Parent Anxiety and Infant Pain During Pediatric Immunizations

Infants’ procedural pain and parents’ treatment room anxiety has been largely ignored in the research and clinical domains. To understand and manage infant procedural pain, it is essential to examine the correlates and potential predictors of this pain. Given that parent anxiety is a strong predictor of preschoolers’ procedural anxiety and pain, it is likely that parents play a role in infants’ distress during medical procedures. The purpose of this study was to thoroughly examine parent anxiety and its effects on infant procedural pain for 37 parent-infant dyads. Results demonstrated that only parent self-report measures were intercorrelated and several measures of parent distress correlated with measures of infant distress. Treatment implications and recommendations for future research are discussed.This article is based on the master's thesis of the first author under the direction of the second, at West Virginia University.     

Infant Distress During Immunization: A Multimethod Assessment

The purpose of this study was to comprehensively describe infant procedural distress and pain across assessment modalities, and to compare similarities and differences across measures. A multimethod assessment of distress was conducted to investigate infants (N = 37) undergoing routine immunizations. Measures of infant distress included Parent report, nurse report, infant heart rate, and an observational measure of infant distress. Parents rated their infant's distress and pain significantly higher than did nurses. Observational and physiological ratings of infant distress were found to vary significantly by phase, and there were no correlations between adult ratings of pain and distress and physiological ratings. Findings suggest that infant procedural distress can be assessed in a number of manners. The discordance between these measures emphasizes the need for multimethod assessment of pediatric procedural distress in both research and clinical settings. Given the differences between parent and nurse ratings, clinicians should be aware that different assessment methods might lead to different conclusions about infant procedural distress.     

Assessing the Relationship Between Cold Pressor Pain Responses and Dimensions of the Anxiety Sensitivity Profile in Healthy Men and Women

Anxiety sensitivity (AS) has been shown previously to be an important factor in the perception and experience of experimentally induced pain within healthy adults. The aim of the current study was to extend this research by: (i) using the Anxiety Sensitivity Profile (ASP) as an alternative measure of AS; (ii) examining whether different coping instructions affect pain reports; and (iii) investigating potential differences between men and women. Participants were 50 healthy adults (23 males, 27 females) who were required to complete 2 versions of the cold pressor pain task; one version required the use of control instructions, whereas the other made use of acceptance‐based instructions. Although the coping instructions were found to affect pain thresholds (acceptance resulted in lower thresholds), a similar pattern of correlations were found between the pain indexes and AS under both conditions. Of the ASP subscales, the gastrointestinal and cognitive concerns components were found to be the most strongly related to pain experiences. When the analysis was conducted separately for each sex, the ASP scales were related to the self‐report measures of pain in women, whereas they were related to the behavioural measures of pain in men. These results not only confirm that AS is associated with experimental pain, but that there may be sex differences in this relationship.     

Relations Among Children's Coping Strategies and Anxiety: The Mediating Role of Coping Efficacy

The current study tests a model that depicts the relationships among coping strategies (active, distraction, avoidance, and support seeking) and anxiety symptoms. SEM is used to test if the relationship between these variables is mediated by coping efficacy. A large sample of Canadian children (N = 506) aged 8 to 11 years (boys = 249, girls = 245, unknown gender = 12) participated in the study. Results showed that coping efficacy is a partial mediator of the relations between active coping strategies and anxiety symptoms, however support was not found for it to be an effective mediator for other coping strategies. This study contributes to the understanding of childhood anxiety by highlighting the importance of the relationship between anxiety and the methods children use to cope with stress and how perceptions of their coping abilities influence this relationship.     

