms, anxiety, anger, or behavioral problems. However, adolescents with diabetes showed greater declines in social acceptance compared with healthy adolescents, and a greater rise in disturbed eating behavior. Over time, depressive symptoms and anxiety increased and self-worth decreased for females but not males; however, these differences were not qualified by group Conclusions Diabetes is not associated with indicators of psychological distress from early to middle adolescence, but may be associated with the emergence of social difficulties and eating disturbances. Gender differences in psychological distress emerged, replicating past research.

2025, Journal of Pediatric Psychology

Objective To examine the relation of parent stress to parent mental health and child mental and physical health. Methods We interviewed children with type 1 diabetes (n ¼ 132; mean age 12 years) annually for 5 years and had one parent complete a questionnaire at each assessment. Parents completed measures of general life stress, stress related to caring for a child with diabetes, benefit finding, and mental health. Child outcomes were depressive symptoms, self-care behavior, and glycemic control. Multilevel modeling was used to examine concurrent and longitudinal relations. Results Greater parent general stress and greater parent diabetes-specific stress were associated with poorer parent mental health. Overall, greater parent general stress was associated with poorer child outcomes, whereas greater parent diabetes-specific stress was associated with better child outcomes. Conclusions Families with high levels of general life stress should be identified as they are at risk for both poor parent and child health outcomes.

2025, Journal of Pediatric Psychology

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.

2025, Journal of Pediatric Psychology

Objective Although cross-sectional studies have demonstrated poor adherence to airway clearance therapy (ACT) for patients with cystic fibrosis (CF), no studies have identified longitudinal patterns of adherence. The objective was to characterize and identify predictors of ACT adherence trajectories for individuals with CF. Methods Secondary data analyses were conducted for a randomized clinical trial examining differences in three ACTs. Participants (n ¼ 153; M ¼ 14.3 years, 55% male, 86% Caucasian, baseline FEV 1 % predicted: M ¼ 86.7)/primary caregivers completed Daily Phone Diaries, an empirically supported adherence measure, every 4 months. Results Group-based trajectory modeling revealed the best-fitting solution was a three-group model: low-adherence (14%), medium-adherence (49%), and high-adherence (37%) groups. ACT type was the only significant predictor of adherence trajectories. Discussion Three trajectories of adherence to ACT for patients with CF were found. With the identification of trajectories, adherence interventions can be targeted for the subgroup at highest risk in order to prevent poor health outcomes.

2025, Journal of Pediatric Psychology

Objective Longitudinal within-subject (WS) associations of mothers' momentary assessed phys- ical activity (PA) parenting practices were examined with children's objectively measured PA during the same 2-hr time frame. Method Mother-child dyads (n ¼ 189) completed five ecological momentary assessment (EMA) measurement bursts over 3 years. During each 7-day burst, mothers EMA-reported their past 2 hr PA parenting practices (i.e., encouraging their child to be physically active, taking their child someplace to be physically active), and children (M age ¼9.6 years, SD ¼ 0.9) wore an accelerometer to measure moderate-to-vigorous PA (MVPA). Two-part multilevel models were used, with zero portions representing not meeting MVPA and positive portions representing any MVPA, controlling for demographic covariates. Cross-level interaction terms of child sex and age with parenting were created to test moderation effects. Results When mothers reported taking their child to be physically active, children were more likely to get some MVPA (b ¼ À0.56, p < .001). When mothers reported taking their child to be physically active more, children had higher levels of MVPA (b ¼ 0.24, p < .001). When mothers reported encouraging their child to be physically active, children were less likely to get any MVPA (b ¼ 0.27, p < .05). However, when mothers reported encouraging their child to be physically active more, children had higher levels of MVPA (b ¼ 0.29, p < .001). These effects were not moderated by child sex or age. Conclusions WS variations of mothers' support for PA across the day were associated with changes in children's MVPA. Future research should consider promoting mothers' provision of support for increasing children's PA.

