Factor Structure of the Pediatric Symptom Checklist with a Pediatric Gastroenterology Sample

Pediatric gastrointestinal disorders are commonly experienced by youth and have been shown to be associated with increased rates of psychosocial difficulties. Aim of the current study was to extend development of the Pediatric Symptom Checklist (PSC), a brief parent-completed measure designed to assess children’s behavioral and emotional functioning, by examining its factor structure in a pediatric gastroenterology sample. Parents of 176 children ages 4–16 years visiting a pediatric gastroenterologist completed the PSC. The factor structure of the PSC was examined using principal component analysis. Parallel analysis was utilized to determine the number of factors to retain and indicated that three factors existed within the data. A principal component analysis with varimax rotation identified factors measuring internalizing, externalizing, and attention difficulties. The three factors that emerged on the PSC provide initial support for the utility of the PSC in pediatric gastroenterology clinics.     

Training Pediatric Psychologists for Perinatal Behavioral Health Services in a Pediatric Hospital

Although pediatric hospitals specialize in providing care to children and adolescents, at The Children’s Hospital of Philadelphia (CHOP), our team has been providing behavioral health services for two unique parent populations—parents with a child in the Newborn Infant Intensive Care Unit and pregnant women carrying fetuses with specific birth defects and receiving prenatal care in the Center for Fetal Diagnosis and Treatment. A new training program was developed to expand the scope of pediatric psychologists’ practice to include perinatal behavioral health services, specifically for these two unique parent populations served at CHOP. The program includes direct service provision for adult mental health concerns, as well as education and support to help families cope with the existing medical conditions. This article describes the training program and its implementation as a model of training for other pediatric hospitals. The roles of psychologists embedded in these units and hospital privileges are discussed.     

Genetic Counseling in a Busy Pediatric Metabolic Practice

Patients with inborn errors of metabolism and their families require unique clinical care including management of acute illnesses, screening for long term complications, discussion of the etiology of the condition, connections to social supports, and clarification of the recurrence risks and prenatal testing and treatment options. Our multidisciplinary pediatric metabolic clinic combines the skills of metabolic geneticists, pediatric dieticians, social workers, clinical pharmacists, nurses and genetic counselors to provide optimal and well-rounded care for our patients and their families. Given the inherited nature of most inborn errors of metabolism and the necessary long-term management for these disorders, the genetic counselor’s role in this clinic setting is integral in providing ongoing support and education for patients and their families. This includes coping with the disease burden, helping patients and families adapt to a condition in the family and ensuring adequate understanding of the genetic risks and the available prenatal diagnostic and reproductive choices. Our clinic provides services to a large geographic area with many isolated populations where unique metabolic diseases are highly prevalent secondary to a founder effect. In this paper, we share our experience in providing longitudinal care to children with complex medical needs due to metabolic disorders and highlight the role of the genetic counselor in this clinic setting.     

Pediatric near-death experiences

A review of one previously reported and three new pediatric near-death experiences (NDEs), in which the experiencers were interviewed as children, suggests that the childhood core NDE as described by Melvin Morse and colleagues may be expanded to include feeling pain-free, seeing a light at the tunnel's end, entering the light, and time alteration. These cases also suggest that the life review may be a function of chronological age.     

Tumor Locus Moderates Anxiety Symptoms in a Pediatric Neuro-Oncologic Sample

Despite the prevalence of pediatric Central Nervous System (CNS) solid tumors, little is understood about patients' disease-related anxiety experience. Data from 25 remitted pediatric CNS tumor patients posttreatment were collected. Significant symptoms of anxiety were reported by 32% of patients. MRI studies showed all anxious patients had right cortical tumors or left cerebellar tumors. Confound analyses suggest these results are not better accounted for by demographic, disease, or treatment variables. These results evidence the risk some pediatric neuro-oncologic patients face for developing significant anxiety symptoms.     

