Somatization symptoms in pediatric abdominal pain patients: Relation to chronicity of abdominal pain and parent somatization

Symptoms of somatization were investigated in pediatric patients with recurrent abdominal pain (RAP) and comparison groups of patients with organic etiology for abdominal pain and well patients. Somatization scores were higher in RAP patients than well patients at the clinic visit, and higher than in either well patients or organic patients at a 3- month followup. Higher somatization scores in mothers and fathers were associated with higher somatization scores in RAP patients, but not in organic or well patients. Contrary to the findings of Ernst, Routh, and Harper (1984), chronicity of abdominal pain in RAP patients was not significantly associated with their level of somatization symptoms. Psychometric information about the Children's Somatization Inventory is presented.This research was supported by grants from the Vanderbilt University Research Council and from the National Institute of Child Health and Human Development (HD2364). Garber was supported in part by the W. T. Grant Foundation Faculty Scholar program during completion of this work. The authors are grateful for the assistance of Fayez K. Ghishan, Harry L. Greene, and Patty Vieira of the Vanderbilt Division of Pediatric Gastroenterology.     

Pediatric Parenting Stress and Its Relation to Depressive Symptoms and Fear of Hypoglycemia in Parents of Young Children with Type 1 Diabetes Mellitus

Parents of young children with type 1 diabetes (T1DM) maintain full responsibility for their child’s daily diabetes self-care and thus may be vulnerable to experiencing parenting stress. This study examined several psychological correlates of pediatric parenting stress in parents of young children with T1DM. Parents of 39 young children with T1DM (ages 2–7 years) completed measures of pediatric parenting stress, mealtime behavior problems, depressive symptoms, and fear of hypoglycemia. For parents of young children, higher stress frequency and difficulty were associated with higher parental depressive symptoms and fear. Regression analyses identified that 58% of the variance in stress frequency was associated with parental depressive symptoms. For stress difficulty, 68% of the variance was associated with parental depressive symptoms and fear. Pediatric parenting stress is common in parents of young children with T1DM. Stress and the psychological correlates measured in this study are amenable to intervention and should be regularly assessed in parents of young children with T1DM.     

Parent and self-report ratings of executive function in adolescents with myelomeningocele and hydrocephalus.

Parent and self-report ratings were obtained for 28 adolescents with myelomeningocele and congenital hydrocephalus using the Behavior Assessment System for Children (BASC; Reynolds & Kamphaus, 1998a, 1998b) and the Behavior Rating Inventory of Executive Function (BRIEF; Gioia, Isquith, Guy, & Kenworthy, 2000; Guy, Gioia, & Isquith, 1998). Parents rated their children as having significantly more problems, compared to published norms, on the BRIEF but not the BASC. Adolescents rated themselves as having significantly more problems, compared to parent ratings, on scales comprising the BRIEF Behavioral Regulation Index; but not on common scales of the BASC. Parents also reported more problems on the BRIEF Global Executive Composite than on all three primary BASC indices, and more problems on the BRIEF Metacognition Index than on the BRIEF Behavioral Regulation Index. We conclude that the BRIEF captures salient executive dysfunction among individuals with myelomeningocele and hydrocephalus, and may be useful in identifying needs for intervention that might not be identified by broad-band behavior rating scales alone.     

Efficacy of a Brief Relaxation Training Intervention for Pediatric Recurrent Abdominal Pain

This study is a preliminary investigation of the efficacy of a brief intervention for recurrent abdominal pain (RAP) via a multiple baseline across subjects design. The intervention consisted of a single 1-hour session including psychoeducation and coaching of breathing retraining; the length, duration, and content of the intervention were designed with a goal of maximum portability to primary-care settings. Five children with recurrent abdominal pain participated in this study, 1 of whom served as a pilot participant. Children received the intervention at 1-week intervals. Parent and child reports of each child's abdominal pain, general somatic complaints, functional disability, and anxiety were collected throughout the study. All children participated in a 3-month follow-up session. Results indicated that this brief intervention was successful in lessening abdominal pain, as demonstrated by decreased Abdominal Pain Index (API) scores in two children and decreased abdominal pain following breathing retraining practice in all children. The intervention was also successful in decreasing some children's general somatic symptoms. Functional disability and anxiety symptoms remained consistent for all children throughout the study, which may be due to low levels of these symptoms pretreatment. Limitations and directions for future research are discussed.     