2025, Journal of Pediatric Psychology

Objective To evaluate the reliability and validity of a commonly used measure of health-related quality of life (HRQOL), the Pediatric Quality of Life Inventory (PedsQL™ 4.0), in a sample of children with a recurrent headache syndrome. Methods Participants were 40 children aged 7-12 who completed measures of HRQOL, headache-related disability, and headache activity during a baseline period and following a self-directed cognitive-behavioral intervention. Results The data are supportive of the reliability (internal consistency and test-retest) and validity (criterion related, convergent, known-groups, and responsiveness to intervention) of the PedsQL™ 4.0 within a pediatric headache sample. Conclusions We conclude that the PedsQL™ 4.0 is a reliable and valid measure of HRQOL in children with recurrent headache and captures important information not routinely evaluated in chronic pain populations.

2025, Journal of Pediatric Psychology

Objectives To empirically evaluate a minimal therapist contact CD-ROM pain management program for recurrent pediatric headache developed as part of this study. Methods Participants were 37 children aged 7-12 attending a pediatric neurology clinic for evaluation of recurrent headache. Children who were randomly assigned to the treatment group worked through the CD-ROM program on home computers for 4 weeks following baseline assessment, whereas those assigned to the wait-list group continued following the prescriptions of their neurologist. Data on daily headache activity and headache-related disability were collected at baseline and up to 3 months after treatment. Results Children who received the adjunctive CD-ROM program had significant improvements in headache activity above and beyond those in the control group. Results provide initial support for the utility of adding an adjunctive CD-ROM psychological intervention to standard medical care for recurrent pediatric headache and potentially other chronic pain conditions in children.

2025

This dissertation tests if a young adult's social location determines what type of information he or she will receive about sexual health from parents and formal sexual education programs. I also test whether sexual education mediates direct associations between social location and 4 protective sexual health behaviors: condom communication, consistent condom use, delaying sexual debut, and reducing the number of lifetime sexual partners. Using the 2011-2013 wave of the National Survey of Family Growth, I look for differences in sexual education and engaging in protective sexual health behaviors among white, Hispanic, and African American men and women ages 15-24. I find that communication about sex from parents and formal sex education programs varies by race and gender. I also find that direct associations exist between social location, parental communication, formal sexual education, and protective sexual health behaviors. However, all of these operate independently from one another, and I find that parental communication and formal sexual education does little to mediate the direct associations between social location and protective sexual behaviors. Policy implications, limitations, and directions for future research are also discussed.

2025, Journal of Pediatric Psychology

Objective The goal of this research is to develop a machine learning supervised classification model to automatically code clinical encounter transcripts using a behavioral code scheme. We first evaluated the efficacy of eight state-of-the-art machine learning classification models to recognize patient-provider communication behaviors operationalized by the motivational interviewing framework. Data were collected during the course of a single weight loss intervention session with 37 African American adolescents and their caregivers. We then tested the transferability of the model to a novel treatment context, 80 patient-provider interactions during routine human immunodeficiency virus (HIV) clinic visits. Results Of the eight models tested, the support vector machine model demonstrated the best performance, achieving a .680 F1-score (a function of model precision and recall) in adolescent and .639 in caregiver sessions. Adding semantic and contextual features improved accuracy with 75.1% of utterances in adolescent and 73.8% in caregiver sessions correctly coded. With no modification, the model correctly classified 72.0% of patient-provider utterances in HIV clinical encounters with reliability comparable to human coders (k ¼ .639). Conclusions The development of a validated approach for automatic behavioral coding offers an efficient alternative to traditional, resource-intensive methods with the potential to dramatically accelerate the pace of outcomes-oriented behavioral research. The knowledge gained from computer-driven behavioral research can inform clinical practice by providing clinicians with empirically supported communication strategies to tailor their conversations with patients. Lastly, automatic behavioral coding is a critical first step toward fully automated eHealth/ mHealth (electronic/mobile Health) behavioral interventions.

2025, Journal of Pediatric Psychology

AIDS supported the validity of the interview method. Grade differences were noted for knowledge of high-risk routes, rejection of misconceptions, and cohesiveness and complexity of children's theories. Theories also differed by race and verbal abilities. Implications for most appropriate ways to assess children's understanding of illnesses and directions for future research are discussed.

