Journal of Pediatric Psychology最新文献

Objective: Parents of children with special healthcare needs (CSHCNs) tend to report low health-related quality of life (HRQoL) in general, however, little is known about parents' day-to-day experiences particularly while their child is in the hospital. Hospital experiences are especially important for families of CSHCN, who are known to spend a considerable amount of time at the hospital. The goals of this study were to examine how daily HRQoL fluctuates in parent caregivers, and to further examine the role of context (hospital vs. home) in daily HRQoL.

Method: One hundred parents of CSHCN (18-69 years, M = 38.12, SD = 8.64) were recruited to participate in the TRIUMPH study (To Research, Illuminate, and Understand Medical Parent Health) from inpatient pediatric units at one children's hospital. For 14 consecutive days, participants received email prompts to complete online survey measures reporting on their daily HRQoL.

Results: Multilevel models indicated that daily HRQoL fluctuated significantly at both between- and within-person levels. Further, daily HRQoL was significantly lower and had significantly more within-person variability on hospital days as compared to home days.

Conclusions: Our results indicated that parents' HRQoL is both poorer and more volatile within the hospital environment. Our results call attention to the need to assess intraindividual variability in parents of CSHCN, as it is clear that parent caregivers are a nuanced population with contextually relevant support needs.

Objective: Burn injuries are a common form of unintentional childhood injury. The psychological sequelae of pediatric burn injury on the injured child and caregivers can be significant, including traumatic stress, anxiety, and depression. Factors such as parent capacity for monitoring and child ADHD (attention-deficit/hyperactivity disorder) symptoms can significantly increase the risk of injury in early childhood. A dual-foci intervention was created to improve family functioning and coping after a burn injury. The current proof-of-concept study examines the Bouncing Back Better (BBB) intervention, which targets parent mood and child externalizing behaviors after unintentional burn injury.

Methods: BBB intervention was completed by 10 parent-child dyads (12 enrolled). Inclusion comprised children (2-5 years) who sustained an unintentional burn injury and demonstrated hyperactivity symptoms upon standard clinical care psychosocial screening. BBB included four (30-45 min) sessions that involve CBT-focused behavioral intervention skills. Feasibility was assessed through recruitment, enrollment, and retention rates. Acceptability was assessed through satisfaction questionnaires and qualitative interviews. Proof-of-concept was demonstrated through analyses of findings from validated measures of depression, distress, and ADHD symptoms.

Results: Findings support acceptability and feasibility of the intervention and provide evidence of a successful proof-of-concept by demonstrating significant decreases in reported parental depression symptoms and improvements in child inattentive and hyperactive behaviors.

Conclusions: An intervention focused on both caregiver well-being and child behaviors improves overall family functioning. Future research aims to expand the BBB intervention to a larger sample and examine initial efficacy through pilot testing using a randomized design and a larger team of treatment providers.

Objective: Caregivers of children in child welfare encounter many unique challenges, increasing their potential risk for caregiver stress. To support children and their caregivers, providers must accurately assess caregiver stress before they can deliver a brief intervention or make an appropriate referral. The current study utilized the PedsQL Family Impact Module to assess foster and kinship caregiver's well-being. Method: This study assessed the construct validity of PedsQL FIM through confirmatory factor analysis, mean differences between medically complex and noncomplex children, and its correlation with child behavior problems in caregivers of children in child welfare.

Results: Caregivers reported above-average well-being. The factor structure of PedsQL FIM did not fit the data well, and no differences in well-being were found between caregivers of medically complex and noncomplex children. Small correlations (r = 0.14-0.26) were found between caregiver well-being and child externalizing problems.

Conclusions: Although the PedsQL FIM has demonstrated reliability and validity within other special populations, the use of the PedsQL FIM to assess well-being of caregivers of children in child welfare needs further exploration to ensure its validity with these caregivers.

Objectives: Caregivers of children with appearance-affecting conditions or injuries can experience common psychosocial challenges, regardless of the cause or nature of their child's visible difference. Despite these common challenges, there is a lack of evidence-based cross-condition support for caregivers of children with visible differences.

Methods: A self-guided acceptance and commitment therapy-based e-book intervention was developed utilizing a Participatory Action Research approach. Twenty-two caregivers of children with a range of visible differences reviewed the full pilot e-book intervention and responded to an online acceptability survey.

Results: While several changes aimed at increasing the accessibility of the intervention materials were discussed, overall the feedback suggested that The Visible Difference Parenting Toolkit addressed an unmet support need. Both the content and the format of the intervention were found to be acceptable by parents, with ehealth Impact Questionnaire scores of >80. Participants recommended specific changes related to accessibility including adding features such as hyperlinks and a search bar to enable users to navigate the e-book.

Conclusions: Caregivers reported that the content of The Visible Difference Parenting Toolkit was relevant to their lived experiences of caring for a child with a visible difference. Parents also reported that the presentation and format of The Visible Difference Parenting Toolkit was clear and accessible. The intervention addresses a previously unmet support need and is an acceptable intervention for caregivers of children with a visible difference.

Objective: Increasing numbers of caregivers in the United States face challenges caring for children with special health care needs. Research has identified unique challenges for caregivers, including limited resources and mental health issues. Caregiver burden involves various strains from the ongoing care of a loved one. This scoping review explored the emotional, financial, physical, and social dimensions of burden among caregivers of children with multiple conditions. It also examined study characteristics, measurement tools, and associations among constructs.

