Journal of Pediatric Psychology最新文献

Objectives: To characterize intraindividual trajectories of behavioral and emotional problems in children with congenital heart disease (CHD) between 2 and 5 years of age, and to explore the predictors of these trajectories.

Methods: Sixty-six patients (42 boys) followed at the neurocardiac clinic of the Sainte-Justine University Hospital in Montréal, Québec, Canada were recruited. Their behavioral and emotional problems at 2, 3 ½, and 5 years of age were reported by parents.

Results: Correlations revealed moderate to high rank-order stability in child behavioral and emotional problems across time. Multilevel growth curves indicated significant fluctuations in intraindividual levels of these problems across time, which were not explained by child aging. Lower gestational age was associated with higher levels of anxious/depressed symptoms at age 2 years, which persisted through time. Severe forms of CHD were associated with a time-related decrease in three types of problems: attention, attention deficit and hyperactivity, and oppositional and defiant.

Conclusions: Levels of parent-reported behavioral and emotional problems in children with CHD tend to persist from ages 2 to 5 years, suggesting the importance of early screening. However, unexplained intraindividual changes were also identified, highlighting the necessity to investigate other parental risk factors, for instance. Infants with a lower gestational age should be given special consideration since they continued to display more anxious/depressed symptoms up to school entry compared to children with CHD born at term. The decrease observed in some symptoms for children with severe CHD could result from altered parental perceptions or adverse effects of prolonged hospitalizations.

Objective: Parents of youth with type 1 diabetes (T1D) experience substantial disease-specific demands and distress, yet their perceptions about the emotional support they receive related to the challenges of caring for a child with diabetes have not been well described. This research aimed to characterize the types of emotional support parents of youth with T1D receive and how they experience emotional support.

Methods: As part of a larger qualitative study on diabetes health-related quality of life, 23 parents (96% mothers) of youth with T1D (M age = 10.9 ± 3.8 years; 35% female) completed semi-structured interviews about various aspects of parenting a child with T1D, including emotional support they received. Interviews were transcribed verbatim, coded, analyzed using thematic analysis, and interpreted according to the social-ecological model to generate major and minor themes.

Results: Three themes were constructed. The "Individual" theme included parent-specific factors, including their openness to and satisfaction with diabetes-specific emotional support they receive. Reflecting sources of emotional support, the "Interpersonal" theme included parents' central supportive networks (e.g., family, professionals), and the "Community" theme included parents' extended supportive networks (e.g., community members, T1D organizations, other families). Parents valued emotional support that was nonjudgmental and demonstrated knowledge of T1D.

Conclusions: Both individual and environmental factors relate to how parents seek and receive emotional support from various sources. Clinicians should normalize the experience of needing emotional support to make parents feel comfortable sharing their experiences openly and, when appropriate, help link families to resources to meet their emotional support needs.

Objective: This study aimed to benchmark pediatric psychologists' involvement in caregiver support and identify actionable strategies to enhance training, practice, and advocacy for caregiver well-being and health equity.

Methods: A benchmark survey was completed by 119 pediatric psychologists and trainees, primarily recruited through Society of Pediatric Psychology membership. The 36-item survey assessed training, supervision, screening/intervention practices, billing, documentation, institutional support, and confidence in delivering culturally adapted, evidence-based care for caregivers. Descriptive analyses were conducted to identify baseline trends and develop actionable goals.

Results: Findings revealed substantial variability in the practice of caregiver support by pediatric psychologists and trainees. About half of the respondents reported regularly screening and/or providing interventions for caregivers, though implementation varied significantly. Only 38% of respondents regularly billed for caregiver services, typically using mental health and health/behavior codes, and often documented these services in the child's medical record. Many participants (54%) expressed a need for additional training, and 70% reported insufficient institutional support for navigating caregiver-focused care. Confidence in providing culturally adapted, evidence-based treatments for caregivers varied widely, highlighting significant gaps in training and institutional resources to address diverse caregiver needs.

Conclusions: These findings emphasize the need for enhanced training, institutional support, and resources for pediatric psychologists to address caregiver well-being, with a focus on cultural sensitivity. Strengthening these areas is critical to advancing health equity, and pediatric psychologists are well-positioned to lead efforts in integrating science, practice, and advocacy to address systemic disparities in caregiver support.

Objective: To understand the experiences of mothers of children with cerebral palsy (CP) regarding the impact of caregiving on their mental health and their engagement with Brazil's psychosocial care network.