2025, Belonging and Belongings. Children’s Sense of Home in Shared Custody Arrangements

This is chapter 4 from the monography 'Belonging and belongings. Children's sense of home in shared custody arrangements'. This chapter examines the routines and rituals that are deployed when children arrive at a dwelling where they will be residing for the next several days. These routines and rituals of return are essential in structuring family members’ everyday lives, enabling them to maintain some degree of stability during times of stress and change. The chapter shows how children (re)define their places and establish a sense of belonging in their ‘new families’ by engaging in these stable practices upon each return ‘home’. Three specific rituals of return are described: integration rituals; anchoring rituals; and (not) unpacking rituals.

2025, Journal of Pediatric Psychology

Objective To examine whether a recent prescription for stimulant medication is associated with peer victimization among youth with attention deficit/hyperactivity disorder (ADHD). Methods Data from 4,965 adolescents attending five public schools who completed an annual web survey over 4 years were used to examine recent stimulant medication prescription and self-reported frequent victimization. Results Adolescents with ADHD and recent stimulant prescription reported more victimization than those without ADHD, but similar to adolescents with ADHD and no recent prescription. Adolescents with ADHD and past 12-month diversion of their prescribed stimulants were at greatest risk of 12-month frequent victimization compared with adolescents without ADHD and adolescents with ADHD but no recent prescription. Youth approached to divert reported more victimization than youth not approached. Youth who diverted reported more victimization than those who did not divert. Conclusions Close parent-prescriber collaboration is needed to ensure effective medical treatment for ADHD without greater risk for victimization and treatment failure.

2025, Journal of Pediatric Psychology

Objective To assess the extent to which adolescents with diabetes and their mothers appraise diabetes as a shared entity across adolescence through (a) assessing appraisals of illness ownership and their relationship to joint responsibility for daily diabetes tasks, (b) exploring whether appraisals of shared illness ownership are associated with congruent views of what is stressful about diabetes, and (c) examining whether age-related declines occur in these shared appraisals across adolescence. Methods One hundred twenty-seven adolescents (ages 10-15 years, M = 12.8) and their mothers completed an interview that probed appraisals of illness ownership, the most stressful events surrounding diabetes in the past week, and a questionnaire regarding who was responsible for performing diabetes-related tasks. Results Dyads, most frequently, agreed that diabetes was a "shared" entity. Shared appraisals of illness ownership reflected the greater joint responsibility of mothers and children in daily diabetes tasks. Shared appraisals of illness ownership were not related to congruent reports of diabetes stressful events, and incongruence in appraisals of stressful events was common. With age adolescents reported less shared illness ownership and congruence regarding stressful events, age differences were not seen in mothers' reports. Conclusions Although diabetes is often appraised as a social entity, adolescents and their mothers experience different aspects of the disease as stressful, especially as adolescents age, and become more independent in performing diabetes-related tasks.

2025, Journal of Pediatric Psychology

Objectives To examine pump duration associations with adolescents' metabolic control and whether parental involvement moderated this association. Methods This study used a cross-sectional sample of 10to 14-year-olds with diabetes (N ¼ 252, 53.6% female) and parents' reported parental involvement; HbA1c was obtained from medical records. Half (50.8%) were on an insulin pump (continuous subcutaneous insulin infusion, CSII), with the remainder prescribed multiple daily injections (MDI). Results Adolescents on CSII displayed better HbA1c than those on MDI. A curvilinear association revealed that participants on CSII for <2 years showed a positive pump duration-HbA1c association, while those on CSII longer showed no association. Parental involvement interacted with pump duration to predict HbA1c. Pump duration was associated with poorer HbA1c only when parents were relatively uninvolved. Conclusions Within the limitations of a cross-sectional design, data suggest that adolescents on CSII have better HbA1c than those on MDI, but may experience a period of deterioration that can be offset by parental involvement.

