Journal of Pediatric Psychology最新文献

Objective: Children treated for cancer and their caregivers exhibit considerable resilience, yet a subset are at risk for adjustment difficulties. Limited research has utilized a resilience-based theoretical framework, conceptualized as the process of harnessing resources. Grit, defined as perseverance and passion toward long-term goals, is one internal resource to consider. The present study investigates the role of caregiver grit in caregiver and child psychological adjustment following a pediatric cancer diagnosis.

Methods: Participants were caregivers of children within 1 year of a cancer diagnosis (meandays = 105.9, SD = 75.04). Parents provided self-reports of grit and posttraumatic stress symptoms and proxy-reports of their child's behavioral and emotional symptoms.

Results: On average, caregivers (N = 107, 89.6% female, 73.4% White, 42.6% college or higher degree) reported a grit score of 3.40 (SD = 0.67), comparable to the general population. A subset of participants (46.7% of caregivers and 21.5% of children) had psychosocial symptoms above clinical cut-offs. Higher caregiver grit was associated with lower caregiver posttraumatic stress symptoms (F(1,79) = 13.77, p < .001, R2 = 14.8%) and lower child psychological difficulties, F(1,70) = 18.78, p < .001, R2 = 21.2%. Caregiver posttraumatic stress symptoms mediated the relationship between caregiver grit and child psychological difficulties (β = -0.23, 95%BC [-0.47, -0.04]).

Conclusion: Among families affected by pediatric cancer, higher levels of caregiver grit were associated with lower caregiver posttraumatic stress symptoms, and in turn, lower child psychological difficulties. Results suggest that grit is a potential target for promoting both caregiver and child resilience in pediatric cancer services. Longitudinal research should examine how caregivers harness grit, as a possible component of resilience, throughout the cancer treatment and survivorship trajectory.

Objective: In addition to the physical challenges of juvenile idiopathic arthritis (JIA), youth with JIA also experience a range of psychosocial sequalae, which requires further attention. This meta-analysis aimed to compare the psychosocial outcomes of youth with JIA to healthy peers and other illness groups.

Method: The protocol for this review was registered on PROSPERO (ID CRD42022348012). Seven electronic databases were searched from date of inception to February 20, 2024. Eligible studies reported on the health-related quality of life (HRQoL) or psychological outcomes of youth (<18 years) with JIA and included a comparison group. A modified Downs and Black Checklist was used to evaluate each study's quality. This research was supported by an Australian Government Research Training Program (RTP) Scholarship.

Results: Fifty-six studies met inclusion criteria, representing a total of 335,708 participants. Compared to healthy controls, youth with JIA had more internalizing problems (g = 0.35, 95% confidence interval [CI] 0.13-0.57) and psychiatric diagnoses (g = 0.29, 95% CI 0.18-0.41), but did not differ on anxiety and depression symptoms. Relative to other illnesses, those with JIA had less anxiety (g = -0.26, 95% CI -0.42 to -0.10) and depressive symptoms (g = -0.51, 95% CI -0.73 to -0.30), but were similar in internalizing problems and psychiatric diagnoses. HRQoL was impaired relative to healthy peers overall (g = 0.74, 95% CI 0.46-1.02) and specifically in the physical domain (g = -0.89, 95% CI -1.18 to -0.60) and psychosocial domain (g = -0.53, 95% CI -0.68 to -0.37). Compared to other illnesses, youth with JIA had poorer physical (g = 0.79, 95% CI 0.03-1.55) and psychosocial HRQoL (g = 0.53, 95% CI 0.04-1.02). The quality of studies included were moderate but were limited by their poor external validity.

Conclusions: Although youth with JIA had more internalizing problems and psychiatric diagnoses than healthy peers, they also demonstrated psychological resilience for anxiety and depression symptoms. However, they face large disparities in their HRQoL compared to both healthy youth and youth with other health conditions.

Objective: This three-arm pragmatic control trial tested the effectiveness of a single-dose evidence-based psychological intervention (EBPI) with and without a sleep kit (treatment arms) to usual care (control arm) among young people (ages 2-20 years) new to a foster care placement.

