Journal of Pediatric Psychology最新文献

Objectives: Depression is prevalent, impairing, and detrimental to health. The objective of this systematic review and meta-analysis was to assess the efficacy of psychological interventions for decreasing symptoms of depression among young people with long-term physical health conditions.

Methods: CENTRAL, MEDLINE, PsycINFO, PubMed, clinicaltrials.gov, and WHO ICTRIP were searched through July 1, 2023. Selection criteria were randomized controlled trials of psychological interventions targeting depression symptoms among people ≤29 years diagnosed with long-term physical health conditions. Risk of bias was assessed using the Cochrane RoB version 2 tool. Outcome data were analyzed using fixed-effects models. Pooled standardized mean difference (SMD) between experimental and control was calculated using an inverse variance approach with a linear model. Heterogeneity was assessed by χ2 test on Cochran's Q statistic and quantified with I2 statistic.

Results: Results included six trials (N = 376) of 11- to 18-year-olds (Mfemale=80%), recruited from pediatric clinics in the United States. Two of six eligible studies had an inclusion criterion related to elevated depression symptoms; the remainder included youth with heterogeneous depression levels. Psychological interventions were more efficacious than controls for reducing depression symptoms and functional disability. Pooled SMD for depression symptoms was -.30 (-.51, -.10), with a significant overall effect (Z = 2.92, p = .004). Pooled SMD for functional disability was -.35 (-.66, -.05), with a significant overall effect (Z = 2.28, p = .02). Moderate study heterogeneity was noted in two study outcomes.

Conclusions: Psychological interventions reduce depression symptoms and functional disability among youth with long-term physical health conditions. Research is needed to elucidate participant/trial characteristics contributing to outcomes.

Objective: Cognitive-behavioral (CBT) interventions combined with either a physical activity (CBT+PA) or exercise intervention (CBT+Ex) are becoming more common in pediatric populations. Considering the independent effects of PA and exercise on health and psychological outcomes, it is unclear whether CBT alone differs from CBT+PA or CBT+Ex in efficacy. The main objective of this systematic review and meta-analysis of randomized clinical trials (RCTs) was to assess the efficacy of CBT+PA and CBT+Ex interventions in pediatric chronic disease.

Method: This review included RCTs in children (≤18 years) with a chronic condition, a CBT+Ex or CBT+PA intervention, and an objective measure of PA&Ex. Seven databases were searched using MeSH terms and key terms and included studies published before July 1, 2023. Abstracts were reviewed for inclusion by two independent reviewers, data was extracted by three independent reviewers. Risk of bias (RoB 2) and study quality were coded. Random effect meta-analyses of differences in between-group change in PA&Ex were conducted.

Results: Eligible studies (k = 5) reported outcomes for a combined 446 children. A small, nonsignificant overall effect was found (d = 0.10, 95% CI -0.16, 0.35) indicating intervention groups (CBT+PA or CBT+Ex) increased engagement in PA&Ex more than comparator groups (CBT). Additional analyses were inconclusive due to the small number of eligible studies.

Discussion: Additional RCTs are needed with integrated PA&Ex interventions targeting pediatric chronic disease. Future trials should report more detailed PA&Ex data. The full protocol for this analysis was prospectively registered in Open Science Framework (project ID: osf.io/m4wtc).

Objective: To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) of behavioral interventions for sleep disruption in children with neurodevelopmental and medical conditions.

Methods: A comprehensive literature search was designed and run for studies published between 1970 and July 1, 2023. Original, peer-reviewed RCTs of children ages birth to 18 years with/at risk for sleep disruption and a neurodevelopmental and/or medical condition were included. Interventions without behavioral components, lifestyle interventions, or pharmaceutical interventions were excluded. Primary outcomes included sleep health domains, and secondary outcomes were condition symptomatology and quality of life.

Results: Data from 15 RCTs were examined (1,374 participants, 78% male, 71% White). Sleep disruptions were predominantly insomnia symptoms. Intervention content included parent training, sleep hygiene education, and relaxation strategies. Adaptations to the interventions for use in children with neurodevelopmental and/or medical conditions included behavioral strategies commonly used in those conditions, sleep education specific to the condition, and/or use of case examples specific to the condition. No studies reported on adverse effects. Behavioral sleep interventions had a significant effect on sleep satisfaction, bedtime resistance, and ADHD symptoms at postintervention. At follow-up, effects were maintained only for sleep satisfaction. Parent rating of child sleep duration improved at follow-up but not postintervention.