2025, Journal of Pediatric Psychology

Objectives To examine development in illness perceptions of type 1 diabetes across adolescence and relationships with intelligence, diabetes responsibility, and diabetes outcomes. Methods Illness perceptions were measured via the Illness Perceptions Questionnaire at 3 times, every 6 months in 213 adolescents (M age ¼ 13.00; SD ¼ 1.54) with type 1 diabetes. Intelligence and adolescents' perceived responsibility for diabetes were examined, and adolescents' report of adherence and quality of life (QOL), and glycosylated hemoglobin (HbA1c) from medical records addressed diabetes-related outcomes. Results Linear growth models showed significant increases in perceptions of diabetes coherence, chronicity, consequences, personal and treatment control, and decreases in diabetes cyclicality and parental control across time. More favorable illness perceptions were generally associated with adolescent intelligence at baseline, more adolescent responsibility for management, better adherence and QOL, and lower HbA1c at each time point. Conclusions Results suggest that adolescents develop complex illness perceptions, which are associated with better diabetes management.

2025, Journal of Pediatric Psychology

Objective To examine whether maternal depressive symptoms: (a) predicted the level of maternal involvement in diabetes management tasks across adolescence; and (b) moderated associations of involvement with adolescent adherence, metabolic control, and depression. Methods Eighty-two youth aged 10-15 years with type 1 diabetes and their mothers completed measures at baseline and 16 months later. Participants rated maternal involvement in diabetes tasks, adherence, and depressive symptoms; metabolic control was indexed from medical records. Results Maternal depressive symptoms were associated with higher involvement at baseline, and slower declines in involvement across time. At baseline, involvement was associated with lower adolescent depression and better metabolic control, but this association was stronger when mothers reported fewer depressive symptoms. Interactions of maternal depression with involvement across time suggested maternal involvement was associated with better subsequent adherence primarily when mothers reported fewer depressive symptoms. Conclusions Mothers' depressive symptoms may undermine her care-giving effectiveness during adolescence.

2025, Journal of Pediatric Psychology

Objective To examine how autonomy and pubertal status explain age decreases in maternal involvement in type 1 diabetes management across adolescence, how they relate to metabolic control, and the reasons that guide declines in maternal involvement. Methods One hundred twenty-seven children ages 10-15 years with type 1 diabetes and their mothers participated. Data included maternal and child report of diabetes management, child report of autonomy level, maternal report of pubertal status, maternal reports of reasons for transfer of diabetes responsibility, and glycosylated hemoglobin (Hba 1c ) values. Results Autonomy and pubertal status partially mediated age effects on reports of maternal involvement. Mothers' reasons for transferring responsibility included responding to the child's competence, promoting competence and maturity in their child, and minimizing hassles and conflict. The transfer of diabetes responsibility from mother to child without sufficient autonomy and when pubertal status was low was related to higher Hba 1c values. Conclusions The importance of chronological age for changes in maternal involvement suggests the need to examine mothers' and adolescents' developmental expectations for diabetes management. The reasons for transferring responsibility from mother to child suggest many avenues for intervention.

2025, Journal of Pediatric Psychology

Objective To examine how children's appraisals of maternal involvement in coping with diabetes are associated with adherence, metabolic control, and quality of life across adolescence. Methods Children (N = 127, ages 10-15 years) with type 1 diabetes completed measures of adherence, quality of life, and appraisals of mothers' involvement in dealing with diabetes problems (i.e., mother appraised as uninvolved, controlling, or collaborative). Metabolic control was indexed through medical records. Results Regardless of age or sex of child, appraised maternal uninvolvement was associated with poorer adherence and quality of life, while appraised collaboration was associated with better adherence and metabolic control. There was evidence that the association between appraised collaboration and metabolic control was partially mediated by adherence. Appraised control was associated with poorer adherence among older, but not younger, children and with poorer quality of life among older females but not among older males or younger children of either sex. Conclusions Maintaining maternal involvement in diabetes care is important across ages 10 to 15, but the optimal form of this involvement may need to be adjusted to be consistent with the child's level of development. The present findings suggest that better adherence is seen across age when mothers are viewed as collaborating with, as opposed to controlling, their child when dealing with diabetes problems.