Predictive Relationship Between Parental Beliefs and Accommodation of Pediatric Anxiety

Behavior performed by parents to assist a youth in avoiding or alleviating anxiety, known as accommodation, is ubiquitous among pediatric anxiety disorders and strongly related to poor treatment outcome. According to cognitive-behavioral theory, the beliefs parents hold regarding accommodation should predict parental accommodating behavior. Unfortunately, little is known about the beliefs parents hold regarding accommodation, as there exists no validated measure of this construct. First, the psychometric properties were examined for the Parental Accommodation Scale (PAS), a novel measure of parental accommodating behavior frequency (PAS-Behavior scale) and parental beliefs about accommodation (PAS-Belief scale). Second, the relationship between parental beliefs about accommodation and accommodation frequency was examined. Results provide preliminary evidence of the internal consistency and convergent validity of the PAS. Stronger positive beliefs about accommodation significantly predicted accommodation frequency, even after controlling for youth anxiety severity. Specifically, beliefs that accommodation prevents youth from losing behavioral and emotional control significantly predicted accommodation frequency. Therefore, efforts to decrease accommodation in clinical settings should involve correcting maladaptive parental beliefs about accommodation, with a particular emphasis on beliefs regarding the necessity of accommodation in preventing a youth from losing behavioral and emotional control.     

儿童程序性元记忆的发展

元记忆包括陈述性元记忆和程序性元记忆。程序性元记忆是对记忆过程的监测和控制。本文从发展的角度对程序性元记忆新近的研究进展进行了回顾。(1)几种记忆监测的发展速度和趋势不尽相同。(2)记忆控制发展较晚。(3)对今后的研究趋势进行了预测。     

Tendency to Catastrophize Somatic Sensations: Pain Catastrophizing and Anxiety Sensitivity in Predicting Headache

General catastrophic thinking styles about uncomfortable bodily sensations may predispose the development of common health pathologies, such as persistent headache. The purpose of this research was to explore the relationships between the Pain Catastrophizing (PC) Scale and Anxiety Sensitivity (AS) Index, which measure tendencies to catastrophize pain‐ and anxiety‐related somatic sensations, respectively. A non‐clinical sample completed the PC Scale, AS Index, and health outcome questionnaires regarding headache (n = 1018). Results revealed that: (i) AS and PC are empirically separate constructs; (ii) the overlap between PC and AS lies within the domain of fearing physical catastrophe; (iii) AS independently predicts weekly headache, headache pain intensity, and the number of a wide range of physical symptoms associated with headache; and (iv) PC independently predicts the presence of weekly headache. Limitations and implications of this research, as well as recommendations for future research directions are discussed.     

Reducing Parent Distress and Increasing Parent Coping-Promoting Behavior During Children's Medical Procedure

The study investigated whether involving parents in their child's cognitive-behavioral intervention would effectively reduce parent distress during their child's medical procedure. Parents participating with their 3- to 7-year-old children prior to a voiding cystourethrogram were randomly assigned to an intervention (N = 20) or a standard care (N = 20) condition. The intervention included provision of information, coping skills training, and parent coaching. Parents participating in the intervention had a significant reduction in anxiety following the intervention relative to parents in standard care. Trained parents displayed fewer distress-promoting and more coping-promoting behaviors during the procedure, even though parents in both conditions reported similar levels of anxiety during the procedure. Involving parents in children's interventions is crucial to reduce parent distress and prepare parents to assist their child during the medical procedure.     

Dimensions of Perfectionism and Anxiety Sensitivity

The current study investigated the extent to which dimensions of perfectionism are associated with components of the anxiety sensitivity construct. A sample of 177 undergraduate students completed the Multidimensional Perfectionism Scale, the Perfectionism Cognitions Inventory, the Perfectionistic Self-Presentation Scale, and the Expanded Anxiety Sensitivity Index developed by Taylor and Cox (1998). The results confirmed that automatic thoughts involving perfectionism and the interpersonal aspects of the perfectionism construct are associated with anxiety sensitivity. Examination of the Anxiety Sensitivity Index factors showed that perfectionism cognitions were associated primarily with anxiety sensitivity involving fears of cognitive dyscontrol, while socially prescribed perfectionism and perfectionistic self-presentation were associated primarily with fears of publicly observable anxiety reactions in a manner suggesting that the interpersonal perfectionism dimensions are linked closely with an anxious sensitivity to negative social evaluation and subsequent panic attacks. The theoretical and treatment implications of the link between perfectionism and anxiety sensitivity are discussed.     