Conclusions: Despite being at high risk for comorbid sleep disruption, children with neurodevelopmental and/or medical conditions are underrepresented in the sleep intervention literature. Future research is needed with larger, more diverse samples and increased methodological rigor to address sleep disruption in these pediatric populations.

Protocol registration: Open Science Framework Preregistration doi.org/10.17605/OSF.IO/KE58C, date of registration December 9, 2023.

Researchers by default tend to choose complex models when analyzing nonindependent response variable data, this may be particularly applicable in the analysis of longitudinal trial data, possibly due to the ability of such models to easily address missing data by default. Both maximum-likelihood (ML) estimation and multiple imputation (MI) are well-known to be acceptable methods for handling missing data, but much of the recently published quantitative literature has addressed questions regarding the research designs and circumstances under which one should be chosen over the other. The purpose of this article is threefold. First, to clearly define the assumptions underlying three common longitudinal trial data analysis models for continuous dependent variable data: repeated measures analysis of covariance (RM-ANCOVA), generalized estimating equation (GEE), and a longitudinal linear mixed model (LLMM). Second, to clarify when ML or MI should be chosen, and to introduce researchers to an easy-to-use, empirically well-validated, and freely available missing data multiple imputation program: BLIMP. Third, to show how missing longitudinal trial data can be handled in the three data analysis models using three popular statistical analysis software packages (SPSS, Stata, and R) while keeping the published quantitative research in mind.

Objective: To provide pragmatic guidance on data analysis, integration, and reporting guidance for investigators new to mixed methods research.

Methods: Three core mixed methods designs (convergent, explanatory sequential, and exploratory sequential) are described. Key decision points related to data integration-specifying intent, data selection, data preparation, integration strategies, use of analysis software, reporting-are explained, including comparison of decision points across the different mixed methods designs.

Results: Recommendations for addressing key decisions during analysis are provided and supported with published examples from mixed methods studies focused on pediatric populations.

Conclusions: Integration of qualitative and quantitative data is the defining characteristic of mixed methods research but can be challenging to fully achieve and adequately report. Decision-making about the aims of the mixed methods analysis and how they will be achieved should begin early in the research process through collaboration among team members' with expertise and experience in qualitative, quantitative, and mixed methods studies. A variety of approaches to data integration and write-up of the integrated results can be taken and are reviewed in the current manuscript.

Objective: We evaluated the effectiveness of SIBS, a preventive intervention for siblings and parents of children with chronic disorders (CDs).

Methods: This two-arm, unmasked cluster randomized controlled trial registered on ClinicalTrials.gov (NCT04056884), included 288 siblings (M age = 10.4 years, SD = 1.9) and parents of children with CDs (mainly neurodevelopmental disorders) randomly assigned to intervention (k = 34, n = 137) or waitlist control (k = 35, n = 151) groups. Eligible siblings were aged 8-16 years and had a sibling diagnosed with a CD. SIBS is manual-based and was delivered as five sessions over 2 weeks in primary care and hospital settings across Norway. Three sessions are separate for siblings and parents, and two are integrated sibling-parent dialogues. The primary outcome was sibling mental health, rated by siblings, parents, and teachers. The secondary outcome was parent-child communication, rated by siblings and parents. Analyses included intention-to-treat (ITT) and complier average causal effects (CACE).

Results: Although not statistically significant, at 3-month follow-up, the intervention group showed fewer mental health problems (ITT: sibling-rated d = -0.16, 95% CI [-0.49, 0.17]; parent-rated d = -0.10, 95% CI [-0.48, 0.12]; teacher-rated d = -0.18, 95% CI [-0.50, 0.29]) and higher-quality parent-child communication (ITT: sibling-rated d = 0.21, 95% CI [-0.10, 0.52]; parent-rated d = 0.24, 95% CI [-0.07, 0.55]) compared to waitlist.

Conclusions: The SIBS intervention demonstrated small, consistent positive effects on sibling mental health and parent-child communication. This suggests SIBS is a promising preventive program for siblings of children with CDs.

Objective: To evaluate associations between peer relationship factors (i.e., quality and quantity) and mental and physical health outcomes in youth with spina bifida (SB).

Methods: One hundred and forty youth with SB (Mage = 11.43; 53.6% female) were recruited as part of a larger longitudinal study. Families of youth with SB were invited to ask the child's closest friend to participate. The study included questionnaire (youth- and parent-report) and observational peer interaction data.

Results: Observational peer interaction data were associated with mental and physical health in youth with SB. The number of friends was negatively associated with withdrawn/depressed behavior. Self-reported friendship quality and peer emotional support were not associated with physical health outcomes in youth with SB. However, peer emotional support was positively associated with emotional quality of life.