2025, Journal of Pediatric Psychology

Objective To examine whether individual differences and intraindividual (within-person day-to-day) fluctuations in late adolescents' self-regulation were associated with daily adherence to the type 1 diabetes regimen. Methods 110 school seniors (M age ¼ 17.78 years) and their mothers assessed adolescents' skills underlying self-regulation (executive function, attention, self-control, behavioral inhibition and activation, emotion regulation) and adherence, with glycosylated hemoglobin from medical records. Teens completed daily diaries reporting self-regulation failures surrounding monitoring blood glucose, adherence, and number of blood glucose checks each day for 14 days. Results Hierarchical Linear Models indicated that better daily adherence was associated with teen and mother reports of better self-regulation skills and teens' reports of fewer daily self-regulation failures. Daily adherence was unrelated to temperamental differences in behavioral inhibition and activation. Conclusions Results indicate that both individual and intraindividual differences in self-regulation contribute to daily adherence highlighting the importance of daily self-regulatory challenges to adherence.

2025, Journal of Pediatric Psychology

Scale (CPASS), a modified version of the adult 20-item Pain Anxiety S;.'mptoms Scale. Methods A community sample of children and adolescens (N-959) aged 8-18;'s215 completed the CPASS and measures of pain catastrophizing, anxiety sensitivity, and general anxiety. Factor structure was assessed using exploratory and confirmatory factor analyses (EFA and CFA). Results EFA yielded a one-and a rhree-facror solution using 17 items of the CPASS. CFA supported a hierarchical model for both a 20-item four-factor solution (based on the adult literature) and a 20-item slightly modified four-factor solution. The CPASS showed excel- lent internal consistency (Cronbach's alpha: .903) and good construct, discriminant, and concurrent validity. Conclusions This study provides support for the relevance of pain anxiety in a community sample of children and adolescens and offers preliminary validity and reliability for the CPASS.

2025, Journal of Pediatric Psychology

Objective To assess longitudinally the relations between four parenting styles (authoritative, authoritarian, uninvolved, and indulgent) and child weight status in Mexican American families. Methods Sixty-nine lowincome Mexican American mothers and their 4-to 8-year-old children participated in a 4-year longitudinal study. Mothers completed demographic and parenting measures. Children's body weight and height were assessed annually. Body mass index was calculated to determine weight status. Results At baseline, 65% of children were found to be normal weight, 14% were overweight, and 21% were obese. Analyses examined how parenting styles at baseline predicted child's weight status 3 years later, controlling for initial weight status. Children of indulgent mothers were more likely to become overweight 3 years later than children of authoritative or authoritarian mothers. Conclusions This study provides longitudinal evidence for the role of indulgent parenting in predicting overweight in Mexican American children. Possible mediating factors that may account for this relationship (e.g., dietary patterns, physical activity patterns, and children's self-regulation) are considered.

2025, Journal of Pediatric Psychology

Objective Children with type 1 diabetes and their parents face daily self-care demands, leading to diabetes-specific emotional distress. A standardized measure of diabetes distress can guide clinical care and prevent negative outcomes. Methods This study evaluated the psychometric properties of child-and parent-report measures of the Problem Areas in Diabetes Scale, adapted for children ages 8-12 (PAID-C) and their parents (P-PAID-C). Participants were from 42 diabetes camps in the United States. Children (N ¼ 804; mean age ¼ 10.3 6 1.1) and parents (N ¼ 968) completed measures of diabetes distress, diabetes-related strengths, and self-care skills. Half of the sample was used for exploratory factor analyses (EFA) with direct oblimin rotation and the other half for confirmatory factor analyses (CFAs). Results For the PAID-C, EFA and CFAs supported an 11-item two-factor measure, Cronbach's a ¼ .91, accounting for 54.6% of the variance. For the P-PAID-C, analyses resulted in a 16-item measure, Cronbach's a ¼ .92, accounting for 51.9% of the variance. PAID-C and P-PAID-C scores were positively correlated with HbA1c (r child ¼ .08, p ¼ .04; r parent ¼ .18, p < .001), and negatively correlated with diabetes-related strengths (r child ¼ À.38, p < .001, r parent ¼ À.29, p < .001) and parent report of child self-care skills (r parent ¼ À.13, p < .001; r child ¼ À0.07, p ¼ ns). Conclusions Initial psychometrics suggest that the PAID-C and P-PAID-C reliably and validly capture diabetes-specific emotional distress for children and their parents. Associations with glycemic control, self-care, and diabetes strengths demonstrate criterion validity. Both measures have potential applications for routine, clinic-based assessments of diabetes distress and may guide clinical decision-making.