Pediatric do-not-attempt-resuscitation orders and public schools: a national assessment of policies and laws

Some children living with life-shortening medical conditions may wish to attend school without the threat of having resuscitation attempted in the event of cardiopulmonary arrest on the school premises. Despite recent attention to in-school do-not-attempt-resuscitation (DNAR) orders, no assessment of state laws or school policies has yet been made. We therefore sought to survey a national sample of prominent school districts and situate their policies in the context of relevant state laws. Most (80%) school districts sampled did not have policies, regulations, or protocols for dealing with student DNARs. A similar majority (76%) either would not honor student DNARs or were uncertain about whether they could. Frequent contradictions between school policies and state laws also exist. Consequently, children living with life-shortening conditions who have DNARs may not have these orders honored if cardiopulmonary arrest were to occur on school premises. Coordinated efforts are needed to harmonize school district, state, and federal approaches in order to support children and families' right to have important medical decisions honored.     

Collaborating With Pediatric Gastroenterologists to Treat Co-Occurring Inflammatory Bowel Disease and Anxiety in Pediatric Medical Settings

Children and adolescents with inflammatory bowel disease (IBD) have distinct physical and emotional challenges that may place them at risk for developing anxiety and that may impede their receipt of mental health treatment. Only a handful of studies have applied empirically validated cognitive behavioral therapy (CBT) to IBD-related issues and no studies have examined the benefit of CBT for anxiety disorders in pediatric IBD. The aim of this paper is to describe a newly adapted cognitive behavioral treatment protocol, Treatment of Anxiety and Physical Symptoms related to IBD (TAPS + IBD), that has been tailored to concurrently address anxiety, including IBD-specific anxiety, and disease management in children and adolescents with IBD in pediatric medical offices. Two case studies are presented to demonstrate treatment implementation and preliminary assessment data. General considerations for health providers working with youth with comorbid anxiety and IBD from a multidisciplinary perspective and future research directions are provided.     

Defining Treatment Outcomes in Pediatric Obsessive-Compulsive Disorder Using a Self-Report Scale

This study examined benchmarks of treatment response and clinical remission on the Obsessive Compulsive Inventory–Child Version (OCI-CV) for youth with obsessive-compulsive disorder (OCD). Participants were 91 youth who enrolled in a randomized controlled trial that examined the benefit of augmenting cognitive behavior therapy (CBT) with either d-cycloserine or placebo. Youth completed the OCI-CV at baseline, Week 4 (prior to initiating exposure therapy), and posttreatment. Receiver operator curve (ROC) analyses examined optimal benchmarks for treatment response and clinical remission as identified by independent evaluators at the posttreatment assessment using the Clinical Global Impression (CGI) scales of Improvement (CGI-Improvement), Severity (CGI-Severity), and Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS). Optimal benchmarks for treatment response were a 20%–25% reduction in the OCI-CV total score. Meanwhile, optimal benchmarks for remission were a 55%–65% reduction in the OCI-CV total score and a posttreatment total score ≤ 6-8. OCI-CV benchmarks exhibited moderate agreement with the CY-BOCS for treatment response and clinical remission. Meanwhile, fair agreement was observed for response and remission with CGI scales. A lower pretreatment OCI-CV total score was associated with less agreement between classification approaches. Findings provide benchmarks for classifying treatment response and clinical remission in an efficient manner. Given the moderate agreement between the CY-BOCS and OCI-CV benchmarks, the OCI-CV may serve as a useful alternative when clinician-rated scales cannot be administered due to limited resources (e.g., time, training). Thus, evidence-based measurement can be incorporated to monitor therapeutic response and remission in clinical practice.     