Method: This descriptive-exploratory qualitative study employed the theoretical framework of Symbolic Interactionism by Herbert Blumer. Interviews were conducted with Brazilian women aged 18 years or older, who had at least one child with CP aged between 28 days and under 19 years. Data collection focused on their experiences with mental health care and their interactions with Brazil's psychosocial care network. The interviews were transcribed and subjected to thematic content analysis.

Results: Fifteen women participated, with an average age of 36 years, predominantly with high school and higher education, who were distanced from the workforce and were married. Two central categories emerged from the interactions analyzed: "My life is not normal": Maternal life with a child with CP amidst mental health demands; and "If you need me, I'm here": The pursuit of maternal self-care, the obstacles faced, and an alternative route, with interconnected subcategories.

Conclusion: The mental health of Brazilian mothers of children with CP is marked by invisibility and multiple challenges. Their social interactions influence their psychosocial well-being, which, while acknowledged, is often neglected in favor of caregiving for their child. These challenges extend to the psychosocial care network in Brazil, characterized by barriers to accessing appropriate care for their needs. As an alternative, mothers engage in self-care activities to reconnect with their personal needs as women.

Objective: In this pilot investigation, we aimed to explore the neurological and biobehavioral mechanisms underlying pain outcomes in adolescent and young adult (AYA) females following orthopedic surgery, an area largely unexplored.

Methods: Functional near-infrared spectroscopy was used to investigate brain responses in the primary sensory cortex (sensory pain processing) and the prefrontal regions (emotional processing) in 24 AYA females who underwent orthopedic surgery within the previous 2 years compared to 20 group-matched controls without a surgical or chronic pain history. A battery of self-reported pain-related and emotional functioning measures (PROMIS; pain catastrophizing) were also administered. Cortical activations and functional connectivity (FC), involving the prefrontal (PFC) and somatosensory cortices (SMC), were assessed during resting state and a descending pain modulation task (conditioned pain modulation).

Results: In the control group, PFC-SMC FC in response to pain was significantly linked to anxiety, whereas this correlation was absent in the post-surgical cohort.

Conclusion: These results highlight distinct altered responses in sensory and emotional brain functioning in AYA females following orthopedic surgery. We suggest that such changes may be related to the involvement of the PFC-SMC communication in the maintenance of chronic pain.

Objective: The aim of this scoping review was to identify and describe the community-engaged research (CEnR) methods used in the development and evaluation of psychological interventions for pediatric sickle cell disease (SCD).

Methods: We conducted a systematic search of three databases in April 2024 (PubMed, Scopus, and PsycINFO). The review was registered with Open Science Framework (DOI: 10.17605/OSF.IO/956AV). All titles, abstracts, and full texts for papers that appeared to meet criteria were independently reviewed by two members of the research team. Inclusion criteria were pediatric or young adult age and use of CEnR for a psychological SCD intervention. Data were extracted from articles meeting these criteria.

Results: The search yielded 235 original articles, of which eight met the inclusion criteria. These articles showed that the involvement levels of community collaborators (patients, families, and community-based organizations) varied across research phases. Notable gaps in the literature were: (1) few studies reported utilizing CEnR methods, (2) variability in language/terms used to describe CEnR methods, (3) limited demographic data about community collaborators, and (4) a lack of description of CEnR frameworks guiding intervention development and evaluation.

Conclusions: This scoping review found few studies describing the use of CEnR methods in a way that would facilitate reproducibility. Recommendations include using MeSH CEnR keywords, identifying CEnR methods and frameworks, and including specific information about community when possible (e.g., demographic information, meeting frequency, etc.).

Objective: Despite the growing number of Hispanic/Latino families in the United States, major concerns are reported when navigating the healthcare system. Monolingual Spanish-speaking families may experience compounded barriers given the inconsistent availability of Spanish resources and services in traditional healthcare settings. Digital health interventions have the potential to alleviate some barriers in healthcare for these individuals. This scoping review summarizes the state of the literature on the development, adaptation, and implementation of pediatric Spanish-language digital health interventions offered to Spanish-speaking families in the United States to better understand current cultural-sensitivity practices and strategies implemented by researchers.

Methods: A search in major databases was completed in May 2024. Articles that discussed the development, implementation, or outcome of any digital health intervention primarily oriented to a Spanish-speaking pediatric population in the United States were included. Telephone- and telehealth-only interventions were excluded.

Results: A total of 44 articles were reviewed, representing 30 unique digital health interventions. Most covered preventive health topics, utilized SMS texting, and were intended primarily for parents/caregivers. Only 22 articles discussed specific methods to culturally tailor the intervention. The most common methods implemented were advisory boards and collecting qualitative data from parents/caregivers and youth. About 50% of articles reported results related to efficacy, acceptability, and feasibility.