2025, Journal of Pediatric Psychology

2025, Journal of Traumatic Stress

People respond differently to potentially traumatic events. To explore predictors of a chronic and delayed trajectory of posttraumatic stress symptoms after a natural disaster, psychometric data collected from 412 Christchurch residents, post the 2011, 6.3 magnitude earthquake were analysed. Participants from suburbs with different socioeconomic levels and quakes impacts completed a door-to-door survey 4-7 months after the earthquake (time 1, N=600) and again 10-11 months after the quake (time 2, N=412). The survey included the Acute Stress Disorder Scale, the Patient Health Questionnaire's 9-item depression scale and the Generalised Anxiety Disorder -7 scale, along with single item measures of variables like family tension. Hobfoll's Conservation of Resources theory was used to guide data interpretation. High depression (OR: 1.26) and anxiety (OR: 1.25) at time 1 significantly predicted membership to the chronic trajectory. Predictors of a delayed onset of symptoms were increased family tension (OR: 1.37) overtime and living in a low (OR: 4.55) or medium socio-economic area (OR: 11.94). Results highlight risk factors for elevated posttraumatic stress symtoms and resources that can be used by individuals to offset threatened loss. The findings have implications for service providers, agencies and the public.

2025, Journal of pediatric psychology

OBJECTIVE : This study aimed to identify children's long-term placement trajectories following early child welfare involvement and the association of these trajectories with subsequent physical and behavioral well-being. METHOD : Participants were 330 children who entered out-of-home care following a substantiated report of child abuse or neglect during infancy/early childhood and their caregivers. Participants were interviewed at child ages 4 and 12 years to assess children's physical and behavioral well-being and every 2 years in between to determine child placements. RESULTS : Latent Class Analyses identified four stable placement trajectories (i.e., adopted [32%], kinship care [15%], stable reunified [27%], and stable foster care [9%]), and two unstable trajectories (i.e., disrupted reunified [12%] and unstable foster care [5%]). Logistic regressions revealed that children in the unstable trajectories had significantly poorer physical and behavioral well-being than chi...

2025, Journal of Pediatric Psychology

Objective Evaluated the effects of a 10-month inpatient treatment program and implemented as a nondiet healthy lifestyle approach. In addition, the effects of two extended treatment programs were compared to a standard cognitive-behavioral treatment program for maintenance of the treatment gains. Methods A within-subjects design was employed to evaluate treatment outcome, including a 14-month follow-up. Children (N = 122) ranged in age from 7 to 17 years (M = 12.7 years) with a mean Body Mass Index (BMI) of 32.5, expressed as a percentage of overweight (M = 77.4%). Results The children lost 49.0% of their weight during the course of treatment. Comparing baseline with the 14-month follow-up, a weight loss of 31.7% was maintained. The children continued to show healthy eating behavior at followup, and their psychological well-being had improved. No significant interaction effects were found for the extended coping programs. Conclusion An inpatient cognitive-behavioral nondiet approach is a promising treatment option for childhood obesity, with lasting effects throughout the 14-month posttreatment.

2025, Journal of Pediatric Psychology

Objective To identify determinants of mothers' home-safety practices for preventing six types of common injuries to children (burns, poisoning, drowning, cuts, strangulation/suffocation/ choking, and falls). Methods Home interviews were conducted with mothers of children 19-24 and 25-30 months old about home-safety practices. For each of 30 safety precautions to prevent these six types of injuries, mothers indicated whether or not they engaged in the practice, and explained why. Results Regression analyses revealed both common and unique determinants of mothers' home-safety practices to prevent these six types of home injuries. For burns, cuts, and falls, beliefs that child characteristics and parent characteristics elevated the child's risk of injury were the key determinants of the mother's engaging in precautionary measures. For drowning, poisoning, and suffocation/strangulation/choking, health beliefs also contributed to predict mothers' practices, including beliefs about potential injury severity and extent of effort required to implement precautionary measures. Conclusions The factors that motivated mothers to engage in precautionary measures at home varied depending on the type of injury. Intervention programs to enhance maternal home-safety practices will need to target different factors depending on the type of injury to be addressed.