Perfectionism in Pediatric Anxiety and Depressive Disorders

Although perfectionism has been identified as a factor in many psychiatric disorders across the life span, it is relatively understudied in pediatric anxiety and depressive disorders. Furthermore, there exists little cohesion among previous research, restricting the conclusions that can be made across studies. In this review, research associating perfectionism with pediatric anxiety and depression is examined and a framework is presented synthesizing research to date. We focus on detailing the current understanding of how perfectionism develops and interacts with other developmental features characteristic of anxiety and depression in children and potential pathways that result in anxiety and depressive disorders. This includes: how perfectionism is measured in children, comparisons with relevant adult literature, the development of perfectionism in children and adolescents, mediators and moderators of the link between perfectionism and anxiety and depression, and the role of perfectionism in treatment and prevention of these disorders. We also present research detailing perfectionism across cultures. Findings from these studies are beginning to implicate perfectionism as an underlying process that may contribute broadly to the development of anxiety and depression in a pediatric population. Throughout the review, difficulties, limitations, and gaps in the current understanding are presented while offering suggestions for future research.     

心理辅导室的建立与小儿外科

手术是小儿外科的主要治疗手段,又是一个创伤过程,同时也是一个心理应激过程,对于患儿来说这种应激会使其产生恐惧心理.同时小儿外科工作具有双重性,不仅要为患儿服务同时还需满足家长不同层次的心理需求.所以有必要在小儿外科科室内建立一个系统的心理辅导机构即心理辅导室来做好家长及惠儿的心理疏导.     

心理辅导室的建立与小儿外科

手术是小儿外科的主要治疗手段,又是一个创伤过程,同时也是一个心理应激过程,对于患儿来说这种应激会使其产生恐惧心理。同时小儿外科工作具有双重性,不仅要为患儿服务同时还需满足家长不同层次的心理需求。所以有必要在小儿外科科室内建立一个系统的心理辅导机构即心理辅导室来做好家长及患儿的心理疏导。     

Medical Crisis Counseling on a Pediatric Intensive Care Unit: Case Examples and Clinical Utility

The intensive care unit is one of the most stressful and demanding work sites of the pediatric psychologist. The rapid changes in health status that necessitate stays on the intensive care unit often constitute an emotional roller coaster ride for both family members and the staff caring for their child. The Medical Crisis Counseling (MCC) intervention model is a useful approach to providing psychological support in the pediatric intensive care setting. A representative year's worth of consultation requests from the multidisciplinary intensive care unit of a large urban pediatric hospital is described and discussed in the context of the MCC model.     

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.     

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.     

An Uncontrolled Examination of a 5-Day Intensive Treatment for Pediatric OCD

This study examined the feasibility of a 5-day intensive treatment for pediatric obsessive-compulsive disorder (OCD). Fifteen children with OCD received a week-long treatment based on exposure and response prevention (ERP). The intervention also emphasized teaching children and parents how to conduct ERP independently at home. All families completed the week-long treatment and symptoms improved significantly as measured by self- and parent-report forms, as well as the Children's Yale-Brown Obsessive-Compulsive Scale, F(2, 22) = 45.67, p < .05. Total CY-BOCS scores decreased significantly from pretreatment (M = 28.00, SD = 4.24) to posttreatment [M = 16.00, SD = 6.0, F(1, 11) = 34.38, p < .05] and from posttreatment to 5-month follow-up [M = 11.5, SD = 7.3; F(1, 11) = 12.94, p < .05]. This level of improvement was consistent with other intensive treatments for pediatric OCD. The study suggests that the 5-day program is a promising treatment for children with OCD who do not have access to local providers.     

Ethics Consultation in Pediatrics: Long-Term Experience From a Pediatric Oncology Center

There is little information about the content of ethics consultations (EC) in pediatrics. We sought to describe the reasons for consultation and ethical principles addressed during EC in pediatrics through retrospective review and directed content analysis of EC records (2000–2011) at St. Jude Children's Research Hospital. Patient-based EC were highly complex and often involved evaluation of parental decision making, particularly consideration of the risks and benefits of a proposed medical intervention, and the physician's fiduciary responsibility to the patient. Nonpatient consultations provided guidance in the development of institutional policies that would broadly affect patients and families. This is one of the few existing reviews of the content of pediatric EC and indicates that the distribution of ethical issues and reasons for moral distress are different than with adults. Pediatric EC often facilitates complex decision making among multiple stakeholders, and further prospective research is needed on the role of ethics consultation in pediatrics.