Altered Emotional Processing in Pediatric Anxiety,Depression, and Comorbid Anxiety-Depression

The goal of this study was to examine some of the mechanisms underlying emotion regulation in childhood affective disorders by examining the impact of distracting emotional information during performance on a working memory task (Emotional n-back or E-n-back). The sample included 75 children (38 girls and 37 boys) between 8 and 16 years of age meeting criteria for: Anxiety disorder (ANX, n = 17), Major depressive disorder (MDD, n = 16), Comorbid anxiety and depression (CAD, n = 24), or Low-risk normal control (LRNC, n = 18). Results showed that the MDD and CAD groups had significantly longer reaction times on negative emotional backgrounds compared to neutral backgrounds, whereas the LRNC group had significantly longer reaction times on positive backgrounds. These results suggest altered processing of emotional information particularly associated with depression. Because the E-n-back task engages higher-order cognitive processes, these results suggest that these alterations in processing emotional information also interfere with the cognitive processes that govern how attentional resources are allocated. Further, research is needed to replicate this study and delineate underlying neural mechanisms.     

Social Anxiety in Children with Anxiety Disorders: Relation with Social and Emotional Functioning

Investigated the psychometric properties of the Social Anxiety Scale for children-Revised (SASC-R) as well as relations between social anxiety and children's social and emotional functioning. Participants were a clinic sample of children, ages 6–11 with anxiety disorders (N = 154) who completed the SASC-R. For a subset of these children, parent ratings of social skills, and self-ratings of perceived competence and peer interactions were also obtained. Factor analysis of the SASC-R supported the original three-factor solution and internal consistencies were in the acceptable range. Among children with simple phobia, scores on the SASC-R differentiated those with and without a comorbid social-based anxiety disorder. Social anxiety was also associated with impairments in social and emotional functioning. Specifically, highly socially anxious children reported low levels of social acceptance and global self-esteem and more negative peer interactions. Girls with high levels of social anxiety were also rated by parents as having poor social skills, particularly in the areas of assertive and responsible social behavior.     

数学焦虑对儿童加减法认知策略选择和执行的影响

根据数学焦虑量表测查结果,随机选取90名小学1~3年级的儿童为被试,每个年级30人(高、低数学焦虑者各15人).采用实验法、观察法和口语报告法相结合的方式,探讨不同数学焦虑水平儿童加减法认知策略选择和执行情况.结果发现:(1)从策略选择上看,高数学焦虑儿童使用出声策略和手势策略较多;使用对位策略较少.(2)从策略执行上看,高数学焦虑儿童出声策略、手势策略和拆十策略执行的正确率较高;竖式策略和对位策略执行的正确率较低;(3)随着儿童年级的增长,数学焦虑对其策略选择的影响越来越显著.     

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.     

数学焦虑影响儿童的数量表征:认知抑制的调节作用

为了考察数学焦虑对儿童数量表征表现的可能影响及认知抑制的潜在调节作用,选取70名小学三年级儿童（高焦虑组36人,低焦虑组34人）为被试,在对抑制条件进行操控的情况下,要求其完成符号、非符号数量表征任务。结果发现,被试在两种数量表征任务中均出现距离效应,与符号数量比较任务相比,高焦虑组在非符号数量比较任务中的正确率显著低于低焦虑组,且高焦虑组表现出了更强的距离效应。鉴于非符号数量比较任务更能反映出个体近似数量系统（ANS）的敏锐性,上述结果意味着高数学焦虑儿童的数量表征更不精确,其在相对复杂问题上较差的表现或许源于基本数量能力缺陷。本研究还发现认知抑制能够调节数学焦虑对个体非符号数量表征的影响,抑制条件下高低焦虑组儿童在正确率指标上的差异大于非抑制条件,抑制条件的设置提高了个体对工作记忆资源的需求,此时焦虑情绪对认知资源的消耗会造成任务所需资源的不足,进而削弱高焦虑个体的认知效用。     