2025, Journal of Pediatric Psychology

Objective The individually delivered Supervising for Home Safety (SHS) program improves caregivers' injury-related beliefs and supervision practices. The current randomized controlled trial used a group delivery in a community setting and assessed program impact, feasibility, and acceptance. Methods Caregivers of 2-5-year-olds were randomized to receive either the SHS or an attention-matched control program. Results In the SHS group only, there were increases from baseline to postintervention in the following: beliefs about children's vulnerability to injury, caregiver preventability of injuries, and self-efficacy to do so; readiness for change in supervision; and watchful supervision. Face-to-face recruitment by staff at community organizations proved most successful. Caregivers' satisfaction ratings were high, as was caregiver engagement (95% completed at least seven of the nine sessions). Conclusion The SHS program can be delivered to groups of caregivers in community settings, is positively received by caregivers, and produces desirable changes that can be expected to improve caregivers' home safety practices.

2025, Journal of Pediatric Psychology

Objective-To examine the association between maternal cocaine use during pregnancy and physiological measures of regulation, which included heart rate (HR) and respiratory sinus arrhythmia (RSA). Methods-Potential mediators and moderators of this association were explored. Participants were 141 mother-infant dyads (77 cocaine exposed and 64 nonexposed) recruited at birth. Average infant HR and RSA was assessed at 4-8 weeks of age during a 15 minute period of sleep. Results-Results indicated a dose-dependent effect of prenatal exposure to cocaine on RSA. There was no evidence that fetal growth or other prenatal exposure to substances mediated this association or that fetal growth or maternal age moderated this association. Regression analyses also indicated that birth weight (BW), but not birthlength (BL), head circumference (HC) or other substance use, mediated the association between prenatal exposure to cocaine and heart rate. Conclusions-These results suggest that cocaine exposure is associated with physiological regulation at 4-8 weeks of age and highlight the importance of considering level of exposure when assessing infant outcomes.

2025, Journal of Pediatric Psychology

Objective This randomized controlled trial investigated the short-term effects of massage therapy on youth with SCD and their parents. Methods Thirty-four children and adolescents, and their parents were assigned to a massage therapy or an attention control group. Parents were trained in massage in their homes once a week for 4 weeks, with instructions to provide nightly massages. Families in the control group were visited weekly by a research assistant. Participants completed measures of depression and anxiety, functional status, pain intensity, medication use, and service utilization. Results Parents in the massage therapy group reported higher levels of depression and anxiety following the intervention. Youth in this group showed higher levels of functional status, and lower levels of depression, anxiety, and pain. Health service utilization rates were unchanged from pre-to post-intervention. Conclusions These results offer preliminary support for parent-delivered massage therapy as an intervention for SCD pain.

2025, Journal of Pediatric Psychology

Objective Families of youth with Sickle Cell Disease (SCD) can face psychosocial adversity in- cluding emotional distress, functional impairments, and sociodemographic risk factors. Systematic screening of psychosocial risk can identify families who may benefit from further assessment and evidence-based care. The Psychosocial Assessment Tool (PAT) is a brief caregiver-report screener based on the tri-level Pediatric Psychosocial Preventative Health Model (PPPHM). Methods Findings are presented from the baseline assessment of a longitudinal study validating a Sickle Cell version of the PAT 2.0. Primary caregivers of 136 youth with SCD receiving care through a multidisciplinary SCD clinic in a children's hospital completed the PAT and validation measures. A subset of 25 caregivers completed the PAT a second time within 3-5 weeks. Results Internal consistency for the total score was strong (a ¼ .87), and for the subscales was moderate to strong (a ¼ .74-.94), with the exception of the Family Structure (a ¼ .38), Caregiver Beliefs (a ¼ .48), and Stress Reactions (a ¼ .56) subscales. Test-retest reliability was also strong (r ¼ .86, p < .001). Moderate to strong correlations with all except two criteria measures provided validation for the total and subscale scores. Validation measures varied significantly across the three levels of the PPPHM. Conclusions Results provide support for the reliability and validity of the PAT in SCD. Systematic screening with the PAT can help identify families of youth with SCD at risk for psychosocial problems and potentially help connect them to appropriate services.