Parent and Self-Report Ratings of Executive Function in Adolescents with Myelomeningocele and Hydrocephalus

Parent and self-report ratings were obtained for 28 adolescents with myelomeningocele and congenital hydrocephalus using the Behavior Assessment System for Children (BASC; Reynolds & Kamphaus, 1998a, 1998b) and the Behavior Rating Inventory of Executive Function (BRIEF; Gioia, Isquith, Guy, & Kenworthy, 2000; Guy, Gioia, & Isquith, 1998). Parents rated their children as having significantly more problems, compared to published norms, on the BRIEF but not the BASC. Adolescents rated themselves as having significantly more problems, compared to parent ratings, on scales comprising the BRIEF Behavioral Regulation Index; but not on common scales of the BASC. Parents also reported more problems on the BRIEF Global Executive Composite than on all three primary BASC indices, and more problems on the BRIEF Metacognition Index than on the BRIEF Behavioral Regulation Index. We conclude that the BRIEF captures salient executive dysfunction among individuals with myelomeningocele and hydrocephalus, and may be useful in identifying needs for intervention that might not be identified by broad-band behavior rating scales alone.     

Pain in children: A review of the literature from a developmental perspective

Abstract

This article presents a review of the current psychological literature about pediatric pain. Prevalence and types of pain problems encountered in children are considered briefly, followed by a developmental perspective on the experience of pain in children, encompassing physical, cognitive, social and behavioral factors. A discussion of the clinical significance of pain in children includes its use in differential diagnosis and the impact of pain on a developing child. Recommendations are made for assessing pain and factors relevant to managing its effects in children. The review concludes with an overview of clinical techniques for management, and recommendations for future research.     

A typology of behavior problems in preschool children

The purpose of this study was to produce a typology of behavior problems in preschool children. Distinct subtypes were identified through the use of cluster analytic techniques on data from the Behavior Assessment System for Children (BASC)-Parent Rating Scales. Analyses were based on archival data collected on a sample of 268 children, aged 2 to 5 years, who were referred to determine their suitability for a day treatment program. Five distinct and reliable subtypes of preschool children's behavior problems emerged. Ratings of adaptive and social skills based on the BASC Adaptive Scales and measures from the Parenting Stress Index served as external variables to assess the distinctiveness of the derived subtypes. The findings provide evidence for the reliability and validity of the subtypes identified in this study that are consistent with the findings of previous subtyping investigations focusing on school-aged children.     

Characteristics of Children Presenting to a Behavioral Treatment Program for Pediatric Headache

This study examined headache characteristics and psychological variables associated with pediatric headache in a specialty treatment clinic. Children were referred by pediatric neurologists to a hospital-based pediatric behavioral medicine clinic for behavioral treatment in conjunction with medical management of the pain. Headache typology of the children indicated that 1/3 of the sample reported at least daily headaches, and a large percentage of patients described experiencing headaches that lasted for more than a day (26%). Child and parent report of pain revealed a fairly high level of correspondence for headache activity. Regarding other psychological characteristics, children in this study endorsed higher than expected levels of somatization even after adjusting for headache symptoms. Compared with children's report, parents' report showed only slightly higher levels of secondary gain experienced by children because of pain. Gender differences were not found. The implications of these findings for improving our understanding of pediatric headache are discussed.     

Parent–Child Relationships and ADHD Symptoms: A Longitudinal Analysis

Evidence both from psychological research and clinical intervention studies suggests that there are bidirectional influences between overt child behavior problems and parent–child relations. Very little research however, has considered the pattern of relations that exists between Attention Deficit Hyperactivity Disorder (ADHD) and the parent–child relationship within a longitudinal context. Using a longitudinal community sample from the United Kingdom which included 194 school aged children (46% male and 54% female) and both parents, this study examined the relationship between child ADHD symptoms and displays of rejection in the parent–child relationship. These relationships were investigated separately for mothers and fathers using cross-lagged panel correlation and reciprocal effects analysis. Mothers and fathers reported on ADHD symptoms and children reported on their feelings of rejection in the mother–child and father–child relationships. Results suggested differences in the direction of effects linking mother– and father–child rejection and child ADHD symptoms; with ADHD symptoms affecting the mother–child relationship and the converse pattern of effects noted for fathers. Implications for future research focusing on the link between ADHD symptoms and parent–child relationships are discussed.     