Methods: Caregivers and youth were screened for sleep concerns before their foster care clinic visit; if a concern was identified, enrolled young people and caregivers (N = 177) completed sleep assessments before the start of their clinic visit. On days when a psychologist was unavailable to address sleep concerns, participants were enrolled in the control arm. When a psychologist was present, clinic days were randomly assigned to condition (EBPI, EBPI + sleep kit). Participants and clinicians were masked to treatment arm during the clinician portion of their visit. Participants were unmasked at the end of their visit. At follow-up visits, surveys assessing sleep were re-administered. Chart reviews captured documented sleep concerns at clinic visits outside the foster care clinic in the 6 months following intervention.

Results: Compared to controls, those receiving EBPI reported less medicinal sleep aid use (e.g., melatonin) following intervention. Sleep concerns persisted in approximately half of enrolled youth and did not vary by study assignment; sleep outcomes were also similar.

Conclusions: A single-dose EBPI to address sleep concerns may be effective for reducing use of medicinal sleep aids but is not effective for addressing sleep concerns more generally for young people in foster care.

Objective: Chronic skin conditions contribute to psychosocial difficulties and reduced child/parent quality of life, impacting condition management and disease control. The objective of this systematic review was to summarize the literature on psychosocial interventions (interventions that therapeutically target psychological/social processes to improve outcomes) for children with chronic dermatological conditions and their families.

Methods: Searches of five electronic databases (CINAHL, PubMed, PsycINFO, Scopus, The Cochrane Library, Web of Science) identified relevant articles published from dates of inception to April 8, 2024, and reference lists were searched for additional relevant articles. Primary outcomes were disease/symptom severity and child quality of life. Interventions could be delivered in any format via controlled or uncontrolled studies. Articles had to report pre-post-intervention data and be published in English.

Results: The review identified 10 eligible studies (reported in 12 papers) involving 2,346 families from seven countries. All reported on interventions for families of children with atopic dermatitis; none examined interventions for any other dermatological conditions. Eight studies evaluated face-to-face group-delivered interventions, and two studies evaluated self-directed online interventions. Meta-analyses revealed a significant effect on disease/symptom severity (standard mean difference = -0.34, 95% confidence interval = -0.53 to -0.15, z = 3.50, p < .001, I2 = 74%) but no significant effect on children's quality of life (standard mean difference = -0.09, 95% confidence interval = -0.26 to 0.09, z = 0.99, p = .32, I2 = 42%). Effects on secondary (parent and family) and other outcomes were mixed.

Conclusions: Psychosocial interventions may help to improve disease/symptom severity and other important outcomes for families of children with atopic dermatitis. Future research should examine efficacy in other pediatric dermatological conditions.

Objective: This systematic review focused on identifying and evaluating assessment tools used to measure outcomes of psychological interventions for pediatric functional neurological disorder (FND).

Method: A comprehensive search was conducted on September 24, 2024, across Web of Science, PsycINFO, and Medline. Studies were included if they involved individuals under 18 with FND diagnosis, utilized a psychological intervention, and assessed treatment outcomes using validated measures. Sixteen studies qualified for inclusion, and 26 different assessment instruments were identified. These were assessed against the Core Outcome Measures in Effectiveness Trials framework, covering symptoms, life impact, and resource utilization. The psychometric characteristics of these assessment tools were examined through further searches which concentrated on reliability, validity, and factorial invariance. The Joanna Briggs Institute critical appraisal tools were used to evaluate the risk of bias. Findings were synthesized narratively due to the descriptive and exploratory nature of the research aims.

Results: No outcome assessment tools designed specifically for pediatric FND populations were identified. Most studies employed measures targeting mental health symptoms and life impact, however, none of these tools were validated with FND samples, and several lacked validation in pediatric populations.

Conclusions: This review highlights significant gaps, including the need for psychometric assessment of tools and validation studies on FND samples. The current evidence does not support recommending FND-specific measures due to their limited development and validation. Instead, using existing questionnaires validated on broader pediatric populations is recommended. Research should prioritize the validation of measures in FND populations to establish more robust, standardized tools for clinical and research use.