2025, Journal of Pediatric Psychology

ObjectiveFamilies of youth with Sickle Cell Disease (SCD) can face psychosocial adversity including emotional distress, functional impairments, and sociodemographic risk factors. Systematic screening of psychosocial risk can identify families who may benefit from further assessment and evidence-based care. The Psychosocial Assessment Tool (PAT) is a brief caregiver-report screener based on the tri-level Pediatric Psychosocial Preventative Health Model (PPPHM).MethodsFindings are presented from the baseline assessment of a longitudinal study validating a Sickle Cell version of the PAT 2.0. Primary caregivers of 136 youth with SCD receiving care through a multidisciplinary SCD clinic in a children’s hospital completed the PAT and validation measures. A subset of 25 caregivers completed the PAT a second time within 3–5 weeks.ResultsInternal consistency for the total score was strong (α = .87), and for the subscales was moderate to strong (α = .74–.94), with the exception of the Famil...

2025, GENDER DIFFERENCES IN EXTERNALIZING AND INTERNALIZING BEHAVIORS AMONG CHILDREN AND ADOLESCENTS WITH CONGENITAL HEART DISEASE

To determine gender differences in externalizing and internalizing behaviors among Children and Adolescents with congenital heart disease (CHD) in Pakistan. A comparative group design was used to study variables. The study was conducted at the Faisalabad Institute of Cardiology from January 2021 to December 2021. A sample of 326 children and adolescents diagnosed with cyanotic and acyanotic CHD was studied to assess the internalizing and externalizing problems in different types of CHD. The strength and Difficulty questionnaire was used to measure the emotional behavioral issues. Parent-reported form for children below 7 years of age and self-report for above 7 years was used. Detailed history and baseline demographics were recorded. The results explained that 49.1% of the CHD population is in the clinical range of externalizing and internalizing problems. The comparison of gender mean difference shows that the male population suffers more as compared to female (p<.05). Whereas no difference was found in internalizing problems in both genders while males have more externalizing issues and females are better in prosocial behavior as compared to male counterparts. Children and adolescents with cyanotic CHD have more clinical range of emotional and behavioral issues(p<.01). Children and adolescents now have a longer life as compared to previous decades but with this growing age and having a congenital condition, they are having problems in their psychological health which is in need of assessment and repair.

2025, Journal of Pediatric Psychology

Explored informant differences and assessed the importance of sociodemographic factors, child health status characteristics, and caregiver burden to variability in psychological symptoms among caregivers to 116 children with chronic medical conditions. Important informant effects were found. Caregiverreported, but not physician-reported, burden was an important predictor. Severity of illness, whether rated by physician or caregiver, had little predictive effect whereas child impairment predicted greater distress, independent of sociodemographics. Lower family income and female child sex predicted caregiver distress independent of other variables. Even among families with higher income, those with the lowest income report much higher distress. Results are discussed in terms of the importance of informant choice and the use of sociodemographics as primary rather than control variables in studies of the families of chronically ill children.

2025, Journal of Pediatric Psychology

sibling and the mother in the use of empirically supported behavioral and cognitive behavior techniques within a clinical setting, and it identifies cultural and linguistic factors relevant to the intervention. Psychological interventions have been proven to be effective in reducing pain responses and anxiety in children who require intravenous access for cancer treatment (e.g., ), but they have not been implemented during port-access. The majority of children undergoing painful procedures, however, do not engage in effective coping strategies unless prompted to do so by an adult . The use of a parent as co-therapist for pain and distress reduction during painful procedures has been suggested (e.g., Blount, et al.,