The Ohio Scales Youth Form: Expansion and Validation of a Self-Report Outcome Measure for Young Children

We examined the validity and reliability of a self-report outcome measure for children between the ages of 8 and 11. The Ohio Scales Problem Severity scale is a brief, practical outcome measure available in three parallel forms: Parent, Youth, and Agency Worker. The Youth Self-Report form is currently validated for children ages 12 and older. The Ohio Scales Problem Severity scale was administered to a clinical and comparison sample of children, ages 8–11, then readministered 1 week later to a subsample of children in order to examine test-retest reliability. The Ohio Scales demonstrated acceptable internal consistency and reliability. The Ohio Scales was significantly correlated with the Behavior Assessment System for Children (BASC) across both samples, providing evidence for concurrent validity. Children of the clinical sample reporting higher scores (i.e., more symptomatic) than the children of the comparison sample on the Ohio Scales, thereby demonstrating construct validity.     

Relative Contributions of Childcare, Spousal Support, and Organizational Support in Reducing Work–Family Conflict for Men and Women: The Case of Turkey

The overarching purpose of the study was to investigate the role of three types of social support (i.e., spousal, childcare, and organizational support) in relation to work–family conflict (WFC) in dual-earner families with children ages 0–6 years. The relationship of WFC to psychological well-being and well-being in the domain of family was explored. Finally, the relationship of spousal support to psychological well-being and marital satisfaction was examined. A total of 434 participants (237 mothers, 197 fathers) in dual-earner families in Turkey with at least one preschool child participated in the study. The relative impact of childcare, spousal support, and organizational support on WFC and outcome variables was tested simultaneously for both men and women through structural equation modeling. Spousal support was related to WFC for women, whereas both spousal and organizational support were related to WFC for men. WFC had a negative relationship with psychological well-being, marital satisfaction, and parental role performance for both men and women. Implications of the results in relation to changing gender roles in a cultural context that is characterized by high collectivism and low gender egalitarianism are discussed. The paper received a Caroline Dexter Best Paper Award Nomination, Academy of Management Annual Meeting, New Orleans, August 2004.     

Identification of cognitive profiles among women considering BRCA1/2 testing through the utilisation of cluster analytic techniques

Based on the cognitive-social health information processing model, we identified cognitive profiles of women at risk for breast and ovarian cancer. Prior to genetic counselling, participants (N?=?171) completed a study questionnaire concerning their cognitive and affective responses to being at genetic risk. Using cluster analysis, four cognitive profiles were generated: (a) high perceived risk/low coping; (b) low value of screening/high expectancy of cancer; (c) moderate perceived risk/moderate efficacy of prevention/low informativeness of test result; and (d) high efficacy of prevention/high coping. The majority of women in Clusters One, Two and Three had no personal history of cancer, whereas Cluster Four consisted almost entirely of women affected with cancer. Women in Cluster One had the highest number of affected relatives and experienced higher levels of distress than women in the other three clusters. These results highlight the need to consider the psychological profile of women undergoing genetic testing when designing counselling interventions and messages.     

Identification of cognitive profiles among women considering BRCA1/2 testing through the utilisation of cluster analytic techniques

Based on the cognitive-social health information processing model, we identified cognitive profiles of women at risk for breast and ovarian cancer. Prior to genetic counselling, participants (N = 171) completed a study questionnaire concerning their cognitive and affective responses to being at genetic risk. Using cluster analysis, four cognitive profiles were generated: (a) high perceived risk/low coping; (b) low value of screening/high expectancy of cancer; (c) moderate perceived risk/moderate efficacy of prevention/low informativeness of test result; and (d) high efficacy of prevention/high coping. The majority of women in Clusters One, Two and Three had no personal history of cancer, whereas Cluster Four consisted almost entirely of women affected with cancer. Women in Cluster One had the highest number of affected relatives and experienced higher levels of distress than women in the other three clusters. These results highlight the need to consider the psychological profile of women undergoing genetic testing when designing counselling interventions and messages.     

Behavior assessment system for children

The Behavior Assessment System for Children (BASC) is a well-designed and useful set of measures for the assessment and identification of school-age children with emotional disturbances and behavioral disorders. The BASC consists of five measures designed to gather information about a child or adolescent from a variety of sources (teachers, parents, direct observations, students, and historical records). In combining this information into an integrated system, the BASC uniquely attempts to provide a multidimensional understanding of a child. This review summarizes the technical qualities of the BASC and critiques its usefulness for practicing school psychologists. Although there are shortcomings, the BASC is made up of some of the best measures of their kind and represents an approach of choice for identifying children with emotional and behavioral disorders in schools.     