Conclusion: While similar methods are implemented to develop and adapt these interventions, there is ample variation throughout the process. Including and learning directly from intended users in the adaptation and development phases of digital health interventions can help create quality and culturally appropriate digital health programs for families.

Objective: This study provided descriptive, psychometric, and correlational data on activity involvement, including engagement with and adherence to medical care activities, using the daily phone diary (DPD) methodology within the context of an ongoing longitudinal study of adolescents and young adults (AYAs) with spina bifida (SB).

Methods: As part of a longitudinal study, AYAs with SB aged 16-24 at Time 5 (n = 68) and aged 19-26 at Time 6 (n = 75) completed a DPD across 3 days, along with measures of demographics, condition severity, and medically related psychosocial constructs.

Results: Findings revealed that AYAs spent roughly two-thirds of their time either sleeping or engaged in recreational activities in their homes. They were more likely to spend time at home (with 50% of this time engaged in less active activities such as TV watching) and less time engaged in school and work activities than has been found in AYAs with other chronic medical conditions. Participants were also more likely to report low rates of catheterization, suggesting adherence challenges. The DPD method showed satisfactory stability over time. DPD data on medical care activities demonstrated adequate convergent validity as well as correlations with lesion level and measures of medical responsibility and medical skill mastery.

Conclusions: This study supports the use of the DPD method to assess engagement with and adherence to medical care activities in AYAs with SB. It also provides an assessment of engagement in other activities, such as in-home recreation and out-of-home school- and work-related activities.

Objective: This study aimed to investigate the role of environmental pollutants, specifically nitrogen dioxide (NO2) and particulate matter (PM10), on children and young adults (CYA) living with sickle cell disease (SCD) in the United Kingdom. Given the heightened vulnerability of this population due to socio-environmental factors, we explored how these pollutants influence hospitalization rates, sleep quality, and cognitive function.

Methods: Data were analyzed from the London Sleep Asthma Cohort, which included 94 CYA living with SCD at Visit 1, although this full sample was not available for all analyses. Participants' exposure to NO2 and PM10 was determined using air quality data linked to their residential postcodes. Hospitalizations, sleep quality, and cognitive function were assessed through medical records, caregiver questionnaires, and cognitive testing. Multiple regression analyses were conducted to determine the relationship between pollutant exposure and health outcomes, controlling for age, community deprivation, and asthma diagnosis.

Results: The study found that NO2 exposure significantly predicted lifetime hospitalizations for acute chest syndrome (ACS), particularly among participants with asthma. However, despite some trends toward significance, no significant relationships were observed between pollutant exposure and pain-related hospitalizations, sleep quality, or cognitive function.

Conclusions: Our preliminary findings suggest that NO2 exposure exacerbates respiratory complications in CYA with SCD, especially in those with asthma. Our results underscore the need for targeted public health interventions to mitigate air pollution in marginalized communities, which could reduce ACS-related hospitalizations and improve health outcomes for vulnerable populations. Further research is recommended to explore the mechanisms linking pollution to SCD complications.

Objective: Although childhood cancer survivors require lifelong "risk-based" follow-up care, most adult survivors do not receive such care, and many are lost during the transition from pediatric to adult follow-up care. The goal of this study was to evaluate the feasibility and acceptability of the "Managing Your Health" self-management and peer mentoring intervention to improve transition readiness and self-management skills among young adult survivors of childhood cancer.

Methods: Survivors of childhood cancer ages 18-25 years were randomized 1:1 to the Managing Your Health intervention (six video/phone calls with a peer mentor, another young adult survivor, and five online educational modules) or usual care. Feasibility was measured through enrollment rates, retention rates, and engagement and satisfaction with the intervention. Participants completed measures of transition readiness, self-efficacy, and perceived support at baseline and 2-, 6-, and 12-months post-enrollment.

Results: A total of 50 participants (Mage = 21.1 years; 60% male) enrolled (32% of the total pool was contacted; 76% of those were screened; 94% of those screening eligible enrolled). Twenty-two (88%) of the 25 intervention participants completed the peer mentor calls. On average, participants completed 96% of the online modules, often closely timed to peer mentor calls. Participants indicated high satisfaction and acceptability of the intervention and suggested some improvements to the online modules.

Conclusions: Managing Your Health was feasible and acceptable to young adult survivors and mentors. Peer mentors appeared to serve as supportive accountability agents encouraging engagement with the online modules. Additional refinements will be made to the intervention prior to efficacy testing.