Journal of Pediatric Psychology最新文献

Objective: Sibling relationships have important implications for individual development and functioning. Evaluating this relationship within the family context is important as it both operates within and is influenced by the family. Research on sibling relationship quality among survivors of pediatric cancer is limited. This study assessed survivor-reported sibling closeness, and the individual- and family-level factors associated with closeness within six months after completing cancer treatment.

Methods: This study is a secondary analysis of a larger study including survivors of pediatric brain tumors and solid tumors. Participants included survivors (n = 73; ages 7-14; Mage = 10.87; Female = 39.7%) that reported having a sibling (Mage = 11.66; Female = 53.4%) and their caregiver (Mage = 43.22; Female = 80.8%). Caregivers completed measures of survivor and family functioning, and a demographic survey. Survivors reported on sibling relationship quality. T-tests, correlations, and a linear regression evaluated hypothesized associations.

Results: In univariate analyses, sibling order was significantly related to closeness such that survivors with an older sibling reported higher levels of closeness compared to those with a younger sibling. Correlations revealed that older sibling age, better family functioning, and fewer survivor externalizing symptoms were significantly related to higher levels of closeness. Linear regression analysis indicated that family functioning was significantly associated with sibling closeness.

Conclusions: Family functioning is uniquely related to sibling relationship quality in survivors of pediatric cancer, beyond individual survivor- and sibling-related factors. Longitudinal research should examine how sibling relationships vary over time, from diagnosis, through treatment, and into remission.

Objective: Type 1 diabetes (T1D) and life-threatening food allergies (FAs) are two diet-dependent chronic illnesses (DDCIs) that require rigorous self-management centered on strict dietary monitoring. Grounded in self-determination theory, this study aimed to investigate differences in motivation for healthy eating and well-being among adolescents coping with DDCI, compared to individuals without DDCI. Additionally, it explored the mediating role of general health practices in the relationship between motivation for healthy eating and well-being.

Methods: A total of N = 116 adolescents, aged 10-18 years (T1D: N = 36, M±SD age = 15.28 ± 1.85; FA: N = 39, M±SD age = 13.31 ± 2.40; no-DDCI: N = 41, M±SD = 14.71 ± 1.76), completed questionnaires assessing motivation for healthy eating, general health practices, and well-being.

Results: Internal motivation for healthy eating was positively associated with general health practices in all 3 groups. A moderated-mediation model revealed that among adolescents with DDCI, internal motivation for healthy eating was positively associated with psychological well-being. Internal motivation was also positively associated with physical well-being, but only among adolescents with FA. Conversely, only among adolescents with T1D, external motivation for healthy eating was negatively associated with psychological and physical well-being. Lack of motivation for healthy eating was negatively associated with general health practices among adolescents with T1D and individuals without DDCI.

Conclusions: Adolescents with DDCI face challenges in adhering to healthy eating recommendations and translating knowledge into action. Targeted interventions are necessary to enhance internal and autonomously driven motivation for dietary changes. Personalized nutrition programs for adolescents living with DDCI may effectively promote self-management and overall well-being in this population.

Objective: Sickle cell disease (SCD) is an inherited blood disorder characterized by acute pain crises and heightened chronic pain prevalence. Approximately 30%-40% of pediatric patients with SCD have chronic pain, contributing to poorer psychosocial outcomes. Central sensitization (central nervous system hyperexcitability) may heighten chronic SCD pain, yet few investigations have examined factors related to central sensitization in pediatric SCD. Sleep has been identified as a modifiable factor that may influence central sensitization and contribute to pain outcomes in both chronic pain-free and clinical populations.

Methods: Our study examined the role of sleep in relation to central sensitization in 55 participants (26 girls: mean age = 16.43 years) with severe SCD genotypes (hemoglobin Type SS n = 54, Type S beta-zero thalassemia n = 1). Mean-level and within-person variability sleep indices were measured at home over 7 days using wrist actigraphy and daily sleep diaries. To measure central sensitization, participants completed one session of quantitative sensory testing. Conditioned pain modulation (CPM) (n = 34) assessed endogenous pain inhibition, and temporal summation (n = 39) assessed pain facilitation. Multilevel models assessed pain ratings for each task.