Patterns of Parental Rearing Styles and Child Behaviour Problems among Portuguese School-Aged Children

The majority of studies investigating the effects of parental behaviour on the child’s adjustment have a dimensional approach. We identified the existence of various patterns in parental rearing styles and analysed the relationship between different parenting patterns and behavioural problems in a group of school-aged children. A longitudinal, multi-informant study was conducted. The sample consisted of 519 school-aged children from the Portuguese general population. Parental rearing styles were measured using the EMBU-C, a questionnaire that evaluates children’s perception of parental rearing dimensions. The assessment of child behavioural problems included the evaluation of internalizing and externalizing problems, and data from multiple reporters (parents and teacher). One year later, after a school transition, the adjustment of a sub-sample of 220 children was evaluated again. Cluster analysis identified four types of parental rearing styles: low support, supportive-controller, rejecting-controller, and supportive. In both assessment periods, low support and rejecting-controller parenting patterns showed higher levels of behavioural problems than the supportive and supportive-controller parenting patterns. These patterns show significant differences between them regarding behavioural problems and have a higher predictive value regarding externalizing problems (versus internalizing problems).     

La thèse du travailleur heureux-productif revisitée : une analyse par profils

This study aims to identify worker profiles in terms of psychological well-being at work, burnout and contextual performance, based on the two-dimensional conceptualization of psychological health (Keyes, 2009) and the job performance model of Borman and Motowidlo (1993). To do so, 1037 Quebec workers responded to self-reported questionnaires. Cluster analyzes revealed four profiles of workers: two convergent profiles, representing high psychological health and performance at work (32%), and low psychological health and performance at work (17%), as well as two paradoxical profiles, one presenting low psychological health and high contextual performance (23%), and one presenting high psychological health and low contextual performance (28%). These profiles were compared quantitatively and qualitatively. In the light of the conservation of resources theory (Hobfoll, 1989, 2001), these results extend and nuance the existing scientific literature on the health-performance relationship.     

Confirmatory Factor Analysis of Arnold et al.’s Parenting Scale Across Race, Age, and Sex

We used confirmatory factor analysis (CFA) to investigate the factor structure of several models of Arnold et al.’s Parenting Scale [Arnold et al. (1993). Psychological Assessment, 5, 137–144] across children from various age groups and races. Participants were parents of children (ages 2–16 years) presenting to four community-based pediatric practices for routine care. Parents completed questionnaires pertaining to various aspects of parenting and child behavior problems. Results indicated that a two-factor revision proposed by Reitman et al. [(2001). Journal of Clinical Child Psychology, 30, 514–524] represented the data well and better than the original three-factor structure and other two-factor models. Results from multigroup CFA analyses indicated that this factor structure did not vary across child sex, child age, and parental race. Results of validity analyses indicated that scores on both factors were related to reports of children’s behavior and parental affect and cognitions. This study was the first to use multigroup CFA procedures to demonstrate that relationships between individual items and factors of the Parenting Scale are similar for parents of children across various age groups.     

Personality disorders and response to outpatient treatment of chronic pain

As part of a comprehensive interdisciplinary evaluation conducted prior to participation in an outpatient chronic pain treatment program, the psychological status of 101 persons was assessed. The majority of participants was found to have a form of personality disorder, determined by conservative cutoff scores applied to their Millon Clinical Multiaxial Inventory (MCMI) profiles. DSM-III-R Cluster C disorders (i.e., Avoidant, Dependent, Obsessive-Compulsive, and Passive-Aggressive) were overrepresented in this sample. Subsequent analyses revealed that personality disorders were related to higher levels of self-reported distress and pain at both the beginning and the end of outpatient treatment. Differential responses to treatment were observed on self-report measures; however, few relations were found between personality disorder and physical therapist ratings of impairment and improvement. Implications for the assessment of personality disorders in outpatient pain treatment programs are discussed and appropriate intervention strategies are considered.     

Parent–Teen Interactions as Predictors of Depressive Symptoms in Adolescents with Headache

This study investigated parent–adolescent conflict, family functioning, and adolescent autonomy as predictors of depressive symptoms in adolescents with primary headache. Frequent headaches during adolescence can have a negative impact on activity levels and psychological functioning. Depression is particularly prevalent in adolescents with headache but little research has examined the role of parent–teen interactions in predicting depressive symptoms. Thirty adolescents diagnosed with migraine or chronic daily headache completed self-report measures of pain intensity, parent–adolescent conflict, family functioning, and depression. Adolescents and their parents also participated in three videotaped interaction tasks, scored by independent raters to assess adolescent autonomy. Regression models revealed that pain intensity, parent–adolescent conflict, and autonomy predicted depressive symptoms. Higher levels of conflict, poorer family functioning and lower levels of autonomy were associated with more depressive symptoms. This study highlights the association between parent–teen interactions and psychological functioning in adolescents with primary headache. Implications for intervention are discussed.