Method: A scoping review followed PRISMA-ScR guidelines using PubMed and PsycINFO for literature searches focused on caregiver burden and experiences.

Results: Eighteen studies met inclusion criteria with three categories emerging: studies on children with medical complexity (n = 3), varied pediatric conditions (n = 7), and specific conditions (n = 8). Significant associations between caregiver burden and the number of co-occurring conditions were noted overall, as well as differences in burden for caregivers of children with and without co-occurring conditions.

Conclusions: This review discusses the general findings, strengths, and limitations of the existing body of research. Future research should aim for more diverse samples and assess caregiver burden longitudinally. Pediatric psychologists should work to assess and reduce caregiver burden in families, especially for caregivers whose children have multiple diagnoses.

Objective: To evaluate the feasibility of a multi-state randomized control trial (RCT) evaluating iAmHealthy, a rurally tailored pediatric obesity treatment delivered via synchronous televideo. This study's primary outcomes included the evaluation of participant retention and the efficacy of blinding. Each intervention arm was hypothesized to retain >75% of randomized participants and preserve blinding. Additionally, the intervention's preliminary effectiveness was evaluated by comparing changes in health outcomes.

Methods: Youth aged 6-11 years with a body mass index (BMI) percentile ≥85th and their caregivers were recruited from rural communities across four states participating in the Environmental Influences on Child Health Outcomes IDeA States Pediatric Clinical Trials Network. One hundred four dyads were randomly assigned to iAmHealthy plus newsletter or newsletter-only control. Retention rates for each treatment arm were calculated. Blinding was assessed via the New Blinding Index (NBI). Child and parent BMI, child physical activity, and child dietary intake were assessed at baseline and post-treatment (6 months).

Results: A one-sample test of proportions indicated retention rates exceeded 75% for iAmHealthy (87%, p = .027) and control (96%, p < .001). Blinding was successful for both groups [iAmHealthy NBI = -0.12, 95% confidence interval (CI): -0.13 to 0.36; control NBI = 0.02, 95% CI: -0.24 to 0.28]. There were no significant differences in health outcomes.

Conclusions: This iAmHealthy multi-state feasibility RCT demonstrated high retention and successful blinding of assessors. Although the study was not powered to detect health outcome differences, iAmHealthy exhibited a tendency toward greater improvement or attenuated declines in child health outcomes, which supports the conduct of a future fully powered RCT.

Clinicaltrials.gov identifier: NCT04142034, Registered: 10-25-2019; Trial name: Feasibility Trial of the iAmHealthy Intervention; https://clinicaltrials.gov/study/NCT04142034?cond=iamhealthy&checkSpell=false&rank=1.

Objective: To systematically review the literature on the implementation and effectiveness of story-based interventions for youth with chronic conditions to improve health-related outcomes.

Methods: The protocol for this review was registered with PROSPERO: CRD42024550328. A comprehensive search was conducted across PubMed, CINHAL, EMBASE, and Web of Science. Databases were searched from inception to June 2024. Studies were included if the intervention was story-based, the sample had a mean or median age between 11 and 25, and participants had a chronic condition. Studies were limited to quantitative and mixed methods. Three reviewers independently screened abstracts and full text for eligibility. Risk of bias was assessed using the Mixed Methods Appraisal Tool. Effect sizes were extracted or calculated. Reported qualitative findings were narratively synthesized.

Results: Of the 3,797 articles screened, 7 articles met the inclusion criteria. Considerable variation existed across studies in intervention goals, components, and outcomes assessed. Notable impacts were related to improvement in distress and depressive symptoms. Intervention strategies ranged from autobiographical writing to digital formats such as video narratives and online participatory community sites. Interventions demonstrated mixed impact in improving health-related outcomes with effect sizes ranging from -0.54 to 5.50.

Conclusion: Story-based interventions focused on youth with chronic illness provide promising means to elicit relevant experiences and impact health outcomes. The knowledge base is in a formative stage and characterized by multicomponent interventions with research designs that do not support strong causal inference. Further research is warranted to replicate outcomes and understand active intervention components.

Objective: The study updated a meta-analysis on emotional and behavioral problems among children with chronic physical health conditions (CPHCs) as assessed with the Achenbach System of Empirically Based Assessment.

Method: A systematic search in electronic databases (PsycInfo, Medline, Web of Science, and PSYNDEX) identified 1,337 studies that were analyzed with multilevel meta-analysis.

Results: Young people with CPHCs had, on average, higher levels of internalizing (g = .51 standard mean difference), externalizing (g = .25), and total behavior problems (g = .49) than peers without CPHCs or test norms. Elevations of total problems were larger than in the past meta-analysis. The largest elevations of internalizing problems were found for chronic fatigue syndrome, while the largest elevations of total problems and externalizing problems were observed in the case of thalassemia. Effect sizes tended to be larger when parent reports were used rather than adolescent self-reports. Effect sizes also varied by country and, in part, by duration of the CPHCs, sampling, target of comparison, equivalence of the compared groups, response rate, age, and gender.

Conclusions: The results call for regular screening for psychological distress in children with CPHCs.