Results: When controlling for age, sex assigned at birth, and task unpleasantness, lower actigraphy-derived sleep efficiency was associated with worse pain inhibition during CPM. Sleep was unrelated to pain facilitation during temporal summation.

Conclusions: Findings provide further evidence linking poor sleep to increased pain via impaired pain inhibition but may be best captured using objective sleep measures in pediatric SCD. Interventions aimed at improving sleep efficiency may have downstream effects on clinical pain in this population.

Objective: To compare sleep and mental health outcomes in adolescents and young adults (AYA) with cystic fibrosis (CF) and healthy controls and to explore associations between sleep and mental health in CF.

Methods: In this cross-sectional study AYA with CF and healthy AYA aged 14-25 years completed 7 days/nights of actigraphy, the Pittsburgh Sleep Quality Index, PROMIS-Sleep Disturbance scale, PROMIS-Sleep-Related Impairment scale, State Trait Anxiety Inventory, and Center for Epidemiologic Studies Depression scale. For participants with CF, disease characteristics were collected from the Canadian Cystic Fibrosis Registry. Linear regression models were used to determine differences between groups and to examine associations between sleep and mental health outcomes.

Results: Eighty-six participants, 45 with CF (median age = 19 years, IQR = 6 years, 51.1% female, 82.2% on elexacaftor/tezacaftor/ivacaftor, ETI) and 41 healthy comparator participants (median age = 16 years, IQR = 4 years, 53.7% female) participated. No significant differences were found between groups in actigraphically measured sleep, self-reported sleep, or anxiety or depression symptoms. In participants with CF, poorer self-reported sleep quality was significantly associated with greater anxiety (p < .001) and depression symptoms (p < .001), but actigraphically measured sleep was not.

Conclusions: AYA with CF had comparable sleep, anxiety, and depression outcomes as their healthy peers. Only self-reported sleep had a significant relationship with mental health symptoms. These findings stress the importance of concurrent assessment of sleep and mental health in the clinical setting and may inform future longitudinal research. Better understanding relationships between sleep and mental health in AYA with CF could have a significant impact on well-being and quality of life.

Objective: To test the mediational effect of self-management behaviors (SMB) on the relationship between diabetes distress (DD) and glycemic levels in adolescents with type 1 diabetes (T1D).

Methods: We conducted a 3-year longitudinal, multisite study of 172 adolescents (M age = 16 years) with T1D recruited at three university medical centers. Blood samples were obtained yearly and analyzed for HbA1c in a central laboratory. The Problem Areas in Diabetes-Teen (PAID-T) scale was completed by youth, and the Diabetes Self-Management Profile (DSMP) was completed by youth and caregivers at baseline, 12, 24, and 36 months.

Results: There were significant negative cross-sectional correlations of PAID-T with adolescent and caregiver-reported SMB, as well as between HbA1c and adolescent and caregiver-reported SMB at the first three time points. There were significant positive cross-sectional correlations of HbA1c with PAID-T at all time points. Longitudinal correlations were in the expected directions, with 82.5% statistically significant. Results confirmed the mediating role of adolescent-reported SMB between DD and HbA1c at baseline, 12, and 36 months; caregiver-reported SMB mediated only at baseline. Significant sex differences were observed across all time points on the PAID-T, with females scoring higher in DD.

Conclusions: The mediational models indicate that higher levels of DD were associated with increased HbA1c through lower SMB according to both adolescents and caregivers, although further study is needed in boys and girls, separately. Adolescents with high distress would likely benefit from support for effective SMB to ensure optimal glycemic levels.

Objective: Pediatric acquired brain injuries (pABIs) broadly impact the child and family, affecting emotional functioning, relationships, and daily life. Given the absence of a comprehensive overview of the impact of pABI on family functioning, this review aims to examine this issue and propose a conceptual model to guide clinical care.