Dimensions of Anxiety Sensitivity and Their Relationship to Nonclinical Panic

The goal of the present study was to examine the factor structure of the Anxiety Sensitivity Index (ASI; S. Reiss, R. A. Peterson, D M. Gursky, & R. J. McNally, 1986) and the replicability, reliability, and validity of its dimensions in a nonclinical sample. One-thousand-and-seventy-one undergraduate volunteers completed the ASI and a modified version of the Panic Attack Questionnaire (PAQ; G. R. Norton, J. Dorward, & B. J. Cox, 1986). A principal components analysis, using oblique rotation and parallel analysis, yielded three ASI dimensions that were highly consistent with those reported in previously published studies. Individuals classified as nonclinical panickers scored higher than nonpanickers on the Physical Concerns and Cognitive Concerns subscales of the ASI. Although spontaneous panic attacks were not significantly related to scores on any ASI scale, the occurrence of panic attacks in the past month was related to higher scores on the Cognitive Concerns subscale. The results are discussed in terms of cognitive theories of panic, and limitations of the present study and directions for future research are addressed.     

父母教育卷入与小学儿童数学焦虑的纵向联系:数学态度的中介作用

为探讨父母教育卷入与学龄期儿童数学焦虑之间的纵向联系及内在作用机制,从山东省聊城市两所普通小学选取1734名三、四年级学生,对其进行为期一年的追踪研究。结果发现：（1）T1父母教育卷入能够显著负向预测T2儿童数学焦虑,但T1儿童数学焦虑对T2父母教育卷入的预测不显著;（2）在同一时间点上,儿童数学态度在父母教育卷入与儿童数学焦虑之间发挥显著中介作用;（3）在不同时间点上,儿童数学态度的中介作用仍然成立,表明儿童数学态度的中介作用具有跨时间的稳定性。该结果强调了父母教育卷入对学龄期儿童数学焦虑变化的重要作用,亦为从父母教育卷入和数学态度角度降低儿童的数学焦虑水平提供了初步有力证据。     

Mapping Mindfulness Facets Onto Dimensions of Anxiety and Depression

Mindfulness has been associated with anxiety and depression, but the ways in which specific facets of mindfulness relate to symptoms of anxiety and depression remains unclear. The purpose of the current study was to investigate associations between specific facets of mindfulness (e.g., observing, describing, nonjudging, acting with awareness, and nonreactivity) and dimensions of anxiety and depression symptoms (e.g., anxious arousal, general distress-anxiety, general distress-depression, and anhedonic depression) while controlling for shared variance among variables. Participants were 187 treatment-seeking adults. Mindfulness was measured using the Five Facet Mindfulness Questionnaire and symptoms of depression and anxiety were measured using the Mood and Anxiety Symptom Questionnaire. Bivariate correlations showed that all facets of mindfulness were significantly related to all dimensions of anxiety and depression, with two exceptions: describing was unrelated to general distress-anxiety, and observing was unrelated to all symptom clusters. Path analysis was used to simultaneously examine associations between mindfulness facets and depression and anxiety symptoms. Significant and marginally significant pathways were retained to construct a more parsimonious model and model fit indices were examined. The parsimonious model indicated that nonreactivity was significantly inversely associated with general distress anxiety symptoms. Describing was significantly inversely associated with anxious arousal, while observing was significantly positively associated with it. Nonjudging and nonreactivity were significantly inversely related to general distress-depression and anhedonic depression symptomatology. Acting with awareness was not significantly associated with any dimensions of anxiety or depression. Findings support associations between specific facets of mindfulness and dimensions of anxiety and depression and highlight the potential utility of targeting these specific aspects of mindfulness in interventions for anxiety and mood disorders.     

Pain: Biopsychosocial Mechanisms and Management

Traditionally, pain has been viewed as a sensory event warning of tissue damage or illness. This explanation fails to account for many of the experiences of people suffering from clinically painful conditions. Over the past two decades, a new biopsychosocial perspective on pain has emerged. This perspective emphasizes that pain is a dynamic process that not only is influenced by biological, psychological, and social mechanisms of pain, but also produces biological, psychological, and social changes that can affect future responses to pain. This review presents findings from recent studies of the biological, psychological, and social mechanisms of pain and discusses the implications of these findings for pain research, assessment, prevention, and treatment, as well as for health care policy.