Conclusions: Friendship quality, particularly observed peer interaction characteristics, was associated with better mental and physical health adjustment. The quantity of friendships was not associated with physical health outcomes but was associated with mental health outcomes. Findings have implications for clinical interventions geared toward improving social functioning in youth with SB.

Objective: Sickle cell disease (SCD), the most common genetic disorder in the United States, disproportionately affects Black individuals. A major aspect of SCD is the experience of vaso-occlusive episodes, a feature often characterized by debilitating pain which may necessitate emergency department (ED) visits. In the ED, adults with SCD often experience discrimination due to intersecting identities of race and disease status. Considerably less is known about experiences of discrimination for youth with SCD. This review aims to: (1) critically examine available research on the experiences of discrimination and stigma among youth with SCD in the United States, (2) describe measures currently used to assess pediatric stigma and/or discrimination, and (3) identify gaps in the literature to guide research.

Method: We conducted a scoping review using a modified version of the Preferred Reporting Items for Systematic Review (PRISMA) and Meta-Analyses guidelines. Data were searched from database inception to May 2023. Initially, 285 articles were retrieved; after duplicate removal, 214 articles remained.

Results: Reports of stigma varied by informant (i.e., caregiver, youth, or providers), method (i.e., qualitative or quantitative), and measure.

Conclusions: A better understanding of experiences of stigma and discrimination across development for youth with SCD is needed. Research aimed at reducing stigma and discrimination and its consequences in youth with SCD is warranted to enhance quality of life and improve health outcomes.

Objective: We evaluated feasibility, acceptability, and fidelity of motivational interviewing (MI) designed to increase neonatal intensive care unit (NICU) presence among ethnically/linguistically/racially diverse mothers. We also assessed study design feasibility to inform a larger, future randomized controlled trial.

Method: We randomized 95 mothers to receive MI (intervention condition) or treatment as usual (control condition) during their baby's Level IV NICU admission. Eligibility criteria included mothers' adult age, English- and/or Spanish-language proficiency, and having a NICU-hospitalized infant. Using single-blind methodology, we assigned mothers to receive MI (n = 47) or treatment-as-usual (n = 42). Mothers rated intervention satisfaction, the extent to which MI motivated their NICU presence, and their openness to additional MI intervention. We evaluated MI fidelity to further assess MI feasibility.

Results: Of 131 eligible mothers, 72.5% enrolled. Motivational interviewing-arm mothers received 1-6 weekly MI sessions. Regarding MI-arm mothers, 100% agreed to subsequent MI intervention, and 90% reported strong MI satisfaction. Eighty-seven percent of mothers reported that MI motivated them to be present in the NICU. Motivational interviewing interventionists achieved expert proficiency for 72.7% of coded MI sessions and basic competency for the remaining 27.3% of coded sessions. Mothers' MI perceptions did not differ by ethnic or linguistic groups.

Conclusions: Motivational interviewing was feasible and highly acceptable across all ethnic/linguistic/racial groups, making MI a promising intervention to increase maternal NICU presence among mothers from traditionally marginalized groups. Future research should evaluate the extent to which MI can increase maternal NICU presence and enhance infant (e.g., medical/developmental) and maternal (e.g., postpartum depression, infant bonding) outcomes.

Objective: To compare adolescents in the United Kingdom with chronic pain with their peers in relation to psychological and behavioral outcomes (i.e., mental health, bullying, substance use) and academic achievement.

Methods: Participants were adolescents with chronic pain (n = 856) and peers without chronic pain (n = 3,093) from the Avon Longitudinal Study of Parents and Children (ALSPAC) who attended a research clinic in the United Kingdom at 17 years and completed data collection at multiple timepoints. Chi-square and t-tests were used to explore group differences across psychological and behavioral measures. Regression and mediation analyses examined the relationship between chronic pain and academic achievement measures, including the derived variables of pathway to higher education and educational qualifications.

Results: Adolescents with chronic pain were found to experience more difficulties with mental health, bullying, and substance use. Additionally, a relationship between chronic pain and reporting a pathway to higher education was found after key variables were accounted for, although group differences were not observed across other academic achievement measures. Further analyses identified a moderate indirect effect of chronic pain on reporting a pathway to higher education when mediated by sleep difficulties.

Conclusions: The limited predictive relationship between chronic pain and academic achievement potentially indicates that, despite struggling more with factors such as mental health, bullying, and substance use, adolescents with chronic pain may utilize enhanced skills in maintaining a developmental trajectory at school or external factors such as support from their caregivers or school. The complex interrelationship between sleep and chronic pain is also an important consideration for the ability to achieve academically.