Methods: A systematic search of CINAHL, Embase, PsycINFO, PubMed, Scopus, Web of Science, and PTSDpubs for articles published January 2013-November 2024 was performed. Eligible articles focused on children (0-18 years) with pABI, examined family functioning, were in English, and used qualitative or mixed methods. Studies on concussions and non-peer-reviewed publications were excluded. Inductive thematic analysis identified themes that were synthesized into a conceptual model. Risk of bias was assessed using the Critical Appraisal Skills Programme. The review, funded by Stichting Koningsheide, was registered in PROSPERO (CRD42023457622).

Results: Twenty-four articles were included, covering moderate-to-severe traumatic brain injuries, brain tumors, stroke, and infections. Family members included caregivers, siblings, and adoptive relatives. Five themes emerged: Changing family dynamics; A different reality; The emotional weight; Navigating emotional challenges; and Needing to be heard and held. These were integrated into the Utrecht Family Support Model for Pediatric Acquired Brain Injury.

Conclusions: Family functioning after pABI can only be fully understood if multiple interconnected psychosocial and practical aspects are considered. Most included studies were of low-to-moderate quality, limiting the reliability, validity, and generalizability of the findings. Nonetheless, the conceptual model could provide a framework for understanding family functioning and enhancing outcomes for pABI.

Objectives: Children of first-time mothers experience an elevated risk of unintentional injuries, though little is known about the safety practices of first-time mothers. The current study aimed to identify factors that influence how first-time mothers respond to young children engaging in injury-risk behaviors in the home. Based on past research regarding influences on non-first-time mothers' safety practices, factors considered herein included: demographic attributes, parent personality, parenting style, and family context.

Methods: : First-time mothers (N = 74) of young children (M = 24.39 months) were exposed to hypothetical scenarios in which a child's behavior could be interpreted in terms of misbehavior or threats to their safety; mothers were advised to react as if the child were their own.

Results: Analysis of verbatim responses made by mothers to their children indicated that first-time mothers were significantly more concerned with correcting undesirable behaviors than addressing safety risks. High scores on parent permissiveness and conscientiousness were protective, predicting higher frequencies of teaching/explaining responses about safety, which has been shown to moderate children's injury-risk behaviors. In contrast, greater household chaos and lower conscientiousness were risk factors, predicting more power-assertive responses, which are ineffective for stopping children from engaging in injury-risk behaviors.

Conclusion: : Injury prevention interventions may benefit first-time parents by assisting them to enact strategies that teach young children about safety, reduce power-assertive parenting, and moderate the level of household chaos. Suggestions for future research are discussed.

Objective: In middle childhood and into adolescence, children increasingly engage in cooking activities using devices that can elevate their risk of experiencing burn and cut injuries. There is limited research, however, on what kitchen devices they use at different ages and their knowledge of unsafe cooking activities.

Method: Focusing on burn and cut risks, this study considered younger (10-11 years old) and older children (13-14 years old) and used parent reports to determine the kitchen devices children use, under what supervision conditions, and the factors parents considered in deciding on their child's readiness to do so. Additionally, children viewed a videotape of a similarly aged child engaging in various kitchen activities while cooking and identified actions they considered unsafe. Their parent did similarly to identify the risky activities they expected their child to recognize.

Results: Older age children used more kitchen devices without parent supervision than younger-aged children. In making decisions about burn-risk devices, parents considered dangerousness as well as the benefits to them of their child doing so, though injury severity risk did not contribute, and none of these factors predicted decisions about the usage of cut-risk devices. Regardless of age, children identified fewer than half of the injury-risk behaviors shown, and parents believed that children would identify a significantly greater proportion of risks than children actually did.

Conclusions: Children are not aware of many risk behaviors in the kitchen, and parents significantly overestimate their child's knowledge of such behaviors. Implications for injury prevention and directions for future research are discussed.