Objective: Disordered eating behaviors (DEB) are more common among adolescents with type 1 diabetes (T1D) relative to the general population, potentially influenced by disease-specific risk factors. This study aims to examine associations among proposed risk factors in the modified dual pathway model and to identify literature-supported adaptations to improve the model's fit for adolescents with T1D.

Methods: The study included 215 adolescents and young adults with T1D (age 13-21 years; 51.2% female). Data were collected from medical charts, diabetes device data, and self-report questionnaires assessing diabetes-specific dietary regimen, dietary restraint, body dissatisfaction, hunger disruption, diabetes-specific negative affect, and DEB. Multiple group path modeling tested the hypotheses.

Results: The original modified dual pathway model showed poor fit. However, adding a well supported, theory-based path and omitting nonsignificant paths improved model fit. Dietary restraint and diabetes-specific negative affect were significantly associated with DEB. Significant indirect paths to DEB emerged from a diabetes-specific dietary regimen via dietary restraint, and from body dissatisfaction via both dietary restraint and diabetes-specific negative affect.

Conclusions: This study supports the associations proposed in the modified dual pathway model and highlights the potential for targeted interventions addressing disease-specific risk factors for DEB, including diabetes-specific dietary regimen, dietary restraint, accelerated weight gain since T1D diagnosis, body dissatisfaction, and diabetes-specific negative affect in adolescents with T1D. These findings underscore the need for strategies that focus on the unique psychological and physiological challenges faced by this population. Longitudinal studies are needed to test the temporal ordering of constructs and identify mechanistic pathways for intervention.

Objectives: To advance the science of health intervention research, pediatric psychologists must carefully design and conduct intervention research studies, including clinical trials. In contrast to guidance about scientific rigor in the selection of comparator groups in clinical trials, far less has been published on equity considerations in this process. The purpose of this paper is to review considerations for centering both equity and rigor in the study design decision, with a focus on the selection of comparator conditions for clinical trials of pediatric psychology interventions and propose potential solutions.

Methods: We reviewed existing guidance on (1) intervention study design with a focus on selection of comparator conditions from health psychology, medicine, and other similar fields, and (2) integration of both rigor and equity considerations into the design of intervention studies.

Results: We present a range of options for study design choices regarding comparator conditions and discuss potential benefits, limitations, and practical considerations for each type of comparator condition. Examples from behavioral intervention trials in pediatric type 1 diabetes or type 2 diabetes were used to illustrate how each comparator condition functions in practice. We developed a practical guide for researchers to consider both rigor and equity in decisions related to intervention study design and comparator condition selection.

Conclusions: The process of selecting an appropriate comparator condition is one aspect of study design that can advance both equity and scientific rigor in pediatric psychology intervention research.

Objective: Although sleep disturbances are common and impairing side effects of treatment for pediatric acute lymphoblastic leukemia (ALL), no research has studied whether prevention programs are effective. The current study assessed feasibility and acceptability of a brief sleep health education program during maintenance chemotherapy for ALL.

Methods: Twenty-five caregivers of children with ALL aged 4-8 years old (M = 5.6 years, SD = 1.3) receiving maintenance chemotherapy enrolled. An oncology nurse navigator (ONN) met individually with caregivers (15-30 min) to introduce them to a psychoeducational website on sleep during ALL treatment and a sleep action plan. Questionnaires were collected at baseline and 1-month follow-up. Medical records were reviewed for the 3 months prior to and following the ONN meeting for appointments documenting sleep discussions.

Results: The program was feasible (of 27 caregivers approached, 25 [93%] enrolled; of 25 enrolled, 22 [88%] completed the follow-up assessment), and the majority of caregivers (77%) rated the intervention as acceptable. Approximately 40% of children experienced clinically meaningful improvements in sleep disturbance or impairment from baseline to follow-up. The average proportion of physician appointments per patient with documented sleep discussions was lower at follow-up (34%) than at baseline (41%), although this was not statistically significant (p = .17).

Conclusions: A brief sleep health education program is feasible and acceptable during maintenance therapy for pediatric ALL. Providing families with comprehensive information on sleep during ALL treatment may improve child sleep and reduce the need to discuss sleep with oncologists. Findings support evaluation of Sleep ALL Night in a statistically powered, randomized trial.